Overloaded workers, health vendors call on House panel for help as families go hungry and medical treatments are interrupted
More than 40,000 Medicaid recipients were wrongly barred from crucial support services last October after an update to the Department of Human Services’ electronic enrollment system triggered widespread IT failures. Seven months later, the problems persist. Some vendors still haven’t been paid for emergency services to Medicaid patients. Health and Family Service employees are still buried under mountains of paper applications. And the number of those kicked off Medicaid has grown to more than 150,000.
Caseworkers with the department, benefits recipients and human services advocates gathered in Chicago Monday to offer testimony to the House Appropriations Human Services Committee. They said the IT problems and resulting paperwork pile-up have become pervasive since the second-phase roll-out of Gov. Bruce Rauner’s technology consolidation plan, the Integrated Eligibility System upgrade.
Witnesses told lawmakers while Deloitte’s $300 million system was supposed to ease the labor load on DHS’ sharply slashed workforce numbers by automating certain data entry processes, it has instead more than doubled their work. Similar Deloitte creations have faced multi-million dollar state government lawsuits across the nation.
Although they were not present, Committee Chair Greg Harris (D-Chicago) said DHS and HFS officials had been invited to attend the hearing.
Thane Dykstra is the CEO of Trinity Services, which provides daily supports for more than 2000 disabled adults in the state. He told lawmakers the state already owes Trinity $450,000 in past due Medicaid claims related to IES roll-out problems. Because the system continues to wrongly kick his fully-disabled adult clients off Medicaid rolls, that total hasn’t stopped growing.
“Every month more people seem to fall off the list,” he said. “Every month our agency is spending cash to purchase food so our people can eat. And again, the problem is that issues roll. So a few people get it fixed this month, and more people come on this list this month. This is a cumulative problem, and especially with the problem of SNAP benefits because I just don’t think the agencies are going to have a mechanism to reimburse the agencies for food.”
Dykstra said costs are mounting beyond food and care to include his staff’s loss of hours repeatedly fixing the same problems, making calls to agencies which go unanswered by a shrunken DHS staff, faxing and re-faxing forms which end up lost or wrongly rejected by the system, following-up on forms that are re-directed across state offices so long that their claim-filing deadlines have passed.
Dykstra said the concern runs top-to-bottom at Trinity.
“They’re really afraid for people receiving supports, and they’re mindful of being good stewards of money. And so they’re worried when they know how much money the agency hasn’t been paid for and how much money we’re having to spend to provide food to the people we support.”
Dykstra is calling on administration officials to commit to paying back-due claims and to provide a plan for vendors during the continued IES problems, but DHS is short on answers and short on staff.
“It’s been primarily one caseworker in the Joliet office that has successfully resolved our claims,” he said. “They are simply overwhelmed and they can’t help everyone right now who needs assistance.”
Lori Gladsden, a human services caseworker out of Tazewell County, has over 22 years of experience at the Pekin offices.
Gladsden said the new data-entry requirements of IES have caused a daily pile-up of foot traffic in human services offices by people who can’t get through on the phones and who have come to be treated by the department as just another number.
“They have taken the human part out of the human services. IES has us so bogged down that from 11 a.m. to 2 p.m. every day we have to pull all of the caseworkers except for our phone interviewers into just taking care of people in the lobby,” she said.
“DHS tries to say it’s worker error. It’s not. There are so many known problems. Three times a day we report on how IES is working–at 11 a.m., 1 p.m., and 2 p.m. We’ve got a scale from one to five. Nine times out 10, it’s a one.”
Gladsden pointed to case after case of protracted, manual data entry that bogged down workers. In one glaring instance, she described a last-minute announcement just two days before the IES roll-out, notifying DHS workers that 11,000 old cases would not be transferred into the new system as promised.
“DHS has had people working on coding these cases for two years so that it would convert automatically when they did phase two of this IES. But then two or three days before the roll-out came they told us we would have to go in and manually convert a case before you could do anything on it because what they had just done for two years did not work,” she said. “How much money did they waste on Deloitte and temporary workers trying to get this to process?”
Rep. Kathleen Willis (D-Northlake) said she was extremely disappointed at the administration’s lack of showing at the hearing, and called for the committee to summon DHS Director Felicia Norwood in any way they could.
