The Post edi­to­rial:

Colorado’s Med­i­caid prob­lems are cause for con­cern and cau­tion.

The Denver Post - - NEWS -

What bad tim­ing for Colorado’s Med­i­caid sys­tem to look like it is in­ca­pable of ac­cu­rately billing the fed­eral gov­ern­ment for Med­i­caid re­cip­i­ents or manag­ing the claims providers make for ser­vices.

As Repub­li­cans look to over­haul the sys­tem — House Speaker Paul Ryan’s plan fun­da­men­tally al­ters and ul­ti­mately re­duces fed­eral sup­port of the Med­i­caid pro­grams run by states — it would be nice if Coloradans could have con­fi­dence that ours is re­spon­si­bly do­ing its job of pro­vid­ing health in­sur­ance to low-income fam­i­lies, chil­dren, adults and dis­abled in­di­vid­u­als.

Un­for­tu­nately, that con­fi­dence may be wan­ing due to two re­cent (al­beit com­pletely un­re­lated) reve­la­tions. The first was that the state over-billed the fed­eral gov­ern­ment for some­where be­tween $20 mil­lion and $40 mil­lion. The se­cond was that providers of care for dis­abled adults were hav­ing their claims in­cor­rectly de­nied by a newly launched pay­ment sys­tem.

While both are cer­tainly cause for con­cern, we would all be wise to note that the com­mon thread be­tween the two er­rors was the roll-out of a new sys­tem, as such launches of­ten come with bumps along the road — an im­por­tant point for Repub­li­cans as they weigh whether to rush through Med­i­caid re­forms.

Josh Block, the bud­get di­rec­tor for the Colorado Depart­ment of Health Care Pol­icy and Fi­nanc­ing (HCPF), ex­plained to us that his of­fice caught the first er­ror by notic­ing that the state’s por­tion for Med­i­caid cov­er­age was com­ing in un­der bud­get.

The Af­ford­able Care Act cre­ated two cat­e­gories of Med­i­caid re­cip­i­ents in Colorado: Those who qual­i­fied un­der the orig­i­nal Med­i­caid thresh­old con­tin­ued to re­ceive 50 per­cent of their cov­er­age from the fed­eral gov­ern­ment; but those who earned more and qual­i­fied un­der the new thresh­old were re­ceiv­ing 100 per­cent of their cov­er­age from the feds.

Colorado was in­ac­cu­rately billing the fed­eral gov­ern­ment for peo­ple who had orig­i­nally quali- fied un­der the lower thresh­old, but who later earned enough money to fall into the Med­i­caid ex­pan­sion cat­e­gory.

The state should have pushed those in­di­vid­u­als to its “tran­si­tional Med­i­caid” pro­gram, a state pro­gram cre­ated to help com­bat the cliff ef­fect that hap­pens when a fam­ily’s income in­creases.

Colorado skipped the tran­si­tional pro­gram and counted those in­di­vid­u­als as part of the ex­pan­sion, and re­ceived 100 per­cent of the fund­ing from the feds.

The mis­take was an hon­est one, it seems, and the im­pact on the state bud­get shouldn’t be big, even if Pres­i­dent Don­ald Trump takes a dim view of let­ting states keep ill-got­ten fed­eral funds.

The se­cond er­ror came from a com­pletely dif­fer­ent side of HCPF. Those billing the state’s Med­i­caid sys­tem for care pro­vided to dis­abled in­di­vid­u­als found their claims be­ing er­ro­neously de­nied.

The Den­ver Post’s Jen­nifer Brown re­ported that the er­ror came as part of the March 1 tran­si­tion to a new sys­tem for fil­ing the claims from a sys­tem that had been in place since 1998. As with any tran­si­tion, hic­cups are to be ex­pected. We hope the rest of the tran­si­tion goes smoothly af­ter th­ese claims get re­solved and that HCPF con­tin­ues to im­prove its op­er­a­tions.

We must move for­ward with cau­tion as we change the Med­i­caid sys­tem, while also con­stantly seek­ing im­prove­ments to this bloated fed­eral and state funded pro­gram.

Two re­cent er­rors within the state's Med­i­caid pro­gram high­light the need for con­stant im­prove­ments in the sys­tem, but also the risk of rapid change.

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