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House Human Services Committee 80 th Legislature Testimony on the Integrated Eligibility System February 23, 2007 Celia Hagert, Senior Policy Analyst [email protected] (512) 320-0222 x100. Overview. Historical challenges in the eligibility system The original Integrated Eligibility (IE) model - PowerPoint PPT Presentation
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Center for Public Policy Priorities www.cppp.org
House Human Services Committee80th Legislature
Testimony on the Integrated Eligibility System
February 23, 2007
Celia Hagert, Senior Policy [email protected]
(512) 320-0222 x100
Center for Public Policy Priorities www.cppp.org
• 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
Overview
Center for Public Policy Priorities www.cppp.org
Center for Public Policy Priorities www.cppp.org
• 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
Historical challenges
Center for Public Policy Priorities www.cppp.org
• 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• Out-of-date technology has lead to duplication of effort and “red tape”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
Historical 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
high turnover rates
staffing
shortages, limited resources for automation
heavy workload,lapses in customer
service
What happens?• System doesn’t work• Client services suffer• Public confidence in
system is undermined• Alternative
approach/fix sought
Center for Public Policy Priorities 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
Benefits(TANF,
Food StampsMedicaid,
CHIP)
HHSCResponsibilities
Application Options
Self Service• Phone• Mail/Fax• Web
Assisted Service• TAA• HHSC Benefits Office
Clients
TAA Responsibilities
Support of EligibilityScreenCollect data for
applications and re-determinations
Process documentsEnrollmentSelect networkManage enrollment SupportMake data changesHandle inquiriesRefer fraud/abuseProcess complaints/
appeals
• Determine eligibility• Certify and issue
benefits instruments• Hear appeals• Provide in person
assistance• Issue expedited
benefits
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
6,920 6,6376,247
5,612
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
Permanent FTEs
Temporary FTEs
Total
Oct 04 Apr 05 Oct 05 May 06
Center for Public Policy Priorities 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
Oct 04 Apr 05 Oct 05 May 06 Oct 06 FY 08-09
Staffing Levels for FY 08-09 (if exceptional item funded)
66976,920 6,637
6,247
5,612
6,309
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
Permanent FTEs
Temporary FTEs
Total
Center for Public Policy Priorities 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 Workload1996-2006
0
2000
4000
6000
8000
10000
12000
14000
1996 2003 2004 2006
Num
ber
of s
taff
200
300
400
500
600
700
800
900
1000
1100
Ave
rage
wor
kloa
d pe
r w
orke
r
Number of staff
Averagew orkload perw orker
Center for Public Policy Priorities 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 - StatewidePercent 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 – past 12 monthsTimeliness in New Application Processing
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
May-06
Jun-06
Jul-06
Aug-06
Sep-06
Oct-06
Nov-06
Dec-06
Jan-07
Per
cent
pro
cess
ed ti
mel
y
FS
TANF
Medicaid
Federal standard = 95%
Center for Public Policy Priorities www.cppp.org
Timeliness – DFW (Region 3)Region 3 Food Stamp Timeliness
60.0%
65.0%
70.0%
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07
Federal Timeliness Standard
Center for Public Policy Priorities www.cppp.org
Timeliness – DFW (Region 3)Region 3 Medicaid Timeliness
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07
Federal Timeliness Standard
Center for Public Policy Priorities www.cppp.org
Timeliness – Houston (Region 6)Region 6 Food Stamp Timeliness
60.0%
65.0%70.0%
75.0%
80.0%
85.0%90.0%
95.0%
100.0%
May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07
Federal Timeliness Standard
Center for Public Policy Priorities www.cppp.org
Timeliness – Pilot Area (Region 7)Region 7 Pilot AreaFood Stamp Timeliness
60.0%
65.0%
70.0%
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07
Federal Timeliness Standard
Center for Public Policy Priorities www.cppp.org
Timeliness – Pilot Area (Region 7)Region 7 Pilot AreaMedicaid Timeliness
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07
Federal Timeliness Standard
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 ComparisonFood Stamp Rates in the Big Eight States in FFY 05 & 06
State FY 05 Cumulative Error Rates
Rank in 05 (lowest to highest)
FY 06 YTD Cumulative Error Rates
(through May 06)
Rank in 06 (lowest to highest)
Pennsylvania 4.51% 1 2.96% 1 Texas 5.03% 2 6.82% 5 Illinois 5.75% 3 6.20% 4 California 6.38% 4 6.06% 3 Florida 7.19% 5 9.38% 8 New York 7.23% 6 5.23% 2 Michigan 7.34% 7 7.07% 7 Ohio 8.65% 8 7.01% 6 United States
5.84% 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
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.
Food Stamp Recipients, FY 2005-present
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
FY 200
2
FY 200
4
Nov-0
5
Jan-
06
Mar
-06
May
-06
Jul-0
6
Sep-0
6
Nov-0
6
Jan-
07
Katrina growth
FY'05 = 2.44 million Now = 2.32 million-5% drop since FY 05
Dec '05 peak = 2.92 million
Center for Public Policy Priorities www.cppp.org
Caseloads – TANF
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.
County Sep-05 Dec-07 Change % Change
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 6,171 NA NA NA
Hays 373 NA NA NA
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