Aid: Setup designed to ease eligibility decisions often wrongly denies benefits to the needy. Officials say worst problems are fixed. By EVELYN LARRUBIA and CAITLIN LIU TIMES STAFF WRITERS

February 17 2002

A $152-million Los Angeles County computer system that was supposed to make faster and more accurate decisions about who is eligible for government aid is millions of dollars over budget and is wrongly denying medical benefits to needy children and families.

Advocates for the poor say they have received hundreds of complaints about pregnant women denied prenatal care, babies who were not allowed vaccinations and sick children turned away by medical professionals. Some poor families who were cut off fell behind on bills and had to move in with relatives.

Aid recipients who are denied benefits often complain to the county and, if that fails, sometimes turn to advocacy organizations. Representatives of those groups say that when they call county workers on behalf of their clients, they are told each time that the problems were caused by the computer system. "The technology was supposed to be a blessing and it's been turned into a curse," complained Linda Feldman, spokeswoman for the Venice Family Clinic. "People are left without coverage. They're totally vulnerable."

Federal and state officials say they too are concerned that the system is denying needy families the health care they deserve in part because programs that potentially affect two out of every three Medi-Cal recipients have not been automated.

"This is really a question of will and priorities," said Glen Rosselli, undersecretary of the state Health and Human Services Agency. "It's unconscionable that they haven't addressed the problem."

Officials with the county Department of Public Social Services acknowledge problems in the massive system, but insist that they have worked out the major glitches and that the minor problems that remain can be worked around. They blame the majority of continued errors on county workers, who in December began receiving additional training to help them master the extraordinarily complex system.

"Yes, there are problems that need to be fixed, but by and large, most people are getting their benefits on time," said Jim Swedlow, deputy director of the project. "It's not in a crisis state."

Federal officials counter that there's no way to know how many are being wrongfully denied--and that the glitches suggest that many people could be harmed.

"Counties ... have an obligation to expeditiously correct computer programming problems that lead to erroneous Medicaid denials and terminations," officials with the federal Department of Health and Human Services wrote the county in September. "Because the L.A. ... system does not recognize [certain Medicaid] program requirements, the potential for erroneous case determinations is high."

Slow Economy Makes It Bad Timing for Agencies

Questions about the computer system's adequacy are particularly relevant now, as the economic slowdown puts additional pressure on welfare agencies to handle increases in demand for services.

LEADER--which stands for Los Angeles Eligibility Automated Determination Evaluation and Reporting system--was designed to automate welfare eligibility determinations. One of the largest data processing systems in the nation, LEADER replaced 18 different smaller systems that helped county workers process applications for government aid. Los Angeles County processes 700,000 such applications annually.

After 31/2 years of design, $66million in cost overruns and a five-month test pilot, technology experts began phasing the LEADER system into county offices in October 1999.

But only about a third of the cases were entered into the system before its memory ran out. It took Unisys, the contractor who built the system, nine months to fix the capacity problem. The computer giant repaired it for free, and the county overlooked the $1.3 million in fines it could have sought against Unisys for delivering the completed system nine months late, according to county records.

Advocates, Union Deny Claims of Compliance

Last August, officials in the county welfare department deemed the system a success. It was working in every office in "substantial compliance" with the county contract, the department told the Board of Supervisors in a memo asking the board to pay Unisys the remaining $5.8million it was owed.

But advocates and county workers union officials complain that it was not working properly then and that it still is not.

"It's the typical bureaucratic line. You don't want to say publicly that this $150-million computer system is a piece of [garbage]," Kim Lewis , a staff lawyer at the Western Center on Law and Poverty.

Among the cases advocates use to illustrate their frustration is the experience of a Venice mother who worries that months of delay in getting Medi-Cal may cost her daughter her sight.

Four-year-old Miranda Robles was diagnosed in September with a deteriorating eye condition requiring surgery. Doctors at the free clinic who examined her say she needs to see a specialist to correct the problem in her right eye, called amblyopia.

"If you don't catch [the condition] early, you can't make up for the problem," said Dr. Anne Arikian, a staff physician at Venice Family Clinic. "After a certain period, it becomes irreversible."

Miranda should have immediately qualified for free health insurance, advocates said. Instead, she waited for months because of problems with the new system.

Initially Miranda's application sat in a pile at the county for three months--twice the federal time limit for processing them--amid a backlog caused in part by workers getting used to the new system. Then, the wrong information was processed, saddling the girl with an improper $916 monthly deductible.

Miranda's parents earn $1,940 a month working as a housekeeper and gardener to support their three children and two other relatives, all of whom live in a modest two-bedroom house.

