Aug 20, 2018

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20th Anniversary Milestones: How CCLP Mitigated a Statewide ‘Disaster’

by | Aug 20, 2018

In celebrating the 20th anniversary of Colorado Center on Law and Policy, we are publishing a series of vignettes about the organization’s most significant accomplishments.

Colorado has suffered its share of deadly natural disasters over the last 20 years from the Hayman Fire of 2002 to the 2013 floods that claimed at least eight lives and damaged more than $1 billion worth of property.

Yet, one of the most significant disasters to hit the state was the result of a computer system “upgrade” that was ill-conceived, mismanaged, poorly planned, inadequately funded and badly implemented.

All told, the massive failure of the Colorado Benefits Management System (CBMS) — a statewide computer network used to determine eligibility and process payments for public assistance programs such as Medicaid, the Supplemental Nutrition Assistance Program (SNAP) and others — put hundreds of thousands of Coloradans in jeopardy without access to health care, medications, cash assistance and food. In 2010, a nine-year-old boy with severe asthma died after his mother was unable to obtain prescription drugs because of the failure.

To mitigate the destructive effects of the CBMS failure for Colorado’s residents most in need, Colorado Center on Law and Policy (CCLP) worked with the Colorado Lawyers Committee and the National Center for Law and Economic Justice to bring a lawsuit against the state when the system consistently failed to make accurate determinations of eligibility for benefits. Ultimately, CCLP secured a settlement requiring the state to meet benchmarks for processing applications on a timely and accurate basis, and held the state accountable until it consistently met the benchmarks. To their credit, the state complied and was released from oversight in 2017.

A tragedy of errors
Intended to streamline Colorado’s human service programs with a faster, more efficient computer system, the project went horribly wrong due to miscalculations from contractor Electronic Data Systems over how much time and effort the project would take and unrealistic expectations from the state, which changed the design mid-stream and failed to adhere to its own benchmarks before going live. To further complicate matters, Colorado’s economy took a turn for the worse, further tightening the state’s budgetary constraints. State legislators perennially expressed frustration over missed deadlines and budget overruns related to the project. In 2004, representatives from county governments approached CCLP with grave concerns about the much-needed update of the state’s legacy systems serving more than 538,000 Coloradans enrolled in benefits programs such as Medicaid, Child Health Plan Plus, Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP).

“The counties came to us and said ‘this is not going to work,’ recalled Elisabeth Arenales, Director of CCLP’s Health Program. “They saw the writing on the wall.”

Part of the problem from the beginning was that state and county agencies historically had not worked well together on IT projects.“Cohesion is incredibly important in a project like this,” Arenales said. “Any IT project needs a clear chain of command and an absolute decision-maker and we didn’t have it with this one.”  Though the state had agreed not to “go live” until they reached a target of 95 percent processing accuracy they proceeded with the launch despite a dismal 67 percent accuracy rates.

CCLP and the Colorado Lawyers Committee went to Denver District Court seeking to stop CBMS from going live through a Temporary Restraining Order. The judge declined to issue the order.

“The judge essentially said, ‘Well, this is worrisome, but it hasn’t gone live yet, so there is no actual harm,’” Arenales said.

Unfortunately, despite dire warnings from county administrators and a tech consulting firm, the state proceeded with the launch of the new system, and the Colorado Lawyers Committee, CCLP and NCLEJ returned to court.

“We came in a few months later and said: ‘look at the actual harm! Tens of thousands of people are going hungry and without medical care,’” Arenales recalled.

Among the problems: the data didn’t transfer from the legacy systems to the new system properly and the new system was built so that it couldn’t sort out its data in a meaningful way. Case workers who didn’t understand the system had to construct time-consuming work-arounds. On top of that, there wasn’t adequate capacity in the computer system itself. If enough workers used the system at the same time, it would crash. CCLP received so many complaints from people who could not access their benefits that it hired a full-time employee, Muriel Arvey, to field the calls.

