Last Updated: Jan 8th, 2015 - 07:42:25

Medicaid expansion could strain local social service staff
By Sarah Steele Wilson, Newsroom Editor
Feb 6, 2013, 15:15

While political figures in Richmond consider whether the state should expand access to Medicaid under the Affordable Care Act, Prince George County’s Department of Social Services is bracing for a challenge they might face if the Commonwealth does decide to expand the program.

Shel Bolyard-Douglas, director of social services for the county, expects to see an additional 11,000 Medicaid cases a year in the county, should the expansion take place. Those are 11,000 cases her staff will have to process and screen for eligibility.

“It doesn’t sound like a lot, but I’ve got the same five folks who are doing all the food stamps, all the energy assistance, all the TANF [temporary assistance for needy families] and all the Medicaid,” she said. “They’ve seen their cases continue to rise.”

Under the Affordable Care Act, states will be able to offer Medicaid benefits to people with incomes below 138 percent of the poverty level, as opposed to the 133 percent threshold that exists in Virginia today. The federal poverty line for an individual in Virginia is $11,170 a year.

The department is bracing for an onslaught of applications from both newly eligible individuals, and people who still do not qualify. Douglas said for every 90 cases they open, there are another 90 they reject on grounds of eligibility.

“So, our staff who would be looking at the applications, they’re probably looking at an easy 100 to 125 additional application in a month, which is a significant case increase for them,” she said, describing the potential challenge.

The process of determining eligibility usually takes 30 to 45 days, as social services employees check necessary documents and confirm details listed in an application. According to the Department of Social Services Annual Report for June 1, 2011 to May 30, 2012, the department saw a seven percent increase in benefits from the previous year, issuing approximately $14.4 million in benefits The report also lists an average of 1,593 cases under review monthly, with 3,471 recipients per month.

If the state does expand the program, which provides health care for individuals with lower incomes, intellectual disabilities, older people and some families with children, the federal government will pay 100 percent of the cost in the first three years, with the percentage dwindling to 90 after that.

But, there is no funding to provide additional staff to help process additional cases.

The Centers for Medicare and Medicaid Service, or CMS, issued a ruling in 2011 providing enhanced funding, through December 31, 2015, to states upgrading their information technology systems for Medicaid enrollment, a list that includes Virginia. According to a report by the Senate Finance Committee, $88 million will be invested in the system.

Douglas said that while those improvements will ultimately lighten her staff’s workload, she’s concerned about the two year gap between when the expansion would go into effect, in January, 2014, and when the technology would be prepared to screen applications automatically.

“That’s almost like opening up the floodgates without giving us the resources behind it to take care of the water coming in,” she said.

In the last four years, enrollment in the county’s Supplemental Assistance Program, formerly referred to as food stamps, has almost doubled as more and more people have found themselves in need.

“I know a lot of agencies are holding vacancies or just not expanding staff,” Bolyard-Douglas said. “We’re just trying to make do with what we have, but the numbers coming in continue to rise.”

Bolyard-Douglas has asked the Prince George County Board of Supervisors to consider authorizing two additional employees for her department, positions that would largely be funded by federal and state money.

“We’re a pretty cheap alternative for a safety net for some of our more vulnerable families,” she said.

On Sunday, the Virginia House Appropriations Committee approved its amendments to the state budget, including a proposal introduced by local representative, Del. Rosalyn Dance, to set aside $5.3 million to restore recession trimmed funding to local departments of social services.

In the state Senate, the outcome was different. The Washington Post reported that members of the state Senate Finance committee are threatening a budget stalemate unless the General Assembly moves to expand Medicaid, a proposal not covered in the amendments that appeared before the committee on Sunday.

“This budget has a fatal flaw,” Sen. Janet D. Howell (D-Fairfax) the Washington Post quotes her as saying. “It does not include Medicaid expansion. I think that’s morally wrong. We must not deprive over 300,000 Virginians of health care. For year’s we’ve known we have one of the most miserly programs in the country. We couldn’t improve it much because we didn’t have the money. Now, that money is being offered us, and we shouldn’t spurn it.”

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