“We need to have them step up and if they don’t show up to the next one I say somehow or other we subpoena them and make sure they do show up,” said Willis, looking down-row to speak to Harris.
“Director Norwood, somebody’s lying someplace on this and we better get this straightened out,” Willis said, adding she hoped the director was listening. “Because she told me to my face when I confronted her with this question that it was not going to affect anyone, that it was just sanctions, and anybody that was currently enrolled in Blue Cross Blue Shield would not have any interruptions in their coverage. And obviously we’re hearing from someone who is having this, who acutely needs to continue that coverage, that this is not true. So I truly do hope that it is being relayed.”
With more than 30 years under her belt, human services caseworker Vonceil Metts said DHS’ Northwest Office in Chicago is also facing a crushing tide of Illinoisans failed by IES’ overhaul and state worker cuts.
“We open at 8 o’clock. People are generally outside 6:30, 7 o’clock in the morning waiting to get those selected slots that they’ll take. There’s a certain cut-off, a number of people that they’ll take every day into the office as walk-ins so those people who are out there at 6:30 in the morning they really need those food stamps and they’re still in the office two hours, maybe three hours later. And some of them are turned away so they don’t get serviced at all,” said Metts.
She said caseworkers weren’t even taught how to convert old cases in the new system until the day IES was being used with Illinoisans, and simple tasks that might have previously taken five minutes now take 45 minutes.
“Now we have a new rule with IES two,” she said. “The rule is you can only spend 45 minutes with a customer.“
Rep. La Shawn Ford (D-Chicago) expressed his frustration with the setbacks, adding that the issue hit home for him.
“The DHS office on the west side is just a little outside of my district,” he said. “So I see those lines. Not only are those lines visible to me, but my family members, my friends, my neighbors–they stand in those lines and they need those benefits.”
Willis pointed out that the lapse in mental health care services to those filing unanswered claims directly impacted the administration’s position of mental health treatment as a means of gun crime prevention.
“Rep. Ford and I are going this afternoon to another meeting regarding public safety and one of the most important things we’re hearing is: Those red flags when people need to get the help they get so that we don’t have breakdowns in our public safety. Well, if we’re not helping them to get the help, what the heck do we expect to happen?,” she said.
Illinois Hunger Coalition Executive Director Diane Doherty said her group serves over 10,000 households annually.
“In all the years that I’ve been here, which is a very long time, I’ve never seen anything like this,” she said. “Prior to the roll-out of phase two on Oct. 25, the state of Illinois had a 98 percent timeliness for SNAP benefits. So we were one of the best in the country in terms of getting folks their much-needed food stamps on time. Since then, it’s out the window. We even recently had one of the local office tell us to forget about expedited SNAP which is required by federal law.”
The Hunger Coalition works with local agency branches regularly to help the poorest Illinoisans.
“Some of the offices that we go to, they see up to a thousand people in a day. Most of these offices are not built to welcome that many people in there but that’s what they’re forced to do,” she said. “Two weeks ago one of the local offices told us that they were doing October’s medicaid applications.”
Rep. David Olsen (R-Downers Grove) called the IES issues unacceptable.
“This IES system replaced systems that were over 40 years old. I think we need to continue to work on this system because we do need to modernize our system and modernize our infrastructure. I think that’s generally agreed, but we do need to make sure that what we do fits the needs that we have in the state, so I hope the department and the vendor continue to work with the staff and the clients on the front lines.”
Reading an April 27 letter from DHS Secretary James Dimas to the committee, Olsen said: “This week there was a 63 percent improvement in the number of time-outs or errors that caseworkers experienced in processing cases, and the average time it takes for a caseworker to determine eligibility in the system is down 49 percent from last month.”
Olsen said that the improvements, while encouraging, were not nearly enough.
Harris called the issue a poster child for government waste.
“We’re looking at today the poster child of waste, fraud and abuse in government,” he said. “It reminds us too of the 12,000 long-term care (Medicaid) determinations that were also found unprocessed in boxes and closets. Now we’re under a court order to process all of those. That’s going to cost us $300 million more.”
