I went to a forum today about FSSA’s recent privitization of the administration of Indiana’s food stamp, medicade, and other benefits. Here are my notes from the forum. I tried to be as accurate as I could, but in many cases, couldn’t keep up with names, positions, or people’s entire stories/statements.
Before I offer my notes, I wanted to give a little of my own analysis. The panel of experts represented various township and state government officials who were presented as experts. While one panelist aknowledged that they were only experts because they had heard so many criticisms and seen so many problems faced by their constituents, I still thought that the lack of people directly affected by the FSSA privitization on the panel was very telling of a system that continues to fail to put people using the services at the center of the disucssion and in control of driving the program’s future. There were a few people who had personally struggled trying to maintain FSSA benefits through the privitization rollout, but many of the voices were from people who worked through agencies or informally as advocates or who were friends, like myself, of people who had to deal with FSSA privatization. The sheer number of people affiliated with agencies or other nonprofits was encouraging because there seemed to be such a consensus that the current system was very flawed.
On the other hand, I think the non-profit to individual ratio represents how voices get masked behind the web of non-profits in Bloomington. Ideally, I would love to see people, not just represented by the non-profits that serve them, but representing themselves, with support (childcare, transportation, media access, employment) from the social services to allow people who are affected by issues of healthcare access or food security to direct their own voices to decision makers. The reason for this seems complicated. Bloomington non-profits definitely lack the resources to be both service providers and support for communities organizing themselves. Still, I think many non-profits are trapped in the mindset of helping the less fortunate or “humanizing the system”, as one commenter stated, rather than being part of more radical and fundamental change by helping those most affected be at the forfront of the dialog and the decision making or critically reshaping the social values and assumptions that underly inequality in Monroe and the policies that preserve it.
The role of non-profits remains a difficult one. As many people at the forum explained, the privitization of FSSA services also involved the removal of local FSSA caseworkers from communities across Indiana. This created a situation where the FSSA representatives that most people dealt with (mostly over the phone) were both unfamiliar with their cases and could not effectively help with problems. Charlotte Zietlow, who works with the Middleway House, made the additional analysis that removing local caseworkers has placed the burden of casework on other local agencies that are already struggling to find the resources to do the work that they’re doing. Exaserbating resource scarcity for supporting people in Bloomington creates a fearful and competitive atmosphere, where non-profits don’t communicate or collaborate and where they choose to hold the course of their work rather than pushing the boundaries of what could be or expanding their work to challenge root causes instead of helping people survive.
Here are the notes:
- Vi Simpson
- Peggy Welch
- Matt Pierce
- Dan Combs
- Linda Sievers?
- Zach Main – FSSA – “The guy in charge of the project”
Comments from agencies
Luanne Morrow (Fiscal Coordinator w/ Stonebelt)
- Deals with developmental disabilities who live in group homes and who are medicade funded.
- Notices from FSSA come from P.O. Box, look like junk mail and are often thrown away.
- Only one phone number for the whole state
- Used to deal with local agencies
- Recently the FSSA line has also been used for natural disaster issues, which has hurt access
- Why can’t regional and local offices have seperate phone #’s
- Monroe co. Medicade office moved and was hard to locate.
- Need e-mail address contacts
- 800# menu is really confusing
- Records are accessed by case # (not medicade #). It’s hard to find this case # because it’s only on the mailings.
- 10+ minute wait on 800 #.
- Can only talk about 3 “consumers” at a time.
- Her caseload is 66+ “consumers”
- Have different points of contact so the same situation has to be explained over and over again.
- FSSA reps wouldn’t talk to her as “consumer” representative because paperwork wasn’t filed
- No phone number for offices.
- Would only allow phone interview
- Only called office phone, when she wasn’t there.
- Thrown into reactive mode for advocating for her consumers
- Forced to neglect other duties
Q (Peggy Welch): What has gotten better? What should we preserve in the system?
A (Luanne Morrow): Hasn’t seen anything that works better yet. “Everything has caused more work.”
Q (Vi Simpson): Why do you have to contact the office so frequently?
A : Each consumer has to have annual review with Medicade. Consumers have expenses with Stonebelt that they owe. This is funded through FSSA. Also, income, child support, etc. changes frequently.
Q (Dan Combs): Is there a specific group or contact for developmentally disabled individuals?
A: There used to be at the local office. There is allegedly a contact at the 800# who is a specific contact for group homes, but she hasn’t contacted them.
Q: Are there some people who navigate this w/o professional advocates?
