by Senator Sam Graves
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by Senator Sam Graves
According to a recent audit done by the Oversight Division of the Office of Legislative Research, Missouri’s Medicaid budget is the single largest item in Missouri’s budget, yet, it receives the least scrutiny.
According to the audit, as reported in a recent article by Jack Stapleton, Jr. of the Southeast Missourian, Missouri’s Medicaid budget has sky-rocketed since 1994 to a whopping $3.4 billion of Missouri’s $17 billion budget. In contrast, Missouri spends only $2.5 billion on public elementary and secondary schools.
As you know, Missouri’s Medicaid program provides health care for children, families, and adults based on their physical conditions and income. In the current fiscal year, approximately 770,000 Missourians will rely on their health care services via Medicaid. That means that one out every eight Missourians will receive their medical coverage through the Medicaid program. Surprisingly, this exceeds the number of Missourians who purchase their own medical coverage through the individual market.
The Medicaid program is financed 60 percent by the federal government and 40 percent by state general revenue sources. Despite the dramatic increases in spending, there has been a real void in oversight over the expenditures. The Department of Social Services administers the bulk of the program. The audit points out that the increased workload also increases the likelihood that fraud, waste, and abuse may be occurring undetected. Because Missouri’s Medicaid system is a fee-for-service system that reimburses providers based on the services that they provide, there is an incentive for dishonest providers to over-utilize or over-prescribe.
In 1995, the Missouri Legislature created the Medicaid Fraud Control Unit in the Attorney General’s Office to review the findings of the internal review unit in the Department of Social Services. The audit concluded that the internal unit was inadequately reviewing complaints and that the Attorney General’s Fraud Control Unit was understaffed. Although the vast majority of Medicaid providers is honest and does not abuse the fee-for-service system, it only takes a few bad actors to spoil the system.
If you have concerns about your Medicaid bill or the bill of someone you know, please contact my office in Jefferson City at (573) 751-3271.