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Medicaid Math: Does The State Have Enough Workers?

by | May 28, 2013 5:30am
() Comments | Commenting has expired
Posted to: Courts, Health Care, Labor, Legal

At the heart of the argument in a class action lawsuit set to resume Wednesday in U.S. District Court is whether the state Department of Social Services has enough workers to process Medicaid eligibility applications in a timely manner.

Arguing for the plaintiffs, New Haven Legal Assistance Association attorney Sheldon Toubman questioned Astread Ferron-Poole, chief of staff to Commissioner Roderick Bremby, about the number of eligibility workers.

In July 2002, before the 2003 layoffs under former Gov. John G. Rowland, Toubman said there were 845 eligibility workers. Today, there are 881 and that includes the 220 new hires created under last year’s state budget.

“What has happened to enrollment during that time?” Toubman asked.

“It’s gone up,” Ferron-Poole testified.

Toubman pointed out that as of May 2, 2013, there were 619,579 individuals enrolled in the program. Almost double the nearly 346,000 who were enrolled in the program in 2002.

“So, you’re still basically flat?” Toubman asked Ferron-Poole.

“I don’t think that’s the correct question to ask,” she replied.

She said it ignores the modernization effort the department has undertaken to upgrade its technology and phone system — changes designed to speed up application processing. Currently, all applications are submitted on paper and hardly any of the eligibility work is being done online. There is a pilot program in Waterbury where the applications are being scanned and turned into a digital documents, but the other 11 DSS regional offices have yet to employ the technology.

“Eighteen months from now it will be replaced,“ Ferron-Poole said of the old eligibility system. But she said some of the other improvements are scheduled to begin in two or three months.

Ferron-Poole also testified that it takes between eight to 10 months to train eligibility workers, so the 120 people hired last summer are just now able to process applications on their own.

“We will begin to see they are making a difference,” Ferron-Poole testified.

U.S. District Court Judge Alvin Thompson seemed surprised that it would take a worker eight to 10 months to be able to begin processing applications.

“I guess I’m not understanding,” Thompson said. “My law students are doing research on their first day.”

Christine Stuart file photo

Sheldon Toubman, attorney for New Haven Legal Assistance Association, testifying earlier this year at the Legislative Office Building

Ferron-Poole, who has worked for the department for 25 years, said it takes a college degree to be an eligibility worker, but “it’s not routine work.” She said workers are generally not productive at all until they’ve been on the job for at least six months. Eligibility workers process applications for Medicaid, food stamps, and long-term care.

A memo from Darlene Klase, the director of training for DSS, said the department needed an additional 540 employees on top of the 661 it had at the time — for a total of 1,201. DSS was given 220 more for a total of 881. Toubman says department still is short about 676 additional employees if it wants to keep up with demand. He tried to ascertain from Ferron-Poole the likelihood of the department’s ability to hire more workers under a statewide hiring freeze.

Ferron-Poole said the commissioner requested more hiring after Office of Policy and Management Secretary Ben Barnes announced a statewide hiring freeze on Jan. 22.

“What I do know is we are in the process of filling 35 eligibility positions,” Ferron-Poole said last Monday. “We requested those 35 positions.”

She couldn’t recall the total number requested, but she recalled that the 35 the department received was less than what had been requested.

According to DSS spokesman David Dearborn, those 35 positions are not new positions to be added to the 220. Rather, he said, they were new vacancies “because of staff departures.”

Toubman said the revelation that the department had to request permission to even hire 35 workers to fill vacancies demonstrates that the department is in the unsatisfactory position of having no autonomy over hiring.

But the department maintains that Toubman seems to want to ignore the technology improvements on the horizon for the agency.

A report by a consultant called First Data suggests that the planned technological upgrades will save the agency the labor of about 395 workers under the best case scenario.

Assistant Attorney General Jennifer Callahan argued that First Data’s conclusion means the department will have enough workers processing applications within the 220 new hires.

Ferron-Poole testified that the department hired an outside contractor to look at how it’s operating before the technological upgrades are in place. She said she expects that the contractor’s assessments will help the DSS increase efficiencies and improve processing times.

Toubman estimated the department would still be about 290 workers short even if it was able to achieve greater efficiencies by employing technology.

“The question of liability in this case is what is happening today to comply with the law, not what will happen or what they hope will happen in the future,” he said.

Toubman pointed out that the percentage of “unexcused delays” in processing Medicaid applications has gone up since the start of this year. At the end of April, the number of “unexcused delays” was 26 percent, which was up from 12 percent in March. The total number of overdue applications in April was 43 percent and 39 percent in March.

Federal law says the applications must be processed within 45 days and many are languishing well-beyond that time period, which is why Toubman filed the lawsuit back in January 2012.

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(10) Archived Comments

posted by: dano860 | May 28, 2013  7:35am

This is the type of situation that a contract with an insurance company or would be applicable. They are talking about an 18 month period that they feel needs the extra coverage, that is all.
Aetna and The Travelers have qualified people on staff and they could oversee temporary employees to pick up the slack for the interim.
What says this work MUST be done by DSS?

posted by: BrianO | May 28, 2013  11:39am

Truth is that if the appropriate investments had been made 10 years ago we could do this with less people, not more. 

