June 28, 2018

Commissioner Roderick Bremby

Department of Social Services
55 Farmington Avenue
Hartford, CT 06105

Re: Unacceptable DSS Call Center Delays

Dear Commissioner Bremby:

The below signed advocates and providers for individuals applying for or receiving assistance
from the Department of Social Services, and some of these individuals themselves, demand
action to address the longstanding, unacceptable delays at the DSS Call Center (also called the
“Benefits Center”). The Call Center has now been in place for nearly five years. It was initiated
when the Department created the ConneCT system in July 2013 choosing to eliminate the
caseload approach, whereby each applicant or recipient was assigned to a specific worker to call
for help. DSS made assurances that efficiencies would result from the change, ensuring client
access despite the loss of assigned workers.

Today there are both long wait times at the call center and no assigned workers to turn to. Since
this system has been in place, the period with the shortest phone wait times (10 to 20 minute wait
time) occurred over two years ago, between May, 2015 and May, 2016. As delays persisted, the
Department claimed that replacing EMS with ImpaCT would resolve delays in processing and
other DSS service issues. After ImpaCT was fully implemented in August of 2017, and the
delays persisted, the Department then blamed this on the learning curve for workers on the new
system.

But we are now ten months past full implementation of ImpaCT, with all training long
completed, and call wait times with ImpaCT are now worse than they have ever been. DSS
reported an average wait time of 96-107 minutes, that is, up to one hour and three quarters,
for the four months of February through May of 2018. Several of us regularly experience waits
in excess of two hours or even two and a half hours. The extreme delays mean that most
individuals who call simply give up. The latest data from your agency shows that between 55%
and 60% of all calls are just abandoned, a shockingly high number. As you know, many DSS
applicants and recipients are working and raising children, or are people with disabilities or
elderly and, as DSS metrics clearly show, cannot wait that long.

In addition, we have recently become aware that callers to the Call Center are sometimes
involuntarily disconnected, and thus denied the ability even to be put on hold, or are put on hold
and then involuntarily disconnected sometimes after a long wait or just when a worker picks up
the call.

This is wholly unacceptable.

The Call Center is the point of entry for someone with a disability to request an accommodation.
A wait time of nearly two hours to even make such a request is clearly a barrier to exercising
rights under the Americans with Disabilities Act, subjecting the agency to liability for violations
of that federal law.

It is the only point of access for conducting mandated interviewing of SNAP, TFA and SAGA
applicants. And DSS is the only means by which elderly and disabled persons can apply for
HUSKY C, the Medicare Savings Program and MedConnect, which cover over a quarter of a
million people on Medicaid, many of whom cannot make it to a DSS office and must therefore
use the phone to do so. Long phone wait times for them violate the Department’s obligation to
provide benefits with reasonable promptness, 42 U.S.C. § 1396a(a)(8); 42 C.F.R. § 435.930(a),
as well as to “[f]urnish Medicaid promptly to beneficiaries without any delay caused by the
agency’s administrative procedures” and “with simplicity of administration and in the best
interests of the recipients,” 42 U.S.C. §§ 1396a(a)(19). The fact that the separate AHCT call
center may allow prompt phone access for HUSKY A and D applicants and enrollees does not
excuse non-compliance with these basic federal law requirements for all other applicants and
enrollees.

Not only is the Call Center vital to requesting accommodations and applying for all public
benefit programs, but it is a crucially important means for restoring benefits wrongfully
terminated due to other deficiencies in the department’s systems and processing. For example,
for years, the Department has wrongfully terminated eligible families and individuals at
redetermination because of its inability to process timely submitted paperwork before families
were automatically terminated at the end of their eligibility period. Legal Services
representatives were assured ImpaCT would resolve this longstanding problem, but it has not.
Many months after completion of training on ImpaCT, there are widespread reports that this
problem continues, and the Department has in fact publicly acknowledged this. When these
individuals who did everything right are wrongly cut off, they usually will try to contact DSS for
help, which, in the case of someone unable to get to a service center, necessarily means via the
Call Center. In the case of individuals wrongly cut off of Medicaid specifically, and unable to
reach a DSS worker through the call center to get the matter addressed, this also violates the
regulatory requirement that your agency “[c]ontinue to furnish Medicaid regularly to all eligible
individuals until they are found to be ineligible.” 42 C.F.R. § 435.930(b).

The problems with the Call Center force those callers, who are able, to get to Service Centers,
where they likely face an even longer, in-person, wait time. On June 5th, one of our advocates
was at the Hartford office. A DSS employee came out at one point and announced that there had
been 177 people waiting outside before the office even opened that day. The employee said
most people there had been waiting five hours and that the wait for a TFA application would be
longer than that. She advised those just entering to complete an application and return another
day, though federal law prohibits a welfare agency from doing this for federal benefits, see
Reynolds v. Guiliani, 35 F. Supp. 2d 331 (S.D.N.Y. 1999).

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Examples of the Harm from the Dysfunctional Call Center
1. A North Haven resident, 75 and on SNAP, received a notice from DSS about 3/20/18
requiring her to complete and return a form to stay on SNAP. She timely completed and
submitted it by mail on 3/28/18, long before the deadline on the notice, but nevertheless received
a notice from DSS on 4/26/18 stating that her SNAP case was being closed because DSS had not
received the redetermination document. She tried reaching the Call Center several times at the
end of April. Repeatedly, she received a recorded message stating that, due to high call volume,
they could not answer the phone and she should call back at a later date. She never got through.
On May 7th, she requested a hearing regarding the SNAP termination.

