How many times have I blogged about the unsupervised, unharnessed actions of the managed care organizations (MCOs) in our State, which happen to be managing billions of our tax dollars for Medicaid behavioral health care? These MCOs, which are in the process of consolidating to create even larger MCOs and to handle even more tax dollar money, are running rampant and unsupervised by the Department of Health and Human Services (DHHS). See blog. And blog.
DHHS is the single state agency charged with managing Medicaid for NC. According to federal law, the single state agency may not delegate certain duties. Our 1915 b/c Waiver allows DHHS to waive some duties related to behavioral health, but not all. For example, it is, ultimately, DHHS’ duty to ensure that our Medicaid recipients have access to care.
It is, ultimately, DHHS’ duty to ensure that the MCOs are following the law.
However, recently, that duty was picked up by the State Bureau of Investigation (SBI). Thank goodness someone is reviewing the MCO’s books!
SBI arrested former Eastpointe CFO William Robert Canupp on December 16, 2015, for nine charges of financial fraud and embezzlement. Eastpointe is one of our MCOs and manages behavioral health care for Medicaid and state-funded programs in 12 counties. These allegations of fraud and embezzlement are from when Canupp worked at Eastpointe.
This recent arrest demonstrates a real need for accountability at the MCOs. While Eastpointe and the other MCOs are terminating health provider contracts and denying/reducing services, who is reviewing these decisions. Apparently, not DHHS.
What can you do?
As you should know, the MCOs are not private entities. They are agents of the state and receive funding from county, state, and federal funds. In other words, the MCOs manage and spend our tax dollars. Therefore, these entities are liable to us for all expenditures and are subject to the Freedom of Information Act or FOIA. The FOIA allows any one of you to request any financial record, any document showing access to care, any document showing monies spent on actual care versus administrative costs, or any other information you desire and the MCOs must provide it to you.
Here is a link to a sample public records request.
The MCOs are bound by NC General Statute, Chapter 132 and must allow you to examine any requested documents within a reasonable time.
Use the FOIA to get answers!
With Carol Steckel’s abrupt resignation September 27, 2013, only 8 months after accepting the job as NC Medicaid Director, we North Carolinians were left without a Medicaid Director. I posted a week or so ago that I can only imagine how difficult it would be to fill the position, considering the absolute mess the Department of Health and Human Services (DHHS) has created recently…the calamity of NCTracks…the negative PR…the high salaries of administration…Who would want to inherit this mess???
While I cannot imagine the person who would actually apply to be our Medicaid Director in the midst of such storms, I do have some advice for whomever attempts to carry the burden of being NC’s Medicaid Director.
I don’t know why Ms. Steckel left. I’ve heard numerous hypotheses. I’ve heard that she didn’t get along with Sect. Wos. I’ve heard that she left because the NC Medicaid system cannot be fixed. I’ve heard the bad media press upset her. I’ve heard she couldn’t handle the scrutiny of the public.
Regardless, anyone who is thinking of applying to be our Medicaid Director needs to understand that this is a public servant job. This is not a private sector job. Why is that important? Because as an officer in the public arena, you are accountable to the taxpayers. You cannot hide behind rhetoric or stop speaking to media. As a public servant, you have duty to be transparent to taxpayers. You will be scrutinized by the public…and this is allowed.
Recently, Secretary Wos responded with this comment when asked about transparency… “I think the word transparency can get pretty dangerous. … If transparency means that we’re in a planning process and you’re asking us, ‘Tell us all the things you’re planning,’ well, my goodness, allow us to work, and then we’ll give you everything that you want.”
While I understand Sect. Wos’ assertion that if all we do is talk then nothing gets done, in the public sector, transparency is, not only desired by taxpayers, but public servants owe a duty to be transparent. Public servants are not spending their own money. It’s my money and your money. We deserve to know how our money is being spent and we deserve to have an opinion as to whether our money is being spent in an economically intelligent fashion.
For example, my blog about the managed care organizations paying the health insurance for its employees and the employees’ families was to point out that our tax dollars are paying for these employees’ families’ health insurance…tax dollars that are meant to provide health insurance to our most needy population.
Similarly, all the media hype about the high salaries of the two 24-year-old staffers, who were given salaries making $85,000 or more, the media are angered because, again, those salaries are paid by us.
Because the money that the Department of Health and Human Services (DHHS) spends is our money, not private funds, transparency is essential.
