Eligibility Decision Error Rate
OFFICE OF LEGISLATIVE AUDITOR
Performance Evaluation and Research Division
Building 1, Room W-314
State Capitol Complex
CHARLESTON, WEST VIRGINIA 25305
(304) 347-4890
Health care services for the aged and disabled account for nearly two-thirds of all Medicaid expenditures. Medicaid and Medicare together have an enormous economic impact in West Virginia. Almost seventy per cent of nursing home revenue is attributable to Medicaid and more than 60 per cent of all hospital revenue in West Virginia is attributable to these two programs.
Nationally, the Medicaid program consumed nearly 20 per cent of state expenditures in 1995, up from an average of 10 per cent in 1987. In West Virginia, Medicaid consumed 15.2 per cent of the state budget for fiscal year 1995. Medicaid is essentially three programs in one: first, it is a health insurance program for low income parents and children; secondly, it is a long term care program for the elderly; and lastly, it is a funding source for services to people with disabilities. Medicaid is one of the largest expenditures within the Department of Health and Human Resources.
The Department of Health and Human Resources is one of the seven Cabinet-level departments of state government created under legislation enacted in 1989. As its name indicates, the Department brings together health-related programs and human resource programs, which include public assistance and social service programs. Although the Department provides services to individuals in institutional settings, emphasis is placed on community-based service delivery.
Programs within the Department are categorized by similarity of service and function into four bureaus:
Bureau for Children and Families. This Bureau manages public assistance programs, social service programs, and child support enforcement and collections. A citizen might have contact with this Bureau's programs in such matters as eligibility determination for Temporary Assistance to Needy Families, Food Stamps and Medicaid, subsidized work programs, child and adult abuse concerns, and child day care, foster care and adoptions.
Bureau for Community Support. This Bureau provides health and behavioral health services to vulnerable citizens with a particular focus on adults and the aging. Services are provided in the home, community, hospitals, residential facilities and long-term care facilities operated by the state or by other providers.
Bureau for Medical Services. This Bureau is the single state agency charged with administering the state's Medicaid program, which provides medical coverage for eligible clients. The Bureau provides administration and reimbursement for medical services to eligible individuals, such as inpatient and outpatient hospital care, physician services, laboratory, x-ray, behavioral health services, prescription drugs, nursing home and care and several in-home services which keep individuals out of institutional services.
Bureau for Public Health. This Bureau administers and coordinates programs that protect the
health of the public and promotes "Healthy People in Healthy Communities." These programs
include: emergency health services, environmental health services, specialized laboratory
services, enforcement of licensure and certifications for hospital and long-term care facilities, and
the state's medical examiner. A citizen might have contact with this Bureau's programs in such
matters as county health department concerns, maternal and child health programs, information
about communicable or sexually-transmitted diseases, birth and death certificates, emergency
ambulance service, food service sanitation or water and sewage permits, community tobacco
coalitions, family planning or services to children with special needs.
As stated above, the Bureau for Medical Services is responsible for the overall
administration of the Medicaid Program. The Bureau for Children and Families manages public
assistance programs, social service programs and child support enforcement and collection. Each
of the county offices falls under the supervision of the Bureau of Children and Families.
The county offices have two distinct branches: Economic Services and Social Services.
Social Services are responsible for child and adult abuse concerns, child day care, foster care and
adoptions. Economic Services are responsible for public assistance. Public assistance services
provide access to financial assistance for eligible West Virginians to help meet their basic needs
and reach a level of self-sufficiency and well-being.
Public assistance services include eligibility determination, case management and other
client services for Aid to Families with Dependent Children (AFDC), Food Stamps, Job
Opportunities and Basic Skills (JOBS), Medicaid, Title IV-A Emergency Assistance,
Low-Income Energy Assistance Program (LIEAP), Indigent Burial Program, Transportation
Remuneration Incentive Program (TRIP), and the Donated Foods Program.
