Poor coordination of health benefits for veterans by the state Department of Health and local social services departments resulted in many veterans being placed in the state's Medicaid program rather than federal programs, according to an audit released Wednesday by State Comptroller Thomas P. DiNapoli. Auditors found dozens of examples where necessary referrals were not made for federal benefits, limiting veterans' health options and costing state and local taxpayers millions.
"Our nation's heroes should be told that they have options when it comes to where they receive the health benefits they need and deserve. They should not be at the mercy of administrative problems, nor should taxpayers," DiNapoli said. "New York needs to do a better job coordinating how veterans are receiving their health benefits. Those who served in our Armed Forces should know all of their possible benefits."
As part of the state's Medicaid eligibility process, local departments of social services identify and refer veterans to the state Division of Veterans' Affairs or local veterans' service agencies so they can file for federal benefits. Such referrals are critical for enhancing the coordination of veterans' Medicaid and U.S. Department of Veterans Affairs benefits, as well as for helping ensure veterans access federal benefits.
In 2002, DOH determined 15,390 veterans received Medicaid services totaling more than $191 million in 2001. At that time, DOH sent a letter to all local departments of social services commissioners informing them these expenditures could be reduced if veterans accessed care through the U.S. Department of Veterans Affairs. The letter told local district commissioners to consider establishing local procedures for educating veterans about their eligibility for health care benefits through the VA, and instructed them to assist veterans in obtaining those services. Since then, DOH has done little to ensure local districts comply with state laws and DOH's Medicaid policies regarding the coordination of veterans' health care benefits.
During the five-year period ending March 31, 2013, New York's Medicaid program reimbursed health care providers $3.47 billion for medical services provided to more than 70,000 veterans. Many veterans enrolled in Medicaid are also entitled to health care benefits through the VA. While it is a veteran's choice to use a VA health care benefit or a Medicaid benefit, significant cost savings could be realized by the state and its localities by assisting veterans and coordinating their health care benefits through the VA.
In a review of case records at counties
with high Medicaid expenses for veterans, DiNapoli's auditors found referrals
to the DVA or VSA were not made in 81 of 91 (or 89 percent) of the cases
tested. Further, local departments of social services did not use available
resources to identify veterans and coordinate their health care benefits
between Medicaid and the VA.
Additionally, DiNapoli's auditors found 679 Medicaid recipients who appeared to be veterans' dependents and were potentially eligible for VA medical benefits during the five-year audit period. Medicaid paid health care providers nearly $50 million for these recipients.
DiNapoli recommended DOH:
•Reinforce policies and procedures regarding local districts' responsibilities, including identifying veterans, advising veterans of federal health care benefits, referring veterans and keeping records of referrals to the state DVA/local VSA, and ensuring veterans file for federal benefits;
•Identify local district best practices and share among all counties; and
•Actively monitor the performance of local districts to ensure they comply with the law and the department's policies and procedures regarding the coordination of veterans' health care benefits.
According to the VA, in 2010, approximately 14 million veterans (of about 22 million veterans nationwide who qualified for veterans' benefits) did not receive care from VA facilities - many because they did not know they could. Several states have started helping veterans, as well as their spouses and children, obtain health care benefits through the VA. California, Connecticut, Kansas, Montana, Texas and Washington have identified the potential for significant Medicaid savings by implementing programs that help coordinate veterans' VA benefits.
About 913,000 veterans live in New York, according to the VA.
DOH officials concurred with several of DiNapoli's recommendations and indicated certain actions will be taken to address them. DOH, however, said it would not implement several other recommendations.
For a copy of the full report visit: http://www.osc.state.ny.us/audits/allaudits/093014/12s162.pdf.