Why is Hawaii not collecting all the Medicaid stimulus funds available to the state?

A three month survey of how efficiently states are claiming their Medicaid stimulus funds from the federal government shows that Hawaii has consistently been in the bottom five.

The statistics come from the federal government website www.recovery.gov.  I have isolated the figures just for Medicaid out of the totals received from the federal Department of Health and Human Services.  The survey covers all fifty states and the District of Columbia.

In December 2009, Hawaii was third from the bottom, having claimed only eighty percent of the total funds available.  In February, Hawaii was second from the bottom, having claimed only 75% of the total.  In March 2010, Hawaii was fifth from the bottom, collecting 86% of the funds available.  However, the total amount of funds available did not change from February to March, 2010 for Hawaii.

The median percentage of funds claimed in March 2010 was 97%.  Ten states managed to collect 100% of the funds available, with another twelve collecting between 98% and 99%.

Hawaii -- deficit plus stimulus funds shouldn't equal a bigger deficit, should it?

The Honolulu bureau of the Associated Press ran a great article a week ago on the impact Hawaii's $1 billion budget deficit was having on education and others in need.

According to the official web site for the American Recovery Act, which tracks the money going out to the states as well as what the states admit to having, Hawaii reported receiving $811.9 million by October 30, 2009. 

The feds say they've awarded Hawaii $1.2 billion in contracts, grants and loans.  Over $1 billion of that is in grants.  One source I found said Hawaii had only received about 40% of the funds, but it's approved. 

Not to mention that the $1 billion projected deficit is by 2011, and we're talking money in the bank now with lots more on the way.

I've asked CMS (the Medicaid federal regulatory people) about this and have been met with evasive responses.  Having personally lived in Washington D.C. for 8 years, I can tell you that evasion from government employees is not a positive indication.

So with education being cut by a day a week and elderly and disabled people being threatened with institutionalization, what's the money being spent on?

Hawaii's decimation of its aged, blind and disabled population worsens

Hawaii's two gold-digging for-profit insurance companies handling Medicaid have sunk to new lows. A Mom on Oahu got a call from her medically fragile son's Medicaid for-profit company. With no written notice, the company was downgrading her son from 54 hours a week of RN level nursing to 14 hours a week of a CNA. A little boy's life will be in danger beginning November 15, while no one knows what Hawaii Governor Lingle has done with the $154 million in stimulus funds she's received that can only be spent on Medicaid. The boy's services are provided as part of a deal Governor Lingle's administration negotiated with UnitedHealth Group and WellCare Health Plans for the two out-of-state, for-profit companies to take over medical care for the state's "aged, blind and disabled" populations. More than 37,000 people on February 1 were dumped from their pay-for-service Medicaid care into the merciless grip of UnitedHealth and WellCare, with no information from the state about this essential distinction in their care. As part of the negotiations, UnitedHealth and WellCare had to agree to make no cuts in home and community services for their 37,000 new clients for 90 days. After a Kauai mom filed complaints with the federal DHHS Office for Civil Rights and Center for Medicare and Medicaid Services (CMS, the division that regulates Medicaid), a wave of new cuts in August was halted. A little boy's life will be in danger as of November 15, when the final slash of 88% of his home care services takes effect. Where are our Medicaid stimulus funds? Background information on these two for-profit Medicaid managed care companies continues to be updated. Unitedhealth has paid out over $1.3 billion in fines, penalties and settlements to 9 states and their own shareholders since January 1, 2008. Their subsidiary Evercare was fired by the state of Texas in May, 2009. Fines and settlement just in 2009 include $536,000 to Missouri in August, $750,000 to Georgia in November, $457,000 to Colorado in October, $3 million to Texas in October, $630,000 to Texas in January, $350 million and a separate settlement for $50 million to New York in February. Yet on October 20, Unitedhealth posted a 13% increase in their profit from the same quarter a year earlier. The company's private plan membership dropped by 6%, but enrollment in its Medicaid and Medicare programs had increased by 14%. I'm not an economist but it seems that the aged, disabled and blind community is not unprofitable. We already reported Wellcare has paid out over $90 million in restitution and fines since May 2009. We recently learned that in February 2009, WellCare was ordered by the CMS to stop taking enrollment in certain of their Medicare plans. A letter from CMS to WellCare noted "WellCare was one of the overall worst performers among all plans,” and “WellCare’s complaints are three times the national average.” CMS kindly released WellCare from the suspension on November 4, 2009, in time for the company to participate in the federal open enrollment period. Also on November 4, "WellCare reported higher-than-expected third-quarter earnings Wednesday, swinging to a profit of $28.7 million, or 68 cents per share, from a year-earlier loss of $18.2 million, or 44 cents a share." Hawaii desperately needs an audit done of where the state's stimulus funds for Medicaid have gone if the companies running our Medicaid can make these kind of profits, while paying the sort of fines and settlements we've described, while at the same time cutting a toddler's home nursing services by 88%.

