Tuesday, December 29, 2009

Are DC lobbyists being paid to advise Hawaii on how to violate federal Medicaid law?

A Washington, D.C. law firm, Covington & Burling, appears to have been paid more than $3 million (as of December 2008), for consulting with the state on its Medicaid QExA program.

All of the contracts appear to have been issued with exemptions from the normal procurement process; in other words, they all appear to be no-bid contracts.

Contracts have been issued in the name of Charles Miller of Covington & Burling, making him a "Special Deputy Attorney General" for Medicaid issues.  Those were issued by the state AG's office, and total $850,000 (of which $375,000 was to be paid through Federal funding).

The remaining contracts were all issued through the Hawaii Department of Human Services.  The contracts that I've located begin in December 2003, and the final one is an extension through December 31, 2008.  Since the latter contract mentions services will likely be needed to extend for several months after the February 1 QExA implementation, I suspect there may be another additional contract that I haven't been able to find.

Part of Covington's responsibility was to "provide strategic advice, consultation, project management and technical assistance on issues and policy decision as needed."  "Covington & Burling is well-established among Medicaid programs nationwide as an expert in the area of Medicaid program structure, compliance, and federal revenue maximization."

My question then is what role Covington has played in the ongoing discussions between state officials and federal Medicaid regulators.  The purpose of the discussions is to resolve potential violations of federal Medicaid law (including EPSDT).  Since Covington is a nationally known expert in Medicaid policy, it seems possible that they are advising the state on this issue.

What a waste of money, in my opinion.  Legal battles have already been fought across the country over Medicaid "policy" issues such as EPSDT, the concept of "medical necessity", and the rights of people with disabilities to remain at home with their families as opposed to institutionalization.

And as with Evercare and Ohana, presently crying poor to the state and asking for more money in their contracts, Covington & Burling overshot their estimate of $750,000 for one project by $1.25 million.  That contract had to be increased to $2 million as a result.

Is it possible that Hawaii is paying this firm to justify Hawaii's policy decision?  Just this week, Dr. Anthea Wang, Medical Director of Hawaii Med-Quest, sent me a document with the official DHS opinion on who decides "medical necessity", and says it's been signed off by the Policy folks.  Would that include anyone from Covington? 

How much money does the state of Hawaii want to waste trying to figure out how to avoid following federal Medicaid regulations?  The language is there to be followed, in recent (the past six months) regulations and official documents published by the federal Medicaid regulatory agency.  The money is probably even there, considering Hawaii's projected budget deficit through 2011 is about equal to the amount of additional stimulus funds the state is receiving.

The problem is the funds are being spent on lawyers and profits for private insurance companies, not on services to our elderly and disabled populations.

Here are links to the five contracts I found: 


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About Me

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I'm the mom of a child with disabilities. Hannah's first neurologist said she might never develop beyond the level of a 2 month old infant, and there wasn't anything I could do about it. The brain damage was just too severe. Nine years later, she walks, uses a touchscreen computer and I've just been shown she can learn to construct sentences and do simple math with the right piece of technology. Along the way, I discovered I needed to teach myself what Hannah's rights to services really were. Learning about early intervention services led to reading about IDEA and then to EPSDT. I've been waiting for the Obama administration to realize the power and potential of EPSDT for the medical rights - including the right to stay at home with their families - of children with disabilities. The health reform people talk about long term care, and the disability people talk about education and employment, but nobody is talking about EPSDT. So I am.