Missouri’s Medicaid Applicants Get Put On Hold

Enrolling in Missouri’s Medicaid program has not been easy.

Many applicants have experienced a barrage of problems when trying to sign up for the program, including long delays until coverage kicks in, lost paperwork and a lack of one-on-one interaction with caseworkers. State officials have blamed a new computer system used to process Medicaid applications.

But there is another reason why some Missourians struggle to get help.

When Deborah Weaver, 28, had issues enrolling in the state’s Medicaid coverage for pregnant women, a switch from her Medicaid disability coverage, she was directed to use a toll-free number, 1-855-373-4636. When she called, Weaver endured long waits and received no guidance.

“I called them three or four times and each time it would take a minimum of 15 to 20 minutes to get through to a human being, only to be given the runaround,” Weaver said.

One time the wait dragged on for so long, Weaver ended the call, worried she was racking up too many minutes on her family’s cellphone plan.

The call center, run by a private company based in Mississippi, handles hundreds of thousands of calls from Missourians seeking help with issues ranging from Medicaid coverage to food stamps, which are defined as income maintenance programs.

Recent records obtained from the Missouri Department of Social Services by the St. Louis Post-Dispatch show that nearly half of the individuals that phoned the call center ended up hanging up, or “abandoning” the call.

And, like Weaver, callers are also spending more time on the phone waiting for an answer.

The average wait time rose to more than 17 minutes in July, up from an average of 3 minutes in July 2013. The maximum wait time increased to about 37 minutes in July, up from 18 minutes a year earlier, the records showed. The maximum wait time spiked to about 48 minutes in March this year.

Violating Contract

Callers are supposed to be directed to a call center staffer in three rings or 20 seconds, or placed in a hold queue within that same time frame, according to the call center’s contract with the state.

“Once in the hold queue, the caller must be connected to a live customer service representative within six minutes,” the contract states.

But callers are waiting in the queue much longer than six minutes.

The average queue time was slightly more than 13 minutes for the month of July, according to the state’s records. The last time the queue was under six minutes was in January.

A month after the Post-Dispatch began requesting data regarding the Jefferson City call center, the Department of Social Services sent a letter, dated Aug. 28, listing “significant concerns” about the call center’s performance to Rob Wells, president of YoungWilliams.

The letter points out the average monthly queue has been exceeding the six-minute limit since February.

The letter also indicates callers have received busy signals, which is not supposed to occur under terms of the contract.

The Department of Social Services now is requesting a corrective action plan within five business days of Aug. 28. Failure to respond to the letter may result in the state’s withholding 10 percent of the next monthly payment, the letter states.

The state signed a four-year contract with Jackson, Miss.-based YoungWilliams to begin operating a call center for income maintenance programs in January 2012 for the Department of Social Services Family Support Division.

YoungWilliams, founded by a group of lawyers, first focused on providing legal services for child support cases in Mississippi in 1993. From there, the company expanded its reach to other states to provide child support enforcement services, consulting and call center services, and services for income maintenance programs.

To date, YoungWilliams has been paid about $9.4 million for its services regarding income maintenance calls, according to the Department of Social Services.

On Aug. 27, an official with the Department of Social Services said that the department was aware of the wait times and that they were working with YoungWilliams to resolve the issue.

“IM (income maintenance) staffing levels at YoungWilliams have been low, which has led to longer wait times for customers who try to contact the information center. In order to address this concern, YoungWilliams immediately began recruiting additional staff members; however, there is a 5- to 6-week lead time to recruit, hire and train staff in preparation for the live call environment,” Rebecca Woelfel, spokeswoman for the Department of Social Services, said in an email.

However, these long hold times were unacceptable to Missouri Gov. Jay Nixon, according to Channing Ansley, the governor’s spokeswoman.

“Moving forward, the Governor’s expectation is that these issues will be resolved so that Missourians receive the quality customer service they expect and deserve,” she said Friday afternoon in a statement.

Mary Ann Wellbank, vice president of YoungWilliams, acknowledges that the call center is in violation of the contract, in particular the hold queue time. But that’s because the Jefferson City call center is receiving more calls, she said.

“For some reason, outside of our control, the incoming calls increased from an average of 141,000 calls per month in 2013 to 160,000 calls per month that we’re receiving now,” Wellbank said. “We’re not staffed enough to handle the calls.”

To help alleviate the situation, Wellbank said, 10 staffers are coming on line this week, and another seven are in the new hiring process.

Wellbank said the call center’s staffers had to navigate more systems the state has brought on line in order to review cases, which is contributing to more time on the phone with callers. All of which, Wellbank said, contributes to the increase in wait times as the same amount of staffers try to do more.

“We’re absolutely committed to rectifying the situation,” Wellbank said. “It will take some time, and we appreciate the concerns of the citizens and advocates.”

But critics say the call center is a glorified answering service because call center staffers are very limited in what they can actually do. Only eligibility specialists, who work for the Department of Social Services’ Family Support Division, can make changes to and help with application issues.

It wasn’t always this difficult to get help with a Medicaid application or food stamps, Weaver said. She used to visit the field office in Hillsboro, the closest office to her home in De Soto, and sit down with a caseworker, also known as an eligibility specialist.

But as the state has cut the department’s budget, it’s become harder to interact with an actual eligibility specialist. Now, people are mailing in applications or applying online.

“Before, you used to have human interaction; now someone walks you into a room and puts you in front of a computer and they leave,” Weaver said of the application process.

And when enrollment issues do arise, it’s nearly impossible to get a hold of an eligibility specialist, she said.

Under the call center contract, the staff provides information and general assistance to callers, but they can’t modify applications or make decision concerning eligibility and payments.

Instead, they typically send emails to the eligibility specialists in the field offices across the state requesting they call the applicant back within two days to resolve the issue.

Dropping Enrollment

The call-center difficulties comes as Missouri reported the single largest monthly drop in Medicaid enrollment.

The average enrollment dropped by 37,260 people, or 4.4 percent, at the end of June compared with a year earlier, according to a report by the Department of Health and Human Services.

And even though fewer people are enrolled in the state’s health plan for low-income Missourians, the backlog has increased. The number of pending Medicaid applications stood at 43,740 at the end of June 2014, up from 29,191 at the end of June 2013.

The precise details are unclear, but state officials say that the switch to a new software system is to blame for enrollment issues and that the issue is improving.

However, Joel Ferber, director of advocacy for Legal Services of Eastern Missouri, and other area health care experts also say the call center is contributing to the drop in enrollment.

“It’s an overwhelming problem because clients are unable to get answers to, and or assistance with, the problem they are having (delays or lost documents). The call center issues are part of the problem,” Ferber said.

Tim McBride, health care economist and professor at Washington University, said many of the people who needed state services weren’t able to wait on the phone.

“Where I can take 30 minutes off and have (a) phone conversation, it’s not feasible for someone who is trying to get on Medicaid,” McBride said. “If you’re disabled, it might be physically hard for you to stay on the phone.” And it might be more difficult for people who have mental health issues, McBride said.

Some also raised the issue that outsourcing itself helped create the current problems.

By terminating state workers and replacing them with call-center employees who lack the authority to make decisions, Missouri creates a system that is slow and inefficient, according to Adam Seehaver, organizing director for Local 6355 of the Communications Workers of America, the union representing workers within the Department of Social Services.

“The reason the wait times are what they are is that there is not enough staff to do the job, and it’s really that simple,” said Adam Seehaver, organizing director for Local 6355 of the Communications Workers of America, the union representing workers within the Department of Social Services.

Ansley, the governor’s spokeswoman, declined to comment on the question of outsourcing.

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