Medicaid deadlines struggle for DSS
By Jon Hawley
Monday, November 13, 2017
North Carolina's departments of social services still struggled with delays in processing Medicaid applications last year, as only DSS offices in Pasquotank and two other counties met timeliness standards in 2016-17.
Those are among the findings the N.C. Department of Health and Human Services provided to state lawmakers in a report released on Nov. 1.
State lawmakers have required DHHS to submit that report annually following major delays in processing Medicaid applications in 2014 and 2015, the report explains. It notes that federal regulations require Medicaid applications be processed within certain times. The deadlines seek to ensure vulnerable people don’t endure long delays in getting health coverage.
The report contains both good news and bad news.
Statewide, 81 percent of Medicaid applications were processed on time in 2016-17, an almost 4-percent improvement from 2015-16. The state also trimmed three days off the average processing time for Medicaid applications, for both disability and other kinds of coverage.
Federal regulations require Medicaid disability applications be processed within 90 days. Last fiscal year, North Carolina’s processing time averaged 58 days, down from 61 the prior year. As for other Medicaid applications, they're supposed to be processed within 45 days, and the state processed those on average within 34 days. The average was 37 days the year before.
But the report also shows counties struggled to consistently process all applications on time. It found only three counties met timeliness standards in every month of 2016-17. Pasquotank was one; the other two were Cherokee and Stanly.
The report shows the Camden and Perquimans DSS offices failed timeliness standards during four months of the year, while the Chowan and Currituck offices failed timeliness standards in three months of the year.
Despite some delays, the report showed Pasquotank and its neighbors processed the vast majority — more than 90 percent — of Medicaid applications on time.
Perquimans reported the lowest percentage for timely processing of non-disability Medicaid applications, at 89 percent, but the highest percentage for timely processing of disability applications, at 98 percent.
NC FAST slows things down
Overshadowing the report is North Carolina's efforts to fine-tune the NC FAST system. Short for “North Carolina Families Accessing Services through Technology,” NC FAST is designed to provide a single platform for processing all applications for social services, including not only Medicaid but Food and Nutrition Services (commonly known as food stamps), heating assistance and, in the near future, Child Welfare and Adult Services.
As a state official explained in Pasquotank last year, DHHS rushed implementation of Medicaid in 2014 because of the federal Affordable Care Act. Medicaid's complexity has resulted in years of frustrating, time-consuming glitches for DSS offices statewide.
In an interview last week, Pasquotank DSS Director Melissa Stokely said Pasquotank has met timeliness standards “despite NC FAST.” The state is still regularly fielding thousands of requests for technical support, she said, adding that Pasquotank DSS continues to have a staffer, Devon Mayfield, dedicated to working through the county's “help desk tickets.”
“It seems like every time they patch (NC FAST), they break something else,” Stokley said.
Currituck officials were less critical of NC FAST. Currituck DSS Director Samantha Hurd, along with staffers Christal Berry Yuvanka Morris, said the state has provided additional training seminars and other resources to help counties work through the glitches caused by NC FAST. They said their case workers all feel comfortable using the program now.
NC FAST does still have its glitches, they continued, but Currituck DSS officials also said the state has improved its technical support. They explained DHHS expedites help desk tickets when the applicants involved have urgent medical needs, or when their applications are at risk of exceeding federal deadlines for timeliness.
Addressing the report's determination that Currituck failed to process applications quickly enough for three months in 2016-17, Hurd and Berry said DHHS has acknowledged issues with how it collected data from July through December of 2016, and is not holding those months against the county. They also said Currituck has met timeliness standards for January through October of 2017.
Page five of the DSS report acknowledges DSS worked through several counties' concerns with its initial methodology for calculating monthly report cards. It also reported that DHHS will not require counties to enter into “corrective action plans” unless they fail to meet timeliness standards after June 30, 2017.
In an email to The Daily Advance, Chowan DSS Director Letecia Loadholt said that NC FAST does still have glitches “that may result in processing delays,” but the state is providing helpful training and other resources to help speed up agency response.
As for Chowan failing to meet standards for part of 2016-17, Loadholt echoed Currituck officials about the data discrepancies that means the report “may not accurately reflect the timeliness of our agency.” She also noted it's possible for a county to “fail” to meet the timeliness standard for a month if it fails to process even one application within the federal limits.
She also reported the Chowan DSS serves about 3,300 Medicaid recipients.
Camden and Perquimans DSS officials did not return requests for comment last week.