Projecting and protecting: Legislators look at Medicaid fraud, cuts
Lawmakers eye Medicaid fraud, cuts
A focus on fraud brought legislators back to the Minnesota Capitol for the first official work since the budget passed. In Minnesota, 1.3 million people get healthcare coverage through Medicaid from 300,000 providers ? including doctors, hospitals, and nursing homes. FOX 9?s Corin Hoggard has the details on lawmakers? latest concerns over potential fraud.
ST. PAUL, Minn. (FOX 9) - A focus on fraud brought legislators back to the Minnesota Capitol for the first official work since the budget passed.
They dug into human services and especially Medicaid on Tuesday with two vast approaches to protecting services and funding for the state.
Republicans and Democrats on the fraud prevention committee have very different lines of questioning.
Hortman Tribute
Return, remembrance:
But they were united in a somber tribute to Melissa Hortman to start things off.
"This is the first official meeting of anybody since the horrific assassinations of Speaker Hortman and her husband, Mark, and the release of the attempted assassinations of Senator Hoffman and his wife," said Rep. Kristin Robbins, the committee's chair. "And we just want to acknowledge that that is still a process we are all dealing with and grieving."
"The work that we do here is really about people and the impact on people," said Rep. Dave Pinto. "And I feel like she pushed us so often to be thinking in those terms. It actually feels appropriate to me that we're having this hearing at this time. In Medicaid, which is a focus that we are going to be talking about today, is so much about the impact on people, making sure that they have the healthcare that they need to lead successful lives."
Medicaid and mistakes
Small number, big impact:
In Minnesota, 1.3 million people get healthcare coverage through Medicaid from 300,000 providers — including doctors, hospitals, and nursing homes.
It’s a $20 billion annual program in the state with a 2.2% rate of improper payments.
That’s less than half the national average, but as Rep. Marion Rarick pointed out, it’s still more than $400 million.
"It's important to note, improper payments do not mean fraud," said James Clark, inspector general for the Department of Human Services (DHS). "There's a lot of administrative error, a lot of documentation issues, not everything that we investigate."
The relatively new DHS inspector general says they’re investigating almost 1,000 cases of potential fraud right now.
How it can cost you
Cuts are coming:
The department is also bracing for federal budget cuts signed into law last week.
They’re expecting half a billion dollars in lost funding and at least 150,000 people losing their healthcare.
"We don't have control over what the Republican big terrible bill did," said Rep. Emma Greenman. "But we will have to deal with the impact of that as it relates to Minnesotans, working-class Minnesotans, rural hospitals. And frankly, the taxpayer dollars at the local level that are gonna go up."
Counties are projecting property tax increases when the impact hits in Dec. 2026.
But some Republicans embrace the pending cuts, pointing to similarly-sized states, Colorado and Wisconsin, each of which spends about $13 billion on Medicaid.
"How is it that Minnesota provides $7 billion more than those states?" asked Rep. Isaac Schultz.
"The majority of our spending is on older adults and people with disabilities," said John Connolly, the DHS state Medicaid director. "We do have a more comprehensive set of benefits, either through waivers or more generally in the program and our state plan, both for seniors and people with disabilities."
High fraud risk
Building protections:
DHS identified high risk in some of the state’s optional Medicaid programs, like sober homes and autism centers, where sketchy providers are responsible for the bulk of the fraud.
The legislature passed more guardrails for those programs this year, but members of the fraud prevention committee will push for more next year.