PHE; STATE NEWS; FWA- Auditors find hundreds of ineligible RI state workers on Medicaid rolls


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[MM Curator Summary]: A minor SNAFU points to a much bigger risk.


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Katherine Gregg

The Providence Journal



PROVIDENCE − At least 369 state employees who make too much money to qualify were nonetheless being carried on the state’s Medicaid health-insurance rolls until January, when a routine data analysis by the auditor general’s office found their state pay exceeded federal income limits.

The discovery of ineligible state workers came to light Wednesday when a Jan. 23 letter from the state’s interim auditor general, David Bergantino, to top state officials was made public for the first time at a legislative hearing.

While a case-by-case analysis “would be time consuming,” Bergantino noted the state pays a monthly fee “ranging from approximately $300 to $900-per-month-per-covered-individual (or more if family coverageis applicable)” even if “their current state employment income makes them ineligible to still qualify for Medicaid.”

The back-and-forth with state Health & Human Services Secretary Ana Novasi and Department of Administration Director James Thorsen did not put blame on the state workers the state was still carrying on its Medicaid rolls.

In fact, the auditor’s letter said: “Many of these individuals are not actively using their Medicaid coverage because they also have health insurance as a state employee.”

But the finding − along with a warning about “operational issues with the critical income validation controls” − led worried lawmakers to question whether Rhode Island was on the brink of another “UHIP debacle.”

“UHIP all over again,” said House Oversight Committee Chairwoman Patricia Serpa, citing the botched 2016 rollout by the Raimondo administration of a new computerized eligibility-verification system that left scores of struggling Rhode Islanders without benefits and others with double payments or letters telling them their very-much-alive children were dead.

Echoed Rep. Michael Chippendale, the House minority leader: “My concern is the bottleneck. You clearly don’t have the staff to handle it…. You guys are going to get buried, 2016-level buried.”

Issue may hint at deeper troubles as COVID public emergency ends

The auditor general’s letter provided the first public look at the kinds of undetected problems state officials may face, starting April 1, when they resume the recertification of Medicaid recipients, a routine process suspended for the duration of the COVID-19 public health emergency.

During the suspension, states were barred from removing people who were ineligible.

Big picture: the state’s numbers-crunchers predicted last November that the number of Medicaid recipients would shrink from 360,000 down to 338,000 when recertification resumed.

Testimony on Wednesday indicated the number of state employees on the original “ineligible” list had been whittled down to 156.

But Bergantino said the deep dive by state auditors found even more basic − and serious − problems that merit “immediate investigation.”

How did these workers end up on the Medicaid rolls?

A Jan. 30 letter put the state on notice: “We identified operational issues with the critical income validation controls and supporting data that are designed within the State’s RIBridges system to prevent individuals that exceed the program income guidelines from being enrolled in Medicaid.”

(RIBridges is the name the state is currently using for the much-criticized UHIP computer eligibility-verification system.)

“Our audit work in this area … identified some serious concerns in relation to income validation procedures within the RIBridges system that require immediate investigation,” Bergantino wrote.

The problems came to light during a House Oversight Committee meeting on the impact of the wind down of the federal public health emergency on people enrolled in state administered public assistance programs.

In every state, participants in the Supplemental Nutrition Assistance Program, commonly known as food stamps, faced the loss of the extra pandemic-related benefits Wednesday. In Rhode Island, more than 300,000 people receive SNAP benefits.

Heading into the hearing, the lawmakers sought answers from the head of health and human services arm of the McKee administration on how the state plans to deal with a deluge of potential questions and concerns from people facing the immediate or imminent loss of benefits, when the call center is closed on Wednesdays to give staff time to catch up on the backlog.

Acting Department of Human Services Director Kim Merolla-Brito tried to assure the lawmakers her agency is ready for the April resumption of Medicaid certifications and has the capacity to hire up to 48 contract employees if necessary.

And Novais attributed some of the problems the auditor general’s office uncovered to a mismatch between the data the state reviews monthly, and the quarterly employment reports from the state’s Department of Labor & Training.

According to Department of Administration spokeswoman Laura Hart, the administration has convened a work group to go through the case files of state employees who “may have unnecessarily remained enrolled in Medicaid during FY 21 and FY 22” when the state was barred from removing people.

“Additionally, this month, DOA and EOHHS plan to reach out proactively to these employees, and when appropriate, request that they unenroll from the program themselves before they are automatically dropped from Medicaid. The ‘continuous coverage’ requirement for all states ends on March 31, 2023.”