Thursday, March 23, 2006

Austin Chronicle: Chipping Away at CHIP

Chipping Away at CHIP

Former State Rep. Patricia Gray has no desire to return to the Legislature she left four years ago, but oh, what she would give to try to make things right with the Children's Health Insurance Program – her baby, if you will. The Galveston Democrat and former chair of the House Public Health Committee shepherded the landmark CHIP legislation through the House in 1999 and cheered when the program kicked into gear in September 2000, creating a new health care source for uninsured children of working parents.

But then a Republican majority swept into power in 2003 and, needless to say, it's been touch and go for kids' health coverage ever since. Now comes word of another setback for CHIP as the Health and Human Services Commission begins transitioning some of its job responsibilities to a private contractor – Texas ACCESS Alliance, a consortium led by Accenture, the Bermuda-based outsourcing giant with a checkered record of performance in several states. The privatization shift began just as tighter eligibility rules and new enrollment fees went into effect, causing widespread confusion and more paperwork for CHIP clients, and sending the program's enrollment figures into freefall, leaving nearly 30,000 CHIP clients in the lurch. As a result, the start of the new year saw CHIP's overall enrollment drop to 295,000, the program's lowest figure since its earliest existence.

This of course is disheartening for advocates who are committed to reversing the state's high rate of uninsured residents, an estimated 1.4 million of whom are children. They believe about half of those children are actually eligible for either CHIP or Medicaid but are not enrolled in either program.

While Gray, an attorney, is enjoying her new life outside of the Legislature, where she spent a decade in public service, she remains an active – and increasingly concerned – health care advocate for low-income Texans. "It's dismaying to watch things that matter to you get pushed aside," Gray said of the latest setback. "When CHIP enrollment exceeded 500,000 I was just so excited. I thought I really did get to work on something that truly made a difference. Now it's back to under 300,000, and the numbers are heading further south. And," she added, "we're making it hard for people to enroll and to stay enrolled. It's just dismaying."

Travis County's decreasing CHIP enrollment reflects the statewide trend. In February, the county had 8,154 kids enrolled, down from 8,330 in January, and 8,550 in December. Three years ago, 12,384 area kids were enrolled in the program. Last week, Rep. Elliott Naishtat, D-Austin, told HHSC Commissioner Albert Hawkins in a letter that his office was fielding an unusually high number of calls from constituents in Travis and Hays counties whose benefits were disrupted or delayed under the new call center operation. Naishtat urged Hawkins to reconsider launching a full roll-out of the new system until all the kinks are ironed out.

HHSC officials say they are equally concerned and are reviewing Accenture's handling of calls from CHIP clients. Similar complaints have been made of Accenture's performance on processing renewals for Medicaid and food stamps.

Responding to growing alarm over the state's haphazard privatization efforts – in an election year, no less – Gov. Rick Perry recently prodded the HHSC to re-enroll 6,000 children who were mistakenly dropped from CHIP coverage. Social service advocates, Democrats, and the Texas State Employees Union say that's not nearly enough; they've stepped up their calls for HHSC Commissioner Albert Hawkins to rethink the agency's $899 million contract with Accenture, or, at the very least, to slow down the process of implementing sweeping changes. The agency's privatization plan calls for shuttering the state's community-based offices, firing thousands of workers, and replacing both with privately operated call centers to determine a person's eligibility for receiving CHIP benefits, Medicaid, food stamps, and other social services.

This is not what the original architects of CHIP had in mind when they designed what was supposed to be a relatively user-friendly program for families who can't afford health insurance but don't qualify for Medicaid. The state-funded program was set up to tap $423 million a year in federal matching funds to serve more than 500,000 eligible children.

The CHIP upheaval stems from the 2003 Legislature's two-pronged massacre of the state's health and human services programs, first with deep budget cuts (since partially restored) followed by a massive consolidation and overhaul of the state's health and social services. The changes wrought by that year's HB 2292, authored by former GOP Rep. Arlene Wohlgemuth, also opened up new contract opportunities for Accenture. Several states have hired Accenture to develop new electronic voter file systems or to manage state-funded social service programs. But Accenture's record on both fronts is shoddy at best. In the last two years, at least half a dozen states have fired the contractor for failing to deliver on its obligations.

Meanwhile, state Democratic Sens. Gonzalo Barrientos of Austin and Eliot Shapleigh of El Paso have asked Lt. Gov. David Dewhurst and House Speaker Tom Craddick to appoint a special joint interim committee to review the state's privatization efforts. Gray believes that would be a good start to correct some of the damage done, but it's unlikely that the GOP leadership will carry out the Democrats' request for review. "This notion that private business always does it better than government is just stupid," Gray said. "What we've done is create a whole new network of people who get the big money and then dole it out in little bits. We've just created another class of people who survive off taxpayer money." still touch and go in Texas