Congressional proposals in 1995 and 1996 to make substantial changes to Medicaid
stimulated debate at all levels of society and government. A variety of proposals received serious
consideration, but key congressional leaders and the president could not reach a compromise for
any major program changes. Key proposals that shaped the debate and may serve as foundations
for future deliberations include the "Medigrant" bill that passed Congress and was vetoed by the
president in December 1995; the Clinton administration proposal; the proposal adopted by the
National Governors' Association in February 1996; and the Medicaid Restructuring Act of 1996.
The National Conference of State Legislatures also has several policies related to reforming
Medicaid.
The recent welfare reform legislation (the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996), signed August 22, 1996, affects Medicaid in several ways:
This report contains references to Aid to Families with Dependant Children
(AFDC) and its links to Medicaid eligibility. In general, however, people who meet
AFDC eligibility criteria that were in effect on and prior to July 16, 1996 will be eligible
for Medicaid. Accordingly, references to AFDC in this report should by read as
references to the "frozen" July 1996, AFDC criteria.
Federal statutes and regulations largely dictate who is eligible for coverage in the
Medicaid program. Over the past thirty years Medicaid eligibility standards have been
progressively broadened to cover the medical costs of more groups of individuals who are
aged, blind, or disabled, and members of low-income families with dependent children.
Federal regulations specify a broad range of groups that must be covered (coverage
groups) by the Medicaid program if the state chooses to participate in the Medicaid
program. A few groups may be included or excluded at state option. The basis for
Medicaid coverage is classified as either Categorical Need or Medical Need.
The groups referred to as the Categorically Needy include:
Within both the Categorically Needy and Medically Needy categories, some coverage groups are mandatory and others are optional.
More than 261,000 West Virginians received Medicaid benefits in January 1995.
Among these recipients, about 245,000 (94%) were classified as Categorically Needy.
The remaining six (6%) per cent are classified as Medically Needy. The State of West
Virginia has provided the optional Medicaid coverage to the Medically Needy group since
1976.
Starting in 1988, federal mandates began requiring states to expand coverage to
include new classes of eligible individuals. For federal fiscal year (FFY) 1994, there were
47,800 recipients (thirteen (13%) per cent of the total recipients) who were covered under
the federally mandated expansions since 1988. Of this total, over 27,400 were either
caretaker relatives of covered recipients or pregnant women. The cost to provide care to
this group for FFY 1994 was $203.7 million, or sixteen (16%) per cent of the total $1.3
billion budget.
As related to the specific issue addressed in this report, a sample of 455 active Medicaid cases were taken from recipients deemed eligible to receive benefits on October 31, 1995. The date was chosen because it predates initial RAPIDS implementation. This guaranteed that case files would be available for review in paper form. Certain eligibility categories were excluded from the study because the eligibility decision is not made by an economic services caseworker in the county office. Aged, blind and disabled SSI cases were excluded because the eligibility determinations are made at the federal level. Boarding Care or Foster Children cases were excluded because the decision is made by social service caseworkers. Cases with the deprivation factor of Not Medical (NM) were excluded because these cases do not actually receive a medical card, this designation is a bookkeeping code used under the OBRA system.
The cases were evaluated based on Federal guidelines as set forth in the Income Maintenance Manual. Eligibility was distilled into three basic components: characteristics; income; and assets. Characteristics are the causal elements which qualify an individual for aid. Characteristics include, but are not limited to, age, absence, disability and pregnancy. Income refers to the applicable income limits for specific coverage groups. Assets refer to the applicable asset limit for specific coverage groups which require an asset test.
