Accurate Medicaid numbers like nailing Jello to a tree

by Joseph Neff, News and Observer, June 19, 2014.

A behind-the-scenes tussle between two conservative North Carolina institutions – the state Senate and state Budget Director Art Pope – surfaced Thursday, as Senate leaders repeatedly asked why Pope and his staff didn’t show up to answer questions about Medicaid.

The Senate called a budget meeting to hash over the $150 million difference in Medicaid spending that separates the House and Senate budgets.

First item on the agenda was a presentation by Pope, a former state legislator and a leading conservative political donor. Pope did not show, nor did anyone from his Office of State Budget and Management, known in legislative lingo as “OSBM,” nor anyone from the Department of Health and Human Services, which houses Medicaid.

Sen. Bob Rucho said arriving at an agreed Medicaid spending number was the linchpin to coming up with a state budget.

“Would someone explain to me why we don’t have OSBM or staff people from DHHS to help us move this budget forward?” asked Rucho, a Matthews Republican.

“I think that’s why we wanted someone here from OSBM today, to answer these questions,” said Senate President Pro Tem Phil Berger.

“It’s June 19 and we still don’t have the numbers,” said Sen. Tom Apodoca, a Hendersonville Republican and chairman of the powerful Rules Committee. “If push comes to shove, we can always issue subpoenas.”

Pope downplayed the talk of subpoenas from Apodaca, whom he called a good friend.

“We did decline to appear on short notice,” Pope said. “We are working on the numbers as we speak, and I can’t drop that to pull a presentation together.”

Pope said he’s been in constant contact with Senate and House members, in nearly daily meetings and in frequent phone calls. He also pointed to the unusual timing of the budget hearing.

“It’s not normal to have a Senate Appropriations Committee meeting after the Senate passes its budget,” Pope said.

The senators were eager for Pope to deliver two key estimates of Medicaid spending: the shortfallfor the current fiscal year, which ends June 30; and an estimate of increased spending for the next fiscal year based on health care inflation and the growth of Medicaid recipients.

Senate leaders put about $150 million more toward Medicaid in their budget than the House did, saying they are planning for a worst-case scenario due to the lack of reliable data. Medicaid has run over budget by hundreds of millions of dollars each of the past four years, a scenario Senate leaders say they want to avoid in the coming year.

Pope and the legislature’s fiscal analysts pointed to several factors that converged to make this year a particular mess for Medicaid budgeting.

Unlike past years, the state does not have reliable numbers of Medicaid enrollees; some are backlogged because of problems with NC Fast, a new computer system used by counties to enroll people in programs such as food stamps or Medicaid. The new federal health care law has caused a surge in Medicaid enrollments. There is a backlog of claims from providers due to problems with NC Tracks, the new computerized claims processing system. And NC Tracks has not provided the necessary data analysis.

“None of the numbers we’re putting out today are absolutely correct,” said Steve Owen, a fiscal analyst for the legislature.

The missing data was troubling to senators on both sides of the aisle.

“It’s like nailing jello to a tree,” said Sen. Jerry Tillman, an Asheboro Republican.

“Can we be certain that people aren’t being overpaid or underpaid?” asked Sen. Joel Ford, a Charlotte Democrat.

No, Owen replied.

“That is a very disturbing scenario,” Ford said.

http://www.newsobserver.com/2014/06/19/3950173/senate-wants-medicaid-questions.html