PRI Committee Hearing Transcript for 09/23/2004

REPRESENTATIVES: Congdon, Graziani, Miller,

Green

REPRESENTATIVE WASSERMAN: I'm going to begin the Program Review and Investigations meeting, public hearing today and we have two topics on which we're encouraging comments.

One is Medicaid Eligibility Determination Process and the second one is Mixing Populations in State Elderly Housing Projects. And we begin with legislators and other officials who may be here. Usually, we take one hour, but I don't believe we have that many signed up and I do hope that comments will be concise and to the point.

And with that, we have Representative Graziani here, who has, I believe, a very brief statement to make and I will permit him to make that.

REPRESENTATIVE GRAZIANI: Thank you very much.

REPRESENTATIVE WASSERMAN: Thank you Representative Graziani. Would you like to make your statement first?

REPRESENTATIVE GRAZIANI: Yes, thank you very much.

REPRESENTATIVE WASSERMAN: Thank you.

REPRESENTATIVE GRAZIANI: I was approached by some residents that I represent in the Town of East Windsor and they presented me with a petition as they did last year and we went through a joint public hearing in that respect.

Unfortunately, they showed up at 10:00 o'clock and unable to be here for the 4:00 o'clock. Our Housing Director, as well, was here at 10:00 o'clock and extended his regrets for not being here.

But what I'd like to do if I may, be permitted to read the petition that they left, and I'd like to have this as a matter of public record. They're from the residents of the Park Hill Complex, senior complex, in once again, the Town of East Windsor.

And the petition reads as follows: We the undersigned, living at Park Hill, East Windsor, Connecticut, are unable to attend this meeting. We were given only ten days to try to get a bus, but unfortunately not enough time to get funds needed. It is also a bad time of the day for us going to Hartford. We still feel as we did last fall that housing the young, mentally challenged and the seniors is not working. It is not a matter of money, although money does come into some sort of mix, the two generations who are like oil and water by mixing with the two different lifestyles. And it's signed by 73 of the residents that reside at Park Hill.

With that, Madam Chair, I'd like to have that reflected, and there's copies there as well.

REP. WASSERMAN: Thank you. That will be done. Thank you.

REP. GRAZIANI: Thank you.

REP. WASSERMAN: I'm also joined by several other legislators here and Representatives Miller and Congdon and the staff of the Program Review and Investigations Committee who, they're responsible for these briefings which you have found, most of you have, in the form of the reports.

With that, the first official would be Dr. Evans. I believe Doreen Del Bianco is going to speak with you?

DEP. COMM. ARTHUR EVANS: Good afternoon, Representative Wasserman and distinguished members of the Program Review and Investigations Committee. I am Dr. Arthur Evans, Deputy Commissioner of the Connecticut Department of Mental Health and Addiction Services and I'm here today to testify to you on the report Mixing Populations in State Elderly Housing Projects. It's a very important issue to us and one in which we've been involved for quite some time.

Given the difficulty that people with behavioral health disabilities have in finding the most appropriate and affordable housing in the community, keeping access to elderly disabled housing for the population we serve is very important to us.

DMHAS is a health care agency. The people that we serve have psychiatric disability or substance abuse disorder. These disorders involve the brain and one's chemistry and one's body as well as other social factors. They are health care conditions just as any other, with identified symptoms and known and effective treatment protocols.

We provide services to over 70,000 individuals in communities all over the state. As any person with a health care condition should expect, we are committed to helping people we serve to achieve the highest possible level of recovery from their psychiatric disability or substance abuse disorder.

That involves first, helping them to learn how to manage their illness. We do that well. Our task is made easier when the person has a safe, decent place to live which heightens the prospects for sustained recovery.

How basic a right is that for any citizen? Unfortunately, it is also one of the biggest obstacles that we face and people face in their recovery efforts. As a Department, it is an ongoing struggle for us to find decent and affordable housing for the people that we serve.

We note in the report, we note that in the report it mentions that the current federal government programs which do allow the federally run housing authorities to apply for and receive permission to segregate the disabled population and senior disabled housing. However, in such instances, there is a process by which the housing authority must document not only the housing needs of those local disabled population, but also their service needs.

In addition, in those instances where the federally run housing authority is granted permission to designate their building as seniors only, the individuals with disabilities who are impacted by such a designation are given portable housing vouchers. These vouchers in turn, provide the housing opportunities so desperately needed by the people we serve.

We, at DMHAS can state for a fact, that we have had many experiences where our local mental health authorities have been called by elderly disabled housing units because of a perceived problem with a person with mental illness, only to find that the person in question does not have a mental diagnosis.

I can also tell you that we have received calls from such housing facilities because of a resident over 62 who is showing signs of dementia. Rest assured that we want to be helpful in finding the right balance on this issue. We want to work this out and we believe that we can but we cannot do it on the backs of the individuals that we serve.

We have been thinking about this issue for a long time and have made a proposal to the Commerce Committee and Select Committee on Housing last year, that we are in the process of implementing. We are having our 14 local mental health authorities and three satellite offices throughout the state, directly providing or contracting mental health, and in some cases, addiction services.

Some of these are state run and some of them are private nonprofits. These are our people on the ground in communities and they have the responsibility for serving certain geographic areas. We are mandating both for the state run programs and the grantee agencies that these local mental health authorities designate a senior contact within their respective organizations to make contact with the directors of local housing authorities in the areas in which they serve.

We are asking them to work with those housing authority directors to do an assessment of each senior disabled site and if appropriate, with them, to work with them to identify problems and take care of individuals for whom they have responsibility as well as to offer services to those other residents who may qualify for services within our service system.

We will then come back to those Committees next year and report on what we have found. That is, behaviors that we found and what made a difference and what frankly, didn't make a difference. Then I think we will be in a much better, we will have a much better handle on the situation and can make recommendations based on facts, not on perceptions and anecdotes.

We are also intimately involved in the inter-agency work group on supportive housing and homelessness. That is, making recommendations to the Governor's Council. We think this is very important work and that work group with support from the Office of Policy and Management, has made, has made a plan to add more than a thousand units of affordable, service supported rental housing including 350 apartments for families, 600 for single adults and 50 for young adults.

Of these, 600 housing units will be made available to persons with behavioral health disabilities. The plan calls for a combination of housing subsidies and new or rehabilitated development. It is estimated that the plan will take at least five years to fully implement, but we believe that it will go a long way towards helping people with behavioral health disabilities to have access to safe, affordable housing.

We are cognizant of the fact that these are difficult issues and ones which have placed a lot of pressure on the legislative process. Thus, we would welcome the opportunity to work with you to address some of your concerns regarding senior disabled housing. It would be of interest to us if the housing authorities with resident service coordinators are the ones that are also not reporting significant issues with regard to their elderly and non-elderly disabled residents. That information would be helpful because it would let us know if that particular program works.

We would also be remiss if we did not remind you that every non-elderly disabled person living in this type of housing is a person, is not necessarily a person with mental illness.

We ask only that you remember that the people we serve also need, and have the right to have safe, affordable and accessible housing in order to achieve recovery and become productive members of our communities.

Thank you for your hard work to this date. It is our hope that DMHAS can play a role, an active role, in helping to achieve a workable solution to this issue for the citizens of Connecticut. We appreciate the opportunity to address you today on this important issue and we'd be happy to take any questions that you may have at this time.

REP. WASSERMAN: Thank you, Dr. Evans. I'll open the questions to the other legislators. We've been joined by two more Senators, Senator Toni Harp and Senator Edith Prague. But I have one quick question.

DEP. COMM. ARTHUR EVANS: Sure.

REP. WASSERMAN: How much interface have you had with our staff on the things that you, yourselves are planning to do. And here is also Senator Coleman.

DEP. COMM. ARTHUR EVANS: Barbara, do you want to handle that?

BARBARA GELLER: We've, I'm Barbara Geller from the Department of Mental Health and Addiction Services.

REP. WASSERMAN: I'm sorry. Would you turn your, the intercom on.

BARBARA GELLER: It is. I'm Barbara Geller from the Department of Mental Health and Addiction Services. We've met with the staff of the Committee. We're in the midst of collecting data for the Committee on the number of residents in elderly housing who are also within the Department.

REP. WASSERMAN: Yes, I'm talking about our staff. When you say Committee, you mean our Committee staff?

BARBARA GELLER: Yes.

REP. WASSERMAN: I'm very happy to hear that because I think at this stage, especially, before we make our final recommendations, it's extremely important to incorporate all the ideas that we can gather and also, as you know, we're going to have a public hearing after we publish those findings and recommendations, which hopefully will end up in legislation if that is needed.

Now, I'll open it up to questions from the floor and I think there are going to be several. Yes.

SEN. PRAGUE: Thank you, Madam Chairman. Dr. Evans, this is really a huge problem. People who are mentally ill who are out in the community need a place to live. Senior citizens in elderly housing are having a hard time, particularly with people who are substance abusers.

People in elderly housing who are depressed are no problem. It's people whose behavior is a threat to themselves and to others, who act out, that present a problem. Particularly, substance abusers are a problem. However, that doesn't mean they don't need a place to live or services to help them get better.

Do you do any outreach work in these housing developments? Do you have people from the Department that regularly go out on a regular basis to the elderly housing developments where you know that your clients are living?

DEP. COMM. ARTHUR EVANS: Yes, we do. Let me make a general statement and then I'm going to turn it to Barbara to give you some more specifics about what we do.

As you know, everyone who's in a senior disabled housing unit who has a psychiatric disability does not necessarily have behavioral problems, the kinds of problems that you talked about.

SEN. PRAGUE: Right.

DEP. COMM. ARTHUR EVANS: Furthermore, some of those individuals who do have those behavioral problems do not also have a psychiatric condition. So I think the issue for us is when people do have psychiatric conditions that are causing difficulties, what should our response be, and we've taken considerable steps to do that. I'm going to let Barbara talk a little bit about that.

But as you mentioned this morning, in the meeting this morning, we have examples of where it has worked well, where we have put in supportive services and there are also instances where it hasn't worked well.

And one of the things that I think was clear in this morning's session is that we really need to look at the data in terms of, where are we having the problems, what are the kinds of problems we're having, and in those instances where we have put in supports, are those the places where again, as you mentioned this morning, that it is working well.

But let me ask Barbara to talk specifically about what we've been doing relative to the kind of outreach that you mention.

BARBARA GELLER: Based on a previous hearing when Commissioner Kirk testified, we came away from that understanding that there are often problems in housing authorities that we're unaware of and that often, housing authorities are not reaching out to us.

So, in fact, some of the data that we're hoping to get back to the Committee is, we have contacted all of our lead mental health authorities and we're asking them to make contact with all of the housing authorities within their areas to talk about residents who are both clients of the mental health authority and of the housing authority and to develop plans with the housing authority of how we could better do precisely what you're talking about, Senator Prague.

How can we reach out and develop a better working relationship so that when there are issues, they're more comfortable responding to us.

SEN. PRAGUE: And that then you can deal with the issues that are currently disrupting the whole complex.

BARBARA GELLER: Hopefully, yes.

DEP. COMM. ARTHUR EVANS: Yeah. And I think it's important also to note that not everyone who might fall into that category are people that we would necessarily have responsibility with, for. We, in those instances when we do, we certainly want to do that. In those instances when those are not, the position that we've taken is that we want to be helpful and we've tried to refer those people to services as well.

SEN. PRAGUE: If I may ask just one more question, Madam Chair.

REP. WASSERMAN: Certainly.

SEN. PRAGUE: The Department receives some federal dollars to construct supportive housing. Are you on your way to do that, and will you be taking people who are living in elderly housing out of elderly housing and placing them into this supportive housing that hopefully you will have, or is this for new clients?

BARBARA GELLER: It's not necessarily for new clients but it's for people who don't have housing. It's for people who are homeless or at risk of homelessness. And unfortunately, there are so many of those that it fills up the houses.

SEN. PRAGUE: Okay. Thank you.

REP. WASSERMAN: Senator LeBeau has joined us and Senator Coleman.

SEN. COLEMAN: I'm following up on, Senator Eric Coleman is my name. I don't have my name tag in front of me. Following up on Senator Prague's question.

Are you familiar with the resident services coordinator? Are they funded through, are they still in existence first of all, and if so, are they funded through your Department?

DEP. COMM. ARTHUR EVANS: My understanding from the report is that they are still in existence but they are not funded through our Department.

SEN. COLEMAN: Okay. Do they work in collaboration with your Department?

DEP. COMM. ARTHUR EVANS: Well, one of the things that we've noted is that we want, we think that there should be much more collaboration with those individuals with our, with the people from our local mental health authorities.

SEN. COLEMAN: And if my recollection serves me properly, part of their function is to sort of conciliate or mediate the kind of tensions that may exist that have been described between elderly residents and non-elderly disabled residents. Is that correct?

DEP. COMM. ARTHUR EVANS: I think in part. But my reading of the, and understanding of the report is that they have a broad set of responsibilities related to helping whatever needs may come up that individuals in senior disabled housing might have and the kinds of things that you're talking about, Senator Coleman, I think would fall into that.

SEN. COLEMAN: Are either of you aware concerning whether or not the resident services coordinators, that is, whether or not they have been at all effective in alleviating some of the concerns that are under discussion today?

DEP. COMM. ARTHUR EVANS: Well, one of the things that I heard in the report this morning was that some of the data that was being collected, was to see whether, in fact, they have been effective and in what instances were they effective. But we really can't speak to that because they're not really within our purview.

SEN. COLEMAN: Thank you, Madam Chair.

REP. WASSERMAN: Are there any? Yes, Representative Graziani.

REP. GRAZIANI: Thank you, Madam Chair. Commissioner, thank you very much for your testimony. A couple things for clarification on my end and perhaps other members.

DEP. COMM. ARTHUR EVANS: Sure.

REP. GRAZIANI: In the opening statement, it says, this is not, this is an issue that DMHAS has been involved with for a long time. And then we move on later on during the written testimony that it's terrific that you're mandating a local contact, so to speak, senior center contact person to make contact with the housing authorities, work with them to identify the problem, then come back to the Committees next year and to see what can possibly be made.

My concern is that if this is a problem that we're familiar with right along, it sounds like we're trying to start from ground one again and when that isn't necessarily the case.

I believe in the past, even last year's public hearing, joint hearing that we had, there were a number of issues that were brought on by the senior housing directors and we heard from coordinators as well. So, to me, that's telling me that we know that the problem exists.

Now it looks like we're going back and saying, now we're going to assign somebody. We're going to start from square one and ascertain that information. To me, that information has been readily available. Would you be able to comment on that?

DEP. COMM. ARTHUR EVANS: Sure. I think that our understanding of the issue as it's evolved over time, I think that people's awareness of the issue and how it manifests itself has changed over time. I think our commitment is that first of all, we want people who are in this housing to be successful and we've made a commitment, the Commissioner has made a commitment for that. I think our response last year was in response directly to issues that had been raised within the Legislature but I wouldn't characterize it as going back to ground one.

Historically, and Barbara maybe you can speak to this, as we noted, this initiative we've been concerned about, I think again, our understanding of that has evolved. I think our response to that is appropriate given the issues that have been raised in this body and in other settings.

REP. GRAZIANI: And just, if I may, when you say within our system to come up with a finding next year, what are you talking about next year for a time frame? Are you talking 2005 legislative session, or, I mean, what sort of time table, because obviously we do have another survey that was sent out once again, which is, I think is terrific and it once again addresses the comments by the housing directors, themselves, on what possible solution that they might have.

Once that information, from what I understand, we have like roughly 70, 75% responses, and there's follow up being conducted now so they can possibly, hopefully, we'll get 100%, but if not, probably 90% range which will be a good indicator. Once that information is passed on, what do you visualize as a time table to come up with, possibly, some recommendations.

DEP. COMM. ARTHUR EVANS: I think we'll have data, I think we'll have data by January, so we're not talking a long time.

REP. GRAZIANI: That's terrific and that's a goal that we can certainly target for. That's terrific.

DEP. COMM. ARTHUR EVANS: Sure.

REP. GRAZIANI: Thank you very much for your comments.

DEP COMM. ARTHUR EVANS: Thank you.

REP. WASSERMAN: Senator Harp.

SEN. HARP: Okay. Hi, Dr. Evans. This is probably going to be one of the few official times that we see you again. I want to congratulate you for your move and to thank you for all that you've done on behalf of the persons that you serve in our state.

DEP. COMM. ARTHUR EVANS: Thank you.

SEN. HARP: And we do appreciate it. If you lived, if we lived in a perfect world and DMHAS could create any type of housing for the type of clients that you serve, both on the mental health side as well as the addiction side, what would that look like? What would you say to us as policymakers that we need to do.

Because I'm assuming that elderly housing is a deferral because nothing else exists. Have you all thought about the best form of housing for your clients and what we need out there in terms of housing for the groups that you serve, and if so, what would that look like in the best of possible worlds.

DEP. COMM. ARTHUR EVANS: Sure. I think that in the best possible worlds there would be a range of housing options available to people. Our data and the feedback that we get from providers, from consumers, from advocates, consistently say to us that the number one problem for people in terms of their recovery is the, is having affordable housing.

And if you look at the range of issues that people who have behavioral health conditions bring, the level of functioning that the people have, it's really clear that people need a whole range of options from housing supports, so that people can just have an apartment, to other kinds of housing where it would be supported by people who are providing some kind of case management services or those kinds of things.

I think from a philosophical standpoint, the Department has been very interested and has promoted the idea of recovery and people living within a community context and I think in that sense, people with behavioral health conditions should live where everyone else lives. And if there are other kinds of problems that Senator Prague talked about, that we in the field have a way of responding to that and supporting people so that they can be a part of the broader community.

So I think that from a philosophical standpoint, we would want people to have the whole range of housing available to them that other people do, that people wouldn't be segregated, that people would have the kinds of support that would allow them to live wherever they wanted to. That would be ideal.

REP. WASSERMAN: Senator Prague.

SEN. PRAGUE: Thank you. For the second time. Would the Department be interested in providing some sort of a training curriculum for the resident services coordinators to try and help them deal with your clients?

DEP. COMM. ARTHUR EVANS: Since I'm leaving, Senator Prague, of course we would. I don't mind committing the Department to anything at this point, so. Yes, I'm going to Philadelphia, Senator. Yes. Yes. (Laughter)

So, yes, you can tell the Commissioner that I committed him. But in all seriousness, I think we'd be happy to do that.

