ALACHUA COUNTY, FL – The following is an overview of the Medicaid Billing Cost Shift issue that is working its way through the State Legislature’s budget process in Tallahassee. This issue could result in Alachua County Tax payers being unfairly charged millions of dollars to cover Medicaid costs for non-residents of Alachua County. The impact of this action would be devastating to Alachua County residents and County government.
Florida counties are required to set aside funds to pay for their share of the cost of certain Medicaid services based upon statements provided by the Agency for Health Care Administration (AHCA). AHCA provides counties with a monthly bill listing Medicaid residents that the county is responsible for paying. Counties review the information to verify the individuals’ county of residence and determine whether the bill is accurate. If the county determines that the bill is correct, it remits payment to AHCA.
If it is determined that an individual is not a county resident, the bill is denied, returned to AHCA, and payment is not made. AHCA researches each rejected bill and provides additional documentation to the county to support its original determination of residency or identifies another county that should be billed. This process continues until the original county pays the bill, another county pays the bill, or until AHCA determines the cost cannot be billed to a specific county. The majority of disputes with AHCA are over determining the correct county of residence.
Backlog of Past Due Billings
As of December 31, 2011, unpaid billings from all counties totaled 325.5 million. The Legislature is proposing collecting overdue payments by withholding revenue sharing dollars (revenues that go to the counties such as a counties share of State Sales Tax) from the delinquent counties. The backlog includes charges denied from the current date to more than four years ago. HB 5301 would require payment based on AHCA’s balance sheet even though older proof of residency information may have been destroyed by the counties. AHCA has estimated 13.4 million dollars in outstanding bills would be collected from Alachua County. The proposed bill would require counties to pay 85 % of this cost. This would be approximately 11.5 million for Alachua County.
Alachua County’s Unique Billing Situation
Fiscal Staff within the Alachua County Department of Community Support Services has been examining Medicaid billings from AHCA using APPX, a software system, to screen out inappropriate bills sent to Alachua County. According to our records and past e-mails, AHCA’s staff explained that they have made “special considerations” for Alachua County because of a computer programming issue that has Alachua County listed first in the list of counties to select. That issue has led to Alachua County being inappropriately selected more often than other counties as the default setting. It was discovered during AHCA’s transition to the Medicaid billing system that the address history tab in the web portal does not have the capability to maintain a billing history file. Billed entries in the web portal do not link to a billing history for the Medicaid recipient. Therefore, some counties pay for additional software, as we do, to process records and keep a billing history. As a result of using APPX Software, Alachua County has been able to deny an average 80% of bills received from AHCA during fiscal year 11.
County Commission Action
On February 14, 2012 the Alachua County Board of County Commissioners (BoCC) approved Resolution 12-12 relating to the unfair Medicaid Billing and sent it to our Legislative Delegation. The resolution stated:
“That the Florida Medicaid Program can only be equitable if the state of Florida allows counties to deny claims that are based on inaccurate information and to have a process by which to grieve the same and is committed to working with counties as partners in the development of a plan that will benefit the state and local taxpayers and citizens.”
View Resolution 12-12 and backup material
We urge citizens to call or email their State Legislative Delegation and ask them to vote no on SB 1988 and HB 5301 concerning Medicaid Billing Cost Shift.
Senator Steve Oelrich
State Representative Leonard L. Bembry
State Representative Charles Chestnut
State Representative Keith Perry
State Representative Elizabeth Porter
To email the entire Joint Legislative Budget Commission, copy and paste the email addresses below into your To: field.
Denise.firstname.lastname@example.org; email@example.com; firstname.lastname@example.org; email@example.com; firstname.lastname@example.org; Darryl.email@example.com; Robert.firstname.lastname@example.org; email@example.com; firstname.lastname@example.org; email@example.com; firstname.lastname@example.org; email@example.com; firstname.lastname@example.org; email@example.com
For more information, contact the Alachua County Communications Office at 352-374-5204.