The Director of the Johnston County Department of Social Services (DSS) wants to hire 25 new employees as soon as possible.
Scott Sabatino appeared before County Commissioners on Tuesday asking for $1.1 million to hire the employees due to a recent change in the Medicaid error reimbursement policy.
Previously, states like North Carolina were required to reimburse the federal government for any Medicaid benefit errors made by county social service workers. A new law took effect in February 2018 that requires counties across the state to reimburse the federal government for any Medicaid benefit errors made by DSS staff. The burden to repay the errors now lies with each individual county and not the state.
Sabatino said an audit found a 2 percent error rate among Johnston County DSS staff processing Medicaid claims, which is low compared to some other county DSS departments. Under the new reimbursement policy, Johnston County will have to pay 100 percent of the cost of benefits back to the government for erroneously issued Medicaid claims. If the applicant intentionally mislead the DSS on their application, the county would not be required to make reimbursement, but the applicant would be subject to a fraud investigation.
Sabatino said current DSS workers carry an average workload of 800 cases. He would like to hire 15 additional caseworkers to cut the ratio to 450 applicants per caseworker. Additionally, 2 supervisors, 2 lead workers, 5 quality assurance, and 1 staff development specialist would be hired under his proposal, all designed to avoid future Medicaid application errors.
In 2017, the Johnston County DSS processed $186 million in Medicaid assistance claims. In 2018, that number is projected to increase to $233 million. Even a small error could be catastrophic to the county. Sabatino said one Medicaid applicant severely injured in a 2011 car accident, who required significant care until their death in 2018, received over $3 million in care. While the applicant was qualified for Medicaid, if the county had made a mistake, that one case would have cost the County of Johnston $3 million.
In addition to hiring 25 new employees, the DSS director also suggested the County purchase liability insurance against future errors. The insurance would cost up to $159,000 yearly with a $5,000 deductible.
75 percent of the cost of the proposed new positions would be reimbursed by the federal government with the county picking up 25 percent of the cost. Commissioners took no action on the request Tuesday but asked County Manager Rick Hester review the request and report back to the board.