- Associated Press - Monday, November 9, 2015

RICHMOND, Va. (AP) - Virginia has provided tens of millions of dollars in Medicaid benefits to ineligible patients because of inadequate reviews and processing delays and is at risk of providing even more, the state’s legislative watchdog agency said Monday.

Virginia officials don’t verify that applicants are telling the truth when they say that they have no earned income, according to the report from the Joint Legislative Audit and Review Commission, which is in the midst of a two-year review of the state’s Medicaid program.

Furthermore, Virginia is failing to promptly determine whether someone’s Medicaid benefits should be renewed after a year, allowing people who are no longer be eligible to remain on the rolls, the report said.

The commission estimated that up to $38 million in the roughly $8 billion program was spent on ineligible recipients in fiscal year 2014 because of that backlog. As of August, nearly 961,000 Virginia residents were on Medicaid and the Children’s Health Insurance Program.

Republicans who remain staunchly opposed to Democratic Gov. Terry McAuliffe’s efforts to expand Medicaid under the federal health care law quickly seized on the commission’s findings as evidence that it can’t handle more recipients.

“You’re taking a program that’s not particularly efficient right now and overburdening it even further,” GOP Del. John O’Bannon said of the expansion, which would add about 400,000 more low-income Virginians to the Medicaid program.

Virginia’s verification process catches only those who report having some income, Jeff Lunardi, project leader for the review told lawmakers Monday. Therefore, people who say they don’t make any money are taken at their word even though it’s likely that “at least some” are actually ineligible for assistance, Lunardi said.

Linda Nablo, chief deputy director for the Department of Medical Assistance Services, which oversees the state’s Medicaid program, said the department has already drafted new policies to fix the problem and they are expected to be in place by the end of the year. She also noted that her department had pushed lawmakers to approve a measure that would have addressed some of the issues, but it was killed in the General Assembly.

The review also found that overburdened offices are failing to promptly determine whether applicants remain eligible for benefits after 12 months.

McAuliffe has signaled that he will make another push to expand Medicaid next session, even though both the House and Senate remain controlled by Republicans, who have blocked his efforts in the past.

Republicans suspect McAuliffe is eying a proposal like one adopted by Colorado that would allow the state to collect fees from hospitals in order to draw down more federal funds that could then be used to pay the state’s share of the expansion costs.

Brian Coy, a spokesman for McAuliffe, said the governor isn’t ready to discuss specific legislation. But he said the state can fix problems in its Medicaid program while also expanding it to cover more residents, if members of the General Assembly don’t “sit on the partisan sidelines.”

“We can always improve our Medicaid system but there is no excuse for leaving billions of Virginians’ taxpayer dollars on the table in Washington when we could be using it to expand access to hundreds of thousands of our friends and neighbors,” he said.


Follow Alanna Durkin on Twitter at twitter.com/aedurkin . Her work can be found at https://bigstory.ap.org/author/alanna-durkin .

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