…because this week a pretty good test case will hit the floor of the Louisiana House of Representatives which will put the issue front and center of who is eligible for Medicaid and who’s enrolled in the program in spite of their eligibility.
You might have seen our post yesterday on the potential $498 million in fraud – we’re using “potential” as a defensive term, as it’s almost certain that amount of money is being wasted in the system – inherent in the 83,000 people who were identified by the Louisiana legislative auditor’s office as having reported more than a $20,000 difference in income between their tax records and their Medicaid applications.
That $498 million number is probably a drop in the bucket. Here are a few points our readers need to understand, and we’d ask your forebearance here because there is very little more “in the weeds” when it comes to discussing Louisiana public policy than the Medicaid question is – and it’s that way because the people involved absolutely want it to be that way.
First, and this is the purpose for HB 480, which is a bill by Rep. Tony Bacala (R-Prairieville) up for a floor vote in the House Thursday afternoon, when you apply for Medicaid they don’t use your tax records to gauge your eligibility. They ask you how much a month you make.
That might seem reasonable, but it isn’t. If you’re a contractor, let’s say, and every six months you finish a job and get paid $100,000 on net, 10 months out of the year you could walk into a Medicaid office and qualify because you didn’t make any money the previous month.
But it’s worse than that. Because they don’t use tax records you can work a job and just lie about what you make to Medicaid and they’ll put you on the rolls. That’s essentially what these 83,000 people did – they didn’t want to get audited, so they told the truth on their taxes but when they saw the Edwards administration’s TV ads they went out and signed up for Medicaid and shorted their income on the form so they’d be eligible. And did so by more than $20,000.
Legislative auditor Daryl Purpera explained this in that video we had in yesterday’s post. Purpera came up with that number because he was sitting on a task force which included the state’s Department of Revenue, and he brought DOR the Medicaid signup records and had them match up those people with their tax information, and the result was of the people they actually had tax records for there were 83,000 of them whose numbers were off by more than $20,000.
Nobody told Medicaid they made $20,000 more than they told DOR or the IRS. That’s just common sense. Anybody who didn’t file taxes, which is actually most of the state’s Medicaid recipients (Purpera’s number was 61 percent), isn’t included in that 83,000 – that’s an entirely different pool of people which could encompass tens of thousands more ineligibles on the books.
We understand that CMS, which is the federal agency administering Medicaid, mandates that the state health departments audit their own books since about 2013. Which is a frighteningly destructive idea, because if anything needs independent auditing it’s this waste-and-fraud engine of a program – but the Louisiana Department of Health actually did that audit. And the first year LDH performed that audit they found something like a 25 percent error rate on these eligibility questions. When the legislative auditor’s office ran the numbers on that error rate they came up with as much as $920 million which could be wasted on people on the Medicaid rolls who don’t belong.
That was before John Bel Edwards expanded Medicaid with some half-million able-bodied adults he signed up on the rolls. What that $920 million figure is now is something which should terrorize every single taxpayer in Louisiana.
Rather than do something to close down the massive amounts of taxpayer dollars being wasted by signing up Medicaid cheats, LDH instituted a rule which is only in place in Louisiana. Here you can lie on your Medicaid application and deflate your income to the tune of 25 – TWENTY FIVE – percent, and they’ll use your lie to calculate your eligibility. You can say you make $40,000 on your taxes and 30,000 on your Medicaid application and they’ll use $30,000 as your eligibility number. Nobody else does this, anywhere in the country. And in this year’s special session when the House Republicans attempted to address it with a reform bill it was shot down.
Why? Because the governor and his allies want as many people on Medicaid as possible. They want that for ideological reasons, but they also want it because they believe it’s an avenue to draw down as many federal matching funds as possible. Bear in mind those federal matching funds can’t be used for roads, schools, coastal restoration or higher education – they go into a Medicaid program which is already far bigger than the state has the resources to service.
How do we know this? Well, there’s the question of the 5,500 – and growing – people who have already died thanks to the state’s Medicaid expansion since July 1, 2016.
“Wait, what?” you say? You read that correctly. According to a study by the Foundation for Government Accountability released in March, there have been over 5,500 Louisianans who died on a Medicaid waiting list since the program was expanded….
Louisiana Governor John Bel Edwards unilaterally expanded Obamacare on July 1, 2016, and the state has since signed up 451,643 people. The program is grossly over budget. Despite promises the welfare program would only cost $1.1 billion in its first year, actual costs came to $2.5 billion.
In that same time period, however, 5,534 people died while on the Medicaid waiting lists. Another 73,929 remain on the waiting list, according to the report. Individuals wait up to six years and six months on average before receiving services.
They’re clogging up the Medicaid rolls with able-bodied people, many of whom had private insurance before the expansion, when there aren’t enough doctors who take Medicaid patients in the state to care for the non-able-bodied traditional Medicaid patients who already existed.
And people are dying. You hear all the time the plaintive wails of the Democrats who scream that if the Republicans’ budget is passed it will kill people, but the fact is the Medicaid expansion is already killing people because it adds more people to the system than the system can process.
So Bacala’s bill would let the Department of Revenue share information with the Legislative Auditor’s office on the state income tax filings of the people who sign up for Medicaid, so as to check to see whether they’re actually eligible to get Medicaid coverage. By doing that, Medicaid can knock the ineligibles out of the system and preserve the limited access to the health care system for the truly needy.
There should be precisely zero opposition to this bill – but just wait until it comes up for debate, because you will see a show. There will be such demagoguery as to astound you during the debate for HB 480, with accusations that Bacala is red in tooth and claw with the blood of the innocent.
All of it will be lies. But there are a lot of people invested in this scam, and they can’t allow it to slow down.
The real question is how much longer this is allowed to continue before somebody – the House Republican Delegation, the state GOP, the think tanks, LABI, whoever – begins a campaign to expose the billions of dollars in waste and fraud being inflicted on the taxpayers of this state. Increasingly this is the reason Louisiana’s tax code can’t compete with Texas. This is why our roads are terrible and getting worse. This is why your kids’ college tuition gets more expensive and TOPS can’t cover it. It’s why the streets aren’t safe, it’s why there are people with mental illness issues filling the jails and the highway underpasses and it’s why there’s no money for a new bridge over the Mississippi in Baton Rouge. Medicaid is soaking up all of our money and it’s getting worse, and it isn’t making our people well but instead has killed 5,500 of them and counting.
HB 480 is a small step toward fixing that. Anybody who votes against it is part of the problem. We’ll be watching.