The Office of Quality Assurance, within the Department of Health and Human Resources, conducts internal evaluations of the Medicaid program and calculates the sanction rate. Quality Assurance bases the sanction rate on the amount of dollars in error, while this study examines cases in error. This means that if a case reviewed by Quality Assurance is in error, but the client has not consumed benefits, then the error is not reflected in the sanction rate. However, this study was developed to test the accuracy with which eligibility rules are followed at the county level, not to impose federal sanctions. Therefore, all cases in which errors were made in the eligibility determination are included in the results. Quality Assurance has the legal authority to investigate Medicaid cases in greater detail. Unlike the Legislative Auditor, they have the authority to make visitations to the homes of recipients and examine bank records, in order to verify eligibility.
The 455 case files were obtained from county offices and reviewed to determine if
the eligibility decision, which rendered the recipient eligible to consume benefits on
October 31,
1995, was correct. The determination was made with an instrument designed by the
Legislative Auditor to test cases for compliance with state, federal and program
guidelines. Audit staff attended Kanawha County eligibility training sessions. These
sessions are the standard instructions provided to county caseworkers. Case reviews
conducted in county offices were discussed with supervisors.
ISSUE AREA: OF THE CASES REVIEWED, MEDICAID
ELIGIBILITY POLICY AND PROCEDURES WERE NOT
FOLLOWED IN 16.5% OF THE CASES
West Virginia maintains a consolidated eligibility manual which contains the
policy and procedures for the State's public assistance programs. The Manual was
consolidated in the late 1970's as the Economic Services Manual. In 1995, the entire
Manual was rewritten and titled the Income Maintenance Manual. This Manual serves as
the authority for all eligibility decisions. It is updated periodically as required by
changes in federal or state laws, clarifications, and other administrative modifications.
To determine whether eligibility decisions are made correctly, a sample of 455
cases was drawn. The cases were sampled from cases determined to be eligible to receive
benefits on October 31, 1995. Therefore, the cases were evaluated based on policy that
was in place prior to the advent of TANF (Temporary Assistance for Needy Families)
and West Virginia Works Programs. These cases were evaluated based on Federal and
State guidelines as laid forth in the Income Maintenance Manual. Medicaid Eligibility can
be distilled into three basic components: characteristics, income and assets.
Characteristics are the properties that qualify someone to receive benefits. These
characteristics include, but are not limited to, absence, age, disability and pregnancy.
Income refers to the applicable income limits for each coverage group. Assets refer to the
applicable asset limit for each coverage group (for coverage groups with an asset test).
Of the 455 cases sampled, 75 cases (or 16.5%) were found to contain errors. Errors include: incorrect eligibility decisions (10 cases representing 13.3% of the total errors); lack of verification such that a proper determination of eligibility could not be made (51 cases representing 68% of the total errors); or the entire file or relevant application had been lost (14 cases representing 18.7% of the total errors;. In cases where an incorrect eligibility decision was made, the most common mistake was that the client's income exceeded the allowable income limit. The remainder of cases which make up this type of error are listed as miscellaneous errors and include: the client's review completed late; client not completing the application; the client moving out of state and the case was not closed on time; and the client not satisfying the necessary qualifications for a particular aid category.
The errors characterized by lack of verification include no verification of client's
reported income, and the largest error type, no verification of client's reported assets.
The rest of the errors include missing files, applications, or sections of the case record.
Of the 75 errors contained in the sample, 81 per cent or 61 cases were the result of a
misapplication of eligibility policy (all errors except for lost cases; see Table 1).
Table 1 Summary of Errors by Type |
Type of Error | Number of Cases | % of the 455 Cases Sampled |
No verification of client reported income | 7 | 1.5% |
No verification of client reported bank accounts | 43 | 9.5% |
Client's income exceeded program limits | 6 | 1.3% |
File or relevant application was lost or missing | 14 | 3.1% |
Miscellaneous errors | 5 | 1.1% |
Total Errors | 75 | 16.5% |
CAUSAL FACTORS
Decentralized and Inconsistent Policy Training
Errors in the sample such as no verification of income, no verification of assets or
the client was over income, may be the direct result of insufficient training, especially
when each worker is required to handle such a large number of cases. In a letter from the
former Acting Commissioner of the Bureau for Children and Families, policy knowledge
of the field staff was addressed. The former Commissioner stated that "there has been a
lack of centralized, consistent policy training offered to field staff over several years that
has created an additional burden on field supervisors."
