For Many Georgians, DFCS Remains A Barrier to Medicaid

Since 2013, thousands of Georgians dependent on Division of Family and Children Services have reported lackluster customer service and telecommunications problems, resulting in extensive delays - and in some cases, outright cancellations - of critical Medicaid benefits. To improve processing, the state is migrating away from the much-maligned 'Georgia One' model to a new multi-agency, consolidated system. But does the $100 million investment get to the heart of the problems plaguing DFCS clients for the last two years?

TOTALLY DEPENDENT: 56-year-old Douglasville, Georgia resident Lisa Allrid has been disabled for more than 10 years. Mentally impaired by sarcoidosis, she is unable to navigate the Medicaid renewal process by herself; were here benefits to lapse, friend Jennifer DeLaune said the consequences could be catastrophic. (Photo Credit: Jennifer DeLaune)

By: James Swift

UncommonJournalism@gmail.com
@UNJournalism

Lisa Allrid, a 56-year-old Douglas County, Georgia resident, has been disabled for a decade. 

A lifetime of grueling labor -- at various points, she was an EMT, a security guard and an armored truck driver -- forced her to undergo several knee and back surgeries. Eight years ago she was diagnosed with sarcoidosis, a condition leading to cirrhosis of the liver. Unable to metabolize toxins, her body’s ammonia levels spike, greatly limiting her ability to think or reason. 

On good days, she can bathe, dress, prepare her own meals and manage her medications. But even then, she remains unable to balance a checkbook or perform simple housekeeping duties. Sometimes she is unable to make telephone calls. 

Today, Allrid lives alone in a low-income neighborhood. Her neighbors try to help her the best they can, taking her grocery shopping and dropping her off at medical appointments. She is unable to drive and has no other family supports. 

Jennifer DeLaune, a home health care physical therapist, met Allrid in 2013. 

“I guess you could say I adopted her,” the Smyrna, Georgia resident said. “She was in terrible shape and unable to manage her condition at the time. She was falling frequently and incoherent. I literally thought that if I did not step in and help her that she may die.”

DeLaune, who works in Douglasville, visits Allrid almost every weekday and usually at least once on the weekend. Sometimes she helps her with her bills and mows her grass. Other times she aids Allrid in caring for Hans, her beloved dachshund. 

More than anything, however, DeLaune said she is there because Allrid -- who is too young to receive services through Georgia’s Community Care Services Program -- needs a companion. 

“I thought she was near death and could not imagine her dying alone,” DeLaune said. “So my goal has been to keep her living at home and to have a friend who cares.” 

Allrid receives both Medicaid and SNAP services through the Douglas County branch of Georgia’s Division of Family and Children Services. In late June, DeLaune completed an online renewal form. Allrid received a letter stating that her DFCS interview was scheduled for July 6 at 10 a.m.

The phone call never came. DeLaune then dialed DFCS’ statewide hotline number to complete the interview. Her first attempt, a recorded message told her she would have to wait three hours. She called again. This time, a message told her the wait time would be an hour.

After almost two hours on hold, DeLaune hung up. She made another telephone call, this time at 7:30 a.m. The recorded message predicted a 10 minute wait. 

DeLaune gave up after waiting for another hour. 

“Not only would Lisa have been mentally incapable of placing these calls,” DeLaune said, “she could not afford the cost of the phone call on her Lifeline cell phone, which has limited minutes.” 

That led to DeLaune paying a visit to the local DFCS office in person on July 23. There, she was given the name and phone number of Allrid’s case worker. 

DeLaune made numerous attempts to contact the DFCS representative. Not once was she able to speak with the case worker. The line didn’t even accept voice mails. 

Shortly before August, DeLaune made another trip to the Douglas County DFCS office. She was given a second telephone number. 

When she dialed it, all she received was a recording stating “this line is not monitored for messages.” 

Allrid soon received a letter from DFCS, dated July 31. 

“Your food stamp case will be terminated on Aug. 31, 2015, for the following reason,” it read, “you did not complete the interview process.”

