Transcript Slide 1

House Human Services Committee
80th Legislature
Testimony on the Integrated Eligibility System
February 23, 2007
Celia Hagert, Senior Policy Analyst
[email protected]
(512) 320-0222 x100
Center for Public Policy Priorities
www.cppp.org
Overview
•
•
•
•
•
Historical challenges in the eligibility system
The original Integrated Eligibility (IE) model
Problems in the IE pilot
The revised IE model
Ongoing challenges – the symptoms of a
troubled system
• Recommendations to support a smooth
transition to the new system
Center for Public Policy Priorities
www.cppp.org
Center for Public Policy Priorities
www.cppp.org
Historical challenges
• Clients are not easy to serve – majority are poor;
many are elderly, have disabilities, or grapple
with language barriers
• Application requirements are complex
• Eligibility determination is complicated &
requires extensive and constant training of
caseworkers
• Rules vary considerably by program and within
programs
• Labor-intensive process is costly for states &
complicated for clients
Center for Public Policy Priorities
www.cppp.org
Historical challenges
• Legislature has not provided necessary
staff or funding to ensure effective
administration
– Cut staff by 40% from 96-04 despite
increasing caseloads and workload
(applications grew, work became more
complex)
• Out-of-date technology has lead to
duplication of effort and “red tape”
• Chronic underfunding exacerbates other
challenges
Center for Public Policy Priorities
www.cppp.org
Center for Public Policy Priorities
www.cppp.org
Historical challenges
• Services to clients have suffered
– Less than half of eligible households get
Food Stamps
– Half of uninsured kids are eligible for
Medicaid/CHIP, but not enrolled
– Clients frustrated, deterred
• Heavy staff workload has lead to high
turnover, poor customer service
Center for Public Policy Priorities
www.cppp.org
A Vicious Cycle
heavy workload,
lapses in customer
service
high turnover rates
staffing
shortages,
limited resources for automation
Center for Public Policy Priorities
What happens?
• System doesn’t work
• Client services suffer
• Public confidence in
system is undermined
• Alternative
approach/fix sought
www.cppp.org
What is Integrated Eligibility?
• Modernization of eligibility determination &
enrollment:
–
–
–
–
Better technology & greater automation
Centralized & paperless computer system (TIERS)
Remote application options (call centers, Internet)
More partnerships with nonprofits
• Privatization – “TAA” contract includes
development, administration, and partial staffing
of system
Center for Public Policy Priorities
www.cppp.org
The original IE model
Application
Options
Self Service
• Phone
• Mail/Fax
• Web
Clients
TAA
Responsibilities
Support of Eligibility
Screen
Collect data for
applications and redeterminations
Process documents
Enrollment
Assisted Service
• TAA
• HHSC Benefits Office
HHSC
Responsibilities
Select network
Manage enrollment
Support
Make data changes
Handle inquiries
Refer fraud/abuse
Process complaints/
appeals
• Determine eligibility
• Certify and issue
benefits instruments
• Hear appeals
• Provide in person
assistance
• Issue expedited
benefits
Benefits
(TANF,
Food Stamps
Medicaid,
CHIP)
Source: Adapted from a graphic provided by the Texas Health and Human Services Commission
Center for Public Policy Priorities
www.cppp.org
Assumptions in the IE Model
• Better technology, smarter processes would
reduce application processing time & staff
workload
• Technology would improve accuracy, reduce
fraud & ensure better stewardship of tax dollars
• Simpler process, more application options would
improve access for clients
• Private sector could do it better, cheaper
• CBOs would support the new model by helping
clients navigate the more automated system
Center for Public Policy Priorities