Officials with the county Department of Public and Social Services acknowledge that Miranda was improperly denied benefits and blame a data-entry error for producing the wrong deductible.

"We have identified the need for additional training and this is another example of that need," said Swedlow, the county welfare official. "The problem is that eligibility is horribly complex. Because we are automating a highly complex system, the [computer] system gets complex."

Workers Can't Tell Why Benefits Are Cut Off

In a survey of 200 workers that the county employees union conducted of its members, a third said the system had improperly denied a needy person benefits in the preceding two weeks. At times, workers complain they don't even know why the system cuts off benefits because it does not give adequate explanations and they find it difficult to fix clerical errors.

For more than a year, state officials suggested to the county that they needed to beef up their technical support, said Elias S. Cortez, California's chief information officer. He said he is not concerned about whether the computer is computing, but rather about the county's ability to prioritize complaints and ensure that workers get the support they need to make the system work.

"It sounds like there's a big need and it needs to be filled," Cortez said. "This is just going to be a leadership issue."

'The Client Shouldn't Suffer for It'

Advocates stress that whether the problems grow from training or programming deficiencies is irrelevant to the needy people who are not getting the help they need.

"The client shouldn't suffer for it," said Lewis of the Western Center on Law and Poverty. "They're too vulnerable for that."

She and others want the department to review all denials and terminations to ensure that they were not the result of computer error or errors in using the computer, but the department has been hesitant to agree.

In some cases the denial of services has the potential for permanent harm. Ten-year-old Ricardo Daniel Rodriguez, for instance, grew so impatient with delays in benefits to pay for a dentist that he resorted to pulling his own tooth.

Ricardo's Medi-Cal benefits have been improperly cut off repeatedly for the past year, county officials acknowledged. His family would complain and get reinstated, only to lose the benefits again--the result of a computer glitch that county officials failed to identify for months.

In December, Ricardo began suffering from a painful molar. His mother, Anna Luque, tried dentist after dentist, but none would make an appointment for Ricardo.

"They said my Medi-Cal was cut off," explained Luque, 47, who earns $1,000 a month from two part-time jobs as a child-care worker and school aide. "Every time I call my [county case] worker, he says it's a problem with the computer."

She said her son couldn't wait for the computer problems for relief. After a week of excruciating pain, Ricardo finally yanked out the aching tooth himself.

Swedlow, the welfare official, at first insisted Ricardo's problems were caused by worker error. But after repeated queries by The Times, he said he dug deeper and found a programming error that caused incorrect information to be transmitted to the state's Medi-Cal computer system, resulting in Ricardo's benefits being cut off.

Swedlow said "a small number" of other cases were also affected by the problem, which has been fixed.

In addition to the other complaints about the system, workers say it can take months to fix a problem even after it is detected.

Union officials said two-thirds of workers surveyed said they had written several "trouble tickets" complaining to department technology experts of computer problems in the preceding six months.

"It took over two months for the problem to be corrected," one worker complained to the union as part of the survey. "In the meantime, I was unable to work the case and the participant kept calling and became very impatient."

In another case, a 38-year-old single mother from West Covina complained for months that her cash aid and food stamps were fluctuating wildly and without reason. Her social worker submitted a "trouble ticket" on the case, but it sat in a pile for five months, wrongly tagged a low priority until press inquiries about it.

Cost overruns related to the system came to light in December 1998, when Unisys and welfare officials asked and got the Board of Supervisors to pay the computer giant $27 million to cover the changes that welfare reform made to cash aid programs. That was on top of the $86 million the computer giant had bid three years earlier to build the massive system.

It was also on top of the $20 million the county agreed to pay to cover some of Unisys' costs when it complained that it had underbid.

But county officials chose not to update the Medi-Cal programs at the time. Instead, they decided that workers could temporarily make eligibility calculations by hand, then override the system.

State officials were baffled.

"I don't know why, given that some of these things have been required since 1998, why they were not incorporated in LEADER when LEADER went into operation," said Bill Walsh of the state Health Department. "It's worrisome and bothersome."

County Supervisor Yvonne Brathwaite Burke said she is annoyed that department officials have for months submitted reports indicating that the system was working properly, suggesting there would be no additional changes.

On her motion, the Board of Supervisors last month ordered the department to report any remaining system problems and cost estimates on automating the outstanding Medi-Cal programs.

Those updates will cost millions, of dollars, county welfare officials said. The exact sum is the subject of ongoing negotiations with Unisys. http://www.latimes.com/news/local/los_angeles_metro/la-000012280feb17.story?coll=la%2Dcommun%2Dlos%5Fangeles%5Fmetro

-- Anonymous, February 17, 2002