The Department of Social Services (DSS) is our state’s largest agency with a budget of $4.8 billion last year, over one fourth of the total state budget. DSS provides and oversees health care for almost half a million people; many are among our most fragile, youngest and oldest state residents.
Our state Commissioner of Social Services, Michael Starkowski, has done a great job with a daunting set of responsibilities and has ably guided the agency through some very rough times. The person who replaces him when he retires in a few months should have impressive national credentials.
Passage of reforms of our broken health care system at the national level is by no means a sure thing, but there is great momentum for change. While some final, and very contentious, pieces have yet to be decided, the broad structure of likely reform is fairly clear. All versions of the current reform bills place a great deal of responsibility, and the costs, on states.
It is likely that Medicaid expansions could bring 100,000 new, previously uninsured Connecticut residents into DSS programs. Together with other added responsibilities such as cost containment, care coordination, raising provider payment rates, expanding the health care workforce, and supporting primary care together with staff losses due to early retirements, DSS could easily be overwhelmed.
Health programs at DSS have struggled in the past few years. In 2007, barely half (54 percent) of HUSKY children ages two to nine received well child care, down from 65 percent in 2006. HUSKY families have endured numerous HMO transitions in the last year, causing great confusion for providers, agency staff, contractors, and families. Communications from the department have been inconsistent and late. Implementation of the Charter Oak Plan has been troubled including difficulty recruiting providers and enrolling consumers. There are currently approximately 10,000 people covered by Charter Oak, but over 24,000 have been denied coverage for administrative reasons and over 1,000 people stopped paying their premiums just in May. Some people have asked for their money back.
DSS has been unwilling or unable to implement a Primary Care Case Management option for HUSKY families to serve both as an option for families seeking health care in the program and as a policy alternative to the troubled HMOs for the state. And these troubles affect DSS without the added 100,000 new recipients.
There have been problems in financial and administrative processes at DSS. A recent audit commissioned by the State Comptroller found that the HUSKY rates negotiated by DSS overpaid the HMOs by $50 million last year. Auditors also found serious lapses in the rate setting methodology used and incomplete, contradictory documentation supporting the rates.
Connecticut does not have an 1115 Medicaid waiver which other states have used as an effective tool to cover their uninsured residents, leaving federal money on the table. Legislators, advocates, the Comptroller and the oversight Medicaid Managed Care Council have all reported difficulty getting accurate and full financial information from DSS.
National health reform provides Connecticut with badly needed opportunities to fix health care – for taxpayers, for businesses, and for struggling consumers. DSS must be ready to take advantage of these opportunities; we must make sure that Connecticut is not left behind.
We need leadership with national qualifications to re-build trust with important stakeholder groups across the state to meet these significant challenges and ensure that everyone is working together. We need leadership that understands the challenges facing the consumers DSS serves and respects the deep resilience among those families.
It is critical that DSS and the administration pursue a national search for expertise at DSS. Connecticut families deserve a national leader to shepherd our state’s health care.