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Integrated Eligibility and CPS Integrated Eligibility and CPS Privatization — Where Are We Privatization — Where Are We

After the 80After the 80thth Legislative Legislative Session?Session?

United Way of Metro Tarrant CountyPost-Legislative Health and Human Services

Public Policy ForumSeptember 17, 2007

Tiffany Roper, Child Welfare Policy Analyst

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What is (was) “IE&E”?

• Modernization of eligibility determination and enrollment:– Better technology/greater automation– Centralized and paperless computer system– Remote application options– More partnerships with nonprofits

• Outsourcing development, administration, and partial staffing of system

• Significant staffing reductions & office closures planned

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What happened to IE&E?

• New system launched in January 2006• Significant problems surfaced during

pilot, rollout put on hold in May 2006• Contract scaled back in December

2006• Contract terminated in March 2007

For more information about outsourcing of public benefits in Texas, see Updating and Outsourcing Enrollment Public Benefits: The Texas Experience, http://www.cppp.org/research.php?aid=582&cid=3&scid=7

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Why did IE&E fail?

• Flawed business model• Unrealistic expectations (too little $

$, overly aggressive timeline)• Inadequate testing/piloting• Technical problems (TIERS, Max-e3)• Unskilled, poorly trained contractor

staff asked to do too much• State staffing shortages

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SB6 Passes in 2005 and Starts CPS Privatization

• Private entities to step into shoes of CPS (post-investigation) to make decisions, do casework, and provide or contract for needed services for families

• Included all court-related duties such as obtaining service, preparing court reports, going to hearings

• DFPS to contract with independent administrator who would in turn subcontract and monitor private providers handling case management and substitute care responsibilities

• Region 8 (28 counties, including Bexar) chosen to be first to privatize

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Region 1 LubbockRegion 2 AbileneRegion 3 ArlingtonRegion 4 TylerRegion 5 BeaumontRegion 6 HoustonRegion 7 AustinRegion 8 San AntonioRegion 9 MidlandRegion 10 El PasoRegion 11 Edinburg

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What Happened to the CPS Privatization Effort During the

Interim?• Failures with

privatization of Integrated Eligibility

• RFPs for the Independent Administrator and Independent Evaluator put on indefinite hold in late 2006

• Child deaths in foster homes run by private providers

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80th Session Begins…

• Media scrutiny & meltdown of eligibility system focuses legislators’ attention on contract/TIERS

• House Human Services Committee appoints IE/TIERS subcommittee to investigate

• Previous support for CPS privatization dwindled at Texas legislature due to IE&E issues and other factors

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Legislative Response to Failures of IE&E

• Contract terminated• Legislative Oversight Committee established &

independent review team created (HB 3575)• Funding for eligibility staff increased • Two riders also authorized additionall staff if

needed to achieve performance measures, or fewer functions outsourced

• HHSC’s Office of Inspector General (OIG) issues report highly critical of TIERS/IE

• SAO audit of TIERS initiated• HB 75 gives families the right to appeal denials of

Food Stamps or Medicaid to state court

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HHSC conclusions“We didn't draw the line between vendor work and state

work in the right place.” – HHSC Commissioner Albert Hawkins

• IE concept is sound and clients want a more flexible eligibility system

• New system must efficiently support state workers and keep complex decision-making in the hands of trained, experienced state employees

• Pilot demonstrated the need to “redraw the line between the state and private sector to clarify that the private sector is there to provide a support role to state staff.”

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Who’s in charge now?

• HHSC awarded short-term contracts to Deloitte (TIERS) & Maximus (CHIP/IE) to keep system running

• HHSC assumed overall management of call centers

• Accenture has some duties, contract will officially “wind down” in October 2007

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What’s next for IE&E

• Reprocurement planned • HHSC will define tasks that will be

contracted, then develop RFP • Separate RFPs for different

components of system (TIERS, IE, CHIP, enrollment broker)

• HHSC will continue to employ interim contracts during the procurement and transition period.

