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Texas' welfare privatization efforts snagged
April 7, 2008

Paperwork for applicants has been lost. Needy Texans have received little help from state workers when they've complained of mistakes. And all too often, Texans who should qualify for state-paid health care and other benefits have been refused because of such errors.

Written by Robert T. Garrett, The Dallas Morning News

AUSTIN – Lawmakers are worried that a partly privatized system for determining who receives public assistance is still shaky and may not be salvageable.

Paperwork for applicants has been lost. Needy Texans have received little help from state workers when they've complained of mistakes. And all too often, Texans who should qualify for state-paid health care and other benefits have been refused because of such errors.

When one closely watched measure of the state's performance on aid requests plunged recently, lawmakers sharply questioned Health and Human Services Commissioner Albert Hawkins. He has announced several new initiatives this year to lure and retain state eligibility workers – and to train more of them on a computer system causing most of the delays.

But those steps haven't calmed lawmakers' nerves. They and advocates for the poor are skeptical he can quickly fix a system that's been in crisis for most of the five years since the Legislature and Gov. Rick Perry slashed the payroll of the state's welfare offices and ordered a shift of many screening duties to four privately run call centers.

State leaders acknowledge that promised cost savings haven't materialized and mistakes are common. Now, the system could be headed for more severe problems, as a jittery economy means more Texans may soon apply for public assistance.

The problems could also distract Texas officials as they separately seek to overhaul Medicaid, the nation's main health care program for the poor. Some advocates for low-income Texans fear that if Mr. Hawkins' agency remains preoccupied with fixing the eligibility system, it will be distracted just as it needs to focus on huge changes designed to cover more adults and improve preventative and dental care for poor children.

"These problems need to be resolved now – not in the next [legislative] session – because people's health is at stake," said Senate Health and Human Services Committee Chairwoman Jane Nelson, R-Flower Mound.

The Texas call-center experiment was supposed to make it easier for the needy to get help. The state would create centralized offices where Texans would call and provide information about their income and family, and workers would determine their eligibility for the state's biggest assistance programs – Medicaid, food stamps, cash assistance and the Children's Health Insurance Program.

There's every indication, though, that it's actually compounded confusion at the gates.

'Just reapply'

Dallas-area health care providers and social workers say inconvenience for aid applicants has spread from the program's initial pilot area, around Austin, to North Texas and beyond.

"They can't give us an answer," nurse Gloria Bugarin of Dallas said of the call centers and state welfare offices, where harried state and private workers shuttle callers back and forth. "They're just, 'Oh, start all over. Just reapply.' Well, that takes a lot of time to go get those documents and copy and fax them again."

Ms. Bugarin, who visits the homes of low-income women having their first child, said the eligibility system's woes threaten a child abuse and juvenile delinquency prevention program she works in, the YWCA of Metropolitan Dallas' Nurse Family Partnership. In the past two years, babies of 10 of her 25 clients lost Medicaid coverage, disrupting immunizations and doctor visits, she said.

State officials acknowledge the failures but say there's no turning back. The new system is "a much more flexible system. It's modern, it's Web-based, and it allows us to provide Texans with a great deal of choice in how they apply for benefits," said Stephanie Goodman, a Health and Human Services Commission spokeswoman.

She said the promised savings and improved efficiency haven't materialized because the program ordered by lawmakers in 2003 hasn't been fully implemented. "But it's also incredibly difficult to modernize a system that 4 million Texans rely on every day. It's like trying to remodel a hotel that's full of guests," Ms. Goodman added.

Transferring data

Lawmakers' original vision would have had private employees assuming a lot more of state workers' duties. But after widespread problems with the Austin-area launch in early 2006, Mr. Hawkins persuaded the Legislature to let him dial back the privatization and partially rebuild the state workforce.

Also of concern to state employees' representatives and some advocates for the poor was Mr. Hawkins' unflappable confidence in a 9-year-old computer system known as TIERS – Texas Integrated Eligibility Redesign System.

By 2007, Mr. Hawkins wanted to complete a big job: Transferring to TIERS the case histories and personal information of all 3.8 million Texans enrolled in the four big social programs. The old mainframe-based system, he argues, can't be sustained.

Just a small part of the job was done on time, though – mostly because of high turnover of state workers, many of whom say TIERS is unwieldy. The problem got worse when Mr. Hawkins decided to route all applications for a new Medicaid benefit for low-income women of childbearing age into TIERS starting in January 2007.

