Tuesday, March 07, 2006

Carlos Guerra: Private sector bungles state's health, social services programs

Carlos Guerra: Private sector bungles state's health, social services programs

Web Posted: 03/05/2006 12:00 AM CST

San Antonio Express-News


When the 2003 Legislature overhauled the state's health care and social services programs, proponents insisted that privatization would deliver huge savings because the private sector always outperforms government, and does so at much lower costs.

So, after becoming the state's lead social services agency, the newly created Health and Human Services Commission set out to fire thousands of state employees who navigate Kafkaesque federal regulations to determine applicants' eligibility, and hired private-sector call centers to do their jobs.

But last week, a more accurate picture began to emerge about where the overhaul's "savings" will really come from.

Enrollment in the Child Health Insurance Program that once covered more than 500,000 children of working poor parents dropped below 300,000 for the first time since the program was established.

And in the three months since Accenture — which got the $899 million call-center contract — started fulfilling the eligibility functions, CHIP enrollment dropped an astounding 9 percent.

"In the last three or four months, there has been a significant drop here too," said Charles Kight, CEO of Community First Health Plans, a nonprofit HMO that handles most CHIP and Medicaid clients in Bexar and the surrounding counties.

"In the Bexar service area in May 2003, we had 42,000 kids enrolled in both plans, and in (January) 2006, we had 24,000," he said. "But of late, it's been dropping like a rock because families who were on the program have had more difficulty staying on the program."

Several legislative changes are contributing to the plummeting coverage. The enrollment process, which involves filling out and filing applications and documentation, must now be repeated every six months, for example, and the required documentation changed.

"Also, when the program started, parents had to pay a monthly premium, but the last legislature set a one-time payment every six months" of $25 to $50 per child, Kight explained. "They instituted that but didn't notify the families, so they had no lead time to prepare to make the payments."

And now, children whose coverage lapses remain uninsured for at least 90 days. But much of the enrollment drop has also resulted from the bungled rush to privatize eligibility determination.

"Back in the fall, the state went with TAA, the Texas Access Alliance, a group of companies in which Accenture is the lead," Kight says. "But TAA has become more like the 'Texas Access Adversaries.' Their processing has not been efficient or accurate, and now, after four or five months, they are only beginning to understand what their issues are and get them corrected."

Thursday, at the request of Gov. Rick Perry, the Health and Human Services Commission announced that it would re-enroll at least 6,000 children who were erroneously dropped from CHIP coverage.

Last month, HHSC officials were still saying that privatization was working well, even though the evidence to the contrary was widespread.

Clearly, they must have known because on Feb. 8 one regional manager e-mailed his underlings to warn them "not to denigrate the call center process, their staff, or their levels of customer service to our clients or to the public in general. If call center staff are doing something inappropriate, we need to manage that in-house, not air our laundry in public."