Wake boosts staff to deal with Medicaid, food stamp backlog

Wake Assistant Human Services Director Liz Scott said Monday that the county is three to four months behind in processing applications for Medicaid, which covers health insurance for low-income children, parents, seniors and the disabled. County officials say a $1.7 million expansion in social services staff approved by the Board of Commissioners on Monday will help them catch up and keep current, but not until October.

"We have a very challenging Medicaid implementation ahead of us," Scott told commissioners Monday. "We are not currently meeting our deadlines for processing Medicaid applications."

Commissioners unanimously approved the proposal to add 36 full-time positions in the division to help keep up with growing demand for social services like nutrition and Medicaid benefits. About half of the funding will come from the federal government through Medicaid administration funds.

"To me, the biggest issue is that, as the county grows, we've seen a doubling of the clientele," Wake County Commissioner Joe Bryan said. "That's one of the major reasons we need to expand."

Scott said her staff has been overwhelmed by both the increase in social services cases and challenges with the rollout of the state's NC FAST system, implemented gradually in 2013 to help streamline the delivery of food stamps and eventually other social services, including Medicaid.

"We may hopefully see some efficiencies in the system. We are not seeing them as quickly as we initially thought," Scott said. "We would have had a different approach a year ago had we known then what we know now."

For several weeks in January and February, county case managers worked overtime and weekends alongside state support staff to clear the majority of the food stamp backlog by a Feb. 10 federal deadline.

But the implementation of Medicaid, she said, will prove even more challenging.

"We have learned that our Medicaid implementation is going to be different than it was for food and nutrition services," Scott said. "We are going to have to enter all of these cases individually as opposed to having an automated conversion."

Medicaid applications from the federal marketplace put in place by the Affordable Care Act, which have not yet arrived, will complicate things further.

But Scott said the root cause of problems with Medicaid predate both NC FAST and issues with the ACA. The biggest impact has come from the overwhelming growth of cases, which for family and children's Medicaid grew by almost 45 percent over the last five years, to about 53,000 annually.

"We have not really met the targets for Medicaid processing in a year," Scott said. "So, we've been pretty consistently behind."

With the boost to staffing, Scott told commissioners the agency would be able to catch up on the backlog in Medicaid cases by an internal goal of Oct. 1.

The expansion of Wake's Division of Social Services comes in addition to the $1.8 million commissioners originally approved through 2014 for the NC FAST transition. That funding covered temporary workers and overtime.

The new money will allow the county to pay $820,000 in overtime and temporary worker wages. About 65 percent of that one-time amount will be reimbursed by the federal government.

Another $870,000 will fund the 36 additional case managers, supervisors and administrative staff the division says it needs to keep up with demand. The new positions expand the size of the current staff by about 17 percent, to 248 employees. The county will cover about 57 percent of that cost, with the federal government covering the remainder.

Scott noted the maintaining the increased staff will bring additional costs for the 2015 fiscal year of about $1.96 million, although she said the new workforce will be evaluated annually to determine whether they're still needed.

"We're really looking at every process we have and sort of tearing it apart and starting over as to what the best way is to address this so we do not get a backlog again," Scott said.