Saturday, January 2, 2010
By Corrie MacLaggan
AMERICAN-STATESMAN STAFF
Landing in the hot seat
Tom Suehs talks about his challenges as the top Texas human services official, from food stamp delays to scandal at homes for people with mental disabilities
When Tom Suehs took the helm of the Health and Human Services Commission in September, he inherited a severely backlogged food stamp application system.
Texas, struggling with a recession-related surge in applications, is failing to process them within the 30 days required by the state and federal governments, and responses are now overdue for about 40,000 applicant families. A legal aid group has sued over the problems.
Suehs, who served as a deputy to former Executive Commissioner Albert Hawkins, was familiar with the agency, but he says: "It's different when the load of that decision is on your shoulder."
Health and human services executive commissioner is one of the toughest jobs in Texas government.
Suehs oversees 54,000 employees at five agencies (consolidated in 2004 from 12 agencies) with combined budgets of $30 billion in state and federal dollars. They include the agency that manages the scandal-racked homes for people with mental disabilities, as well as Child Protective Services, which in 2008 initiated a raid on the Yearning for Zion Ranch in West Texas that resulted in one of the largest child custody cases in U.S. history.
The Statesman sat down with Suehs on Dec. 21 at commission headquarters on North Lamar Boulevard. The discussion ranged from how he'll address the food stamp problems to how national health reform will affect Texas — and how he fears a combination of the two would be chaotic.
Since our conversation, Suehs has taken the unusual step of asking State Auditor John Keel to investigate the eligibility system, an audit Keel says has begun.
Here's an excerpt from our talk with Suehs:
Why is it taking so long to fix the food stamp problem? What is so hard about figuring out whether somebody is eligible?
Because of the large number and massive amount of different rules. There's state rules and there's federal rules. And the fact that you have (295) offices around the state makes it complicated. Whether you're applying for food stamps in Austin, Texas, or in Waxahachie, you've got to be consistent. You have a large volume of people applying for assistance. Our offices, in most cases, weren't designed to handle that type of volume. So you've got a large volume of people, offices that weren't designed properly, and you've got all these complicated rules, some of which probably in modern economic times don't make sense.
What if you were told you have to fix this problem tomorrow? If you could have anything — people, money, expertise — is there something that you could do to fix it?
There is nothing I could do to fix it tomorrow. Well, can I fix it the next month? Maybe. I've got to have a process expert. We're looking at revamping the whole system. We're studying other states: Oregon, Washington state, New Mexico, Pennsylvania. I am concerned that (federal) rules aren't keeping up with the new poor. The rules aren't set up to handle a person that still has their house, they still have maybe two cars. So you've got all these asset tests that don't make sense in the modern times.
So the problem is with the federal rules?
There are some state rules that are problematic. Some of the asset tests are state requirements. Finger imaging is a state requirement.
Are you thinking of suspending finger imaging? (Texas is one of four states that fingerprints food stamp applicants, which federal officials have discouraged, saying it slows down the process).
I can't suspend state law. Last time I looked, they didn't quite put that in my job description. But I am thinking of evaluating it enough so the Legislature can have it under consideration when they come back into town (in January 2011). Nothing is off-limits.
Why can't you treat this as an emergency and suspend some requirements?
I've got a review being done on the statutes now on that. There has to be a federal declaration.
What are the successful states doing?
They've kind of created a triage system to a certain extent. As soon as somebody comes in, they triage the person and say, "What's your issue?" They may be able to answer the question right away. So it's redesigning that front contact with the client. That means you've got to have more trained staff.
What sort of hurdles are in the way of doing what the successful states do?
Making sure we have the trained staff. A large number of our offices aren't designed properly. So we may need to redo the layout of how the lobby flows. I was in the office in Waxahachie. That office was never designed to handle that volume. Small lobby. A single reception window. (After a series of Dallas plants shutting down), all of a sudden instead of having 20 people sitting in the lobby, you have 100 people. Well, that's not going to be a nice atmosphere. I think we lost sight of that client as our customer. I won't stand in line for 2½ hours, three hours for an application. And I don't like customers to do that, either.