One reason why training is inconsistent is the lack of a statewide consolidated
training manual. Each trainer would have instructed each worker with their own
interpretation of the Income Maintenance Manual. In 1995 two regional trainers were in
place. Region I has had a regional trainer since 1992, Region II since 1991. For the
remaining two regions, Region III and Region IV, each of the supervisors were responsible
for training in their respective offices. Since training was the responsibility of individual
supervisors, over twenty-seven (27) different people (two regional trainers and 25
supervisors for Regions III and IV) would have been charged with the training of their
staffs. In 1995 there were 468 workers. This means that each individual would have
been in charge of training an average of 17 individuals, each instructor teaching a different
format of the 35 entrances into the Medicaid program. Interpretation of the Income
Maintenance Manual varies from supervisor to supervisor. A policy survey was
conducted among the Economic Service Supervisors. This survey was faxed to each of
the supervisors in the county offices. The survey contained a question regarding the
verification of assets (the single largest source of errors). The question dealt with the
necessity of verifying bank accounts. The policy states that for programs which have an
asset test, all bank accounts must be verified at application and when a change is reported.
This is regardless of the amount contained in the bank account. Of the 39 supervisors
responding to the survey 14 (36%) posted responses that were inconsistent with policy.
Table 2 contains a sample of responses to the survey questionnaire.
Table 2 Supervisor's Responses from Policy Survey |
"We do not verify bank accounts reported to be below $100." |
"Unless there are other assets beside checking and savings we normally do not verify the assets if the customer states that these accounts are for depositing their monthly checks and for paying their monthly bills and the current balance is below $100." |
"Verification of assets is being done at the workers discretion depending on the amount and the client involved. The workers verify all questionable assets." |
"If the combined assets are near the maximum asset level and the worker questions the amount in the bank accounts, it can be verified." |
"Bank accounts of this nature are not routinely verified. However, if the worker believes there may be a problem then verification is requested. Also if there are other assets involved which are near the asset maximum, then bank verification may be needed." |
"We verify the bank accounts if the assets are close to the countable assets for the program for which they are applying. We verify all Nursing Home bank accounts and Medicaid Waiver bank accounts." |
"We have always verified any information that we question. We have verified bank accounts much lower than $100 if we question the validity of a customer's statements." |
"For medical coverage groups with an asset test and a small bank account may need verified because if it puts the case over the asset limit then the case would be ineligible and the customer would not get the benefit of the Medical help." |
Errors in the sample such as no verification of income, no verification of assets or income over the allowable limit, may be caused by a confusing reference tool. Medicaid policies are inherently complex and difficult to understand. This was one reason why the Income Maintenance Manual was compiled in 1995. The Income Maintenance Manual is designed to be a ready- reference tool. This Manual is two volumes and 23 chapters. Each volume is three inches thick. It has had 75 updates since 1995. The former Director of the Policy Unit stated that the Manual needs to be updated whenever eligibility changes are required due to changes in laws, clarifications, or other administrative modifications.
The policy contained in the Income Maintenance Manual is not in a format that is user friendly. To determine if someone would have been eligible for AFDC, one would need to refer to the following chapters:
This needs to be done at intake and does not take into account whether or not the person is eligible for Food Stamps. It also does not take into account whether the person would have to quarterly report nor does it account for any other aspect of the case maintenance process.
The Income Maintenance Manual is difficult to understand because it contains both policies and procedures. Many of these procedures are now performed automatically by RAPIDS. This issue is now being addressed by the RAPIDS team and the Policy Unit who plan on putting the Manual completely on-line on RAPIDS. The Director of the RAPIDS project offered the following comments:
One of the issues yet to be resolved is the detail to be included in the on-line manual.