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Tentative Timeline - CHIP

• Issue request for information May 31, 2007

• Issue final request for proposals December 2007

• Contract Award May 2008

• External review of contract June-August 2008

• Transition of services Completed by Jan. 2009

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Timeline - Call Center and IE Support

• Issue request for information May 31, 2007

• Issue final request for proposalsDecember 2007

• Contract Award May 2008

• External review of contract June-August 2008

• Transition of services Completed by Jan. 2009

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Tentative Timeline – Enrollment Broker

• Issue request for information May 31, 2007

• Issue final request for proposalsDecember 2008

• Contract Award December 2009

• Transition of services Completed by July 2010

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CPS Privatization Continues, But on Much Smaller Scale

(SB 758)• Definitions of services provided by DFPS and by

private providers changed (TFC §264.106 (a)):– DFPS maintains legal responsibilities– DFPS maintains case oversight

• Mandate to use Independent Administrator removed (TFC §264.106, Human Resources Code (HRC) § 45.004)

• Contracts must specify performance outcomes (TFC §264.1063)

• Private providers must give attorneys and guardians ad litem/CASA access to records (TFC §264.106(e)(4))

• Goals for contracting (HRC §45.101):– Achieving timely permanency for children in substitute care– Improving overall well-being of children in substitute care

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Case Management vs. Substitute Care Services

• Case management services = working with and developing case plans setting up services for children and biological families. Includes decision-making about children in state’s care

• Substitute care services = recruiting, training, and monitoring foster and adoptive homes and completing adoptions

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Privatization of CPS Case Management Services

• Case Management Services = casework when children in substitute care (conservatorship of DFPS) (TFC §264.106(a)(1))

• Pilot project - goal of case management responsibilities handled by private providers in 5% of all cases in which DFPS has temporary or managing conservatorship of a child by September 2008 (TFC §264.106(c))

• Of note, “case” not defined – could be per child or per family unit

• DFPS to contract with one or more private providers in one or more geographic areas (TFC §264.106(c))

• DFPS maintains case oversight and legal responsibilities (TFC §264.106(a)(1))

• Evaluated by 3rd party (HRC §45.054(c) and (d))

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Privatization of CPS Substitute Care Services

• Substitute Care Services – recruiting, training, and monitoring foster and adoptive homes (TFC §264.106(a)(5)

• DFPS to assess need for substitute care services (TFC §264.106(b)(1))

• DFPS to contract for substitute care services “when the department determines that entering into a contract will improve services to children and families” (TFC §264.106(b)(2))

• DFPS to monitor quality of services (TFC §264.106(b)(3))

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Privatization Contracts Not Only for “Private” Providers

(SB 813 -- Janek)• Child welfare boards, children’s advocacy centers, or local

governmental boards granted the powers and duties of a child welfare board to contract with DFPS to provide case management or substitute care services

• SB 813 in response to Attorney General Opinion No. GA-0476, issued October 30, 2006, after query from Harris County:

– Under SB6, DFPS may not contract with a governmental entity for the provision of substitute care and case management services, except for emergency services or as a service provider of last resort

– In a region that has an independent administrator to procure substitute care and case management service providers, the independent administrator may not contract with a governmental entity to provide such services

– Notwithstanding the privatization of substitute care and case management services, a governmental entity may continue to provide community services to the extent authorized by other law

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Budget for CPS Privatization Pilot Project

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CPS Improvement Plan

• In developing plan, DFPS shall seek to expand on or modify initiatives that have resulted in demonstrable improvements and that seek the primary goals of:– Keeping families together while insuring child safety in

the home;– Reducing the length of time children remain in state care;

and,– Improving the quality and accountability of foster care

• Improvement Plan must build on reforms started in 2005 by SB 6

• DFPS to report annually about plan and its implementation

• Plan to be implemented only as funds available

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Highlights of Improvement Plan:

– Reduce caseloads;– Implement in-home support program;– Provide additional purchased client

services;– Enhance support of kinship placements;– Improve quality and accountability of child-

care licensing monitoring and investigations;– Expand substitute and adoptive placement

quality and capacity in local communities; and,

– Implement statewide pilot program for time-limited, post hospitalization “step-down” rate.

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During Session, CPPP on IE&E

• Update on the Integrated Eligibility System, www.cppp.org/research.php?aid=668&cid=3&scid=7

• CPPP Statement on Tiers/IE System Recommendations, www.cppp.org/research.php?aid=660&cid=3&scid=7

• Testimony on Problems Enrolling Texans in Public Benefits, http://www.cppp.org/research.php?aid=627&cid=3&scid=7

• House Appropriations Subcommittee on Health and Human Services Testimony on SB 1, http://www.cppp.org/research.php?aid=626&cid=3&scid=7

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During Session, CPPP on CPS Privatization

• Privatization of State Foster Care and Adoption Services: An Idea Whose Time Has Come or a Disaster in the Making?, www.cppp.org/research.php?aid=649&cid=4

• Strengthening Child Protective Services: Comparing SB 758, HB 2140, and HB 3916 with HB 1361, www.cppp.org/research.php?aid=634&cid=4

• Strengthening Child Protective Services: An Analysis of DFPS’s LAR and Senate Bill 758, www.cppp.org/research.php?aid=628&cid=4

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