SEN. PRAGUE: It's important.

DEP. COMM. ARTHUR EVANS: I think it's important, too. And I think that you know, again, my understanding of the role that they play is a more generic one and as you know, behavioral health conditions require some specialty and special skills and we will be happy to help people in terms of those skills.

SEN. PRAGUE: Thank you.

DEP. COMM. ARTHUR EVANS: Sure.

SEN. PRAGUE: We'll call you if it (two speaking at once)

DEP. COMM. ARTHUR EVANS: I'm just down the road.

REP. WASSERMAN: Senator LeBeau.

SEN. LEBEAU: Thank you, Madam Chairman. Dr. Evans, good luck in your new job.

DEP. COMM. ARTHUR EVANS: Thank you.

SEN. LEBEAU: Along the same lines as Senator Prague, talking about the resident services coordinators, you seem to have put a lot of stock in their ability to deal with some of the problems that have arisen at senior housing and it seems to me that there was, and first of all, I apologize. I was late. I came in about fifteen minutes ago, so I don't know what you said before I walked in.

DEP. COMM. ARTHUR EVANS: Okay, that's fine.

SEN. LEBEAU: The, are you, you're not in charge of those folks, then.

DEP. COMM. ARTHUR EVANS: We are not. We are not in charge of them at all.

BARBARA GELLER: I believe it's DECD.

SEN. LEBEAU: DECD. But you don't do any training of those folks.

DEP. COMM. ARTHUR EVANS: We don't. At this point.

SEN. LEBEAU: And I've seen, I've actually seen some of the data in the past on what they do, how they spend their time and shared with me. What I've seen is that they spend very little of their time actually working on solving problems. At least in the past. That data was shared with me last spring, and that there was very little in the sense of conflict resolution that was going on.

It was mostly, I'm not sure how to call this, custodial care, helping people shop, helping people go out, doing a variety of kind of like service functions, helping, you know, helping folks with a variety of different kinds of chores that needed to be done, essentially.

And I'd like to know that, the purpose of the resident services coordinators that we're funding these folks, that in order to help solve problems that that's what they're doing. On the other hand, you're leaving, so I can't (inaudible-two speaking at once)

REP. WASSERMAN: Barbara will be here.

DEP. COMM. ARTHUR EVANS: Yeah, Barbara will be here.

SEN. LEBEAU: Actually, Barbara, you might want to speak with us.

BARBARA GELLER: Well, you know, we don't fund them so it puts us in an awkward position at the moment. I do believe, though, that one of the things that the Committee is doing, if I'm correct, is trying to gather precisely the data that you're talking about, to figure out exactly what do they do.

It is true that I don't believe that they're trained in negotiation skills, so that we may be putting them in a position where we ask them to do a job and then not train them to do it. But I think that we'll have better information about that after the Committee finishes its search.

SEN. LEBEAU: So I can turn to the Committee and ask that is true in terms of what is being looked at.

Thank you very much.

REP. WASSERMAN: If there are no other questions from the legislators, I would like to see, does the staff have any questions while Dr. Evans is here?

MICHELLE CASTILLO: No, but (inaudible-not using microphone)

REP. WASSERMAN: Well, I would like to urge that there be very close communication and I hope you understand that we need, we have deadlines and we need to come up with legislation before the end of the year, proposals, which will be finalized in January. So your input is extremely important early on and even if your numbers are not finalized, I think we should have everything from you that you have and then communicate with us. All right? Thank you very much.

DEP. COMM. ARTHUR EVANS: We will do that.

REP. WASSERMAN: And good luck!

DEP. COMM. ARTHUR EVANS: Okay. Thank you.

REP. WASSERMAN: The next speaker will be Susan Hoover, to be followed by Representative Larry Miller.

SUSAN HOOVER: Good afternoon, Representative Wasserman and members of the Committee. My name is Susan Hoover and I'm the Special Projects Director of the Permanent Commission on the Status of Women. Thank you for this opportunity to talk to you about the importance of presumptive eligibility for pregnant women and the need to implement it in a manner that will improve the health outcomes for women and their newborn infants.

Medicaid is a significant source of health care coverage for pregnancy and childbirth for many low income women in Connecticut. In fact, according to data from the Children's Health Council, as many as one in four births in Connecticut were babies of mothers enrolled in HUSKY A or other Medicaid programs.

In the City of Hartford, it's over 60% of all births were covered by HUSKY A. If we want to protect and improve birth outcomes across the state and make sure that infants get a healthy start in life, then we have to focus our attention on the HUSKY and Medicaid programs.

The underlying, the concept underlying presumptive eligibility for pregnant women is simple. The sooner a pregnant woman receives medical care, including routine screenings, care and treatment, instruction about nutrition and wellness, the greater the chances that she'll have a healthy baby.

Presumptive eligibility means that an applicant at certain sites will be granted immediate eligibility for up to 60 days until her application is processed and eligibility is determined. In other words, she can see the health care provider sooner, rather than later, not have to wait 45 days or more for eligibility to be determined.

This is especially important because while federal law permits up to 45 days for applications to be processed, determinations pending on applications for medical assistance in Connecticut are often late.

According to data collected by Connecticut Legal Services organizations and summarized by Connecticut Voices for Children, as many as one-third of the applications were still pending beyond the 45 day period.

Under current state law, the state is supposed to grant presumptive eligibility to pregnant women up to 185% of poverty. This is an important provision in our statute and must be preserved. However, we believe that true presumptive eligibility has not yet been implemented. Instead, an effort to provide an expedited eligibility process for pregnant women was in place but it was tied to the Healthy Start programs. Unfortunately, many Healthy Start programs have been defunded and closed.

We respectfully ask the Program Review and Investigations Committee to examine how eligible pregnant women are currently enrolled in Medicaid and to make recommendations for a prompt, effective, implementation of presumptive eligibility.

Pregnant women and their newborns cannot afford to wait. And I thank you for your time.

REP. WASSERMAN: Thank you very much. Were you able to come to the meeting this morning?

SUSAN HOOVER: I'm sorry, I was not. I actually was asked kind of at the last minute to deliver this testimony. Our Executive Director Leslie Brett is involved in another meeting in another part of the state and so I was drafted at the last minute.

REP. WASSERMAN: Well, this and related issues were brought up and if you have a copy of the report, the initial report, you will see some references to these problems.

SUSAN HOOVER: I'll make a point to get that.

REP. WASSERMAN: Are there questions from legislators? If not, thank you very much for coming up.

SUSAN HOOVER: Thank you for your time.

REP. WASSERMAN: Representative Miller, to be followed by Patricia Wilson-Coker.

REP. MILLER: Good afternoon, Chairman Wasserman, members of the Program Review Committee. My name is Larry Miller. I represent the 122^nd District encompassing the Town of Stratford and the City of Shelton. I'm also a Ranking Member on the Housing Committee and I would just point out that this past winter we had a public hearing regarding senior citizens and handicapped people in the housing projects and about 100 people showed up and we heard some horror stories.

And let me just state that I have no props. I mean nothing, no disrespect to handicapped people. But I don't think it's fair that senior citizens living with people with handicaps such as alcoholism and drug addition and for the past six years I've been involved with the areas, particularly with these two types of handicapped people and seniors are having a heck of a time living in these housing projects, housing areas and having some young man down the hall who is drinking, who is high on pot, or whatever it may be.

Quite often they tell me that they're afraid to have their grandchildren come to visit them because they're not sure what this guy down the hall's going to do and what effect it's going to have on those children.

But I think that people in their twilight years of life who are living in senior citizen housing, they may have five or ten years to live, why do we subject them to this kind of, the people who are going to cause problems. It's not fair. They ought to live out their lives as comfortable as possible. They're sick, they probably have a lot, you know, of pain from whatever may be bothering them ailment-wise, don't have a lot of money.

The least we can do is make sure that these people live a normal life and finish out their years on this earth in a pretty quiet area where they're not afraid of these young people who are there, or druggies or alcoholics. I just think, I don't think it's fair for them to be subjected to that kind of activity.

I know that in the City of Milford, Ray Collins when he was here, had a tremendous amount of problems in Milford with their housing authorities with these type of individuals.

Town in Stratford we've had problems. Even in Trumbull we've had a little problem that's been, I think taken care of, but it's not right. If we want to take care of seniors who, these are the people who need our assistance and help, don't subject them to the kind of activity you might come about with drug addicts and alcoholics and maybe some people who are mentally disturbed.

It's my wish that this doesn't happen and I'm not sure what the answer is with these young people who are drug addicted or with alcoholism but there's got to be another area for them to reside or to be taken care of by the state or the city. So that's my pitch. I have no testimony to give out, but I am very concerned and just want to express my views to this distinguished Committee.

REP. WASSERMAN: Are there any questions from legislators?

SEN. PRAGUE: Thank you.

REP. WASSERMAN: Senator Prague.

SEN. PRAGUE: Has your housing authority tried, do you have a resident services coordinator?

REP. MILLER: You know, I can't say for sure. I know my director has written me a number of letters over the last three or four years regarding (inaudible) but I doubt it. I doubt it.

SEN. PRAGUE: I totally agree with you, Representative Miller. It is a huge, huge problem. The trouble is, you can't put people out on the street with no place to go.

The other problem is, the elderly want to live in peace. Maybe for the moment, until we get housing in this state, offered money, maybe we need to train the resident services coordinators to go to these areas of conflict and attempt to resolve them. We just can't let it go on the way it's going on.

REP. MILLER: Right. Exactly. I just want to say, you know that I may be youthful in appearance but I'm an old guy so I really have a lot of concern for seniors. I'm a senior and I really want to make sure that they get the best care and best housing and the least amount of problems from anybody.

SEN. PRAGUE: I want you to know, Representative Miller that my grandson said when he was a little guy, you know, Grandma, I learned on television that old people have wisdom.

REP. MILLER: I would hope so. Thank you very much for the compliment if it is one.

REP. WASSERMAN: Larry, thank you very much for coming up.

REP. MILLER: Thank you, Madam Chairman. Thank you.

REP. WASSERMAN: Oh, I'm sorry, Senator Coleman has a question or a comment.

REP. MILLER: Oh, I'm in for it now.

SEN. COLEMAN: No, no, no.

REP. MILLER: Good. Thank you, Senator Coleman.

SEN. COLEMAN: I agree with Deputy Commissioner Evans when he said that he believes that the ideal solution is more affordable housing and I just wanted to comment on the heels of your testimony that I think that's why the fights to preserve and hopefully expand affordable housing opportunities is so important a fight because I think the evidence exists that the waiting list for seniors waiting to get into affordable housing is long as well as the list of non-elderly disabled waiting to get into elderly housing is also long, suggests again that affordable housing opportunities need to be expanded in the State of Connecticut.

One of the things I suppose that was of concern to me, I was also in attendance at the Joint Committee's public hearing when this issue was heard. This year, some of the elderly acknowledged that there are non-elderly disabled including people with mental health problems and people with substance abuse problems that were good neighbors.

And one of the things that's disturbing to me about the proposals that have been advanced to this date is that they're very broad and the implementation of such proposals would penalize those non-elderly disabled who happen to be good neighbors as well as those who are causing problems.

The other thing that was of interest to me that occurred at the Joint Committee's public hearing was that there were elderly individuals who testified that they were residents of elderly housing and that there were also elderly residents of public housing who perhaps drank too much and who had perhaps carried on too much and were, in fact, bad neighbors. So it seems to me that at least part of the solution is to do what we would all do if we were apartment dwellers, particularly, but even some homeowners, but particularly with respect to multi-unit dwellings. If there is a resident in such a dwelling that's causing a problem, then the owner of that dwelling relies upon the summary process laws and the eviction laws.

And I understand that there are some complications when those laws are applied to disabled individuals, but it seems to me that there ought to be a little bit more focus on that particular approach as a remedy to some of the difficulties that were discussed today.

Thank you, Madam Chair.

REP. WASSERMAN: Senator LeBeau.

SEN. LEBEAU: Thank you, Madam Chairman. Larry, I really respect you coming out today and speaking. Larry, you don't look that young. (Laughter) But you've been a great Representative and certainly served your district of the state well. Thank you for all those years of service.

Just reading over this, I was looking for a quote because I want to express something. This, one of the reasons that we're here today is because particular housing authorities that have gone through some very difficult times and in the attempt to find a solution to this, and I basically agree with my colleague, Senator Coleman, that the bottom line problem is the lack of housing.

I find it interesting, just reading over Dr. Evans' testimony, begins on Page 2, third paragraph toward the bottom, he says "Rest assured that we

GAP FROM SIDE A TO SIDE B.

But what I see is the exact opposite that has been occurring, which is that the problem of mental health and the lack of funding that we've made for mental health services and the lack of funding for places to live for people with mental health problems has been now visited upon the elderly and that as we've seen, seen over the past ten, 15 years, is that more and more mental health, people with mental health problems are living in elderly housing to the extent that three towns, they are the majority in state financed housing and they are the majority in at least three, in East Hartford at least three units, or three different developments that are the majority within those facilities.

So this is a difficult problem and it is one that this Committee is going to continue to struggle with and I think, hopefully, the Legislature will actually take seriously next spring trying to assure that the needs of both communities are met in a fair and equitable way. I really appreciate your testimony today.

REP. MILLER: Thank you.

REP. WASSERMAN: Senator Harp. You're not done.

SEN. HARP: Well, and I guess I wanted to sort of identify with you as someone, too, who has a lot of elderly housing in my district with some of the same problems. Occasionally, although not most often, we do hear about synergistic relationships between the young and the old and how they're very helpful to one another and make life more interesting.

Most of the time I hear the negatives to be honest with you. But in my civilian life, I coordinate a project to provide health care to the homeless and most of the homeless people that we serve have addiction issues or they have mental illness issues or they're mildly mentally I guess, academically disabled.

And what I've noticed over the past 15 years doing this work, is that we haven't done anything to provide housing for this group of people and the only place that we have to go to get them stabilized so that we can deal with their health care is our elderly system. It's become a safety net because we have done nothing else.

And one of the things that you look at in our state is how much bonding has gone for affordable housing in our state. About 12 years ago we were putting about $120 million into bonding for housing. Now, we're lucky if it's $10 million. And it has created in my district, not just for these vulnerable populations, but for everyone, a housing crisis.

And the elderly housing is the safety net, unfortunately. And so you have all of these inappropriate and unsupported placements there because there is no place else other than shelters which again is inappropriate for this vulnerable population.

We've got to step up to the plate, I believe, and come up with the housing options that we haven't come up with for the past 15 years in our state. We are 15 years behind and hopefully, I'd like to work with you on working toward some of those kinds of solutions in the future because this issue, and I'm sure our staff is going to do a wonderful job and maybe we'll train these resident service coordinators. But that's not the solution.

The solution is that we need more affordable housing. We need more supports for these vulnerable populations that we have insisted live in our communities because we closed all of our state facilities. There's no place else for them to go except shelters and as a compassionate democracy, we should and can do better.

Sorry.

REP. MILLER: That's okay.

SEN. HARP: Work towards that goal. It's long range and will require some resources to take care of.

REP. WASSERMAN: Thank you, Larry.

REP. MILLER: And we need compassionate people.

REP. WASSERMAN: The last official on the official list is Commissioner Wilson-Coker. Good afternoon.

COMM. PATRICIA WILSON-COKER: Good afternoon.

REP. WASSERMAN: Thank you for coming.

COMM. PATRICIA WILSON-COKER: Absolutely. Good afternoon members of the Committee. My name is Pat Wilson-Coker and I'm the Commissioner of the Department of Social Services.

I'm here this afternoon to offer testimony and comment on the Committee's Medicaid Eligibility Determination Process Report which you were briefed on earlier today.

First, let me say that the Committee's staff, in my opinion, did an excellent job of putting into a relatively few pages, what is an extremely complex area of law and practice. And as the briefing report acknowledges, the federal Medicaid entitlement is one that is extraordinarily complex, comprehensive and I might add, expensive.

Out of our $3.9 billion budget, Medicaid accounts for about $2.9 of that. The federal and state regulatory framework is absolutely voluminous and there are a variety of sources, whether it's the Code of Federal Regulations, the Medicaid State Plans, the Transmittals and Regulations that come out of the federal government, our own state law, our own state and federal court decrees.

I really want to comment on the reality of our situation with Medicaid because it doesn't always come through when you have discussions about some of the problematic encounters that occur in the system.

Connecticut is a national leader in public health care coverage and I think that's something that we can all be proud of. I certainly am. We have one of the most extensive and benefits rich programs in the country. Each month we serve about half a million people through a variety of Medicaid programs whether it's HUSKY or Fee for Service, ConnPace, SAGA, half a million people. That's a lot of people there.

And there have been increases. In HUSKY, for example, since the inception of the program, or at least since the A and B in 1998, there's been an increase of about 34% in HUSKY A. That's more than, that's close to 54,000 children that are receiving comprehensive health care benefits that wouldn't otherwise be getting them and more than 90,000 parents and relative caretakers.

I also want to comment on the work that DSS does in this area. Staff in the regional offices are the primary individuals who determine eligibility for HUSKY A, for Medicaid Fee for Services, for SAGA and for other medical services and I have to say that they are doing, in my opinion, a tremendous job.

The Eligibility Determination Process is as complex as the Medicaid rules that govern it. In fact, it's the rules that run the program. And with variation in more than 33 separate Medicaid coverage groups, so this is complicated work.

You also have to think about the fact that many of these, the individuals that are receiving HUSKY services are also receiving services such as food stamps, such as temporary family assistance and the rules for each of these programs that are often federally governed and were under, you know, possibility of sanction because we don't do it clean enough or fast enough, you know, in those different programs the rules don't run parallel to each other.

They often, they sometimes conflict with each other and sometimes you have to have, you know, the same individual might be receiving more than one program but they have to have separate appointments for these various programs.

So I think that in many ways, and I want to say this publicly and emphatically, my staff are doing an incredible job. I know this morning I heard Senator Prague talk about the mess we are in and we are in a bit of a mess, but it's not because of the work that is not being done by staff in my agency.

Now, as you know, we've had some very significant staff losses. In January of Fiscal Year 03 we had 2,423 staff, including a few part-timers. By June of this year, after layoffs, early retirements and retention, we have about 1,881. That's a nearly 25% reduction, 24.4% actually, I believe.

