Transcript Slide 1

Funding State Services Conference
Center on Budget and Policy Priorities
Making the Case for an
Adequately Funded Eligibility System
November 14, 2006
Celia Hagert, Senior Policy Analyst
[email protected]
Center for Public Policy Priorities
www.cppp.org
The Big Picture
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Looking Back a Decade
Caseload and Staffing Changes, 1995-2006
7,000,000
14,000
6,000,000
12,000
5,000,000
10,000
4,000,000
8,000
3,000,000
6,000
2,000,000
4,000
1,000,000
2,000
0
Clients
Total Staff
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
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State, Federal Welfare Reform
Instigate Staffing Reductions
• TANF/Food Stamp caseloads decline
following state and federal welfare
reforms in 1995-1996
• Legislature begins reducing staff
– 96-99: 12% cut
– 96-01: 18% cut
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Number of families
seeking services did not drop
• Applications for benefits increased
due to Medicaid growth
• Food Stamp applications dropped
12%, TANF 37%
• Medicaid applications increased 18%
• Food Stamp and Medicaid caseloads
much larger than TANF
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Fewer clients, but heavier
workload: 99-01
• Individual workload grew due to welfare
reform policies, substantial increase in
frequency of Food Stamp renewals
• Average time for eligibility interview
increased from 50 to 90 minutes.
• Passage of CHIP in 1999 required more
work
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Workload increases, staffing
cuts continue: 99-01
Staffing and Workload Changes, 1995-2001
13000
460
12000
440
420
11000
400
10000
380
9000
Staff
Workload
360
8000
340
7000
320
6000
300
1995
1996
1997
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1998
1999
2000
2001
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Services to clients suffer
• Only one-third of eligible households
get Food Stamps
• Only 1 in 4 children referred to
Medicaid from CHIP successfully
enrolled
• Procedural denials surge in kids’
Medicaid (>65% denial rate in
transfer of kids from CHIP to
Medicaid)
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Customer Service Shortcomings
• Turnover rates ranged from 32 to 38% in metro
areas,
• Training, customer service suffer as understaffed
offices with
• inexperienced workers try to keep up
• Many positions remained unfilled due to difficulty
recruiting and retaining workers in competitive
job market.
• Vicious cycle: heavy workload
high turnover
heavier workload
difficulty recruiting/training
staff, etc.
• Several lawsuits related to customer service
shortcomings
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Advocates propose eligibility policy
reform, simplification in 2001
• Eliminate face-to-face initial interview
requirement*/assets test and allow 12 months of
continuous eligibility for children’s Medicaid*
• Eliminate vehicle asset test for Food Stamps
and TANF*
• Allow “hardship” clients to have phone
interviews for Food Stamps*
• Use policy simplification as opportunity to reduce
staff workload
*6-month renewal, $15K vehicle exemption, FS phone interview all passed
Center for Public Policy Priorities
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Advocates propose eligibility policy
reform, simplification in 2001
• Eliminate face-to-face initial interview
requirement*/assets test and allow 12 months of
continuous eligibility for children’s Medicaid*
• Eliminate vehicle asset test for Food Stamps
and TANF*
• Allow “hardship” clients to have phone
interviews for Food Stamps*
• Use policy simplification as opportunity to reduce
staff workload; argument rejected, cuts continue
*6-month renewal, $15K vehicle exemption, FS phone interview all passed
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State Proposes Modernization,
Outsourcing in 2004
•
•
•
•
57% reduction in staff
Close one-half of local offices
Set up call centers, online application
Replace higher-paid, policyknowledgeable staff with lower-paid, les
skilled contract workers
• Better use of technology
– centralized computer system
– paperless system
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Advocates Voice Concerns, Urge
Caution
• Too few staff = poor customer service,
delays in benefits, and improper denials
• No staffing analysis, state ignored
staffing shortages
• Not enough attention to special
populations
• Too little testing, too aggressive timeline
• No proposals to simplify policy
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Advocacy Challenges
• How to counter the “bread is too fresh” response
to criticism
• Just protecting state employees, big government?
• Lack of involvement from other
advocates/nonprofits
– Busy protecting vital services
– Fed up with current system
– Fear of retribution, strain on relationship with state
administrators
• Huge budget shortfall in 2003: Cuts in
infrastructure preferable to cuts in services
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Advocacy Challenges
• Legislature/Congress more pro-privatization,
anti-government: Many lawmakers
interested in shrinking sate services, gov’t’s
role in providing them
• Lack of understanding of eligibility
determination system:
– Complicated rules, many can’t be changed just
because perceived as “bureaucratic”
– Hard-to-serve clients
– Lack of funding for staff, technology biggest
problem
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Advocacy Strategies
• Involve feds, urge scrutiny/monitoring of
new system
• Engage media
• Engage members of Congress
• Build support among fellow nonprofits,
advocacy groups (particular for vulnerable
populations)
• State legislation to require pilot, testing
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What Happened?
• Technical problems, lack of testing
complicate roll-out
• Aggressive timeline, unrealistic expectations
lead to premature loses of state staff
• Poor training of contract workers
• Children lose health insurance (-100K from
Dec 05-Apr 06)
• Backlog, delays in application processing:
timeliness drops below federal standards
• Frustration among clients and staff
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Workload Soars
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Heavy Use of Temporary Staff
• Number of temporary staff increased from less
than 2% in 2004 to 30% in Sep 2006
6,826
7,000
6,213
5,491
6,000
4,494
5,000
3,933
4,000
Permanent FTEs
3,000
Temporary FTEs
1,794
2,000
756
1,000
0
94
Oct 04
1,056
424
Apr 05 Oct 05
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May 06
Sep 06
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Timeliness
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Caseload Declines
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Caseload Declines
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Error Rates Increase
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Outlook is Grim
4,000,000
14,000
3,500,000
12,000
3,000,000
10,000
2,500,000
8,000
2,000,000
6,000
1,500,000
4,000
1,000,000
Eligibility Staff
Caseloads (recipients)
Staff* and Caseload Changes, 1997-2007
2,000
500,000
0
0
1997
Food Stamps
2004
Medicaid
2007
TANF
Total Staff
FY 2007 figure includes both state and contract staff
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