Far from an isolated incident 

DeLaune has experienced difficulties obtaining services for her friend before, having had similar problems getting in touch with DFCS reps in 2014. 

“After calling the 877 number several times, we were able to reach someone after one hour,” she recalled. “So I guess we were lucky last year.”

With the cancellation date of Allrid’s benefits looming, DeLaune decided to make one more visit to the DFCS office. This time, she was there to hand deliver a formal complaint to Douglas County DFCS Director Kay Wimpy.

“I walked in and tried to approach the window without taking a number and was totally ignored,” she said. “There is a glass window with a small hole for passage of documents. They keep it blocked with another small, clear plastic partition.”

DeLaune ended up dropping it off in the after-hours box. Yet again, she received no response.

Having exhausted all her options, DeLaune emailed a complaint to Georgia’s Department of Human Services, which oversees the state's DFCS.

“I am appalled at the difficulties imposed upon those in need, some of whom may not have a capable advocate to help them,” she stated in the message. “I am writing not only for Lisa, but for countless others who are in similar situations.”

She forwarded the email to several members of the metro Atlanta media. After a month of delays, she got a call from a DFCS representative, who said that Allrid’s interview would be completed immediately.

“They called her back later that afternoon to tell her that her renewal was approved, and that hers was a ‘special case,’” DeLaune said. “Although I am relieved that Lisa’s issue is resolved, I am still infuriated about what people who are in real need of these services must go through.” 

The difficulties experienced by DeLaune and Allrid mirror those of thousands upon thousands of Georgia residents, who, since late 2013, have reported both extreme delays and abrupt cancellations of food stamp and Medicaid benefits. 

For years, Georgia’s Office of Family Independence representatives managed caseloads -- meaning, essentially, that one person handled all the program needs for a family.

“While this model served the state well for many years, as the economy declined, our caseloads greatly increased to a point that was not manageable, especially in the larger metro counties,” said DFCS spokeswoman Susan Boatwright. “This occurred simultaneously with state budget reductions, and unfortunately, we were unable to hire additional staff to decrease the caseloads.”

A FRAGILE LIFE: Jennifer DeLaune, left, has been a close acquaintance of Lisa Allrid for more than two years. “I thought she was near death and could not imagine her dying alone,” DeLaune said. “So my goal has been to keep her living at home and to have a friend who cares.”  (Photo Credit: Jennifer DeLaune)

In mid-2013, DFCS introduced its new Georgia One model. Instead of one caseworker handling all the benefits needs of a family, the agency’s workers were instead assigned one duty -- such as processing applications, renewals and changes -- for families throughout the state. 

This effectively created “one large statewide caseload,” Boatwright said. 

“The thinking was that if a worker only had to do one action, they could become more efficient and could complete more work,” she continued. “This also allowed for the state to process work on a statewide level – meaning that an application or renewal could be given to a worker in any county in the state.”

As part of the Georgia One model, a statewide call center was implemented in Jan. 2014. County office lines were directed to voicemail at one centralized call center, and local office receptionists were reassigned -- many to Office of Family Independence lobby staff positions. 

By all objective measurements, the transition was a colossal failure -- something several high-ranking DFCS administrators have no reluctance admitting.

Shaky technology and understaffing produced a customer service nightmare, with benefits seekers waiting hours to speak with agency representatives -- if it all. Clients were sent renewal applications, with cutoff dates listed well before the actual letter was mailed to them. Local DFCS offices were swamped with clients, understandably upset over both the cancellation of their services and the inability to get in touch with flesh-and-blood officials about their cases. Nor were the telecommunications problems limited to the overstressed call center network, as many clients also reported widespread problems with the Common Point of Access for Social Services (COMPASS) system, the agency’s online “self-service” portal.

The backlog got so severe that in spring 2014, the United States Department of Agriculture -- the federal agency that oversees the national food stamps program -- threatened heavy fines against DFCS. Although processing improved enough to avoid federal penalties -- thanks to a statewide mandate forcing DFCS officials to work extended overtime hours -- it wasn’t long before clients began reporting the same delays, cancellations and utter lack of human interaction. 

