In Minnesota, Liz Gomez finds herself in a difficult financial situation due to a Medicaid fraud investigation that has delayed payments to her caregivers.
MINNEAPOLIS — Every day, Diana Zambrano meticulously sorts her medications in her Owatonna apartment while her daughter, Liz Gomez, watches closely to ensure she doesn’t overlook any pills.
“Some days I just get so tired of taking pills,” Zambrano remarked as she filled each container and noted the times for their administration.
Gomez serves as her mother’s personal care assistant (PCA), providing essential support to Zambrano, who is battling end-stage renal disease.
Though Gomez is employed by a company, her salary comes from Medicaid reimbursements facilitated by the Minnesota Department of Human Services.
She expressed appreciation for the PCA program after leaving her job to care for her mother full-time. However, her paycheck, due to arrive this Friday, didn’t come.
“It’s just incredibly frustrating that some people are exploiting this system for profit,” Gomez said. “It’s harming those who genuinely need help.”
The Department of Human Services (DHS) has halted payments for 14 Medicaid services identified as “high risk” for fraud.
“It might take up to 30 days for a clean claim to receive payment,” said Deputy Commissioner John Connolly during a press conference on Monday.
Initially, DHS projected that around 80,000 claims would be reviewed by the contractor Optum. However, a DHS spokesperson later stated that the number had jumped to 104,000, with unflagged claims expected to be processed by January 27.
For Gomez, this payment freeze brings about ongoing financial uncertainty. She intends to continue caring for her mother despite the delay in payment, though the financial strain is significant.
With two children and a part-time job, Gomez mentioned that her mother’s Social Security income helps cover some of their costs, but she wishes there was more support for the household.
“What’s really alarming is the thought of being evicted,” Zambrano said. “Where would we even go? What would we do?”
Zambrano undergoes dialysis three days a week—Tuesdays, Thursdays, and Saturdays—which has become a large part of their daily routine.
Until Gomez receives her paycheck, the family is navigating through each day. Minnesota DHS has a total of 920 registered personal care provider organizations.
