Center for Public Policy Priorities Making the Case for an Adequately Funded Eligibility System Funding State Services Conference Center on

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Funding State Services Conference

Center on Budget and Policy Priorities

Making the Case for an Making the Case for an Adequately Funded Eligibility SystemAdequately Funded Eligibility System

November 14, 2006

Celia Hagert, Senior Policy [email protected]


The Big Picture


Looking Back a Decade

Caseload and Staffing Changes, 1995-2006

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Clients

Total Staff


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


Number of familiesseeking 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


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


Workload increases, staffing cuts continue: 99-01

Staffing and Workload Changes, 1995-2001

6000

7000

8000

9000

10000

11000

12000

13000

1995 1996 1997 1998 1999 2000 2001

300

320

340

360

380

400

420

440

460

Staff

Workload


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)


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


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


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


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, policy-knowledgeable staff with lower-paid, les skilled contract workers

• Better use of technology– centralized computer system– paperless system


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


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


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


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


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


Workload Soars


Heavy Use of Temporary Staff • Number of temporary staff increased from less

than 2% in 2004 to 30% in Sep 2006

6,826

94

6,213

424

5,491

756

4,494

1,056

3,933

1,794

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Permanent FTEs

Temporary FTEs

Oct 04 Apr 05 Oct 05 May 06 Sep 06


Timeliness


Caseload Declines


Caseload Declines


Error Rates Increase


Outlook is Grim

FY 2007 figure 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


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Center for Public Policy Priorities Making the Case for an Adequately Funded Eligibility System Funding State Services Conference Center on