News of the large sums of federal Medicaid funding that Kansas will have to repay certainly is troubling, but it also makes one wonder what kind of system allowed such overpayments to be made in the first place.
Kansas already has agreed to refund $32 million in misspent Medicaid money and now is looking at an additional repayment that one state legislator says may run over $25 million. That amounts to a pretty costly mistake for the state of Kansas, but it also raises questions about who actually is responsible for the problem.
The repayments are coming in response to an audit by the U.S. Office of Inspector General, which is charged with making sure states are properly using Medicaid funds. Medicaid is a combination of federal and state dollars that are used to defray the costs of health care for low-income residents.
Tom Lenz, the regional administrator for the federal Centers for Medicare and Medicaid Services office in Kansas City, Mo., told the Journal-World, "We have a fiduciary responsibility to assure that taxpayer dollars used to fund the Medicaid program in the state of Kansas are expended appropriately."
About the Inspector General's audits, he added, "States have flexibility in how they design their programs. That means there are going to be gray areas as to how those programs are administered. So until we see what's there, there's not much anybody can say."
All taxpayers would agree that the government has a responsibility to see that Medicaid dollars are used correctly, but it seems that duty falls both to state and federal officials. The "gray areas" Lenz refers to may give states some flexibility, but they also make it more difficult for states to determine what is allowed and what isn't. It's unlikely state officials would intentionally ignore federal regulations and put the state in such a financial hole. If the "gray areas" make the regulations difficult to interpret and follow, perhaps federal officials should make them more clear.
It also seems that Lenz, and other federal officials, might have played a stronger role in making sure Kansas officials were correctly interpreting the federal Medicaid regulations rather than just coming back later with an auditor to tell them what they did wrong and how much the state had to repay. It would be far better to work together to correct mistakes before large sums of money are paid out incorrectly.
The responsibility of federal officials goes beyond providing oversight and assessing penalties after a mistake has occurred. They also have the responsibility to work cooperatively with states to clarify regulations and make sure programs are in compliance so state officials - and state budgets - aren't taken by surprise by demands for restitution.