Medicaid Math: Does The State Have Enough Workers?
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.”
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.