A recent follow-up report by the state Auditors of Public Accounts found several of its recommendations regarding the Community First Choice Program have been largely ignored.
The program headed by the Department of Social Services allows elderly and disabled indivduals hire personal care attendants, who are paid with Medicaid dollars.
The audit primarily assessed the timeliness of the application and enrollment process, payment controls, participant assistance, fiscal intermediary role, and overall management of CFC services. The findings indicate that DSS has only partially or fully implemented 31% of the 16 audit recommendations, sparking concerns among state officials.
DSS collaborates with four access agencies across the state to conduct client assessments, create personalized care plans, perform annual reassessments, and work alongside a fiscal intermediary to provide employer assistance and budget management support to clients.
In March, the vendor that pays the PCA’s will change. After years of objecting to paycheck processing errors by a state-contracted payroll vendor, a union representing 11,500 Connecticut home care workers was optimistic as the state prepared to transition to a new fiscal intermediary.
Beginning next March, Michigan-based GT Independence is expected to start operating payroll processing for personal care attendants funded through a handful of state agencies.
The program has seen substantial growth. In fiscal year 2020, it saw an increase in its clientele, with 3,952 clients compared to 1,683 in fiscal year 2016, marking a 134% increase. Expenditures also surged, reaching $125,192,539 in fiscal year 2020, up from $36,419,833 in fiscal year 2016, representing a substantial 243% increase.
The audit report highlighted 16 key recommendations aimed at improving the program’s efficiency and effectiveness. These recommendations focused on integrating data systems, identifying clients struggling with self-direction, tracking historical assessment dates and technical assistance calls, streamlining critical incident report submissions, enhancing data systems, bolstering data integrity, ensuring contracts contain adequate performance measures, and improving fraud investigations and improper payment collections.
Since the release of the audit, DSS has taken steps to address these recommendations. Measures included enhancing the exchange of information between the Strategy and Operations Units’ data systems, improving data system access for CFC staff, adding a CFC-specific feature to the Operations Unit data system, and onboarding new support staff. However, DSS also noted facing competing priorities, including public health emergencies and staffing changes, which have impacted their progress.
Senate Republican Leader Kevin Kelly expressed deep concern regarding the DSS’s partial implementation of the audit recommendations. He emphasized the importance of providing essential services and support to the elderly, vulnerable, and disabled individuals who rely on the CFC program for their well-being and independence.
“This is a failing grade, and that’s unacceptable, especially when you consider how our elderly, vulnerable and disabled are the ones who are being left behind. The State of Connecticut must constantly work to assist individuals with accessing services and supports to enable independence and care in the environments of their choice,” Kelly said. “It must be our priority to provide these individuals the dignity and lifestyle choices they deserve. This follow-up audit shows that it isn’t. Performance must improve, efficiencies must be implemented, taxpayers’ dollars must be respected, and these recommendations must be implemented. In short, DSS must do better.”