Please, if you're the parent of a kid with special needs, read this

For the first time in my history as the mom of a kid with disabilities, we parents have the ability to get our kids all the home and school support services, technology and therapies that their doctors think are medically necessary. We can go straight to the source, rather than wait around for our local Department of Education or Voc Rehab to get their paperwork together. All you need is a prescription, the evaluation and a letter of necessity, and you turn it over to your Medicaid case worker. Better yet, some of the corporations such as Dynavox, handle all the paperwork for you. The timing is perfect. The government has dumped over $28 billion into state coffers that can only be spent on Medicaid, with more on the way. Schools have been given more money as well, with a particular emphasis being given to using it on assistive and augmentative technology. The percentage of a state's total Medicaid budget which will actually come out of state accounts is somewhere between 10-35%. I did a rough calculation, and for a state paying the highest percentage, for every $10 million of its own money the state does NOT spend, the state loses about $28 million in immediate jobs and services. The only problem is, in too many states, nobody knows what happens to those stimulus bucks once they disappear into some new, very deep coffers. If your state is continuing to cut medicaid services for your child, if your school is trying to cut service hours from the IEP, then there's a good chance there are some questions about how your stimulus tax dollars are being spent (and even if they are at all). Last week, the Government Accounting Office issued a report focusing on how states are using their stimulus funds. The report called into question the "quality and reliability" of data that the states are giving the feds about how and on what they're spending their stimulus bucks. Meanwhile, Department of Health and Human Services Kathleen Sebelius released an additional $600 in stimulus funds to the states just between September 17 and 30, 2009. Nobody in the media, nobody in the government, is paying attention to the mystery of how states are spending their stimulus dollars. CMS refers all calls on the subject to its Baltimore headquarters. Three states are under some sort of federal investigation for violating federal Medicaid law and the Americans with Disabilities Act, and 7 more have civil suits filed or in preparation alleging similar violations. A friend of mine with disability law experience and I have put together a group called Children's Disability Rights Education Association. Our role is to help parents and caregivers take greater control over their child's health and education. As CDREA we have a petition up, calling on DHHS to require complete accountability from the states, and to ensure priority is given to restoring Medicaid service budget cuts made since July 1, 2008. These cuts have unfairly targeted children as well as adults with disabilities who need skilled care to live at home with their families. Similar problems are plaguing state stimulus funding received for education. I just found this source, but the correlation between what's happening with money for both special education and medicaid home support systems is an atrocious example of discrimination against children, as well as adults, with disabilities. Please consider signing our petition, and forwarding it to your friends.

We're Site of the Day on About.com's Special Needs Children forum

Please read and consider signing our petition - states are continuing to make cuts in services that have a serious impact on the quality of life of our elderly and our people with disabilities while billions of stimulus funds sit in their bank accounts. Thank you Terri for your help!