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For years, Missouri residents have watched the minutes, even hours, tick away as they waited on the telephone to apply for Medicaid, food stamps or other social services in a state bureaucracy hampered by understaffing and antiquated technology.
Within the state’s Department of Social Services (DSS), which also handles the foster care systems, computer programs are so clunky that workers must often spend time correcting messy handwriting, transcribing state forms or inputting information from mailed-in paper forms that could be done with more automated programs.
Some of the systems are decades old, according to officials, and don’t have the ability to share information. Missourians seeking services may need to update the same data multiple times as employees try to verify their income or get the correct mailing address on file.
With Missouri’s finances still buoyed by federal coronavirus relief, an extra $6 billion is available in the state’s budget heading into the fiscal year beginning in July. Many lawmakers and officials hope 2023 will finally be the year for substantial upgrades to archaic computer systems throughout state government that have contributed to staff shortages, low morale and dismal services.
While outdated technology is a problem throughout state government, it is especially acute for social services.
In his 2024 budget recommendations, Gov. Mike Parson, a Republican, recommended the state make a $40 million investment in system upgrades, namely for the Missouri Medicaid management information system, which handles things like claims processing, financial management, drug rebates and provider enrollment, to name a few.
Currently, one system manages things like child care, food stamps and Medicaid recipients who are elderly, blind or disabled. Another system manages Medicaid for the adult expansion groups and children.
The state is hoping to merge its various programs into one in the coming years, with a hefty part of that investment coming from federal funds. In the governor’s recommendation, $33.5 million of the cost would be covered by the federal government, with the remainder coming from state funds.
End of public health emergency puts extra pressure on state workers
Acting DSS Director Robert Knodell said pressure from the federal government should expedite the transition into one system.
The public health emergency put in place that allowed for Americans to stay continuously enrolled in Medicaid during the pandemic is expected to end. States are now required to redetermine eligibility for Medicaid recipients starting April 1. But they’re also supposed to try and reenroll recipients without requiring a response from them, something called an “ex-parte,” or automatic, renewal.
Missouri is one of only eight states not already processing renewals this way, according to the Kaiser Family Foundation. Instead of using a system that automatically supplies information such as income or address, the agency sends out mailers to every recipient that will often require them to respond with their updated information. This process increases the risk of a resident temporarily losing health care coverage if they did not receive the piece of mail or respond in time.
State Sen. Lauren Arthur, D-Kansas City, is sponsoring a bill to expand postpartum health care to low-income women for a year after they give birth. Part of her legislation would require the state to move toward automatic renewals.
“It’s obvious but Missouri families, especially kids, shouldn’t be kicked off of Medicaid because the state government uses a really outdated computer system. And it’s really a life or death situation,” Arthur said.
“The state required that those Missourians use paper renewal forms, and families didn’t get the forms. Often these are very transient families. Forms were lost, or families weren’t even aware of the policy change.”
Understaffing and high employee turnover make the situation worse for social service recipients and put additional strain on the workers who remain, Arthur said.
Turnover throughout state agencies dropped from 30% to 27% after employees got a raise last year. But the state is still struggling to meet the market rate for salaries to stay competitive with the private sector, state budget director Dan Haug said in a hearing with the House subcommittee on appropriations for health, mental health and social services this week.
“The actual process of getting those letters out, taking phone calls, reenrolling people, that is very laborious and time consuming, and it requires a huge workforce. And that’s just not the reality of the state of our DSS right now,” Arthur said.
Knodell said the pressure from the federal government will overall help support the transition into one management system.
“I believe that some of the changes coming from the federal level in terms of eligibility requirements and reenrollment rulemaking is probably going to hasten some of that transition over to one system,” Knodell told The Beacon. “It makes more sense. It makes us better stewards of taxpayer dollars if we simply migrate away from the legacy system, rather than spending dollars to sort of prop that up.”
Last year, the agency netted $100 million in appropriations from the state and federal government for systems upgrades, Knodell said. But it often takes years to see the return on that money, since the state has to search for contracts and go through the bidding process with contractors who build or implement new systems.
“Those are multiyear processes,” Knodell said.
DSS hopes that new technology will help with understaffing, turnover
Although low pay and high workload are most often cited when it comes to understaffing and turnover within the Department of Social Services, Knodell said cumbersome old computer programs also drive potential employees away.
“We think it’s critical. Having more modernized and more up to date technology makes us a more attractive employer…,” Knodell said.
“We don’t want them to have to come to work for the state and have to step back 10, 15, 25 years in time to older technology that they may not even have the knowledge of how to operate.”
The agency has been working for years to phase in new technology, called FACES, within the state’s foster care system. Funding has been allocated, but the state is still in search of a contractor to pick up the project, according to its 2024 budget request.
FACES is intended to be a self-service portal that will enable those involved with a child in the foster care system, like their social worker, attorney, biological parents, foster family and other community partners, to access centralized information and updates about situations that often change quickly.
Caseworkers are supposed to be able to input information directly into the system to be viewable by everyone involved in the case. Currently, they must fill out paperwork in the field and input it into
Laurie Snell, a family attorney based in Kansas City, said caseworkers often spend all day in the field, then have to return to the office to manually input all of the information they had collected on paper forms. She said improving the technology is a step in the right direction, but more workers and funding for the agency should be the top priority.
Some case managers are managing anywhere from 30 to 50 cases in the Kansas City metro area, Snell said, when the industry recommendation is around 15 cases. Knodell said he hopes paring back some of data entry demands on social workers will help them cope with heavier caseloads until the state can hire more staffers.
“It will give us a great deal of ability to talk better to other systems, whether that’s in health care, through the courts, to law enforcement,” Knodell said. “It will also give our caseworkers the ability to actually use that in the field and not to have to come back to the office and manually input a number of forms that document their work.”
“It’s going to allow our staff to manage very challenging caseloads more efficiently and, hopefully, help us retain more employees.”