COMPTROLLER'S AUDIT SHOWS
MEDICAID UNIT STRUGGLING TO REBUILD

Recommends remedial action by state, county as essential for unit's success

Mineola, New York - Nassau County Comptroller Howard S. Weitzman announced the release today of an audit of the Nassau County Department of Social Services Medical Assistance (Medicaid) Unit. The audit, which examined functions performed by the Department of Social Services (DSS) Medicaid Unit and whether DSS operations adhere to New York State regulations, found that even as the county makes strides toward improvement, outdated equipment, excessive caseloads, and inadequate procedures for payment processing, eligibility determination, and follow-up have severely hindered the Unit's abilities and performance.

New York is one of only 20 states that require local governments to participate in Medicaid funding, with Nassau's mandated contribution averaging 22% of the county's total. In 2002, Medicaid costs for Nassau residents were $1.1 billion, with the county's share of that totaling more than $200 million. "Once again, a Nassau agency finds itself in a morass created by the mismanagement of the previous administration," said Comptroller Weitzman. "While the Medicaid Unit struggles to rebuild itself and solve its most immediate problems, Medicaid remains the single largest mandated cost-component of the county's budget and Medicaid costs continue to skyrocket.

"Even if Nassau's finances were in first-rate shape, it would behoove us to ensure that the system is efficient and cost-effective and that each entitled recipient is getting the care we are paying for." While the state directs and administers the program, the county's function is largely eligibility processing. With understaffing noted as having the most consequence on the department's effectiveness, the Comptroller's Office has identified several areas where potential cost savings could be achieved through more efficient operations.

Among the more significant findings:

• The state's computerized welfare management system is antiquated and inadequate for determining compliance with federal income-eligibility requirements
  
• There is no local oversight system in place to review vendor payments made on Nassau's behalf by New York State
  
• Excessive caseloads and inadequate technology make it difficult for caseworkers to verify and retrieve information in order to make reliable eligibility determinations, process applications within the required 45 days, and service cases properly
  
• Improved access to technology and greater legal oversight is needed in identifying previously overlooked excess financial resources, opportunities to recover financial assets, and for asset-recovery efforts
  
• Staffing levels are critically inadequate even though DSS receives up to 75% federal and state reimbursement on salaries

In his response (contained within the audit report) to the comptroller's assessment, DSS Commissioner Robert Sherman noted that many of the auditors' findings would require a policy change at the state or federal level and that many important cost-control measures would require initiatives on New York State's part. However, he said, several actions are already being taken to remedy issues related to understaffing, access to technology and data, caseload reduction, and pay-ins and spend-downs. These steps include the addition of new welfare examiners and attorneys, and additional temporary clerical staff assigned to the Medicaid Unit; several procedural initiatives that, once implemented, should help bring caseloads down; an exploration into the cost-effectiveness of having a PC on each workers' desk, and increased access to existing computerized databases and records.

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Nassau County Department of Social Services Medical Assistance (Medicaid) Unit Audit Report
April 2003 (~ 697 KB .pdf file - 52 pages)

Corrective Action Plan ( ~ 38 kB - 6 pages "pdf" file)