Not all Med­ic­aid en­rollees prop­erly vet­ted

Baltimore Sun Sunday - - FRONT PAGE -

Mary­land may have al­lowed res­i­dents who did not qual­ify for Med­ic­aid into the gov­ern­ment health pro­gram for the poor by fail­ing to con­sider all of their in­come, ac­cord­ing to a rou­tine au­dit of the quasigov­ern­men­tal agency that over­sees the Mary­land health ex­change.

The Mary­land Health Ben­e­fit Ex­change was cre­ated un­der the Af­ford­able Care Act, known as Oba­macare, to run an on­line in­sur­ance por­tal where peo­ple could buy in­sur­ance if they did not get cov­er­age at work. In Mary­land, res­i­dents also sign up for Med­ic­aid through the ex­change.

Close to 1.3 mil­lion Mary­lan­ders — about 20 per­cent of the pop­u­la­tion — are en­rolled in Med­ic­aid, which was ex­panded as part of Oba­macare.

Dur­ing the au­dit, span­ning fis­cal 2015 through fis­cal 2017, au­di­tors checked a small num­ber of cases and found that more than a third of the time the ex­change con­sid­ered only state-col­lected in­come in­for­ma­tion and not data from fed­eral sources.

Fed­eral sources are far more com­pre­hen­sive, pos­si­bly al­low­ing peo­ple who earn too much to en­ter or re­main in the Med­ic­aid pro­gram.

The re­port also found that the agency did not prop­erly limit who had ac­cess to the sys­tem and could over­ride el­i­gi­bil­ity de­ter­mi­na­tions.

The au­di­tors did not de­ter­mine how many peo­ple, if any, re­ceived ben­e­fits to which they were not en­ti­tled.

Michele Eberle, the ex­ec­u­tive di­rec­tor of the Mary­land Health Ben­e­fit Ex­change, did not dis­pute the bulk of the find­ings in a writ­ten response to au­di­tors and said the agency would re­tool its pro­ce­dures to con­sider all in­come sources. She said deep ac­cess to the sys­tem would be lim­ited to so-called Su­perUsers whose job is to ad­dress el­i­gi­bil­ity sna­fus.

Au­di­tors also found a half-dozen other con­tract­ing and se­cu­rity is­sues at the ex­change as part of the fi­nan­cial re­view, some of which were re­lated to the botched launch of the ex­change in 2014 and the scram­ble to fix it. The site crashed on the first day and re­quired a com­plete tech­ni­cal over­haul. It has run smoothly ever since.

Eberle said sys­tems are all be­ing im­proved to ad­dress the is­sues, such as not clear­ing cer­tain in­for­ma­tion tech­nol­ogy con­tract­ing with the ex­change board, an is­sue first re­ported by The Bal­ti­more Sun in 2015; po­ten­tially lim­it­ing bid­ding by not al­low­ing suf­fi­cient time for pro­pos­als; and not prop­erly se­cur­ing data on for­merly used servers. — Mered­ith Cohn

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