AUGUSTA – Gov. John Baldacci hired a national business consultant in an effort to correct problems that have plagued Maine’s Medicaid program for decades.

During review of a faulty new computer system, representatives at the New York firm Deloitte Consulting identified more deficiencies within the MaineCare program, said Mike Hall, deputy commissioner at the Department of Health and Human Services.

Baldacci tapped Hall to head up the program’s overhaul.

The program spends $2.6 billion a year on health-care services for more than 300,000 low-income Mainers.

At a State House press conference Wednesday, Hall said consultants will continue with their probe of the agency until October. During that time, they plan to meet with Medicaid providers as well as clients to help craft the blueprint for a revamped program. Implementation of the changes likely will continue well into next year, he said.

“We’re not simply shifting around resources and making small incremental changes,” he said. “We are in essence designing a new MaineCare agency for the state of Maine.”

The goal is to organize the agency like a business, he said. Though public, MaineCare is the largest insurance provider in the state.

Hall said the agency should be able to pay its bills on time, respond to the Legislature’s directives, provide good customer service and be a good place for people to work, all things it now lacks.

“The organization … has been in a state of crisis and turmoil for longer than any of us can remember,” Hall said. “It’s not a place that is capable right now of functioning at its best level and we need to move it to that place.”

Hall said management at MaineCare has lacked needed resources and technical skills. The new $22 million computer system installed in January is not working properly. Clients are not getting services and providers are not getting paid as quickly as they should, Hall said.

“All those things ought to be benchmarked off of national performance standards,” he said.

Hall said the consultants are “moving forward aggressively” to fix the computer that processes MaineCare claims.

The computer system has been at the center of recent criticisms of the agency. Earlier this year, it overpaid providers by about $51 million after rejecting their claims. The state was then forced to recoup the money.

Hall said the problems run much deeper than hardware and software issues.

“If we don’t get at the underlying structural issues the state is vulnerable to the same problems like this in the future, and we have to address those now in a preventative way,” Hall said.

Two years ago, a state audit of the department uncovered accounting errors amounting to millions of dollars. That triggered the hiring of a different consulting firm.

Many of the problems identified by Deloitte are entrenched at the agency, Baldacci said.

“These practices have gone on for over three decades and they haven’t changed and they need to change,” he said. “We want to regain the confidence of the providers. We want to regain the confidence of consumers.”

Hall said the cost of Deloitte’s services are being negotiated.

Overhauling the agency should enable departmental officials to better forecast spending for future budgets, Hall said.


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