PROVIDENCE – The common entry point for poor, needy and frail Rhode Islanders who qualify for government services and benefits will soon be a single online portal, supported by a new software system, what is known as the Unified Health Infrastructure Project, or UHIP, which cost some $364 million to build and install, paid for by mostly federal dollars.

Whether it be for health care under Medicaid, EBT cards for food benefits under SNAP, cash assistance, child care or long-term care services and supports, the new software system comes with the promise by government officials that it will provide seamless integration to make it “easier and more convenient” for Rhode Islands to apply for and track their benefits, and to enable benefits to be delivered more quickly.

At the same time, perhaps equally important, the state will have access to “real time data” to tighten down on any duplications, waste and fraud, to determine who is eligible and when they may no longer be eligible for benefits, according to state officials.

The launch of the new state-of-the-art technology system, which earlier this year had been re-branded as Rhode Island Bridges, is scheduled for Tuesday, Sept. 13 – primary day for the 2016 elections in Rhode Island. Was this a coincidence?

But, for some state workers, mostly social workers and their supervisors at the R.I. Department of Human Services, the new software system may also serve as an exit door: last week the R.I. Department of Administration announced that 70 state workers were being laid off, first in a media advisory, then in a detailed news briefing.

[Many will be able to exercise their rights to “bump” other workers as part of their union contract; others may transition to open state jobs at the R.I. Department of Children, Youth and Families, state officials said.]

The new software system comes with projected cost savings of some $15 million in FY 2017 and $40 million in FY 2018, not so much from decreases in labor costs but from decreases in waste and fraud and greater efficiencies in business systems practices, according to Department of Administration officials.

Yet, for some advocates, particularly those involved with long-term care and nursing homes, the layoffs a month in advance of implementation raise serious concerns.

More than, say, a changeover to online banking services and the resultant layoff of bank tellers at neighborhood branches, the new system may create its own set of worries and problems, particularly for long-term care patients [and their caregivers] attempting to negotiate the complex application process for Medicaid services, once their Medicare benefits have been exhausted, particularly for patients that may be suffering from dementia and have behavioral health care issues.

“Why not implement the new program, and have it up and running and working appropriately, making sure that that all the bugs are worked out, before deciding how many staff can be assigned elsewhere?” asked Virginia Burke, president and CEO of the Rhode Island Health Care Association, told ConvergenceRI. “To do it a month before you’re going to implement this new program doesn’t make any sense.”

Burke continued: “Why have the people with the most experience gone by the time the new system is implemented, when the inevitable bugs are going to occur?”

The workers who know best how the system works won’t be there to fix the problems encountered by customers, Burke said.

Usual suspects
Many of the usual suspects from the Rhode Island news media had gathered in advance of the media briefing on the afternoon of Aug. 26; they were busily going through the warm-up rituals, setting up microphones and cameras in the windowless cave known as Conference Room B on the second floor of the R.I. Department of Administration building.

There was Steve Klamkin from WPRO, Kristin Gourlay from RIPR, cameras and reporters from Channels 6, 10 and 12, Karen Lee Ziner from The Providence Journal, as well as Bob Plain and Steven Ahlquist from RI Future, recent additions to the media scrum.

In the hiatus awaiting the start of the briefing, ConvergenceRI and Kris Craig, veteran photographer with The Providence Journal for more than 25 years, shared stories about old video, production-quality news cameras, computer technologies and digital formats, from the age when dinosaurs still roamed the Earth during the 1970s and 1980s, while awaiting Michael DiBiase, director of the R.I. Department of Administration, and Melba Depeña Affigne, director of the R.I. Department of Human Services to make their entrance. Can you say Ikegami 79?

Changes in technology platforms have dramatically altered the way that the news is covered. Media briefings are, in many ways, a kind of archaic, residual format in the news dissemination world, to fill in the blanks around tweets and posts and online coverage.

[Later, as he was leaving the briefing, DiBiase admitted he was surprised by the media turnout, which was larger than what he had been expected; he pondered out loud: “It must have been a slow news day.”]

Indeed, much of the news to be covered by the briefing had already been delivered and published online from the earlier media advisory release: some 70 state employees were to be laid off, in anticipation of the replacement of a “three-decade-old eligibility and enrollment software system.” That may have been the headline and lede, but it wasn’t all the news.

New details emerge
There were some significant new details that the veteran reporters coaxed out of DiBiase and Affigne:

• The exact number of DHS social workers to be laid off from their jobs was 52; the other 18 laid-off workers were mostly in supervisory roles. However, the likelihood is that many of the state workers will migrate to new jobs opening up at the R.I. Department of Children, Youth and Families, or at the R.I. Department of Labor and Training. The reality is that many will remain as state employees, in a different capacity.