Comment (Linda Sievers): Works for an agency that has gotten access to the system to be able to pull up the FSSA records and pull up individual info by case #. This has been able to help some people.
Comment (Zach Main): Not here to argue or defend the system. “We’re working very hard.” Listening to feedback.
Chris Holly – Private advocate for medicade
- Lots of people shouldn’t need me (if the system worked)
- Personally likes to use the internet and feels tech savy, but the web forms on the FSSA site doesn’t work well.
- FSSA doesn’t honor paper applications from the old days, even when the computer system doesn’t work.
- This is important because things are time sensitive.
- Biggest problem is that we can’t call someone at FSSA to finish a case.
- Appointed rep doesn’t get notices.
- For him, phone interviews are okay but
- Reps aren’t familiar with the part of program he’s dealing with. He gets bumped to a specialist but can’t contact them directly.
- Reps haven’t looked at documentation
- Only get one chance for a call in a 2 hour window and one callback in 10 minutes.
Q: Peggy Welch: Does “failure to cooporate” describe people’s rejections from FSSA? Call doesn’t come through, often call the next morning instead, don’t reach the person, and the client get’s “failure to cooperate”. What does failure to cooporate mean?
(Lots of people in crowd raised hands in response to the first question)
A (Zach Main): Defined failure to cooperate as when reps say that they’ve sent them multiple notices and people haven’t met their responsibilities.
Q: Peggy Welch: In the past people could call to respond to find out why they got a failure to cooperate (what signature was missing, etc.). Now they can’t. What we’re missing is caseworkers (or a person responsible for a person). This is what missing, not the online forms.
A: Chris: This is a problem. There isn’t one person who understands the case and one person who is responsible. Social security has undergone similar modernizations but still has case workers.
Jody from Community Health and Wellness center in Bedford (also does WIC program)
- One postive thing – likes being able to check WIC eligibility on the Internet
- 17/52 prenatal patients are ineligible
- One patient has applied 3 times.
- Internet form didn’t let her enter info
- Another patient is Asian and there are head of household communication issues
- Jody has tried to support this family
- Has had wrong doctor and wrong managed care assigned to her
- Has been billed for ultrasound personally when she was eligible
- Computer issue, website issues, enrollment center training issues, local agencies aren’t trained, provider issues, panel issues, accurate adding of people to
- Using federal grant money to cover charges for ineligible folks “Who’s going to pay for them anyway.”
Vi: Why are they ineligible?
Vi: What about being in the 3rd trimester?
Tara Doyan: Crisis Pregnancy Center
- Previously an enrollment site. Weren’t given info on how to do this in transition.
- Needs caseworkers with knowledge of TANIF, childcare, hoosier healthwise, etc. that is a broad knowledge instead of having to be bounced around
- Only given notification of interview call for 2 hour time frame a day before or 2 days before. This doesn’t work for working moms.
? from Southern Indiana Pediatrics
- services thousands of kids (like 9000) on medicade
- wants to provide same level of service to kids regardless of payer
- Things have improved
- Can now work with Anthem, MDWise, MHS, (Maybe one other)
- Reimbursement rates improved under privitization because rates can be negotiated based on quality of care, level of utilization,
- They’ve worked hard to develop relationships
- Anthem and MHS works well (communication and websites)
- Decrease in caseworkers has hurts patients
- Autoassignment hurts patients
- Assigned to care in a different county
- Switched from provider they’ve used for years.
Walked away from plans who have been bad business partners. They’ve steered parents away from MDWise because they haven’t gotten paid correctly from MDWise.
Jason Karns – Caseworker for Baron Hill’s office
- Since conversion 2-3 issues a week (vs. 2-3 issues a month before)
- 812.336.3000 – Contact Baron Hill’s office if you’re having a problem
Steve Sharp – Indiana Legal Services
- 1.800.822.4774 – ILS contact # for help
- Read letter from coworker who is a lawyer and wasn’t able to make the forum
- Since mid may saw a sig. increase in cases due to clients losing benefits
- Due to “Failure to cooporate”
- In most of the cases of “failure to cooperate” people sent requried documents by deadline
- i.e. document blurred in fax transaction = ‘failure to cooperate’
- rejection letter was returned to sender so she never got the notice
- didn’t find out until she tried to buy food and didn’t have funds
- reapplied for expedited food stamps in May but never got a response
- took a week for the release form to allow advocate to represent him
- Call center rep verified that person had sent the required documents but couldn’t fix the error
- No prompt way to resolve even agency errors
- Old system: caseworker could solve this
- New system: explainers and fixers but people can’t do both.
