Opinion: The Human Touch; State Starts Using Common Sense

Staff EditorialHouston Chronicle5/5/2006

There's nothing wrong with using technology for tasks done by humans. That approach was the driving idea when the Legislature voted to assign screening for key social services to a private company. Unfortunately, the plan failed — in historic dimensions. Now the state must commit to repairing the damage.

Ever since state-federal coverage for children of the working poor fell to screening giant Accenture in December, the Children's Health Insurance Program rolls dropped by an astonishing 28,000 Texas children. Numerous families have been told wrongly that their applications were lost or incomplete, or that they were ineligible.

Privatization deserves only part of the blame. At the same time Accenture came on board, the state enacted major bureaucratic hurdles meant to reduce the number of children eligible for CHIP. On the other hand, Children's Medicaid, which saw no rule changes but also was assigned to privatized call centers, lost enrollment, too. Between Nov. 1 and Feb. 1, membership in the program dropped by more than 78,600 children.

The common element in the children's health insurance crisis is removal of the human factor. Before privatization, CHIP also used call centers. But they were fully staffed with experienced workers. Screening families for social services and guiding them to appropriate resources is complex work. Removing trained employees and cutting staff, as the Legislature did in 2003, pulled the keystones from these essential services. Their replacements — anemic rosters of undertrained contract workers and a costly computer meant to screen applicants for multiple programs — have failed.

Democrats and Republicans alike are horrified by what's happening. "I don't think anybody, regardless of party affiliation, wants to spend money on something that doesn't work," Mary Katherine Stout, of the conservative Texas Public Policy Foundation, told Chronicle reporter Polly Ross Hughes.

To stem the damage, the Health and Human Services Commission has finally taken measures. The most important is the commission's acknowledgment that the system is in crisis. Last week it halted the rejection of 28,000 more children from health insurance. It is spending $3 million to help families fill out the complex CHIP applications. And it is surveying families about the biggest problems in the snarled mess that Texas' social service screening has become.

This is responsible. It's just not enough. Texans should not and cannot afford to have tens of thousands more children visiting emergency rooms for their first contact with doctors.

Now that it's admitted the privatization plan is deeply flawed, HHSC must look inward. It's got to truthfully identify the staffing shortfalls, computer failures and policy changes that are casting so many children off insurance. No more children should lose their insurance until the system's fixed.

The commission also has to start listening again. Surveying parents in the trenches is a start. But since privatization, the state's dialogue with advocates and service providers has dwindled to near-silence. Figuring out eligibility for services and spotting fraud demand critical thinking and experience. A whole community of stakeholders can offer this human touch and should be encouraged to do so. It's something short-term employees and a computer can never do alone.

http://www.mysanantonio.com/news/columnists/cguerra/storyindex.html

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