The Children's Aid Society

Testimony to the NYS Assembly on Disaster Relief Medicaid Transition and Family Health Plus

February 4, 2003

Kate Lawler, Program Director,
Health Care Access Program (HCAP), Children’s Aid Society

Testimony Before the New York State Assembly’s Committee on Health and
the New York City Council’s Committees on Health, General Welfare, and Oversight and Investigation

Friday, January 10, 2003

I would first like to thank the State Assembly Committee on Health and the City Council’s Committees on Health, General Welfare, and Oversight and Investigation for holding this hearing and for giving me the opportunity to present the Children’s Aid Society’s perspective on the Disaster Relief Medicaid (DRM) transition and Family Health Plus implementation.

Over the past 5 years, the Children’s Aid Society has walked thousands of adults and children through the process it takes to get public health insurance in New York. Over the past year, we have experienced firsthand the incredible contrasts between the simplicity and speed of Disaster Relief Medicaid and the complexity and delays of our “normal” enrollment system.

The two issues I would like to address are: 1) why so many DRM beneficiaries were lost in the transition process, and 2) what problems we are currently facing with Family Health Plus (FHP) implementation.

DRM Transition

In the DRM transition process, as with our ongoing programs, there is a fundamental mismatch between the reality of applicants’ lives and the requirements of the enrollment process. On the one hand we have the complex and ever-changing lives of human beings – temporary and episodic work, informal and unstable housing, relationships that break up, people moving in and out of households, and a rich tapestry of languages and cultures. On the other hand, we have an equally intricate and multi-faceted application system that can barely keep up with its own complexity. So, when you take the complexity of real-life and try to filter it through this immensely complicated system, it actually seems harder to explain how people make it through the enrollment process than to explain why they get lost.

The reasons that people could not make it through the DRM transition are the same reasons that hundreds of thousands of New Yorkers who are eligible for public health insurance remain uninsured. What is different about DRM is that we had a more “controlled experiment.” We had a finite population that we were tracking over a specific period of time. The large number of people who did not transition from DRM to ongoing coverage is quantifiable and tangible. Until the DRM experience, the hundreds of thousands of low income New Yorkers who were in need of public health insurance but unable to make it through the process of obtaining it were largely invisible.

As long as the Medicaid program has existed, people have quietly gone into Medicaid offices and left, never to return because no one in the office spoke their language or because they knew they would never be able to get all the documents required on the list. We could never quantify the number of eligible but uninsured New Yorkers who never even try to apply for public coverage because they hear the talk on the street about how you have to bare your soul -- from who and where your child’s father is, to how you pay your rent, to whether you feel guilty about using alcohol and drugs. We’ll never know the stories of all those who just don’t want to put a friend or family member at risk by revealing on the application that they are doubled up in a room without the landlord’s knowledge or living with an undocumented relative.

With DRM, low income New Yorkers in need of health insurance were not afraid or discouraged from coming out to apply. They were visible in the lines that wrapped around HRA offices and in the magnitude of the DRM enrollment numbers. Unlike those who came before them, we noticed when the DRM population was unable to make it through the complexity of the “normal” enrollment process. Their reasons are no different from the scores who have been invisible in the past and who will remain invisible in the future unless this system changes.

Just as there are multiple reasons within the lives of applicants that they cannot make it through the enrollment process or never even try, there are chronic problems within the system itself that kept people from successfully transitioning. Computer glitches, data entry errors, notices and cards that never arrived in the mail, and a myriad of other snafus that you could not even make up if you tried, kept people from transitioning. These mix-ups occurred despite the best of everyone’s intentions at the city and state. The fundamental problem is the underlying complexity of the system, and until it is simplified, people will continue to lose or never secure the health coverage they need.

FHP Implementation

I want to end with a few words about Family Health Plus implementation. We are now almost a year into FHP enrollment here in the city and the biggest problem we face are the delays from application to activation of coverage. On average, it is taking between 2 and 5 months, and often much more, from the time a person completes an application until she has a Family Health Plus card. These delays are the result of an enrollment system that hinges on a whole series of interfaces between HRA, Maximus, the state, and the managed care plans. Even in the best-case scenario, when all of these connections are made without a hitch, a 2 to 3 month wait can be expected. More often than not, some snag is hit along the way setting off a wait for 4, 5, 6 or more months.

None of the problems that I have described today are unfixable. We saw through DRM that where there is a will, there is a way to offer public health coverage simply and immediately. The real question is whether we have the will to do so. We are talking about the health of low income New Yorkers. We are talking about their ability to receive regular check-ups, get their blood pressure and asthma medications, have disease diagnosed at the earliest stage possible, and receive treatment for chronic and disabling illnesses. The blinding complexity of our enrollment system allows us to forget that that is what is at stake. If the political will exists to make the health of uninsured New Yorkers a priority, then the resources and brainpower that currently go into managing the complexity of our current system should be redirected to figuring out how to make it actually work.

Thank you again for the opportunity to testify at this important hearing.