Tuesday, March 14, 2006

Outsourcing Justice

Over the past couple of years the State of Texas Department of Health and Human Services has been reorganizing and streamlining (read "cutting back on programs for the poor" just here).

If you ask Albert Hawkins, the Commissioner, the reason is simple: the state wants to gain efficiency and get more bang for its buck.

You would think that would mean serving more people with the same amount of money, right?

Apparently not.

One of Mr. Hawkins' tactics has been to set about outsourcing the delivery of services to Texas' poorest families.

Central Dallas Ministries participated in the ramp up to this outsourcing by consulting on several occasions with Accenture, the company that eventually landed the contract to serve the state's health and human services needs.

The plan involved the aggressive implementation of technology, purportedly to make certification and registration faster and more accessible to the people who needed the services.

The idea sounded really good to me as we discussed it.

We even talked of kiosks in places like a few of our locations here in Dallas that would make the delivery of services much easier and more seamless for those who were eligible.

Well, so far, all I can say is. . .




Take one aspect of the outsourcing company's new assignment: Medicaid, the health insurance product for poor children, disabled persons and the elderly.

That would be the youngest, the oldest and the weakest?

Got it?

Since November 2005 and through February 2006, the number of children receiving the Medicaid health insurance benefit in the state dropped by almost 79,000 participants.

Further, this sharp decline occurred over three consecutive months--the first 3-month decline since May 2000.

Maybe what we have here is a new system, still a hybrid with the old, trying to get the "kinks out."

But I have my doubts, serious doubts.

The fact is, in Texas, the poor are being squeezed from two sides.

On the one hand, the federal government keeps cutting into Medicaid and other Health and Human Services benefits--in many cases severely and unjustly.

On the other, here in Texas, a new management system kicks tens of thousands of the poorest kids off of health care benefits.

And these numbers don't count the sharp decline since December in the Children's Health Insurance Program (CHIP)--a plan designed to serve those children just above the poorest in the state.

The CHIP program is in decline even though the legislature restored funding and approved program expansion during its last session.

Maybe the program will smooth out.

But then, maybe it won't.

Here at Central Dallas Ministries we have watched the Medicaid program for at-risk pregnant women and children decline to almost a trickle of real, meaningful assistance.

This radical cut back that slashed a very valid, needed program has been accomplished strictly administratively, again, thanks to Mr. Hawkins.

The cuts were so blatant that the U. S. Supreme Court ruled against the State of Texas last year, forcing Mr. Hawkins' department to make changes in the way this particular program operates.

We'll see if he defies the highest court in the land. So far, changes appear miniscule to our staff.

In the meantime and overall in our state, thousands of our children go without medical care, expect when things get so bad their parents resort to emergency rooms. Not a smart way to deliver primary health care services to the poor.

I'm going to keep watching. But, I'm not impressed.

Does faith have anything to say to this situation?


Anonymous said...

My faith is telling me that I have to do something, because my sense is telling me that the government is getting out of the business of "providing for the general welfare."

At what point does it stop? When the only healthcare available to the poor is the bare minimum available to stop the bleeding (emergency rooms), and that sort of service that is provided by churches and groups like CDM?

Anonymous said...

Is Commissioner of TX HHS a political appointment? If so, November can't come fast enough for me to translate faith into action at the voting booth.

Larry James said...

The Commissioner of HHS in Texas is an appointed position.

Anonymous said...

Thanks Larry. I don't know how people are even able to navigate the system.

My wife and I are seminary students here in Abilene, and both are kids are on Medicaid. Last month our daughter was dropped b/c of a paperwork goof-up at the Medicaid office. It's still not resolved. Our case worker went away for training - for four weeks - after apologizing and offering to fix it. No one else will touch it. Yesterday my wife was "disconnected" three times while on the phone trying to get things resolved.

Finally I stopped by the office, still dressed for work in my black suit. Not only was I treated entirely differently once someone saw me in person, but case workers rolled their eyes at the problems we encountered on the phone and said that that's the status quo. 30 minutes later we were good to go. Apparently appearances help... I was also told to not bother calling if anything else came up - stop by if at all possible.

I don't know how someone that's unemployed, minimally educated, or even homeless could possibly have gotten their concerns addressed. I'm glad that you're out there helping them...

Larry James said...

Appearances, including "complexion," still matter and matter a lot in this country. Many people don't want to hear it--remember the Katrina debate?--but the truth is the truth.

Appearances, including clothes, matter and matter a lot.

There is a national bias against the poor. No doubt about it. We just need to face it.