Center for Public Policy Priorities House Committee on Government Reform Staffing and Training Challenges in the IE&E System July 26, 2006

Center for Public Policy Priorities www.cppp.org

House Committee on Government Reform

Staffing and Training Challenges

in the IE&E System

July 26, 2006 Celia Hagert, Senior Policy Analyst

[email protected]


Overview

• Why modernize? What are the challenges? What are the risks?

• Staffing and training issues in the IE&E System

• Recommendations for future IE&E rollout


Why Modernize?

Goal # 1: Make it easier for workers to administer benefits

Goal #2: Make it easier for clients to access benefits

Goal #3: Improve efficiency to lower costs


What are benefits of modernization?

• Better technology (e.g., TIERS, “AVR,” paperless system) eases

workload, improves accuracy, increases access, enhances program

integrity

• Simpler application process (e.g., fewer office visits, less

documentation required of clients) eases workload, increases access

• Flexible enrollment process (e.g., call centers, online application,

extended business hours) increases access, particularly for working

families

• Integration of rules across programs where possible (e.g., same

documentation requirements, one asset test) supports automation

process, eases workload, may increase eligibility for benefits

• If successful, modernization may lower costs and produce long-term

savings


What are the challenges of modernization?

• Requires an up-front commitment of new resources -- automation is expensive and time-consuming, especially when developing new computer system; testing and evaluation are critical

• States may resist policy changes critical to simplifying and automating processes

• Shifting the burden of the application process to clients and local communities may compromise client rights and customer service and potentially alter the mission of nonprofit organizations

• More remote application process, less face-to-face assistance could create barriers for hard-to-serve (seniors, persons with disabilities, persons with language barriers)


What are the risks of modernization?• Modernization may further overwhelm systems already

struggling from a lack of resources, as is happening with IE&E

• Pressure to achieve savings may lead to premature deployment of new system/features – Testing is critical

• Modernization may reduce workload and achieve savings in the long-run, but no system can function without an adequate number of well-trained staff

• Harm to clients, • Financial liability to state


The Importance of Well-Trained staff• Eligibility determination is a complicated process that

requires in-depth knowledge of program rules to ensure timely service to eligible applicants and maintain program integrity.

• The rules governing each program vary considerably, which makes determining eligibility even more difficult

• Constant policy changes at the state and federal level: workers face a constantly moving finishing line in the mastering of program rules

• The people who qualify for these benefits are not easy to serve: the majority of clients have incomes below the poverty level; many are elderly, have disabilities, or grapple with language barriers.


Training and Retention Are Critical• Effective training and retention strategies are critical

to maintain an adequate number of quality staff• Though the amount of training varies by program, it

can take months to train a Food Stamp worker and up to two years to train someone to process Medicaid eligibility for Long-Term Care services.

• Constant retraining of existing staff is as important as training new staff

• Poor training can lead to high turnover which can negatively affect program access and program integrity

• You need to maintain an adequate number of seasoned staff while training new staff


Staffing Shortages Hurt The “Old” System…• Prior to IE@E, the number of workers were cut

40% from 1996-2004 from almost 12,000 to fewer than 7,000

• Caseloads dropped from 1996-2000, but applications continued to grow and work grew more complicated

• Caseloads rebounded in 2000 with sharp increases in Food Stamp and Medicaid enrollment

• The workload per worker doubled, growing from approx. 350 recipients per worker in 1996 to approx. 680 in 2004. The workload per worker in 2006 is almost 1,000 recipients per worker.


Staffing Shortages Hurt The “Old” System…

• Staffing shortages affected services to clients, frustrated workers, led to lawsuits

• Texas’ eligibility system fails to reach many needy individuals and families: – Less than half of eligible households receive food

stamps– It is estimated that at least 700,000 children –

representing half of the uninsured child population in Texas – are eligible for public health insurance but not enrolled in either CHIP or Medicaid


Impact of Staff Reductions on Workload

Downsizing of Eligibility Workforce Increased Workload 1996-2004

0

2000

4000

6000

8000

10000

12000

14000

1996 2003 2004

Num

ber of

elig

ibili

ty sta

ff

0

100

200

300

400

500

600

700

800

Num

ber of

rec

ipie

nts pe

r w

orke

r

Number of staff Average workload per worker


Staffing Continues to Fall Short of Needs

• Since 2004, the number of state staff has dropped 27%, from 7,573 to 5,550

• The number of temporary staff has increased from less than 2% of total staff to 19% of total staff

