The Minnesota Department of Human Services’ decision to disenroll the majority of providers in 13 different Medicaid programs may turn out to be more of a weekslong bureaucratic nightmare than an indefinite crisis for tens of thousands of Minnesotans on Medicaid.
A department spokesperson emailed me Tuesday that providers who appeal their disenrollment can get funding reinstated during the appeals process in order to ensure continuity of care. The spokesperson said that DHS has discretion on whether to keep paying the provider, based on whether the needed paperwork was submitted on appeal.
Also, all disenrolled providers can bill Medicaid for services rendered up to the point of disenrollment, which for most health care facilities happened in the last week of May. Under Medicaid, providers typically seek reimbursement every other week.
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Individual providers and associations that lobby on their behalf say this news comes as a relief, but that their situation is still a mess.
“It’s less dire but they should have communicated that initially so people did not have the reaction that they did,” said Sue Schettle, CEO of the Association for Residential Resources in Minnesota, which represents disabilities service providers.
These providers and their patients are caught in the middle of a political fight between President Donald Trump and Gov. Tim Walz, Schettle said.
How were so many providers cut off from accessing Medicaid revenue?
The state’s decision to purge provider rolls was meant to appease the Trump administration, which has vowed to withhold over $2 billion in Congressionally appropriated Medicaid dollars due to their stated concern over providers committing fraud.
Earlier this year, the federal Centers for Medicare and Medicaid Services approved a so-called corrective action plan DHS submitted concerning 13 programs deemed highly susceptible to fraud.
These programs run the gamut and show the reach of Medicaid, which is the primary source of health care coverage for almost a quarter of Minnesota’s population. They include mental health rehabilitation, transportation to medical appointments, and home-care assistance, among myriad other services.
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Under the corrective action plan, DHS agreed to revalidate the eligibility of every single provider in these 13 programs by May 31.
Normally, the revalidation process takes place every five years. It includes paperwork regarding who owns the company or nonprofit, their insurance, and whether they have the correct care licenses.
This emergency revalidation process incorporated all the usual paperwork. It also included the element of unannounced site visits. The state pulled in employees from other departments to help DHS scrutinize these providers.
The final product resulted in 2,061 providers getting approved and 3,411 being disenrolled. According to DHS, 73% were disenrolled for incomplete paperwork or documentation.
Were the rest disenrolled because of suspicions of fraud?
No.
It is not clear if any providers were disenrolled due to fraud suspicions, though the department’s Office of Inspector General is set to review 59 providers, or less than 2% of those disqualified.
Sue Foseid runs Northern Access, a company that provides nonemergency medical transportation in the Duluth area, picking up and dropping off Medicaid recipients for scheduled appointments such as dialysis treatment.
Northern Access was disenrolled due to a “clerical error” of not properly noting that one of her staff members performed a managerial role, Foseid said.
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Foseid was informed Friday, May 28, that Northern Access had been booted off Medicaid, which accounts for about half the company’s revenue. Foseid appealed the decision on June 2, and said that she has yet to hear back from DHS.
“I have called them three times in order to talk to a live human being but I was put on hold for over 45 minutes” before eventually hanging up, she said.
DHS has pledged in appeal replies that it will get back to providers in 7-10 business days.
In the meantime, Foseid said that Northern Access is not providing transportation to Medicaid recipients.
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