Things came to a head in spring 2015, when, on behalf of several plaintiffs denied benefits, the National Center for Law and Economic Justice and a consortium of Atlanta attorneys filed a class action lawsuit against the state’s DHS for failure to process applications in a timely manner. 

Northern District of Georgia Judge William Duffey, Jr. approved the settlement on Aug. 5. Pending the USDA gives its consent to the suit, all DFCS clients who were wrongfully denied food stamps from Jan. 1, 2013 to the time of the Melanie K. v. Horton ruling are eligible for retroactive benefits. The suit also requires Georgia’s DHS to improve its processing of food stamp applications until it reaches a 96 percent on-time processing quota. 

However, the suit does virtually nothing to address those who were denied other benefits, including Medicaid services. 

As DeLaune illustrates, that’s a much more concerning issue for many Georgians receiving benefits through DFCS. 

“[Allrid] only receives $16 a month for food stamp benefits,” she said, “but if her Medicaid were to lapse, she would be in big trouble.”

Looking for help, receiving none

Douglasville resident Sharquel White was in a serious motor vehicle accident on July 4, 2015. The 24-year-old mother of two suffered extensive injuries down the left side of her body. Her ankle, femur, shoulder bone, pelvis and spine were all fractured, with permanent metal plates grafted under her skin. Later, a blood cot formed on one of her lungs. Two more would form on her left leg. 

"I can only get around in a wheelchair or with a lot of help," she said. "I have not had any feeling in my knee since the accident. I'm praying that numbness is not permanent."

Since the accident, White has had four surgeries. She's spent about three months of the year hospitalized; her medical expenses have reached more than $1 million and she's still getting new bills in the mail. Her recovery incurred a big setback a few weeks before Thanksgiving, when she aggravated her already severe leg injuries trying to keep a mirror from falling on her son. 

LIFE BEFORE: Sharquel White, 24, has been
confined to a wheelchair since July 4, 2015. After the
Independence Day automobile accident, her medical
bills have surpassed $1 million. (Photo Credit:
Sharquel White)

She applied for disability in August. As of mid-November, she is still awaiting a response. 

White and her children now reside with her mother. Besides SNAP benefits, her sole income is $300 a month in child support payments. 

The ceaseless physical pain, she said, is secondary to the loss of her independence. Left immobile at the peak of her youth, she said she has fallen into deep depression and anxiety.

"I cannot cook for myself, shower myself, drive and put my clothes on," White said. "I am unable to do basic daily necessities, to sum it up." 

Previously on Georgia’s Right From the Start Medicaid program for pregnant women, she knew her services were set to expire at the end of September. She began the reapplication process in August.

“I have gone to the local DFCS office three times and talked to at least 10 people on the phone,” she said. “I have been told over and over that a supervisor would escalate my case as emergency Medicaid and also find me a caseworker.” While "emergency Medicaid" exists in Georgia, it is only available to non-citizens and those who have been legal residents for less than five years for dire medical situations requiring immediate care, such as childbirth or life-threatening injuries.

Each time, White said she was told that an agency rep would get back in touch with her within five to seven days. As of late October, White was still waiting for those services. During that time, her prescription blood thinner medication - crucial to prevent the blood clots from forming on her heart - and wheelchair rental both lapsed. 

It is not the first time White said she has had to battle the bureaucracy for benefits. Earlier this year, her newborn daughter's Medicaid coverage was abruptly cancelled - all because an employee entered the wrong birth date. 

On her first visit to the Douglas County DFCS office to renew her own benefits , an agency rep told White to reapply for Right from the Start Medicaid. She even revisited the office after filing the application, to make sure she sent off the right form. On Aug. 17, White received a note informing her that she was approved for that type of Medicaid until August 2016, pending she met the income eligibility requirements. Then, she received a letter in the mail, stating that her Medicaid coverage was still set to expire on Sept. 30.

White called DFCS and was told that she filled out the wrong form – instead of pregnancy Medicaid, she needed to apply to the state’s Family Medicaid Program.  After waiting in line for four hours, a representative at the Douglasville DFCS office told White that she would send an email to her old caseworker. She said White should expect an answer in 30 to 45 days.