And on any given day, the workload is absolutely overwhelming. Eligibility staff hold appointments with clients that for some programs can last up to two hours. They receive and open mail. They have e-mails. They answer phones and they perform the full range of functions that constitute the Eligibility Determination Process for initial applications and for redeterminations.

Amongst other duties, they manage and maintain the data in the EMS system. They perform case management functions such as changing addresses and updating income information, responding to alerts that tell you when someone has maybe made some money that hasn't been reported or other kinds of things that have to be adjusted on the caseload.

And as I said, most staff carry a mixed caseload. So in addition to the tasks associated with Medicaid, they are on a daily basis involved in sometimes time consuming activities that are peculiar to other programs.

You heard I think, this morning, something about the pressures we're under from the food stamp program, the fact that we're under sanction and are needing to reinvest money in order to have to keep from writing a check for $2 million, reinvesting consultants to try to help us do a better job of accuracy in that program.

And it's ironic to me that sometimes the federal programs that we run conflict with each other. The fact that we're getting performance bonus money in TANF with some of the very things that cause us to be fined in food stamps, because when, well, I mean, I don't have to go into all of that but the programs tend to conflict with each other.

And in temporary family assistance, sometimes you are involved with the external work with other departments. You're sometimes involved in such things as conciliation and sanctioning, accommodating people with disabilities, involved in exit and extension interviews, referrals to social work services, attendance at fair hearing, processing voter registration. All of these things go into the day of the Eligibility worker.

It is clear that one reason for this study was to assess the impact of staffing losses that were sustained by DSS during the budget crisis of 2003. And under the circumstances, it is fair to ask how we have tried to manage the multiple challenges of an increasing caseload and diminished staff.

Our voice mail system is taxed and our human resources are spread unbelievably thin. Customer service is clearly not what I'd like it to be, not what any of us want it to be.

The DSS staff are dedicated and they are skilled and they take their jobs very seriously. But they cannot accomplish the impossible. To that point, let me just say a word about volume.

In March, the Hartford Regional Office received 118,000 calls. In August, the New Haven Office received 36,000 pieces of incoming mail. In the same period in Bridgeport, there were 4,124 people who walked in to the office. Only 20% of those had been scheduled for appointments.

The other 80% were, you know, walk-ins that came in for anything from child support to electronic, you know, to get their EBT card, social work emergencies and non-emergencies. Yesterday in Bridgeport, took a little poll to see what was happening there and found out that there were 5,000 incoming telephone calls.

Now, this morning I heard some question as to how we might do a better job, or whether we could do a better job with answering the phone and responding to these kinds of things and I did a little calculation, or actually one of my RAs did a little calculation and found out that it would probably, if we took those 5,000 calls and gave one minute per call, which is probably inadequate from the outset, we would have to have 11 full-time people doing nothing but answering the phone. No going to the rest room. No eating lunch. No doing anything except sitting there for eight hours answering the telephone in order to be able to adequately address that need.

So what else have we done? We have had to be as judicious as possible in the use of our overtime. We, in this year, have probably used half again as much as we would ordinarily have allocated, so we're using more overtime than we'd like.

We have also increased case processing time and case processing time is what we're doing in our regional offices two afternoons a week, and I, you know, after having assessed the situation with our Department, could see no other way to manage an increased caseload with decreased staff except to make hours where, somehow make hours out of the day.

So we, on the afternoons when people are doing case processing, they attend to the paperwork that accumulates during the rest of the week.

I've heard the office in some instances, although I did hear the legislative staff mention this morning that the offices are not closed and I was pleased to see that correction. Our offices most certainly are not closed during processing time. There are people that are coming in for child support or social work issues. Anyone who comes in with an issue is seen. They just may not be seen by their worker who is doing individual work on the existing cases.

And case processing time is imperative because that's the only way we're going to get at the backlog. If you, if we were not doing, you know, to the extent that you're not getting at that backload, you're getting an increase in calls and an increase in walk-ins and it's, you know, it sort of is a vicious cycle if you don't find some way to manage it. And so that's what the case processing time is about. We try to be consistent so that people would get used to the idea across the state and do the same thing in all of our offices with regard to that.

Now, we have been given authority to rehire some 45 Eligibility workers and we have in fact done that. And some number of these were deployed in Willimantic albeit only enough to open the office for three days a week. That doesn't mean that staff aren't working five days a week. They most certainly are. It's just that the folks who are just you know, coming in, it's sort of like they have an extra half a day of processing time because there were originally fewer staff allocated to that office.

Given these kinds of resource constraints, a number of measures have been implemented as a strategy to mitigate the consequences of our staffing deficiencies. Caseload equalization is one of those mechanisms. Essentially, it's a share the pain theory.

We had caseloads that, because of the layoffs in the ERIP and the bumping and all of the disruption that went on with regard to that, we had some seriously out of line caseloads in other places where they were not so. So we had to move staff around to try to reasonably balance caseloads.

Now, that may have solved one problem. You didn't have somebody with 1,000 cases over here or 200 cases over here, not that 200 is a good number, although it's half of what we've got when we equalize. But the fact of the matter is that we had to do something to be able to distribute the work as evenly as possible and to continue to try to be able to get the work done.

We are also doing things like working with sort of a somewhat new concept, out stationing workers in hospitals and in nursing homes to try to deal with the long-term care backload. What, basically, it's an arrangement where the hospitals or the nursing home might purchase, as it were, a worker from us on a three year contract so that that person could be dedicated to work on the, for the clients that come through an individual facility. That's one way of keeping the caseload, you know, manageable and trying to assist the problem with the backload in long-term care.

We have also worked with community action staff to be able to, to try to mitigate against some of the problems that were caused when we had to close some of our offices. We were able to, for example, in the areas where offices were closed to contract with community action agencies so that they could not perform eligibility functions, but do application assistance, help people to get paperwork to us so that they wouldn't have to travel unnecessarily to offices.

We also put a lot of things into place where people didn't actually have to come to the office at all. Many of our applications can be done, you know, by the mail or in other mechanisms and we try to have staff do that as often as possible.

I heard this morning, the Program Review staff mention that the HSI paradigm shift, if you will, and note that they thought that they were going to look into how in the future that was going to assist with Medicaid determinations or improve that process. And I guess I need to say, I'm not sure that it's going to, because that system was designed for another purpose.

There is a great amount of fragmentation in the external social service system and the intent of HSI was to create a one stop social service opportunity for people to be able to reach service providers within the larger community. There was, certainly in the beginning, an emphasis on trying to see how they could help to prepare clients so that they could get to DSS and work more effectively with us.

But one of the things we found over the early implementation of this program is that probably 90% of the people who were working for CAP agencies are already involved with DSS, so I'm not looking for there to be a large impact on, through that particular program, or it's not really a program, it's really just a new way of CAPs doing business. I'm not looking for there to be an impact in that area.

I am going to be making a presentation to the managed, Medicaid Managed Care Council I think in November on this topic so we can explicate that a bit more at that time, but I did want to make that note here because it seems like people were going to have some false hope in that regard.

I do have a few other matters that I'd like to bring to the Committee's attention. There are some technical corrections and some issues in the report that we take, not exception to in a negative way, but that we, some clarifications that need to be arrived at and I was pleased to see the staff saying this morning that they were welcoming those kinds of issues and changes and getting that input from us and that's extremely helpful. In the long testimony, you'll see some of that laid out.

The Committee's document, there are a couple of other issues I would like to take up here in my testimony. One of those is the fact that the Committee's document states in several places that the percent of pending applications overdue is increasing and it may be because a fiscal year is used instead of a calendar year and I'm not really quite sure how we can reconcile this.

But our records are showing that over particularly the last four or five months, there has been a decrease, not an increase, and I think that perhaps the Committee might want to take a look at the distinctions there because we're showing over, you know, the last four months, we're doing a lot better faster. And I certainly want to take account of that.

Another important perspective from my way of thinking is illustrated by a snapshot. In July, 2004, DSS received 16,000 new Medicaid applications. Of these, 9,000 were HUSKY applications and at the end of July, 1,481 of those were classified as overdue. Of that number, 832 were long-term care cases. So if we remove those for a minute because there are many reasons why those, you know, I think some of that came out this morning, why those tend to be overdue, there were only 211 of those 9,000 cases which were HUSKY. And of that 211, 139 were attributed to third party delay. So there were, in effect, 72 unexcused cases out of that 9,000.

Now, I'm not quibbling about the fact that those 72 cases are extremely important, particularly if you were the individual who was one of those 72 cases.

When people don't get an eligibility determination in a timely manner, it makes a real difference in their life. They might not seek medical care because they are afraid to incur a bill that they can't pay. They might have anxiety and will have anxiety and all sorts of negative consequences when applications are late. I more than realize that.

But while I understand that anxiety and frustration, I do think that some perspective is possible. Of the 9,000 HUSKY aps, 72 were overdue. Now, the audience here perhaps, and those that may come to testify behind me, may be illustrative of another point I'd like to make.

Since the creation of the HUSKY Plan, or since it was combined, HUSKY A and B in 1988, 1998, DSS has partnered and supported a myriad of people in the community, human service providers who have been working with us and independently to try to improve this program.

We have funded outreach and application assistance providers. We work with the Covering Connecticut Kids and Families Coalition. We've worked with Supporting Families After Welfare Initiative through the Robert Woods Johnson Foundation. Our staff have worked alongside community advocates to address eligibility and enrollment issues.

The interest and involvement of the community in this program is a very important attribute of this program because HUSKY belongs to Connecticut. It's not just DSS. It belongs to everybody here and everybody out there receiving services and the kind of input that we get is valued and it's important.

But at the same time, it tends to shine a light on some of the you know, difficulties that can occur in the program, some of the bumps in the road, the cases that don't work out right are perhaps more likely to be highlighted. And even that is not a bad thing. But again, I would urge that the negative experiences that some people have had be viewed in proportion to the overall success of this program in serving hundreds of thousands of children, teens, pregnant women, parents and relative caregivers.

I am not the least bit hesitant to acknowledge that there are ways to improve. I hope somebody can give me some additional ways to improve this program. But I am not free to do other than live within the funds which you appropriate and the staffing levels which I'm given to work with.

When people talk about EMS and the inflexibility of that system, and you know, I'm one of the people, frankly, some of the time. You know, rarely do people talk about how well the system actually manages the eligibility processes or the cost that would be involved in replacing it.

Replacing the system would cost an estimate of somewhere between $30 million and $40 million and it could take a couple of years, frankly, to make the changes that would have to be made. I think it's probably took that long, although I wasn't with the agency when EMS came in. People, you know, you talk about the implementation of EMS and they pull their hair out.

I would also be concerned about the (inaudible) error rates would take a shoot to the high heavens because that's what has happened in other states when they've changed their eligibility system and that can cost money.

Someone raised this morning the issue of you know, why we would focus on accuracy instead of timeliness and I think some of the numbers I've given you would give you some idea of what some of the problems are. But when you think about the federal fines that, you say, I'm not talking about just like a slap on the hand or somebody writes you a nasty letter. Two million dollars is what we had to pay in food stamps or would have had to pay. They do give you opportunities to kind of work it off over time. You know, because our food stamp error rate is not what it should be and even though it dropped tremendously, the national error rate was dropping ahead of ours so we were still in a sanction mode.

And should that happen in Medicaid, fortunately we have never been above that 3% but it could cost tens of millions of dollars because of the way they extrapolate an error and the cost and the penalties involved. So it's very real. It's not about not wanting to deal with customer service.

It's about the realities of trying to manage a program given the kinds of regulations and given the kinds of problems and issues that are set upon us in some regards by the federal government in their attempt to get the most out of the dollars that they give us.

The report also mentions in reference to MIS, that some 90% federal reimbursement might be available for an eligibility system. But what they failed to mention is that only the Medicaid portion of that system would be reimbursable at 90%.

There is much less that might be available in federal reimbursement for portions of the system that support other assistance programs. This is an integrated system. It does eligibility for all of our programs and we have more than 90 of them.

So I am very interested in the outcome of the further review of the Program Review staff in areas that they mentioned that they're going to be looking into are things that I will be interested in reading and learning more about as well.

They may ultimately conclude as did the federal government when they came to visit us recently. You heard this morning that there was a complaint and the feds came out and you know, reviewed our processes and they may very well find that things are not nearly as bad as they were portrayed. In fact, I think the feds were impressed that we were doing as well as we are under the circumstances and they did not find what they had been told that they would find.

I'm also very interested in the public comments that will be offered this evening from individuals and families and folks that have been challenged by the operations of the Medicaid program. I view this forum for public comment and those that follow all across the state as being an important source of information because we need to hear and understand what people's experiences are with this program and how it is that we can work to improve the program's responsiveness.

That is why I am joined this afternoon by both of my Deputy Commissioners, Mike Starkowski and Claudette Beaulieu and also by my regional administrators, Frances Freer from the Southern Region and you guys can just raise a hand so people will know who you are there. Ron Roberts from the South Central Region was not able to be here today. Sylvana Flattery and some of her managers from the North Central Region are here. I'm also joined by Kevin Loveland, our Director of Assistance Programs and Rose Ciarcia, our Director of Managed Care and David Porella, our Medicaid Director.

They are here because they want and need to hear what is being said. These are very important areas of inquiry and I want you to be assured of our continued cooperation in this process.

I would also like for you to know that your staff's interaction with mine with over 3,000 pages of DSS documents have been supplied, field work accomplished, interviews conducted in central and regional office and I understand they made a trip to Boston to view our federal oversight agency.

I must say that they have been very thorough and professional and I certainly commend their efforts and appreciate the energy with which they, I wish I had that kind of time to put that energy into looking so it's useful to have the sort of document that channels us in the right direction.

I want to thank them for that work and I want to thank you for letting me have this opportunity to raise the issues I have in this matter. I will be happy to respond to any questions that you might have and my staff as well.

REP. WASSERMAN: Commissioner, thank you very much.

COMM. PATRICIA WILSON-COKER: You're very welcome.

REP. WASSERMAN: I'd like to say a lot but in the interest of time, and there are quite a few people here that we need to listen to.

I do want to say that I can't tell you how grateful I am that you have brought up things in response to the report which are very important and which, again, bring forth to me the importance of your agency and all the other agencies, and I mentioned this with Dr. Evans when he was here before, and the staff who is doing the analysis, working on the report, that there be collaboration between those major players. It's absolutely critical.

COMM. PATRICIA WILSON-COKER: Yes, it is.

REP. WASSERMAN: And it's not too late. You've brought up certain things and in context, they may be seen differently, but certainly they need to be looked at and I hope that your staff will be available. I know you're very busy yourself.

COMM. PATRICIA WILSON-COKER: We're all busy.

REP. WASSERMAN: I look forward to very hopefully a positive report and with your input as much as anybody else's.

COMM. PATRICIA WILSON-COKER: Certainly. Thank you.

REP. WASSERMAN: To me, that's always been critical. I've been on this Committee for 14 years and I think everybody is tired of hearing me say it, but it's the only way to get the best possible product in the end.

I do have one question, very quickly, before I open it up to the other legislators. This morning I brought up the issue sort of off the cuff. I've seen a lot of departments at work. I was trained as a microbiologist but I've worked as director of health for many years and I've seen departments in the larger institutions streamline, that's probably a dirty word, but it's one I have to use, with the use of computerization and any of the modern technological devices and you did mention that in here. I'm not acquainted with what you perhaps presently have in place.

Would you, do you yourself have some ideas about further use of technological advances that maybe we can talk about at some point.

COMM. PATRICIA WILSON-COKER: Yes. Well, in addition to what I've said about the EMS, you know, system, we certainly are looking into, in fact we've formed a group to look into on-line eligibility, eligibility on line application. But that will, might improve access. It won't improve the back, it won't help with some of the problems that are, you know, inherent that we're now dealing with.

But it certainly, as computers become more a factor in people's lives, it certainly is a direction which we're pleased to try to move in and I know that, I almost called you Lieutenant Harp, I don't know where that came from, but Senator Harp is interested in that area as well.

So that's something that we've talked about and something that we will continue to meet on, so that, certainly in that area of technology. And as we are able, we certainly are updating our system of e-mail, you know, availability and things of that, so wherever we can use additional technology, we certainly do. But the cost and the disruption factor are a very scary thing.

And when you think about what, you know, you might hear sometimes, it quoted that oh, it will cost $5 million or $6 million to replace it, you know, you have to look at what the computer system does and it's not a single purpose system. It covers all of the programs and I don't want to say it's state of the art because it's an old main frame inflexible system, but it's a workhorse and it does the job and we haven't got anything any better and we can't afford to buy anything else as far as I can tell.

So it's, it's a struggle, you know. But it does, it is inflexible. It certainly creates problems with notices. You can't change, you know, I mean, I don't want to be down on my only workhorse here, you know, but, you know, there's some issues with EMS but I don't know what there is out there that we can afford that can be replaced, you know, immediately, and which would give us the same benefit as that does right now.

So while we can vision for the future, we better vision a way to pay for it.

REP. WASSERMAN: Well, neither do I know. I haven't the slightest idea. We are joined by Representative Green as well and now I'll open it up to questions.

SEN. PRAGUE: Thank you. I have to leave so I appreciate your allowing me to ask my question first.

REP. WASSERMAN: Of all the input that we get you know that.

SEN. PRAGUE: Yes, I know.

REP. WASSERMAN: I've been fighting for this a long time.

SEN. PRAGUE: Thank you. Commissioner, I mean, your challenges are enormous.

COMM. PATRICIA WILSON-COKER: Yes, they are.

SEN. PRAGUE: I want to tell you something. I want to apologize to you for referring to the mess that you have in your agency, but you know, the layoff has created a mess in a lot of our state agencies and it's not the fault of the staff that's currently working. God knows they're doing yeoman's jobs trying to do the best they can with what they have to do.

But I do think that we have to seriously look at increased staffing for your agency particularly, because you suffered enormous amounts of layoff and I'm very happy that the Senate Chair of the Appropriations Committee is here and I, as the Senate Chair of the Subcommittee on Human Services certainly will recommend that we give you more people to do the enormous amount of work that has to be done.

So, again, I want to tell you that I really apologize for saying it's a mess, but state agencies are in a mess because they don't have enough help. When Governor Rowland, ex-Governor Rowland laid off 2,800 state employees, it was a disaster for people like yourself who are trying to fill the needs of the people of the State of Connecticut.

Having said that, I promise you that I will work to try and get you more staff. If we have the money to be able to do it, we need to do it because the people you have, I mean, it's incredible that they do what they do but they need to have more help to do the rest of the job that needs to be done.

