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Wednesday, March 29, 2023

Looming Medicaid Tsunami

Overburdened Rhode Island DHS Faces Renewal Crisis

By Steve Ahlquist For UpRiseRI

With the end of the COVID emergency all states, including Rhode Island, must begin the process of annually renewing those who receive Medicaid benefits starting in April. 

Unfortunately, under the administrations of former Governor Gina Raimondo and present Governor Daniel McKee, the Department of Human Services (DHS) has experienced a dramatic shortage of workers, which may cause the 300,000+ people in need of Medicaid renewal long wait times, unnecessary stress, and possible gaps in medical coverage. 

An already overburdened DHS will be seeing an increase of 15,000 renewal applications per month, rising to 25,000 later in the year. With roughly half the renewals being passive, that is relatively automatic, it still leaves DHS with 7,000-12,500 renewals per month, on top of the regular work they already do.

On March 8, Stacy Smith told the Rhode Island House Finance Health and Human Services Subcommittee that DHS is unprepared for the “tsunami” of Medicaid renewals that will be starting in April. 

Smith is the President of Council 94 AFSCME/AFL-CIO Local 2882, representing 280 workers who make eligibility determinations for programs such as Medicaid, SNAP benefits [formerly food stamps], cash assistance, and child care.

“While things have improved slightly under the McKee administration, Director Brito’s leadership, and the General Assembly’s required reports on hiring, we are still desperately short staffed,” said Smith.

Speaker Joseph Shekarchi (Democrat, District 23, Warwick) held a Medicaid Renewal Information session for House members and reporters. Uprise RI asked Director Merolla-Brito about the 120 unfilled positions at DHS. 

Director Merolla-Britto countered that the most recent numbers she had indicated that there are 117 open positions throughout the entirety of DHS, and 75 open positions that affect field operations, including eligibility technicians.

“It’s definitely an area of concern,” said Director Merolla-Brito. “We do feel as though we have the staff. We have ongoing efforts with recruitment and retention in process… We do have all of those covered, in terms of ‘in process’ for different stages of the recruitment process. 

"We have offers being made to at least 15-20 [potential employees] from this week to last week. I cannot say that number will be zero when we get into the end of April or May but I do feel that our workforce projections – the work that we put into that model – does allocate the staff that we need to manage work ahead, that we know through the renewal process and anticipated new work coming in. [That] doesn’t mean it will be easy and it does mean we will need additional support in terms of our interagency work and community providers and such.”

Another issue when it comes to providing service is long wait times on the telephone when utilizing DHS call centers. Representative Edith Ajello (Democrat, District 1, Providence) asked about this. Director Merolla-Britto claimed that wait times were now down, on average, and that she has brought in an MCO [Managed Care Organization] to help. An MCO is an outside contractor.

“Our average, as of this week, I think, was 54 minutes,” said Director Merolla-Brito. “And that is an average of all the different program cues.

“We made some very hard decisions with [a letter we sent out] to not list the DHS phone number on that letter. And we partnered with the MCO … to help us take those calls because we didn’t want the experience for our customers to be poor.”

During her testimony before the House Finance Subcommittee, Stacy Smith provided a list of reasons why she sees possible disaster The following has been adapted from Smith’s written testimony:

·       “The Bridges Program does not always work properly, frequently making it hard to do our work. [Note: The Bridges Program was provided by Deloitte, and had a disastrous roll-out during the Administration of Governor Gina Raimondo.]

·       The number of cases are crushing.

·       My members are held to strict time limits to resolve a case

·       They are supposed to complete a case in 35 minutes maximum.

·       In our Call Center, my members often have only 20 minutes to work a case, before a supervisor shows up to their cubicle and tells them they have been on call too long and to wrap it up.

·       Determining eligibility is very technical and time consuming work.

·       Often obtaining the necessary information from clients requires extensive discussion.

·       Not to mention you have to know federal rules, regulations, and policy for each program.

·       This type of pressure leads many employees to quit.

·       Working at the call center is especially challenging, as I previously stated, having the added pressure of a Supervisor standing over you with the clock ticking on the time you’ve spent on a case can be overwhelming.

·       While we want to help each and every client, strict time allotments can make dedicating enough time and attention to complex cases nearly impossible.”

Smith also outlined the additional pressures to come:

·       With the Covid Pandemic Public Health Emergency ending, renewals will have to start once again.

·       Over 300,000 recipients’ eligibility will have to be redetermined.

·       While DHS says half that amount will be passively recertified that leaves over 150,000 individuals who will require renewal.

·       This amounts to a Tsunami like increase in workload.

·       With the state only adding net three positions in two months, if they keep hiring at the current trend, I’m worried our agency will get swamped.

·       While the Department is trying to hire, they are simply not moving fast enough.

·       It’s like we, as Eligibility Technicians, are standing at the shore watching the tsunami come at us, and management is debating how to add a crew to combat it, but the wave will hit us first, and no one has a life preserver.

·       What is also not helpful is that while we are meeting regularly, for some reason the state is giving new hires up to six weeks to separate from their old employer and come aboard.

At the end of last Thursday’s Medicaid Renewal Information session Representative David Morales (Democrat, District 7, Providence) stood up to ask his fellow legislators to support his bill to “provide stop gap health insurance coverage for anyone who is found to no longer be eligible for Medicaid due to the end of the Federal COVID Emergency funds.” 

The Governor’s budget provides for two months of stop gap coverage and is tied to eligibility. Under the Morales bill the state would provide six months of stop gap coverage with no eligibility requirements.

Capitol TV cut away from the event as Representative Morales rose to speak, but Uprise RI was in the room and has the video.

“I think the most important thing that the legislature can do, because we cannot legally stop the renewal process, is that we can ensure that everyone who gets terminated from their Medicaid coverage, regardless of their federal poverty level status, is guaranteed coverage through Healthsource with six months of premiums covered,” said Morales when asked to clarify.

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