Arvey started with CCLP as a volunteer but was put on the payroll when it became evident that more help was needed.

“We were very, very busy,” Arvey recalled. “Once people knew there was an organization working on this, we had lots of calls.”

The court issued an injunction ordering the state to establish a back-up customer-service unit so that people could get their benefits, address noticing issues and ensure that the state did not go after people who had been overpaid SNAP benefits because of system error. A settlement agreement was reached in 2006, which among other things, required the state to improve the timeliness and accuracy of benefits processing.

According to a 2011 report by two researchers from the University of Denver detailing the troubled system’s history: “The new system was not capable of processing transactions as efficiently as the systems it replaced… Huge backlogs of unprocessed transactions developed, which resulted in employees working overtime, the hiring of temporary employees, and the installation of additional computer servers to add capacity.”

The project ran $75 million over-budget and the state spent $481,000 defending CBMS in court in 2005.

And as many Coloradans were being denied benefits, a 2006 legislative audit revealed that the state had accidentally administered about $90 million in improper over-payments.

According to a 2005 article in The Denver Post:  “The state realized early on it could not afford all it wanted out of the system, but forged ahead anyway…. Counties administer the programs CBMS is designed to handle. But some of them failed to participate in the computer system’s development or get their employees trained.” In the end, Arenales noted, “it was nearly impossible to train workers to perform well on such an ill designed system.”

Fixes required time and money
The disaster spanned more than 10 years through three governors; costing hundreds of millions of dollars and leaving a trail of disgruntled caseworkers and tech firms in its wake. Over the years, the state has gradually improved its performance so the system processes applications more accurately and with shorter lag times.  Among the state’s biggest changes was the establishment of the Office of Information Technology (OIT), within the Governor’s office, designed to oversee major IT projects.

While CCLP earned much credibility in advocacy circles for taking on the state and winning, the effort tapped out many of the organization’s resources.

“I’d say it was an absolute 24-7 job for six to nine months,” Arenales said, noting that she continued to work on CBMS on and off for a full 13 years. “I probably spent the better part of two years on that case. In fact, we spent so much time on that case that we barely did a bit of fundraising during that time.”

Fortunately, local grant-makers stepped up their support of CCLP so that the organization could continue its important work and grow.

“It was a complex but important case,” said Ed Kahn, an attorney who helped found CCLP and worked on the CBMS case. “The more you see due process not being given by the federal government the more you realize how important that case was. I’m thinking of the immigrants in detention and the way that’s been screwed up. That’s a worse example than CBMS but it is similar in that there was a lot of willful conduct in implementing something without fully testing it first.”

In the end, the CBMS case not only improved what was a severely flawed computer system — sparing Coloradans aggravation or unnecessary crises — it also established CCLP as an advocacy force to be reckoned with.

“The case has defined my relationship with state government departments — particularly HCPF [Colorado Department of Health Care Policy and Financing],” Arenales said. “They know that we mean it when we say somethings not right and they need to do something so that people don’t get hurt.”

-By Bob Mook

Recent articles

HEALTH:
HEALTH FIRST COLORADO (MEDICAID)

To maintain health and well-being, people of all ages need access to quality health care that improves outcomes and reduces costs for the community. Health First Colorado, the state's Medicaid program, is public health insurance for low-income Coloradans who qualify. The program is funded jointly by a federal-state partnership and is administered by the Colorado Department of Health Care Policy & Financing.

Benefits of the program include behavioral health, dental services, emergency care, family planning services, hospitalization, laboratory services, maternity care, newborn care, outpatient care, prescription drugs, preventive and wellness services, primary care and rehabilitative services.

In tandem with the Affordable Care Act, Colorado expanded Medicaid eligibility in 2013 - providing hundreds of thousands of adults with incomes less than 133% FPL with health insurance for the first time increasing the health and economic well-being of these Coloradans. Most of the money for newly eligible Medicaid clients has been covered by the federal government, which will gradually decrease its contribution to 90% by 2020.

