Saturday, July 03, 2010
“Lost in Hawaii” -- $327 million in federal funds as DHS fumbles its responsibilities
by Larry Geller
Who should be voted off the island for an ongoing fiasco at Hawaii’s Department of Human Services which may risk $327 million in federal funding that the state badly needs?
DHS Director Lilian Koller is the focus of yet another controversy over the operation of her department. This time big bucks are involved, money that the state could clearly use. But in this ongoing reality drama, is it Koller who should go, or her boss, Governor Linda Lingle?
Disability Mom advocate and blogger Summer Harrison posted two DHS letters in her article, Letters show Hawaii out of compliance with ARRA and CHIPRA since April 2009 (6/24/2010). The first, dated April 8, 2009, requests an increase in staff. Koller describes the critically needed positions and their functions, then states:
As you know, we had placed a self-imposed hiring freeze as we began our reorganization. When we were ready to begin filling those positions, a State government wide hiring freeze was placed. We did make a request for approval to fill a set of critical positions, that was approved. Currently, we still have a large vacancy rate (62 positions plus 4 imminent retirements), and we are unable to adequately meet the current demands of increased applications and enrollment with determinations within the required timeframe, the requirements of the ARRA., and the implementation of the CHIPRA. These programs can generate in excess of $327 million in new Federal funds for the State if we meet all of the requirements.
$327 million is not chump change. Also, the letter states that unless the positions are filled, the state would end up being out of compliance with federal regulations:
Not filling these vacancies will impede our ability to fulfill our full safety-net role because we will not be able to make timely eligibility determinations. The Eligibility worker is responsible for determining initial and ongoing eligibility for medical assistance. If application processing is delayed beyond 45 days, the department will be out of compliance with federal regulations. [See article linked above for full text of the letters and complete discussion.]
Koller incidentally confirmed that DHS is outsourcing its work to a contracted call center (See: Opportunity to teach Hawaiian language in Mumbai (4/10/2010) in which I theorized that DHS would outsource its services):
The Customer Service Center currently has a 56% vacancy rate in this unit. Staff are struggling to meet the current volume and will be unable to effectively address the increased volume without filling these vacancies. If we do not fill these vacancies; we will need to continue and expand a temporary contractual relationship with an outside call center.
The next episode takes place on June 24, 2010 as Dr. Kenneth Fink, Administrator of DHS’ Med-QUEST division, writes a letter to Koller clearly cribbed from her letter to Lingle one year earlier:
As you know, we had placed a self-imposed hiring freeze as we began our reorganization. When we ready to begin filling those positions, a State government wide hiring freeze was placed. We did make a request for approval to fill a set of critical positions, that was approved. Currently, we still have a large vacancy rate (62 positions plus 4 imminent retirements), and we are unable to adequately meet the current demands of increased applications and enrollment with determinations within the required timeframe, the requirements of the ARRA, and the implementation of the CHIPRA. These programs can generate in excess of $327 million in new Federal funds for the State if we meet all of the requirements.
This is tantamount to an admission that the state has been out of compliance with federal regulations, if the regs described are currently in effect.
New in Fink’s letter:
In addition, due to the cut backs that are occurring in the Department of Health that are reimbursed by the MQD (i.e., 15% reduction in DD/MR waiver and decrease in case management for AMHD), clients are appealing the DOH's decisions. These appeals have doubled the number of appeals that Member and Provider Relations is processing.
With regard to the DOH cutbacks that DHS pays for, they are not just minor administrative matters. Cutbacks in services by DOH may be responsible for a reported 36% increase in deaths 2009 over 2008 (See: Hawaii’s deadly cuts in mental health services demand state response, 3/18/2010), Class action lawsuit filed against Hawaii Department of Health to reverse cuts in mental health services (6/23/2010) and Star-Advertiser: State sued over mental health cuts, (6/25/2010).
It appears that the Department of Human Services is in disarray. For want of 41 positions, $327 million and federal compliance are being sacrificed. Dr. Fink is asking Koller again for what she asked Lingle a year earlier and was apparently denied.
The question is really who should be voted off the island, Koller or Lingle?
There is plenty of context for calling for the removal of Director Koller (since Lingle can’t be voted off the island anyway). If these inhumane actions were not her idea she might have resigned rather than implement her orders.
Instead of caring for those citizens of Hawaii who depend upon DHS for services, Koller has attempted to slash those services in ways that undeniably would cause harm. She’s been thwarted by the courts in one instance and by the Legislature in another, but supported in both by Governor Lingle.
What made the news earlier in the year was Koller’s plan to decimate services to the state’s most vulnerable citizens by eliminating 232 caseworker jobs. Articles such as this appeared in major newspapers:
Hawaii Department of Human Services Director Lillian Koller's plan to streamline how the poor, elderly and ill receive state assistance was roundly dismissed as coldhearted and ineffective at a public briefing held Thursday night by the chairman of the state House Human Services Committee.
