Counties are still working to get the backlog from the FNS portion of the implementation under control — in January, the statewide backlog included 23,000 families, 8,300 of whom had waited more than three months for benefits — while facing the next hurdle: running Medicaid applications through the system.
“Any big system has problems rolling out, and we’re hopeful it will eventually be resolved, but we’re just needing commissioners to be aware of the issues and maybe help us put some pressure on the state program,” Bob Cochran, director of social services for Jackson County, told commissioners in a recent work session. “Slow it down and make sure that Medicare clients won’t go without their services and not roll it out any further until we get some of these problems resolved.”
The new system is significantly more labor-intensive, with FNS applications taking twice the amount of time to process as they did under the old system and FNC recertifications taking 88 percent more time, Cochran said.
“When we started the NC FAST program, things changed after they started the implementation due to the federal health care,” Macon County Director of Health and Human Services Jane Kimsey said.
NC FAST had originally been slated to kick in during 2017, but the state sped up implementation to stay ahead of the implementation date for the Affordable Care Act. Changes and rewrites to comply with the law as it came into effect further gummed up the works for NC FAST.
But there were plenty of issues with the FNS portion of the program, which doesn’t fall under the Affordable Care Act umbrella. The system changes almost by the day, Cochran said, and staff are constantly searching for workarounds to make it function.
“You have these workarounds that come about every couple of days, and they range from a three-step workaround to a 17-step workaround,” Cochran told commissioners. “They can’t stay on top of it. It’s almost a worst-case scenario.”
Cochran’s staff has been working overtime in order to handle the transition as best they can, coming in about one weekend per month to fit in some extra hours. Haywood County is also seeing reduced efficiency, and while Kimsey said her county hasn’t been seeing much of a backlog, they’ve hired two temporary fulltime positions to absorb the extra workload.
None of that has come cheaply. Since 2011, Haywood County has spent nearly $240,000 on overtime, temporary workers, equipment and information technology upgrades related to NC FAST, $60,000 of that going to temporary workers. In Macon County, hiring temporary workers has cost more than $70,000 since July 2012. Between July 2013 and January 2014, Jackson County shelled out nearly $30,000 for overtime and temporary employees, also footing the bill for $43,000 worth of food vouchers requested due to slow-downs in processing state food stamp benefits with NC FAST. The federal government will reimburse counties somewhere between 50 percent and 75 percent of their extra labor expenses, depending on the type of application they’re associated with, but it’s still costing a pretty penny.
And those temporary positions aren’t necessarily remaining temporary.
“I think additional staff time is going to be the new normal for us,” said Teresa Allison, economic services director for Haywood County’s Department of Health and Human Services.
Rather than pay staff overtime and temp salaries indefinitely, Haywood DHHS concluded they simply needed additional in-house staff to process NC FAST applications. The agency eliminated an office assistant position — which they could do without following a consolidation of the social services and health department under one umbrella — and reassigned that position to NC FAST.
“It was determined the position would be better used in NC FAST,” said Ira Dove, Haywood County manager.
Looking for a fix
As more and more Medicaid cases are transferred from the old system to the new, the workload will only increase, so Cochran presented commissioners with a set of recommendations to pass on to the N.C. Association of County Commissioners.
“One of the reasons we want to come to the commissioners association is because there are some messages being given to the committee in Raleigh that the system is fine, there’s nothing wrong with it,” Cochran said.
On his end, though, that’s not the case. Cochran’s recommendations advised that the state immediately suspend EPASS, the online portal clients can use to access NC FAST, and refrain from converting more programs into the system until those already in place are working. The counties and state should work together, he said, and come up with some hard metrics to measure success before new phases are rolled out. The state should develop a process to handle emergency Medicaid applications held up by NC FAST and work on Medicaid applications coming through the federal system itself rather than sending them to counties. Finally, Cochran told commissioners, the county should be held harmless legally for any errors NC FAST causes.
Though Haywood County hasn’t put together any comparable list of requests, Dove, who previously directed the social services department, agrees with the lion’s share of Cochran’s recommendations.
“I would agree that this system needs to be fixed and that applications for Food and Nutrition Services should be stopped until all the system issues are resolved,” Dove said. “Also, as to bringing additional program areas beyond Medicaid, Work First and Food and Nutrition online, it would be best to wait until the work-around solutions and other issues are resolved before adding to the system.”
However, though Dove agrees that some short-term processing help with Medicaid applications coming through the federal system would be helpful, he would steer clear of asking the state to fully take on that role.
Kimsey agreed that the rollout has had its share of issues, particularly when it comes to the EPASS system, but she pointed out that the state has been putting forth some effort to identify and fix the issues. A survey sent to county directors had them rank the most pressing problems, and a soon-to-be-released list identifying the top 18 will provide the framework for the state’s response to the problem.
“One of the highest priorities has to do with EPASS,” Kimsey said.
In addition, the state has slowed down the rollout of integrating Medicaid into NC FAST, with only a specific subsection of Medicaid cases now being handled through that system. As with any system as large as NC FAST, problems take time to address and work out. And until that happens, counties have to find their own fixes to ensure clients receive services.
“In Jackson County, we’ve had ten years up until NC FAST of 100 percent timely processing and 100 percent accuracy on audits of our food stamp cases,” Cochran said. “This is a strange place for us to be where we’re not meeting basic timeframes and we’re having errors right and left.”
Many of those errors and backlogs are coming from blips in the system due to expedited cases. Cases that meet the criteria for “expedited” are emergencies that county departments are expected to turn around within seven days, a much shorter timeframe than the standard 30 days.
But the EPASS system has been flagging a good many cases as expedited that, in fact, do not meet those criteria. That eats up staff time that might be better prioritized on a different task and keeps people whose cases genuinely do qualify as “expedited” from getting the services they need on time.
“It’s causing a lot of problems on the local level,” Cochran said.
In Haywood County, Allison is seeing the same thing happen. Before NC FAST came online, the department was seeing rates of 98 to 99 percent for accuracy and timeliness. After a dip downward, they’re now back up to 96 percent for FNS services, but health care services are down around 79 percent since the transition to NC FAST for Medicaid applications began in October.
“We have some system defects still that are hindering our productivity,” Allison said. “We will experience some backlogs for awhile, quite honestly.”
However, counties still believe that the NC FAST system will be a success once it gets off the ground. The old system required entering the same information multiple times, for each of the up to 17 programs a family could apply for. For instance, if a family qualified for Medicare, FNS and child care, county employees would have to enter their information three separate times.
“The big positive is the promise is still there,” Cochran said. “I think every single one of us still believes that this will work out in the long run, that we will have a highly efficient system that is not so redundant.”
The process is getting better, Allison said, with the Medicaid rollout running a little smoother than the FNS rollout. But there’s still room for improvement.
“I think that we learned lessons from the first rollout,” she said, “that slowing down, taking time to make sure that the system is ready, that it’s been thoroughly tested, that as many issues as can will be worked out ahead of time, will be the best case scenario not only for the staff who do the work but for the people who get the services.”