The Star's recent coverage and editorial on the Family and Social Services Administration's privatization of Indiana's Medicaid and Food Stamp program eligibility fell short on several points:
The removal of caseworkers and the transfer of employees from the state to the contractor took place in March 2007, well before any area officially rolled out. Thus the seven-trip, 10-hour wait experience of one Marion County food stamp client reported last Thursday is indeed an indication of how the system has been run down during the rollout process, even though the state has not yet officially designated Marion County as a "rollout county."
The June 23 USDA Food and Nutrition Service letter to FSSA Secretary Mitch Roob citing food stamp program failures was, as The Star indicated in its correction, not an official order to halt the privatization rollout. But it was very close to it. How else can we interpret words from the federal government such as "requires" and "would expect . . . prior to the next rollout phase."
Roob claims that he halted further rollouts because of the June storms, not because of the federal action. Yet there was apparently a long series of exchanges between his office and the Food and Nutrition Service over Indiana's shoddy performance, including February and early June communications cited in the June 23 letter. The evidence suggests that Roob knew what was coming before the storm afforded a plausible excuse.
In the face of massive evidence of failed service and calls to stop further rollouts, Roob never publicly disclosed the June 23 letter. Had the Associated Press not discovered its existence, we might never have known of the letter. Roob's failure, if not a cover-up, reflects questionable judgment and ethics in handling a public trust.
Certainly, the old system cried out for change, but what is now occurring is arguably much worse than that system. And while glitches may be unavoidable and, as The Star editorializes, require some tinkering, the massive problems clients now face go well beyond mere glitches.
The central design failure is the elimination of the caseworkers. With a caseworker, a client can deal with one person who is familiar with her or his situation. Under the current privatized arrangement, a client deals with whichever call center employee answers the phone or is assigned the contact that day, typically someone who knows nothing about his or her situation. This random access approach is driving the current mess.
Contrary to what we've been told, caseworkers are needed for more than just a few "high touch" clients. Call centers employees can handle such matters as file updates, but assigning major parts of the process in pieces to whoever is available and doing this by phone clearly isn't working. This buck cannot be passed. The Medicaid and Food Stamp eligibility system has been trashed. The useful part of what now exists -- replacing paper files with digitized records -- should probably continue. But the process needs fundamental revamping, with every client able to work with a genuine caseworker. The lives of some 1 million people in our state are too important to leave to privatization, too important to be modernized in this manner.