A. The Blue Ribbon Commission setup by the Governor has the following function to make high level decisions concerning state Health and Family Services (not just Medicaid) and provide oversight for the Medicaid Program as well as other Health and Family Services. The reason for this is that each state has unique problems in this area that vary in degree from other states and to insure that the state family’s needs are met efficiently without duplication. The Commission should meet on a regular basis or as required. Funding for the Commission should be separate. It has the following mandate:
1. Determine what services are legally required of the state mandated by law and by Federal guidelines.
2. Research Censes data to determine the type and degree of the state’s family problems. For example: juvenile crime, drugs, school dropouts, disabled, medical services etc.
3. The commission must then define how available funds are to be spent and in doing so they will define just what the State’s policies are concerning Medicaid and other programs.

B. The Cross Functional Team more appropriately could be called the “Health and Family Services Team” consists of high level personnel from each of the State’s Service agencies. The Team should meet on a regular basis or as required. Funding for the Team should be from the budgets of each of its members. The Team has the following Mandate:
1. They will follow the Commissions oversight recommendations and put in place the high level rules to be followed by the various agencies.
2. In addition the Team will be the watch-dog over its own members to prevent duplicated services and to be sure family services are provided efficiently and timely. The Commission is to be alerted in a timely manner when violations occur.

C. The Medicaid function is budgeted and managed separately from other agencies. The organization of this function should not be the traditional bureaucracy but a flat organization with “Work Improvement Teams” consisting of those personnel who actually deliver the services. Each team will meet weekly to suggest and install approved improvements to the processes of the function. This will provide continuous improvements in providing services to the Public.

Of critical importance in preventing fraud is the State’s computer systems which should provide cross references and positive identification of applicants for Medicaid. I have identified how these computer systems should be structured using SQL Relational Databases in Article 84. “The Failure to Manage State Resources due to Obsolete Computer Systems”. If Your State’s Information Systems Manager insists that these SQL Relation Databases are not warranted you should seek a second opinion from one who understands the problem and does not have a hidden agenda. The SQL Database systems although expensive to install can save the state billions. Without them its nearly impossible to prevent fraud.

The last recommendation is for a comprehensive Performance Budgeting system. Beginning with identification of labor and other operational costs a Funding Formula is developed for direct input into the next year’s Performance Budgeting system. For more on this see Article 85. “A Tutorial Roadmap for Medicaid Management Reform”.