WRAL Investigates

Critic: Medicaid program problem not an isolated incident

Posted January 25, 2011

WRAL Investigates

— Last November, the WRAL Investigates team introduced viewers to Margaret Street. She was caring for her mother, Edna Street, an 88-year-old double amputee who had spent nearly six months waiting to be assessed for in-home care, which is part of the state's Medicaid program. 

WRAL obtained an e-mail from a state official with the Department of Health and Human Services who said that Edna Street did not qualify for the program. The e-mail was dated Nov. 5, the day after WRAL’s story ran.

Yet, a week and a half later, the Carolinas Center for Medical Excellence, the company that assesses people on the state's behalf, sent Edna Street an approval letter. The Streets later learned that the state's decision trumps CCME's.

Edna Street, who suffered major medical issues, died in mid-December. Although she was finally approved for 80 hours a month, she never received additional help.

“(It) made me really sad that the system failed me like that,” Margaret Street said.

Tracy Colvard, director of government relations for the Association for Home and Hospice Care of North Carolina, says that is not an isolated incident.

“It’s not right, any way you slice it,” he said. “Nobody knows what’s going on. You have to rattle cages, and you never get an answer.”

Colvard says there's a widespread problem of CCME approving hours for people whom the state says are not eligible.

“And at the same time, the state is paying the bill,” he said.

According to the state's $24 million no bid contract with CCME, the company makes $245 for each new assessment.

Vicki Smith, executive director of Disability Rights North Carolina, said she finds it alarming that CCME is assessing patients who aren't eligible, while qualified patients are waiting weeks, if not months, for an assessment.

Disability Rights took its concerns to the national level with letters to the Department of Justice and the Centers for Medicare and Medicaid.

“The state can’t afford to be inefficient,” Smith said. “Everything about how the state is responding to personal care services continues to be a red flag.”

Tracy Colvard Critic speaks out on Medicaid problems

CCME declined to comment and referred WRAL to various websites for information.

DHHS released the following statement: “We are continuing to work with our partners to fine-tune a system of care that addresses eligible client needs in a timely manner. It is the goal of this administration to employ measures of providing quality services to those who qualify for them, while ensuring wisest possible use of taxpayer dollars."

Margaret Street said she does not trust the system at all after what happened to her mother.

“Now she’s gone to a better place, because now she’s not in no more pain,” Margaret Street said. “And I won’t have to worry anymore, trying to get help for her and worrying about her. She is OK now.”

28 Comments

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  • dsmith679 Jan 27, 5:19 p.m.

    "No disrespect to anyone but just to set record straight...only US citizens get NC Medicaid Home Care services..mostly are women, 65-70 and above year, elderly and the disabled.. "

    Perhaps this is true. Illegal aliens do however qualify for other medicare services so they can have prenatal care, have children in the US, which then qualifies the children for services, and on ,and on , and on.....

  • Strike 1993 Jan 26, 3:56 p.m.

    No disrespect to anyone but just to set record straight...only US citizens get NC Medicaid Home Care services..mostly are women, 65-70 and above year, elderly and the disabled.. this is NOT about any Obama Care issue or illegals.. The only thing "illegal" and immoral is the way the State and its contractors treats these folks and how they fool the taxpayers by sending 92,000 folks into rest homes and nursing homes (more costly) versus more family friendly in home services. I think the State Auditor and the Federal Justice dept should investigate this weird CCME contract thing and HHS. Way to go WRAL. so sad

  • kjkemper Jan 26, 3:23 p.m.

    Thank You WRAL for keeping this in the public eye.

  • Jim Britt Jan 26, 2:07 p.m.

    Hello privatization.

  • stupiditydeservesnosympathy Jan 26, 2:01 p.m.

    The whole DHHS system needs an overhaul. Illegals shouldn't even get any kind of assistance. Our system has been drained for about 20+ years from them. Drug testing should be required as well.

  • ambitious1 Jan 26, 1:24 p.m.

    I have also written and emailed the WHITEHOUSE/ PRESIDENT BARACK OBAMA in regards to North Carolina Medicaid problems in 2008 upon his election because North Carolina Medicaid program is in crisis they are denying too many disabled people Medicaid. My mother also has fibroid tumors along with other medical issues and they keep denying her Medicaid so that she can have her surgery before the tumors get too big her stomach ios already sticking out like she is pregnant with tumors. They need to investigate and audit everyone employed caseworkers etc with DSS/ North Carolina Medicaid because this doesnt make any sense. I have to stop my life and everything else to assist my mother because they keep denying her Medicaid so that she can obtain Home Health Care Services

  • ambitious1 Jan 26, 1:19 p.m.

    WRAL please continue to investigate for reason that the North Carolina Medicaid has bee denying my 66 yr old disabled diabetic mother Medicaid for 3 yrs. They discontinued her Medicaid in 2008 where she then had to struggle to pay for her diabetic insulin syringes blood pressure & cholesterol medications. She also had to struggle buying her food paying her living expenses rent light & telephone bills all essential necessities. I recently submitted another application to Durham County Medicaid Office on 1/24/2011 for reason that my mother needs to be on the CAP program so she can receive Home Health Care I have been caring for my disabled mother by myself thus far and if she can receive the Medicaid CAP I can sign her onto a HomeHealth Agency when I tried signing her onto Medicaid in 2008 one of the DSS employers showed of boxes full of denied Medicaid for other clients. Please continue to investigate for reason that my mom, Marion Hester, is in need of Medicaid. Thank You

  • shokkou Jan 26, 12:56 p.m.

    "According to the state's $24 million no bid contract with CCME, the company makes $245 for each new assessment."

    Which translates into money back into Cansler's pocket, right? Whatever happened to the ethics complaint against the HHS secretary? He works both sides of government and it's all very beneficial to himself and his cronies. Fraud and abuse in NC seems to begin at the very top of the government food chain. Very frustrating.

  • diamondintherough Jan 26, 12:43 p.m.

    In my career, I encounter numerous concerns/problems with the DHHS. Just last week, I had to "walk" a DHHS Medicaid case worker through the NC Medicaid website to show her a section in the Medical Policy and Procedure Guidelines to dispute her and her supervisor's answers to my questions, related to a patient's care. They did not even know this section was even written into their own Policies and Procedures. These DHHS employees have been with the DHHS for quite some time. I do not work for the DHHS nor NC Medicaid and I had to give an "In-Service" to them in regards to their website accessible to DHHS, Members, Providers and the General Public.

  • kjkemper Jan 26, 12:09 p.m.

    I work in homecare and see this happening everyday! It appears CCME can do what they any way they want with no "Questions" asked from our Governor or DHHS!

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