Thousands of Mainers Forced a MaineCare Accountability Debate — Now DHHS Must Hear From the Public
Maine DHHS will hold a public hearing Sept. 10 on citizen-petitioned MaineCare accountability proposals involving provider inspections, improper payments and stronger oversight. Here’s what is being proposed, who brought it forward and how Mainers can participate.
Maine DHHS Commissioner Was Copied on $45.6M Medicaid Audit Response — But Agency Says No Senior Leadership Briefing Record Exists
Maine DHHS Commissioner Sara Gagné-Holmes was copied on correspondence surrounding the state’s response to a $45.6 million Medicaid audit. But when The Maine Mirror specifically sought a final briefing memorandum, executive summary, or decision memorandum prepared for the Commissioner or senior leadership, DHHS said there were no responsive records.
CMS Put Maine DHHS on Notice After $45.6M Autism Medicaid Audit — Four Findings Required Corrective Action
Federal records show CMS identified four findings requiring corrective action after Maine’s $45.6 million autism Medicaid audit and gave Maine DHHS 30 days to respond. CMS also warned that an outstanding refund could lead to federal disallowance before Maine submitted its corrective-action plan in March.
Maine’s Autism-Service Program Began in 2010. Federal Auditors Say a Statewide Post-Payment Review Never Happened.
Federal auditors found Maine had not performed a statewide post-payment review of Medicaid-funded RCS services since the program began in 2010. Maine DHHS agreed with the finding and committed to reviewing 30 Section 28 providers per year, with all providers projected to undergo review by 2029.
Maine DHHS Agreed It Failed to Provide Effective Oversight of Autism Services — Then Said Its Own Rules Were Outdated
Federal auditors concluded Maine made improper and potentially improper Medicaid payments because it failed to effectively oversee RCS services. Maine DHHS agreed—and records obtained by The Maine Mirror show the state acknowledged its Section 28 rules contained “outdated, ambiguous, and inaccurate provisions” and committed to replacing them.
The Other $22.4 Million: Federal Records Flag Unreliable Session Notes in Maine Autism Services
Federal auditors estimated Maine made $22.4 million in potentially improper Medicaid payments for autism-related RCS services and flagged “cloned or otherwise unreliable session notes.” Records obtained by The Maine Mirror show Maine DHHS agreed the findings warranted review and acknowledged broader problems with oversight, provider guidance and outdated rules.
Does Maine Actually Owe the Federal Government $28.8 Million? Records Show the Answer Is Not Yet That Simple
Federal auditors recommended Maine DHHS refund $28.8 million after estimating at least $45.6 million in improper Medicaid payments involving services for children with autism. Newly obtained records show Maine only partially agreed with the finding—and reveal what the state promised to do next.
After Maine’s $45.6M Medicaid Audit, CMS Required Corrective-Action Updates — New Records Show What Happened Next
Newly obtained records show what happened after Maine’s $45.6 million Medicaid audit, including CMS’s demand for corrective-action updates, Maine’s four response plans, and the unresolved questions surrounding a recommended $28.8 million federal refund.