JACKSON - With the state facing a $268 million shortfall in Medicaid and officials predicting the program will soon go broke, some are questioning the extent of abuse among those who receive the assistance paid for by taxpayers.
Senate Appropriations Committee Chairman Jack Gordon, D-Okolona, said he had heard estimates that as many as 75,000 ineligible people are receiving Medicaid payments.
Francis Rullan, a Medicaid spokesman, said, however, abuse is not a widespread problem in the program that serves 786,0000 Mississippians.
"I would be amazed if (recipient Medicaid abuse) even approaches $30 million," Rullan said. "It's not prevalent enough to justify a $268 million shortfall."
Rep. George Flaggs, D-Vicksburg, said he, too, is concerned with the possibility of Medicaid funds going to those who are not eligible. But he said no one has presented him proof to substantiate such claims.
When told Medicaid officials acknowledged that abuse could cost the taxpayers millions of dollars a year, Flaggs said, "If that's true, then the Division of Medicaid needs to reduce those numbers."
Flaggs is one of six lawmakers currently negotiating on a Medicaid bill as lawmakers look for ways to buy more time for the health care program for the needy and elderly that is set to go broke March 11.
"There needs to be more accountability," Flaggs said. "I want all the cards on the table face up so we can see what we are working with."
Dr. Rodney Hunt, an oral surgeon in Jackson, said that from his experience in working with Medicaid patients, it appears Medicaid abuse has increased in frequency in recent years.
"Some people decide that it's easier to get on government benefits and pursue a life that way instead of taking care of themselves," he said. "We just feel like there's too many people on it that could be out helping themselves."
Flaggs agreed, saying "the whole idea is to move people from a welfare status to a self-supporting status."
Flaggs said he comes from an impoverished family and knows first hand the uphill path to success.
The problem, he said, is that without hard work and dedication, "poverty breeds poverty."
"I'm a product of pulling myself up by my own bootstraps," Flaggs said. "Government cannot and should not be everything for everybody. Any government that is big enough to give you something is big enough to take it away."
Rullan attributes the growing Medicaid deficit to an increasing population of poor people and rising medical costs. Medicaid rolls ballooned from 517,693 to 559,379 immediately after 1999 legislation raised the eligibility requirements from the state poverty level to 135 percent of the poverty level. Today, the number of people on Medicaid is about 786,000.
Rullan said the Division of Medicaid generally investigates provider abuse rather than abuse by recipients. He said a new law that should be implemented this month and requires in-person interviews and medical screenings could curb recipient abuse. But, he said, the real problem lies with social values.
"They never intended for this program to become a lifestyle," he said. "But Medicaid does not create deficits, social problems create deficits."
According to the most recent U.S. Census Bureau figures in 2003, 19.9 percent of Mississippians were below the poverty level.
Rullan said a family of four with limited resources and making less than 135 percent of the poverty level - $26,123 - and with less than $6,000 in assets can be eligible for some form of Medicaid.
However, he said that there are so many variables and the system is so complicated that he could not make a blanket statement saying who is eligible for the program. Mississippi's median income for a family of four is $46,570, according to census data.
Gordon said Medicaid abuse is an obvious problem and that's why lawmakers passed legislation last year to insure face-to-face interviews with Medicaid recipients. Annual requalification had been done by mail.
"We believe that a great number of people won't even come back to sign up because they don't even qualify," he said.
Mary Troupe, executive director of Mississippi's Coalition for Citizens with Disabilities, said she does not believe recipient abuse is as severe as some claim. But she said that a law requiring those using the benefits to show picture identification at a doctor's office could help.
"Any time you have any program, somebody is going to find a way to abuse it," she said. "But I don't think there is a lot of recipient abuse."
Attorney General Jim Hood provided The Associated Press with a report that said Medicaid costs, for various reasons, have increased 48 percent in four years. In 2004, 40 individuals were convicted of some type of Medicaid abuse, 417 investigations were opened and 1,963 complaints were reviewed.
Hood said provider abuse is even more extensive than recipient abuse but did not provide estimates on provider abuse. The report said eliminating Medicaid abuse could save the state $18 million to $36 million per year.
Dr. Brian Callahan, an optometrist in Pearl, said, "You've got to ask the question: 'Who is entitled to what?"'
Callahan said the Division of Medicaid should more thoroughly investigate who is getting benefits.
"I think the whole program is going to die unless they do some drastic taxation or just strip it to the bone," Callahan said. "They need to just strip it to the bone. Surely not a quarter of the people in this state are disabled or really need Medicaid."
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