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Star Tribune - Editorial: Congress sharpens Medicaid questions

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Location: Washington, DC

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Minnesota won't start its new, independent audits of the state's controversial $4 billion-a-year Medicaid contracting until 2014 at the earliest.

Congressional Republicans, however, are signaling strongly that this new outside financial review should begin sooner and should prioritize the contracts from 2010 and before -- a time frame that includes the program's administration under former Republican Gov. Tim Pawlenty.

Legislators, as well as Gov. Mark Dayton's administration, should take heed of these continuing congressional concerns. Given that the state's Medicaid program is the focus of three federal investigations, the new audits should start now -- not in two years, as the recently passed HMO audit legislation provides for.

The U.S. Department of Justice, the U.S. House Oversight and Government Reform Committee and the office of Sen. Charles Grassley, R-Iowa, are investigating the program.

Key questions asked by congressional investigators: whether the state has overpaid private plans to administer its Medicaid program and whether federal funds have been used improperly to subsidize state-only medical-assistance programs.

Questions about Minnesota's Medicaid contracting continue to intensify. Like many states, Minnesota outsources coverage of this medical assistance program to private insurers.

A surprise $30 million giveback by one of them -- UCare -- in 2011 triggered state and federal scrutiny. The Dayton administration has initiated competitive bidding and pushed the plans to give back more than $73 million in excess 2011 Medicaid profits.

In late April, the state's program was a key focus of a U.S. House Oversight Committee hearing on Medicaid waste and abuse. The state's Department of Human Services commissioner, Lucinda Jesson, drew bipartisan criticism for her handling of the UCare giveback.

Serious questions remain about her management of the money -- half of which should have promptly gone to the federal government. Jesson's recent, belated release of a legal opinion about the giveback only heightened concerns that she has failed to disclose key documents to investigators when previous requests were made. What else don't they know about?

On May 15, the U.S. House Oversight Committee sent Jesson a sharply worded, 10-page follow-up letter. It's clear that congressional investigators are interested in far more than the UCare giveback. The letter highlighted Jesson's previous statements that the Medicaid contracts were too generous under previous administrations and that the Dayton administration is "not doing it that way anymore."

The letter demands to know what "that way" means and asks what the state is doing to root out previous potential improprieties -- questions Minnesota legislators did not pursue with equal zeal.

As painful as it is to see Minnesota health care in congressional crosshairs, the scrutiny is needed and has broader implications as Medicaid is expanded under the 2010 Affordable Care Act. With that expansion comes the sobering responsibility of ensuring that state and federal dollars funding this sprawling $457 billion-a-year program are used efficiently.

The Oversight Committee's line of questions makes it clear that too little is known about Medicaid ratesetting in Minnesota and elsewhere, and whether state and federal agencies have the right data or properly review that information to determine appropriate payments to providers or health plans.

Those are important questions as many states move Medicaid enrollees into managed care. Minnesota may well provide a window into where more oversight is needed.

It's a matter not only of ensuring the money is used for its intended purpose -- medical care for the needy -- but that the program remains affordable. House Republicans have political motivations for scrutinizing Medicaid, but they are also asking the right questions.

Medicaid has for decades been dogged by concerns about waste and abuse. Its historic expansion under the Affordable Care Act is an opportunity for reform, and Congress needs to follow through.


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