Home Coronavirus Potentially 500,000 Newly Medicaid Eligible: DMAS Will Fumble

Potentially 500,000 Newly Medicaid Eligible: DMAS Will Fumble

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by Dan Sullivan

Virginia is two consecutive Democratic Administrations in and there is a single distinguishing attribute: governance in malaise. Senator Deeds used to say that the Republicans are like the dog chasing a bus: lots of show in the pursuit but not a clue what to do with it once caught. Malaise is worse.

Access to healthcare is more essential today than ever. Yet the culture in the Departments of Medical Assistance Services (DMAS), Social Services (DSS), and Corrections (to name the worst Departments) effectively creates a barrier to access and indeed a catalyst for the pandemic. Cover Virginia, the contractor hired to facilitate Medicaid enrollment, reflects the same foot-dragging incompetence as the Department it serves. Time to take action. Time to demonstrate leadership.

Over the next few weeks, hundreds of thousands of Virginians will become Medicaid eligible. That’s just reality and a reality that DMAS and DSS can’t manage.

Where is Virginia’s Section 1135 waiver request in response to the COVID-19 national emergency? This waiver would provide the ability to grant state Medicaid agencies a wider range of flexibilities that will remove administrative burdens and expand access to needed services.

First step (not to be confused with the insidious STEP VA) is to change the culture that makes those Departments’ duty effectively to ensure the insurance companies’ profit from Medicaid. That may not be the public policy; but that is what effectively occurs because policy has been shaped by the insurance industry. It is embarrassing to hear not only members of the Executive Branch but also our Legislators mouthing the mantras of corporate profit.

This manifests in the general attitude by Medicaid caseworkers that it is their duty to deny coverage and, thus access to care. So, any excuse to deny eligibility is grasped. Often when caseworkers don’t understand the Medicaid eligibility criteria, (I might add that the Medicaid Manual has substantial eligibility criteria errors) they make up requirements that effectively cripple the applicant’s ability to comply. One of my personal favorites is “prove you don’t have any income.” That’s right: Prove a negative! There is this strain of cynicism which permeates that everyone applying is a potential fraud. The fact is that the greatest Medicaid fraud is committed by medical providers NOT Medicaid recipients.

Federal guidelines require Medicaid eligibility determinations be made within 45 days (10 days for pregnant applicants). DMAS and DSS have made 45 days the standard. Just call. The recordings (good luck finding a human or getting a return call) will emphasize and remind you of that. The caseworkers rely on that for an excuse not to act in a timely manner. The whole culture aims at delay, not bothered if in frustration applicants just quit calling. Then: denied.

Virginians losing jobs and coverage do not have 45 days to find out of they will accrue substantial debt if they seek treatment for COVID-19.

Show some leadership and management competence, Governor Northam. Distinguish yourself from your two immediate predecessors.