COMM. PATRICIA WILSON-COKER: Thank you, Senator.

SEN. PRAGUE: You're welcome, Commissioner. Thank you for coming and spending all this time.

COMM. PATRICIA WILSON-COKER: You're very welcome.

REP. WASSERMAN: Senator Harp.

SEN. HARP: Good evening.

COMM. PATRICIA WILSON-COKER: Good evening.

SEN. HARP: I, I guess I'm wondering, because I know when I first came to the Legislature, I remember Mike Starkowski was the Deputy Commissioner then and David Parella and they met with us about this new system. This had to have been 12, almost 13 years ago and that's when EMS went on line. And it was a bumpy road at first, but I mean, if you look at DCS eligibility system, it's a bumpy road, too.

But now, as a person, a baby boomer who has sort of grown up with a typewriter that used finger power and seeing the way that technology has progressed, now it progressed almost, progresses, you know, like by the time you buy something in a computer store, it's already out of date. And we bought this thing 12 years ago. Something (inaudible) our desire to do this.

There have been 100 iterations of technology that have passed us by and I guess my question would be, how does the Department think about when it's time to make changes, and is there a process that you go through and what are the stumbling blocks that you incur as you do. Have you done that?

I mean, poor Mr. Loveland, he has come and talked to us many times, you know. We pass a bill in the spring. We see him in the winter and say, gee, have you implemented it yet, and you know, it's always no, because you pass these other bills and it takes us six months to program this dinosaur that we have somewhere. I'm afraid to even ask you where it is. It's got to be scary. It's got to be taking up a lot of space. (Laughter) Because that's what the old things did.

I'm just wondering what it would take, because I think we spent about $30,000 on the, $30 million on a dinosaur.

COMM. PATRICIA WILSON-COKER: Well, that's why I -

SEN. HARP: And if it's only going to cost $30 million to do it again, I -

COMM. PATRICIA WILSON-COKER: I am being very conservative, because I don't have an exact figure, so I'm like, it's in excess of $30 million. It's probably twice that, it could be twice that.

When you consider the consultant time that you would have to have, when you consider the conversion, the cost of conversion, when you consider the training and the off-line time you have to have for staff to be able to get on board. And it's not that I don't want another system, I do. I just don't have $50 million and I don't know of anybody else that does because if I did, I'd go begging.

So I mean, and plus, there are other systems within the Department, our MMIS system, the system that BRS uses. There are other systems where you know, getting into trouble with the feds because we are not able to do certain things or because some of our systems need to be replaced.

So it's not just, EMS is a monster, but there are other, got other monsters that we're having to deal with and I'm probably not qualified to talk much about this because I don't, you know, as Commissioner, I don't spend a lot of time on EMS. I suspect if I did, I wouldn't be much help, I could do. It's amazing to me the work that people, the work arounds with the inflexibility and the kinds of things. I mean, I appreciate your frustration.

I'm not sure, probably Kevin is probably as close to an EMS expert as I've got back here that might have some, might be able to shed some light on some of the questions you're having. But we do look at these things.

I can also say that there are people from other states that you know, look at EMS and think we've got something pretty good compared to what they have. Believe it or not, even after, even though it's older, it is still one of the, I am told, one of the better systems in the country. So it's, I don't quite know how to respond to your question and if there's one of my trusty staff who can do a better job, please step up here and help me out.

But I mean, it's, you know, it's a monolithic, it would take a monolithic effort and a huge amount of money and yes, change will have to come at some point. But I'm just fearful of, not fearful of planning for the future or looking toward the future, but cognizant of what will happen to our service during the year or two period that we, even if we had the money, and if manna fell from Heaven and I had $50 million, it would still be two years, probably, before it is a minimum, two to five years probably, before we would be able to make that change and the disruption that would cause now, you'd be commissioning another study to find out why we were doing so badly.

But Kevin has stepped up here so he may have a few comments he'd like to make.

KEVIN LOVELAND: Well, I don't want to, I'm not a -

COMM. PATRICIA WILSON-COKER: Identify yourself for the record, Sir.

KEVIN LOVELAND: My name is Kevin Loveland. I'm the Director of Assistance Programs for DSS. I'm not an IT person but I am the person that works with them to try to get changes, as Senator Harp mentioned, program defined and put into the system.

We've been, actually started looking around. You know, we've looked at a few other examples of systems that have been implemented recently. In particularly Maine recently implemented a system called ACES that is very nice but even though it's brand new, state-of-the-art, it doesn't have the same level of functionality as our eligibility management system has. It doesn't perform some of the functions that EMS does. It cost us $25 million to implement the system.

Some of that cost isn't just the system development. You have to buy all new hardware and usually when you bring in new systems, they are server based systems so you have to buy the servers instead of the main frame. And, but it's a very nice, it looks nice.

But then we look at Maine. They have one of the highest error rates in the food stamp program in the country as a result of going through this implementation of the new system. They are not able to, they were being sanctioned the last I knew for not doing their data reporting for TANF.

So, and they had all kinds of problems, believe it or not, with their notices, that they had notices coming out that were 50 pages long and they had to rewrite most of, or reprogram most of the notice components of the system.

So, as the Commissioner indicated, this is something

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in this area. EMS is, was originally, the contract was signed in '86, I think, and it was fully implemented in late 1989. It's at least a three year, well, these days it might be a little shorter, maybe two to three years development effort, but we're probably, maybe it is time, as you mentioned where the cost of maintaining the current system may be greater, or maybe getting to the point where we need to look, and we are starting to look in that direction.

SEN. HARP: Thank you. Do we need to encourage you a little bit to do some looking? Do you need some resources?

COMM. PATRICIA WILSON-COKER: (Inaudible) Absolutely.

SEN. HARP: To me, I'm just wondering if in fact some of the hardware can come out of capital projects. Why does it have to come out of the operating budget? It should come out of capital if you're going to keep it for 15 years, for crying out loud. It seems to me like that would, and not that we haven't overspent the capital side over the past few years while we've diminished the operating, but the reality is, there have at least been more dollars, we're used to spending more money on that side than we are on others. I mean, that was just one thought.

The other question that I have regarding, and one of the things that sort of came out at me and I don't want to criticize the Department because I know that you've been under stress, but the tracking system differences between offices, how difficult would it be to implement the best practices in all of the district offices?

COMM. PATRICIA WILSON-COKER: Extremely difficult. The tracking system that you're -

SEN. HARP: Why?

COMM. PATRICIA WILSON-COKER: Because it's labor intensive. There's no system support for it, so you're talking about people who need to be processing those cases, making, you know, checks on a piece of paper to try to figure out, you know, how it's going.

The only place that I'm directly aware of where there was some tracking in place is in the New Haven office and I believe that that was, it was a stop gap measure so that we could manage the sudden influx of cases that you know, because I think it was mentioned earlier today when the sub-offices were closed, everything went to New Haven and then subsequently things were moved from New Haven to Meriden, from Meriden to Middletown. Sorry.

And in that process, there was a lot of, you know, you couldn't, it was, for a couple of weeks there it was pretty tough if someone called in, the multiple changes were a real problem so a system was developed to, a hand run system was developed to be able to simply keep track of those cases so when someone called in you'd be able to manage. But it wasn't, it was a very labor intensive effort and still is. And I just don't have the staffing to do it.

There may be, is there some tracking possibility in EMS?

KEVIN LOVELAND: Well, I wanted to comment. I actually wanted to discuss that part of the report with the Committee staff because EMS does track applications once you put them into EMS and my understanding was the problem in New Haven was they weren't able to get them screened into EMS quickly enough so that they built this, you know, stop gap system to keep track so if clients called and said, wanted to confirm we had their application, that they'd be able to look it up.

But EMS is really, in most offices, those applications are entered in within a day or so of when they're received in the office and then it's right there for you to find and see. They're tracked in the EMS system. So I think that's perhaps unique to something in your neighborhood, Senator.

SEN. HARP: Thank you.

REP. WASSERMAN: Yes, Representative Green.

REP. GREEN: Thank you. Good afternoon.

COMM. PATRICIA WILSON-COKER: Good afternoon, Sir.

REP. GREEN: I just guess I'm trying to get clear on the, this difference in whether or not you could take advantage of a federal match, a federal reimbursement. You indicated that the report mentioned that there was availability of 90% federal reimbursement and you sort of disagree with that.

COMM. PATRICIA WILSON-COKER: Well now, I really didn't disagree. I said that that 90% is only available for the Medicaid, for those portions of a system which would directly relate to Medicaid and a system like EMS that is, has, that integrates multiple programs I thought that it was misleading in the report because it seemed to suggest that we could get 90, we get 90 cents on the dollar for the whole thing and that's not true. You could only get 90 cents on the dollar for those portions that related to Medicaid and I believe it would be what, 50%?

Fifty percent for foods stamps, in other words, different amounts. So it's just a little misleading because it seems like that's a lot, you know, and that's just not the case.

REP. GREEN: I think, you know, for someone who's just not really versed in a lot of these issues, I have to say they're very complicated. I guess a report would be helpful to me that talks about the different rates for different kind of programming so that when I hear somebody say well, they can get 90% reimbursement, I want to know exactly. And when you say you really can't, I just want to be able to say, what you can and cannot get it for.

I think doing a report that would be helpful so that we as legislators are clear when they talk about you know, whether or not they can or cannot get reimbursement.

Of course you mentioned that some programs you get no reimbursement, so again, I don't want to think that a program could get reimbursed and it can't.

COMM. PATRICIA WILSON-COKER: I think that that's one of the things that we will be taking up with the Committee and I think that some of our comments, you know, attached to the long version of my testimony do address that and certainly if there's a way that we could help to clarify that, I think it's sometimes, it's, you know, the program is so complicated that it's easy to, you know, make an error or not fully understand an aspect of that. So I think the final report will probably address that.

REP. WASSERMAN: Senator Harp has a question.

SEN. HARP: I guess one of the fundamental things that we would have to accept about the Eligibility system is that all of those programs should be linked. You said you had 90 different types of eligibility that are linked into one program which is mammoth.

COMM. PATRICIA WILSON-COKER: No. There are 90 different programs. They're not all, you know, the Department runs at least 90 different programs but they're not all linked in any meaningful way. I mean, some of them are.

SEN. HARP: But are they, the eligibility is determined through, going through various screens in EMS, right? And so my question would be, is it necessary to have all of those 90 links?

One of the things that I thought federal law was trying to do with Medicaid was de-link Medicaid from TANF and come up with a program. So, what if, and I think there's a way to do it, because I think you guys even tried to explain to computer illiterate me when we met not too long ago that there's a way to, if you wanted just to be able to compare data and utilize data into another system. I think in never-never land of all of these, there's a way to upload information from one program into another program and what if we had a system where we just de-linked Medicaid and kept EMS doing other real complicated stuff and came up with a way to, if we wanted to see whether or not a person qualified for Medicaid and therefore would then qualify perhaps with some of these other programs if we asked other questions.

That you could upload it into this other system and then ask the other questions if the people were interested in these other programs. But what about the poor guy, and I've had constituents like this that only want one program, that by the way, you know, one of the things that I don't believe was even mentioned in the report, maybe it was, we have so many programs and so many details that the workers can't keep track of it all. The human mind can't keep track of it.

COMM. PATRICIA WILSON-COKER: And that's, yeah.

SEN. HARP: It's huge. And even in Medicaid, because there are some programs that we forgot we even enacted. We didn't forget but your workers forgot and we (inaudible), but anyhow. What if we totally de-linked Medicaid from your other eligibility and came up with some kind of way to link it into your current eligibility. Is that possible?

COMM. PATRICIA WILSON-COKER: I certainly will let Kevin respond to that, but one thing that I do want to say is that part of the you know, it's like in some areas something that's a plus is also a minus.

My understanding of one of the reasons that all of our programs, you know, that when you apply for one program we assess whether or not you're eligible for anything else was because of legal actions. You know, someone mentioned today we're being sued by, you know, I have 11 different suits and you know, I can probably add a few more.

But, you know, one of the, this came out of sort of a legal services action, my understanding is, and that's one of the reasons we got notices that were 40 pages long is because of, you know, of an issue that in trying to accommodate one need, which is to, you know, why should a person have to know what these 90 programs are and apply for each one, you know. Why not have, as we have, something that would help you understand what you might be eligible for and pull information. That's a plus, but it can also be a minus.

And I don't know, Kevin, you might want to add something.

KEVIN LOVELAND: Well, my comment would be that you know, I respectfully disagree, Senator. I don't, people come to us to apply for whatever benefits we offer. And what we have is a uniform intake process that they go through. We capture the data. So a common situation is a family that comes to us and wants cash assistance, they want food stamps and they want HUSKY.

And we only, we only have to answer, a lot of the questions that we have to ask that need to get answered for those programs are the same ones for those three programs. So we ask that information once. It goes into the computer once and then there are additional questions for each of those programs, that, you know, in addition to those that are in common.

It does, and then there's one application form created that the computer will print out at the end, you know, for all those programs. So I think in the way we do business, it is effective to have, be able to serve people in that way, to in a way simplify the process for them.

It's for the person who only applies for one program, yes, you know, it seems as though it would make more sense to have just a separate process, but we really, it does have to be integrated. The de-linking of cash for Medicaid means that the fact that you're eligible for cash doesn't automatically mean that you're eligible for Medicaid. That's what we got with the, you know, with the Welfare Reform Bill and now we have different criteria now for those two programs, so it's not directly related to a system. I mean, it's still connected in our system. It's one of the ones in the cue. Almost done, actually. It's in the works of being programmed at last, but -

SEN. HARP: How long has it been?

KEVIN LOVELAND: Eight years. But, well, it passed in '96, so October, '96, but we're getting close to having that done. It hasn't had a major impact because our TANF, or our TFA program and our HUSKY family program are almost exactly the same. It hasn't had a real negative impact on families per se.

SEN. HARP: Okay. I just wanted, and I'm just trying to remember this. We had a call today and this just gives you an indication of the inflexibility. We had a family where the father wasn't working. Then the father was working. He sent in different applications. The machine spit out two different things, both of which were wrong and the worker, when we called the worker, the worker basically said well, we're going to go with this last wrong thing because it's more right than the other one and I can't correct it and help the family.

I mean, there's something wrong with that. And so, don't get after Mr. Roberts. He's not here. I'm not saying that, I'm just saying that it sort of shows what happens when you have inflexibility. And I don't want to hear a year from now that my client got some services that her family was not entitled to because of the inflexibility in the machine and the worker's inability to work around it.

So I just think that the technologies that are, and we can do better and it may take us five years. But it's taken us what, almost eight years to implement this new federal policy. So five years is not a long time in that sense.

REP. WASSERMAN: Well, Commissioner, thank you so much for giving us and your colleagues, your staff, all this time. It will pay off.

COMM. PATRICIA WILSON-COKER: I hope so. May I add just one comment, though, because there was something that came up this morning that bothered me a great deal and I just want to clarify it.

One of the questions that was asked by one of the members this morning at the briefing had to do with our fair hearings and the suggestion that I took from it was that we might, the thought that we might be closing cases in order to speed up our time line somehow and that we might be having, you know, that, if we looked at our fair hearings we might see that we were somehow, and I actually had someone run some numbers and take a look because I didn't think that that was the case but I wanted to, for the record, state that it most certainly is not.

That not only, I think, the figures that I have suggest that 80% of our Medicaid applications are granted, about 19.5% aren't. But our fair hearing requests before the layoffs and now, in terms of the number of cases that are actually filed and the number which, for the appellant or you know, for the Department, is not substantially different.

Now, it's true that there have been more fair hearing requests based on the timeliness issue but it is also true that more of those have been resolved prior to the hearing. In other words, someone may have, may have been overdue and someone may have requested a fair hearing but that was corrected prior to the time that the fair hearing exists.

But I hesitate to, you know, pull up my time here but I simply could not just let that go because we don't do that.

REP. WASSERMAN: I understand. It will be passed on.

COMM. PATRICIA WILSON-COKER: Thank you. I appreciate your time and concern as well. Thank you.

REP. WASSERMAN: And thank you again for coming and staying. And with this, the part of the hearing for officials is closed and we will open it up after two minutes and Senator Harp will hold the public hearing.

SEN. HARP: For some reason, September is one of those chatty months and it's really good to see everybody again because we've been away during the summer and haven't had an opportunity to meet. And so, just because you've all been so patient, I believe our three minutes is up and we're going to start with Belinda May. Good evening.

BELINDA MAY: Good evening, Senator Harp. Members of the Committee, I guess that's you at this point, right? (Laughter) My name is Belinda May. I'm the Vice-President of AFSCME Local 714 representing the Eligibility Workers at the Department of Social Services. I am also an Eligibility Services Supervisor with the Department of Social Services with 28 plus years of service.

I want to thank the Committee for allowing me to speak today and I want to thank in particular, Kathryn Conlon and Brian Biesel for the tremendous time and effort spent on the report to this Committee. Their report is very accurate and detailed, however misleading in some areas. I would like to try to clear up some of these details.

The report reflects an average caseload of 400 per worker. This is not an accurate picture statewide. The caseloads for many of my staff average approximately 1,200 for Medicaid food stamp workers and around 500 for eligibility specialists that process the TFA cases. Not every eligibility worker has a caseload and I believe that this is a factor that has influenced the numbers.

Even if the number were 400, the actual number of cases would be double that due to the related case factor. I have sample caseloads here (inaudible) available to the Committee.

The reports also indicate that the workers have Wednesday and Thursday afternoons to process cases, but the report does not reflect the fact that staff answer the phone and return calls as well. We have a phone system that allows the caller to zero out to an attendant rather than leaving a voice mail message. The workers are the attendants. The volume of calls is so high that it takes two, three and sometimes four days to get back to a client.

The problem is simple. DSS is grossly understaffed. Last year under the Rowland administration, more than 200 DSS staff positions were cut from the budget. These positions were not eliminated due to lack of work. The waiting lines are so long at the Hartford office that we are closing the application process down at 8:45 in the morning. We open at 8:30.

The staff shortage is harmful to our most vulnerable citizens, our poor and our working poor. DSS has an amazing, well-trained group of people working hard to achieve an impossible task. It is not that we cannot do the job. We cannot do the job with the resources we have been given. Please re-staff DSS so that we can do the job we were hired to do.

And I would like to take one final minute to thank our Commissioner for giving the praise due to the workers that are out in the field. Thank you, Commissioner Coker.

