Last Friday I attended a Jefferson City meeting on Medicaid (officially: MO HealthNet). Each month senior staff from the Department of Social Services join a crowd of us to discuss issues with the system.
Medicaid covers one of every six Missouri citizens. Every month MO HealthNet spends $800 million buying health care [ https://dss.mo.gov/re/pdf/fsd_mhdmr/1712-family-support-mohealthnet-report.pdf ]. More importantly, the program literally has the lives of vulnerable people in its hands.
Yet, meeting after meeting state supervisors tell of delays in computer improvements; unstoppable incomprehensible computer-generated letters sent to patients; and, a debilitating shortage of staff. Simply put, Missouri won’t hire enough horses to pull the wagon.
For example, every family getting state help deals with DSS Call Centers. If you want to apply for food stamps, call. If you need to report a change of address, call. The result is 130,000 to 200,000 calls a month. In December, on average, it took 24 minutes 53 seconds for each call to get answered. Once answered by a Tier One worker, the call may get routed to the electronic waiting rooms for Tier Two or Tier Three specialized workers.
The goal is to have 500 staff assigned to the Call Centers. Well, the state pays little and phone work with desperate people shovels stress. Most months the state struggles to hire enough new workers to replace those who left that month. Allow for the three month training cycle and it’s easy to understand why getting 300 workers on phones nowadays calls for champagne and strawberries.
Now, DSS folks know that they need more staff and to get those people they need to pay better wages. But the state’s unofficial slogan is “Do much more with much less.”
Monday the Missouri House of Representatives took a big step in making this bad situation worse.
House Bill 1486 by Rep. Hannah Kelly (R – Mountain Grove) claims that forcing responsibility – get a job or lose food – is in everyone’s best interest. [ https://www.house.mo.gov/Bill.aspx?bill=HB1486&year=2018&code=R ] Yes, taking food away from families with kids appears mean, but, it is necessary to motivate poor people.
I was among those who testified against this bill. For one thing, it offers no partial credit. Work 20 hours a week or else. Get just 19 paid hours and lose stamps for months or years.
This bill also creates a fiscal problem:
7 CFR 273.7(d) Federal financial participation
(4) Participant reimbursements. The State agency must provide payments to participants in its E&T [employment and training] program, including applicants and volunteers, for expenses that are reasonably necessary and directly related to participation in the E&T program…The State agency must inform each E&T participant that allowable expenses…Reimbursable costs may include, but are not limited to, dependent care costs, transportation, and other work, training or education related expenses such as uniforms, personal safety items or other necessary equipment, and books or training manuals…
Closer to English, you can make people work for their food stamps but if you do you have to help with transportation, child care and such.
They forced responsibility in Wisconsin a couple of years ago. They worked-out that, over two years, their program would cost about $50 million.
Missouri’s Fiscal Note estimated that implementing HB 1486 would have a $250,000 impact and require four more state workers.
Monday night, during the debate on HB 1486, the sponsor and Rep. J. Eggleston (R – Maysville) decided that Missouri’s Fiscal Note was too generous: Missouri has more than enough DSS workers, so, they can handle this new effort without extra money or staff. The House agreed, damning the Fiscal Note and advancing the bill to the Senate.
As I mentioned in my testimony on HB 1486, I want everyone who can work to work. Paychecks are good things to have. Yet, you can’t play baseball with balls and bats.
Based on Missouri’s experience with the FUTURES program in the late 1990’s (which did a decent job when it was fully funded and staffed), my estimate is that it will take 200 additional staff – case managers – to assist the thousands of families a year forced to ‘be responsible.’ And, based on Wisconsin’s recent experience, think at least $15 million a year in new funding.
Refuse to hire and spend and, well, HB 1486 will just hurt thousands of families each year – sending them to pantries and churches seeking help.
By the way, those state folks who come to the Medicaid meeting every month are good people. They work hard and believe in their work or they would have left years ago.
Yes, it’s okay to feel sorry for them.
Submitted by Glenn Koenen, WCD Member