Two legislative committees agreed Monday to allow the Department of Social Services to outsource case management work for about 500 people with acquired brain injuries, after defeating a similar proposal about four months ago.
Officials from the Department of Social Services told the two committee that if they didn’t outsource these services they would have to move forward with hiring an additional 17 social workers, which is impossible to do now that the state has implemented a hiring freeze.
“Even if the department were to fill social work positions, it would take over a year for new staff to be fully trained and able to absorb a full caseload and, in the meantime, the department would be out of compliance” with federal requirements, according to DSS Deputy Commissioner Kathleen Brennan.
However, officials said when they get the case management contract into place they will be able to start filling slots at the rate of one per month over the course of the year. Currently, there are about 41 people on a waiting list for services.
Medicaid director Kate McEvoy told the committees Monday that in order to serve people on the wait list they have to have sufficient care management services in place. At the moment, social workers in the department are unable to keep up with their caseloads and the department is failing to meet quality standards set forth by the federal government, which partially funds the program.
McEvoy said the Centers for Medicare and Medicaid Services is concerned that only 60 percent of those individuals on the waiver had timely reviews of their care plans. That’s far short of the 85 percent that is the minimum standard, she said.
Outsourcing the care management services wouldn’t reduce the number of social workers in the department, but it would free them up to work on other types of cases, according to McEvoy.
The state is projected to save about $353,515 in the first year of the contract, $542,171 in the second year, and $584,000 in the third year, according to an analysis by the Department of Social Services.
The Appropriations Committee voted 45-6 and the Human Services committee voted 14-2 in favor of allowing the state to move forward with changes to the waiver.
Rep. Terrie Wood, R-Darien, said she believes DSS has done its due diligence to provide the committees with information regarding the cost savings associated with outsourcing these services.
“They addressed the concerns that were brought up,” Wood said, referring to the rejection of the waiver about four months ago.
At that time, legislators weren’t convinced DSS had made a case that the services should be outsourced. Families and advocates of individuals who receive these services have lobbied against the change.
Dominic Cotton, board member of the CT Brain Injury Support Network, said what the state is losing by contracting out these case management services is the experience the DSS social worker has with the program.
“You’re going to have a new entity come in and it’s going to be a difficult transition,” Cotton said.
But Cotton also acknowledged the difficult spot lawmakers are in with the budget deficit.
“You’re in a hiring freeze and you’ve got more money to cut to get to a budget,” Cotton said. “It’s difficult.”
Advocates are worried about what this will mean for the services they receive.
“I don’t know the blind alley we’re going down right now,” Kathy Johnson, the mother of a brain injury survivor, said. “It is frightening.”
Rep. Jay Case, R-Winsted, said his concern is that the state really isn’t saving any money by contracting out these services because it isn’t shrinking its employee base.
“There’s a lot of open-ended questions,” Case said.
Brian Anderson, a lobbyist for AFSCME Council 4, the union that represents social workers in the department, urged lawmakers to reject the proposal.
He called the outsourcing of case management work the “privatization” of state services.
“The only reason for privatizing these services is to drive down the cost of labor,” Anderson said. “This turns middle class employee jobs into low wage jobs.”
He said many of these private nonprofit workers are paid so little that they qualify for welfare supports.
Earlier in the day, officials from the CT Community Nonprofit Alliance, argued that the state would save money if it contracted with their organizations, instead of directly providing the services to residents.
Jeffrey Walter, interim CEO of the CT Community Nonprofit Alliance, said they would still save the state money if the state adequately funded their services.
Walter said it costs the state $248,000 per client to run a group home. That same operation only costs private providers $130,000 per client, per year. However, he said the state continues to put these homes out to bid at a cost of $120,000 per client, which is about $10,000 too far below costs for the private providers to even bid.
There’s also an inherent conflict of interest when it comes to providing these services.
“How does the state oversee its own services and oversee a private community system as well?” Walter said. “Not very well.”