Will thousands of new Medicaid enrollees inundate an already overloaded social services workforce?

By: - September 20, 2018 6:45 am

Virginia just launched its new Office of the Children’s Ombudsman, aimed at overseeing the state’s child welfare system. (Ned Oliver/ Virginia Mercury)

Virginia’s 120 local social services departments are on the front lines when determining eligibility for benefit programs like Medicaid, and they’re trying to prepare for the wave of applicants they’ll likely see once Medicaid expansion hits the state in January.

That could be a daunting task, though, as the state’s eligibility workers are already overworked and have a low retention rate. According to the League of Social Services Executives, 40 percent of benefits eligibility specialists in local departments leave within five years.

The state has taken steps to ease the burden on those local departments, including hiring 310 additional staff members to spread the work around — but there are still some doubts of whether that’s enough.

During a Joint Subcommittee for Health and Human Resources Oversight meeting Wednesday, Elaine Burgess, president of the Virginia Benefits Program Organization who works in Virginia Beach, said most of the workers in her agency have caseloads of up to 800 cases.

They are expected to determine each person’s eligibility within 30 days — a tough lift with such a large number of cases.

And in January, 400,000 more people are predicted to apply for Medicaid.

At Wednesday’s meeting, Del. Scott Garrett, R-Lynchburg, expressed concern about the workforce’s ability to sign up that many new members when they’re already so stressed.

“This is my greatest heartburn: That we make the commitment and we’re not ready to roll it out,” he said.

But Virginia Department of Social Services Commissioner Duke Storen said officials doubt that all 400,000 people will converge on local departments.

Right now, only 35 percent of those who enroll in Medicaid do so through a local department, while others are enrolled in other ways, like through the state’s Cover Virginia Call Center or the online application portal, CommonHelp.

Some groups will also be automatically enrolled in Medicaid, such as those on GAP, or Governor’s Access Plan, which is for adults with serious mental illness.

And the Department of Medical Assistance Services, which manages Medicaid in Virginia, is also working to transition Virginia’s relationship with the Affordable Care Act’s marketplaces. In the past, if someone applied to the marketplace when they likely qualified for Medicaid, their application would be forwarded on to Virginia, resulting in months of backlogs during some open enrollment periods.

But Virginia is trying to change that process so that the marketplaces can determine Medicaid eligibility based on Virginia’s rules, the setup that some states have already.

“The combination of automatic enrollment and expedited enrollment and pushing CommonHelp and pushing the call center means that we believe that we are not going to have going to have an influx of 400,000 applications at the local Departments of Social Services, and we are very intentional about making sure that doesn’t happen,” Storen told the subcommittee Wednesday.

The 310 number for additional workers was based on the best estimate available earlier this year when the General Assembly was considering the budget, he said.

Del. S. Chris Jones, R-Suffolk, said the General Assembly spent countless hours trying to formulate the right numbers and that he feels confident that, based on the data that was available at the time, 310 was the right number.

“I think we all want preciseness in everything we do, but this is almost like a helicopter with a million moving parts,” he said. “I understand the alarm and the concern, but I am comfortable, based on what we had on the time.”

Storen noted that the Virginia Department of Social Services likely won’t know if the local departments will have enough staff until several months into implementation, by which time it will likely be too late to add a request to the budget.

But he said on Wednesday, with even more recent data available, 310 is the right number. There is some flexibility in the Cover Virginia Call Center, too, to add more capacity and handle additional applications if that proves to be necessary.

“My tea leaves are no better than anybody else’s, but I can say we have spent a lot of thoughtful time on this, and I think we’re in a good place, I really do,” he said. “And if we’re not, then I’ll let you know.”

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Katie O'Connor
Katie O'Connor

Katie, a Manassas native, has covered health care, commercial real estate, law, agriculture and tourism for the Richmond Times-Dispatch, Richmond BizSense and the Northern Virginia Daily. Last year, she was named an Association of Health Care Journalists Regional Health Journalism Fellow, a program to aid journalists in making national health stories local and using data in their reporting. She is a graduate of the College of William and Mary, where she was executive editor of The Flat Hat, the college paper, and editor-in-chief of The Gallery, the college’s literary magazine.