SEN. HARP: Thank you. I was going to say, are there any questions, but I'm the only one here. Does staff have questions? If not, thank you so much.

BELINDA MAY: Thank you, Senator Harp. Keith Gatling.

KEITH GATLING: Good evening, Senator Harp. You're the Committee, so I'd like to thank you for holding this Committee today. I want to thank the individuals that put together the report that we heard this morning.

I came prepared with a speech, you know, but someone told me it's good to swing from the hip, and I'm going to swing from the hip.

As I said, Commissioner Coker relayed the sentiments of how greatly staff are needed for our agency. I don't have to push that. I'll say this. I've been privileged to speak before a number of Committees at the LOB the last couple of years, unfortunately, due to layoffs.

I'm not surprised we're here today talking about the time limits that are not being met to grant Medicaid cases and unfortunately, I wish that was the case that all we had to worry about at DSS was Medicaid cases. But unfortunately, that's not the case. TANF, food stamps, and other programs that have a wide range of federal regulations that have to be mandated and upheld.

The burden is large. It's overwhelming and I think that word was used here today and that's just putting it mildly. And so, it's really bad for our employees. The sad part about this is that it's affecting the most vulnerable citizens in this state.

I'm reiterating a message that I've stated a year and a half ago when I spoke before the Appropriations Committee about, that we have to think about eliminating the staff at DSS because by eliminating that staff, you were going to put a greater burden on our society, the most vulnerable people in our society.

And just a witness that, or to believe that all you that to do is attend the Hartford office any morning during the week and a lot of those people are being turned away. And we're talking about the elderly. We're talking about children and we're talking about medical benefits.

A lot of us in this room, I'm sure, if a problem develops, we have a doctor that we can attend to and our medical need will be met. And the Commissioner mentioned that there are thousands that we help each year and that's great. But there are thousands that we're turning away every day.

And it's hard for me to believe that we're only here tonight because of 72 cases of overdues. So I'm going to reiterate what I've said all along. This is a staffing issue and I know that equates to money. This is about money. And it would be great to have a computer system that you know what, that you could walk out to the curb and take the applications but we don't have that. We need bodies and even with a great computer system we're still going to need bodies.

We have the CAP agencies helping but still and all with Medicaid, it still has to meet the people that I represent. I've personally been to every DSS office in this state and it's across the board, it's ridiculous what they're dealing with. It's not even reasonable.

The question is, and I learned this as a child when my mother taught me this. If you're going to take on a task, do it right or don't do it at all.

We've tried, you name it, we've tried it at DSS. I've been at DSS for 14 years, and by the way, I think I forgot to tell everyone who I am. My name is Keith Gatling and you mentioned that Ms. Harp. I've been with the agency for 14 years as a lead investigator. I'm the President of Local 714. That was my vice-president who just a while ago quickly came up and related a numbers message, a caseload.

And we talked about a lot of figures today and it's overwhelming. I don't know about for you guys, but it is for me, you know. Just to think that someone's sitting at a desk with a caseload of 1,200 you know. I know in that report they mentioned a number of 400. We differ with that. We've gone back and forth with the Commissioner's office about that number. And I don't look at it as 1,200 cases. I look at it as 1,200 individuals.

And that's actually what it is.

My field is human services. I deal in human lives. I don't deal in numbers. So, I'm here for my staff and I'm here for those people that are going to be in that line tomorrow morning and they're going to get turned away.

It is my hope that from this, that a wrong is made right. The Rowland administration saw fit to make cuts that did not benefit this state. It greatly hurt this state and I'm looking for the people in leadership in this state to do the right thing.

We've tried over the years, expedited redeterminations. We've talked with generalists, specialists, all kinds of things, gimmicks, to try to make these caseloads work.

My question to this Committee is, when are we going to do the right thing? And I know that equates to money, and I thank you for your time and have a good evening.

SEN. HARP: Mr. Gatling, I was just wondering, one of the things that comes up, so your number is about 1,200 per worker. Before there were layoffs, what was the number, was your number?

KEITH GATLING: My number?

SEN. HARP: Or your union's number.

KEITH GATILNG: My union's number. Well, I have to ask Belinda because I know she's a supervisor and she supervises the caseload. I know, and with that number of 1,200, if we're going to get into particulars, we're talking about, we have a system here of primary cases and related cases.

Primary cases in the Hartford office right now, that's about 840, in that range primary. That's an individual coming in and applying. That other 500 cases are related cases that relate to an individual. It could be they come in for Medicaid and food stamps and TANF and so on.

It was lower, because we had more staff. The exact number I don't know, I don't have it off the top of my head right now, but -

BELINDA MAY: It was lower.

KEITH GATLING: It was lower. It was lower. But I tell you this, even when it was lower, there's still, there still was a need in our agency, so it just made it worse when we got rid of, you know, 25% of the people that I represent.

I could tell you this, 1,200 is just ridiculous, you know. We talked about here today with the phone calls. Just the example that the Commissioner cited, you know. The phone calls alone, 11 people and there were 5,000 phone calls today in Bridgeport, you know. And in the street, we're all around here, we're talking about these things and I'm not a politician. Talk is cheap and I truly care about the people that I service out there in that community.

And I tell you this. If we don't do something about this, it's going to continue. I made this statement two years ago and I'm not a prophet. We lost 64,000 jobs in this state over the last four years. It wasn't a brainstorm that DSS was going to be affected. People are out of jobs. They don't have medical benefits. They're going to come to DSS. You cut our staffing, they're going to be backlogged.

Some of this stuff is, you know, we get caught up in areas that as one of the Representatives here has cited to me that instead of dealing with the root of the issue, we get caught up in the leaves. And that's where we are it seems, all up in the leaves of this issue and the root of it is that we have people in need and we're not helping them.

And I want to know when I leave here today, when I put my head on my pillow tonight, at least I know I spoke for the people with the greatest need in this state and that's the ones we're hurting by not staffing these agencies and getting them the medical benefits. We're talking about Medicaid, medical benefits. So.

SEN. HARP: Well, I guess my question was, more from, if we think 498 is bad and you're saying it's 1,200 were we probably bad before and now we're just, as you say -

KEITH GATLING: We're worse.

SEN. HARP: As they say on the street, worser still.

KEITH GATLING: Worse. And you know what? If it was 498 truly, you know, we may have some breathing room. But we don't even have that. So it's a problem. You know, I guess I'm happy I'm not the one that has to make that decision because when you mentioned $30 million earlier, I could never put only behind $30 million. And so I know it's a problem.

But I'm here, like I said, asking for those. It's easy for me, because it's easy to ask for someone else who's in need. I think I'm, like I said, we come in this building and it's a beautiful building, but the people we service, they don't have these things and I think if you really want to get a true feeling of the need out there, go to these offices, talk to the front line staff. Go in the morning, if you don't even want to stop, drive by and look. Just look. You don't have to, our Hartford office, 3580 Main Street. It's not that far and those are the people I think we are here to serve.

SEN. HARP: Thank you very much.

KEITH GATLING: Thank you.

SEN. HARP: Further questions? Marilyn Ricci.

MARILYN RICCI: Hello. Marilyn Ricci from Canton, Connecticut. Board of Directors of NAMI, Connecticut the National Alliance of Mentally Ill.

I am testifying today as a person with a family member with serious mental illness and as the past president of the Board of Directors of the National Alliance for the Mentally Ill of Connecticut. It's 3,000 members, people in recovery from mental illness, their families and friends.

People of all ages with disabilities of all kinds have lived in the state funded elderly housing since 1961 when the state recognized, in addition to the need for subsidized housing for people over 65, that people with major disabilities also needed help.

The fundamental problem our state faces is the lack of affordable housing. The solution is to expand housing options. Limiting housing opportunities for any group at any age should not be an option. Legislation was introduced last year to expand rental assistance and supportive services targeted to non-elderly disabled persons on housing authority waiting lists or already living in elderly disabled housing.

This would provide choices which essentially do not exist now. Most of the younger disabled persons in state subsidized housing have incomes at less than 60% of the federal poverty level and cannot afford any market rate housing anywhere in this state.

Housing authorities should also develop relationships with the local mental health authorities in their areas who serve people with serious mental illness.

The state has also funded resident service providers in some housing authorities to assist residents who need services. This needs to be expanded. By promoting access to services for all residents, and mutual understanding, we can make state supported housing a pleasant living environment for everyone. Thank you.

SEN. HARP: Thank you. Questions? Thank you. Lisa Sementilli.

LISA SEMENTILLI: Good afternoon. I'm Lisa Sementilli with Advocates for Connecticut's Children and Youth, Connecticut Voices for Children and the Covering Kids and Families Coalition. We focus on eligibility and enrollment in HUSKY so we were able to discuss a lot of the issues in the report at our meeting in June but Committee staff were there at the meeting and a lot of what was discussed was also echoed in trainings that we've had, collaboratively with DSS in 22 towns across Connecticut and both community outreach partners from private agencies and DSS staff attended those.

We found pretty much the same things, I think, as the Committee staff found in their report, but we wanted to take the opportunity to give you a better sense of the impact of eligibility on Connecticut's families.

I think all of us are approaching this and welcoming the study as an opportunity to improve eligibility for families and to help DSS get the resources that we need. So I hope that the Committee process will be viewed in that light and that DSS will also see this as an opportunity to improve on their resources.

The only thing I would say is that I think you've seen today, the commitment of DSS staff by their presence here and their attention to the details of their report and their cooperation with the Committee staff. Unfortunately, I don't think there's as much attention on the part of the Legislature. So I hope that we can do a better job of educating your colleagues about some of the problems.

First, I just wanted to comment on staffing issues. I know there's been a lot of debate about the overdue applications and I don't think there's any question that in general, overdue applications have risen since the layoffs.

One thing you might not know, though, is that with the state layoffs we also lost a centralized processing unit at DSS which insured that newborns got HUSKY and that children moving from HUSKY A to HUSKY B or vice-versa were transferred. Now, workers just don't have time to refer families who are over-income from HUSKY A to HUSKY B.

And let me share with you just one story about a newborn. This summer a Willimantic mother called an outreach worker for help because she had applied for HUSKY three months earlier for her newborn. The baby's application had been denied because the mother didn't have the birth certificate and the social security number at the time of the original application. The mother tried to call her worker many times but didn't get a call back. We hear that a lot.

The outreach worker finally reached the DSS worker who said that the mother would need to reapply. The newborn was sick and needed to go to the doctor but was uninsured for over three months.

The next thing I wanted to talk about a little bit was the whole technology EMS issue. Because EMS has not been updated, many cases require manual corrections and I know that you spent a lot of time talking with the Department about the price tag for upgrading, etc. But I just want to point out again, what I hope is obvious, that we may not know exactly what the price tag would be to upgrade that system and I think there are good people who work for DSS who could develop that.

But we also don't know what the price tag is for the monster that we have now. We don't know how much time staff are spending and how much money we're spending paying them to do the manual corrections and how many families are cycling on and off because of the corrections or the inadequacies in the system. So I just caution as we look at price tags, we look at not only what we're spending on technology now but on staff time because the manual corrections are inefficient and they mean that people go without coverage.

Workers shouldn't have to memorize federal rules and families shouldn't lose health insurance because we can't update our computer programs.

Here's an example. Eighteen year olds are routinely cut off because workers don't have time to make the corrections to keep them on. DSS's own report showed that hundreds of eighteen year olds lost coverage when we eliminated continuous eligibility.

In August, a West Haven father called an outreach worker because his 18 year old son was cut off of HUSKY. The young man, the 18 year old was diabetic and needed insulin. He was in school full-time and otherwise eligible but the computer cut him off. The worker told the father that he had to reapply and start all over again.

So again, I don't know how you want to cost, you know, this out, but there are, there's a big impact you know, in the families that are covered by the system as well.

I know you talked about the on-line application and I hope that DSS will continue to work with the Committee and we stand ready to help the Committee in doing any further research on the cost and implementation of that.

Another point that I wanted to make is that on-line systems and technology are not a panacea. Paper applications, face-to-face outreach and telephone hotlines are needed for lots of families. The lack of our community outreach and the defunding of programs like Healthy Start have limited our ability to enroll eligible families in HUSKY. Our policy choices have limited HUSKY enrollment at the same time that employer sponsored insurance is less likely to be offered. Children are cycling on and off of HUSKY driving up administrative costs.

I wanted to make a point about continuous eligibility and the choice that we made to eliminate that because we thought it would be cheaper and that we would save money. Low income families cycle on and off of HUSKY more often because of changing incomes. Churning drives up the cost of running the program and undermines efforts to provide care.

Research shows that 12 months of continuous eligibility can actually lower our administrative costs and so reinstating it could save us between 2% and 12% of our administrative costs. Continuous eligibility kept more children enrolled in HUSKY. In fact, between 2001 and 2003, an average of over 6,500 children per month would have otherwise lost coverage.

A point about presumptive eligibility for pregnant women and children. Presumptive eligibility is like same day voting, same day registration for voting. Families can enroll when they need immediate medical attention.

I think this is the last story so I'm going to tell you this one because it's near and dear to my heart. A Norwalk woman called an outreach worker in May because she was six months' pregnant and had no insurance. She applied four months earlier but had been denied because she didn't give a doctor's note proving the pregnancy at the time of the application and before the deadline, the cutoff for that.

She had no insurance and she couldn't afford another prenatal visit to get the doctor's note from the doctor. After that, the woman left several messages for her DSS worker, didn't get a call back again. The outreach worker called the DSS supervisor later and the woman did get HUSKY ultimately but she had to cancel several prenatal visits and wait seven months, seven months for prenatal care because she didn't have cash and she couldn't get through to her worker.

And I tell that story not to bang DSS over the head or say why aren't they calling back. They're not calling back because they have caseloads of 1,200 people and it's a matter of where the squeaky wheel is. And we heard that over and over again in the trainings that we conducted with DSS for DSS workers and for outreach workers.

So, last I just want to say that I support the Committee process, that Covering Kids stands ready to help DSS and you all to help improve the program. And I think by improving eligibility we can send a message to families that their care is important. Thank you.

SEN. HARP: Thank you. Are there questions? If not, thank you very much. Our next speaker is Sal Luciano.

SAL LUCIANO: Hello. My name is Sal Luciano. I'm the

Executive Director for AFSCME Council 4 representing many of the both clerical members and eligibility members at DSS.

I'm not going to go on and on about the limited staff. You already heard that. I'm actually here to say that I think the problem is going to get worse in about a week.

The Legislature passed the Universal Engagement piece and for many of, I think, our clients and our staff it's better called Universal Enragement or Universal Estrangement and as far as public policy goes it probably should best be called Universal Derangement.

In order to get, in order to get TANF, a person must get engaged with, have a job assessment and those kinds of things and it seems to make sense up front. But if the family in need of the services misses an appointment for whatever reason, transportation difficulties, sick child or whatever, they have to start from square one. They have to again verify their income. This is on top of all of the other frustrations you just heard.

And so if, if the goal here is to frustrate people who need these services so that they have to try to survive by prostitution, theft, crime and other ways, it clearly is going to meet its goal because it is not going to provide timely help for these people in need.

And you already heard about the staff shortages. Here we go back again. You're starting the process. These people have to jump through five and six hoops to get through that. They miss a hoop, they've got to go back to hoop number one. It's senseless and I would hope that we look at this as it's supposed to take effect October 1^st.

SEN. HARP: Thank you very much. Are there questions? Thank you. Yeah, there is a question. Sorry, Mr. Luciano. Representative Green.

REP. GREEN: I'm sorry. You know, I'm constantly talking to the various departments about whether or not statute makes them do something or their interpretation of those statutes and their regulations that they then develop, make them do something.

You miss an appointment and you go back to step one. Is that because of the statute and we say you have to do it that way or is that something that the Department has some flexibility on doing or saying. Well, we have some information and if you miss an appointment, maybe we can stop one day. Is that something that they have to do or is there some flexibility here?

SAL LUCIANO: I would hope there's some flexibility. I don't know the answer. I do know that whether it's in statute, the interpretation is, for whatever reason, if they miss that job assessment ability, it's automatic that the money stops and they start from square one.

Now, I'm hoping that there is flexibility and if not, then the Legislature will look at changing that.

REP. GREEN: I still would be interested to know if someone from the Department might be able to respond to that.

SAL LUCIANO: The Commissioner is here. There's other people here that I'm sure can answer that question.

REP. GREEN: I just, you know, I just want to know if there's some flexibility in that.

SEN. HARP: Mr. Loveland.

KEVIN LOVELAND: This Universal, well actually often referred to as early engagement requirement is in statute. It was passed in the last session. It does require that a TANF, a time limited mandatory employment TANF client, but before they can get benefits they have to show up for the scheduled appointment at the one stop center to have their initial assessment done.

It does provide that we can delay the processing of the application if we don't get that schedule within a certain time frame.

The issue of, I think it's been mischaracterized a little bit, the issue of the automatic denial if somebody doesn't show up. There is, if somebody doesn't show up and calls the worker with a good reason as to why, you know, whether a sick child, an appointment, that type of thing, their application is not going to get denied.

But our experience in the TANF, in the temporary family assistance program is, we experience about a 50% no show rate at the one stop center, under our current system. So this was a change that was made to put incentives, you might say, to get clients to appear and actually to be consistent with what most other states are doing.

Most other states require most, something like, you know, three-quarters of the states in this country require somebody applying for TANF benefits to participate in some type of work activity. In our case, it's just appearing for the initial assessment at the one stop center before they're given benefits. So this was a policy that was, a statute that was enacted last session to try to address that issue.

REP. GREEN: Let me try to understand what

GAP FROM SIDE A TO SIDE B

that need to be attended by this person. Is there more than one appointment that needs to be attended to by this person? Yes, or no?

KEVIN LOVELAND: There is an appointment at DSS -

REP. GREEN: Is there more than one appointment?

KEVIN LOVELAND: And then they have to attend the appointment at the one stop center.

REP. GREEN: Only two appointments?

KEVIN LOVELAND: Two appointments. And if they miss that appointment at the one stop center and call their worker with a good reason they'll be scheduled for another appointment at the one stop center and their application will not be denied.

REP. GREEN: Okay. And the information that is then needed to sort of review or to have the process continue does not start again. They can use that same information.

KEVIN LOVELAND: That's correct. And actually, we -

REP. GREEN: Yes, or no, do they have to go back and now reevaluate all the initial information that was then gathered, say if they miss the second appointment.

