WRAL Investigates

Critics: Delays in state Medicaid program 'unacceptable'

Posted November 4, 2010

WRAL Investigates

— Delays in the state’s Medicaid program have some people waiting weeks or months for care. There are also reports of people dying as they wait to be assessed for services, according to Disability Rights North Carolina.

The state tried to rid the system of fraud and abuse, but the result has been that those who aren't trying to take advantage of the system are unintentionally penalized, WRAL Investigates found.

In May, Margaret Street applied for her mother, Edna Street, to receive state-funded in-home care. So far, there is no help for the 88-year-old who takes 20 to 25 medications a day. Edna Street is a double amputee who never leaves her bed and needs to be moved at least 10 times a day.

“(I) have to keep her back side from breaking down,” Margaret Street said. “If I had help, she could get up more, because it’s dangerous for one person trying to get her up.”

Margaret Street says she is “fed up” after having to resubmit the paperwork four times for various reasons.

According to the state's $24 million no-bid contract with Carolinas Center for Medical Excellence, assessments and patient notification should occur within 14 days. It has been more than five months for Edna Street.

Cheryl Burleson works for a local health care company that provides in-home care. She says Edna Street has fallen through the cracks.

“The amount of time is absolutely unacceptable,” she said. “Once it hit the state level, it got lost in the big black hole ... I think they implemented a system before it was ready to roll."

Medicaid patients seeing delays with service Medicaid patients seeing delays with service

CCME began assessing people who need in-home personal care services in April. Their contract says that from the date someone is referred to them, home care services are to begin within 30 days. The Department of Health and Human Services says CCME is currently averaging 27 days.

Kathie Smith, with the Association for Home and Hospice, said she believes 30 days is a long time as it is.

“We receive many calls of cases where they’re beyond the time frames, well beyond,” Smith said. “It’s frustrating to see and hear the stories of people waiting for services.”

In a Sept. 8 letter to the Department of Justice and Centers for Medicare & Medicaid Services, Disability Rights North Carolina’s executive vice president, Vicki Smith, says it's estimated that "several thousand individuals have been referred to in-home PCS (Personal Care Services)" since April 1. However, "relatively few individuals have actually been authorized to begin receiving PCS since then," she wrote.

"People who need in-home PCS ... are suffering during these lengthy delays," Smith wrote. "(One) individual died after waiting three months without ever receiving an assessment."

DHHS declined WRAL News' repeated requests for an interview but provided a written statement, which says DHHS is working with CCME to considerably shorten that average timeline.

Meanwhile, Margaret Street continues to wait, barely able to hold on.

“That’s why I’m begging for some help, because I’m not getting any sleep at night or anything like that,” she said.

Margaret Street cooks for, feeds, bathes and cleans up after her mother, but says it’s worth it.

“That’s my mother,” she said.

Edna Street says she would rather die than go to a nursing home. So, for now, Margaret Street will keep doing what she has to day and night.

“I appreciate her very much,” Edna Street said.

37 Comments

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  • leggrn Nov 9, 10:40 a.m.

    As a healthcare provider and having worked in the home care setting, I too have seen abuse of the PCS system. I agree that some form of control needed to be exerted over the program in order to maintain its sustainability and the integrity of the home care providers. The route that our state choose, however was not the best option. Our state could have very well hired more RN's as surveyors/fraud investigators for a fraction of what the CCME contract cost our NC taxpayers. The real problem lies in the fact that the surveyors for the state did not do a very good job at weeding out the agencies that were stealing from our state and our elderly citizens whom need these services. Our agency has also experienced the long wait times for CCME to respond to these requests for services. For example, a lady that was assessed for short term PCS services (@ 3 mo) per her MD's request has been waiting 5 weeks since she was assessed to even be given an approval or denial for services. All the wh

  • lsonger Nov 8, 2:35 p.m.

    I too have been working in the PCS program for 4 years. Yes there has been agencies out there that abused the system, however as an ethical Home Care Manager I am disappointed in our state as how they are using your and my tax dollars at the expense of our geriatric and disabled citizens. There are citizens in our state that require these services to maintain there independence, they would rather die than have to go into a long term facilities. Its a shame that someone who has worked their entire life being a productive member of our state has to wait for services. Under the old way, the needy would have their needs met within a couple of days, now the wait it too lengthy. Had a client come home with new diagnosis, needing 5 days a week, she had been receiving 3. Did my change of status with CCME, it took them 2 weeks to assess her, CCME did authorize her 5 days, HOWEVER, she has to wait 10 more days before the 5 days are implemented. The wait is 4 weeks from the day she came ho

  • janebanks Nov 5, 4:33 p.m.

