Testimony about the state Department of Social Services’ handling of Medicaid applications resembled something of a math problem Monday.
At issue in the trial in U.S. District Court in Hartford is whether the department has enough employees to process Medicaid applications in time frames required by the federal government. And on Monday, each side offered its take on what is needed to meet the record-setting demand for the medical assistance program.
Sheldon Toubman, an attorney with the New Haven Legal Assistance Association who filed the lawsuit, presented two figures. By his calculation, DSS needs 640 more workers to handle eligibility. It currently has 881.
He also presented evidence that a DSS official last year thought the department needed 540 more workers, but didn’t think the commissioner could request so many new hires from the governor’s budget office.
But attorneys representing the department and a top DSS official offered a different view, with a different set of calculations. In the past 18 months, the department has hired 220 eligibility workers, and there are plans to hire 35 more. Major changes in the department’s technology and operations are slated to take effect in the coming months, which they said could improve the way applications are handled without requiring more staff. And they suggested that the department is making improvements with existing staff and resources, and shouldn’t be subject to sanctions.
The lawsuit, filed last January, alleges that a decade of eroding staffing levels have made the department unable to keep up with skyrocketing demand for social service programs, leaving people who apply for Medicaid to wait months without health care coverage — far longer than the 45 days federal law gives the state to process most applications.
Toubman noted that since 2002, the number of people receiving Medicaid has grown by nearly 80 percent, from approximately 346,000 to more than 619,500. In that time, the number of people responsible for determining whether people are eligible rose by about 4 percent, from 845 to 881.
His projection that DSS needs 640 more workers is based on the premise that the number of staff should have risen proportionate to the number of people enrolled in Medicaid.
A more modest calculation came from Darleen Klase, who is in charge of training at DSS. In a memo to Commissioner Roderick L. Bremby last year, Klase suggested DSS needed 540 more eligibility workers, but she wrote that, “I do not think you could make a request for that level of staffing.”
Instead, over two rounds of hiring since then, DSS added 220 more workers.
The memo came up during the testimony of Astread Ferron-Poole, DSS’ director of administration and chief of staff.
If Klase’s analysis was correct and the department needed 540 more workers, Toubman asked Ferron-Poole, didn’t hiring 220 workers leave the department 320 short?
But Ferron-Poole said she didn’t think the analysis was correct. It didn’t address advances in technology or changes in business processes intended to improve efficiency and improve application handling, scheduled to take effect in the next two to three months.
“All of which is in the future,” Toubman said.
“But the future is in the next few months,” Ferron-Poole said.
Toubman suggested that department officials had sought to hire more workers, but had been rebuffed by the governor’s budget office. He pointed to a Jan. 22 memo to department heads from Office of Policy and Management Secretary Benjamin Barnes, which said only requests to fill “critical vacancies” would be considered, and that no hiring would be approved that leads to an overall increase in filled positions.
Ferron-Poole noted that Bremby requested to hire more workers after that memo, and that Barnes’ office gave DSS permission to hire 35 eligibility workers. That’s fewer than requested, she said.
The changes in technology and how DSS does business, referred to as modernization, include an interactive phone system that lets clients learn about their case without talking to a worker, the ability to access case information online, and a document imaging center that will computerize all files, allowing any eligibility worker to help a client who calls. Currently, the department uses paper files, and a client calling to get specific information about a case must talk to the worker who has his or her physical file.
Beginning in July, Ferron-Poole said, “Whoever on the DSS side answers the phone will be able to help a client and get the client whatever information they need, so that the client doesn’t have to speak to their particular worker,” she said.
Toubman asked Ferron-Poole about a report from a consulting firm that suggested that, once modernization is fully implemented, DSS would need between 81and 395 fewer workers than it otherwise would.
If DSS needs more than 600 more workers to match the caseloads of 2002, Toubman said, wouldn’t modernization at its most efficient still leave the department more than 200 workers short?
Correct, Ferron-Poole said.
But in cross-examining Ferron-Poole, Assistant Attorney General Jennifer Callahan, representing DSS, took issue with Toubman’s projection of how many more workers are needed. She suggested that caseloads haven’t increased as dramatically as Toubman’s figures indicate, and that changes in how the department functions make the comparison to earlier caseload and staffing levels invalid.
Under questioning from Callahan, Ferron-Poole explained the difference between the number of enrollees in the program and the number of cases. Because multiple people in a family are often covered, there are more individuals in the program than there are cases. And since 2002, the rise in cases has not been as dramatic as the rise in the number of people enrolled.
In addition, she said, there have been changes in programs that have made it less time-consuming for workers to process some applications. And DSS has outsourced some functions since 2002.
And what about the other suggested number of hires, 540 new workers? That recommendation came before the 220 newest workers were hired, and before the technology changes, Ferron-Poole said.
Add the 220 new workers and 395 — the number of workers the efficiencies of modernization could represent — Callahan said, and doesn’t that bring you over 540?
Correct, Ferron-Poole said.
Gian-Carl Casa, a spokesman for Malloy’s budget office, said the administration has asked agencies to “do more with less.”
“We’ve given DSS staffing assistance so they can do a better job of processing paperwork in a timely fashion, but we also know that the real goal is to improve the department’s technological capabilities, which have really not been upgraded in more than 20 years,” he said.