Virginia League of Social Service Executives

Position Paper

of the

Virginia League of Social Service Executives

Partnering with Virginia DSS and DMAS

as we plan for the future of Virginia’s Medicaid program

Adopted July, 2010

The Virginia League of Social Service Executives (VLSSE) is a professional organization of the directors and assistant directors of local Departments of Social Services. The League focuses on professional staff development for the directors and employees of local departments and seeks to inform and educate local and state officials and community partners on human service needs in local communities and the programs of the Social Services System. The League’s members are Virginia’s experts on the structure and administration of local Social Services Departments and programs.

Guiding Principle:

The VLSSE Financial Services Committee’s goal is to assure that Virginia’s low income families have access to the financial services they need. The committee strives to do this by working with our state partners to resolve problems, eliminate barriers and develop an efficient and effective locally administered, state supervised benefits delivery system.

Issue:

Governor McDonnell has formed a commission to review current government processes and recommend possible reforms and restructuring for the future. These reforms should reduce or eliminate redundancies and provide for improved efficiency and effectiveness of services. The federal government has passed a Health Care Reform law that will increase the number of eligible Virginians by an estimated 220,000 to 450,000 individuals in 2014. Secretary Hazel has announced a Virginia Health Reform Initiative with the following key question regarding Medicaid; “How do we process the massive influx of applications?”

The VLSSE is willing and ready to partner with both the Department of Medical Assistance Services (DMAS) and state DSS in planning for this expansion of Medicaid. The Financial Services Committee is made up of local leaders who manage benefit programs in the localities. The committee can provide expertise and work in partnership with state representatives in their effort to improve the efficiency and effectiveness of the Medicaid program. The next two to three years offer a great opportunity for Social Services and DMAS to work together to create an eligibility system that is accessible, responsive and well managed.

In anticipation of this opportunity, the VLSSE Financial Services Committee has prepared the following ideas and issues for consideration.

Currently in Virginia:

As of March, 2010, there were 821,526 individuals enrolled in Medicaid in Virginia. This represents a 24.5% growth in the Medicaid caseload since the recession started in 2008. With the current economic realities, most localities are managing this increased workload without additional staff.

For FY09, the state had 694,276 individuals enrolled in Medicaid programs and 94,536 children enrolled in FAMIS. The FAMIS caseload represents 12% of enrolled Medicaid individuals.

Currently, the state supervises local departments of Social Services, which administer all of the Medicaid programs. FAMIS Plus is administered by DMAS in a centralized location. FAMIS is administered through a DMAS contractor at the Central Processing Unit (CPU) in Richmond.

The Financial Services Committee has identified the following issues, concerns and ideas, which we hope will be considered as decisions are made regarding the future of these programs:

Local Presence:

There are 120 localities in Virginia. These localities contribute approximately $200 million dollars to the cost of administering Medicaid benefits.
The localities also provide infrastructure for administering the program. This includes office space, lobby space, file systems, telephones and reception.
Local DSSs are able to respond to individual needs quickly in the case of emergency. Local staff regularly receives and responds to emergency calls from providers who have a Medicaid recipient in the office and have discovered the Medicaid case is closed. Local staff is often able to reopen those cases or develop a plan to fix the problem quickly.
Many local DSSs have developed contracts for outstationed workers. These workers are supervised by the local agency and are located in hospitals, health clinics, Community Services Boards and rehabilitation centers in local neighborhoods. The non-Federal cost of these positions is paid by the local partner. These community partners value our local accessibility and connection. We have shared goals and work together serving our shared interests. There are currently 67 outstationed eligibility workers throughout the state.
The local office has the capacity to see a real person, face to face, to better serve the needs of the customer.
Local staff is aware of other community resources and can provide referrals for additional local services to meet the needs of the customer.
Local agencies serve as a hub of human services for the customer. The local agency not only determines eligibility for Medicaid, but assesses the family’s entire situation and links the family to other services, including; Child Welfare and Adult Services.
Having a local office allows the customer to choose which “door” to use to enter the system. There is “no wrong door”.
Many Medicaid applicants are not able to navigate a centralized system. They may be illiterate, facing overwhelming health issues or face other barriers. They often need help from a local worker to complete the application.
Many local offices serve a large population of non-English speaking applicants. Often these applicants are illiterate even in their own language. These customers benefit from the presence of the local office, which is able to assist them face to face.

Multiple Programs:

Many of the families who apply for Medicaid also need either SNAP or TANF benefits. The 133% of poverty income level is very close to the income level for SNAP.
Local DSSs are the only organizations than can determine eligibility for multiple programs.
The goal of the Medicaid program is to assure families and individuals receive quality health care. SNAP benefits provide for needed nutrition, which is important to promote healthy families.
Those Medicaid cases for families also receiving SNAP or TANF are reviewed simultaneously, which eliminates a potential redundancy.
Combined eligibility determinations assure consistent information in the programs.
Local DSSs offer employment resources.

Looking Forward:

The growth of the workload with Health Care Reform is more than either the localities or the DMAS CPU can manage. A continued partnership between DMAS and DSS would allow us to use all of our strengths to manage this influx of new customers.
Additional staffing will be required however this increase is managed. The current staffing of localities and the CPU cannot absorb this new work.
In order to adequately manage this increased workload, the state will need to make additional investments in staff, infrastructure and technology.
An eligibility system where some customers are served locally and some are served centrally or where families are served by both systems is confusing. We should anticipate that customers will have changes that move them from one program to another.
Any system where local DSSs partner with a centralized team would require both entities to use the same data system.
The VLSSE does not recommend centralizing any Long Term Care programs. In order to accurately complete these applications, a lot of contact is required. These applications are often very complex and families may be in crisis.
The VLSSE is on record supporting the Enterprise Delivery System for VDSS. These improvements would streamline processes and allow all eligibility workers equal access to the tools needed to manage Medicaid. A content management system is essential for all Medicaid workers.

Contracted Eligibility Workers:

While the current CPU is a contracted service, THE VLSSE does not support the broad use of contracts for eligibility determinations.
The CPU’s efficiency is based on its limited focus; one program and limited processes.
Contractors must make a profit. Because of this, any growth in workload or additional processes may increase the cost. The local DSS workers and administrators are employees of the local government. They are closely tied to their communities and, as civil servants, are careful stewards of local and state resources.

The Virginia League of Social Services wants to be a full partner with the Virginia Department of Social Services and the Virginia Department of Medical Assistance Services as the state determines the future structure of the Medicaid program. We have identified some issues and concerns in this paper. We realize this is not all inclusive and know that there will be many issues and opportunities that arise through this restructuring. We are ready to share our knowledge and expertise and to provide assistance with this process.