The complicated and troubled NC FAST computer system used for determining eligibility for social service benefits took center stage at the legislature Thursday.
By Rose Hoban
Scarcely 48 hours after receiving word from federal authorities that North Carolina had met its deadline to clear a massive backlog in food stamp applications, Department of Health and Human Services officials were warning state lawmakers that similar problems could arise in other social service programs due to staff shortages in county social service offices, new federal rules and a pressured implementation schedule for more computer-program changes.
At the Joint Legislative Oversight Committee on Health and Human Services Thursday, DHHS Sec. Aldona Wos told lawmakers that in order to meet a federal Department of Agriculture timetable to clear the food stamp application backlog, the state spent an additional $7 million to help counties finish processing applications on time.
Wos said the problems with finishing Food and Nutrition Service applications was due, in part, to a confluence of deadlines last summer. Even as her department was preparing to launch the new NC FAST system that handles food stamp applications, DHHS information technology staff had to roll Medicaid changes into the computer system several years before they and the changes were completely ready.
She said that changed the way county social service workers interacted with the computer system and slowed them down in completing food stamp applications.
On top of that, Wayne Black, director for the Division of Social Services, told lawmakers that clearing the food stamp backlog took about $14 million more than what individual counties had budgeted for implementing NC FAST.
He said that it was his understanding that these expenses included “staffing, bandwidth, equipment, temporary staff, overtime and any other expenses related to that process.”
Wos and other DHHS leaders blamed the backlogs and the expense to clear them on a confluence of events: The deadline for rolling out NC FAST and new federal requirements for Medicaid applications both went into effect last summer.
Then in October, the state started to get many new Medicaid enrollees who learned they were eligible for the program as they attempted to sign up for insurance on the federal insurance exchange website, healthcare.gov.
According to Angela Taylor, acting director for NC FAST, the original timeline to implement the information system called for adding the Medicaid pieces into NC FAST years from now, in 2017.
But the Affordable Care Act required states to change Medicaid eligibility processes on July 15 of last year, which contributed to the backlog in completing food stamp applications.
“If you talk to a lot of the counties, before July 15 they were doing very well; things were running smoothly,” Taylor said. “But when we had to put the new module in on top of that, it changed some of their screens and the way that system was functioning.
“They had to go in and change some of the things they’d already learned, so it was a challenge.”
Taylor said DHHS eventually got permission to delay implementation of some of the new Medicaid eligibility changes. Nonetheless, she said, beneficiaries are required to provide much more documentation than before, which has added to the confusion.
In the past, recipients who had been approved for Medicaid only had to provide a few documents in order to get certified. Now the requirements are greater, Taylor told reporters after her testimony to lawmakers. She said beneficiaries coming in to complete the annual recertification process often have to be sent home to get more documentation. That’s delayed the recertification process in many instances.
“County workers are having to learn that new information is required, what the rules and policies are around that, and then citizens are saying, ‘Why am I having to provide all this new information?'”
Taylor maintained that, in the long run, NC FAST will provide benefits, because instead of entering an applicant’s information multiple times for programs such as child-care subsidies, food stamps, Medicaid or home-heating subsidies, the information goes into the system only once.
DHHS officials also made the point to lawmakers that the number of county workers has not kept pace with the increased demands being made on them.
According to Black, county DSS workers have seen an increase in food stamp application caseloads of more than 75 percent over the past five years. At the same time, counties have added only 27 percent more workers.
Demands for Medicaid services have also grown, Black said, by about 25 percent over five years, while the number of county case workers has only grown by 4 percent.
The increased workload was confirmed by several county DSS leaders who were in Raleigh for the day.
“We’ve been tracking this [increased caseload] since the early 2000s, and it’s been a steady climb since then,” said Catawba County DSS head John Eller. “Even before the recession, we were seeing increases. But since then, it’s exponentially increased.”
Eller said his county had spent additional dollars to meet their backlog. He wasn’t sure how much yet, as he was still adding staff.
But Buncombe County’s head of social services, Mandy Stone, said her county spent $1.9 million in county dollars adding staff, a call center and training to handle the new processes and work through the backlogs.
Alamance County’s DSS director, Susan Osborne, said that her county, a small one, had spent an additional $185,000.
Eller, Stone and Osborne all described how their departments coped: running food drives to help food stamp recipients tide over, buying food for recipients and distributing vouchers.
They said that some DSS workers even gave cash out of their own pockets to help out.
“Individual employees were very stressed by their inability to help the person across the desk,” Stone said, “a person who lives in their community.”
Stone said that in the past, it took only nine days to get approval for a food stamp application. But under the NC FAST system, information goes through a central processing center at the state’s DHHS computer center. She said DSS workers got frustrated that they had no control over those cases stuck at the state level, sometimes for weeks.
DHHS officials have, at times, criticized county officials as they worked through the food stamp backlog. But Eller and the others said they felt like state officials were beginning to appreciate the pressure they’ve been under.
More storm clouds
Across the state, county DSS workers process about 82,000 Medicaid recertifications each month. But with the end of the enrollment period for the Affordable Care Act, the counties have been handed an additional 94,000 new applications, all at once.
“So we’re coming out of food stamps and we’re implementing Medicaid,” said Osborne. “There’s a lot of work to be done.”
And counties are already behind as a result of implementing new federal regulations for determining Medicaid eligibility for current recipients going through their annual recertification process.
“The fix for Medicaid is not that easy. And we’ve got a stack, a statewide stack, of new applications that aren’t being processed,” Osborne said.
She said that when families caught in the food stamp backlog needed help, her workers could hand them a bag of food. But it’s harder to provide a temporary solution when beneficiaries need the health care provided by Medicaid.
Stone said county DSS departments have to talk to their recipients and let them know more delays are probably coming.
Nonetheless, all of the county DSS chiefs said they looked forward to the day when the NC FAST system would be completely implemented and their workers were trained and up to speed.
“We all believe it’s the right direction for the future – that we have to move to an automated system,” Stone said.
“But I think it’ll be sometime before we see the efficiency that we’d hoped for,” Eller added.