A few weeks ago, when I flew to New Mexico, I had to go through airport security. I had to take off my shoes (yuck! and walk on the airport floor), place my purse and laptop on the conveyor belt and step into the “All-Seeing Machine.” You know, the machine that you have to place your feet a little apart and raise your hands above your head, while the machine whirls around your body. I always feel slightly mortified every time I have to go through that machine. I even suck in my breathe a little so my belly doesn’t poke out. It is just a strange feeling to have a stranger look that closely at you and scrutinize your body. You never know what the person looking at your image is thinking. Being scrutinized is not fun.
Similarly, as NC Medicaid Director, and a public servant, you will be scrutinized. Every word. Every action…and non-action.
Remember Mary Poppins? Remember the sweet, little song the two children sang about the criteria for their new nanny?
If you want this choice position
Have a cheery disposition
Rosy cheeks, no warts!
Play games, all sort
You must be kind, you must be witty
Very sweet and fairly pretty
Take us on outings, give us treats
Sing songs, bring sweets
Never be cross or cruel
Never give us castor oil or gruel
Love us as a son and daughter
And never smell of barley water…
Well it applies to the Medicaid Director position too. Here is the “Perfect NC Medicaid Director Song:”If you want this choice position Have an open disposition Know Medicaid laws and rules Don’t treat media as fools You must be strong, you must be smart Very tenacious, open heart Take on naysayers, show guts Move our Agency out of ruts Be transparent, don’t circumvent Never say to media, “No comment.” Love our citizens; our state And always, always update…
I found the job posting for our Medicaid Director on the National Association of Medicaid Directors’ (NAMD) website.
Here it is:
DIRECTOR OF MEDICAL ASSISTANCE
The North Carolina Department of Health and Human Services (DHHS), in collaboration with our partners, protects the health and safety of all North Carolinians and provides essential human services.
Within DHHS, the Division of Medical Assistance (DMA) provides access to high quality, medically necessary health care for eligible North Carolina residents through cost-effective purchasing of health care services and products. The Department of Health and Human Services and DMA are devoted to quality customer service.
The Director of Medicaid directs the administration of the state’s Medicaid and NC Health Choice Programs. The Medicaid program serves more that 1.7 million North Carolinians and provides services to children, the elderly, the blind, the disabled and those eligible to receive federally funded assisted income maintenance payments. The North Carolina Health Choice (NCHC) Health Insurance Program for Children is a comprehensive health coverage program for low-income children. The goal of NCHC is to reduce the number of uninsured children in the State. The program focus is on families who make too much income to qualify for Medicaid but not enough to afford private or employer-sponsored health insurance.
DMA has approximately 400 employees and a budget impact of 14 billion dollars which includes 3.8 billion in state appropriations. DMA partners with over 78,000 physician providers throughout the state to provide essential services to recipients. The Director is responsible for multi-million dollar contracts and performs an array of fiscal agent and administrative services which include cost reimbursement and integrated payment management reporting to local management entities (area mental health programs). The position manages the state waiver program and demonstration projects. The Director is the primary interface with the Federal Centers for Medicare and Medicaid Services (CMS) and for the Committee Management Office. (CMO)
KNOWLEDGE, SKILLS AND ABILITIES:
Prior leadership and policy role in large complex organization administering the Medicaid Program or within a Medicaid Reimbursement or Health Insurance Agency
Demonstrated knowledge of the federal and state funding process for Medicaid and Medicare
Proven ability to build consensus among diverse stake holders which includes constituents, providers, advocacy groups, the media, the public and the legislature
Demonstrated ability to provide leadership during a time of change or reorganization
MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS:
A Masters Degree in Business, Public Health, Health Administration, Social or Clinical Science or a related field and six years of broad management experience in Health Administration or in Healthcare financial management of which at least three years must be at the Director or Assistant Director level of a statewide or federal division in Health Administration or Financial Management.
To be considered for this opportunity please submit a detailed resume to firstname.lastname@example.org
To learn more about the North Carolina Department of Health and Human Services, please visit our web site at: www.ncdhhs.gov
All applications will remain confidential.
Equal Opportunity Employer
Nowhere in the advertisement for the NC Medicaid Director does it say what the Medicaid Director ACTUALLY has to do in real life.
Undergo scrutiny. Talk to the public. Maintain transparency. Be a public figure in a time of crisis.
It’s our money. So talk to us.