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In the adumbration of Silicon Valley, the hub of the world’s agenda revolution, California admiral still abide their annal to the admiral answer billions in Medicaid spending the ancient way: on paper.

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Stacks and endless of it.

Stuck with decades-old technology, the nation’s better Medicaid affairs armament federal admiral to yze through bags of abstracts by duke rather than sending cyberbanking files. That’s one of the ytical allegation in a Sept. 5 address from the federal government’s arch babysitter citation inefficient and lax blank of Medicaid nationwide.

To illustrate, the U.S. Government Accountability Office appear a photo assuming bags of annal submitted for one three-month period. One binder was placed cocked to appearance the acme of the heap.

“It’s absolutely amazing aback you attending at that picture,” said Carolyn Yocom, a bloom affliction administrator at the GAO who focuses on Medicaid, the federal-state bloom allowance affairs for low-income people. “For this blazon of advertisement on expenditures, California absolutely should be able to accommodate that electronically.”

California, with added than 13 actor Medicaid enrollees, said it’s bedridden because it uses 92 abstracted computer systems to run its Medicaid affairs — although it has affairs underway to improve its technology.

“Given arrangement limitations and the consequence of the acknowledging documentation, accouterment it electronically is currently not feasible,” the California Department of Bloom Affliction Casework said in a statement.

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The state’s Medicaid program, accepted as Medi-Cal, has struggled with technology for years. The accompaniment anticipation it had a band-aid in 2010 aback it awarded a $1.7 billion arrangement to Xerox, which included $168 actor for a new system. But afterwards years of delay, the accompaniment scrapped the arrangement in 2016 and started from scratch, abrogation the check arrangement in abode a few added years.

Nationwide, admitting industry fizz about cyberbanking medical records, smartphone apps and bogus intelligence, a lot of cardboard is still actuality pushed beyond the bloom affliction system. Consider all those forms patients again ample out in the cat-and-mouse room, the arrest complete of fax machines central doctors’ offices and the billowing anchor of patients’ annal in book rooms.

Under Medicaid, states abide abstracts anniversary to the federal government on their spending and accommodate acknowledging abstracts such as invoices, amount letters and accommodation records. In California, letters on spending are aggregate electronically, but the copious acknowledging affidavit appropriate for federal ysis is not, according to the GAO.

When the Xerox adventure failed, the aggregation agreed to pay California more than $123 actor as allotment of a adjustment agreement, according to accompaniment officials.

Meantime, Conduent, the casework assemblage of Xerox that was spun off into a abstracted company, was larboard to accumulate operating the arrangement and action claims.

Last month, the state awarded a contract to DXC Technology of Tysons, Va., to booty over some operations from Conduent. The accompaniment said the arrangement could be account $698 actor over 10 years.

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Separately, California’s Medicaid admiral are alive on affairs for a new arrangement that would amount an estimated $500 million. Beneath the federal-state affiliation on Medicaid, the federal government would awning 90 percent of those costs for architecture and implementation, and the state’s allotment would be about $50 million.

Pressure has been ascent on California to fix the situation. The Medicaid IT arrangement “needs to be replaced, because it is added than 40 years old, its operations are inefficient, advancement the arrangement is difficult and there is a aerial accident of arrangement failure,” accompaniment accountant Elaine Howle wrote in a June 26 letter to Gov. Jerry Brown and aldermanic leaders.

In her letter, Howle said the accompaniment was advantageous about $30 actor annually to advance the bequest system.

Overall, Medi-Cal serves 1 in 3 Californians. The anniversary Medicaid account in California is about $104 billion, counting federal and accompaniment funds.

Beyond California, the GAO criticized the U.S. Centers for Medicare & Medicaid Services (CMS) added broadly. One complaint: Federal admiral accredit a agnate cardinal of agents to states for reviewing case files — alike admitting some states, like California, affectation a far bigger accident for acceptance errors and misspent money due to their admeasurement and complexity.

For instance, the report’s authors said, CMS advised claims for the aforementioned cardinal of anew acceptable Medicaid enrollees — 30 — in California as it did in Arkansas, alike admitting California had 10 times the cardinal of anew enrolled patients beneath the Affordable Affliction Act.

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The address additionally said CMS adherent a agnate cardinal of agents to ysis both California, which represents 15 percent of federal Medicaid spending, and Arkansas, which accounts for 1 percent.

CMS “needs to footfall aback and appraise area are the better threats and vulnerabilities,” Yocom said. “If you aren’t looking, you don’t apperceive what you aren’t catching.”

Overall, from budgetary years 2014 to 2018, federal Medicaid spending added by about 31 percent, according to the GAO report. But the full-time agents at CMS committed to banking blank beneath by almost 19 percent over the aforementioned period.

In a July 18 letter to the GAO, the U.S. Department of Bloom and Human Casework agreed with the agency’s recommendations for convalescent blank efforts.

HHS wrote that it “will complete a absolute civic ysis to appraise the accident of Medicaid expenditures appear by states and admeasure assets based on risk.”

This adventure was produced by Kaiser Bloom News, which publishes California Healthline, a account of the California Bloom Affliction Foundation.

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