The Post editorial:
Colorado’s Medicaid problems are cause for concern and caution.
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.