KEVIN LOVELAND: If they miss that appointment and have their application denied, they do have to reply but they do not have to attend an interview. We wrote our policy so all they have to do is either mail in a new application form, or typically, they will come to the office and be screened and do a short form application form to re-establish the re-application.

We use the information we had in the previous interview. They don't have to come back for that one and a half, two hour interview that was referred to earlier in the Commissioner's testimony. Those are the time limited TANF interviews that typically take an hour and a half to two hours. They do not have to repeat that process.

REP. GREEN: Okay. Thank you.

SEN. HARP: Can I ask you a question, though, and I know that you're probably going to add some things, but what happens to the other 90 eligibility issues that, or the other 89, I guess. Do you stop those, too, or do you go ahead and process everything. Does the computer, I'm just, I mean, not that I want to be fixed on the computer, but what happens to all that information that you have on the client if they don't go to that appointment?

KEVIN LOVELAND: The denial, only, that whole process only applies to TANF. It doesn't apply to food stamps or Medicaid. Those applications move forward you know, assuming we have what we need, they're approved. So this process we're speaking about is only, and it's only for the time limited, you know, mandatory employment.

Deputy Commissioner Beaulieu just reminded me that the other reason we enacted this change is it's in the TANF reauthorization bills, is a universal engagement requirement that requires that, no, these haven't passed Congress yet but they're in both the Senate, House and Senate versions that every TANF client have that initial plan done within 60 days. So that was the other reason we made this change, was in anticipation of the change in federal law that we saw coming down the pike.

SEN. HARP: So, I'm a little bit confused between what you're saying and what Mr. Luciano is saying. Have people received any cash benefits before they've gone to this plan or is it after the plan is approved. How does that work? And then I guess the thought that I wonder is, say they don't show up, they can come back and mail in an application and be approved? I mean, that's kind of what I thought you said. Did you say that?

KEVIN LOVELAND: All right, let me. They don't receive, your first question is, no, they don't receive a cash benefit until they've shown up at the one stop center for their assessment, so the intake process requires, as I was telling Representative Green, two steps. One is an intake interview, an eligibility intake interview at DSS and at the end of that interview, they are scheduled for an orientation assessment at the local one stop center within ten days. That's the arrangement we have with the one stop system, is they're going to make spots available so we don't delay that application.

Hopefully, this is moving forward concurrently. We're verifying what we need to for eligibility purposes in that same time frame that the client is scheduled to appear at the one stop. So if they show up at the one stop, they've met that requirement. Assuming we've got everything we need for eligibility, we can grant benefits.

Your second question, I've forgotten, Senator. Sorry.

SEN. HARP: So now the, something happens, they reschedule, something happens again, that they still feel they have a need, you're saying they don't have to sit down for the two hour face-to- face?

KEVIN LOVELAND: That's correct.

SEN. HARP: What do they have to do? Just so that it's clear in my mind.

KEVIN LOVELAND: They have to apply, so they have to reapply. That will move. They will lose retroactive benefits and actually some of this was, there were some budget assumptions that this was based on. So the fact that they applied, they didn't follow through, got denied, they reapplied, let's say 20 or 30 days later, we're not going to pay for that 20 or 30 day retroactive period. Their application starts with the new application for benefits.

But the information we took 20 or 30 days before is pretty current. I mean, all we need to do, they have to reapply and there's a short income asset household composition review just to make sure, you know, the information still is current. We've already collected all that information we've needed for child support, for the service needs assessment we do preliminary to their referral. We don't have to go through all that again.

All we need to do is schedule them again for an appointment at the one stop. They show up at the one stop, we're ready to go. You know, we can, assuming again, you know, there might be verification of income issues that the normal eligibility issues that need to be addressed as part of the normal process.

SEN. HARP: But I guess I'm understanding that they must have that plan or else they can't get TANF. Period.

KEVIN LOVELAND: Right. There is an exception in, the bill was amended to provide that if we don't get that one stop appointment scheduled within ten business days of the date of application, that we can't delay the processing of the application, you know, beyond the normal standard time for processing applications.

But actually, we have plenty of opportunities to reschedule them within that, it's a 45 day period also for the TANF application. So I don't anticipate that's going to have to be used very often. You know, most people we get to show up on the second or the third appointment and all that should happen during the first 45 days.

SEN. HARP: You know, just from a, because we're not doing -

KEVIN LOVELAND: This is, I was going to say -

SEN. HARP: It's just kind of interesting. Who makes that appointment? Does the worker make that appointment or does the individual, or is the individual required to make that appointment?

KEVIN LOVELAND: The worker has on-line access into the Connecticut, our DSS worker, while they're at the interview at DSS, has on-line access to Connecticut Works Business system, the one stop automated system.

They go in, they find an appointment slot for them, you know, arrange that slot, hope what's convenient for the family, print out the appointment sheet and give it to them. So they leave their DSS intake interview with an appointment at the one stop center.

SEN. HARP: But I guess the thing that is important for us to consider is that there is a mandatory face-to-face visit for TANF.

KEVIN LOVELAND: Yes, there is.

SEN. HARP: And if they're applying for Medicaid, too, and typically, now this is what I heard, now correct me if I'm wrong. Typically, it's about an hour and a half, this visit?

KEVIN LOVELAND: Yeah. That's probably the most typical time frame. It depends upon the size of the family.

SEN. HARP: So that in all honesty, if there was a staffing shortage, that it interferes with all of your eligibility, this time requirement.

KEVIN LOVELAND: Well, this is -

SEN. HARP: This is federal law?

KEVIN LOVELAND: This is, there's no federal law on this per se. As I mentioned, there is in the reauthorization bills, this universal engagement requirement that we were reacting to.

SEN. HARP: Face-to-face visit.

KEVIN LOVELAND: Oh, the face-to-face visit, no. That is, is it something, it's in state, it's actually in state policy, but we need to do it given the extent of the information that needs to be gathered. It isn't really practical to do this type of application through the mail.

UNIDENTIFIED SPEAKER: Especially when they're applying for food stamps.

KEVIN LOVELAND: Yeah, that's true. They're often applying for food stamps at the same time. That is a federal law requirement that there be a face-to- face interview for food stamps.

SEN. HARP: Thank you. Do you have a question? Okay, thank you.

KEVIN LOVELAND: Thank you.

SEN. HARP: Shirley, and I'm going to mispronounce your name, but I think it's Berget?

SHIRLEY BERGERT: No. It's Bergert.

SEN. HARP: Bergert, okay. Sorry. Welcome, good evening.

SHIRLEY BERGERT: Thank you. My name is Shirley Bergert. I'm an attorney with Connecticut Legal Services and I'm here representing the interests of the intended beneficiaries of some of these programs who have not been getting some of the services that they need.

I'd like to reiterate what others have said. I think Medicaid is so complex that there's a federal court decision where the judge referred to it as a surbonian bog and I think the staff in this report did an incredible job summarizing enormous amounts of complexity and they've identified many of the problems that exist in the program.

Some of what I'm going to tell you is in response to comments that have already been made, but I want to tell you that there are legislative decisions made every session and special session that affect Medicaid and some of the other programs that DSS is responsible for administering.

And particularly in the area of Medicaid, they're often made in the context of an extensively long implementer bill where there is no real opportunity for study regarding the implications and for you all to be informed by the people out there who actually do understand the implications.

So my first suggestion is here, at this legislative body, that you move back to a more deliberative process, that the implementer bill should not be used for the kind of substantive changes that are in part making it very difficult to administer this program in a timely and effective manner at DSS.

Every time there are policy changes, you're asking the workers in the field, and it's a reduced number now, to keep up, and they can't. The computer can't support it as people have noted. They don't have the staff to make the computer adjustments to support it even to the extent that EMS could support it with the appropriate staffing. And certainly, the clients out there, the individuals who are the intended beneficiaries, don't understand the changes and they get lost in this.

The policy changes functionally limit access, so I think that's in summary what I'm trying to tell you. We need some stability at DSS generally and in this program in particular.

There's another problem, besides it being difficult for clients to understand what's going on, it's very difficult to access the public policy that guides Medicaid.

So one other change that I think would be really appropriate for the Legislature to make is to require this agency to publish in a readily accessible location, its regulations. There is a statute that authorizes DSS to publish regulations in something known as the Uniform Policy Manual.

If you want to get a copy of state regulations, there is an official reporter, The Regulations of Connecticut Stage Agencies. To the extent regulations are in UPM, they are not in the official Reporter. They are not published and available at libraries. You have to be in the know to find this information. It is not published on their web site.

So either there should be a (inaudible) publication and it's in the Regulations of Connecticut State Agencies, or it should be on the agency's web site. We have DSS which is required to provide copies of relevant policy to individuals who ask for it, saying go over to Legal Services and get it. And we help them when we can, but it just shouldn't be that difficult to read the policy.

The other thing that's happened relating to access to policy that's highly problematic is that with privatization, rights and obligations are now being codified, if you will, in contracts between the agency and the provider.

Now, those aren't published and yet they have third party beneficiary rights for the intended beneficiaries of these programs and it's very difficult to assert them if you can't find them.

And lastly, the agency does extensive policy implementation guidelines in various forms. Some are in so-called P pages in the Uniform Policy Manual. The TANF ones are in a separate document. But these, as well, should be published and available so that people can find what they need to find regarding these problems.

I do think it's going to help some of the individuals directly who are beneficiaries, but it would be an incredible boon to the legal community, and particularly the legal community working with the elderly, to have ready access to these documents, but as well to social service providers out there who work with this population.

There are serious problems that have been mentioned. There is limited access to workers and I know that the Commissioner wanted to be sure that everybody was clear that the offices are not part-time, but functionally they are part-time. If you look at it from the perspective of an individual in the community who needs access to a worker, there are, depending on the office, between one and a half days and two days a week where you absolutely cannot get through to your worker.

It may be that if you can get to DSS and you have an emergency, there will be somebody there who can hear you and address it. But it is not the availability that the public needs. I'm sympathetic to the need of DSS staff, many of whom I think, we're asking them to do an impossible task.

I'm sympathetic to their need for blocks of time to work but the blocks of time to work on processing paper are coming at an incredible cost. It's virtually impossible as the Committee found, to access DSS consistently on the phone or access a worker on the phone. It's more than a few days often. It's often not a return call at all. That is, if you don't have voice mail that's backed up in the system and we've complained about this through Legal Services to the Department over the years and it's really become much more difficult with the layoffs.

There's a lack of internal coordination at DSS that affects Medicaid and I'll give you a very specific example. As well, Senator Harp, this is partly a concern with your mentioning the linking and I claim no IT expertise and so maybe it wouldn't be a problem but my perception is, a non-IT person is that it would.

If you you're an elderly or disabled person and you receive benefits through the ConnPace program, the expenditures for your pharmaceuticals count toward your Title 19 spend down. The spend down, you need as a recipient, to document all the expenditures that have been made in order to demonstrate when Title 19 kicks in and covers your bills.

If you have some competency limitations or you're extremely ill, this can be very difficult, and those are the people on these programs. What we need is a computer system that automatically notifies the Title 19 worker when the expenditures have been made so we don't lose people in this process. Spend down is an absolute nightmare for anybody to understand. I think you could probably count on your fingers the people outside DSS who do understand it and you're going to have some fingers left over on this. It's just very complicated.

There is a problem with contractors from a recipient perspective understanding when the contractor is DSS and when the contractor is a contractor and I would suggest that this is an impossible distinction and certainly an unfair one to ask those folks to find out.

And I notice, and I'm glad that it was in there, that in the report, it indicated that there had been confusion with things like reporting an address change to your Medicaid managed care organization and that information not being transmitted to DSS and that causing problems in terms of access.

There's a serious problem with the Department of Social Services controlling their Medicaid contractors and getting their Medicaid contractors to behave in accordance with the law. There have been serious problems particularly with notice, there's, notices provided to individuals when services have been denied and there are serious oversight problems from the agency.

There are out of control delays in processing applications and redeterminations and I don't care which way you spin it and if it's getting a little bit better in the last few months, there are very real, very ill, very needy people who are not being timely processed for a program that's very critical. This is not an extra. This is medical access.

DSS has engaged in a process to equalize staff. It's a really nice sounding word, so that people will have, in theory across the state the same untenable burden for processing. But no matter how you look at it, it is untenable. Even if you equalize it, it's untenable.

What you really need is a fair study which has never been done regarding what staffing level is needed to accomplish the task that you've assigned people to do. So 400 and something cases in untenable. But we don't know what really is tenable because we refuse to study it and it would be really useful, I think, if the Legislature had the agency study it effectively.

As has been indicated, there are problems with food stamps as well as the recent CMS visit. I'm interested in seeing what CMS ultimately orders the state to do regarding the Medicaid delays, but initially CMS had indicated that they felt that the result in the Alvarez case, which allowed some delay in applications, was not binding on them, that it was perhaps too generous in the level of delay that was allowed.

In the Commissioner's response which is attached to the report to CMS, there's overtime authorized to resolve the problem immediately. I want you to take into account that overtime is a short-term resolution. It does not solve the internal staffing problem and it may get CMS out of the picture immediately if it's successful. But the problem will return unless you have adequate staff there to process.

The other staff in the Commissioner's letter are not newly authorized positions. They're just positions that are going to be filled or transferred. So again, it's not, while if you read it, you would think there were additional staff authorized, that does not appear to be the case.

The welfare population, the folks that we're serving and that DSS serves are a disproportionately disabled group and there's plenty of federal data on this even if the state does not track that data.

The program complexities create barriers to people accessing services when they're disabled. The key disabilities that cause problems because we generally have offices with ramps and elevators now, are the disabilities that people don't come in on their forehead, the people with cognitive impairments or who have mental health problems, elderly folks who are in early stages of dementia and attempting to maintain programs and benefits.

Every complexity in the program, every complexity in processing, every time programs are changed, you are impacting these most vulnerable people. And one of the things that we've done in recent years in Medicaid is to make the system far more disjointed than it used to be when it was a simple fee for service program.

Now, I don't want to tell you that I thought fee for service in the old days with Medicaid was wonderful. But I will tell you, I never thought I'd look back, in the future and say, those were the good old days. But they were the good old days with all the flaws in the system, particularly for people who are into Medicaid managed care at this point.

So I want to give you a sense of what that means to a mom coming in with some kids applying for assistance, which she's got to do. First, she has to be determined eligible. That's that one and a half to two hour application. Then she has to choose an HMO from the ones that are available. Once she chooses the HMO she must find treatment providers for everyone in her family. If she's got an ill or disabled child then this population also has a disproportionate number of ill and disabled children, she has to make sure there are appropriate providers or that there's continuity of providers for those individuals.

She has to arrange appointments. It's really sometimes very difficult, even when somebody's a member of the HMO to get an appointment or to find a treatment provider who's currently taking Medicaid HMO members.

Accessing specialists, this is an incredible nightmare. You need to be articulate enough when you go see this new doctor to articulate all your problems and why you may need a specialist evaluation because they function as gatekeepers. You need referrals.

Many, particularly people with cognitive impairments, don't know how to articulate what kind of specialist help they need. I have many times, with clients, said, ask your doctor for this type of specialist and tell them these are the symptoms that you're suffering and that's why you're seeking that. And I'll write it down for them.

But we're not paying these doctors enough to do the kind of screening that would allow them to identify that. It's just not happening.

And then there's the problem that when you do get access to a specialist, we're now dealing with the medical transportation brokers who then say, we're not providing you with transportation. Why? Because we think there's a closer specialist. Well, who? Well, we don't know. You have to find them. So for many people, you can imagine, this is daunting as it is if you were perfectly competent. By and large when you're applying for assistance you're in crisis and you may have some other disabilities that also impede your ability to access it.

Now, the reason that access to evaluations is really important is the obvious one, people need treatment. But it's also an eligibility criteria for some of the programs and so if you can't access the Title 19 system to demonstrate that you're too disabled to work, then you are going to be sent as a TANF applicant, over to the Department of Labor even though your disability may interfere with your getting there. And by the way, it's two appointments at DOL, not one. Two. So three appointments before you get your benefits.

If you're disabled and you don't have the documentation to demonstrate that, you're in trouble immediately. Now, call your worker and tell him you've got a really good reason why you couldn't be there. Well, good luck getting through and getting that arranged and fixed in a timely manner.

I'm counseling one of the cases that's mentioned in the report, Raymond vs. Rowland. This is a case regarding the failure of the Department of Social Services to identify and accommodate disabled people that they're serving to insure that they don't run a discriminatory system. That is, to insure that disabled people are able to obtain and maintain their benefits despite their disability.

This case was filed in January of 2003 after we had been meeting with the Department of Social Services for a year and a half trying to convince them that this was a serious problem in referring them to HHS, Office of Civil Rights Guidance regarding steps they could take.

The situation wasn't working well before the layoffs, but the layoffs and the closure of six offices. I know the report indicates five and DSS downplays the importance of the Killingly Office but if you look at a map, you know that for people who are out in the far northeast part of the state, the Killingly Office is critical for access. And there was staff there during working hours although they weren't necessarily workers, but it was access, direct access to DSS and workers were moved there for interviews.

But anyway, when they closed over a third of their offices and laid off all the staff in those offices, it took a difficult situation and turned it into an incredible crisis and I don't think you can get around the fact that there are just too few staff.

I've covered some of this, so let me review here. Since we filed this case, the Department has undertaken a number of important steps to identify disabled people who may need assistance, but they haven't followed through with some of it. So I'll give you a couple of examples.

Midway in the case, they actually adopted a policy, a nondiscrimination policy applying to clients regarding the Americans with Disabilities Act, but that has yet to be codified in its policy. Policy in the UPM or in regular regulations are what folks on the outside have ready access to and it's what staff have access to. How staff implement this is beyond many staff people. They simply don't know what this implies and they don't have adequate guidance regarding it.

They've implemented a system of file tagging on the computer to identify disabled people who may not be able to make it through the application procedures, but they by and large have not implemented it with the workers.

They are not coordinating with the contractors. When somebody is disabled and needs an accommodation to obtain and maintain benefits, contractors providing DSS administered services like the HMOs and the medical transportation brokers are not provided information that somebody needs an accommodation in order to access the service.

And then to the extent some accommodations are provided, there may be disparate impact that's negative for individuals, particularly the date of eligibility for benefits.

SEN. HARP: We were not going to stick to the three minute provision but, could you please summarize because there are a number of people behind you and you've already been speaking for about ten minutes now.

