$20,000,000 is the least of our problems

Big scoop came out Friday. As first reported by VPR’s Peter Hirschfeld, the still-troubled Vermont Health Connect could cost the state as much as $20 million extra this fiscal year — for expenses that the federal government might decide not to cover.

The story got some legs, although it came out in the journalistic dead zone of Friday afternoon. It was picked up by other outlets and became kind of a big deal.

And it was the best possible thing that could have happened to the Shumlin Administration. 

Why do I say that? Because it sucked the oxygen out of that particular room, leaving a much bigger VHC story flailing in its wake. (Mixed metaphor? Sorry.)

The story, by VTDigger’s Morgan True, included the $20 million bit, but also revealed a host of other problems with VHC. The story paints a bleak picture of a system still in disarray, and facing big new challenges in less than two weeks.

The problems, in rough order of appearance in True’s narrative:

— The VHC website will be up and running in time for the new open enrollment period, which starts on Nov. 15. But previously insured customers seeking to renew will be asked to stay away from the website and instead fill out a paper form and submit it by mail. The reason: More of this year’s “customer service frustration” is expected by health care reform chief Lawrence Miller. Great.

— As open enrollment looms, there’s still “a mountain of old problems” that will be impossible to resolve by the 15th. So the masters of health care have come up with a kludge: they’ll keep the old cases active with tricks like fake zip codes, even as they’re working on new cases.

Gee, that sounds like a sure-fire plan. Nothing can go wrong with loading fake zip codes into an already wonky system, can it?

— The state’s contract with its new contractor, Optum, hasn’t been renewed yet. If it’s not by the end of business Monday, the company won’t continue to work and “‘Vermonters will not be renewed and will lose coverage,’ according to a document obtained by VTDigger.”

— The state has failed to keep up with required income verifications for “thousands of Medicaid beneficiaries,” which is “a growing concern of the feds.” If some recipients turn out to be ineligible, the state could be on the hook for their medical bills.

— This is more of a problem than you might think because “during the past year, people were hastily added to the state’s Medicaid rolls in order to close out their cases and get them off the hands of overworked employees,” according to the anonymous VHC worker.

— One anonymous VHC worker reported internal problems with Optum employees making mistakes, being poorly trained, being shuttled in and out of state frequently, and “a lack of ownership on the part of mid- to lower-level state employees,” who believe that if the system fails, Optum will take the heat.

— The motives of Optum and other contractors are being questioned by a top VHC official, who pointed out in an Oct. 15 memo that the contractors “have financial motivation to protract their term of employment… to generate profit.” He says the state needs to find a path forward that gives contractors a reasonable profit but ensures that Vermont doesn’t pay too much.

— “Many of the state employees… are temporary workers.” Some have been working on VHC for over a year, which is far longer than is allowed for temp staff. Unlike regular, unionized state employees, the temps don’t get any benefits, just a straight hourly rate.

— Because some coverage has tax implications and VHC staff are not trained in that area, there’s a fear that thousands of VHC customers could find themselves with an unexpected tax bill come April.

This is all on top of the potential $20,000,000 shortfall. Which is bad enough, but now you know why I say the Shumlin Administration should thank its lucky stars that it was Hirschfeld’s story that got spread around and not Morgan True’s far more detailed, far more damaging one.

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