One of my frustrations over the past year has been the fact that I can never get in touch with my caseworker from the Indiana FSSA, the agency which handles Medicaid and food stamp benefits. I have finally learned why.
In October 2005, FSSA began a process for privatizing eligibility services for public assistance programs by issuing a Request for Information (RFI). The RFI asked potential vendors to submit plans for providing eligibility services for six programs - Food Stamps, Temporary Assistance for Needy Families, all types of Medicaid, Child Care vouchers, IMPACT (employment and training for Food Stamps and TANF) and Foster Care funding eligibility. Responses to the RFI were due in January 2006; and after reviewing the proposals a Request for Proposal (RFP) was released January 31, 2006 with responses due on March 15, 2006. The initial RFI stated, and the RFP clarifies, that the goal of the process is to find a “business solution” not a technology solution to make the eligibility process for these programs more efficient and effective. Some of the reasons FSSA has identified to support pursuing a private contractor include: Poor customer service; Limited hours of operation; Inability to access system by phone, fax or e-mail during the application and re-determination process; Various application sites for different programs; Lack of program integration; and a system for applying for public assistance that is old.
Many agree that Indiana’s system for providing public assistance is not perfect and that improvements are needed. However, it is not cleat that privatization which is the solution identified by FSSA will improve the system without negatively impacting low-income and vulnerable Hoosiers. In fact, the scale of what FSSA is attempting through this privatization process is unprecedented nationally. No other state has tried to privatize as many programs as quickly as Indiana is attempting, and those that have privatized smaller portions of public assistance and eligibility services have not always been successful. Because no other states have attempted as broad a change, proposals submitted by companies will be built on assumptions and speculations and selection will be based on a bid from a company that will have to grow in order to provide the services.
It this does not spell trouble as you read it, it should. They are taking a system that already doesn't work and trying to fix it in a hurry. I have been a client of this system for the greater part of the last nine years, the exception being two years during which I lived in another state. During the time in which I have been a client of Indiana's Medicaid and food stamp system, the quality of services has diminished drastically. In 1998, I knew who my caseworker was but often had to wait up to a week for a return phone call. I no longer know who my caseworker is, and in 2005 and 2006 it was common for my calls to simply not be returned. In June of 2006, when I went in for an appointment, I found that the caseworker had left for the day! Another worker processed my review, staying late after her shift had ended in order to do so. My caseworker returned to the office during this time and apologized for failing to notify me, stating that her caseload was very large and she could not keep up. I noted that she seemed exhausted.
What I don't know is how privatizing the system fixes this problem. Based on my reading, it seems that one idea is to have people apply for benefits using automated systems for the initial intake procedure. There are problems with this: many clients are either illiterate or do not have access to a computer. However, this could be utilized as one option. However, the problem seems to be that there is no solution the the dilemma facing overloaded caseworkers. This is why I am not getting my calls returned. The proposed solution is to change eligibility criteria so that there are not so many people in the system. Personally, I find this objectionable. It is not an appropriate solution at all. It's all well and good to try to get people off the system; but depending on the situation there may be only so much that can be done. The solution is creating more opportunities for people who are actively trying to get off the system, making a way for people who are currently on the system to get their questions answered so that they are able to utilize resources effectively, etc. In summary, if things ran more smoothly, everyone would benefit.
This post from the Indiana law blog highlights the importance of the relationship between caseworkers and clients. Sometimes I have basic questions such as what I need to report and when. If I can't get these answered, I can't get off the system if I try.