PROVIDENCE – In retrospect, it was a revealing give and take that took place at the Oct. 7 briefing at the R.I. Department of Administration between WPRI reporter Ted Nesi and Elizabeth Roberts, secretary of the R.I. Executive Office of Health and Human Services.

Nesi repeatedly asked questions about whether concerns had been voiced by federal authorities about the Sept. 13 rollout of the Unified Health Infrastructure Project, known as UHIP, the $364 million IT project to create one single entry point for eligibility for all the services provided to poor, frail and needy Rhode Islanders seeking benefits and services.

The news media had been reporting on a laundry list of computer glitches: people unable to access new SNAP balances on their EBT cards; hours-long wait times, both on the phone and in person at Department of Human Services offices; and delays in making direct deposits into accounts to some 29,000 aged, blind and disabled persons who qualified for meager $39.92 monthly payments from the state in Supplemental Security Income payments.

As reported by ConvergenceRI, Roberts kept fencing with Nesi, deflecting his questions about what concerns may have been voiced by the feds about the Sept. 13 rollout, finally saying that she had talked on the phone with officials from the regional offices of the Centers for Medicare and Medicaid Services earlier in the week. [See link to ConvergenceRI story below.]

“They read the newspapers, they want to hear directly from us about how things are going. I respect them for that,” Roberts said: “They’re concerned, as we are.”

It turns out that Roberts’ answer was, at best, incomplete; it was also somewhat less than accurate and transparent; and it was more than a bit misleading.

Curiouser and curiouser
At no time during that Oct. 7 briefing did Roberts share the fact that two letters had been sent by Kurt Messner, the regional administrator for the U.S. Food and Nutrition Service, on Sept. 2 and again on Sept. 6, to Melba Depeña Affigne, director of the R.I. Department of Human Services.

In each of these letters, Messner had voiced strong concerns about potential problems in the UHIP implementation related to the Supplemental Nutrition Assistance Program, or SNAP, warning that, in his opinion, “The transition plan remains inadequate and unacceptable.”

Messner also warned that the Rhode Island’s decision to launch the new system without a live pilot test of the system was “in violation” of federal SNAP regulations and could end up costing the state money due to “program penalties or disallowed costs,” according to the letters, first published by WPRI.

Was Roberts’ decision not to share this information at the briefing one of omission? Or, was it one of deliberate calculation?

Roberts, Michael DiBiase, director of the R.I. Department of Administration, and Depeña Affigne, all knew about the letters and their content, along with the fact that observers from the U.S. Food and Nutrition Service had been onsite to monitor the launch in the days following the Sept. 13 launch.

Roberts, DiBiase, Depeña Affigne and Jennifer Wood, Deputy Secretary of R.I. Executive Office of Health and Human Services, had been huddling together for more than an hour in advance of the Oct. 7 briefing, carefully preparing their remarks and presentations, according to an agency official. What was to be said – and what was not to be said – had been carefully scripted.

The messaging at the briefing emphasized that the system was working well for the large majority of recipients, accentuating the positive.

That messaging, however, fell apart four days later when, on Oct. 11, the letters from Messner were published by WPRI. That revelation, in turn, led to the decision to hold a joint hearing on Oct. 20 by members of the House Finance and House Oversight Committee.

What did Raimondo know, and when did she know it?
On Oct. 12, in a follow-up interview with WPRI, Gov. Gina Raimondo said that she was personally unaware of the letters from Messner, saying: [They] were not brought up to me, no,” claiming that, at any given time, “There’s a lot of letters being sent from the federal government to my team on any number of issues.”

Despite her denial, it does seem rather difficult to understand how Raimondo would not have been informed about the two letters from Messner, particularly since Messner directly threatened the potential loss of federal funds if the UHIP implementation went ahead as scheduled on Sept. 13 and it resulted in problems.

The denial by Raimondo, claiming that they had not been “brought up to her,” raised any number of questions, which may or may not be asked and answered by the legislative hearing this week.

Parsing the questions
Did Roberts or DiBiase hide such information from Raimondo? It’s hard to believe that either would intentionally deceive the Governor. [DiBiase took responsibility for apparently not sharing the letters with the Governor, falling on his sword.]

Did Roberts or DiBiase present the information to Raimondo’s staff – only to have the staff fail to pass it along to Raimondo? Once again, it’s hard to believe that Roberts or DiBiase could not pick up the phone and talk directly with Raimondo, if either chose to do so. Or, that Raimondo, who reportedly calls her team all the time, at all hours of the day and night, was not in frequent contact with Roberts and DiBiase about the UHIP launch.

Was Raimondo’s response a way to deflect the question, to say that she had never “seen” the letters, saying that they had never been “brought up” to her, but, in fact, the letters may have been discussed? There were similar kinds of unresolved questions raised about exactly when Jim Skeffington had briefed Raimondo and her team about the new proposed Red Sox stadium, in advance of the proposal becoming public.

Had Raimondo set a deadline for Roberts, DiBiase and their team of Sept. 13 and told them to make that deadline, with no excuses or complaints accepted, after the first planned rollout in July had been delayed? This sounds like a more plausible explanation, given Raimondo’s reported penchant not to brook any excuses or complaints about why things cannot be done, in her drive to achieve results.