She was never given the caseworker’s phone number.

“I left and haven’t gone back since,” White said. “I have two children under the age of three, a disabled mother, no help and I’m disabled at the moment myself. I couldn’t wait up there all day just to be told ‘there is nothing I can do.’”

For White, the constant delays, hold-ups and setbacks have created a cruel, cyclical pattern. “I’ve had to put off almost five appointments because I’m uninsured,” she said, “and I am uninsured because [DFCS] employees gave me the wrong information.” 

White said she averages eight physician visits a month now. While some are covered by Medicaid, she said she must pay out of pocket for many of them until her Amerigroup plan kicks in. 

"I was supposed to switch from home care therapy to outpatient therapy more than a month ago, but I have been waiting on Medicaid," she said. For the same reason, she said she can't see a psychiatrist to treat her postpartum depression and the anxiety stemming from her Independence Day accident. 

With so few doctors who are willing to accept clients without insurance, White said she is left with no choice but to visit the emergency room and bury herself in even more debt.

"If I was to never get Medicaid for my kids and I, it could cause us more health problems, which could be deadly," she said. "If I have so many hospital and doctor bills to pay back, how will I continue to take care of my kids?"

Rebuilding the system

Long before the ruling in Melanie K. v. Holder was announced, Georgia DFCS officials were working on a plan to transition out of the oft-criticized Georgia One model. 

In early 2015, DFCS Director Bobby Cagle appointed Jon Anderson as the new deputy director of the Office of Family Independence program. Anderson, a 17-year policy vet for DFCS, was previously the Department of Community Health’s deputy chief of Medicaid. 

He readily admits the centralized model, especially the call-center component, did not adequately meet residents’ needs. 

“The agency was trying to do a little too much service,” he said. “I don’t think we had all the processes clearly defined … there were some changes that needed to be made, and we’re making changes that are getting us to the right place.” 

After months of performance evaluations and reviews of customer service processes, Anderson vouched for DFCS to replace the model with a more localized benefits processing system -- essentially, the same model the state abandoned in 2013. 

Georgia’s DFCS officially re-introduced the One Caseworker, One Family Model in August. 

Under the new model, each DFCS client is assigned a single caseworker, who serves as a point of contact from the time an application is filed until it is finalized. Communications have been shifted from “virtual supervision” to more direct local services; this new regional management system, Boatwright said, allows for greater programmatic oversight than the previous centralized system. "We believe the new model will allow for more effective performance management as the supervisors are in the same location as the staff they supervise," she said. 

BRUISED, BUT NOT BROKEN: Sharquel
White, a 24-year-old Douglasville, Georgia resident,
seen here with son Zecheria Washington and 
daughter Zuri Washington, suffered extensive 
injuries in an an automobile accident last
 Independence Day. The mother of two has
 experienced numerous delays obtaining
vital Medicaid services through the county's
DFCS office ever since, with her blood clot
medication and wheelchair rental both
lapsing while she waited for her benefits to
be processed. (Photo Credit: Sharquel White)

DFCS services, Anderson said, need to be heavily localized. “When you have a county-based model, they have connections to other social services and job fairs," he said, "they can take advantage of those things and meet their immediate needs.”

The move, Boatwright said, has boasted morale among DFCS case workers. “Staffers prefer serving the people in their own community and interacting with the people within their own community,” she said. “When it’s not people living in your community, it’s hard to get motivated and feel connected about what you’re doing.”

Anderson said DFCS officials have been trained on multiple social services programs since spring. That way, he said representatives from the agency will be able to take in applications from other agencies, such as the Department of Public Health and the Department of Community Health.

He said improving communications – both client-to-agency and department-to-department – is a necessity. Internally, he has implemented a slew of new protocols, such as establishing a direct “feedback loop” for staff to better communicate with leadership and including all DFCS staff in weekly updates highlighting program accuracy and timeliness data and best practices for processing cases. DFCS employee training has also been beefed up over the last few months, with new supervisor and case manager summits implemented along with an OFI Road to Excellence Educational Series. He even started a Peach Stars recognition program to celebrate excellent customer service.

