Starving for Assistance Pt. 1

EBT CardOld school food stamps

The past few months have been pretty rough for the North Carolina Department of Health and Human Services. DHHS Secretary Dr. Alonda Wos has faced questioning multiple times regarding the ongoing issues that have plagued the department she oversees. Two major issues that have come to everyone’s attention lately are 1.) NC FAST, the system that processes requests for food stamps and other assistance programs and 2.) NCTracks the Medicaid payment system, which processes payments to healthcare providers who treat Medicaid patients. The food stamps have become a great concern for many around the state, especially because the United Stated Department of Agriculture has set a February 10th deadline for the state to make some significant progress towards resolving the backlogged food stamp and other nutrition assistance program initial & recertification applications. If the state fails to make enough progress to address the backlogged applications the USDA could potentially withhold approximately $88 million in funding; which essentially covers administrative costs associated with running the food stamp program annually. As DHHS Officials began to review the pending cases they, did report there were numerous cases of duplicate applications, especially for those who had been waiting longer periods of time.

Secretary Wos faced questioning by the NC Legislature regarding the continued delays with the food assistance program, After hearing the new numbers and finding out the true status of things at DHHS, some of the leadership felt they had been mislead about the state of affairs at the department and the food assistance program.  The Secretary was not unable to provide concrete answers that seemed to satisfy anyone, nor did it appear that she was able to boost the morale about the ability to resolve the ongoing issues. Secretary Wos was questioned about everything from personnel decisions to whether or not the new system was actually going to work for the state or not.

Legally applications should be processed within 30 days. However based on the USDA letter to NC DHHS date January 23, 2014; NC had approximately 19, 974 untimely applications, and another 11,482 recertification applications. Secretary Wos has stated that changes in Medicaid eligibility have effected the department, as well as the implementation of the Affordable Care Act. So to address the backlog of pending applications the State sent about 200 employees to various counties around the state to assist them with things like processing applications, technical, and policy support. Some counties like Cumberland County allowed certain employees to work from home when some county social agencies were shutdown due to inclement weather. Enabling employees to work from home allowed them to continue to chip away at the pending applications. Cumberland County had the second highest number of overdue food stamp applications. The state sent four staff members to help process applications, and two others to assist with policy or technical support. Other counties like Wake County; have their staff working overtime, which includes late evenings and some Saturdays. Wake County had the highest number of overdue food stamp applications for the entire state. However it appears that the county has made major progress with processing the applications. They too received assistance from several staff members of the state that were sent to help out with the backlog.

In the Triad & Northwestern NC Counties local agencies have been very hard at work to resolve pending applications, like other agencies all over the state. The most significant area of improvement for Triad & Northwestern NC Counties is resolving applications that were 120 days overdue- combined the local agencies reduced the number of applications from 204 to nine in the normal processing cycle and also reduced the number from 126 applications to nine in the expedited processing cycle. It is clear that the counties are stepping up and doing everything that the possibly can to help resolve the pending applications. When asked individually each county seems confident that they are capable of meeting the USDA deadline.

As of Monday February 3rd there were approximately 7,000 applications that were still pending. It’s not so much that the applications can’t be processed by the 10th. It’s more about can DHHS prevent this from happening again? Should the state be considering other options for a computer system to manage things like the food stamp program? Will there even be funding for a food stamp program after Monday?

In an update reported today by WFAE 90.7 in Charlotte, it is reported that unfortunately NC just barely missed the USDA February 10th deadline to clear the entire backlog of food stamp applications by approximately 25. However, the state has until the absolute and final deadline the USDA has imposed to completely resolve the backlog which is March 31, 2014. Secretary Wos stated that counties will continue to maintain the same work schedules that they have been working until the state has satisfied the demands of the USDA. Some county employees have been working long work schedules requiring their day to begin at 5 a.m. and ending at 9 p.m. and almost all counties have their staff working overtime to resolve the backlogged applications.

