The Colorado Cross-Disability Coalition Supports Funding to Redesign Benefits Management System for the Good of Colorado
COLORADO CROSS DISABILITY COALITION SUPPORTS FUNDING TO REDESIGN BENEFITS MANAGEMENT SYSTEM FOR THE GOOD OF COLORADO
Background: The Department of Health Care Policy and Financing and the Department of Human Services have submitted a $30 million request to the legislature to fix CBMS. They have a detailed work plan and timeline. The proposal is a complete rebuild of CBMS --when it is done it will be a new system but because we have to have something while the build is going in it is being done incrementally--in other words flying the plane while it is being built. This is on the budget section of the HCPF web site. The question is does CCDC support this request?
Recommendation: It is the recommendation of the Colorado Cross-Disability Coalition (CCDC) that the JBC authorize funding for this plan with the following expectations:
- HCPF will agree to do "workarounds" to preserve Medicaid for clients using work incentives. This must include ALL 1619b clients. This also must include adding HCBS to the Buy In because the Buy In as implemented does not include personal care as a benefit, making it useless for most clients who are current Medicaid recipients. Currently CBMS and other HCPF computer issues cause problems for clients using work incentives--for example due to the department of labor data mixing with HCPF clients on 1619B who are severely disabled and legally allowed to make more money get a letter every quarter telling them that they are over income and if they do not call (and reach) their county technician they get kicked off Medicaid. Alternatively they have to drop everything to file appeals. HCPF decided to stop the letters for other clients due to confusion but did not address the letters for these clients.
- HCPF will continue to do individual problem solving with clients with significant disabilities who have benefit problems as a result of system inadequacies who are using work incentives and diligently trying to follow the myriad of rules and processes.
- HCPF will do individual problem solving for clients coming out of nursing facilities to assure NO interruption in benefits and NO requirement to re-apply.
- The CBMS management team will involve an expert vetted by CCDC to assure that the rebuilt system can create notices that comply with the Americans' with Disabilities Act, Section 504 and 508 of the Rehabilitation Act.
- The CBMS management team will involve an expert vetted by CCDC when the rules engine is rebuilt to assure that ALL work incentive programs are included and that the various disability issues we have identified as problematic in the current rules engine are remedied. The new rules engine must also have capacity to create changes in the long term services and supports (LTSS) system. Our ability to get enhanced federal match in the future may rely upon making some improvements in LTSS.
We also expect that HCPF and CDHS would include subject matter experts in due when drafting rule engines and client content notice.
The General Assembly has repeatedly stated that their policy is that people with significant disabilities should be allowed to work and keep Medicaid. When rules are not written to support this policy, the programs fail. The General Assembly has also made it clear that they expect people with disabilities and seniors to be able to live in the community if they so desire and do not support system driven barriers. Finally, both parties have clearly supported the notion that Medicaid must be able to serve those MOST in need, whose very lives depend upon daily, uninterrupted Medicaid, who have no other options. We believe that the above expectations are in line with existing bipartisan policy.
Everyone knows CBMS is a disaster. Other options include doing nothing (which is not acceptable) or buying a new system. There are no off the shelf systems we can buy. Even new system would require significant customization. This would be more expensive and take longer. This proposal stands out from previous "fix CBMS" efforts as follows:
- The two departments and the governor's technology office are working closely together, this had never occurred in the past.
- This is a complete redesign with specific plans on how each problem issue will be addressed.
- The timeline is realistic and it is not a blanket promise to do everything for everyone.
- Three independent experts have reviewed the system and all came to the same recommendations.
The disability community has raised many issues about CBMS for years and does need assurance that they will be fixed, even if they are not going to be fixed during the first phase of the re-build. The most severe of the disability specific issues are:
CBMS cannot generate alternative format notices, for example they cannot generate large print. This puts the state at risk of litigation.
The system does not recognize many work incentive programs and does not work properly with Social Security causing clients using social security work incentives serious problems.
Clients getting out of nursing facilities almost always have a problem that is CBMS related.
We understand that these problems will not be able to be remedied in the next 18 months. The policy related problems that are tied to specific programs cannot be fixed until the basic structure is rebuilt. The proposal is to literally rebuild this system one piece at a time. We believe that there is an obligation to deal with issues that affect life or liberty now, but believe it can be done as a "work around" until the system fixes are complete. There are also problems that affect all clients and have a serious impact on our community including but not limited to:
When someone files an appeal before the date of benefits being terminated they are entitled to ongoing benefits during the appeal process as a matter of law. The current system does not allow this and the proposal addresses this as an early fix.
Client notices are horrible--they have dates from many years ago and often do not have the date of the proposed action. There are many other problems. The fix is in this proposal.
Clients moving from one county to another are kicked off benefits.
We lay out our expectations to be clear that we understand the magnitude of the project and the necessity of addressing structural issues first, followed by issues for larger populations. While we can accept these limitations we need the policy makers to understand that the clients we represent often have life and death consequences when systems fail.
We are taking a leap of faith in supporting these recommendations and are doing so because we have seen some changes coming from this administration in Medicaid. For example in the past few months this administration has:
Finally implemented a change so that SSI clients moving to HCBS do not need to fill out the long Medicaid financial application (this never made sense because SSI has more stringent financial requirements than HCBS)
Management accepted our request to implement a partnership model for creating solid public policy regarding the CDASS program and demonstrated a commitment to expansion. Management has remained open to our ongoing concerns and we are working with the Medicaid director to address issues. We are working through ongoing trust and transparency issues.
Stopped two series of cuts that were occurring without reason or prior public input to allow time to gather input and reassess the appropriateness of these cuts.
Actively worked to implement HB 12-1177 which is the fix offered by the JBC to remedy the problems caused by previous department backed legislation.
These actions demonstrate improved responsiveness in several key areas, and the departments have acknowledged that continued improvements are needed and that there remain programs and issues that we have not begun to fix. Seeing actions follow words has given us confidence to support this recommendation. However, we feel it necessary to let the legislature and our members know that with our STRONG SUPPORT of the budget proposal we do have expectations as listed above.
Given these considerations the Colorado Cross-Disability Coalition strongly encourages the JBC and the General Assembly to support the CBMS supplemental request submitted on 2/15/12.
This position was ratified by the CCDC board of directors unanimously on March 22, 2012.