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Audit reveals coverage issues for Medicaid-eligible newborns in RI

Target 12

PROVIDENCE, R.I. (WPRI) – Rhode Island is not determining Medicaid eligibility for newborns within the federally required timeframe.

The finding is one of many deficiencies outlined in Auditor General Dennis Hoyle’s state audit for fiscal year 2017, an annual document that is required by Rhode Island and federal law.

According to the audit, newborn enrollment delays resulted in “significant and related delays in provider claims adjudication and payments to managed care organizations (MCOs).”

R.I. Medicaid Director Patrick Tigue acknowledged the issue, which is related to UHIP, the half a billion dollar computer system that has not worked properly since its launch in September 2016.

“Fortunately, those issues have not impeded access to care,” he told Target 12. “They really relate to payment for newborns, so we are focused on ensuring families receive access to care while ensuring that providers on the back end get the payments that they’re entitled to.”

Those advance payments for newborns with pending eligibility total $6.5 million, according to the audit.  Federal law only allows payments after eligibility has been determined, the report states.

Tigue says the federal government has not threatened fines over the state’s noncompliance.

The audit also revealed a 16,000-person difference between two computer systems, UHIP and the state’s payment system.

“In certain cases, sometimes individuals have eligibility who perhaps should not, and in other cases, individuals who don’t have eligibility should,” Tigue explained. “We’re working to resolve all of those.”

“As of today, we’ve worked that difference down to 7,400, so we’ve made really significant progress,” he added. “We won’t be done until we’ve worked down every single case to ensure that the payment system and the eligibility system are completely matched up.”

Tigue said he does not have an estimate for Medicaid’s overpayments or underpayments that have been made due to UHIP system issues.

Among the other issues outlined in the audit; ongoing problems with SNAP benefits for food and IT security risks statewide.

Copyright 2019 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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