Given our demographics, loss of jobs, increase in incarceration etc. these were very, very obvious trends for which we never prepared.

The inability of our state govt. to analyze data appropriately and invest where needed is a huge reason we have so much debt. and we always have budget deficits.  We have an imbedded inability to forecast and measure.

posted by: Robincys | May 28, 2013  8:11pm

1.  Legally eligibility cannot be privatized
2.  There are confidentiality standards
3.  Since Rowland’s layoffs we have been short staffed
4.  Due to economics management “forced” retirement of those with years of knowledge and it took until now to replace them
5.  Upper management hired quite a bit more upper management, for some reason
6.  The State considers employees a liability due to pensions etc. guess upper management is ok for some reason
7.  Long term care especially is extraordinarily detailed.  To really know it takes 3 years.  The largest portion of welfare is Medicaid (title 19). And the largest portion of Medicaid is Home Care and nursing homes. This is where the $ is.  It is not the so-called welfare moms.  There are a great many legal issues with these cases.  It is not easy nor easy to learn.  It should NEVER be privatized.  ( you wouldn’t like the outcome). It is also federally reimbursed a certain %.
...Now you know the real story.

posted by: Robincys | May 28, 2013  8:18pm

One more thing.  They hire the CIA ( no, not the spys) to do what Best Practices has already done ( at no cost because it was employees) and pays them $$$$$.  Talk about double dipping.  That is upper managements doing. Not rank and file.  Now I’m done and know you all really do know everything.

posted by: dano860 | May 29, 2013  7:51am

BrianO, you are correct, this is a case of the 4P’s for certain. Poor Planning = Poor Performance.
Unfortunately this will be a case for Dannel and the Union to forge more expense and burden the State with more bureaucracy.
The answer to the ‘what’ question I asked earlier is “the union”.
As a former part time employee of the Community College system I can tell you that the computer systems are not integrated in any way. I have a State Employee number assigned to me. So, you think, that would be all you need to go from one school to the next, right? NOPE, you must fill out the redundant paperwork for each school that you work for. It is a waste of time and paper, duplication of effort and each school operates on their own modified rules. No standardization at all.

posted by: ad_ebay | May 29, 2013  9:08am

There should be enough workers…the state is hiring managers like crazy.  Oh wait…they don’t actually work in a position.  Never mind.

posted by: GuilfordResident | May 29, 2013  1:09pm

Standardization costs A LOT of $s. And needs to be constantly maintained ... which costs $s. The state should develop its IT force to sell its services outside of the state agencies it serves then use that $ to reinvest.

posted by: gutbomb86 | May 29, 2013  3:31pm


I see a lot of industries and private companies failing because of the same inability to adapt that BrianO is talking about. There’s a whole generation of poor thinkers who try to optimize old, ineffective technology - gerry-rigging one bad system with another - until they have a patchwork of bad methodology held together by a thread. That thread, of course, is the expertise of a handful of individuals in each department who eventually leave or are downsized and the organization slips another rung downward on the ladder away from a level of sustainable service or functionality.

And kudos to Robincys for speaking up.

What’s interesting as well in these comment threads is the two schools of thought that seem to pervade - one complains because of the cost to the taxpayers while the other points out the human cost for those who fall through the safety net because of inefficiency and managerial failure.

posted by: dano860 | May 29, 2013  9:51pm

Guilford Resident, you are correct about the cost of standardization, initially. The expense to maintain 17 Community Colleges with entirely redundant, duplicate management and staff in every way except the way they operate is beyond expensive.
I wouldn’t hold out hope of the State IT developing anything anytime soon…or later. Certainly not anything sellable. They still can’t get the computers to talk between the 17 Community Colleges. They need to contract with a company like CSC, Computer Sciences Corporation, located in Norwich.
Fifteen years ago I watched an acquaintance milk the State for years as they were attempting to standardize the radio communications systems between the S.P. and fire departments with other emergency services. It still hasn’t been completed.
They retired from the State and were called back as a ‘consultant’, they just never learner care.

posted by: Robincys | May 30, 2013  8:33pm

We are talking here about medical assistance, the largest financial portion is for the elderly.  That means you, your parents, your grandparents.  The eligibility process is based on statute- law.  There are so many variables that it is extraordinarily difficult to standardize.  This is not a business though some would like it to be.  We deal with lawyers all the time who find countless loopholes.  It is not that standardizable.  Unless you’ve done this job you don’t know.  So to Dano and Brian, your comments just are not applicable.  For the most part there is a business model.  But speak to the elder law lawyers before you try to fix DSS. 
At any rate we try.  We were decimated by John R.  For State employees who want to do a good job, have integrity, but were so overloaded for so long ( and I am certainly not saying poor me) and management did not listen - we think the whole thing will come down to privatization anyway.  So less people paying tax, more out of work but supposedly, that will solve the budget problem.  We, the lower middle class, have been duped again.