Enrollment Drops, Eligibility Snags, Cyber-Errors In Ga. Benefit Programs Spark Concern

Eligibility for these safety-net programs is based on family income, and the declines are at least partially due to an improved economy. Boosts in household pay mean some families and children who previously qualified for the benefits are no longer eligible.

Consumer advocacy groups acknowledge the economic factor. But they also point to more restrictive processes and to barriers they attribute, in part, to the state’s new IT system for benefits eligibility.

That system, called Gateway, is part of a multiyear, multimillion-dollar contract for Deloitte. That’s the same firm which was recently awarded the $1.9 million contract to develop health care waiver requests to the federal government for Georgia’s Medicaid program and the health insurance exchange.

The Gateway system was implemented statewide in 2017 and is run by the state’s Department of Human Services (DHS).

The questions come as thousands of poor and elderly Georgians were terminated from Medicaid, an enrollment cut first reported by the Atlanta Journal-Constitution. State officials said they believe they properly notified most of those people it was time to renew the benefits, and that those beneficiaries simply did not respond.

The newspaper’s Ariel Hart reported that the Gateway computer system started the problem with these members’ renewal of coverage when it accidentally created a backlog of 30,000 cases for cancellation last year.

The state said it would reinstate the Medicaid benefits of thousands of these Georgians, the AJC reported.

Meanwhile, consumer advocates have pointed to the Gateway eligibility system, which state officials have set up to take applications only between 8 a.m. and 4 p.m. On top of that, DFCS, which must verify eligibility for benefits, is short about 500 eligibility caseworkers who review applications.

At least one state agency has requested that its application hours be extended.

“If you can’t get through to apply or renew, the natural result is that your rolls will go down,’’ Vicky Kimbrell, an attorney with the Georgia Legal Services Program, told GHN on Monday. “Our clients are often unable to get their applications or renewals completed because they’re unable to get through to their caseworkers, their computer system, the phones, mail, or even in person.’’

On the Gateway issue, a Deloitte official referred GHN to state officials for comment on the IT system’s performance.

State officials say that Deloitte has been paid $269.5 million from the beginning of the Gateway project in 2012 through the end of fiscal year 2019 (which is this coming Sunday, June 30). The expenditure covers costs for design, development and implementation and maintenance and operation of the system.

The Gateway contract is funded by both the federal government and the state, DHS says. While the cost-sharing formula varies according to the activity, generally about 15 percent has been funded by the state.

DHS says the new eligibility system is an improvement over the former system.

“Generally, it is working well. With any system this size, you are going to spend time making tweaks,’’ Ashley Fielding, a spokeswoman for the Department of Human Services, told GHN.

Gateway “has improved the integrity of the system,’’ she said, adding that families no longer have to deal with separate agencies for these government programs. “You don’t have to give four different agencies your pay stubs.’’

The state has an obligation to issue benefits only to people who qualify for the programs, she said.

Enrollment numbers have gone down for the Childcare and Parent Services (CAPS) program, which provides subsidies to low-income families to pay for child care, after-school and summer programs for children. CAPS is mostly funded by the federal government.

State figures show a plunge from 94,206 CAPS children in 2016 to 68,655 last year. The first-quarter figures this year have sunk to 56,617.

A spokesman for Georgia’s Department of Early Care and Learning (DECAL), Reg Griffin, said the agency’s designation of “priority groups’’ for the child care benefit — based on greatest need, such as kids in foster care — was partly responsible for the enrollment drop. He also cited a transfer of eligibility verification to DECAL from the Division of Family and Children Services and the implementation of Gateway.

The agency’s goal, Griffin said, “is to maintain around 50,000 children at any given time.’’

DECAL has requested that the state change the CAPS rules on Gateway “to widen the hours of availability for our families.  We especially want to offer evening hours. Ultimately, the goal will be allowing them to apply anytime 24/7,’’ Griffin said.

Short Hours Criticized

Georgia’s Medicaid program covers about 2 million Georgians, most of them children.

A Georgetown University report recently said that 20,000 fewer children were enrolled in Medicaid and PeachCare in December 2018 than the year before.

State figures, meanwhile, also show that 86,000 others, including many children, were dropped from Medicaid a year ago as part of a unusually big “reconciliation’’ process. The disenrollment figure was much higher that month than in any month before or since, state data show.

Erica Fener Sitkoff, executive director of the advocacy group Voices for Georgia’s Children, noted the children’s uninsured rate in the state rose in 2017. She described the limited hours of the Medicaid application process as a problem.

“Knowing that the number of uninsured children in our state has risen drastically in the last year, we of course have concerns that system barriers, such as time-limited Gateway access, are preventing children from getting the services they need, or even being able to be considered for enrollment in Medicaid or PeachCare,’’ Fener Sitkoff said.

“I am hard-pressed to understand why the state does not prioritize 24-hour enrollment application access for working families to apply for coverage for their children, especially considering that these parents often have to make significant extra effort to find broadband connectivity in the first place,’’ Fener Sitkoff said.

DHS’ Fielding told GHN that families still can check eligibility status, submit renewals, finish applications, and make changes to cases after 4 p.m.

“Division leadership changed several processes to speed application reviews, to increase access to local caseworkers and ensure Georgians got the benefits for which they were eligible,’’ she said. “One of these changes included limiting the availability of new applications online to business hours. This change ensured case manager resources were directed toward Georgians who were most in need.’’

Fielding said DFCS is working to recruit 500 eligibility caseworkers. “Manpower is an issue,’’ she said. The improving economy has made it more difficult to find people for those positions, Fielding added.

The food stamp drop has been linked to new work requirements for beneficiaries.

As of May, about 1.3 million Georgians were receiving Supplemental Nutrition Assistance Program benefits, commonly known as food stamps. In state fiscal 2013, the number of Georgians using food stamps was 1.95 million.

State employees and advocates working with poor and low-income Georgians say the decline is the result of several factors — including the institution of work requirements for people the state has identified as able-bodied adults without dependents, the AJC reported. Food stamp use has dropped nationally as well.

Meanwhile, the commissioner of the state’s Medicaid agency said recently that his department is looking at the processes involved in the terminations of the thousands of poor and elderly Georgians.

“Our No. 1 priority is that people who are eligible get the benefits they are entitled to,’’ Frank Berry, Department of Community Health commissioner, told GHN.

“We’re always trying to improve our systems,” Berry said. “I don’t think we’re ever satisfied that any of our systems are working as efficiently as they can be.’’

The terminations of elderly Medicaid recipients resulted from a glitch with Gateway.

Because of the large numbers of people involved, Medicaid enrollment changes constantly. Every month, thousands of people are either added to the rolls or are removed. The 30,000 people who were backlogged should have been part of that regular flow after they didn’t respond to renewal notices, the AJC reported. The computer should have sparked an alert for a caseworker to review each case and end the account if necessary.

Instead, a glitch surfaced in October, according to the newspaper. When Deloitte fixed the mistake in January, the backlog was too big for caseworkers to review. Community Health decided to terminate them.

Andy Miller is editor and CEO of Georgia Health News