Appropriations committee hears Medicaid utilization, provider and waiver concerns in Human Services budget briefing

State health officials presented detailed Medicaid utilization and budget projections to the Appropriations - Human Resources Division committee during a morning session, focusing on developmental disabilities, long-term care and Medicaid expansion.

The presentation emphasized that timing of claims payments — not necessarily the date services were delivered — drives much of the month-to-month volatility in budget data, and that program growth in home- and community-based services (including a state 1915(i) benefit) poses the most significant cost risk going forward.

The committee heard that spikes and dips in the department’s charts largely reflect when providers submitted and received payment for claims, not steady increases in demand. Sarah Aker, executive director of the Division of Medical Services, told the committee that “providers on average bill us approximately around 45 days after the date of service,” and that providers have “up to 6 months, a hundred and 80 days to bill Medicaid for timely filing.” She also said the division’s “average time frame for payment of all claims is 7 days.”

Aker and staff attributed several pronounced swings in the medical-services graphs to a national billing outage at Change Healthcare, which temporarily prevented many providers from submitting electronic claims. Aker said, “Change Healthcare had a, data breach ... that really impacted a lot of providers [and] their ability to submit claims,” producing large dips followed by catch-up…