Persistent staffing concerns may pose challenges to Md. health department as it responds to audit findings

As the Maryland Department of Health attempts to fix years’ worth of inadequate financial documentation and recordkeeping found by state auditors, the agency continues to struggle with staffing levels that might prolong improvement efforts, officials said Wednesday.

The November review was conducted by the Office of Legislative Audits and examined how the Medical Care Programs  Administration the processed Medicaid, the low-income federal health care assistance program, from August 2018 through March 2022, under the administration of Gov. Larry Hogan (R).

During those years, auditors found that years of “unsatisfactory” recordkeeping may have resulted in some $7 million of Medicaid dollars that were improperly paid out for people who did not qualify or were deceased. The audit also found that inadequate program oversight meant that some people did not receive state health care services that they were entitled to in a timely manner.

Now, with Gov. Wes Moore (D) in office, the new Department of Health leadership is left with trying to untangle the situation. But staffing levels, one of the factors that contributed to issues identified in the audit, remains a challenge for the department.

“It’s really incumbent for them to bring in the staffing that they need,” Sen. Clarence Lam (D-Anne Arundel and Howard) told Maryland Matters. Lam is Senate chair of the Joint Audit and Evaluations Committee, which reviewed the audit results at a meeting in Annapolis on Wednesday.

He said that filling staff vacancies should be a priority of the department.

Health Secretary Dr. Laura Herrera Scott and Deputy Secretary of Health Care Financing Ryan Moran were called in front of the committee to provide an update on the progress of a recent audit.

The November audit reported that as of June 30, 2022, MCPA had 87 vacant full-time positions out of a total of 618, or 14.1% of the workforce. The Moore administration has tried to curb vacancies in state agencies, but those efforts have so far fallen short.

Herrera Scott said that they have hired on and contracted out additional support staff to MCPA since then, though she did not have data on hand at the time of the Wednesday meeting.

“I just want to emphasize that the staff we have works tirelessly day in and day out to get this work done,” Herrera Scott told the committee. “And they just, unfortunately, were under-resourced across the board to be effective.”

Moran said that the department is looking into updating software within the agency and improving automated processes to more efficiently handle the workload at MCPA and reduce the likelihood of human error.

“We have a lot of people doing a lot of manual processes…these manual processes are very prone to error and if we can remove that manual process and remove the error, we hope to improve system-wide,” Herrera Scott said.

Del. Jared Solomon (D-Montgomery), House chair of the auditing committee, noted that increased automation may also allow staff resources to shift to other necessary responsibilities of the agency.

The Wednesday conversation did not go over the findings of an October audit of the Maryland Department of Health, which found a “pervasive lack of documentation” regarding financial transactions, federal reimbursements and contractor agreements during the Hogan years. As a result, the audit found some $1.4 billion in potential federal revenue that is currently unaccounted for and could result in a budget shortfall.

Lam said that there is a “bipartisan frustration” among lawmakers about long-standing repeat audit findings and mismanagement among state agencies under several different administrations.

“There’s a lack of accountability [on] how state agencies ensure they are good stewards of taxpayer funds,” he said.

Lam told Maryland Matters that that there are some actions that the joint audit committee could take to add pressure onto agencies, such as requiring more frequent updates from the department or even withholding some state funds until the department improves on the issue.

But he also noted that Herrera Scott and the Moore administration have been in office for less than a year, and repeat audit findings over several years have created a “tall order” for the current health department to tackle.

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