Anderson acknowledges that the decentralized system is not an instant fix to the agency’s woes. “The model does take time to perfect, so it’s one of those things were we’re seeing a lot of good results but there are some areas where the state needs some improvement,” he said. “We’re getting a lot of great customer experience, and there’s good and bad to all of it, but at least we’re seeing the light.”

He is quick to note, however, that the widely criticized telecommunications system was not the only problem plaguing DFCS. Even through electronic, self-service portals like COMPASS, it’s still up to a caseworker to process applications and make final eligibility determinations.

With an estimated 2,000 caseworkers handling services for approximately 877,000 households receiving Medicaid services, Anderson said it is clear the agency remains understaffed. In the upcoming state legislative session, he said the agency is requesting funding to hire an additional 500 employees.

“We’ve done an analysis and looked at each county and try to project how much a caseworker can do in a month,” Anderson said, “and as we move forward, we will look at them as the most needy and fill them in and proceed from there.”

The big statewide initiative for 2016, he said, is a new multi-agency integrated eligibility system. The Georgia Gateway online service will function similarly to COMPASS, but ties together other agencies – including the Department of Early Care and Learning (DECAL), the Department of Pubic Health (DPH) and the Department of Community Health (DCH) – into one centralized network. This approach, Anderson said, will allow greater flow of information across agency lines and speed up the benefits process.

“Now we’ll be able to take applications from several programs,” he said. “Once we receive information and turn in verification, the agency doesn’t have to submit additional information … it will do a lot more for our caseworkers, allowing more decisions based on what they are getting out of the interfaces and help them move out those screens quicker.”

A pilot program begins in Henry County in April 2016. There will be two waves of roll-outs during the summer, with the program online statewide by mid-October.

"Customers will have one portal to apply for multiple benefits," said DFCS spokeswoman Mary Beth Lukich. "Several state agencies have been working, along with a vendor, Deloitte

CORRECTIVE MODE: New Office of
Family Independence Deputy Director
Jon Anderson admits the state made
mistakes implementing the Georgia One
model. "I don't think we had all the processes
clearly defined," he said. "There were some
changes that needed to be made, and we're
making changes that are getting us to the
right place." (Image courtesy the Georgia
Department of Human Services)

Consulting, to design and develop the new system."

The $100 million project will replace two longstanding public assistance systems, COMPASS and System Uniform Calculation Consolidation Economic Support Services (SUCCESS.) Medicaid - along with SNAP, TANF and WIC benefits - will all be tied to the new initiative.

As with the Georgia One model, all telecommunications will be routed through a centralized number. However, Lukich said that calls will be limited to changes, general inquiries and assorted help desk functions. Program specific questions will instead be routed to the appropriate agency. "DFCS will not handle WIC questions," she said. "Those calls will be routed to WIC staff in Public Health." 

Lukich said the state is hard at work to make sure the same Georgia One mistakes are not repeated. “We have estimated the current population of all programs and are testing the system at the capacity with room for growth,” she said. “The new system will have intensive testing prior to implementation so that the issues seen in the past will be mitigated.”

By giving the state a "complete view" of a customer's benefits, Lukich said the new model will provide more clarity for staffers and reduce the potential for fraud. Just prior to implementation, she said all agency staffers will receive training on Georgia Gateway, which covers business processes in addition to system functionality. 

Even with the new model in place, however, Anderson notes that many barriers to service remain. Many clients lack the technological know-how to navigate online services and require face-to-face communication to complete applications. That can be very problematic, he said, for clients who are disabled or lack access to transportation.

While there have been proposals for more mobility services, Boatwright said there are no immediate plans to incorporate more transportation resources into DFCS’ budget. For homebound clients, she said much of the process can be complete by phone or fax, and special accommodations, if need be, can be arranged.

Is the problem computers, or people?

While the state is making heavy investments in technological consolidation to improve benefits processing, White contests that the real problem isn't a telecommunications system - rather, it's the people hired by DFCS. 

