TBO.com - TBO is Tampa Bay Online

Glitch Halts Medicaid Workers' Paychecks

ADVERTISEMENT

By LINDSAY PETERSON

The Tampa Tribune

Published: July 18, 2008

Updated: 07/18/2008 12:33 am

Glitches in a new Medicaid computer system have left many workers who care for Florida's poor and disabled without paychecks for the past three weeks.

The state hired Electronic Data Systems of Plano, Texas, three years ago to design and develop a new system to enroll providers and process claims for the state's $15 billion Medicaid program.

The goal was to increase efficiency, state officials said at the time, but several Medicaid providers say they've never experienced such disarray.

"This is devastating," said Sandy Dayton, who employs 28 home care workers at an Inverness agency called Moving Mountains. They help disabled people in their homes, providing personal care, companionship services and life-skills training.

"This is the third week I'm having to call my employees to ask if they can wait another week to get paid," she said. "These are the people we depend on."

In addition to the payment delay, the caregiver rates have been cut by about 7 percent. With the cuts and the delays, Dayton is afraid she will lose her best workers.

"I'm afraid the very, very good providers we have will say, 'I can't do this anymore. I have a family to take care of.'"

The new computer system was set up to process claims for all 100,000 Medicaid providers in Florida, but the most seriously affected seem to be the ones like Dayton, who are part of what's called the Medicaid Waiver program.

The program provides in-home services to disabled people who are in danger of having to move to assisted-living facilities or nursing homes, where the care would be more expensive.

Aaron Nangle, who runs Web sites for Medicaid Waiver caregivers, said he's heard complaints from hundreds of people. "It's quite a mess," he said.

The Agency for Health Care Administration, which manages the Florida Medicaid program, could not say how widespread the problem was.

Spokeswoman Shelisha Durden said about 14,000 providers have been paid without any problems under the new system. But "some claims have not processed appropriately and consequently will be 'suspended' for a few hours or a few days until a system modification is applied to correct the processing anomaly," she said.

"One system issue ... could affect all provider types or could affect only a single provider type or any number in between," she said.

She said EDS has fixed most of the problems and is working on the rest. It expects to have all the problems identified by next week and will have them fixed "shortly thereafter."

A Complex System

The new system is "extremely complex and is designed very differently from our previous mainframe system," Durden said. It required the conversion of 5 million lines of code from the old system.

The new EDS system cost the state $308 million. That includes its design and five years of operation. It is more complex than the old system, agency officials said. But it's intended to be more efficient, too, enabling providers to keep track of their own records while they are being processed.

Since the system went into service on June 26, however, it has had Meryle Axelrod "pulling out her hair," she said. Based in Tavares, she operates a service that processes Medicaid Waiver claims for smaller providers, many of whom don't understand why they're not getting their money.

"I had a provider call me this morning, crying that she's going to lose her home," Axelrod said. "I know people are supposed to have backup finances, but in this economy, it's not easy.

"I'm working on it all day and at night, I'm exhausted," she said. "I sleep but I don't sleep because my mind is racing all night long trying to figure out how to get people paid."

Of all the calls she's made to the toll-free numbers EDS has set up to answer questions, no one has been able to explain to her what the problem is, she said.

The state conducted several training sessions across the state, Axelrod said. She attended three, but didn't get any hands-on training. And when she began using the system on her own, "it wasn't as easy as they made it look."

'There's No Rhyme Or Reason'

She and others describe a variety of problems. They will fill out a form and submit it, only to be told they don't have billing authorization. Often, when the form is accepted and they try to open it later, they're told it does not exist. Then, if they resubmit it, it's rejected as a duplicate bill.

Not everyone, however, is having problems.

Marlo Rogers, of Suncoast New Options in Tampa, said she's been able to get all of her claims through. "I've had to hit the submit button a couple of times, but that was it.

"It's a great system. I love it," she said. "I can go in and see my claim in real time and see if there are any problems."

It's hit or miss, said Jennifer Finnin of Advantage Home Care in Largo. The system is accepting some claims but not accepting others, she said.

About 14 of her agency's claims, $22,000 worth, are now holding, waiting for the system to correct the problem that caused them to be rejected in the first place.

"There's no rhyme or reason to any of this," she said. "This company has had this contract for more than two years; you'd think that would be ample time to get the bugs worked out."

Reporter Lindsay Peterson can be reached at (813) 259-7834 or lpeterson@tampatrib.com.

Share this:

Loading Comments...

Email Print

ADVERTISEMENT