Ultimately, Smith says, his curiosity and candor earned him a reputation for being uncooperative. After four years with AHCCCS, he was terminated in August of last year. He says leaving was not easy.
He thinks AHCCCS is, overall, a worthwhile program.
AHCCCS officials have always claimed that the seemingly incestuous relationships between contractors, state employees and providers is a by-product of the relatively small pool of skilled data managers in the health-care field. AHCCCS claims, essentially, that such relationships cannot be avoided.
They certainly are continuing. Bridgewater left AHCCCS in November. Her replacement, LeAnn Dale, is an ex-FourThought employee who has also worked for Mercy Care Plan, the second largest of the 15 health plans that have AHCCCS contracts.
At times, AHCCCS has suffered for being perhaps too far ahead of the curve of national health-care policy. Since most of the other states don't have managed-care systems, national Medicaid regulations about the administration of federal money often fail to fit with AHCCCS' goals and methods.
Examples of vague federal rules, a lack of oversight of important processes and wasted money are not hard to come by.
AHCCCS has been warned on several occasions that it needs prior approval for certain large expenditures on data-processing software, equipment and personnel. In 1992, AHCCCS was hard at work developing a plan to expand program services to cover mental health and needed the data-processing equipment to meet those needs. AHCCCS had been spending money on products it would need for months--but Health Care Financing Administration balked when asked to make the federal contribution to those purchases.
In October of that year, the federal government approved plans for the mental health services equipment, but indicated it would not reimburse the several hundred thousand dollars AHCCCS spent between April 1992 and February 1993. The feds said that AHCCCS had spent the money without necessary approval; for a time, it looked as if the state would have to eat those costs. Ultimately, HCFA agreed to repay those funds--but not before a lot of panicky phone calls between AHCCCS and HCFA offices in San Francisco.
It wasn't the only time it would happen.
In 1993, AHCCCS needed to purchase software design equipment for a federally mandated system which would streamline claims processes and cut down on paperwork.
Again, AHCCCS records show, the program had to ask HCFA for retroactive approval of the funds to cover purchases it had already made.
HCFA personnel told AHCCCS officials that money was being spent on the $8 million project before it had been approved. Discussions continued for several months, but in June 1994, HCFA finally told AHCCCS that all federal money for the project would be cut off. It would not flow again until the state stopped spending money the feds hadn't allocated.
AHCCCS officials say that as a managed-care system, Arizona's program doesn't fit into the traditional Medicaid scheme of things. Often, they claim, HCFA forces them to jump through regulatory and procedural hoops they otherwise would not have to deal with. The aforementioned project, for instance, was essentially designed to streamline the fee-for-service process. As a managed-care system, AHCCCS never had the problems the new project was designed to alleviate.
There is, in fact, remarkably little oversight of key AHCCCS functions, especially considering the scope of the program and the amount of money involved. State financial audits are performed regularly, checking out the program on strictly monetary lines. But the state Auditor General's Office says AHCCCS is not scheduled for a full-blown performance audit (which might reveal costly functional problems, such as keeping dead people on the benefit rolls) until the year 2002. HCFA does not do the types of audits on AHCCCS that might reveal such problems, either.
Linda Minamoto, a computer systems analyst at HCFA's San Francisco office, says AHCCCS is regarded as a good program, that it receives no more or less oversight than any other state's Medicaid program. Federal regulations regarding prior approval of expenditures, she says, are vague. Often, those regulations could be interpreted inconsistently by different federal officials at different times.
HCFA did eventually approve the funding for the AHCCCS data-interchange project. Formal confirmation came after two and a half years of discussion--and just days after New Times inquired about the project.
Although federal funding has been approved, one last problem remains. After spending years of staff time and millions of dollars getting the computer project rolling, the state and federal governments have reconsidered. They have decided the system, actually, is not necessary.
AHCCCS now says the project has been put on hold. Indefinitely.
