In the mid-1970s, Kathy Lynch was working in a Houston Food Stamp program office when she and her husband decided to leave the city. She transferred to Pearsall, where she learned about the long-term Medicaid programs that help the elderly and people with disabilities.

"I quickly learned that the Medicaid financial policies were very different for the elderly than for, say, single parents," she said. "And I experienced what it's like to have (a parent or other close relative) dying on a hospital bed in the living room as the family tried to figure out what to do next."

The programs were relatively limited then, and her ability to translate complex regulations was satisfying because it changed people's lives.

In the next 30 years, Lynch rose from caseworker to supervisor, and finally to a policy position at the Department of Human Services. And Congress successively made more people eligible for the long-term care programs that now are among Texas' most widely used social safety nets.

But those growth spurts, Lynch says, also expanded the documentation required of applicants, and the complexity of the Kafkaesque regulations grew geometrically.
She has since retired from the agency, but still uses her encyclopedic knowledge of the regulations to help seniors and people with disabilities. Frequently, that means conducting multiple interviews and making complex financial arrangements so applicants can get the care they need and deserve.

Lynch also is lobbying to have those programs kept out of the state's new — and faltering — Integrated Eligibility System that has at its heart call centers that will replace about one-third of the state's field offices and thousands of eligibility workers.
Health and Human Services Commission higher-ups defend the new system — whose rollout is on indefinite hold — as an improvement because clients will not have to miss work to make office visits.

"But what may be a convenience for young single moms will be a technological nightmare for the elderly and disabled," Lynch said. "We have elderly children caring for their even more elderly parents; how many moms and pops with early dementia or Parkinson's, or the effects of a stroke, can explain their financial history over the phone, Internet or by fax?"

Commission officials counter that 200 field offices will remain open. But Patricia Sitchler, a lawyer who specializes in elder law and for whom Lynch works, worries that the remaining offices will be significantly understaffed.

"The agency work force will fall from 7,864 in 2004 to about 3,900 when the system is fully functional," Sitchler said. Like others who have criticized the new privatized, one-size-fits-all eligibility system, Sitchler and Lynch worry that it will prove inappropriate for the special needs of the elderly and people with disabilities.

"It is human contact, one-on-one, face-to-face discussions between a caseworker and the family that make the process work," Lynch said. "Finding programs to ease the load is the caseworker's function. The diplomacy and expertise of the caseworker working with a grieving family is at the very core of what their job is all about."

And as growing numbers of baby boomers start turning 60, the need for their services will grow.

"There is also a misperception about who these benefits are really for," Lynch says: "They are for mainstream America."