DSS concedes eligible low-income residents may be losing health care

Department of Social Services Commissioner Roderick Bremby said eligible low-income people may be losing their Medicaid health benefits every month.

The department is facing a huge backload of paperwork, the result in part of an antiquated computer system, fewer employees and an ever-higher caseload.

“We are concerned,” he said during an interview at the state Capitol complex.

Each month, DSS sends about 40,000 people a form to fill out and send back so the department can determine if they remain eligible for government-funded health care.

Ron and Carol Erhardt, an unemployed Plymouth couple, both have significant health care needs. DSS workers failed to file their paperwork in time, and the department’s computer system automatically cut off their health insurance coverage.

“This is happening every day in Connecticut even though federal law forbids the state from kicking eligible people off,” said Sheldon Toubman of New Haven Legal Assistance, the Erhardts’ lawyer.

He said thousands of eligible low-income and disabled Connecticut residents are losing their benefits each month because of the backlog of paperwork the agency faces.

Bremby said Monday that he has no way of knowing how far-reaching the problem is. But his department’s information technology director said last month during a court deposition that people are often losing their benefits without overburdened DSS workers looking at their paperwork.

Bremby said of the Erhardts’ situation, “Look, when we heard about this case, we reinstated the benefits that day.”

But Toubman said this temporary fix for one case doesn’t help all the other people whose benefits are discontinued.

Toubman’s solution: The department should end its “automatic termination” policy, Toubman and his colleague Shelley A. White wrote to Bremby last week.

Turning off this “automatic termination” switch and arranging for a DSS client to stay on Medicaid unless and until a worker can determine eligibility would work better, the lawyers said.

It “could be changed to do that… That doesn’t seem like a large-scale fix or enhancement,” Louis Polzella, the agency’s IT director testified May 29 in a pending lawsuit filed by Toubman.

Such a change could end up costing the state millions, Bremby warned. “We will not be reimbursed for those we mistakenly covered… The state will be responsible” for that bill, he said. The federal government reimburses the state for half the cost of its eligible Medicaid clients.

Help on the way?

The agency has a plan that involves updating its decades-old computer system that is the root of many of these problems.

“The whole system we use — the telephones and the computers — they’re all antiquated. They go down often or it takes longer than it should to do things,” said Bremby.


Paper piles up at a DSS office in this photo taken last year by Commissioner Roderick L. Bremby.

The department is planning to roll out a new document system by next spring that will scan in every document it receives so that forms — including redetermination paperwork — are not sitting around.

“It’s getting there from here,” said Bremby, urging patience. “Our current system never imagined a system with this much volume.”

Medicaid enrollment grew by 52 percent in Connecticut between fiscal 2001 and 2011. Meanwhile, the number of eligibility workers shrunk by 25 percent, or 249 employees.

“That is huge,” said David Dearborn, a spokesman for DSS, adding that since 2011, the Malloy administration has hired 175 new eligibility staff, which includes 60 that handle the Medicaid applications and annual redetermination cases. “We are working in reversing this trend.”

Over the next several months the agency also plans to hire about 100 more eligibility workers. Some of these will be new positions and other will be replacing departed or promoted staff, Dearborn said.

Toubman said while he is happy that new workers are being hired and that the system is being updated, “It will be years before the problem is corrected” with this strategy.

He says the computer system modernization will still require a trained staff member to decide eligibility. And the new staff are in some cases not able to handle their own caseloads for as long as their first year, according to the agency’s chief of staff Astread Ferron-Poole.

Phil Ober, an operations manager at Bridgeport’s DSS office, testified that the new staff members at his office have provided little relief to the backlog.

“One reason is these workers couldn’t work on these cases yet at this point in their development,” he testified in May. “They’re all young… They are able to do small tasks that free up the workers who can… The help they’re giving us is minimal.”

New state, same problem

Other states have faced similar dilemmas with eligible Medicaid recipients losing benefits, but how the problem is resolved varies. In Washington, D.C., it took a court injunction. In Colorado, the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services ordered corrective action.

In Louisiana, officials decided on their own to fix the problem.

“Our kids were on, off, on, off Medicaid. It was taking up a lot of our time to get them re-enrolled and then we would be at the same place in 18 months when they again didn’t have insurance. It’s like a hamster on a wheel. We weren’t getting anywhere,” said Ruth Kennedy, who runs Louisiana’s Medicaid program.

Her agency over the last 10 years has deployed a range of initiatives as it brought its computer management system into the 21st century.

While awaiting that lengthy and expensive upgrade, the state agency began a new approach: It automatically re-enrolled children and adults for Medicaid. The letter that used to be required to be filled out, returned by the recipient and then processed by her agency in order to continue services now just requires recipients to call if their situation has changed.

Bremby didn’t outright dismiss this possible solution from happening in Connecticut down the road, but he said he’s not sure if it’s feasible and wants to see how the computer modernization and new staff helps out.

“We are as concerned with this situation as Sheldon is. We are working to improve,” he said.