Is there a number of staff that you see as adequate?
We started out in September to put on 850 (additional) staff. I think I'll hit that in January, and I think I just need to reassess the situation. I believe that's enough staff. But if the economy continues not to improve, I may have to ask for more staff. But I won't make that determination until March.
How much did privatization play a role in the problems we see today? (In 2005, Texas hired a group of companies led by Accenture LLP to manage the Children's Health Insurance Program and run call centers enrolling Texans in food stamps and Medicaid).
The Legislature made a decision to cut 4,000 staff based upon the assumption that privatization would be implemented. That was a terrible budgetary decision. That, quite frankly, is the primary cause. Now, that wasn't privatization — that was a budgetary decision. I will do everything I can to make sure it doesn't happen again.
Wasn't privatization supposed to modernize the eligibility system?
That is part of it. The reality is, we need the automation. Our paper process cannot continue. You go into an office, and you see room after room with boxes and boxes of files. That can't be. You go to the airport nowadays, you don't even wait in line. You go to a kiosk. That type of system, why not for us? We need to have a paperless process. But I can't automate a bad process. I've got to fix the front-end process.
What is your biggest challenge in your new job?
I've had people say, "Commissioner, why are you spending so much time on the eligibility? That's really a small piece of your role." I say, if and when Congress does health care reform, I can't have a broken eligibility system. You start making 2 million more people eligible for Medicaid and I don't have an eligibility system, I guarantee you there'll be chaos in this state. I guarantee I'll have more politicians calling for me to be flung up on the flagpole. My whole thrust is, I've got two years to get this eligibility system turned around, and then I can focus on working with the health care reform.
How do you see health reform impacting Texas?
We know already that only about 70 percent of the people who qualify for Medicaid seek eligibility. So because of the individual mandate (to obtain health care coverage), our takeup rate will go from 70 percent to 94, 95. Then it's going to change different eligibility standards. So I think all of our eligibility policies will have to be changed, which is scary. It means you have to retrain everybody. So it's going to be a massive load on the staff again.
What's the status of the reforms the Legislature made to the 13 state supported living centers for people with mental disabilities following a U.S. Justice Department report showing they failed to provide adequate health care and protect residents from harm? Are there cameras yet in all the state supported living centers as lawmakers mandated?
You have cameras in Corpus Christi. The other ones are still in process.
How long does it take to order a camera?
It's not just ordering cameras. The Legislature didn't give you enough money to fully camera-ize the whole campus, so you've got to pick the high-risk areas. You've got to have the fiber optics to run the cameras back to a central office. You've got to have staff that's monitoring. It's not just throwing cameras out there. It's a whole system of security that you're building there. It's expensive and time-consuming to get it established.
What about the monitors who are supposed to inspect the facilities as part of an agreement between Texas and the Justice Department? (The agreement requires Texas to improve health care and more quickly investigate reports of abuse and neglect, and to make it legally binding, the Justice Department sued the state.)
The monitors start in January. They'll start reviewing the state supported living centers and produce a report establishing a baseline. From the baseline, we hope to have clear criteria established of what we need to improve so that when we meet that criteria, that facility can be removed from the lawsuit. It's a four-year process.
As this four-year process goes on, how do you ensure in the meantime that there's no repeat of what we saw in Corpus (where employees were encouraging fights among residents)?
You know, I don't know how you prevent individuals from being stupid. I think the issue is, if you're focusing your staff on customer services and you're making your staff feel good about themselves, there's less risk of those things happening. It's back to prudent supervision.
At Child Protective Services, has the problem with children sleeping in state offices been resolved? (In 2007, hundreds of children who had been removed from their homes because of abuse or neglect were sleeping at a state office building when state workers could find nowhere else for them to go.)
I have had no reports since I came into office of that taking place.