Texas shifted three years ago to greater reliance on private call centers to determine eligibility for some of its entitlement programs. Now that decision has become the focal point of recriminations as problems arise with the private contractors. Depending on whom you talk to, the problems either involve the natural learning curve of developing a new system or represent a disastrous example of the dangers of privatization.
The state began implementing a new system of call centers to deal with renewals of coverage for programs like Medicaid and CHIP (Children’s Health Insurance Program) as part of House Bill 2292. The plan – in theory – was to save the state money and also improve efficiency by taking advantage of technology. The program allows people to re-register for services on the telephone after business hours, or through the Internet.
But since the plan was implemented, 30,000 children have been dropped from the CHIP roles alone, reducing the program to levels not seen since its first year. Critics blame the call centers, citing complaints from the public that the centers are slow to respond.
Rep. Garnet Coleman (D-Houston) said call centers could work if the staff was well-trained and understood the rules. Just as important, he said, is the culture of the staff. “Is the culture of the organization,” he asks, “a culture that says it’s good to provide benefits to Texans who work hard and play by the rules, or is it a culture that says these are scum bums who don’t deserve anything and have never paid taxes in their lives?” Coleman said private companies were less likely to have the former culture and more likely to have the latter.
Although the Health and Human Services Commission (HHSC) agrees there is a problem with the system, spokeswoman Stephanie Goodman says it less a matter of the principle involved than of the need simply to work the problems out. “We’re really in the very infancy of this major transition of services,” Goodman said. “It merits close scrutiny, we understand that. But to pass final judgment at this point is obviously much too early. “Whether this would be outsourced or state-run,” she said, “you would assume that this would be a transition period and that you would want to do a pilot, as we did, to make sure things are working, make adjustments that you need to do and move on.”
The problems that HHSC has identified include long hold times and resulting high “abandonment rates” – when callers give up. But since changes have been implemented by the vendor, HHSC says, the abandonment ratehas dropped from 36 percent to four percent, and hold times have been reduced from 14 minutes to 30 seconds.
Goodman said those changes were relatively easy. What will take more time is the issue of training. Call center operators, the agency discovered, were not properly familiar with rules and procedures. As a temporary stop-gap, the agency has brought in some of its own employees to observe and offer assistance. In the long-term, many employees will need more training. HHSC anticipates the call centers handling the vast majority of the complaints and forwarding the small percent of really complex cases on to the agency itself to be resolved.
Coleman’s skepticism is shared by several outside groups. The Texas State Employees Union, for example, has blasted the call centers, saying in a press release that the decline in CHIP enrollment “shows call centers aren’t working.”
Comptroller Carole Keeton Strayhorn has received legislative requests to investigate the contract, and has pledged to do so. An internal review by HHSC is not good enough, she said. Coleman agrees. Strayhorn, not surprisingly, has focused the blame on the program on Gov. Rick Perry – her opponent in the 2006 election. The contracting proposal, however, was initiated in one of Strayhorn’s own e-Texas recommendations. But Strayhorn says the end product was not her vision. “The eTexas recommendation said that we should use call centers for CHIP and children’s Medicaid only,” she said. “It did not lay off a single state employee in over five years.”
Not a new phenomenon
Goodman made the point that focusing on privatization ignored the point that much of the state eligibility determination process was already privatized before the passage of HB 2292, the 2003 reform of the agency and its policies. Additionally, the CHIP call centers are only a part of a wider contract. Ultimately, she said, some problems are anticipated, as the natural result of a roll-out. In fact, she said, that’s precisely the reason the program was started in only two counties rather than statewide. By learning the pitfalls there, Goodman said, the program can be refined before it expands. That expansion, however, is on hold until HHSC completes a review of the process.
The agency conducted a detailed survey, whose preliminary results were announced in April, but which will be finally completed and released by the end of the month. That survey is being conducted by the Institute for Child Health Policy, which is contacting every family up for renewal in the CHIP or Children’s Medicaid rolls to determine the reason.
The preliminary findings in Children’s Medicaid:
* Most found the process easy to understand and had plenty of feedback.
* 63 percent were told that they were missing information in their packets.
* 78 percent of those denied renewals were clients who either failed to return the renewal packet or turned it in late.
* 10.5 percent were denied for excess income.
Findings in the CHIP program:
* 56 percent had packets with missing information.
* 27.8 percent completed the renewal process, but did not have eligible children. Of these, 56 percent were eligible for Medicaid (incomes too low for CHIP), and 44 percent had incomes too high.
Overall, one-third of the disenrolled families said children currently have insurance coverage, either through employees, Medicaid, or private policies. This, some argue, is the ideal outcome – getting children out of government health insurance programs and back into the private market.
Mary Katherine Stout of the Texas Public Policy Foundation wrote in an op-ed in the Houston Chronicle that despite the problems, CHIP reforms are working. “Unsurprisingly, the assets test and income verification revealed that some families applying or reapplying for CHIP benefits exceeded the allowable levels,” she said. “Common sense policies from 2003 have contributed to the decline in the caseload.” But to Coleman, the assets tests aren’t catching people who are over qualified, but inadvertently are catching those who are qualified but fail the tests based on rigged rules and schedules.
