By Leslee Kulba- Way back in June of 2014, the county’s Economic Services Director Phillip Hardin lamented before the Buncombe County Commissioners, “To some extent, it was like a perfect storm that happened all at one time.” He was referring to demand for welfare services exploding, attempts to mainstream the behaviorally challenged, transitioning to the state’s flawed and glitchy NC FAST computer system, and finding out what was in Obamacare after it was passed. The comments provided a bird’s-eye view of why the county was going to increase its social services budget by $3.6 million. That was on top of $373 million the Department of Health and Human Services expected to collect, mostly from state and federal sources.
As Obamacare rolled out on the national level, 49,000 Medicaid cards for North Carolina children were mailed to the wrong address, food stamps for just about everybody in the state got held up in lengthy processing cycles, and ubiquitous commercials flooded the networks telling people they might be surprised to find out they’re eligible for food stamps, which would give them a beautiful body. During the budget process that year, County Manager Dr. Wanda Greene warned the commissioners that the problem was not going to go away anytime soon.
But nobody’s blaming Buncombe County. Fiscal conservatives have nothing but praise for the competence and professionalism of Greene and Assistant County Manager Mandy Stone. The problem is, county management controls only about ten percent of its budget. The rest is mandated by state and federal law, and those laws go beyond mandating targets to micromanage. For instance, they required the state to use NC FAST when it was replete with glitches, they set supervisor-to-worker ratios lower than some departments may deem necessary, like 5:1. And now, with Obamacare, those guidelines have become moving targets.
These days, getting notices from the federal government for noncompliance with changed guidelines is part of American culture. And so it should come as no surprise that North Carolina was one of several states to receive an Advanced Warning Letter from the USDA back in May. To keep getting its $75,610,621 annual federal subsidy, $7.9 million of which would go to Buncombe, the state would have to, as Stone put it, “achieve and maintain a 95% statewide timeliness rate for the 6 month period of January –June, 2016, an increase from a previous 85% statewide timeliness standard.” Since most demand for social services comes from the counties with large urban centers, the onus is on those few counties to bring the state percentages up. What’s more, losing the money would in no way absolve the county leaders from their compassionate and mandated responsibility to provide social services.
It’s no secret that the needs of the needy are expanding. Prior to Stone’s presentation, Genny Pugh with Smoky Mountain Center, which oversees mental health for Western North Carolina, told of her $4 billion operation needing to grow capacity in many ways. The commissioners appreciated her sharing the words of Congressman Tim Murphy (R-PA), “We have replaced the hospital bed with the jail cell, the homeless shelter, and the coffin.” In Buncombe, drug abuse treatment is up 25 percent over 2013, and 70 percent of kids in the system, aged 6 months to 10 years, tested positive for having illicit drugs in their bloodstreams. Today, 19,906 families are receiving food assistance, 72,000 social worker cases are processed a year. The PowerPoint presentation included a heart-wrenching depiction of a little girl in ponytails, clutching a doll as if protecting it – from what? – to illustrate that almost 5000 child abuse reports were taken in this county alone last year. One in five Buncombe County residents receives some form of assistance from the county. For those not feeling the burn, yet, there are more numbers.
Throughout her presentation to the Buncombe County Commissioners, Stone was emphatically empathic for people who are hurting among us. She, and all others in DHHS would love to help and heal ASAP, but there is only so much that is humanly possible – particularly when the humans are required to spend a huge portion of their time fighting inferior software to complete inconsequential paperwork. Stone said NC FAST has doubled the time it takes to perform any function, and NC FAST keeps evolving, with learning curves in tow. The courts, with diversion strategies, are ordering more involved and extensive engagement from social workers. Then, Obamacare is complex, for example having different income and asset requirements for each category in Medicaid. And now, DHHS has to process applications 4-5 days faster.
The new mandate puts pressure on people in normally high-stress, high-trauma vocations. Stone described how being short-staffed is snowballing. Social Services has become a 24-7 operation, with six staff in the field, knocking on doors, at any given time. Social workers must now complete “complex assessments required” after working 24-hour shifts. Staff are accruing one to three weeks of overtime a month, and the fatigued are going to claim their compensation in time off rather than cash. Dryly, Stone said thorough, evidenced-based research indicates stress like that leads to increases in turnover. While turnover in Buncombe County’s DHHS is well below state and national averages, it has seen a 50 percent increase recently. Currently, seven positions are open at any time because employees are taking time off, on leave for required training, or moving on to greener pastures.
None of the commissioners objected at all to Stone’s request for a budget amendment totaling $119,925 to see DHHS through the rest of the fiscal year. No new workers would be hired. Instead, positions would be reclassified to move administrative and technical staff “to the front lines.” It was estimated the restructuring would add $280,913 to the department’s 2017 budget. Commissioner Ellen Frost asked if the county provided mental health services for the overworked employees, and Stone said they did, adding extra trauma recently rippled through the department when a child protective service worker elsewhere in the country was murdered paying a household visit.
What to do? Speaker of the House Paul Ryan (R-WI) politely hinted at where the federal government ought to stick its administrative overload in an interview on Bret Baier’s show. “Here’s the deal,” said he. “If we’ve spent trillions of dollars over a fifty-year War on Poverty, we have barely moved the needle, Bret. We still have 50 percent poverty rates, among the highest in a generation. 46 million people living in poverty. So, yeah. If the status quo were working, we wouldn’t have this problem. The status quo isn’t working, and so people like to measure success in the War on Poverty not based on outcomes or results (Are we getting people out of poverty?), but based on inputs (How much money are you spending? How many programs in Washington are you creating? How big is the bureaucracy that doesn’t work?). It’s hurting people. It’s trapping people in poverty. I would argue that the federal government has helped put in place a poverty trap that traps people in poverty, that disincentivizes work and prohibits people from getting on the rung of the economic ladder to pull themselves out of poverty. And so, yes, we are taking on the status quo and those who want to protect the status quo will criticize those of us who are challenging them.”