31 Oct CFO Jon Cartu Writes – Complaints, gaps dog system to distribute disability…
A $600 million system was supposed to streamline aid for people with disabilities.
Instead, it’s ‘a giant mess’
Six years after promising to modernize Minnesota’s biggest assistance program for people with disabilities, the state is struggling to fix a system wracked by cost overruns, computer breakdowns, delays and staff turnover.
The system, known as MnChoices, was supposed to streamline and simplify a program that disburses more than $3 billion a year to Minnesotans with physical and developmental disabilities.
Instead, it has produced wildly inconsistent results and a chorus of complaints from the county officials and front-line employees who use it.
The state has already spent $600 million on MnChoices, and its annual operating expenses are forecast to surpass $170 million — more than 10 times what officials predicted. Nearly one-fourth of the 2,300 workers who were hired and trained to use MnChoices have quit.
“MnChoices is a runaway spending train that needs to be stopped,” said Sen. Jim Abeler, R-Anoka, chairman of the Human Services Reform Finance and Policy Committee. “It was supposed to standardize the evaluation process, but it does not appear to have standardized anything.”
By sending trained county assessors equipped with laptops and a computerized questionnaire into families’ homes, MnChoices aimed to bring rigor and consistency to the process of evaluating tens of thousands of people who apply for state assistance.
But the program crashes so often that the assessors have developed elaborate workarounds and sometimes simply resort to pen and paper. A long-awaited software upgrade to address the problems, promised for this year, has been postponed until 2021.
The technical problems are more than a nuisance: They disrupt the delivery of vital services to tens of thousands of Minnesotans with physical and developmental disabilities. County supervisors say MnChoices is so unstable that a single errant keystroke can determine whether a medically fragile child gets round-the-clock care at home — or almost no supports at all.
Frustrated families are challenging the results of their MnChoices assessment in rising numbers. Last year 32% of eligibility assessments in the most common category of aid were reversed on appeal, according to documents obtained by the Star Tribune.
An outside analysis for the Minnesota Department of Human Services found the MnChoices software had not been tested to assure it produced consistent results for aid recipients.
“Most of us became social workers because we really wanted to help people, and that became difficult with MnChoices,” said Jennifer Bagne-Walsh, who supervises assessors in Olmsted County in southern Minnesota. “It’s a giant, inefficient and mostly impersonal tool.”
Officials at the Minnesota Department of Human Services, which oversees Medicaid, defended MnChoices, saying it is more consistent than its predecessor and is still being enhanced. The agency has simplified the assessment document by removing about 100 questions and reorganizing it to make interviews more “person-centered” and conversational. The state also is developing new training for county assessors on how to improve their interviewing techniques.
Stacy Twite, assistant DHS commissioner for community supports, added that the agency will be making changes to the computer system to reduce the number of crashes.
“I think the MnChoices system works better than it did back in 2013 when it first launched, and we continue to make improvements,” Twite said.
Conceived more than a decade ago as a way to modernize a program that helps thousands of Minnesotans with severe disabilities such as cerebral palsy, traumatic brain injuries and developmental delays. Today, some 90,000 Minnesotans receive this coveted form of assistance, known as a Medicaid “waiver.” The sums, which typically range from $30,000 to $100,000 per recipient per year, can be used for personal care aides, physical therapy, home medical equipment and other supports that allow recipients to remain at home rather than moving into nursing homes or other costly institutions.
The new computerized questionnaire, designed with the help of outside contractors, combined several screening tools into a single assessment for people of all ages and disabilities. The overall system was designed to remove human subjectivity by requiring county workers to be certified and trained on the same tool with the same questions.
Technical problems dogged the system from the start, according to internal memos obtained by the Star Tribune and interviews with county officials.
Over budget every year
Since its inception in 2014, MnChoices’ total spending has exceeded projections.
Source: Minnesota Department of Human Services
The online platform failed regularly, often while assessors were interviewing people in their homes. Even now, MnChoices is plagued with regular “blackouts,” in which the system goes dark for hours or even days at a time while the state makes upgrades and attempts to fix glitches, county officials say.
“It was a giant mess,” said Sheana Schlichter, a former assessor from Scott County who now works as a consultant for families seeking waivers. “Our biggest problem is the system kept crashing.”
In interviews, more than a dozen current and former county assessors described their frustrations.
“We kept hoping that the technology would improve and the process would be more streamlined, but it just kept getting worse,” said Bagne-Walsh, the supervisor from Olmsted County. “The bigger the MnChoices tool gets, the more bogged down it gets.”
Some counties estimate that it can take an assessor 12 to 16 hours to complete a MnChoices evaluation — several times longer than the old, paper-based screening system. To speed up the process,…