For the Hawaii population most in need of the social safety net, the state Department of Human Services is a critical conduit to health and other services. Where medical care is concerned, however, the web of clinics and providers is the real delivery mechanism, the extension of DHS services into the community.
That crucial connection is weakened by gaps in the technology links — and the basic human communications pipeline could be vastly improved, as well.
The problem, which is only the latest in a series of glitches that DHS has encountered in its service, came to light at a legislative briefing last month concerning Medicaid, the federally funded program providing medical coverage for the poorest Americans.
The focus of the complaints lodged by service providers at community health centers was Kolea, the DHS online Medicaid eligibility system whose costs, all told, could top out at $144 million.
Last weekend the agency temporarily took down the system to install updates. That was part of a scheduled upgrade, but the providers said they hoped that this would resolve some of their frustrations.
Those include frequent episodes of the system freezing and then losing applicant information, as well as delays in the promised "overnight" eligibility approvals.
Tuesday was the first full day the clinics could use the upgraded system, days before DHS conducted training sessions for health centers’ staff. It should be possible soon to probe the robustness of the new Kolea interface and get a better reading.
And probing it — Kolea, as well as the less technological, more bureaucratic lapses — is exactly what state lawmakers need to do in the coming weeks.
For starters, they need to get clarity from DHS and the vendor servicing the Kolea contract, KPMG LLP, about where the information-technology problems lie. It will help underscore for decisionmakers how the modernization of the state’s antiquated IT needs to be prioritized.
What should be horrifying to taxpayers is that the agency has long touted Kolea as the means to speed approvals of patients seeking Medicaid.
Initial provider feedback after the weekend upgrade indicates there still have been applications lingering in "pending" status, and some of the "navigators" — staffers helping patients file their applications — were unable to log in. So technical problems likely remain.
The state has had since October 2013 to get the system refined and should have better results than this, especially considering the investment.
The public has the right to feel appalled that something meant to save government labor and time so far has not accomplished goals other than the enrichment of contractors. So far that’s also been the experience with the costly Hawaii Health Connector system. It, too, has stumbled badly in its purpose of delivering insurance under the Affordable Care Act to those who can’t qualify for Medicaid. The contractor in that case is CGI Group Inc., so the problem here seems to be systemic rather than limited to a single vendor.
Beyond the technology, of course, there is also a more fundamental communications gap. Example: Providers report getting no notice when changes are made to forms accepted through the website.When questions come up, they added, calling one DHS office or another is likely to give you different answers.
Finally, some say that training opportunities have been insufficient. This week’s sessions suggest an encouraging change, and DHS must continue to step up such efforts.
DHS officials said that many of the difficulties users see arise because of limitations of the Internet-based portal, including network logjams and computer performance problems unrelated to this software. Early versions of Kolea also lacked some features because of the deadline to launch it along with the Connector, they said; the upgrade adds useful functions.
The new DHS director, Rachael Wong, said the agency will devise a better way for end users to troubleshoot any problems. Fulfilling that pledge would be a hopeful development. For this much of a public investment, the public expects a lot. The community clinics are the integral partners of DHS and should be kept in the loop much more efficiently than is now the case.
Wong, a former executive of the Healthcare Association of Hawaii, said she knows the community perspective, and that should help. Creating a better alignment between her agency and the professionals who deliver the coverage has to top Wong’s job priorities this year.
