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The Honolulu Advertiser

Posted on: Friday, March 8, 2002

State denies it's losing its due in Medicare

By Alice Keesing
Advertiser Health Writer

A group lobbying for a state contract to pursue federal Medicare money claims Hawai'i may be missing out on at least $30 million a year because it is not going after reimbursements aggressively enough.

But Susan Chandler, director of the Department of Human Services, disputes the group's figures and said the state is getting its share of federal Medicare dollars.

The Legal Aid Society of Hawai'i is pushing a bill at the Legislature this session that would have it paid to pursue Medicare reimbursements. Legal Aid already runs a program for the Human Services department to maximize welfare money, bringing in $2.8 million last year, said Victor Geminiani, executive director of the Legal Aid Society. The state paid Legal Aid $274,000 for that program.

Geminiani said the state is relying far less on the Medicare program than other states with comparable Medicare-eligible populations.

For example, in 1998, Hawai'i's Medicare expenses for home healthcare and skilled nursing care were $30 million, compared with $63 million for Montana, $87 million for New Hampshire, and $106 million for Idaho, the group says.

Medicaid is primarily for the poor, and the state and federal governments split the cost. Nearly 18,000 people in Hawai'i are eligible for both Medicare and Medicaid. Medicare, which is 100 percent federally financed, is for people 65 or older and certain people with disabilities.

Geminiani believes that the state could apply for more Medicare money or reimbursements, which would in turn save the state money it is spending on Medicaid.

"Something is happening in this state around applications and appeals (for Medicare) that is not very aggressive," Geminiani said.

But Human Services Director Chandler said the society's numbers are exaggerated.

"Maybe if we were somewhat more aggressive there might be, I would guess, $500,000," she said. "But certainly the numbers that people are tossing around I think are somewhat irresponsible."

While the Department of Human Services is cautious about the idea, it has won approval in the Senate.

"The support is there for the idea," said Senate Ways and Means vice chairwoman Colleen Hanabusa, D-21st (Barbers Point, Makaha). "We are probably going to be more interested in funding situations like that where for an expenditure of 'X' amount, we will be able to recoup a lot more or get matching funds."

The bill passed a vote of the full Senate Tuesday.

Geminiani said a key part of the society's strategy would be to appeal any services rejected by Medicare. "Nationally, 80 percent of the denials by Medicare are reversed on appeal," he said.

The society also could maximize federal dollars by structuring services so they are eligible for Medicare.

"For example, in some situations they require home healthcare three times a week; if you provide it only twice, but could justify three, you could become eligible for home healthcare," Geminiani said.

Judith Stein, executive director of the Connecticut Center for Medicare Advocacy, said she would be surprised if there was not more money that could be brought into Hawai'i.

Between 1986 and January 2000, the center has recovered more than $170 million as a result of Medicare appeals, Stein said.

But Chandler said Hawai'i's system is very different from other states, so comparisons may not be valid.

For example, Hawai'i already maximizes its use of Medicare, Chandler said, because it investigates for Medicare eligibility before falling back on Medicaid. Other states will pay everything through Medicaid, and seek Medicare reimbursement later.

She also disagrees with the Legal Aid Society that there are large untapped Medicare possibilities in home healthcare or skilled nursing. For example, a large part of home healthcare services in Hawai'i is for special-needs children, who are not eligible for Medicare, she said.

"I'm sure we could be even more aggressive if the Legislature wants us to work with a private-sector company to try to do this on a contingency basis; we'd be more than willing to be helpful," Chandler said. "But I think it's irresponsible to suggest these huge numbers or suggest we're not working hard to do that, because that's just not the case."

Reach Alice Keesing at akeesing@honoluluadvertiser.com or 525-8014.