Not only is DFCS sorely understaffed, White said those who are working the phone lines and pushing paperwork are often incompetent and insensitive. "Random people are being hired, seems like it, and then these anybodies are being thrown on the work floor just to tell us, the people, that they don't know the answer to our questions," she said. "The government is expecting them to get the job done right, without trained, proper knowledge."

At the Douglas County office, White said the employees are hardly a portrait of professionalism. "The last time I was on the phone with DFCS, the woman I was speaking with was taking to her coworker about if they wanted KFC for lunch or Subway while I'm sitting there on hold." 

In the transition from Georgia One to One Caseworker, One Family, Boatwright said there have been no significant changes to DFCS policies on managing performance.

"Each corrective action or disciplinary plan is different and depends on many factors," she said. "Typically though, we try to counsel with an employee about concerns and develop a plan to improve performance before having to use disciplinary actions such as written reprimands and termination."

Having worked since she was 15, White said she cherishes the idea of going back into the workforce and earning a living for herself. 

However, she said DFCS’ inability to secure her Medicaid to receive rehabilitative services has exacerbated her physical problems and extended the amount of time she will be unemployed. 

“DFCS will have your case screwed up if you don’t stay on them,” she said. “They don’t have a care in the world about your situation … I’m sure there are a select few who will go the extra mile to get you help, but most them are either trying to get you off the phone or out of their face.”

RECOVERY CONTINUES: Sharquel White, who
experienced numerous fractures in an Independence
Day wreck earlier this year, has had to rely upon
emergency room services while waiting for her
Medicaid benefits to kick in. "DFCS will have
your case screwed up if you don't stay on them," she
said. (Photo Credit: Sharquel White)

Many employees, she said, have no idea how important the services are to clients. An application error on their part, she said, can leave individuals - and their children - without health care coverage for months at a time. 

“It is extremely important to have these services, especially for my kids,” she said. “Anything can happen at any time, and it could be deadly without medical treatment. 

DeLaune said the plight of those denied Medicaid services is a gravely under-reported issue. In fact, she said that if her job didn’t directly put her in contact with individuals adversely affected by cancellations and delays, she likely would have never thought about the matter herself. 

“Without that experience, of trying to help someone, no one can relate or appreciate the problems and difficulties these people face,” she said. “I don’t think they have a voice.”

Allrid’s food stamp benefits and Medicaid would have been long cancelled had DeLaune not advocated for her friend, who had no way of contacting the agency for help on her own. 

To demonstrate just how serious the lack of care can be, DeLaune brought up a client she had a few years earlier - a 42-year-old woman who, not unlike Allrid, had limited capacity to take care of herself. 

She was dependent on Medicaid services, and her nearest caretaker lived an hour away. 

“I saw her only twice, and her blood pressure was very high,” DeLaune said. “I emphasized to her that she needed to obtain a primary care MD for follow-up, but she stated that she could not find one who was taking new patients.”

The closest physician accepting Medicaid patients was two hours away. DeLaune recounts trying to contact her for a third session.

“I called the emergency contact number listed in her chart, which was her father’s,” she said. “He told me that she had passed away.”

Without the help of others, and certainly without Medicaid services, DeLaune said the tragic episode above isn’t just a “worst case” scenario for Allrid, it’s a downright probable one. 

“This is our current Medicaid system in Georgia,” she said. “People who are not exposed to those in need should consider this to be an important issue because it can happen to any one of us. An unexpected illness or car accident can produce piles of medical bills, and with medical bills being the leading cause of bankruptcy, we are all subject to the possibility of needing these services."

While cutting out redundant forms and eliminating unnecessary interviews may speed up the processing time for benefits, DeLaune said DFCS’ problems will persist until the agency becomes more “in-tune” with the harsh realities its beneficiaries face on a day-to-day basis. 

“I know that these programs are a huge burden on the state’s budget, but increased efficiency in the process would help,” she said. “As part of their training, I think every DFCS official and employee, from Bobby Cagle on down, should have to assist one beneficiary and go through the identical steps that I had to go through.”

Uncommon Journalism, 2015.