The present Income Maintenance Manual is a policy and procedure manual. The
decision has not yet been made as to the necessity of having procedures in the on-line
manual other than those procedures that are carried out external to the system. Once
that decision is made, the process of putting the material together to up-load to
RAPIDS will begin. The target for the new manual development has been moved
back to January, 1998 due to the necessary work for both the Policy Unit and
RAPIDS team relating to welfare reform.
However, simply extracting the procedure portion from the Manual will not solve the
problem. Once you have located the applicable policy, the difficulty is not over. Consider the
following excerpt from the Manual:
The Social Security Act provides for the crediting of quarters of coverage based on
yearly earnings including deemed military wages (the amount of deemed military
wages must be determined by the SSA) divided by the amount required to qualify a
calendar quarter as a quarter of coverage. ...However, special treatment is required if
the individual is self-employed. If the taxable year is a calendar year, or begins with or
during a calendar year, and ends with or during the same calendar year, the
self-employment income will be credited to that calendar year. If the taxable year is
not a calendar year, the self-employment income will be allocated proportionately to
the two calendar years, of which portions are included in the taxable year, on the basis
of the number of months which are included completely within the taxable year.
The current format of the Income Maintenance Manual serves only to provide the
information without regard to the reader's circumstances. Although Medicaid policy is complex,
it is no more inherently complex than tax law, yet a tax form is constructed so that most citizens
can complete it without previous tax training. A tax form is designed to guide the user, not just
distribute information. Consider the previous example of quarters of coverage in a new format:
Quarters of Coverage: Is the applicant self employed? If yes, go to Section B, if no,
go to Section A.
Section A:
Step 1 - Add Yearly Earnings plus deemed military wages (as determined by the SSA)
Step 2 - Take the amount from step 1 and divide by the amount required to qualify a calender
quarter as a quarter of coverage.
Quarter of Coverage = (yearly earnings + deemed military wages) âamount required to qualify a
calender quarter as a quarter of coverage
Section B:
step 1- Is the taxable year a calendar year? If yes, go to step 3, if no, proceed to step 2.
step 2- Is the taxable year fall completely within a calendar year? If yes, go to step 3, if no, go to
Section C.
step 3- Consider the self-employment income to be yearly earnings and go to step 4.
step 4 - Add Yearly Earnings plus deemed military wages (as determined by the SSA)
step 5 - Take the amount from step 4 and divide by the amount required to qualify a calender
quarter as a quarter of coverage.
Quarter of Coverage = (yearly earnings + deemed military wages) âamount required to qualify a
calender quarter as a quarter of coverage
Section C: Allocate the self employment income to the two years covered using the following
formula:
Year 1
step 1 - Divide the number of months worked during the first calender year by 12.
step 2 - Multiply the self-employment income by the number from step 1. This is the yearly
earnings for year 1.
step 3 - Add Yearly Earnings plus deemed military wages (as determined by the SSA)
step 4 - Take the amount from step 3 and divide by the amount required to qualify a calender
quarter as a quarter of coverage.
Quarter of Coverage for year 1 = (yearly earnings + deemed military wages) âamount required to
qualify a calender quarter as a quarter of coverage
Year 2
step 1 - Divide the number of months worked during the second calender year by 12.
step 2 - Multiply the self-employment income by the number from step 1. This is the yearly
earnings for year 2.
step 3 - Add Yearly Earnings plus deemed military wages (as determined by the SSA)
step 4 - Take the amount from step 3 and divide by the amount required to qualify a calender
quarter as a quarter of coverage.
Quarter of Coverage for year 2 = (yearly earnings + deemed military wages) âamount required to
qualify a calender quarter as a quarter of coverage
This revision would save the caseworker time in two ways. First, it limits the text that
needs to be read to only portions of the policy that apply. Second, it eliminates the time it would
take the reader to determine what policy needed to be applied. If an online manual were
developed in this manner, it could produce on-line prompts which would save more time and
increase accuracy by telling the reader exactly which information to supply or insert.
