To solve DSS delays, more staff or better technology?
It’s not uncommon for a worker’s phone to ring 20 to 30 times a day at the Department of Social Services’ Danbury regional office where Isabel King works.
The workers she supervises, who handle applications for the department’s wide range of social service programs, must choose between answering and explaining to a client why they haven’t processed his or her application, or letting their voicemails build up while trying to tackle the crush of paperwork.
King said eligibility workers face caseloads of 2,400, nearly 10 times what they were when she began the job two decades ago. She’s often at a loss for how to tell them to prioritize.
“The goal is to get as many of the new applications into the system as possible,” she said. “But it’s also to complete as many of the old applications as possible, and when you have emergencies or you have things that need to be activated … to get those done as quickly as possible.”
Eligibility workers like those in King’s office are in the crosshairs of contradictory trends: A massive increase in applications for social service programs and, in the past decade, a more than 30 percent drop in the number of workers to handle them.
The department has 558 eligibility workers in its 12 regional offices, down from 648 in 2009 and more than 800 in 2002.
King said the situation can be improved by hiring more staff to help get the work done now. So do the legal aid attorneys who sued DSS last week, alleging that the erosion of agency staffing in the past decade had produced widespread delays in processing Medicaid applications, leaving thousands of low-income residents without access to medical coverage and the state at risk of losing federal matching funds.
Social Services Commissioner Roderick L. Bremby said Saturday that the agency plans to seek approval from the governor’s budget office to hire more than 100 new staff, all but 14 of which would be eligibility workers. The department is already in the process of refilling 52 eligibility worker positions that were vacated through retirements in September and October, and is seeking authorization to hire back retired workers to help with eligibility on a temporary basis.
But Bremby said that fundamentally, the way to improve the problems that stem from “decades of lack of investment” is to transform the way the work gets done at an agency that still relies heavily on paper and a computer system from 1989. Some technological improvements — part of a “modernization” plan — will be available within six months, he said.
“We can’t just throw people at this,” said Bremby, who became commissioner in April. “We need to throw technology and a changing culture and some strong leadership, and that’s what we’re focusing on. It’s the entire system.”
Bremby likes to illustrate the balance of human and technological solutions with a story: If he told people to take down a tree and handed them a pocket knife, they’d have trouble. He could send in 10 more people with pocket knives. Or he could get them a chainsaw.
But what happens before the chainsaws are available?
King sees hope in the prospect of better technology but said it can’t come fast enough.
“It seems like everybody’s saying, ‘When modernization happens, it’ll be better,'” she said. “That’s not helping the people that we’re trying to serve right now.”
The Medicaid lawsuit was aimed at making a similar point. Sheldon Toubman, an attorney with the New Haven Legal Assistance Association, said Bremby’s public statements helped inspire the lawsuit.
“His plan has been a long-term plan, and I’m not saying it’s not a good plan. It may be. We hope it is,” Toubman said. “But those public statements have done nothing about immediate hiring, which is the only way to address the problem, the backlog, in the short term.”
The blanket’s too small
King and others say the strain on workers has been heightened by the move made last year to devote some eligibility workers to handling only the Supplemental Nutrition Assistance Program, or SNAP, the program formerly known as food stamps. Last year, federal officials warned that the state could face financial sanctions if it did not improve its record of delays and inaccuracies in SNAP — problems that then-Commissioner Michael P. Starkowski attributed to understaffing, skyrocketing caseloads and outdated technology.
Bremby said the decision to assign some workers to focus on SNAP was based on the threat of sanctions and the need to understand why errors were occurring and how to eliminate them and reshape the department’s work processes.
In King’s unit, there are now four people who work on SNAP cases, two devoted to other individual programs, and two who serve as generalists, handling eligibility for all the other programs DSS administers.
“I’ve been with the department for 25 years, and it seems that we’ve always reacted and whatever the fire of the moment is is where they put the resources,” said Jay Bartolomei, who works at DSS’ Hartford regional office and is president of AFSCME Local 714, which represents eligibility workers.
“You can rearrange the deck chairs however you want,” he added. “The bottom line [is] years ago we had 800 folks processing eligibility. Now we have over 500.”
The nursing home industry has also raised concerns about delays in processing applications for benefits, although its approach has been to work with the department on potential solutions.
It’s not uncommon for applications for Medicaid long-term care coverage to be pending for six months or more, said Matthew Barrett, executive vice president for the Connecticut Association of Health Care Facilities, which represents nursing homes. When the applications are for people already in nursing homes, DSS can owe the facility upwards of $500,000 in back payments by the time the application is granted.
“Nursing homes for long periods of time are being expected to provide effectively free care while nursing homes have ongoing obligations to meet payroll and pay critical vendors,” Barrett said.
In other cases, Barrett said, the delays could cost the health care system more money if a person is staying in a hospital — with higher costs — while the application for Medicaid coverage for nursing home care is pending.
Barrett said he’s asked DSS to consider advancing payments to nursing homes as a short-term solution.
“We think the agency is on target in working towards long-term solutions,” he said. But he added that DSS needs to increase its staffing or use of overtime to process the backlog of applications.
Bremby acknowledged that department officials often have to choose to focus on a particular area at the risk of leaving behind something else. He likened it to having a blanket that’s too short to cover everything that needs coverage.
But he said the idea of hiring hundreds of people in the short term is unrealistic for the department’s current infrastructure. When DSS had more than 800 eligibility workers, it also had three more regional offices and two outposts; even if the department could hire 300 more eligibility workers, there wouldn’t be space for them, nor would there be a need given the coming technological changes. Bremby also dismissed the idea of having a vendor handle applications, saying there are privacy and infrastructure concerns.
Getting new hires on board takes time, and Bremby said the department is also examining how it hires. Until now, recruitment had been done separately by DSS’ three regional human resources offices. Officials have begun to centralize the process.
“I hesitate to say this, but we’re trying to make changes and correct the collateral damage of decades of lack of investment, and we can’t do that in a year,” Bremby said.
Into another century
The modernization effort Bremby touts is slated to roll out in phases, taking a total of 16 months from its Nov. 28, 2011, start and ultimately giving people the ability to apply for benefits or provide updates to the department online. Bremby said most of the changes are scheduled to be in place this year. There’s also a project under way, officially launched Friday, to replace the department’s eligibility management system that dates to 1989.
By May, every DSS office is scheduled to have an interactive phone system that allows people who call in to access information on their cases, or more general information, without having to wait to speak to a person, like the eligibility workers in King’s office.
Four regional offices have the new phone systems already and Bremby said they’re resolving 40 percent of the phone calls without a worker having to answer. Bremby said workers in those offices have reported that the phones aren’t ringing as much as they used to, and that they can actually get work done, while clients have said they got the information they needed.
The schedule also calls for a “MyAccount” feature within six months that would allow someone to find out the status of his or her case through the DSS website and learn whether any additional documentation is needed.
By the end of 12 months, the department is scheduled to have a centralized way to access documents, reducing the need for paper case files and allowing a worker in one office to answer case-specific questions for a client calling from another region. The department would also have a centralized benefits center to address incoming calls and serve clients throughout the state.
Although he expects the department to ultimately do more, Bremby acknowledged that much of the work will be to catch up.
“It brings us into, OK, the 20th century,” he said.
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