Goodman points out that the state isn’t forced to pay the bills for the program if the results don’t pan out. The funding is tied to certain benchmarks, and if those aren’t met, the state doesn’t pay. “The way that contract is worded is that the bulk of that – more than half of the eligibility component – is a variable cost,” she said. “Basically...we pay on workload, so since we haven’t rolled out so much in the state, those variables are about $50 million below what we anticipated what they would have been at this point.” Even some of the “fixed costs”, she added, aren’t fixed until the rollout continues.
Until the problems are addressed, the agency will not expand the privatization any further. Unless the program expands, the contractors don’t get all of their money. That provides an incentive for progress.
Displaced students enrolled in Texas schools performed significantly worse on the TAKS test than Texas students. According to the News, the number of 11th grade pupils that passed the TAKS was less than half of the percentage of Texas students that passed the TAKS. The passing rates of 11th grade evacuee pupils were even less than half of the passing rates of those students in other grade levels. Click here for link
Additionally, in March the Fort Worth Star-Telegram reported that many of the third and fifth grade evacuee pupils, who took their grade’s version of the TAKS, scored worse than Texas students and many of them could be held back. According to the Star-Telegram, Texas officials are blaming New Orleans’ poor public school system for the test performance of the evacuee children. Click here for link
An appropriations bill passed by the Texas House earlier this week includes some hefty amounts for some north Texas four year institutions. Many of the appropriations to Texas schools were for the expansion of existing campuses and for building of facilities related to the engineering and science fields. In total, $1.8 billion in college construction bonds was dished out.
Tarleton State University (Stephenville) – $11.1 million dollars for a University Dairy Center and $24.3 million dollars for a nursing building.
Texas A&M University at Texarkana - $75 million for a multipurpose library building and central plant
UT-Arlington – $70.4 million for an engineering Research Building
UT-Dallas – $12 million for a vivarium and experimental space
Additionally, $5.3 was appropriated to the University of Texas System for the purpose of reimbursing debt service paid on “long-term obligations related to the construction of a natural science and engineering research building” at UT-Dallas.
The muffins that made 18 employees sick at Lake Highlands High School contained marijuana, according to Dallas County health officials. The Fort-Worth Star-Telegram reports that a man in his late teens or early twenties delivered the muffins to the teachers lounge at the school. The man was caught on surveillance video and the FBI is currently looking for the man.
Physician’s reports indicate that the patients tested positive for cannabinoids and showed symptoms consistent with acute marijuana toxicity.
The good news: The Dallas-Fort Worth area will be getting more than $2.5 million in grant money to fight gang crime, according to U.S. Attorney General Alberto Gonzales, who was in town yesterday.
Attorney General Alberto GonzalesThe bad news: Dallas is among the top six cities for gang crime in the country, up there with such lovely places as Cleveland, Milwaukee, Philadelphia, Los Angeles and Tampa, Fla.
During one of his stops Gonzales said about 80 percent of the meth distributed in the United States comes from Mexican-run organizations - once again showing they're willing to do the jobs Americans aren't doing.
Mayor Laura Miller is out and about this morning seeing first-hand how caseworkers are helping hurricane evacuees living in Dallas to get back on their feet.
Rocky Vaz, project coordinator of Project Exodus, will be taking Mayor Miller for a ride-along on visits to two different clients. Over the past few weeks, these caseworkers have been working on a one-on-one basis to determine both the immediate and long-term needs of evacuees currently in Dallas.
A triage of every individual, combined with intensive case management, is allowing them to create an action plan toward independence for the evacuees.
In late March, after funding hotel expenses for those evacuees not eligible for FEMA extensions, $500,000 from the Mayor’s Disaster Relief Fund was allocated to bring on additional case managers to help with the long-term needs of the evacuees in the Project Exodus program.
Texas Comptroller Carol Strayhorn is also an independent candidate for Governor of Texas. Yesterday she said that her top priority as governor would be to repeal the new business tax that Gov. Perry had signed into law only a few hours before. She didn't say what she would propose to provide the revenue that tax would raise. Nor did she, as some had expected, announce she was going to certify the revenue levels for the tax as required by law.
Typically American Airlines wants you at your flight gate 30-minutes before the flight takes off. But in anticipation of summer planes loaded with inexperienced flyers AA will be asking passengers at DFW Airport to be at the gate at least 40-minutes earlier. The airline believes this will help with getting luggage on flights. The airline also notes that more passengers are using remote or Terminal D Parking that requires more commute time to their gate.
The Nebraska Congressional delegation has introduced a bill that would exempt that state from the Wright Amendment. It also wants planes taking off from Love Field in Dallas to be able to write "through tickets" that would allow anyone stopping in Omaha to fly to another destination without have to recheck luggage. Sources say that the Colorado delegation is planning to introduce similar legislation in the next few weeks. Tennessee already has a similar bill pending. However, Texas Congressman Joe Barton, chairman of the House Commerce Committee, says that no such special exemptions will be granted by Congress.