Several speakers at the meeting that drew about 80 Maui residents said the department's proposal, which would close a half-dozen benefit eligibility offices in Maui County, displayed a "lack of compassion" and "nearsightedness."
However, after the dust of acrimony settled Thursday, lawmakers asked for and received ideas to help hold off the administration's proposed cuts.
The Maui residents, most of them DHS benefit eligibility workers and their clients, joined Oahu Rep. John Mizuno to express their outrage at Koller's intentions to eliminate 232 DHS caseworker jobs statewide. Apparently, this includes all of those positions and offices in Maui County. Department of Human Services leaders have declined to provide specific details, saying they need the Hawaii Government Employees Association union to come to the bargaining table.
DHS leaders were invited to Thursday's legislative briefing, but no department administrators showed up. [Maui News, DHS streamline plan attacked as coldhearted, 2/27/2010]
The plan angered those who still vividly recalled reports of the state’s attempt to cut off lifesaving dialysis and chemotherapy services to COFA (Compact of Free Association) residents, a move that was ultimately halted by the courts. Just to recap that sad example of public service:
In June , facing budget shortfalls, DHS initiated a clandestine and illegal effort to halt health-care benefits to many COFA residents. In August, DHS escalated its campaign, announcing new rules that slashed the health care benefits provided to COFA residents already in Hawai'i. Among other things, DHS moved to eliminate coverage for life-saving treatments such as chemotherapy and dialysis and to withhold lifesaving prescription drugs. DHS gave notice of this change mere weeks before it was to be implemented, in English only, and with little to no guidance for health care providers. In short, DHS's haphazard efforts at cost-cutting led to panic in the COFA and medical communities and created a life-threatening situation.
Unfortunately for DHS, the rule of law prevailed, as the U. S. District Court issued a temporary restraining order restoring benefits to their previous levels because DHS was violating recipients' constitutional due-process rights. [Honolulu Advertiser, quoted in Lawyers for Equal Justice News blog, DHS official shows lack of empathy for those who need help, 3/9/2010]
Koller’s partner in crime is Hawaii Governor Linda Lingle. The COPA cutbacks could not have occurred without Lingle’s assent, and Lingle actively opposed the Legislature’s move to block Koller’s neutron bomb attack against eligibility staff by exercising her veto:
As expected, Gov. Linda Lingle on Tuesday vetoed the state Legislature’s attempt to block her from reorganizing the state Department of Human Services.
Nearly at the same hour of the veto, DHS workers and supporters on the Neighbor Islands, including Kaua‘i, were rallying to keep the DHS status quo, as the DHS reorganization would mean closure of three DHS offices on Kaua‘i as early as July 1, and another round of layoffs of DHS employees here and across the state. [The Garden Island, Lingle vetoes DHS-reorganization bill, saying it is discriminatory, 4/27/2010]
Lingle’s veto was overridden and the bill became law on 4/29/2010.
There has been ongoing controversy over DHS’s awarding of the QExA (QUEST Expanded Access) contracts to two Mainland for-profit health insurers, United Health and Wellcare. For only a few examples, see: Successful Advocacy in Hawaii. These individual stories illustrate the need for further investigation into a system which also may be designed to fail the most vulnerable citizens it should be serving.
It is safe to assume that for each patient who chooses to appeal there are many others who have simply acquiesced to denials and service cuts. We don’t know if “many” might be dozens or hundreds of real, flesh-and-blood people—some of whom may have died as a result of denials, I might add.
Related to the above is this current news article about one of the two providers::
The allegations of wrongdoing at WellCare Health Plans Inc. continued Tuesday with the unsealing of two more whistle-blower complaints against the Tampa company.
Clark J. Bolton, a former supervisor of special investigations at WellCare, said the insurer encouraged overbilling and refused to audit claims for fraud in order to curry favor with doctors and hospitals and build market share. The result was millions in excessive and illegal expenses passed through to federal Medicare and state Medicaid programs, Bolton said.
Eugene Gonzalez, a referral coordinator for seven years, claimed WellCare met government customer service standards only because it had employees create backdated documents and make bogus calls to the company's phone lines. Failure to meet these standards would have resulted in the loss of billions of dollars worth of Medicare and Medicaid contracts.
These complaints bring to three the number of whistle-blower lawsuits that have been made public in the federal investigation into WellCare, which began with a high-profile raid by FBI agents in October 2007. [St. Petersburg Times, More lawsuits against Tampa company WellCare made public, 6/30/2010]
It’s not possible to cover the issues surrounding the two DHS contractors in a short article, but for United Healthcare, try this Google search for a starter. Within Hawaii, there have been a number of informational briefings at the Legislature looking into complaints against the two providers, and the controversy isn’t over yet.
I’ll close with a question for you: How come in Hawaii, the Department of Education can’t learn, the Department of Health is sick, and the Department of Human Services is inhumane?
$327 million wasn't lost. In fact, DHS drew down the entire $327 million plus more without having to add on more positions that would have cost the state millions of dollars.