Much gratitude and respect to those who are working diligently around the state to process the backlogged food stamp and nutrition assistance applications.  Hopefully our Secretary of DHHS will find a more concrete solution to resolve the issues with the system that the state has decided it will use to process applications for assistance programs such as food stamps and nutrition assistantce. So that nothing like this happens to the residents of NC again in the future.

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North Carolina & The Affordable Care Act- A Love Hate Relationship

With so much talk about the new changes that would come into effect January 1, 2014 when the Affordable Care Act (or Obamacare as some call it) officially became an enforceable law in America. Some haven’t really given much thought to any of it at all. While others are tired of hearing about it all together. There has also been much talk around the state of NC, especially since we were one of about 25 states that opted to decline federal funding to expand Medicaid. Many in the healthcare industry have mixed feelings. However still quite a few wonder what things would be like if our state had made some different decisions. It is estimated that if NC had participated in the Medicaid expansion around 500,000 individuals & families would have become eligible to enroll in Medicaid. This would have also helped to reduce the number of uninsured North Carolinians as well, which is estimated to be around 1.5 million. It also would have helped to create some competition among the private insurance companies that decided to participate in the federal insurance exchange marketplace. (There was only one company that decided to participate.) 

In October 2013 at a speaking engagement in Washington D.C., North Carolina Gov. Pat McCrory cited a couple of concerns such as adding an additional 500,000 people to the state’s Medicaid program & also concern over whether or not the federal government would actually pay its portion of the cost of the program after the first 3 years as factors in why he ultimately chose to decline the federal funds for the Medicaid Expansion. saysnorthcarolina.html#.UuR4_WQo7BIThe Governor also admitted that due to another new piece of federal legislation that had recently become law, NC may not have a choice but to reconsider the Medicaid Expansion. The new federal law allows hospitals to make “presumptive eligibility” decisions for those uninsured patients they feel may qualify for Medicaid under the current NC Medicaid eligibility requirements. Based on the “presumptive” decisions made by hospital personnel the state can be billed for services received by the patient until a final decision is made, which can take up to 60 days. In the event that the hospital has made the wrong decision about a patient and their ability to qualify for Medicaid the state still has to pay for any services the patient received prior to a final decision made about their Medicaid eligibility, regardless of the fact that ultimately they did not qualify for services.

Although many might believe that not excepting federal funding for expanding Medicaid in NC was a good decision. When you think about the amount of money that hospitals across the state end up attempting to collect every year from those that are uninsured, it makes one wonder if some of the expenses can’t be avoided or decreased. It is estimated that within the first 8 years of expanding Medicaid an estimated $65 million could have been saved by providing coverage to those who would typically be uninsured. The North Carolina Hospital Association is even encouraging our Governor to reconsider his position on the Medicaid Expansion. The Hospital Association feels that this is an opportunity for hospitals to be compensated for services they provide (which they would normally be providing for free.) They also point out that expanding Medicaid would also be an opportunity to provide primary care to those who utilize emergency rooms across the state for non-emergent care regularly thus providing access to primary care for everyone & hopefully helping to close the gap in the access to care.

At the end of December 2013 our state ranked 6 out of all the states with individuals or families using the federal exchange marketplace to enroll in some type of healthcare coverage. According to the data in a New York Times article, there were a little more than 274,000 people enrolled in our state. Out of that number only a little more than 31,000 of them were found to qualify for Medicaid or CHIP (a type of medical insurance assistance program for children from the government.) It seems like the residents of this state want affordable health insurance, improved access to care, and they don’t mind paying for it either.

When you consider the fact that the state has to budget for Medicaid expenses annually any way and one of the purposes of declining federal funding was to save NC money, you begin to wonder if that is still possible with some the new developments since the Governor made his decision. If the state will now be responsible for unknown amounts of hospital expenses regardless of whether or not an individual actually qualifies for Medicaid; you wonder will this plan lead to savings for the state? Or will this cost the state more in the long run? Will Gov. McCrory end up trying to get others in his party to reconsider accepting federal funding for the state to expand Medicaid? (Many believe this would be very difficult and therefore is very unlikely.) Whatever happens NC is sure to continue experiencing some growing pains with all of the changes that are sure to come as far as healthcare is concerned.

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