• The loss of staff has affected every region of the state

• The loss of staff is due to attrition, largely the result of HHSC’s IE plans and the announcement of layoffs in October 2005


Staffing and Caseloads Changes

* Number of staff in 2007 is based on HHSC estimate at the time IE&E contract was awarded and includes both state and contract staff

Staff* and Caseload Changes, 1997-2007

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

1997 2004 2007

Cas

eloa

ds (

reci

pien

ts)

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Elig

ibilit

y S

taff

Food Stamps Medicaid TANF Total Staff


Permanent vs. Temporary FTEsChange in Permanent vs. Temp. FTEs

6,8266,213

5,491

4,494

94424

7561,056

0

2,000

4,000

6,000

8,000

1

FT

Es Permanent FTEs

Temporary FTEs

Oct 04 Apr 05 Oct 05 May 06


Change in FTEs by RegionRegion FTEs, October 2004 FTEs, May 2006 Decline

Austin Call Center 0 69Centralized Units 0 187Total 6974 5,550 20.4%

17%

23%

374

808

21%

27%

25%

22%

19%

23%

36%

22%

242

1042

492

554

212

310

974

286

Region 10 - El Paso - Upper Rio Grande

450

Region 11 - Edinburg - Lower South Texas

1052

Region 7 - Austin - Central Texas

765

Region 8 - San Antonio - Upper South Texas

711

Region 5 - Beaumont - Southeast Texas

297

Region 6 - Houston - Gulf Coast

1352

Region 3 - Grand Prairie - Metroplex

1291

Region 4 - Tyler - Upper East Texas

365

Region 1 - Lubbock - High Plains

269

Region 2/9 - Abilene – Northwest/West Texas

422


Problems Related to Staffing Shortages in IE&E Pilot

• Shortages of both state and contractor staff have caused problems

• Pre-existing backlog of thousands of cases, dating back to September 2005, complicated transition to IE

• Delays in benefits to thousands of applicants since January 2006 (More than 7,000 food stamp applications were delayed as of May 2006)

• Caseload declines across programs• Poor customer service• Long hold times/high call abandonment rates at call

center


Problems Related to Poorly Trained Contractor Staff

• Clients given incorrect information • Clients asked to provide unnecessary

documentation• Delays in application processing• High percentage of cases returned by state staff

to vendor because worked incorrectly• Could see spike in error rates (incl. incorrect

benefits issued, improper denials, and ineligible applicants given benefits)

• High turnover and difficulty recruiting staff is complicating these problems


Problems Will Persist Without an Increase in Staff

• IE promises to reduce workload, but until it does, the number and caliber of staff must be increased to 2004 levels.

• Until technical problems are fixed, resources and staff will continue to be diverted to pilot area -- services to clients in other parts of your state will suffer without enough resources to keep the “old” system going


Public or Private: Reevaluating the Contract • Can $7-9/hr employees do the job now assigned to them?

Can TAA retain an adequate number of adequately trained staff at this low pay?

• Constant retraining takes time and money. You need to have an adequate number of staff answering calls while training new recruits

• Can TAA provide a career ladder and incentives to staff to stay? (State offers longevity pay, good retirement, good benefits, and a career ladder)

• Many people enter the eligibility system with a social work background; they stick around because they see the job as part of their professional commitment to help people. How important is this element to retention?

• Can TAA offer a mission-charged environment that convinces $8/hour employees not to leave after 6 weeks to go work for the call center next door?


Recommendations

1. Increase total staff (not just in the pilot area but also in non-pilot areas of the state) AND

2. Reevaluate division of labor between public and private employees (giving state staff more responsibility and restricting duties of private staff), ORReevaluate pay and qualifications of private contractor staff so they are easier to recruit, train, and retain


Recommendations

3) Revise training to include on-the-job training for new TAA staff that is comparable to the OTJ training given state staff now

4) Before each rollout phase check for existing backlogs in that area and deploy staff PRIOR to rollout to process backlog

5) Once problems are resolved, test system again in Travis/Hays for at least 3 months to ensure “fixes” are working before adding new areas/clients


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Center for Public Policy Priorities House Committee on Government Reform Staffing and Training Challenges in the IE&E System July 26, 2006