www.cppp.org
Assumptions in the IE Model
• Overall staff could be reduced
• Many policy-knowledgeable state staff
could be replaced with lower-skilled
vendor staff
• Fewer local offices would be needed
• State would save $646 million over 5
years
Center for Public Policy Priorities
www.cppp.org
Flaws in the IE Model
• No staffing analysis to determine true needs in
“old” system – staff had already been reduced
40% from 1996-2004
• No evidence to support two primary
assumptions:
– Fewer staff would be needed in IE model
– Low-skilled, low-paid vendor staff could replace
trained state staff
• Staffing assumptions dependent on assumptions
about technology & automation
Center for Public Policy Priorities
www.cppp.org
Missteps in the IE Approach
• Unrealistic expectations about savings
• Overly aggressive timeline
• Premature loss of staff
• Inadequate testing & training (i.e., Max-e/TIERS
interface)
• Premature pilot
= Delays & denials of services to clients
Center for Public Policy Priorities
www.cppp.org
Permanent vs. Temporary Staff
8,000
7,000
8,000
6,920
6,637
7,000
6,247
5,612
6,000
5,000
6,000
5,000
Permanent FTEs
4,000
4,000
3,000
3,000
2,000
2,000
1,000
1,000
0
Oct 04
Apr 05
Center for Public Policy Priorities
Oct 05
May 06
Temporary FTEs
Total
0
www.cppp.org
Pilot Problems
• Technical problems
– Computer interface didn’t work
– Documents lost or couldn’t be located
• Poor training of vendor staff
– Unable to answer questions
– Did not process applications correctly
– Asked clients for wrong information
• Inadequate complaint resolution process
• Staffing shortages – private and public (long wait
times at call center/high call abandonment rates)
Center for Public Policy Priorities
www.cppp.org
Pilot Outcomes
• Large backlogs in application processing lead to
delays in services to thousands of families
• More than 100,000 kids lost health coverage in
first four months of the pilot
• Surge in missing information requests &
“procedural denials” for failure to complete
application process
• Rise in Food Stamp error rates
Center for Public Policy Priorities
www.cppp.org
Federal oversight
• USDA is monitoring system’s performance
• Conditioned funding & contract approval on
new system’s ability to maintain program
access and program integrity
• Hired Booz Allen as technical consultant to
monitor system readiness from a technology
perspective & evaluate potential risks
• Conducted two reviews of pilot in 3/06 and
9/06
Center for Public Policy Priorities
www.cppp.org
Federal oversight
• USDA’s main concerns & findings
•
•
•
•
Lack of timeliness
Rise in error rates
Higher denial rates
Data collection problems – HHSC has not
provided the data requested & needed to
evaluate performance
• Problems with TIERS, in particularly its ability to
track overpayments (also noted by HHSC OIG)
• Funding for further rollout remains
conditional
Center for Public Policy Priorities
www.cppp.org
Revised IE approach
• Contract size & term reduced
• Maintain current state staffing levels,
convert many temps to permanent staff
• Reduce role of vendor staff, increase role
of state staff
• Focus on technology
• Continue with TIERS rollout
• Re-launch pilot “when ready”
Center for Public Policy Priorities
www.cppp.org
Staffing Levels for FY 08-09
(if exceptional item funded)
8,000
7,000
8,000
6,920
6,637
7,000
6697
6,309
6,247
5,612
6,000
6,000
5,000
5,000
Permanent FTEs
4,000
4,000
Temporary FTEs
3,000
3,000
2,000
2,000
1,000
1,000
0
Total
0
Oct 04
Apr 05
Oct 05
Center for Public Policy Priorities
May 06
Oct 06
FY 08-09
www.cppp.org
Ongoing Challenges
• Inadequate staff & heavy workload
• Application delays persist - timeliness
is below federal standards in most
metro areas
• Error rates are above national
average, exposing state to potential
financial penalties
• These problems WON’T go away until
