The memo is scathing.
Ohio Medicaid director Maureen Corcoran uses words such as “inadequate,” “unacceptable,” “poorly implemented” and a “mess” to describe what she inherited from the administration of former Gov. John Kasich
Corcoran, who was appointed by Gov. Mike DeWine, says the Medicaid department is dealing with big problems and could face huge fines from the federal government if they’re not fixed. She criticized Kasich's administration for both creating and failing to fix those mistakes.
Of the Kasich-backed plan to move providers of addiction and mental health treatment for low-income Ohioans into the Medicaid managed care system, Corcoran writes: “The implementation was the worst I have seen in my professional career of more than 30 years.”
She also said that implementation was hampered by what she calls “questionable decisions,” system flaws that were big and numerous, and “overall mistrust and poor communication.”
That behavioral health redesign caused delays of millions of dollars in payments and even led to some providers shutting down.
But in a conference call discussing the memo, Corcoran said it’s not just a flamethrower pointed at her predecessors.
“It's not about pointing fingers or denigrating good work that was done by the prior administration," Corcoran said. "But it is about sort of clearing the air so that these things that have very real operational implications don't get tangled up with what we'll be laying out even more fully in the weeks ahead."
Among other things, Corcoran is referring to new work requirements affecting as many as 60,000 people in Medicaid expansion, which are set to go into effect next January.
Corcoran says that as Medicaid gets those work requirements up and running, she has to repair issues she’s found with several parts of the program.
For instance, a federal audit found Ohio’s error rate for determining Medicaid eligibility was double the national average – which doesn’t necessarily mean there were improper payments made or that people were kept out of the program. But Corcoran said it does mean that the state wasn’t doing what it was supposed to, and that’s why the feds told her that the state could have been fined almost $6 billion.
“I don't anybody to misinterpret this as we're saying, 'We're going to pay back $6 billion.' We're gonna have to pay back, we think, about $88,000," Corcoran clarified. "But down the line, if we don't remedy this, then we could be looking at penalties of that magnitude."
Corcoran said Medicaid is trying to replicate the mistakes the audit found to figure out if they’ve been fixed. She also says she found a backlog of cases that she describes as longstanding and unacceptable.
In the memo, Corcoran wrote that the $1.2 billion Ohio Benefits System that processes applications has forced employees to use thousands of workarounds for basic tasks. And she said there have been big mistakes in documentation generated by the system, such as private information being released to other recipients, inaccurate dates that can affect renewals and disappearing paperwork.
Jim Lynch, a spokesman for Kasich, pushed back on Corcoran's criticisms. Lynch didn’t agree to an interview, but rather provided a recorded statement defending his former boss.
“When Gov. Kasich came into office we had an $8 billion shortfall due in no small part to unsustainable growth in Medicaid," Lynch said. "So we got to work to reform the program, cut the cost growth from 9% to below 4%, and covered 700,000 more people. The state’s leadership now has the opportunity to build on eight years of progress.”
John Corlett was the director of Ohio Medicaid from 2007-2009, under Democratic Gov. Ted Strickland. He’s now with the Center for Community Solutions, a policy research group in Cleveland.
He admitted he hasn’t seen anything like this memo.
“I haven’t. But I mean, this program is so important, it’s important to get the details right. It’s important to get the program right," Corlett said.
Corlett gives credit to Kasich for expanding Medicaid, but said he’s concerned that people who are eligible for Medicaid aren’t getting it or are falling out of the program needlessly. Medicaid caseloads have been falling.
Corlett says he’s hoping those at the agency now are reaching out to people on the front lines.
“Those caseworkers and those application assisters and those community agencies and those large Medicaid providers – let’s talk to them," Corlett said. "Are their patients, are their clients, are the people who live in their neighborhoods able to access this program in a reasonable way, in a timely way? I think that’s where we should focus our efforts. I don’t think we should be talking about blame."
Corlett has been critical of the plan to implement work requirements that’s been pushed by Republican state lawmakers and DeWine. He said the state shouldn’t be adding more responsibility into a system that isn’t working right.
Corcoran said if she doesn’t have confidence in the system when it’s time to launch work requirements, “then we will pause.”