- In the old system caseworkers could contact people when there was a problem. In the new system, people don’t run into problems.
- i.e. document blurred in fax transaction = ‘failure to cooperate’
Response (Zach): If a case takes too long to resolve, it does count against the error rate for IBM. If IBM’s success rate drops below 95%, they could lose funding
? – Rep from Area 10/2-1-1
- Questions, need help, call 2-1-1
- Calls, faxes, computer data gets “lost”
- Better results when things are “wireless” (I assume she means face to face communication)
- Food stamps is a big problem
- Monroe county had a flood but even worse in Owen county
- “Hispanic” community in Owen county even more vulnerable (esp. homes condemmed)
- Dan Denny with HT has been able to get help for people by contacting FSSA directly
- FSSA Ombudsman hasn’t been as helpful
- Ever since the transition 2-1-1 has seen more calls.
Liz Jones – Area 10/2-1-1
- Immediately on rollout got calls
- Confused about system
- Confused about lack of caseworker
- 2-10 calls a day related to FSSA services
- Mostly foodstamps
- Lost benefits
- Ultimately refered to local food pantries
Janet ? – Bloomington Housing Authority
- 1350 section 8 families served by BHA
- 17% (~945 familes) are disabled or elderly
- “volumes you can’t believe” of folks coming with stacks of paperwork asking BHA to send (fax) paperwork for them
- HT has been helpful
- Not getting info from FSSA in a timely manner because these benefits effect people’s standing with BHA
- Don’t always have case #, used to accessing by SSN#
Jacob ? – Legal aid coordinator w/ Shalom
- As soon as the rollout happened, Shalom inundated with calls for assistance
- IU law student has dedicated his summer to help folks with understanding the system and dealing with appeals
- 20 cases active in last week
- 3 “areas of concern”
- Lack of local caseworkers
- Frequent complaint from people the shalom center works with
- Forms themselves are way too complex.
- Folks need local caseworker to help understand forms
- Homeless folks don’t have phone or internet, phone number to receive call back
- This is the biggest concern
- Rollout was handled by mass mailing
- Transient population didn’t get the notice.
- I.e. family lost housing so they didn’t get packet
- lost benefits for them and their kids, still working to get benefits back.
- In the past time between application and interview was ~ 2 days, now it’s 20 (even with expedited application)
- Also, 7 day “limbo period” after app. submission
- can’t confirm receipt or any errors
- Also, 7 day “limbo period” after app. submission
- Lack of local caseworkers
Charlotte Zeitlow – Case manager w/ Middleway House
- Burden for caseworking has effectively been transferred to local agencies at a time when their resources are even more limited.
- Women who get services from MWH need services but aren’t sophisticated electronically.
- Don’t have time to get access to computers or needed training
- Many women don’t have telephones
- Asking people with the fewest resources to do the most complicated things technologically.
John Cardwell – Indiana Home Care Task Force, Generations project (looks at privitization issues)
- Problems articulated at this forum have been articulated in Muncie/Anderson/Kokomo particularly affected because they are the last community affected by the rollout
- People affected by this should work with caseworkers or representatives to file a “formal complaint:to “Food and Nutrition Service of U.S. Department of Agriculture” (Tim English, I think he said). Chicago office. Send foodstamp complaints here.
- Center for Medicade and Medicare Services (CMMS) – has Chicago office. Will take formal complaints.* Above 2 orgs initiates fed investigation into Indiana problems.
- Biggest problem is lack of caseworkers
- As a test, gave highly educated people the 16 page app. They would have all received a failure to cooperate notice because they couldn’t interpret the application
- Thinks IBM/ACS contract needs a “thorough public audit”.
- Federal law
- How $’s are being used
- Staff in Marion call center aren’t trained
- Caseworkers who were transferred have left
- Wants formal legislative hearings on this.
Comments from individuals
Mike Biggs – interested in this issue
- Indiana didn’t knock people off rolls initially and was successful and keeping good track of who should/shouldn’t be on the rolls. This got worse with privatization.
- Replacing trained FSSA staff with IBM workers and volunteers. This change hasn’t helped people. One state number instead of local service. Offices inaccessible because they’re hard to find and harder to get to.