    I have operated a Home Care agency for the past 14 years. The State made a terrible mistake when they allowed CCME to take over the assessments. Clients in our county are waiting weeks for an assessment for much needed care. The State required us to respond within 48-72 hours and have services in place; now its "okay" to wait in excess of 30 days for care. Many times patients are back in the hopsitals or in a Nursing facility before any home care assessment has been done. This is more expensive than caring for them in the home.

  • sqstroublemaker Nov 5, 3:26 p.m.

    Strike 1993,

    I have been screaming at the State since August to get a copy of the Medicaid contract with the ACS company that is now overseeing the pre-authorization of medications and medical procedures. So much for transparency, it does not exist as Bev says. The medicaid and medicare funds are going to so many different private companies that are forcing dr.s and other medical personal to beg for services for their patients. It is going to continue to get worse.

  • Strike 1993 Nov 5, 2:43 p.m.

    After reviewing these comments, if these so called CCME Nurses are not carrying out their duty or have issues of neglect, then why can't the Board of Nursing investigate like they do when complaints are filed with Nursing Home Care Neglect or Hospital Care neglect??..Why isn't the State Auditor or even the Attorney General looking into this "No Bid" Contract with DHHS and this CCME outfit? Perdue claims she runs the state with complete openness and transparency-more than any other Governor. Then Bev, Open the windows, pull the blinds up, and throw open the curtains at DHHS and expose the "transparency."??Most sad when it takes WRAL TV News Crew to force the State to act openly, honestly, and with accountability.

  • sharonb Nov 5, 2:15 p.m.

    CCME is limiting access to PCS services. I have been in homecare for over 25 years, and I have never seen such incompetency and inefficiency from a state program. CCME has 30 days to complete an assessment that providers had a few days - usually 48 - 72hrs to complete. Aide services would begin promptly. NOT the case now, thanks to CCME and their HUGE contract with NC Medicaid. The NC DHHS would have shut our agency's doors for operating like this. I have personally dealt with CCME and their "black hole." Just one example: they claimed that they had faxed us patient information, and they didn't even have our fax number (after we had submitted the fax # 4 times.) For those who question the cost of in-home aide services - do some research and compare the cost with nursing home costs. In-home care is much cheaper than nursing home care, and both are paid for by NC Medicaid. With limiting PCS services - where are the savings?? And North Carolina, you're paying CCME for what??

  • sqstroublemaker Nov 5, 1:49 p.m.

    Amazingly, the State can give a no-bid contract for $24 million dollars to a company that is clearly failing to do what they were contracted to do. Where are the penalties? Where are the fines? If I fail to do my job, I am written up, given suspension time, and lastly fired. Why are our tax dollars paying $24 million dollars to a company that is not performing its duties? Why aren't some of those $24 million dollars going directly to the families? If their doctor says they need services, that should over rule any company assessment that is not happening within the 14 day time period.

  • slocumbak Nov 5, 1:37 p.m.

    I am disappointed that the care of our elderly is not a priority to this state. If any state knows the hardship and labor that was put into building this state by all, we would not sit by idle and have a personal political debate about things that dont matter. My grandmother lost her services at the same time her house was destroyed by a tornado, I beleive that to be enough for an 85 yr old to have a heart attack. It should not take CCME as long as they do for anything but its not just PCS, they are slow and alot falls into the "black hole" with them. Oh yeah how much was there contract to do what we as providers can do. By hiring these Social Workers and Nurses you have said to the staff of private providers that their RN's arent smart enough or have enough ethics to complete assessments. Everybody arent criminals, and this system is a crime of its self.

  • contact37 Nov 5, 12:01 p.m.

    It's so unfortunate that institutional bias, when it comes to the delivery of health care and long term care, is so rampant.

  • 27615 Nov 5, 11:26 a.m.

    ?Just wait for the future when the Republicans control everything and their lacking of any degree of compassion for the unfortunate has its effect on the system.?

    We don't have the money to provide everything for everybody that can't afford it!!!! That's why we have a national debt b/c we spend more than we have...

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