Good Government

DHS officials dismiss critical state review

October 5, 2021

Ray Carter

Increased funding provided to the Oklahoma Department of Human Services (DHS), intended to move people with disabilities off a years-long waiting list and begin providing them state services, has had little impact, a new review finds.

Instead, the Legislative Office of Fiscal Transparency (LOFT) found that the greatest reduction in Oklahoma’s Developmental Disabilities Service Waiver Waiting List was the result of purging those who were no longer eligible—including individuals who may have died.

DHS officials dismissed those findings, telling members of the Oversight Committee for the Legislative Office of Fiscal Transparency that its programs are too technical for outside reviewers to understand and that much criticism in the report was the product of being “too transparent.”

Justin Brown, director of the Oklahoma Department of Human Services, said the report was not a “worthwhile use of time and resources.” He said DHS Chief of Staff Samantha Galloway met with LOFT officials when the review process began to discuss the Developmental Disabilities Service Waiver Waiting List.

“In hindsight, she was likely too transparent in those meetings,” Brown said. “Pieces of this report exploit the transparency provided by DHS to LOFT at the entrance conference and along the way and are indicative of why the agency has historically been so closed and siloed to any external review or cross-agency collaboration.”

Under federal law, states can waive some Medicaid requirements to provide services to individuals with certain developmental or intellectual disabilities. However, when a state lacks funding to cover all applicants, they are placed on a waiting list.

In Oklahoma, there were 5,619 Oklahomans waiting to receive services through a state waiver as of March 2021. Many of those individuals have been on the list for years.

“Approximately 65 percent of these people have been waiting for waiver services for more than seven years,” said Andrew Welch, an analyst with LOFT. “Over the past five years, the wait time has increased by two years, going from 11 years in fiscal ’16 to the current wait time of 13 years. With a 13-year wait time, a five-year-old child placed on a waiting list today would be 18 years old before receiving waiver services. That child would effectively age out of the in-home child waiver and first receive services through the adult waiver. There is the potential that failure to receive early treatment and care may result in more expensive services being needed by the time they enter the waiver program.”

In recent years, lawmakers have dedicated increased funding to the waiting list to reduce both the number of people on the list and the length of time they go without services. LOFT reviewers found that money had little impact.

“LOFT found that the number of people moved from Oklahoma’s Waiting List into waiver services over the past decade has remained relatively flat, despite the Oklahoma Legislature dedicating almost $9 million over the past eight years to the Department of Human Services (DHS) for this purpose,” the report stated. “LOFT observed no direct correlation between the additional appropriated funds and the actual transition of people moving from the Waiting List into a waiver.”

Instead, LOFT officials found many changes in the list had nothing to do with people getting services.

“The greatest change in the Waiting List—2,400 applicants removed in 2019—was due to purging the names of those who could not be reached or no longer needed services,” the report stated.

The LOFT report said DHS has not assessed applicant needs when people first apply, meaning the agency has operated without knowledge of how much money the agency will need to cover the cost of services once they are provided.

DHS officials responded that they have recently begun doing up-front assessments and are in the process of assessing the needs of those already on the waiting list.

Brown said the report presents “the plan DHS laid out as though LOFT developed it.”

He also objected that a LOFT employee previously worked for DHS and left “under adversarial circumstances.” Mike Jackson, executive director of LOFT, told lawmakers the former DHS employee had almost no role in the report.

In many sections of the LOFT report, Brown said “the data is just plain wrong,” and claimed LOFT reviewers lacked “understanding of what a developmental disability is, who we serve, what DDS waivers are, overall agency financials and budgeting, and the technology and manpower infrastructure necessary to run and transform an organization.”

“The report itself is full of inaccuracies, inconsistencies, and contradictions, and ill-informed and accusatory statements,” Brown said.

He said DHS employees feared the loss of employment due to the report’s findings.

“There are folks who are really concerned about their own jobs when this LOFT report came out, and that’s unacceptable,” Brown said. “We need to defend our team, and that’s in part what we’re doing today.”

At least one lawmaker noted DHS officials were not denying the report’s core conclusions.

“What I heard was some discussion about the differences in the studies and some semantics around the way the population was defined,” said Rep. Jeff Boatman, R-Tulsa. “But what I didn’t hear was an objection to the finding that there’s not been substantial progress made in eliminating the waiting list. You’re not saying that, so are you not objecting to that finding or are we just kind of nibbling around the edges?”

“We are definitely objecting to the finding in all of its forms,” Brown responded.

DHS officials claimed they were given little time to respond to the report’s findings.

But Regina Birchum, deputy director of LOFT, said DHS officials chose not to engage with LOFT at points in the review process. After LOFT provided DHS a copy of the draft final report, Birchum said Brown emailed her and turned down the opportunity for an exit conference.

“I wish we had been swimming in data and information,” Birchum said. “I wish we’d had that luxury. What we had instead was a deliberate move from the agency to not respond to follow-ups, not verify information.”