Levels of supervisor case review insufficient
Errors in the sample such as no verification of income, no verification of assets or the client was over income, may be the direct result of lack of supervisor case review. In an environment where policy is complex and always changing, knowledge levels are suspect, supervisor review is even more essential. However, in a letter from the Secretary of the Department of Health and Human Resources, the Secretary stated that "from 1994 through February 1996 mandatory supervisory reviews required the review of 5 Medicaid Cases by every supervisor every month. The supervisors were instructed to review cases that in their judgement were error prone." In 1995 there were 42 Economic Service Supervisors. If each supervisor reviewed 5 Medicaid cases a month, then the total number of Medicaid cases reviewed would have been 210 cases per month. Assuming that each supervisor reviewed different cases each month, then the total number of Medicaid cases reviewed during the year would have been 2520 cases. In 1995 the total number of Non-Assistance (medical assistance only) Medicaid cases was 125,837. This means that the supervisors were required to review two per cent (2%) of Medicaid cases (see Table 3).
Table 3 Summary of Medicaid Cases Reviewed for 1995 |
Total Number of Economic Service Supervisors | 42 |
Number of Cases Reviewed in One Year (assuming no case was reviewed twice in the same year) | 2,520 |
Total Number of Medicaid Cases for SFY 1995 | 125,837 |
Percentage of Cases Reviewed | 2% |
In addition to the five Medicaid cases, each supervisor was to review 20 AFDC cases.
Applying the same analysis techniques found above yields slightly different numbers. If each
supervisor reviewed 25 public assistance cases a month (5 Medicaid and 20 AFDC), then the
total number of public assistance cases reviewed would have been 1050 cases per month.
Assuming that each supervisor reviewed different cases each month, then the total number of
public assistance cases (Medical Assistance Only and AFDC) reviewed during the year would
have been 12,600 cases. In 1995 the total number of public assistance cases was 263,907. This
means that the supervisors were required to review less than five per cent (5%) of all public
assistance cases (see Table 4).
Table 4 Summary of Public Assistance Cases (Medical Assistance Only and AFDC) Reviewed for 1995 | |
Total Number of Economic Service Supervisors | 42 |
Number of Cases Reviewed in One Year (assuming no case was reviewed twice in the same year) | 12,600 |
Total Number of Medicaid Cases for SFY 1995 | 263,907 |
Percentage of Cases Reviewed | 5% |
It has come to my attention through conversation with my staff and from a recent
USDA Corrective Action Monitoring Report that not all Supervisors are completing
the reviews or are completing less than the required number. I would like to remind
you that this activity is considered mandatory for all Supervisory Staff that supervise
line staff directly. If the time factor is a problem, we recommend that only the error
prone elements listed be checked. These elements account for 66% of the dollar
errors in the Food Stamp Program. We are looking for optimum results for the time
involved....I am sure you would agree that consistent and uniform application of
basic corrective action is the key to successful reduction in the error rate in West
Virginia.
The Secretary further stated that "the Department of Health and Human Resources
discontinued mandatory case record reviews when RAPIDS was implemented. These reviews
became obsolete as the paper record now contains old information." There are two regions
currently implementing experimental case reviews in RAPIDS. Due to the newness of each of
these methods of supervisor review, there is no data currently available as to their effectiveness.
Lost Cases
Another factor contributing to the error rate is the number of lost cases. Nineteen per cent (19%) of the error cases are cases where either the file was lost, a particular application was lost or sections of the case record were lost. In one instance, one of the DHHR offices had recently changed locations and some of the case records were lost. Another possible explanation is that some of the older material contained in the case records had been purged. Some of the recipients may have moved from county to county and the case records were lost in the transfer. The final possible explanation is the sheer bulk of case records on hand makes it difficult to store the records properly.