new system rolls out AND delivers
promised efficiencies
Center for Public Policy Priorities
www.cppp.org
Downsizing of Eligibility Workforce Increased Workload
1996-2006
14000
1100
900
Number of staff
10000
800
8000
700
6000
600
500
4000
400
2000
Average workload per worker
1000
12000
Number of staff
Average
w orkload per
w orker
300
0
200
1996
2003
Center for Public Policy Priorities
2004
2006
www.cppp.org
Timeliness – Delays
• Statewide, new application timeliness is well
below federal standard (95% processed within
30 days for Food Stamps/45 for Medicaid)
• Delays are severe in Region 3 (DFW), Region
5 (east Texas), Region 6 (Houston), Region 7
(pilot area)
• Food Stamps/TANF – worst in Regions 3, 6 &
7
• Medicaid – worst in Region 3 & 7
Center for Public Policy Priorities
www.cppp.org
Timeliness - Statewide
Percent of New Applications Processed Timely, January 07
Medicaid
Food Stamps
TANF
Region 1
96.6%
95.3%
95.2%
Region 2
92.8%
91.2%
92.4%
Region 3
81.7%
72.2%
78.3%
Region 4
96.3%
94.3%
95.9%
Region 5
93.2%
91.0%
94.5%
Region 6
87.9%
84.2%
88.5%
Region 7
68.9%
78.9%
84.6%
Region 8
96.5%
93.4%
97.0%
Region 9
93.3%
92.6%
93.7%
Region 10
94.3%
96.6%
94.7%
Region 11
97.0%
90.8%
92.8%
Region 00
98.1%
75.3%
0.0%
State
86.9%
84.6%
88.6%
Federal standard = 95%
Center for Public Policy Priorities
www.cppp.org
Timeliness in New Application Processing
Percent processed timely
Timeliness – past 12 months
100.0%
Federal standard = 95%
95.0%
FS
90.0%
TANF
85.0%
Medicaid
80.0%
75.0%
May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan06 06 06 06 06 06 06 06 07
Center for Public Policy Priorities
www.cppp.org
Region 3 Food
Stamp Timeliness
Timeliness
– DFW
(Region 3)
Federal Timeliness
Standard
100.0%
95.0%
90.0%
85.0%
80.0%
75.0%
70.0%
65.0%
60.0%
May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07
Center for Public Policy Priorities
www.cppp.org
Region 3–Medicaid
Timeliness
Timeliness
DFW
(Region 3)
Federal Timeliness
Standard
100.0%
95.0%
90.0%
85.0%
80.0%
75.0%
May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07
Center for Public Policy Priorities
www.cppp.org
Region 6 Food Stamp Timeliness
Timeliness – Houston (Region
6)
Federal Timeliness
Standard
100.0%
95.0%
90.0%
85.0%
80.0%
75.0%
70.0%
65.0%
60.0%
May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07
Center for Public Policy Priorities
www.cppp.org
Region 7 Pilot Area
Timeliness –Food
Pilot
Area
(Region
7)
Federal
Stamp Timeliness
Timeliness
Standard
100.0%
95.0%
90.0%
85.0%
80.0%
75.0%
70.0%
65.0%
60.0%
May-06 Jun-06
Jul-06
Center for Public Policy Priorities
Aug-06 Sep-06 Oct-06
Nov-06 Dec-06 Jan-07
www.cppp.org
7 Pilot
Area (Region 7)
Timeliness – Region
Pilot
Area
Medicaid Timeliness
Federal Timeliness
Standard
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07
Center for Public Policy Priorities
www.cppp.org
Food Stamp Error Rates
Texas Food Stamp Error Rates Increase in Federal
Fiscal 2006
Oct. 05
4.47%
Oct. 05 - Nov. 05
4.57%
Oct. 05 - Dec. 05
5.67%
Oct. 05 - Jan. 05
5.96%
Oct. 05 - Feb. 06
6.77%
Oct. 05 - Mar. 06
6.95%
Oct. 05 - Apr. 06
6.86%
Source: Health and Human Services Commission
Center for Public Policy Priorities
www.cppp.org
Error Rate Comparison
Food Stamp Rates in the Big Eight States in FFY 05 & 06
State
Pennsylvania
Texas
Illinois
California
Florida
New York
Michigan
Ohio
United
States
FY 05
Cumulative
Error Rates
4.51%
5.03%
5.75%
6.38%
7.19%
7.23%
7.34%
8.65%
5.84%
Rank in 05 (lowest
to highest)
1
2
3
4
5
6
7
8
FY 06 YTD
Rank in 06 (lowest
Cumulative
to highest)
Error Rates
(through
May 06)
2.96%
1
6.82%
5
6.20%
4
6.06%
3
9.38%
8
5.23%
2
7.07%
7
7.01%
6
5.75%
SOURCE: Summary data reported by states to USDA's Food and Nutrition Service. Data for
FY 05 are preliminary as of 2/1/06. Data for FY 06 are unweighted and preliminary as of
9/22/06.