Harris took a swing at Rauner’s contract for the system and his claims that IT consolidation at the department would save money.
“When you hear about hundreds of millions of dollars in savings, that’s because you’ve knocked people off the rolls and it will take them seven months to get back on. For those seven months those people do not get their healthcare,” he said. “Do you attribute this to incompetence or do you attribute this a plan? I don’t know, but we intend to continue to look into this and find out.”
He said it made him heart sick.
“You think about the hundreds of people who were not able to come here, who were not connected enough to get on our radar, who are worried so much just about surviving from day to day and doing their jobs and paying their rent and getting their children to whatever healthcare the state has decided it will allow them to have in this ongoing cyclone mess,” he said.
His chairmanship of the House Appropriations Human Services Committee means Harris is tasked with measuring the depth of injuries endured by the state’s human services during the two-year budget impasse. Since last summer, a parade of desperation and vulnerability has passed in front of his gavel.
State workers too proud to quit, scared parents who are trying to keep their kids’ oxygen tanks full, senior caretakers with tired eyes, and furious advocates–they’ve all come before this panel. They unwind their stories delicately as bandages to reveal the gruesome damage left untreated after the state’s brutal budget fight, looking for–if nothing better–at least one more band-aid to help them make it through the year.
Core Problems: While the stakeholders testifying at the subject matter hearing represented a range of relationships to the state’s human services, all of them reported facing nearly identical problems. The following briefing lists those problems shared by the greatest number of impacted Illinoisans.
- Thousands of critically ill kids and their parents are tasked with navigating a maze of paperwork which is repeatedly lost or wrongly denied for months at a time. Parents are being provided incorrect or conflicting information on state medicaid forms, phone calls often require waiting on hold in a queue of hundreds, and physical offices are either considered inaccessible or require up to eight hours of in-office waiting time. An untold number of paper applications have been destroyed by faulty office equipment and countless more applications sat untouched for months after DHS gave the wrong fax number to applicants. Children are increasingly at risk as time-sensitive medical treatments are disrupted, and parents are losing jobs as they wait in line for hours to obtain life-saving care for ailing family members or themselves.
- While most witnesses testified that residents’ SNAP benefits are being cut too short by the state, others noted the state is overloading other SNAP accounts with large sums of money. Recipients could be liable for the funds if spent. A growing number of elderly SNAP recipients are receiving conflicting information from DHS, refusing to use their benefits, and going without meals because they are afraid the state will cancel their accounts and pursue charges against them. State lawmakers have no way to assess how wide-ranging the issue of overpayment has become. Religious groups continue to pick up the slack but are wearing thin.
- State workers at DHS and HFS, most particularly caseworkers, are spread dangerously thin across workloads which have more than doubled following repeated electronic system failures. Caseworkers describe being caught between an increasingly angry public, an IT system which multiplies each filing task several times, and (for some) newly imposed per-person time limits. State workers are being blamed for setbacks by administration officials despite the digital paper trail left as they complete mandatory daily IES surveys and meeting minutes detailing HFS’ knowledge of potential added workloads. In one standout instance, caseworkers were required to manually enter the same information for 11,000 people not once, but twice, following a failed two-year coding project which cost the state millions.
- The state may be in non-compliance with federal law as expedited SNAP benefit programs have all but been given up on in some parts of the state. And other federal compliance problems have become apparent: Federal law requires food stamp recipients to complete half-year reports with updated financial eligibility information, but states overcome by applicant backlogs can apply for a waiver through the USDA. Illinois previously applied for this waiver through the budget impasse. Expecting speedier automated processing via IES two, Illinois did not re-apply for another waiver. IES two’s failure then created the legal necessity for an additional report for nearly every SNAP recipient in the state, while the Medicaid application backlog is worse than it was when the waiver was last obtained.
- Community service and health care providers are owed millions of dollars in back-due compensation from the state after footing the bill to provide emergency food, services and medicine to medicaid recipients in life-or-death situations. Providers says they can’t get older medicaid claims honored, there aren’t enough caseworkers employed at local agencies to handle the nuanced medical paperwork process, and there is no mechanism by which the state can compensate them for the cash they’ve spent on food for Illinoisans.