DSS’ new system wrongly cutting off benefits, advocates say

Even though Pamela Brown twice sent in the paperwork needed to maintain her family’s Medicaid benefits, she ended up uninsured. That meant she had to pay out-of-pocket for her 3-year-old daughter’s flu shot last month (needed for day care) and, for a time, went without her thyroid medication because she couldn’t afford both the prescription and groceries. “I was trying to wait it out because I did everything [the state Department of Social Services] had wanted me to, twice,” Brown said.

One of Abigail Egan’s clients, a woman whose daughter has spina bifida, learned her Medicaid coverage had been terminated when she went to the doctor and was turned away early this month, according to Egan, the human services director for the town of Plymouth.

Legal aid attorneys say there are many more people who also lost their benefits despite doing what was needed to continue receiving assistance. And they say it will keep happening each month unless DSS changes how it handles clients’ cases.

It’s not clear how many people have lost benefits despite sending in the needed paperwork. Despite repeated requests from The Mirror, DSS has not provided information on the number of people whose benefits were terminated at the end of October, or on how many people cut off in previous months later had their benefits restored.

DSS’ ability to handle the paperwork needed to provide and maintain assistance for close to 750,000 state residents has long been a source of contention and litigation between the state and client advocates, who say the agency needs to hire more staff. DSS leaders have maintained that a recently implemented system for handling paperwork will be enough to improve things. But advocates say the experiences of clients like Brown indicate that DSS isn’t able to address clients’ cases fast enough, and that in some ways, the new system has made things worse.

DSS spokesman David Dearborn said people lose benefits for various reasons. In the “great majority” of cases, he said at the end of October, the discontinuances were appropriate, including situations in which people were no longer eligible or did not submit the required documents, although he did not provide specific numbers.

In some cases, Dearborn said, people send in their documents too late for workers to process them by the time they’re slated to be cut off at the end of the month.

Egan said the clients of hers who lost their benefits at the end of last month had certified mail receipts proving they sent in their forms. They were able to get their benefits reinstated if they went in person to a DSS office, she said, but some went almost a week without food stamps.

“It’s really, really appalling,” Egan said. “These are all people that we have good documentation that their paperwork was sent in in a timely manner.”

As part of DSS’ new system, all client documents are routed to a state contractor that scans them into a computer system that DSS workers anywhere in the state can access. It’s intended to speed up the processing of cases, since any worker can handle any client’s case. In the old system, workers were assigned specific cases and relied on paper files, so if one worker was busy or away, a client’s case might not get addressed.

But legal aid attorneys say it appears that in the new system, the department can’t prioritize which forms workers should tackle first, leaving some renewal forms to linger in the computer system, unprocessed, while clients get notices that they will lose benefits.

In a letter to Social Services Commissioner Roderick L. Bremby, they asked for DSS to do one of three things: Set up a system to identify renewal forms that get scanned into the computer system so they can be prioritized and processed before someone is at risk of losing benefits; hire more staff to process cases; or change the system’s defaults so clients remain eligible unless they’re found to be ineligible, rather than requiring action to keep them enrolled.

Previously, legal aid attorneys asked DSS to extend the benefits of people facing renewal deadlines to avoid wrongful terminations. The department had done so in late August because there was a backlog in scanning documents into the DSS system.

But department officials declined the request to do the same thing last month, saying the scanning backlog had been eliminated. They said clients who sent in the needed forms but had their benefits cut off would get their benefits retroactively.

That’s not good enough, legal aid attorneys wrote to Bremby.

“It is impossible to retroactively provide health care to the recipient who delayed refilling an important prescription or retroactively quell the hunger of a child whose parents could not buy food. These fully predictable terminations are not only illegal but are causing harm,” wrote the lawyers, Kristen Noelle Hatcher of Connecticut Legal Services and Sheldon Toubman and Shelley White of the New Haven Legal Assistance Association.

Often, people who lose their Medicaid benefits don’t learn about it until they go to the doctor or try to fill a prescription, advocates say. Egan heard from people whose children have severe medical needs and go to the doctor frequently, but she figures there are more people who lost coverage but have healthy kids and don’t use their Medicaid benefits as often. In those cases, she said, “We’re not going to know until they get strep throat and something happens and oops, suddenly they have no benefits.”

In the case of food stamps, some clients have learned their accounts weren’t replenished until they tried to check out at the grocery store, advocates said.

Sarah Hamby learned her food stamps were cut off by checking online. Although she sent in the paperwork to show she still qualifies before it was due in September, Hamby said DSS’ online account system repeatedly told her that her documents hadn’t been received and she wouldn’t get any benefits in November.

Hamby, who attends college as part of a retraining program for veterans, called DSS and heard a recording that said the department was having trouble scanning documents on time, but that people would get their October benefits.

On Nov. 1, when Hamby logged into the DSS computer system and learned she wasn’t getting food stamps, she called the department and, after an hour on hold, was told she needed to do a phone interview. In the past, Hamby said, DSS would send a letter if she needed to do an interview, but she didn’t get one this time. She did the interview that morning.

Although the online system said that morning that DSS had not received her paperwork, Hamby said the worker doing the interview referred to it, indicating that the agency had it.

Her food stamps were restored that day. But Hamby worries others will go hungry if they’re not as persistent.

“There are people who don’t know that you have to kind of harass people, because you do,” she said. “There are probably people who have given up by now.”

Legal aid letter to Bremby (back to story)