DHHS Ends State Fiscal Year 2012 Without Significant Shortfall in Medicaid Program

Maine Department of Health and Human Services Commissioner Mary Mayhew informed the Legislature on Friday that the projected $12.5 million shortfall was all but eliminated in the final five weeks of State Fiscal Year 2012.

July 23, 2012
DHHS

AUGUSTA– Maine Department of Health and Human Services Commissioner Mary Mayhew informed the Legislature on Friday that the projected $12.5 million shortfall was all but eliminated in the final five weeks of State Fiscal Year 2012.

In late May, DHHS officials met with Legislators to share that the preliminary year-end analysis showed the possibility of a $12.5 million shortfall in the Medicaid program. This estimate was based on claims payment projections over the final five funding cycles coupled with money owed to the Department from other areas of state government.

“I am pleased to report that this projected shortfall has been eliminated due to lower than expected cycle payments, the reimbursement of more than $3.4 million from other parts of state government, more than $3 million in increased drug rebates and an unparalleled team effort across State Government to aggressively move financial orders forward to allot funding to the appropriate accounts,” the Commissioner wrote in her message to the Legislature. “In the end, just one provider of nursing facility services was unable to be paid a small amount, but that provider was issued payment on the first business day of State Fiscal Year 13.”

Mayhew stressed in her message that predicting the year-end expenditures in MaineCare is not an easy task. “Many items that contribute to the analysis, like the volume and dollar amount of claims processed each week, are variable. With weekly cycles ranging from a low of $29 million to a high of $62 million during the past year, staff experience and trend data are critical to projections. This year, calculations were extremely accurate. This level of accuracy, combined with the effort to aggressively pursue financial orders throughout the last cycle and a bit of fortuitous timing of payments owed to the Department being received, netted a positive result.

“The variables outside of our control will always make the year-end financials in the Medicaid program unpredictable. Clearly, a much higher than average cycle during the last five weeks of this fiscal year could have led to a significant shortfall,” Mayhew stated. “Since providers have up to a year to bill for a service and Medicaid members are entitled to services, even the best projections can miss the mark.”

Mayhew expressed her understanding of the need to continuously improve the ability to proactively manage the situations within the Department’s control. She praised the collaboration between the Office of the Controller, the Department of Administrative Services, MaineCare Finance and DHHS staff. “We are working together in a meaningful and unprecedented manner and these relationships certainly were essential to managing this year-end process. All individuals involved in the process were committed to the work and to assuring that the necessary administrative steps were taken so that service providers would experience the least possible financial impact,” Mayhew said.

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