By Richard Craver
Winston Salem Journal
A combined $9.7 million is owed to about 2,500 Medicaid services providers, the N.C. Department of Health and Human Services confirmed Thursday.
The state’s $14 billion Medicaid program covers about 1.9 million North Carolinians. It has had a nearly $2 billion financing gap since the start of the 2009-10 fiscal year.
The payment delay is related primarily to NCTracks, the Medicaid claims-processing system that debuted in July 2013. At a $484 million contract cost for development, implementation and support, it represents the biggest information technology project in state government history.
Provider complaints about nonpayment or under payments began shortly after the NCTracks launch.
The underpayments were announced last week by Lee Roberts, the state’s budget director. DHHS officials said it began reimbursing providers for the underpayments in March.
The payments affect providers who serve both Medicare and Medicaid patients. Medicare is the federal health insurance plan for the elderly, while Medicaid mostly serves the poor, elderly and disabled.
DHHS said its Medicaid budget “can cover the $9.7 million without requiring additional appropriations this fiscal year. We are still analyzing the impact to future years’ budgets to determine what, if any, adjustments may be needed.”
Roberts said Thursday “there is no doubt NCTracks has had implementation problems.”
But he said the $9.7 million issue comes from NCTracks having to respond to Centers for Medicare and Medicaid Services changes about the dual enrollees.
“It’s not an NCTracks problem per se as much as a policy clarification issue,” Roberts said.
Gov. Pat McCrory proposed in his 2015-16 budget creating a Medicaid reserve fund of $50 million for fiscal 2015-16 and $125 million for fiscal 2016-17 “for a buffer against the inherent uncertainty in actual expenditures.”
That’s even though Wos said the program had a $63 million surplus in 2013-14.
Rep. Donny Lambeth, R-Forsyth, and former president of N.C. Baptist Hospital, said he understands the complexity of the state Medicaid program.
“There are frequent audits and reviews to assure proper controls,” Lambeth said.
“It is unfortunate and inappropriate not to pay providers of care for services they render to patients. Even with a major audit of all aspects of the agency, this was not discovered.
“But now that it has, it needs to be corrected quickly and payments made.”