September 27, 2011

Maine DHHS tries to pass test it has failed since '05

The state will gain millions in U.S. aid if auditors find the MaineCare computer system meets standards.

By Susan M. Cover
State House Bureau

AUGUSTA -- A federal team of program auditors is in Maine this week to determine whether a computer system used by Maine's Department of Health and Human Services meets federal standards.

If it does, the state will get more federal money to support Medicaid services.

Stefanie Nadeau, director of MaineCare Services, told the Legislature's Appropriations Committee on Monday that the team from the Centers for Medicare and Medicaid Services will spend this week touring facilities, listening to presentations and reviewing operations.

The state hasn't had a billing system that meets federal requirements since it switched computer systems in 2005. If the state meets the standards, it will get a 75 percent match for Medicaid services. The state now gets a 50 percent match.

Maine's $6 billion, two-year budget books nearly $17 million in savings in the next fiscal year on the assumption that the state will be deemed compliant and get more federal money.

MaineCare is the state's version of the federal Medicaid program, which provides health insurance to low-income people. The state pays out $30 million in claims each week from 5,000 MaineCare service providers, who must process claims through the system. The providers range from hospitals and nursing homes to podiatrists and mental health agencies.

Nadeau said it will likely take 60 days to get an answer from the federal government on the state's compliance. While states sometimes get conditional certification -- contingent on a set of additional requirements -- it's not likely, Nadeau said.

"We're either going to be certified or we're not," she said.

The state hired Molina Healthcare, based in California, to install the new system last year and to run a call center where the state's providers can get help with problems. In addition to Maine, Molina has contracts with Idaho, Louisiana, New Jersey and West Virginia to manage Medicaid billing systems.

Since 2005, Maine lawmakers have heard complaints from providers who have had trouble getting claims processed by the state.

Richard Rosen, R-Bucksport, Senate chairman of the Appropriations Committee, joked with Nadeau and DHHS Commissioner Mary Mayhew about whether there's anything lawmakers can do to help the state earn the federal clearance.

"Do you need members of this committee to put on a lobster feed?" he said.

MaineToday Media State House Writer Susan Cover can be contacted at 620-7015 or


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