Medicaid system vexes providers

Some Idaho health care providers say they’re being financially stranded by the state’s new Medicaid claim processing system.

Molina Medicaid Services took over the reimbursement system as Idaho’s contracted vendor on June 7, just as the state was enacting a three-week delay in Medicaid payments to allow the Department of Health and Welfare to balance its budget at the close of the fiscal year.

Many providers expected to be paid for their back claims at the close of the three-week period, but department spokeswoman Emily Simnitt says the switch created a bit of a backlog. The problem was compounded by some providers who missed the deadline to sign up for the new system.

“Basically, we have been since the second week of June with no reimbursement, nothing,” said Jodi Smith, director of Family Support Services of North Idaho in Coeur d’Alene.

Smith says her business applied for enrollment before the April 30 deadline, following the directions provided by the Idaho Department of Health and Welfare. But Smith says her business received conflicting information about the application process from Molina representatives, and had their application denied once. The company was told a Molina employee would “manually put it through” but they were still unable to submit some claims.

Now, Smith says, some of her 250 clients are still being deemed ineligible – she believes erroneously.

“We have 60 staff members who continue to need to get paid while we’re not getting reimbursed,” she said. “We’re fortunate. We had some additional reserves and some income that doesn’t come from Medicaid.”

Stephanie Spencer Whipps, director of the Idaho Center for Autism in Boise, said her business may close its doors next week if something doesn’t change. She said the majority of her agency’s claims are still pending, and Molina representatives have told her it will take until August to settle them. Meanwhile, she said, banks and credit unions have turned down her request for credit because they can’t loan money on future income.

Simnitt said the first time individuals and providers go through the system, there are some extra steps and that can make the process take a bit longer.

Any problems should be resolved in the next couple of weeks, she said.

“We haven’t seen any major problems with the new system, but there are a few issues that are being worked through right now, and hopefully will be addressed as everyone gets used to operating with a new system,” Simnitt said.

Of the 14,000 Medicaid providers in Idaho, Simnitt said 2,000 did not file their enrollment applications by the deadline.