There’s never been a test like COVID-19. Will the state pass?
Applications for food stamps in Connecticut spiked tenfold to a one-day high of 1,400, then settled to a daily average of 453 — merely triple the norm. Unemployment claims totaled 250,000 over 18 days, about 70,000 more than in the entirety of 2019. A $25 million emergency small business-loan pool was exhausted in two days.
The numbers are numbing.
Never have so many needed so much so soon.
The COVID-19 pandemic is subjecting state government to an unprecedented stress test. Connecticut is struggling to simultaneously slow the spread of the disease, meet immediate medical and material needs, assess and implement new federal benefits, and plot a long-term recovery of its economy and health care system.
“It’s just chaos,” said James Bhandary-Alexander, a New Haven legal-aid lawyer trying to guide needy clients while working remotely from home.
And that, he says, is not criticism.
“I know they are working like crazy,” Bhandary-Alexander said. “Overall, we need big-picture thinking. And the big picture is people need resources now.”
It’s just chaos…I know they’re working like crazy. Overall, we need big-picture thinking. And the big picture is people need resources right now.”
With the passage of three aid packages opening the federal treasury, the challenge is less about money than devising how to get it where it’s needed now. There is a five-week backlog in processing unemployment claims. Without offering details, Gov. Ned Lamont said Monday that his administration is exploring procedural and technological fixes that could quicken the processing of unemployment benefits.
Lamont says the crisis has exposed the inadequacy of information-technology systems in state governments across the U.S. While the state was already planning an upgrade, the computer powering Connecticut’s unemployment is a mainframe that runs on COBOL, a 60-year-old programming language.
“We’ve crashed a couple of times,” Lamont told MSNBC on Tuesday.
Substantive procedural changes would require a sign off by the U.S. Department of Labor. But, for better or worse, change is coming faster in the age of the coronavirus.
The old organizational charts and rules for buying, building, approving and distributing things are in a state of suspension. Connecticut is being governed by officials organized around 15 “Emergency Service Functions,” or ESFs, and a nearly daily stream of executive orders drafted by a small staff of lawyers and signed by Lamont.
“The usual procurement playbook at this point is out the window,” said Josh Geballe, the commissioner of administrative services and, since Feb. 27, also the state’s chief operating officer. “We are being much more aggressive, acting much more quickly and candidly taking much more risk in the procurement process.”
Lamont’s first move
Lamont on March 10 issued Executive Order 7 imposing a public health emergency, giving him sweeping powers. The legislature offered no objection, and it effectively suspended its 2020 session the next day.
Connecticut had two laboratory-confirmed cases of COVID-19 and no deaths when Lamont declared the emergency. On Monday, April 6, less than a month a later, the state had 6,906 cases and 209 deaths of patients who tested positive with the disease. The governor has issued 23 other orders supplementing or revising the original.
The COVID-19 caseload is projected to peak here in late April or early May. Less certain is how long it will take for public health officials to recommend loosening the restrictions on commerce, travel, education and social life — or what a recovery will look like.
“This is a very different type of emergency, both in its type and its duration,” said Deidre Gifford, the commissioner of social services. “So the thinking is it needs to be flexible and reflect the nature of the needs that are arising as a result of the COVID-19 emergency.”
Gifford, a physician who was a deputy director at the federal Centers for Medicaid and Medicare Services before taking over at DSS last June, is the coordinator of Emergency Service Function 6: the delivery of mass care, emergency assistance, housing and human services.
Her old employer is issuing waivers of federal rules on eligibility for Medicaid and other programs at a rate impressive to legal aid lawyers, who often chafe at the constraints in providing aid to everyone who need it.
“The feds are giving broad, broad waivers,” said Sheldon Toubman, a legal aid lawyer who works on health access issues.
While the president regularly tussles with governors over the adequacy of the federal response to the pandemic, the cooperation generally has been good at the agency level.
“We’ve had for the most part, with some exceptions, pretty quick turnarounds,” Gifford said. “They are approving waivers from all over the country. The lines of communication generally have been open, and we’re appreciative of that.”
Better in theory
Legal aid lawyers and others say they are racing to keep up with the changes, some of which sound more enticing in theory than in practice, at least immediately.
