The reason is a chicken-and-egg feedback loop that’s been transferring personal responsibility to government. Nobody knows where it all started, so the story here will arbitrarily begin with households in Buncombe County. Today, one in five families is receiving government food assistance, and one in five are Medicaid beneficiaries.
But more than one in five people in Buncombe County are dependent on government. According to a 2012 count, with just shy of 16,000 employees, government comprised 14.0 percent of Buncombe County jobs. The government sector also paid the highest average wage, close to $45,500. As Stone pointed out, every dollar these people spend from their income, as well as every dollar of welfare benefits spent, supports local grocers, landlords, and healthcare professionals.
Progressive media outlets, like Salon and Mother Jones love to hate Walmart for its capitalism, and yet the low-price retail giant is believed to collect 18 percent of the $80 billion annually disbursed by SNAP, the new name for federal food stamps. Salon estimated 80 percent of the store’s workers were on welfare, but those numbers have since come under fire.
As the population continues to outpace employment, even with redefinitions of “fulltime” intended to hide the problem, the situation can only get worse. But compounding the problem of trying to help the poor is increasing administrative requirements from both state and federal governments.
North Carolina is still converting its administration of the food stamps program to a new computer system, NC FAST. In the early stages of the transition it was hard to miss the pathetic autonym, as computer glitches were standing between people and food, sometimes for months. Now that the bugs have been largely ironed out, the program is far from the Eden of which its promoters dreamed. If and when the transition is complete, NC FAST will combine the old system of seventeen silo programs with neither duplication nor gaps.
But before all that could get sorted out, Obamacare came on the scene with requirements that all welfare be administered centrally by states, and North Carolina’s 30-year-old computer system falls short of federal standards. It can’t be made compatible with the Federally-Facilitated Marketplace, and upgrades will require time, and additional staffing.
The NC DHHS provided estimates of resources needed to bring counties up-to-speed with the new programs. Buncombe County was told it would need 82 new hires at an estimated annualized cost of $2,680,195. Ever pragmatic and out of deference to taxpayers, Buncombe County management identified tremendous efficiencies.
But implementation won’t be easy. Federal guidelines require anybody handling the Consolidated Management System to be a “merited government employee.” They forbid contracts and require the county to offer health insurance to all county employees working thirty hours or more. Training people with the admittedly complex system is expected to take 9-12 months, so the county can no longer hire through a temp agency.
Stone said failure would be “certain” without the requested hires. If the county refused to hire more staff, it would first be subject to a round of penalties for noncompliance in the form of withdrawn federal funding. Short-staffing would inevitably result in backlogs, which would prevent people in need from getting essential services. Pushed to sacrifice accuracy for speed, staff would start making more errors in eligibility screenings. And this would subject the county to a second round of penalties. Meltdown could result in the state taking over administration of Buncombe County welfare and slapping the county with the bill.
During the ugly in-between-stages, data entry has grown monstrously. Stone said all the extra upfront data entry was supposed to pay off with superior retrieval capability. Instead, the county now finds itself spending more time than before tracking three types of Medicaid. Stone showed flow charts of the old and new systems indicating the number of steps for processing food assistance applications and recertifications have increased by more than half.
The average time spent processing a food assistance application has increased from 55 to 109 minutes, while the average recertification time has increased from 23 to 45 minutes. Processing time for family Medicaid applications has increased from 60 to 124 minutes; recertifications slowing from 46 to 88 minutes. Adult Medicaid processing has sustained the least damage with applications slowing from 105 to 147 minutes, and reviews increasing from 45 to only 57 minutes.
The timing for foisting the big learning curve upon HHS employees was not at all good. Stone shared some data from the last seven years. In 2007, the number of families on food stamps was 8995. Last year, it was 20,636. Over the same period, the number of applications processed rose from 1002 to 1650.
Stone shared the county’s expenditures on the transition during the last fiscal quarter, half of which will probably be reimbursed by larger government entities, all tax collections nonetheless. Overtime cost $323,762; new salaries with benefits, $1,020,963; direct-hire temps, $466,636; agency temps, $276,122; and reassignments, $120,646. The county expects no reimbursement for the $25,917 it spent on Ingle’s gift cards for families “whose food assistance cases were held up in NC FAST.”
From 2007-2014, the number of Medicaid recipients rose from 34,165 to 44,174. The number of applications processed each year rose from 1609 to 2371. If the state continues to reject Medicaid Expansion, the number of recipients is expected to remain flat, between 44 and 45,000 through 2016. If Expansion is approved, the number could rise over 56,000.
So far, Buncombe County has received 4006 applications for insurance from the Obamacare “Marketplace.” Of these, 1029 were approved for Medicare. It took on average 2.07 hours to process an application, which will be good for only one year. Stone annualized the investment to 8292 man-hours, or the equivalent of six fulltime employees. If Medicaid Expansion is approved, Stone will have to ask the commissioners’ permission to hire yet another 30 employees.