Other populations eligible for Medicaid include children, who qualify with income up to 142% FPL, pregnant women with household income under 195% FPL, and adults with dependent children with household income under 68% FPL.

Some analyses indicate that Colorado's investment in Medicaid will pay off in the long run by reducing spending on programs for the uninsured.

FOOD SECURITY:
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)

Hunger, though often invisible, affects everyone. It impacts people's physical, mental and emotional health and can be a culprit of obesity, depression, acute and chronic illnesses and other preventable medical conditions. Hunger also hinders education and productivity, not only stunting a child's overall well-being and academic achievement, but consuming an adult's ability to be a focused, industrious member of society. Even those who have never worried about having enough food experience the ripple effects of hunger, which seeps into our communities and erodes our state's economy.

Community resources like the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, exist to ensure that families and individuals can purchase groceries, with the average benefit being about $1.40 per meal, per person.

Funding for SNAP comes from the USDA, but the administrative costs are split between local, state, and federal governments. Yet, the lack of investment in a strong, effective SNAP program impedes Colorado's progress in becoming the healthiest state in the nation and providing a better, brighter future for all. Indeed, Colorado ranks 44th in the nation for access to SNAP and lost out on more than $261 million in grocery sales due to a large access gap in SNAP enrollment.

See the Food Assistance (SNAP) Benefit Calculator to get an estimate of your eligibility for food benefits.

FOOD SECURITY:
SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC)

Every child deserves the nutritional resources needed to get a healthy start on life both inside and outside the mother's womb. In particular, good nutrition and health care is critical for establishing a strong foundation that could affect a child's future physical and mental health, academic achievement and economic productivity. Likewise, the inability to access good nutrition and health care endangers the very integrity of that foundation.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides federal grants to states for supplemental foods, health care referrals, and nutrition information for low-income pregnant, breastfeeding and non-breastfeeding postpartum women and to infants and children up to age five who are found to be at nutritional risk.

Research has shown that WIC has played an important role in improving birth outcomes and containing health care costs, resulting in longer pregnancies, fewer infant deaths, a greater likelihood of receiving prenatal care, improved infant-feeding practices, and immunization rates

Financial Security:
Colorado Works

In building a foundation for self-sufficiency, some Colorado families need some extra tools to ensure they can weather challenging financial circumstances and obtain basic resources to help them and their communities reach their potential.

Colorado Works is Colorado's Temporary Assistance for Needy Families (TANF) program and provides public assistance to families in need. The Colorado Works program is designed to assist participants in becoming self-sufficient by strengthening the economic and social stability of families. The program provides monthly cash assistance and support services to eligible Colorado families.

The program is primarily funded by a federal block grant to the state. Counties also contribute about 20% of the cost.

EARLY LEARNING:
COLORADO CHILD CARE ASSISTANCE PROGRAM (CCCAP)

Child care is a must for working families. Along with ensuring that parents can work or obtain job skills training to improve their families' economic security, studies show that quality child care improves children's academic performance, career development and health outcomes.

Yet despite these proven benefits, low-income families often struggle with the cost of child care. Colorado ranks among the top 10 most expensive states in the country for center-based child care. For families with an infant, full-time enrollment at a child care center cost an average of $15,140 a year-or about three-quarters of the total income of a family of three living at the Federal Poverty Level (FPL).

The Colorado Child Care Assistance Program (CCCAP) provides child care assistance to parents who are working, searching for employment or participating in training, and parents who are enrolled in the Colorado Works Program and need child care services to support their efforts toward self-sufficiency. Most of the money for CCCAP comes from the federal Child Care and Development Fund. Each county can set their own income eligibility limit as long as it is at or above 165% of the federal poverty level and does not exceed 85% of area median income.

Unfortunately, while the need is growing, only an estimated one-quarter of all eligible children in the state are served by CCCAP. Low reimbursement rates have also resulted in fewer providers willing to accept CCCAP subsidies.