By Travis Perry │ Kansas Watchdog
OSAWATOMIE, Kan. — A relatively small provision within Obamacare could end up costing big bucks for the state government and Kansas taxpayers.
At issue is an innocuous clause within Section 2202 of the Affordable Care Act, which permits some hospitals to make on-the-spot judgment calls to enroll certain people in Medicaid without all the muss and fuss that go along with actually making sure they’re eligible.
They do get checked eventually, but if individuals are found ineligible for Medicaid they get booted off the plan — and the state gets stuck with the bill, according to Medicaid spokeswoman Emma Sandoe.
The concept itself is nothing new — it’s already in place at specific hospitals and clinics for children and pregnant women — but under Obamacare in Kansas it’s expanded to include low-income caretakers and parents. Eileen Hawley, spokesperson for Gov. Sam Brownback, said even with conservative estimates the provision could cost Kansas upwards of $700,000 annually.
“The State of Kansas is developing a set of rules and regulations that will ensure participating hospitals must demonstrate a high degree of accuracy in making Medicaid eligibility determinations,” Hawley told Kansas Watchdog.
It’s that accuracy — or rather, the possible lack thereof — that concerns Joshua Archambault, health care policy and program manager for the Pioneer Institute, a nonpartisan, privately funded, Massachusetts-based think tank. He says Section 2202 opens the door for potential fraud and deception.
Presumptive eligibility doesn’t require the same level of verification as an actual application, which likely could result in patients lying about their personal information — such as income or family size — to receive care, Archambault said.
“The Medicaid program has fraud problems and this might make it slightly worse,” he added.
A major factor which Hawley said will help stamp-out presumptive eligibility fraud is the impending rollout of the Kansas Eligibility and Enforcement System. Turnaround with the current paper-based application system can take as long as 45 days, but the implementation of KEES, which will reference multiple state databases to verify benefit eligibility, could cut that down to a single day.
The provision outlining presumptive eligibility has been baked into Obamacare from the start, but Medicaid officials didn’t release the final ruling until July.
Chris Butler and Adam Tobias contributed to this report.
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