WRAL Investigates

Critic: Medicaid program problem not an isolated incident

Posted January 25, 2011 6:00 p.m. EST
Updated January 25, 2011 6:57 p.m. EST

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.”

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.”