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Medicaid cites provider enrollment backlog, NEMT shortfalls and cyber risks as areas needing staff and reform
Summary
Medicaid officials told the committee they need more staff to speed provider screening and revalidation, improve non-emergency medical transportation contracts — especially in rural areas — and strengthen cybersecurity after recent national incidents affected claims processing.
Division staff described three operational problem areas where lawmakers were asked to approve additional positions and contract funds: provider screening and enrollment, non-emergency medical transportation (NEMT) oversight, and cybersecurity and IT resilience.
Provider enrollment: Administrator Stacy Weeks acknowledged continuing provider-screening and revalidation backlogs and daily provider complaints about slow enrollment. "This is the area that unfortunately continues to be the one I hear more about. You know, a provider cannot get enrolled," Weeks said. The division asked for staff to accelerate revalidations and to revamp online provider portals.
Non-emergency medical transportation: Lawmakers heard rural examples where local hospitals lacked drivers or insurance to run transportation programs. Weeks said the current vendor struggles in both rural and urban areas and the administration is exploring alternate models and considering asking MCOs to assume more rural NEMT responsibility and community reinvestment dollars. "One of our big requests in that procurement was what are your creative tools to address ... challenges in the rural areas around transportation," Weeks said.
Cybersecurity and claims processing: Witnesses flagged heightened IT and fraud risks, referencing the Change Healthcare cyberattack last year that temporarily halted claims processing for personal-care providers. Weeks asked for additional IT staff to mitigate ransomware and cyber threats and to improve claims-processing resilience.
Why it matters: Provider access, timely enrollment and reliable transport to care are core access issues for Medicaid recipients. Cyber incidents that freeze claims processing can prevent timely provider payment and disrupt services.
Lawmakers pressed for job descriptions and cost estimates for proposed IT and enrollment staff. Weeks offered to follow up with more detailed duty statements and to share procurement results for NEMT plans.
Ending: Weeks told the committee the division will bring more detail and vendor analyses: "This vendor and this work is really trying to help some of our fee-for-service side where we are struggling on improving access." (Administrator Stacy Weeks)
