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Poor logistics put patients at risk

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There is no painless way to tell 4,500 people they’re losing their government health care, even with the best of equipment. Now imagine trying to manage the steep cuts in federal Medicaid funding with a 23-year-old computer system that is ailing itself.

But that is the logistical nightmare facing the embattled state Department of Human Services between now and January, when reduced enrollment overall and curtailed coverage for the remaining eligible population — lower-income children, pregnant women, disabled individuals and elders — is due to take effect.

The department is going to need help getting from here to there, and some offers are coming in from the community it serves — health care providers who see the Medicaid patients, for starters. DHS should take that help. The providers are in a position to assist the state with reaching people who are either re-enrolling in Medicaid or being scratched from the rolls.

The state is getting a boost from Uncle Sam with the desperately needed computer upgrades, including the Medicaid eligibility system — $27 million in federal funds for the $3 million in state funds approved by the Legislature. A similar 9-to-1 federal match for state investment is expected to underwrite development of the electronic health records system, which will be so essential to fully implement health care reform in 2014.

But DHS still will be struggling with its old eligibility database as it shrinks its Medicaid rolls; officials don’t expect the new system to be fully functional for a few years. They plan to alert people about changing status through postal notices and alerts on the department website (hawaii.gov/dhs).

This won’t be enough. Some of the department’s contact information on the needy families and individuals is outdated and, health advocates say, an unexpected piece of mail delivered even to a current address can be overlooked easily. There needs to be more outreach; a multimedia campaign would be a helpful supplement to this effort.

In addition, the department plans to change its system of renewing eligible clients, a change that could lead to many families being bumped unwittingly from coverage. Now families receive mailed notices that they return if any contact information needs an update; if they don’t submit a change, DHS assumes everything is current and renews them automatically.

Under the proposed plan, these people would have to return the card, whether or not anything has changed, or be deleted from coverage. This could end with families discovering their lack of coverage only when they next need medical help. They would have to re-enroll and undoubtedly would end up in the emergency room, neither of which is cost-effective for the health care system.

Beth Giesting, chief executive officer of the Hawaii Primary Care Association, has a worthwhile suggestion. Providers who see families now in advance of their renewal date could help the state by seeing that their renewal card is sent back to DHS, she said. They also could help get the word to people at risk of being bumped.

To further lighten the load, Giesting added, hospital and clinic staffers who are hired with Medicaid funds to process applications can handle the pre-screening, enabling DHS to simply approve applications without the current delays.

During the crunch period ahead, it would be smart for DHS to think outside the box for coping strategies. DHS already has reliable partners in the community; it’s time to deputize them, which will ease the pain on everyone in the months ahead.

Comments on the planned changes to Medicaid will be taken through May 19. Email dhs@dhs.hawaii.gov, or address them to: MQD Community Input, P.O. Box 700190, Kapolei, HI 96709-0190.

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