The Minnesota Department of Human Services disenrolled 60 percent of providers from high-risk Medicaid programs, but only a small fraction of those were forwarded on for further investigation.
As part of the state’s agreement with the federal government’s Center for Medicare and Medicaid Services, the Department of Human Services was required to revalidate nearly 5,600 providers of high-risk Medicaid programs by May 31. According to data released Thursday, the agency disenrolled more than 3,400 providers, the majority due to incomplete paperwork and documentation.
For providers taken off the rolls, payment is stopped. The entities have two months to appeal. Officials also created a website for Minnesotans whose care has been disrupted due to a disenrollment.
But only 59 providers were flagged for further review by the department’s Office of Inspector General, the agency’s fraud fighting office. Details about those cases have not been made available.
“The paperwork is a critical step,” Deputy Commissioner Shireen Gandhi said in a written statement. “This is not just checking the box.”
Many providers expressed concerns that they were disenrolled simply because the agency ran out of time to revalidate them before the deadline. As of May 27, the last day the state updated data before the deadline, the majority of provider statuses remained pending.
When asked how many Medicaid recipients in Minnesota would be impacted by the mass disenrollment, a DHS spokesperson said the agency didn’t have an answer “at this time,” but said more than 800 appeals are already in progress “with more coming in daily.”
Sue Schettle, CEO of the Association of Residential Resources in Minnesota, said on Monday many members of her organization submitted the required materials to the agency, but never heard back.
“These are providers that have been doing this work for decades. They’re very legitimate providers that have never had this kind of scrutiny,” Schettle said. “They’re just caught in this terrible situation between the federal government and the state government.”
Earlier this year, the Trump administration froze $243 million in Medicaid funding after saying Minnesota had not adequately addressed fraud in certain programs. The state adopted a corrective action plan, which included a requirement that the state implement a revalidation program for high-risk service providers by the end of May.
“These numbers are astonishing and problematic,” Kristin Robbins, Chair of the House Fraud Prevention and State Agency Oversight Committee, said in a press release. “I am grateful Dr. Oz and his team at CMS have come in here to restore integrity in our Medicaid programs.”
The state agency said common reasons for disenrollment notices included “failure to disclose management authority or report change in ownership, failure to report changes in or maintain proper credentials… and incomplete applications.”
Providers had been asked to supply documentation about their ownership, locations and contacts as well as licenses and insurance information. DHS was also seeking verification of workers performing duties tied to the Medicaid programs.