For example, the governor imposed a 60-day grace period for premium payments, policy cancellations and non-renewals of insurance policies that began April 1. It is broader than what legal aid requested, as it includes life, health, property and casualty, and other types of insurance. But it is not automatic.
Consumers must provide certain information to their insurance providers, and Toubman said there is no such thing as a simple transaction these days, given the high volumes at call centers. Toubman said delays in resolving an auto insurance bill may be tolerable, but not if health care is at stake.
Gifford is on the daily unified command call, a statewide status report that can run between 45 minutes and nearly two hours.
This is unlike anything we’ve seen in our lives.”
Backing her is a working group that includes two agency heads, the commissioners of the Department of Housing and the Office of Early Childhood, plus the director of the Office of Health Strategy and the president of Foodshare, a non-profit operator of a regional food bank that serves Hartford and Tolland counties.
Jason Jakubowski, the president and chief executive of Foodshare, delivers summaries to Gifford that reflect that status of the philanthropic network that helps feed the hungry. Programs like his are coping with an increased need and a loss of volunteers, some who are retirees heeding advice to self-isolate.
“This is unlike anything we’ve seen in our lives,” Jakubowski said.
Gifford’s group is focused on immediate needs and long-term consequences of the pandemic.
The Office of Early Childhood is hurrying to establish day care programs for health care workers and other first responders to the pandemic, while it also works on maintaining cash flow for a vital service industry with tight margins.
If the day-care industry collapses, the economic recovery will be all the harder for working parents, said Beth Bye, the early childhood commissioner.
Victoria Veltri, the director of the Office of Health Strategy, is monitoring access to health care during the pandemic and the costs to those who need it.
“We sort of went into this with the idea no one comes out of this situation with medical debt as a result of a public-health emergency,” Veltri said.
An early and immediate question: What would COVID-19 tests cost? Who would pay for them? Testing is necessary for individual care and tracking the advance of the disease.
As of Monday, there were 26,686 tested, with the numbers increasing rapidly as the capacity expands. There were 1,241 tests reported Sunday and 3,416 on Monday — 17 percent of the total in just two days.
Some insurers had agreed to waive co-pays on testing, but not all. The first federal relief bill mandated the testing be free to patients.
“That actually lifted a weight off us,” Veltri said.
In the past month, the governor has pushed hospitals to expand capacity by about 50 percent, an unprecedented change for an industry where expansion is closely regulated to balance needs against costs.
“In a normal week, we would be working on collecting data on health-care cost growth and implications of utilization rates and the certificate of need process,” she said.
A certificate of need is required for health care providers to make major changes, such as hospital mergers, substantial capital investments in new equipment or facilities, changing access to services, or discontinuing a medical service.
The third of the governor’s executive orders eased the process for obtaining waivers from the certificate-of-need process for many changes. Veltri’s office eventually waived even the need for a waiver on issues relating the temporary increases of bed capacity and suspension of other services to focus on COVID-19 care.
Instead, hospitals need to only email her office with notice of the changes.
At the same time, the state has encouraged the use of telemedicine to allow doctors to remotely examine and prescribe medications for patients, a policy intended to protect provider and patient from unnecessary exposure to the coronavirus.
“On the technology end, it’s not forced the issue, but accelerated it,” she said.
Veltri’s subgroup also is with working with Emergency Service Function 14, the group in the emergency governing structure responsible for long-term recovery and mitigation. It is led by David Lehman, the commissioner of economic and community development.
The state has opened enrollment to Access Health CT, the health insurance marketplace created under the Affordable Care Act. Access Health can provide premium assistance for insurance or care under Medicaid.
The income threshold for assistance is $49,960 for a single person and $103,000 for a family for four. For Medicaid, it is $17,608 for a single and $36,156 for a family of four.
The COVID-19 pandemic has tested every aspect of the health care system, from cost to availability. Veltri has studied the system from the viewpoint of consumers, while serving as the state healthcare advocate, and now from a broader vantage as the director of Office of Health Strategy in the midst of a crisis. She also sits on the the board of Access Health CT.
“I think it’s a stress test for everybody across the country,” she said. “It’s unlike anything I’ve seen in my lifetime. I think most people probably feel that way.”