TITLE
Title
DHHS-DIVISION OF SOCIAL SERVICES (DSS) UPDATE
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SPONSOR
Sponsor
Heather Skeens
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BACKGROUND
Background
Since fiscal year 2010, eligibility caseloads have continued a steady upwards trend. Caseloads for Family & Children’s (F&C) and Adult Medicaid have risen from 46,498 in 2010 to 62,175 in fiscal year 2015. Food and Nutrition Services (FNS) caseloads were at 34,261 in 2010 and have risen to 49,492 in 2015. These are active caseloads and do not include denied or withdrawn cases. In fiscal year 2015, an additional 14,153 combined FNS and Medicaid cases were denied.
In addition to application and recertification workloads managed by eligibility case workers, we also have an additional “unseen” work load of 40,000-45,000 changes to active cases annually; which includes responding to returned mail, processing information received through Turbo Tax portals, and responding to updated tax forms required for Medicaid eligibility. During this same time period, we had 250 eligibility staff in 2010 which was reduced to 198 in 2015, due to budget cuts. This loss of staff while caseloads have steadily increase has resulted in our inability to comply with federal regulations. (Please see attached Dear County Director Letter, “Factors Impacting County Administration of Economic Services Programs”).
This is an update regarding the hiring of the thirteen (13) new positions granted on January 21, 2016 and a follow-up to the Able-Bodied Adults Without Dependents (ABAWDS) presentation in December 2015.
Able-Bodied Adults Without Dependents (ABAWDS)
DHHS-DSS created a team of five (5) eligibility caseworkers to maintain ABAWD FNS cases and, as of February 23, 2016, Guilford County has 7,930 recipients receiving benefits. We have updated ABAWD cases through April 2016 to reflect correct evidence to ensure this population will not lose benefits, if the recipient is eligible. We anticipate the impact of lost benefits will begin April 2016.
In collaboration with Commissioner Ray Trapp, DSS hosted two (2) events to educate community partners on ABAWD policy in February 2016. Approximately 114 community partners attended the event. The department will continue to work with the community and partner with agencies to educate ABAWD recipients, as well as, local organizations about the progress of the ABAWD population. Departmental staff are scheduled to attend the second annual Food Summit, hosted by the Greater High Point Food Alliance (GHPFA) on March 18, 2016 at Oak Hollow Mall in High Point to take FNS applications, and will attend a job fair and resource event on March 19, 2016 at Peeler Community Recreation Center.
Medicaid
In December 2015, the County was notified by the North Carolina Department of Health and Human Services (NCDHHS) that, effective immediately, counties can no longer utilize contractors or temporary agencies to determine Medicaid eligibility. We initiated a contract with Vanguard in July 2015 to process 2,000 recertifications and/or applications on a monthly basis. The fees are dependent on the type of Medicaid case processed and ranged from $35 (recertification) to $71 (Family and Children’s Medicaid application), or $82 (Adult Medicaid application). To date, Vanguard has processed approximately 13,000 applications and recertifications for Medicaid. Vanguard has used as many as thirty-five (35) employees to process our cases, and our current contract will end June 30, 2016. In order to remain compliant with federal Medicaid policy and NCDHHS requirements, we need to terminate the contract with Vanguard effective immediately (with a 30-day notice), however the eligibility cases will still need to be processed.
A Dear County Director Letter was issued by NCDHHS on February 17, 2016 (see attachment) specifically addressing “Merit Based Requirements for Eligibility Determination Functions”. In the letter, the State concludes that non-merit based staff completing eligibility determinations are “…prohibited and could result in loss of federal administrative reimbursement and other sanctions”.
In order to have Medicaid staff fully trained by July 1, 2016 (when the Vanguard Contract is scheduled to end), we will need to on-board them no later than April 18, 2016. We cannot handle the current caseload in Medicaid with existing staff and without the contract.
On January 21, 2016, the Board approved four (4) eligibility caseworker (ECW) positions for Medicaid and all four (4) have been recommended with a start date of March 21, 2016. In addition, one (1) Office Assistant position was allocated with scheduled on-boarding in March 2016.
Food and Nutrition Services (FNS)
The United States Department of Agriculture (USDA) has informed NCDHHS that the state is not in compliance with timely processing requirements for Food and Nutrition Services (FNS) benefits. A letter issued by NCDHHS was forwarded to counties on July 31, 2015, and summarized the Advance Warning letter issued by USDA. The letter noted the agency's requirements for state timeliness averages were 85% for July 1, 2015 - December 31, 2015 and 95% for January 1, 2016 - June 30, 2016. Failure to comply with the state's corrective action plan could result in the “suspension or disallowance of administrative funds in accordance with the code of Federal Regulation (CFR) 276.4” (see attachment). Guilford County currently has a timeliness rating of 95% (see attachment). To achieve these requirements, the Division of Social Services transferred staff from Medicaid to FNS eligibility determination and utilized overtime (mandatory and voluntary) beginning September 2015. In addition, the processing requirement deadlines have changed from seven (7) to four (4) days for expedited, and thirty (30) to twenty-five (25) days for regular applications. All late recertifications are now considered new applications and must be assessed as expedited applications. This has moved the work to same day processing, since all cases require an interview with the applicant prior to processing.
The efforts that we have put into place are not sustainable.
On January 21, 2016, the Board approved eight (8) ECW positions for FNS and six (6) have been hired with a start date of February 22, 2016. The remaining two (2) positions have been recommended with a start date of March 21, 2016.
Overtime
We have used approximately $125,000 in overtime payouts since July 2015.
Recruitment
Training for new employees in FNS eligibility is three (3) weeks, while training in Medicaid eligibility is six (6) weeks. We anticipate a total of 4-6 weeks required, from time of hire to training completion, to on-board a new employee.
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BUDGET IMPACT
Budget Impact
It is anticipated no additional County funds are required in the current fiscal year, however additional funding will be requested for FY2017. DHHS-Social Services believes it can avoid requests for additional County funds during FY2016 by utilizing the following sources of funding: remaining dollars designated to the Vanguard contract and lapsed salaries.
FY2017 will require approximately $76,000 in County dollars to sustain the seventeen (17) new positions.
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REQUESTED ACTION
Requested Action
Receive an update from DHHS-Division of Social Services and approve seventeen (17) new eligibility positions:
8 Eligibility Caseworkers - Medicaid
7 Eligibility Caseworker Assistants - Medicaid
1 Eligibility Supervisor
1 Office Support Supervisor
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