Unanswered questions answered

Last week I posed two questions to Culver administration officials and the answers came in after the stories I’d filed on the topic — several hours in one instance; a day later in the other.

First question, from last Tuesday, after the governor again commented on the “texting while driving” issue:  just how much federal money does the State of Iowa stand to lose if the legislature & governor do not enact a new law banning texting while driving?

Erin Seidler, the governor’s communication director answered that question a few hours later:  The federal sanctions in the highway bill have not passed yet. There is support in Congress, and if a 25% sanction passes, Iowa could lose $75 million.

Second question, posed last Monday morning to Department of Human Services spokesman Roger Munns, seeking comment on an audit which found the department does not have a system to check for errors or fraud in applications from Iowans seeking Medicare coverage.  Here’s last Monday’s Radio Iowa story on the audit.  Below you may read the agency’s response, which came on Tuesday afternoon.

Roger Munns, Iowa Department of Human Services spokesman: Sorry for the delay. It took a little time to dig back into this.

The DHS screening process to determine eligibility for Medicaid has struck a good balance between trust and verification, but improvements are always in the works and we value suggestions from the auditor or
anyone else on how to be more precise.

It’s worth noting that applicants for Medicaid are required to provide verifiable information on income, which is the single most important factor in determining eligibility. In all cases, income is verified at application and on review. Furthermore, a DHS computer automatically cross-checks the applicant’s Social Security number to make sure that the data matches. The department would have to employ dozens more workers to perform exhaustive household and other types of checks on every one of the some 420,000 people who are eligible for Medicaid.
Thus, eligibility workers make judgments based on their experience to determine which applications need more scrutiny.

Medicaid recipients are informed that they are required to tell us if there are changes in their circumstances that might influence their eligibility, and there is a high level of compliance with this requirement. The DHS processes over 140,000 changes annually for all DHS assistance recipients, and at least 114,000 are for Medicaid or multi-program recipients.

Iowa performs well in comparison to other states regarding Medicaid eligibility accuracy. The auditor comments that the national Payment Error Rate Measurement system does not include verification of client application information. In fact, beginning in federal fiscal year 2008, PERM has included this feature. Specifically, verification for PERM is
citizenship, residency, household composition, bank accounts, earned and unearned income, and enrollment in the plan for managed care
beneficiaries. In the most recent PERM report (November 2009), Iowa Medicaid outperformed the national average by a large margin. In the eligibility portion of PERM, Iowa’s error rate was 3.32 percent compared to 6.74 percent estimated national error rate.

Finally, the auditor believes that, based on interviews with DHS workers, there are inconsistent policies from county to county. The policy is consistent from county to county, and we do our best to make sure that all of the income maintenance workers interpret the policy the same way.

It is possible the auditor misunderstood requirements for reviews. The auditor declares that in one county, he found that employees conduct reviews every six months while in another county they do it annually. In
every county, Medicaid-only clients have an annual review, which is what Medicaid rules require. Eighty percent of Medicaid members also receive food assistance. In every county, the review period for food assistance is six months. The same is true for recipients of the Family investment Program (FIP).