WRAL Investigates

Critics: Delays in state Medicaid program 'unacceptable'

Posted November 4, 2010 6:00 p.m. EDT
Updated November 4, 2010 7:11 p.m. EDT

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."

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.