AUGUSTA, Maine (NEWS CENTER) -- Maine DHHS Commissioner Mary Mayhew says its taken a tremendous effort by her staff, other state agencies and private contractors, but they now have a clearer picture of why the department's latest computer problem went hidden for so long.
Mayhew has said she learned of the problem in January, but didn't inform the Legislature until March. Democrats have harshly criticized Mayhew for the delay, saying she withheld critical information from them at the same time they were working out details of Medicaid budget cuts.
The basic problem is that the computer system for Medicaid eligibility and the system for paying Medicaid claims did not properly communicate with each other. That resulted in more than 7,000 people receiving Medicaid health insurance benefits, even though they were no longer eligible.
The six-week examination of the problem shows a total of $10,600,000 was paid in claims for ineligible patients. DHHS Commissioner Mary Mayhew told lawmakers nearly $4 million of that was federal funds that will have to be paid back to the federal government. The rest came from state taxpayers money, and she said they will not be able to get those funds back, either. Mayhew said the payments were made to legitimate health care providers, who provided services for people the computer indicated were still eligible.
There has been a lot of speculation about the impact of the computer problem on the 2013 Medicaid budget - which is still waiting to be voted on by the Legislature. The Medicaid program has been facing a projected $84 million shortfall in 2013.
Mayhew said clearing up the computer problem will only reduce that by $1.5 million, meaning the Appropriations Committee must still find $82.5 million in Medicaid cuts and program savings. That process is scheduled to begin on Monday. Lawmakers are awaiting a new state revenue forecast, which is expected to promise increased tax revenue because of a slowly improving economy.
Lawmakers say that could also give them another source of money to help balance the budget, but Governor Paul LePage continues to say the Legislature must make significant structural changes in Medicaid benefits and programs.