If penalties are assessed and federal funds lost, would the contractor, Deloitte, be held accountable as part of the existing contract provisions and face financial penalties? To date, Deloitte has never been held accountable and been assessed a financial penalty for previous problems and glitches.

It was a question that ConvergenceRI asked directly of DiBiase at the Oct. 7 briefing; DiBiase replied that while there were contract provisions that called for potential financial penalties for poor performance. In response to a follow-up question from ConvergenceRI, he said there had never been a situation for which those clauses had been invoked, resulting in money being paid back to the state.

“Obviously, there is a give-and-take in any of these contractual relationships. We have a couple of years’ experience in doing work with Deloitte,” DiBiase said.

It’s the same old story
In January of 2015, ConvergenceRI broke the story that continuing glitches in the implementation of the UHIP system as part of its rollout with enrollment for HealthSourceRI had cost the agency an extra $9.7 million in expenses in 2014, according to an internal report obtained by ConvergenceRI.

The problems included: inadvertent disenrollments that caused many Rhode Islanders to believe they had health coverage and who were up-to-date in paying their premiums, only to find out that they were not covered when they went to the doctor’s office, hospital, or pharmacy.

In addition, there were numerous glitches in billing as well as numerous reports of poor interface between UHIP and the insurance carrier systems.

“We began to divert resources at the HealthSourceRI and the Contact Center to mask these defects and to address the needs of those consumers, carriers, brokers and small businesses facing significant problems,” the report said.

“We have been operating under a contingency plan for the past 10 months,” the report continued, causing a major diversion of staff resources. Up to 14 staff at HealthSource RI had been redirected to address UHIP defects, issues and workarounds, according to the report. Of the 18 members of HealthSourceRI’s small business outreach team, some 6-8 members have been devoted solely to addressing UHIP system issues for small business customers, the report said.

The information came from a briefing book prepared by the former director of HealthSourceRI, Christine Ferguson, which she had provided to the Raimondo administration, but the Raimondo administration chose not to share it with the public.

Instead of paying any financial penalties for the glitches, Deloitte provided pro bono services to the Governor’s Working Group To Reinvent Medicaid. At the working group’s June 24, 2015, session, an 11-member team from Deloitte facilitated the session on a pro bono basis, as the working group finalized its formal principles. [See link to ConvergenceRI story below.]

Scoring political points
In an election year, the legislative hearing on Oct. 20 promises to be more of an opportunity to score political points rather than to ask and answer some of the larger, fundamental questions.

There will be those who will claim that the UHIP implementation was “botched” and demand answers, in angry tones.

In response, no doubt, there will be a continued flow of messaging from the Raimondo team, pointing out that with any implementation of a big, new software system, there are always going to be glitches, and those glitches are being addressed, and that, as the Data Fact Sheet issued on Oct. 14 by DHS and EOHHS said: “It is estimated that a vast majority [98 percent] of beneficiaries continue to use the system without significant issues.”

And, that in response to the glitches, “Teams are working quickly to identify, prioritize, and resolve technical issues as they arise. Such issues which are normal and expected for the launch of a system of this size and complexity.”

The Data Fact Sheet continued: “When issues arise, our top priority continues to be ensuring that customers’ needs are being met as quickly as possible and in accordance with federal guidelines.”

[Further, a 69-page data report, covering activities through Oct. 3, submitted on Oct. 14 by Depeña Affigne in response to a request by by requested by the Food and Nutrition Service, was made available on the afternoon of Oct. 14 following the briefing.]

The next big test of UHIP will be on Nov. 1, the day after Halloween and one week before the Presidential election. Trick or treat?

Massaging the media
What has not yet been addressed to a large degree is the sophisticated way in which the Raimondo team manages the news flow, churning out a regular series of events that cheerlead efforts by Raimondo to rebuild Rhode Island’s economy and improve educational outcomes. As the old song lyric goes: accentuate the positive, eliminate the negative, and don't mess with mister inbetween.

On Friday morning, Oct. 14, for instance, as a part of a PSAT pep rally at Pilgrim High School, the Governor appeared with the Pilgrim High School cheerleading squad in a photo op, one that was later shared with the news media.

Yet, at a briefing on Friday afternoon, Oct. 14, Depeña Affigne revealed that earlier that morning, Raimondo had visited the DHS Providence offices, talking with “customers” waiting in line. It was a stop that had not been placed on her public calendar and no news media had been invited.

Depeña Affigne, who had accompanied Raimondo, said the Governor had an opportunity to understand “first-hand of some of the struggles that our families are facing,” adding that the customers had been civil and honest about their frustrations, according to a story by Karen Lee Ziner in The Providence Journal.

Why had no media been invited for a photo op?

Editor's note: On Monday afternoon, Oct. 17, Gov. Gina Raimondo announced plans to increase the hours at the Providence Deparment of Human Services office, having it remain open until 6:30 p.m. two days a week to ease the wait time. She also announced that, at her urging, Deloitte will immediately assign additional managers, at no additional taxpayer cost, to supervise technical staff and better manage regular data reporters about the new UHIP system

Her statement with the news release seemed to reflect a new sensibility on her part, as if she had read the ConvergenceRI story above: "Big system transitions like this take time, but that acknowledgement doesn't make it easier for a mom who has to wait half a day at a field office to get her application approved."