Auditor: Little monitoring of Medicaid spending

During the past decade, Vermont has spent $675 million setting up Medicaid managed-care programs but has done such a spotty job monitoring them that they can’t even be audited.

That’s the upshot from a letter state Auditor of Accounts Douglas Hoffer sent to lawmakers last week. It followed up on an internal report in January by the Agency of Human Services detailing gaps in answers to this question: Have the state and federal governments — and taxpayers — been getting their two-thirds of a billion dollars’ worth?

Nearly every Vermonter is touched, or knows someone who is, by the wide range of programs in question, Hoffer said in an interview.

“People with developmental disabilities, mental health issues, poor people who need some assistance, schools — these are programs reaching an awful lot of Vermonters,” Hoffer said.

Vermont entered a unique arrangement with the federal government in 2006 called “global commitment,” in which as long as it stayed under projected spending caps, the state would be allowed unusual flexibility in how it spent federal Medicaid dollars.

It was an ideal arrangement for a state where many politicians and activists wanted to expand health coverage to the uninsured while holding down costs — Vermont would become a laboratory for health reform.

While those efforts have unfolded, there has been an increasing focus on government accountability — checking up on programs to be sure the money being spent on them is bringing the desired result. The latest such effort was a “results-based accountability” law passed last year.

Last summer, then-Human Services Secretary Doug Racine decided to focus on the state’s unique role as a Medicaid managed care organization.

Racine left his job in August, but the review he launched resulted in the internal January report, which was obtained by The Associated Press, showing many instances in which the tools of government accountability — performance benchmarks and data on whether they were being reached — did not exist.

Continue reading at: Burlington Free Press