SHIRLEY BERGERT: Okay. Let me see what I think is most important through here. One final thing. I think you understand the problem the disabled folks are facing. There was some discussion regarding using the hearing system to evaluate what's happening with Medicaid and there's an increasing problem in the fair hearing system that it would be useful if it was addressed, and that is, for many of these disabled people, it's difficult to complete the form.

In fairness to DSS, the fair hearing form is very simple, but it also has a number on it that tags it to a particular adverse action taken by DSS. If an individual has difficulty completing the form, the fair hearing office now is sending them a letter asking them for the missing information, often information that is already in their system. It's a problem that that would define access to a fair hearing, so those hearings would then be dismissed if somebody couldn't respond appropriately.

The second problem, and this is violation of DSS policy, but it occurs fairly routinely now is, the worker will say I fixed the problem. From the client perspective it's not fixed but the hearing is dismissed.

So, I'm happy to answer any questions, but that's all I was going to say.

SEN. HARP: Thank you very much. Staff, do you have questions? I'm sorry, Representative Green first.

REP. GREEN: Well, I was just going to ask and hope that, I don't know where you say you were from or what organization you're representing, but I'm hoping that the study, they talk to a person like you. I think you just brought out some interesting points that seem to be contrary to some of the things I heard earlier. So I'm just hoping that some of your thoughts are incorporated in the report.

SHIRLEY BERGERT: I'm happy to talk to anybody. I'm from Connecticut Legal Services.

SEN. HARP: Thank you.

SHIRLEY BERGERT: Thank you very much.

SEN. HARP: Kate McEvoy.

KATE MCEVOY: Good evening, Representative Wasserman, Senator Harp, Representative Green and esteemed participants of this hearing. My name is Kate McEvoy. I'm the Assistant Director of the South Central Connecticut Agency on Aging and I'm here representing the Elder Law Section of the Connecticut Bar Association as it's Vice-Chair.

Our comments are intended to illustrate impact of consolidation and staffing losses on primarily on older adult and younger individuals with disabilities with whom we have contact as advocates as a section.

First, I'd like to say, very briefly, we greatly appreciate the staff who worked on this preliminary report, principally for describing the scope of these issues with great precision and detail. It is essential in any inquiry of this kind to gain that.

And second, we sincerely appreciate the opportunity to speak in the presence of the Department and recognize their collaborative posture and the resource constraints that they face. That's obviously a context in which we have to treat all of these issues.

We have submitted written testimony this evening and I would just like to amplify on a few major themes in brief.

Two areas that we focused on in our written testimony with respect to particular impact on older adults who are typically recipients of this program, are typically frail, experience multiple impairing health conditions, frequently have cognitive deficits that represent further challenges for them and often are isolated, homebound and without natural advocates and family caregivers or other friends and associates.

Those two areas represent certain access barriers, physical access and perhaps, if you will, perceptual barriers that impact their ability to access the Medicaid program initially and also may impair their continued involvement in it, their continued receipt of services.

The second area is obstacles and delays in the application and redetermination process. And as I said, I'd very briefly like to expand on those two areas.

With respect to access barriers, just a few examples of the impact of the closure and loss of staff. First, Senator Harp will be very familiar with this issue. The issue of the closure of the Meriden office. Just to illustrate the practical difficulties that were implicated with this closure, recipients of assistance from this office were initially, as you are aware, redirected to New Haven.

When we became involved with clients who were looking to make the trip to the redirected office, the New Haven office on Bassett Street and in communication with Connecticut Transit, the primary source of transportation for many recipients of public assistance, we discovered that this represented a trip of slightly over one hour, and a nearly insurmountable barrier for an older adult who has no other alternative to do so.

Certainly not all older adults were expected to make this journey and I don't want to over-emphasize that aspect. But again, many did receive notices, particularly for redetermination that requested in person participation in that effort and again, just to illustrate, pragmatically, what that might have meant for them in the way of a trip.

Second. Briefly, with these practical access barriers, the, one of the conduit points for evaluation of access to Medicaid for older adults is the Alternate Care Unit of the Department of Social Services. The Alternate Care Unit does the initial screening for all individuals applying to the home care program for elders, which as you're aware includes the Medicaid waiver for home and community based services.

In June, the regional offices of the Alternate Care Unit were consolidated to one single office in Hartford and this presented immediate obstacles in terms of processing delays of getting people on the program that have been ameliorated since but again, that just represents what does happen with consolidation and loss of staff due to retirement.

Final area under the access barriers that I'd like to briefly address, and I was very heartened by the Commissioner's comments in this area. Members of my section were very concerned to believe that this new initiative to involve community action agencies as hub or entry points to programs of assistance from the Department, very concerned about the technical capacity of the CAP agencies to handle this very complex area that requires precision, requires significant follow up and requires completeness in order to help people effectively access the benefit.

But the Commissioner did remark that she did not expect that this would be looked at as supplanting the regional offices in this role and we would just underscore, we believe that that's the right direction to continue to focus on, increasing capacity in the offices rather than rely on the CAPs for this function.

The second area I would just briefly comment on are obstacles and delays in the application and redetermination process. Again, I've already mentioned the primary populations we have in mind already face significant physical and capacity obstacles of their own and when they're coming to make application at this program either for long-term care coverage in a nursing facility, or through the home care program for elders, there are a number of pitfalls that have typically plagued them in accessing them and becoming eligible.

First, and again not to be redundant with previous speakers, so I'll just run through it very quickly. The voluminous supporting documents that are required of all applicants. One very concrete example I could give you is, of course, given the three year look back, the look back review of financial records of each applicant. Each is expected to furnish three full years of bank records which you might understand would be practically very difficult in that we have very few local banks any more. We're working with regionalized banks, banks that charge fees for these services and often don't respond in a timely manner.

You'll see one of our practical suggestions at the end of our written testimony is that the Committee work with DSS to determine areas in which the line staff could be more affirmatively helpful in gaining that supporting documentation, particularly bank records.

Another issue that has been problematic despite DSS's best efforts, and we do recognize them, are redundant requests for documents that have already been submitted or notices to the applicant that their applications are incomplete notwithstanding submission of documents that should make that not the case.

Those redundant requests, of course, delay the entire review process and put people in a position of potential disfavor with receiving the medical assistance they need.

A very substantial concern of ours is the section, again, many changes have been made in statute to Medicaid provisions concerning coverage for older adults. In the past two years, notable among these is the shift of the Legislature to the income first policy in determination of division of assets and income between married couples, members of married couples as they apply for long-term care assistance.

Irrespective of the statute being clear, it is not always, does not always seem to be the case that people in the regional offices have a uniform understanding of these new practices or a universal understanding of terms.

An example of this is the exempt asset of a burial plot. There's been a lot of different interpretation of that particular term and application in terms of the review.

Finally, and most significant, there is no way to, there's no way, mentioning this again is redundant because it's very important to all of us, and that is the inability of the Department, due to many staffing constraints and other factors that we recognize to be the case, to meet the time deadlines for review, the 45 day expectation.

We do appreciate the Commissioner's remark that in certain cases, individuals in nursing facilities are continuing to spend down towards eligibility. That is a discreet sub-part of this population and that does complicate matters in terms of timeliness but there are many situations in which the time guidelines are not being observed.

What, just very quickly, what impact does this have on these two populations, those seeking Medicaid coverage for a nursing facility or those seeking home and community based services? In the nursing facility, we have seen many situations in which people have applied with the expectation of timely review, only in certain cases to be found ineligible after certain months living in a nursing facility, facing a bill that can be approximately or greater than $7,000 per month and with no capacity out of their own resources to meet that debt. And that obviously places the nursing facilities in a terrible position also with having to look for that payment from essentially indigent individuals, often.

Impact on people in the community is, in my opinion, almost more grave and that is, people seeking Medicaid support from the waiver component of the home care program have no services in their interim while they're waiting for a review and approval of the, from the Department.

These people, as I've already described, face multiple health conditions, serious impairments and they're at substantial risk either for unnecessary institutional placement, again, at much greater expense to the state or hospitalization, not having received the intervention that they need in the short run.

So I would just underscore that the issue of the time limits is particularly important in our opinion as a section and deserves absolute scrutiny to determine what resources the Department needs to effectuate that in a more timely manner.

I'll just wind up by saying that the last page, Page 6 of our written testimony, makes six recommendations for use of the Committee going forward and I greatly appreciate the opportunity to speak tonight. Thank you very much.

SEN. HARP: Thank you. Are there questions? If not, thank you very much.

KATE MCEVOY: Thank you very much.

SEN. HARP: Kate Maldonado.

KATE MALDONADO: Good evening Senator Harp and Committee members. My name is Kate Maldonado. I'm the Manager for Community Support Services at Rushford Center in Meriden. Rushford is a private, nonprofit organization that provides comprehensive mental health and addiction services to children, adults and families in locations in Middletown, Glastonbury, Portland, Clinton and Meriden. Rushford is the leading mental health authority in Meriden and Wallingford.

I'm speaking to you today representing also the Community, Connecticut Community Providers Association, the CCPA. This agency represents organizations that provide services and supports for people with disabilities and special needs, including children with, children and adults with addictions, mental illness, developmental and physical disabilities.

I would like to testify today about the mixing populations in State Elderly Housing Project Study, one of the key services provided by our staff in supporting consumers and finding stable, safe and affordable housing. Many of the people we serve are on fixed incomes and they have difficulty affording stable and safe housing. Housing resources available to our clients is extremely limited. Increasing rents are lessening the options that are available for housing for our clients.

At Rushford Center we serve approximately 700 to 800 clients presently through our community support services program. About 70 to 80 individuals live in public housing with 28 approximately, as the number of individuals living within the elderly and disabled housing locations.

Housing options in Meriden and Wallingford are very limited. Many local programs have waiting lists and the shelters are at capacity or are seasonal and at capacity while they are open. Shelters are not the solution, however. The people we serve with mental illness need and have a right to stable, safe and affordable housing. Many deal with stigma issues on a regular basis and often experience discrimination. They're at risk of facing discrimination in the housing arena as well.

There is also a portion of our population that we serve that not only suffers from mental health issues, but also from medical issues and the benefit from being in these elderly housing units because of the handicapped accessibility.

Rushford Center has an extensive case management service that supports people with mental illness in the community. We have had positive experience in working with local authorities to try to support people with mental illness in public housing settings. Although at the same time community between these providers and housing authorities can always be enhanced.

This collaboration will better assist us in maintaining stable housing for those people that we serve. We work to educate the local housing authorities and they in turn have educated us about the needs of varied populations. Continued education may allow all residents a greater level of comfort and understanding of their neighbors.

We want to continue to be able to provide the community resources to support adults with mental illness in their housing so that they can maintain their independence.

Providing services in the community setting does have a cost. At the local mental health authority, we are committed to working in a variety of settings to support individuals with mental illness. At the same time, supports provided by on-site resident service coordinators, or by staff of mental health authorities needs to be funded adequately to assure program successes.

What we need in Connecticut is more affordable and subsidized housing and more supportive housing options. We encourage the Committee to look at the lack of housing itself as a problem that needs to be addressed for all populations. We welcome the opportunity to work with the Committee in forging solutions that will enhance the life of people with disabilities and similarly enhance the lives of the elderly residents. Thank you for this opportunity.

SEN. HARP: Thank you. Are there questions? Yes, Representative Green.

REP. GREEN: Thank you. I guess I'm concerned with this idea that this conflict between the elderly and the non-elderly disabled in housing complexes is so great

(Cass. 3) GAP FROM CASS. 2 TO CASS. 3

what the complexes are and what the percentages are but I want to ask I guess is that, what kind of conflicts, if you find any conflicts, do you find with your clients that they live in elderly complexes are?

Do you get a response from them in terms of what are the conflicts they have and do you hear from different housing authorities or landlords what are the problems they're having with your clients and can maybe describe a little bit of these conflicts and whether or not you find these conflicts to be by a number of your clients or by a small percentage of your clients that may account for, in a sense, most of the conflicts.

KATE MALDONADO: I think a lot of the conflicts can be related to more discriminatory issues than lack of education. It seems to me that folks, our folks feel that the elderly may be afraid of them, that there's stigma attached, especially if there was someone in the housing units who may be more disruptive than others that that carries across the board to people who may fall under the category, real or not the case that they are also that way.

REP. GREEN: Let me, because I'm trying, if I think that I have, let's imagine I have four non-elderly disabled in a housing complex of 20 people, you know, one-fifth of the population, I may have one individual, say that's non-elderly disabled that could be loud and possibly scary looking, I don't know.

And you know, people say, well, you know, there's four people that are non-elderly disabled, we have a problem with those four and it may not be those four, it may be just one of those four. Do you find that you might have two, three, or those four individuals at non-elderly disabled having particular problems, or maybe one person may or may not be having those problems in a complex.

KATE MALDONADO: I think it varies. I think it's probably a couple of those would have the problem. It's not across the board. It also has been my experience, a little bit off your question, but that it's not only the folks with mental illness who cause issues that have been raised within this study but also to some degree, a portion of the elderly community, or people who fall in neither of those categories.

As to the, you had asked about the number of percentage of our folks that feel affected by this, was that your question?

REP. GREEN: I would just, and you've actually answered. I was just trying to get a sense of if this was a real serious problem with most of the units you were dealing with or most of the people because my first reaction was that we were having this statewide problem and as the report seems to indicate, you know, we really don't have the data to say what is the problem. And I'm still just trying to understand what is the problem. I haven't figured it out yet.

So I'm trying to figure it out and I just can't find, you know, I find isolated incidents with individuals, but I haven't found a pervasive problem with these complexes, at least by, except for maybe a couple of housing authorities that when I've read their information, again, haven't shown up. And as I recall the previous hearing that we've had a few months ago, they didn't show up, so, you know, I'm not hearing the problem and I'm trying to figure it out.

KATE MALDONADO: I think -

REP. GREEN: You don't have to respond.

KATE MALDONADO: Can I? Yeah, and I may not have the answer to that question so I do think, however, our relationship with the housing authority may be addressing some of those issues before they get to this level and that relationship is extremely important.

SEN. HARP: And can I also say that it may be, in fact, unique. Do all of the lead mental health authorities throughout the state have the kind of relationship that you have with your housing authority or not? I mean, I think that's one of the -

KATE MALDONADO: I can't speak for all of the LMAJs but I would assume that there's varying levels of relationship between the organizations.

SEN. HARP: Thank you. Our next speaker is Sue Greeno.

SUE GREENO: Good evening Representative Wasserman, Senator Harp and Representative Green and members of the Program Review and Investigations Committee. Thank you for the opportunity to provide testimony regarding the application and eligibility process for the Connecticut Medicaid Program.

And really, before I begin my testimony, I have to commend the Committee staff for your extraordinary effort in going out to the people to hear what the concerns are and not just staying within the governmental bodies to gather your information, so you should be congratulated on that.

My name is Sue Greeno and I'm the Director of Eligibility and Outreach Services for the Community Health Center and I have a staff of nine and we, the Community Health Center serves 50,000 individuals throughout our sites in Connecticut that include Clinton, Meriden, Middletown, New London, New Britain, Old Saybrook and Groton. And for nine years my job has been to help people enroll, maintain and re-enroll in the Medicaid program. And during the past year my staff and I have screened over 3,500 clients and successfully helped 2,400 individuals enroll in these programs.

We're actually one of the community partners that the Commissioner had made reference to, so we work very closely with the Department of Social Services.

I could speak on many issues surrounding enrollment as I've had a lot of experience over the nine years, or retention, but I choose to emphasize and I think that this is the single most important change that you could make and why you should do it, and that is to reinstate the presumptive eligibility program for Medicaid.

I'm not speaking theoretically here about a proposed idea. I'm speaking about a program that existed from 2000 to 2003 that worked, that made a difference and that needs to be brought back. Let me tell you why.

Through the PE program, the state qualifies or deputizes organizations such as federally qualified health centers, school based health centers, and community action programs as qualified entities to screen applicants and make a determination that they're presumed eligible and award same day coverage or enrollment for that child.

This coverage lasts only 30 to 45 days but it's enough to meet the immediate health needs and health care needs for that child. And also time to complete the full, more comprehensive application for Medicaid and other assistance programs.

Let me tell you my organization's history with PE. During a two year period of January, 2001 to December, 2002 when PE was in place, 3,054 children presented at CHC without health insurance, met with one of my staff, were screened and granted PE. Statewide, during the same period, a total of 8,000 children were enrolled into the HUSKY program through presumptive eligibility.

One mom shared her story with me of how PE allowed her to fill her daughter's prescription for asthma medication and said that without the help of this program, her daughter might well have ended up in the hospital emergency room because the mom had no funds to pay for the prescription at that time.

When DSS eliminated the presumptive eligibility program, they took away an important health care tool. Children now have to wait up to 45 days to become insured and in many cases must wait it out until coverage is granted before they're able to access many important health care services.

When DSS eliminated the presumptive eligibility program, the burden of granting HUSKY fell back on the regional DSS workers who were already stretched to the max.

Reinstating presumptive eligibility will provide assistance to the DSS staff. It will increase efficiency by having part of the work being done by the qualified entities and most importantly reducing delays in obtaining health care coverage so critical to the well being of Connecticut's children.

In addition, I'd like to make one more recommendation that the Committee encourage DSS to actively pursue the creation of a web based on line application for Medicaid. Federal, state and private funds that are, are available to potentially tap into for financing such a venture.

In fact, there currently exists a line item in the state budget for this purpose. An on line application will provide a solution to some of the concerns identified by the Committee's key findings.

I also need to take one more second. One of my colleagues did not appear tonight and she was going to speak on presumptive eligibility for the prenatal program for Healthy Start. And I would encourage hand in hand that the presumptive eligibility for children and pregnant women be looked at together for true presumptive eligibility. And you've already heard testimony on that.

Thank you for listening and for the contribution that you're making to improve the Medicaid program. Thank you.

SEN. HARP: Thank you very much. Are there questions? If not, thank you so much. It was very well said. Richard Schreiber.

RICHARD SCHREIBER: Senator Harp, Representative Wasserman, Representative Green, members of the staff of the Joint Committee on Program Review and Investigations, I am Richard B. Schreiber, Chairman of the Board of Directors of the Mental Health Association of Connecticut.