The program's popularity – and a much-criticized decision to move the public assistance cases of the applying women's family members – helped to more than double the TIERS workload last year, to more than 400,000 active cases.

"All is not well, clearly," said Rep. Patrick Rose, the Dripping Springs Democrat who heads the House Human Services Committee. "We've got to find a solution that doesn't allow further cases from the Women's Health Program to be converted into TIERS."

Ms. Goodman said it would cost $1 million and take about a year to reprogram the old mainframe system to handle the women and their families.

In January, Mr. Hawkins, decided to hire his way out of a jam. He announced emergency pay raises for state workers of at least 5 percent. They take effect June 1.

At the Feb. 19 hearing before a new House-Senate panel overseeing the eligibility system, Mr. Hawkins said he had just launched a nine-week drive to train 313 state workers to use the computer system, to be followed by more training and hiring

Ms. Goodman said there are early indications that the promise of higher pay may be slowing attrition. Though she touts raises of as much as 17 percent for newly hired workers, starting salaries remain low. Before the raises, they averaged about $26,000.

Also, veteran state eligibility workers complain that Mr. Hawkins simply has pulled manpower away from the older computer system, so that it soon will be mired in delays, too. Fewer than half of food stamp cases processed using TIERS are now decided in the maximum 30 days allowed by federal law.

Problems continue

As policymakers and experts in Austin bicker, needy Texans continue to report problems. When they complain, poorly trained state and contractor employees respond inadequately, they say.

Plano housewife Cecilia Davidson is one such person, baffled – and frustrated – by the sputtering system.

Ms. Davidson, whose husband got laid off from a construction job and struggled to find work, got her two sons on Medicaid. When their six months of coverage ended last April, she applied for renewal, but state workers' errors left the family without coverage until December.

Ms. Davidson abandoned hope of getting help from the state. Despite her own chronic medical condition, she took a job last summer, hoping it would be the ticket to private family coverage. It wasn't.

She said that by September, her 16-year-old son, Leth, who has a mild form of autism known as Asperger's, needed care. So she applied again to get government coverage for him and his brother Scott, 8.

In December, Ms. Davidson rushed Leth to the emergency room because he had seizure-like "twitching and jerking." Hit with a $3,000 tab, she redoubled efforts to get coverage for the boys. On some days, she recounted, she spent up to five hours on the phone.

"You get run around so much," she said. "My application had so much weighing on it."

Ms. Goodman acknowledged that Ms. Davidson provided all information requested of her, and the boys should have had continuous coverage.

Under Medicaid, a child's bills from the last three months can be paid when they enroll – so Leth's ER visit is covered. Ms. Davidson said she winces, though, when state workers tell her that millions more Texans eventually will have their records pulled into TIERS.

"Everybody's going to be on it," she said. "God help everybody."

Possible solutions to enrollment program problems

Idea: Close four privately run call centers, hire more state workers and stop entering cases into a troublesome computer system until its problems are fixed.

Pro: The needy would get better service. Eligibility workers would use an older, more reliable system and have manageable caseloads, the Texas State Employees Union says.

Con: Going back to workloads that state workers had in 2002 would require hiring 6,300 more employees, costing $287 million more annually. The newer computer system known as TIERS is sustainable, while an older, mainframe-based computer system has "technical limitations," the state says.

Idea: Obtain permission from federal officials to interview food stamp recipients every year, instead of every six months.

Pro: Fewer than half of new food stamp cases entered into TIERS are completed within 30 days, as federal law requires. State workers are swamped with renewal applications.

Con: The state may have to trim monthly payments to offset a rise in enrollment if income is checked less frequently.

Idea: Use the older computer system during initial interviews with aid applicants.

Pro: Applications are handled faster and the system is more popular with state workers. Special teams could call people back to get additional information that TIERS requires.

Con: "This would take lots more workers and cost lots more money, and we don't exactly have an excess of either," says Health and Human Services Commission spokeswoman Stephanie Goodman.

Idea: Stop taking applications for the Women's Health Program in TIERS.

Pro: Last year's launch of the new Medicaid benefit for low-income women, ages 18 to 44, has heaped extra work on the portion of the system in TIERS. Family planning clinics are urged to have virtually all patients apply because the federal government picks up 90 percent of the cost. A pause would help.

Con: It's easier to train more state workers how to use TIERS than to spend $1 million and wait a year to reprogram the older system for Women's Health applicants, the state says. Also, personal data now faxed to a central, secure location would have to be sent to general fax machines at local offices, breaching confidentiality.

SOURCE: Dallas Morning News research

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