FAILED MEDICAID APPLICATION SYSTEM CREATES MULTI-MILLION DOLLAR LIABILITY FOR PALMETTO STATE TAXPAYERS …
The S.C. Department of Health and Human Services (SCDHHS) is in the process of dividing up $12 million to give to the nursing homes in South Carolina.
Why would SCDHHS do this? And what does the state get in return?
I’ll try and give you a little background on how we ended up where we are today. When former SCDHHS director Tony Keck came to work in South Carolina, he completely changed the process of approving Medicaid applications for the disabled and senior citizens for nursing home care.
The previous system had its flaws, but it was 100 percent better than the fish bowl dream Keck and former governor Nikki Haley came up with. The original system had state employees in each county that would handle the Medicaid applications for nursing home care for that county.
Keck and Haley’s system took all state employees that handle Medicaid applications for nursing home care (and all the applicants) and put them in one big fish bowl. So now we have state employees from Greenville trying to process a Medicaid application for nursing home care in Georgetown – and to compound the problem, now the state employee who started the application completes the first section and puts it back in the big fish bowl for someone else to complete the next section.
This is done until the application is completed – by someone else.
Still wondering where the $12 million comes into play? The federal Centers for Medicare and Medicaid services (CMS) contracts with SCDHHS to process the Medicaid applications. CMS gives SCDHHS 45 days to process Medicaid applications for nursing home care and to give the nursing homes a decision on whether or not the individual qualifies for nursing home care.
Realize the applicant is usually in the facility already receiving services while the application is being processed for approval or not and this is why CMS gives SCDHHS forty-five (45) days to process the applications.
Keck and Haley’s “fish bowl” system has been a complete disaster.
There are applications for individuals in every nursing home in the state that are 90 days, 180 days – even 365 days and older – that are still waiting on approval. Meanwhile the homes providing care for these individuals aren’t sure if they’ll actually ever get paid.
So why does SCDHHS want to divide up $12 million to give the nursing homes in the state? Because they do not want the nursing homes to sue them.
Thats right. To receive their share of this $12 million, the homes must sign an agreement not to sue the state over timeliness issues. The problem with this is the state owes a minimum of $50 million to these homes due to the fact that it can no longer process Medicaid applications in a timely fashion and does not have an answer as to how to fix the problem.
My suggestion on how to fix the problem is simple: All applications that go beyond the 45-day period CMS gives the state and SCDHHS to process applications should be approved – period. The state can continue its “fish bowl” process of processing the applications, but if someone is denied and not approved for benefits the state and SCDHHS can go to the family and recoup the money.
Why should nursing homes be responsible to take on this liability and financial burden because state government cannot complete the applications within the time frame that CMS gives them?
Instead of paying $12 million in HUSH MONEY to nursing homes, why not just pay them the $50 million the state actually owes for services already provided?
P. Scott Jones
President, South Carolina Nursing Home Association
Scott: What a letter! Thank you for choosing FITSNews to raise this issue – which is something this website clearly needs to do some digging on. Rest assured we will!
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