The Mental Health Association strongly supports as many different housing opportunities as possible for persons with psychiatric disabilities. We oppose taking away housing opportunities. Persons with mental illness must be able to choose from a variety of safe, affordable housing options. Our association provides residential support services to over 340 people in six communities. Bridgeport, Danbury, Stamford, Torrington, Waterbury and West Hartford.

In Waterbury, in addition, we also have a social club with over 350 members and a supported employment program for 30 people. Of the over 700 people in our various programs, approximately 90 live in elderly combined disabled housing programs, both state and federally funded. Some have lived in such housing for anywhere from eight to twelve years.

Our experience convinces us that seniors and persons with disabilities can live successfully side by side. Last winter, a person in one of our programs appeared at the Joint Hearing of the Select Committee on Aging, the Select Committee on Housing and the Commerce Committee regarding elderly and disabled housing.

This person stated, and I quote "When I first got my apartment it was the most exciting, most wonderful thing in my life. I have now lived there for four years. We have a unique building in that we all look after one another. The elderly and the disabled intermingle. We enjoy each other's company. We take classes and celebrate holidays together and we help each other with daily tasks like laundry and grocery shopping. We are a vital community for one another. Without our friendship each one of us would have a much more difficult time in life."

Also attached to my statement are statements from two members of Independent Center, our social club in Waterbury. They were unable to attend today's hearing.

Of course, we understand that there have been reports of problems in some housing where young people live with seniors, but we believe that individual problems must be dealt with as they occur, not generalized to all situations. Each person who causes a difficulty needs to be dealt with regardless of whether that person is elderly or a person with a disability. People with disabilities must not be treated differently simply because they have a disability.

If any person in state elderly housing needs treatment, the response should be to try to get that person the treatment needed. We urge the Committee not to further limit housing opportunities for persons with psychiatric disabilities.

The current housing supply in Connecticut is insufficient, as you've heard. Any further decrease with any selected group targeted to bear the burden of such decrease will mean more people will live in substandard housing, become homeless and have to live in shelters or on the streets.

In addition, we believe that discrimination in this regard against persons with physical or mental disabilities violates the Connecticut Constitution.

We urge the Committee to include in its recommendations the following four points. One, increase the supply of safe, affordable housing and in addition, two, increase the number of resident service coordinators.

Three, link housing authorities with area social service agencies that assist the elderly and persons with disabilities.

And four, provide operating subsidies to state funded housing. Thank you very much for the opportunity to speak to you today, this evening.

SEN. HARP: Thank you. Representative Wasserman.

REP. WASSERMAN: Thank you, Madam Chair. Thank you, Mr. Schreiber for your patience waiting. I do think, and I'm not sure you understand this, there is a lot of feeling and some opposition not so much to the fact that elderly are living with people with disabilities, mental disabilities, but the gender differences. And that was brought up several times today, that the cultural orientation of the elderly is quite different from the much younger generation and not necessarily with mental disabilities. And that seems to be an additional problem to deal with.

Maybe your RX would fix that. I'm not sure. But the emphasis definitely is on the gender difference as well.

RICHARD SCHREIBER: Could you expand on that? The age differences?

REP. WASSERMAN: Yes.

RICHARD SCHREIBER: Coupled with gender and cultural orientations.

REP. WASSERMAN: That is what is being brought out that I heard a lot about today and also previously. I don't have a solution to it, but there seems to be a feeling that, it was brought out earlier by one of the Representatives who has several housing projects in his district that some of the elderly have trouble dealing with the young who have, for instance, a taste for music at 3:00 o'clock in the morning and that kind of thing. That's what was brought out several times, rather than the mental disabilities. I don't know what the solution is.

RICHARD SCHREIBER: I thank you for clarifying that. Among my first thoughts is, aren't there, in fact, among elderly people, cultural differences? Just among the elderly, the holidays observed, for example, the family and neighborhood traditions, just among a sampling of elderly folks, would not be as true. I thank you for adding more details to my perception.

SEN. HARP: Thank you very much. Jennifer Gouthier. I probably mispronounced your last name, Jennifer.

JENNIFER GOUTHIER: Good evening. My name is Jennifer Gouthier. I'm here to talk on behalf of the elderly disabled housing. I am currently living in elderly disabled housing and I currently get along with all my neighbors and my neighbors get along with me and all the younger folks that we get along with.

And, when I first moved into my housing, I was very adamant about moving there because I didn't think that I was going to get along with any of them. I didn't know what I was going to have in common with them but in fact, I have a lot more in common than you may think.

We have music in common. We, there's a lot of movies that we have in common. There's, we enjoy cooking and baking in common. There's books that we have in common. And I love listening to the stories that a lot of the elderly have to tell because there's a lot of them that were alive when I wasn't even born.

Yeah, there's a lot of stuff that I've heard tonight where they say that you know, that the mentally ill and people with drug and alcohol addictions, that elderly are afraid to live with. Well, I think that those are the elderly that don't know people with mental illnesses that don't give us a chance. It's because of a lot of the stigma that they've heard on TV and they, you know, they see a young person moving into their complex and they're like, oh, my God, they have a psychiatric disability. They're dangerous.

And I know that that's how a lot of the people when I first moved in, they knew I had a disability and I came right out and told them, yes, I have a psychiatric illness. I went out there, I was nice to them. They got to know me. If you don't get to know somebody and you automatically judge them, like a lot of other people do, you're not going to get to know them, and that's how a lot of people are. They judge them and they think that we're dangerous but we're not.

There's a lot of people, elderly people who live in their own private homes that live next door to people who have psychiatric disabilities, but you don't hear them complaining about people with psychiatric disabilities. You don't see them here saying that their neighbors are dangerous. You don't see them complaining saying, you know, I don't get along with my neighbors and stuff. How come it's only in the elderly disabled complexes that the elderly are complaining about the disabled people?

You know, we have elderly people that are in psychiatric hospitals with the younger people. You don't hear them complaining about us there. You have elderly patients that are put in with psychiatric patients, or younger folks in hospitals. You don't hear them complaining there. Well, why are they complaining because they're in with the younger disabled people in their complexes?

Because it's the media that they hear them saying that we're crazy and all this negative stuff and they don't give us a chance to get to know us. But when they do get a chance to know us, like the people where I live at, Michael Corey Terrace in Torrington, they find out that we have a lot more in common and that we're not, we're not people to be afraid of because our psychiatric disability is only a piece of our lives. It's not our whole entire life.

And when you give us a chance, get a chance to know us, we're just like everybody else. We're just like the elderly. We're just like you. And you know, we have a right to live in the communities with everybody else. And you know, it's like, give us a chance and the elderly will find out that we have just as much in common with them as they do with us. Thank you.

SEN. HARP: Thank you. I guess we have a question for you, Jennifer.

REP. GREEN: Thank you. I thought your testimony was very striking and you mentioned, and I was going to ask you, you mentioned that you live in Torrington. How big is your complex that you live. Do you know how many units? Forty people, 50, 100? Do you know how big it is?

JENNIFER GOUTHIER: We have like six units. Each unit has three floors.

REP. GREEN: So it's not a very large one.

JENNIFER GOUTHIER: No, but in Torrington, there's like four elderly disabled complexes. But we get along really great and we have, we always have picnics together, we go on trips together. In fact, one of our residents was going through cancer and I would bring him to his treatments and stuff. We walk our animals together. We play cards together, do arts and crafts together.

REP. GREEN: And I think that I had asked a question earlier, that you know, really trying to get a picture of this and as I've talked to the elderly in those non-elderly disabled that live in the complexes, I hear stories like I'm hearing from you. I just haven't, you know, I've heard very few isolated stories on the other side and am trying to get just a picture of how prevalent this problem is, but I'm constantly hearing stories like this. I'm trying to find out where the problem is at and I'm just not finding it.

JENNIFER GOUTHIER: They even had a petition put up in our day room for people to sign if they had any problems with the disabled and nobody signed it. Nobody would sign it.

REP. GREEN: Let me ask, who put up that petition?

JENNIFER GOUTHIER: They just -

REP. GREEN: The management?

JENNIFER GOUTHIER: Yeah. And nobody would sign it. Nobody in any of the elderly disabled complexes would sign it in Torrington.

REP. GREEN: And that's one of the things I'm hoping through the report as I review it, is the concern on where this is coming from. It would appear to me that it's a few isolated incidents and that now it's being fueled by housing authorities or management that we have this problem and I'm really not hearing it from the residents.

And so when you talk about a petition, I have a petition up here that's signed by all of these residents saying they do have a problem, and I'm trying to figure out, does everybody that signed it have a problem?

And I just want to try to make sure the data and information that the Review Committee, and I think from the preliminary, have done a good job, is that we're really getting a true picture on the extent of this problem before we make any major changes to a policy that to me, doesn't appear to be broken.

And also, I think based on the comments of the last speaker I hear is that a need for housing for all of our citizens and some working relationships with both. And I think as a state, us doing a better job to give money for operations so people can be in the community.

So thank you for your comments and you did very well. Thank you.

JENNIFER GOUTHIER: Thank you very much.

SEN. HARP: You did a nice job.

JENNIFER GOUTHIER: Thank you.

SEN. HARP: Barbara Sheldon.

BARBARA SHELDON: My name is Barbara Sheldon and I'd like to thank you all for taking the time and staying a little bit later to listen to me as I had not planned to testify this evening because I haven't had time to read your report on Medicaid eligibility and I had planned to do so before I testified at one of the regional areas. But I really felt compelled to talk nonetheless.

I am the mother of a 19 year old son who very much needs Medicaid, but I've been told is ineligible. He was happily at college for his freshman year when he attempted suicide twice, back to back, nearly completing suicide in a very violent manner and was taken out of college and now has been forced to live in our home instead of being where he wants to be.

We obviously now need Medicaid because my son also has a very extensive medical history and does not qualify for private insurance. He has basically been blackballed because of all of his medical conditions and so we need state assistance. We need the medical plan that you all offer us.

However, I'm told that we are ineligible because my income has to be taken into account because he is under the age of 21. If I was able to kick him out of my home, then he would then qualify. I find that really appalling in this day and age and in this state, that I would have to kick my son, my one and only child, out of my home while he is very ill in order for me to get him medical help. But that is what I've been told by DSS.

And I'm going blank. Sorry about this. I have gone, I have actually made on several attempts, numerous phone calls, actually numerous phone calls to the Middletown office trying to get an application. That's how I started with this process. Did not get a return phone call which was a little appalling when I'm in crisis.

So I make the ride down to the office to pick up the application. I think I'm hoping, at least, that due to our crisis situation, in that my son is still suicidal, that I will, I cannot seem to be able to fill this out accurately. I have asked the person at the front desk for help. That is not her job, so I don't get help.

I have called the Hartford office and talked with someone who was very helpful except that she said that she's with the Hartford office, she's not with my office. I need to contact my office. I contacted the worker that she told me to contact and that worker has not once returned my numerous phone calls. I don't know how much longer I can continue waiting. And I cannot pay out-of-pocket for all of my son's care.

I have had in the past to borrow money from my mother who is now retired, to the tune of just about $100,000 for my son's care because he has had all of these medical issues that are not covered.

So I really can't go to that pot any longer because she doesn't have the money.

I then was told that we actually were still an active HUSKY case, which surprised me because I thought we were closed in the Bridgeport office because we had moved from Bridgeport and my son had left the state to go to college. So I thought we were closed and it turns out, lo and behold, in the mail over a week ago, I get this letter saying that we are up for redetermination, so I was really ecstatic and really hopeful that wow, maybe I actually, God has granted me this gift and will allow my son health insurance.

I contacted the worker in Bridgeport to say, you know, can the case be moved to Middletown because we now live in Chester and so she said, well, she needed to talk to me a little bit. And then I said, I have one question. I thought on HUSKY my son would not qualify because he's 19 and I thought HUSKY was for under 19. She agreed. She said, well, your son isn't 19. I said my son is 19 and we had a little argument over that.

And then I said, if she would just take the time to pull up the record that she had sent us in the mail, that had his date of birth on it and did the math that she would realize that indeed, my son was 19 and he had turned 19 in March, at which point she pulled all the information up, did the math and then said, you're right, he doesn't qualify for HUSKY. He is ineligible as of today and then just click. Nothing more was said to me.

And my family is sitting here in crisis, wondering what am I going to do with my suicidal son. I just am appalled that we are ineligible for services but that I'm also told that at the age of 21, my assets will no longer go into this eligibility determination, even though he could still live in my home. That appalls me. I'm like, why are my assets so important from 19 to 21 but thereafter they are not, and chances are, he will still be in that very same home with that very same parent if I can help it.

And if I can keep him alive for two years so that he can then be determined eligible to receive services in this state. I'm sorry, I'm very angry. But that's where it stands and I'm done. Sorry.

SEN. HARP: Thank you. I know that there's supposed to be a program that DMHAS runs for that age group. I don't know -

BARBARA SHELDON: There's the young adult program. I was told.

SEN. HARP: Yes. Have you tried to apply for that?

BARBARA SHELDON: We have applied. We've actually been granted into the River Valley Program but I'm told he needs to have Title 19. So he can't get Title 19 so he probably is going to lose his eligibility at River Valley, which he has been given a case worker, a psychologist and a psychiatrist.

And the other hard area for us is that my son does not want to acknowledge that he is suicidal except to me, and then when he has to be hospitalized for those three day periods, and then while he actually had slit his wrists nearly killing himself, and was hospitalized for his surgery.

SEN. HARP: And I guess there's the medically needy program. I don't know if they're spin down that you might be eligible for. Maybe your income is too high, but -

BARBARA SHELDON: I'm only $1,500 over and my liabilities are so incredible, that even at the $1,500 over, I'm not even making all of my bills paid every month. I pay about not even a third of them every month.

SEN. HARP: Well, I see there's someone here from the Department that can help you. I see (inaudible). So maybe we can take care of your issue but the other people that have this problem I'm sure we're going to have troubles. So it's important that you gave us this issue and hopefully we'll be able to help you tonight and help your son.

BARBARA SHELDON: Yeah, because I'd like to think that 19 to 21 year olds are out there in no man's land. It's just unacceptable. I'm like, my son is old enough to vote for the President of the United States this year and yet, he's still not considered a full adult until he's 21. And he can go over to Iraq and he can fight in the war. But what if he got hospitalized over there. Would he be able to get out? Would he be able to be covered? I'm like, I'm just appalled.

SEN. HARP: Thank you very much.

BARBARA SHELDON: Thank you.

SEN. HARP: Further questions or comments? If not, thank you very much. And hopefully, why don't you see someone from the DSS staff and maybe they can help you.

Our next and last speaker is Larry Deutsch. Dr. Deutsch. And I probably mispronounced your last name, too.

DR. LARRY DEUTSCH: Thank you. I promise to be very, very succinct. To address the comments about eligibility requirements and so on. I'm actually surprised there are this many people remaining and I congratulate them on their fortitude.

I'm Larry Deutsch, a pediatrician and a public health researcher and worker and we've heard comments throughout the evening about the problems with turnover, program complexities, the cycle and the churning and the benefits of continuous eligibility, simplicity in the system and how it would benefit the quality of care to have continuous enrollment and that's cited in one of the earlier speaker's references, six and seven, the benefits of continuous primary without interruption.

I would just like to say that I have a fairly simple way to save DSS and the state millions of dollars and improve quality of health care and I really believe it and this is something you may ask how can this be done.

I think you can take a position that many individuals are now taking, including doctors and other health providers, in terms of improving the health care system, and that is simplify it by having universal eligibility, by having a universal qualification and let's apply that to the 78% of those who get family care, not the disabled for this moment and say simply this.

The Academy of Pediatrics at some points in the past has proposed universal health care for all children and adolescents. We have meant by that, under age 21, not 18 or 19.

A universal program consistent with the United Nations Declaration of Human Rights, the right, the human right to have care.

And so, this is not such a radical proposal as it may seem at first pass because in many countries of the world which have better health statistics and more efficient systems, this is the case, the right to health care is universal.

Let's make an analogy. In the United States the qualification for Medicare is being over age 65. In some amusement parks, the qualification to go on the roller coaster is being under 48 inches. Very simple. So let's think about, just for a moment, a simple criteria, that anyone age 21 receives a health care without a lengthy and complex eligibility process.

So I just suggest we think about it for a moment before rolling it out and then, of course, the question will be asked, well, how will we finance such a system. And again, this is not so difficult.

You roll all the dollars in the private and public systems right now, the employer, employee, self-pay, all the money that goes toward insurance and self-pay out-of-pocket into a single agency, a statewide agency. That is not unheard of. It can be public or semi-public and that agency guarantees universal health care for all those children, adolescents under age 21.

It will eliminate some of these issues of course, complexity, turnover, inefficiency, people going without health care, some of the unconscionable delays in health care that we've heard about just now and throughout the evening due to bureaucracy, computer inefficiency and so on and so forth.

So I speak as someone interested in good health care for the individual and also from a public health perspective. I don't think it needs to be emphasized that we need good preventive and continuous care and so again, it will also go a long way toward resolving the issue of health disparities among our population. And we all I think are attuned to that now, that our individuals and groups in our population do not get equal health care and some of it has to do with the eligibility issues, bureaucracy, as well as the quality of health care in general.

And so finally, I would say, P.S., what about all those who are now involved in the eligibility process. Will we have a lot of workers who are involved as you've heard, long hours, looking at computers, doing manuals, over-rides, seeing who's eligible, re-establish eligibility when some families have lost it and trying to avoid the tragedies that we've heard of, the medical tragedies.

And so for those people, we don't want to throw all these good hard DSS workers out of work, and let's turn their efforts instead towards improving care coordination, towards outreach, quality review, some useful activities which contribute to a universal prevention or consistent rather than a kind of bureaucracy and monetary waste which is especially characteristic in the system that we have now. And we've had that well documented.

And so I mention that more for the sake of the minutes and whether the people disagree here, of course, it's hard to say. But I at least think it would be on the agenda for the next two or three years right here in the state, as in other states, a universal program. So much simpler and so much more effective and continuous. Any questions or comments?

SEN. HARP: Thank you very much. Are there questions? Sounds great. Thank you so much for sharing your visionary idea. Appreciate it.

DR. LARRY DEUTSCH: Well, I do hope it won't be so far in the future. Again, there are plenty of models that currently exist.

SEN. HARP: Thank you so much. He was our last speaker who was signed up. Are there any others that care to speak on these two staff briefing reports? Going once, going twice, going three times. If not, this hearing is adjourned.

Whereupon the hearing was adjourned.