• The principal contractor for Rhode Island Bridges, née UHIP, is Deloitte. When asked if there were any contract provisions regarding poor performance covering glitches, DiBiase deflected the question, saying: “There are many contract provisions.”

The initial rollout of UHIP with HealthSourceRI had created numerous, costly glitches in 2014, forcing the agency to perform manual overrides, spending about $10 million and divert staff to address the snafus. [See link to ConvergenceRI story below.]

The current rollout had been delayed, in part, by the suggestion from the federal partners that the new system needed further testing.

Still, if and when things go wrong, and bugs occur, it remains unclear whether the state will be able to recoup any additional costs through performance penalties assessed to Deloitte as a result of glitches.

• While all current six field offices run by the R.I. Department of Human Services will remain operational, according to Affigne, the office in Woonsocket appeared to be undergoing a significant downsizing, reportedly moving from 36 to 14 employees.

Ahlquist attempted to pin down Affigne about the limited services that were currently available in Woonsocket, and how the nearest office was in Pawtucket, which would mean that residents without cars would be required to take a four-hour round trip by bus, and whether the layoffs were related to changes at the Woonsocket office.

• What the actual name is to call the new system remains unclear: DiBiase and Affigne that the new portal would not have a distinct name on the website, it would not be referred to as UHIP, nor would it be referred to as Rhode Island Bridges. DiBiase said that the re-branding effort was not being used for the rollout of the new system.

• The major investment in health IT infrastructure by the feds and the state is banking on savings being created by new, improved technology, aligned with new business processes. The goal is not just to help the customer access and manage benefits but to cut costs for the taxpayer as well.

“It will deliver substantial savings for taxpayers, both by identifying and eliminating fraud and waste, and also by creating efficiencies to do this in a way without paper,” DiBiase said.

Transitions and turmoil
The layoffs of the social workers and their supervisors, coupled with the implementation of Rhode Island Bridges, come at a time when many in the long-term care business are facing transition and turmoil.

Earlier this month, Neighborhood Health Plan of Rhode Island sent out notices to some 2,500-3,000 nursing home residents, informing them that they were enrolled the second phase of its Rhody Health Options program, called “Integrity,” an initiative that brings together the state Medicaid program with the federal Medicare program into a combined approach to what’s known as the dually eligible population of frail, elderly Rhode Islanders.

The new “Integrity” product has been touted as a way to improve care and reduce costs as well as to provide a way to “transition” poor, frail Rhode Islanders out of nursing homes and back to a system of community care and out of nursing homes. To date, despite the altruistic goals, the initiative has not been as effective as promised, by the numbers.

In the last few years, since the implementation of the first phase of Rhody Health Options, now relabeled as “Unity,” only some 36 nursing home residents have been transitioned back to the community under the direct auspices of Neighborhood Health Plan, despite the promise that there would more than 3,000 such transitions. [See link to ConvergenceRI story below.]

The reinvention of Medicaid
For many nursing facilities and home care providers in Rhode Island, the new system is being viewed with great trepidation and the layoffs seem premature.

“We have no guarantee that this [new system] is going to run without having any problems,” Nicholas Oliver, executive director of the R.I. Partnership for Home Care told The Providence Journal. “We’re concerned whether or not there are going to be problems with access to care for those seeking to become new Medicaid beneficiaries.”

A deeper worry is how the new system will impact Rhode Islanders currently receiving nursing home care – after a heart attack, a stroke or hip surgery – that have lost their Medicare coverage and need to apply for Medicaid services.

The nursing facilities then provide services without compensation while the application is being processed. A decision is supposed to be made with in 30 days, but lately the determination can often take months. Even if the facility receives a retroactive check months later, the process can play havoc with a facility’s cash flow.

The financial burden placed upon nursing facilities awaiting a decision on Medicaid eligibility can be severe. As a number of sources told ConvergenceRI, the funding stream for Medicaid payments from the state has reached a crisis level.

“Nursing facilities are already financially fragile, due to their heavy Medicaid census. The state today owes millions to these facilities whose Medicaid applications are dragging on. If it gets worse some will have difficulty making payroll,” one source said.

At the same time, the home care agencies are experiencing great difficulty in finding workers because of low reimbursement rates from the state. [See link to ConvergenceRI story below.]

How bad are things? A radio talk show host recently received the following email from a former worker at United Methodist Elder Care of Rhode Island:

“I, along with seven other people, got laid off last week; they completely closed down the development department. Grants were down because they were so badly in the red. It’s tough to keep a low-income housing and health care center going on Medicaid payments. I hope the organization will be able to pull out of it.”