- Goal of this was to knock people off of the rolls
Mary – Medicade User
- Forum balance on agencies rather than users
- Spent 2 hours on phone this morning and was referred to 6 different numbers to get one medicade answer
- Can’t have a needed procedure until another (lower cost) procedure was done first
- Trying to be a good steward of medicare money, response was “just do the procedure anyway”.
- Couldn’t get info about restricitons and her particular case
- Given the run-around on the phone
- Don’t know what department to direct her to on the phone
- Wants to find a caseworker.
Catherine – Restuarant Owner
- Crime in neighborhood has increased since FSSA changes
- Increase in mentally ill people visiting her restaurant
- Feels these people are getting knocked off of FSSA rolls
- “I’ve never seen poverty like I’ve seen in Indiana”
- There’s a “war on the poor people in Indiana”.
- IN should find a model in other states that works and be adopted in IN.
- Case workers are very important to bring back.
? – Received foodstamps and medicade services for children
- Ivy tech student, had to miss classes to attend forum
- Didn’t receive call at the time that they said.
- Threatened with loss of job
? – Works with immigrants
- Children (even undocumented) are able to have some benefits
- When calling, call center doesn’t speak spanish, asks for SSN which people can’t give (even though their undocumented kids are eligible)
- Technology difficult to navigate, even for those with computers
- Need computers and tech support at local offices
- Need people who can interpret different languages
Dianna Goodman – Ivy tech student
- Classmate couldn’t take full course load, so she lost eligibility
Bob – medicade user
- Dyslexic, found out today that he was denied for 2 years for his medicade
Linda (Panelist) – Township Trustee
- Township can help
- Food pantry
- Rent/mortgage assistance
- Makes decision about this in 72 horus
Vi Simpson (Panelist) – State rep
- Thanked FSSA for their flood relief, esp. one stop shop for Brown county
- Flood relief proves that we can accomplish things when we work together
- system faced “sudden and emotional changes”
- system is broken
- Because so many lives and vulnerable people depend on these programs working well and efficiently, by working together we can improve things. This is really the reason for today’s meeting.
- Hope that by bringing caseworkers here today, they could solve specific problems, but also wants to identify systemic problems
- I learned today: 2 page document to apply for children’s health service -> 18 page document
- Vi was on comittee that recommended a 2 page app.
- This summer there will be hearings on this issue
- Contract needs to be funded in the budget so this could come into play in the budget hearings
- FSSA has suspended rollout to further counties
Matt Pierce (Panel) – Rep
- The way we serve the neediest members of our soceity is the fundamental gauge of our government
- General assembly must provide oversight
- Understand what’s happening in system
- ensure that changes are made if needed
- Hearings this summer, this is the beginning of the process.
- Â Goal: to have as few people as possible slip through the cracks -> contact his office if you need help
- Biggest concern: people reduced to data points. We might have moved into a structural system that has caused this to happen.
Peggy Welch (Panel)
- Â Panel of “experts” because they’ve heard from so many people about this
- There’s been an increase in calls. This represents some kind of systemic problem.
- Peggy serves on ways and means committee. Not sure if current contract represents the most efficient use of taxpayer money in terms of people getting services. These questions will be asked during the summer.
- This forum will be broadcast on CATS.
Dan Combs (panel) – township?
- Â Most disturbing forum he’s ever been at
- Developmentally disabled left on their own w/o advocate.
- Sees this as a result of deinstitutionalization
- Vendors don’t neccessarily want to work in this area. They’re in it to make money.
- Has taken 20+ years to build relationships with vendors
- Local mortuary was going to stop taking medicade burials because they couldn’t get paid
- Township couldn’t get ahold of FSSA via phone number after rollout
- Media coverage changed this and the township was able to get a direct contact
- Direct contact is key, this doesn’t exist for client
- Social services will never be cheap or cost effective
- Good people in Indiana, not out to do a bad job, but we need to look and see if the job we’re supposed to be doing is what we’re doing.
- Low income people couldn’t have made a later meeting either because of non 9-5 hours of many workers* “Maybe it’s even bigger than what I thought it was”.
Zach Main (panel) – FSSA
- Changes in the last 3 years had the goal of making life better for neediest Hoosiers
- “It’s not a perfect system”
- Local office channel of communication is still available (his answer for call to casework)
- FSSA will increase staffing of local offices
- FSSA local office will be able to handle cases from beginning to end
- FSSA will remind people of local office option
- Goal wasn’t to force people to use phone/Internet
- FSSA working on forming closer partnerships with advocate organizations
- “Today is not the end, it is the beginning”