Other Potential Causes
One potential cause is caseload. In March 1993 the Department of Health and Human
Resources (DHHR) established a caseload standard. The caseload standard was set at 360 cases.
In 1994 the average number of cases per worker per county, based on allocated positions,
exceeded the standard by 218 cases. In 1995, the average number of cases per worker per county
exceeded the standard by 166 cases (see Table 5). In 1996 the county offices began converting
cases to RAPIDS. Since RAPIDS does not track recipients the same way as the C-219 and
M-219 eligibility systems, current caseload information was not available.
Table 5 Summary of Caseload Data |
Year | 1994 | 1995 |
Total Number of Allocated Positions | 487 | 516 |
Total Number of Cases | 243,929 | 263,907 |
Average Number of Cases per Worker per County | 565 | 513 |
Caseload Standard | 360 | 360 |
Average Number of cases in excess of standard | 218 | 166 |
Source:Department of Health and Human Resources, Office of Audit Research and Analysis |
In addition to the causes above, there may be additional causes for errors which there is
currently no evidence to support. One of these causes could be pity on the part of the
caseworker toward the client. This could affect cases where the client was over income my some
small amount and the caseworker simply overlooked the discrepancy.
Another such cause could be apathy on the part of the caseworker. This could affect
cases where the client claimed a bank account with a very small balance and the caseworker did
not think that it would affect the client's eligibility.
EFFECT
The effect of misapplied policies and procedures is that funds are spent incorrectly. For the 455 cases in the sample, the total expenditures were $1,239,900. Cases that contained a correct eligibility decision accounted for 88.20% of all expenditures or $1,093,557. This includes four cases which were miscoded by the worker. Several of these miscoded cases were cases in which the clients income was excessive for the program that the worker placed them in, but there incomes were not excessive for other programs. Therefore, these clients would have still been eligible despite being placed in the wrong category. Total expenditures for sampled cases determined to be in error were $146,343 accounting for 11.8% of total sample outlays.
Table 6 Summary of Outlays for Eligibility Sample |
Type of Case | Total Number of Cases | Dollars Consumed |
Correct Cases | 376 | $1,092,577 |
Miscoded Cases | 4 | $980 |
Total for Correct Cases | 380 | $1,093,557 |
No Verification of Income | 7 | $3,914 |
No Verification of Assets | 43 | $86,552 |
Client Over Income | 6 | $9,845 |
Lost File, Application, or Review | 14 | $26,420 |
Miscellaneous Errors | 5 | $19,612 |
Total for Error Cases | 75 | $146,343 |
Total Expenditures | 455 | $1,239,900 |
CONCLUSION
Since October 31, 1995, the Department has taken steps to address these problems. Cases where the client was over income should no longer happen (barring collusion with an employee) since RAPIDS will automatically determine if the client is eligible based on their reported income and the applicable income limits. To help with training, each Region has developed a regional trainer. Currently the Department is in the process of developing a statewide training manual. The Department is also in the process of putting the Income Maintenance Manual on-line, although the Director of the RAPIDS project stated that the RAPIDS team is working with the Office of Family Support Policy Unit to ensure that the policy in the system is identical to the printed manual now available in local offices. Although these measures address several of the causal factors, at least in part, there is no assurance they will address all types of errors, especially verification errors--the most common type of error identified in this study.
RECOMMENDATIONS
Recommendation 1:
The Department of Health and Human Resources should conduct a needs assessment to
measure where training is lacking in both preservice and inservice. Training modules should be
developed to fill the training gaps and standardize training for basic operations.
Recommendation 2:
The Department of Health and Human Resources should develop a stepwise policy
manual with a decision tree format that will eliminate interpretation differences and facilitate easy
reference.
Recommendation 3:
The Department of Health and Human Resources should develop a new method of
supervisor case review and ensure that the level of review is sufficient.