Center for Public Policy Priorities
www.cppp.org
Caseloads – Food Stamps
Food Stamp Recipients, FY 2005-present
3,500,000
Dec '05 peak = 2.92 million
Katrina grow th
3,000,000
2,500,000
2,000,000
Now = 2.32 million
-5% drop since FY 05
FY'05 = 2.44 million
1,500,000
Ja
n07
ov
-0
6
N
Se
p06
Ju
l-0
6
06
M
ay
-
06
M
ar
-
Ja
n06
ov
-0
5
N
20
04
FY
FY
20
02
1,000,000
Notes:
• The influx of Katrina evacuees makes it hard to identify caseload trends
• TIERS data collection problems make it difficult to identify trends in the
pilot area.
Center for Public Policy Priorities
www.cppp.org
Caseloads – TANF
County
Sep-05
STATE
190,989
151,890
-39,099
-20%
Harris
27,240
19,339
-7,901
-29%
Hidalgo
24,965
23,179
-1,786
-7%
Dallas
17,188
12,171
-5,017
-29%
Bexar
12,773
9,234
-3,539
-28%
El Paso
12,740
10,683
-2,057
-16%
Cameron
11,824
10,522
-1,302
-11%
Tarrant
10,240
7,415
-2,825
-28%
Travis
Hays
Dec-07
Change
% Change
6,171 NA
NA
NA
373 NA
NA
NA
Notes:
• Caseload decline is similar to previous two years – due to full family
sanctions, time limits, work-first approach
• TIERS data collection problems make it difficult to identify trends in the
pilot area.
Center for Public Policy Priorities
www.cppp.org
Important questions
• Technology – does it work? How much does
automation reduce workload?
• Are there enough state staff to support the
transition?
• How long will it take to roll out the new system?
• How many staff will be needed in the new
system?
• Can vulnerable populations navigate more
automated system?
• Does the revised model (new business
processes/workflow) work?
• What is the right role for a private company?
Center for Public Policy Priorities
www.cppp.org
Recommendation #1:
Improve oversight
Overarching goal: prevent similar problems from
occurring through better oversight
• Establish legislative oversight process
• Establish statutory benchmarks and criteria to evaluate
IE:
– Timeliness at or above federal standards
– Reduce procedural denials to FY 2005 levels
– Rebuild child health enrollment, stabilize caseloads
– Error rates at or below national average
• Use these criteria to determine whether system is
performing well, contractor is meeting performance
measures, and IE is ready to expand
Center for Public Policy Priorities
www.cppp.org
Recommendation #2:
Protect the vulnerable
• Evaluate impact of remote application process
on vulnerable populations (i.e., seniors,
persons with disabilities, the homeless, people
with language barriers)
• Look at caseload & administrative data relevant
to these populations
• Survey CBOs that serve these populations
• Conduct exit interviews with applicants
• At the end of the day, the true test of a good
system is its ability to serve the most vulnerable
Center for Public Policy Priorities
www.cppp.org
Recommendation #3:
Support contracting reforms
• Improve contract writing, monitoring &
enforcement by building agency capacity
• Establish a means to monitor contractor
performance
• Strengthen conflict-of-interest provisions
• Establish a sound process for making
outsourcing decisions that protects clients
and taxpayers
Center for Public Policy Priorities
www.cppp.org