Audit blasts Idaho’s Medicaid database

BOISE – The Idaho Department of Health and Welfare’s Medicaid eligibility system contains thousands of errors and the department doesn’t appear to be setting a high priority on correcting the problems, according to a report from state auditors released Thursday.

The Legislative Services Office first recommended in 2003 that the department establish a reconciliation process between the automated computer system it uses to determine eligibility for Medicaid and other programs, and the computer system it uses to process payments, to make sure that client eligibility was properly recorded and that medical providers were paid promptly.

But the department has not yet reconciled all the data between the two complicated programs – and that means that some people’s access to Medicaid is being delayed, or isn’t being established at all, according to the auditors.

“The last completed reconciliation was for a 13-month period and contained 23,240 errors,” according to the department. Within five weeks of those errors being found, Health and Welfare workers managed to correct more than 1,500 of them, but more than 21,600 errors remained.

“Based on these numbers, we estimate 400 errors and only 300 corrections occur each week, resulting in approximately 100 new errors that will not be corrected,” the auditors wrote in their report.

If the reconciliation process isn’t completely developed and integrated into the department’s information management system, the Medicaid program could face federal sanctions, the auditors warned.

Health and Welfare spokeswoman Emily Simnit said the auditors’ report is based on information that is few months old, and that the department has since collected documentation to show it is addressing the problem.

“The federal Medicaid agency is the one that would impose the sanctions, and we’ll be submitting that information to them within a week or so,” Simnit said.

She said that documentation would be enough to stave off any sanctions while the department continues to work on reconciling the two programs.

Most of the errors did not affect client eligibility or Medicaid payments, Simnit said.

“They haven’t impacted real people in real situations. And the ones that do have an impact on payment and eligibility, those are prioritized at the top of the list. We’re working to address those first,” she said.

Both computer systems are slated to be replaced with new systems next year, Simnit said. The department is working on creating a reconciliation process for the new systems.