On June 12th, she called the Call Center again and got the recording saying there was higher than
normal call volume but this time it told her to stay on the line. She called at 9:45AM and a
DSS worker finally answered the phone at 12:15PM, 2.5 hours later. She started to explain
the situation, but the DSS worker said “you have to go to the hearing” and then hung up on her.
The SNAP benefits were reinstated just before the hearing on June 19th.

2. On May 11, 2018, an elderly individual called the Call Center at 10AM because her Medicare
Savings Program benefits were denied due to DSS having erroneous income information. She
gave up after waiting 3 hours. She requested a hearing, and did not get her MSP benefits until
weeks later, just before the hearing.

3. A 69 year old resident of Milford with a disability was cut off of the Medicare Savings
Program and SNAP. The SNAP termination was incorrect because DSS was double-counting
certain income. The termination of SNAP has been fixed but not MSP. She does not know why
the MSP was terminated. She tried to call the Call Center several times over the last few months,
starting in April, 2018. She has waited over an hour each time, and had to give up each time
because she is using a cell phone with limited minutes. Her MSP benefits have not been
reinstated.

4. An assistant director of a special needs agency manages nine accounts for special needs
individuals. Her average wait time is 2 hours to get to speak to someone at the call center but
several times she has tried to call and hold, but the system didn’t allow her to do that. For
example, she made a call for such a person who was terminated from HUSKY C, on 3-5-18 at
8:50am, and was cut off the phone at 8:50, then called back at 10:30am, and was on hold until
1:25pm before she spoke to a person. And on 4-1-18, the matter not having been resolved, she
called again for the same person, was on hold for two hours and then was cut off.

The calls she makes to the call center are critical because often they are about redeterminations
where she is calling to try to get someone at DSS to look at timely submitted redetermination
forms which have gone unprocessed, either to undo a termination or stop one before it happens.
She recently had two individuals who ended up with closed accounts because of this system and
not because they were late or they did not qualify.

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DSS has been in chronic crisis mode for almost two years. It clearly lacks the needed human
resources to answer the phone, given the other system deficiencies. For disabled clients with
mobility issues, for whom the phone may be the only point of contact, DSS access is effectively
barred. We know that this a complicated system to fix. But it has to be fixed. The need is urgent
for individuals who depend on DSS for their health coverage and basic subsistence benefits.
DSS has achieved timely phone response for HUSKY A and D applicants through its
subcontractor (CHNCT) and its sister agency (AHCT). It achieved a timely phone response at
the DSS Call Center between February and May of 2016, when wait times averaged seven to
nine minutes. Callers cannot be forced to await needed long term changes to ImpaCT before
getting timely access to DSS services via telephone.

DSS should be able to respond to calls, i.e., ensure that a knowledgeable worker picks up the
phone within ten minutes, and under no circumstances should callers be denied the option of
being put on hold or involuntarily disconnected after they have been put on hold. DSS should
achieve this while continuing its commitment to resolving all matters identified in the course of
the call. Timely phone response is not a solution if it is achieved by deferring resolution of the
issues to other workers at a later time.

Ten minutes for anyone willing to be put on hold is a standard that the department previously
met and exceeded, and is less burdensome than the standard it imposes on its own contractors.
We ask that you get back to us within two weeks with an express assurance to commit the
necessary human and other resources to promptly reach and then maintain this standard. If not,
we will explore all advocacy options to bring about the necessary changes.

Thank you.

Respectfully yours,

Advocates for Medicaid Enrollees

Kathy Flaherty
Conn. Legal Rights Project

Daria Smith
CT-State Independent Living Council

Gretchen Knauff
Disability Rights CT

Ellen Andrews
CT Health Policy Project

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 Steve Karp
National Association of Social Workers-CT

Tom Connolly
People's Center

Melissa Marshall
CT Cross Disability Lifespan Alliance

Heather Petit
Center for Excellence in Developmental Disabilities |
UConn Health

Sheldon Toubman
New Haven Legal Assistance Association

Kristen Noelle Hatcher

Connecticut Legal Services, Inc.

Luis B. Perez, LCSW

Mental Health Connecticut, Inc.

Eileen Healy
Independence Northwest

Jaclyn Pinney
Independence Unlimited Inc.

Lucy Potter
Greater Hartford Legal Aid

Mary Moran Boudreau

Connecticut Oral Health Initiative

Peaches Quinn, M.P.H.

Benefits Management Consultant
Older Adult Advocate

Sharon J. Heddle
Disabilities Network of Eastern CT, Inc.

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 Marc Anthony Gallucci, Esq.
Center for Disability Rights

Maureen McIntyre
CT Association of Area Agencies on Aging (C4A)

Jay Sicklick and Bonnie Roswig

Center for Children’s Advocacy

Kathi Liberman and Ellen Cyr

CARSCH

Bette Marafino
CT Alliance for Retired Americans

Judith Stein
Center for Medicare Advocacy

Charlie Conway
Access Independence

Michele Ann Palulis

Medicaid Benefits Attorney, Eastern CT

Kelly Phenix
Recovery support specialist

Julie Peters
Brain Injury Alliance of CT

Kathleen Bordelon
SilverSource
A Leading Resource for Older Adults

Elizabeth McOsker
Over 60 Club Inc.

Rev. Dr. Jan Carlsson-Bull, Social Justice Council

Unitarian Universalist Church, Meriden

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 Kristen Witt, LCSW
Michelle Bottone, MA, LMFT
Westport Department of Human Services

Beatrix Winter
Norwalk Senior Center

Medicaid Enrollees

Joe Luciano

Suheil Laracuente

Elaine Kolb

Joshua Tryon

Keith Mullinar

Medicaid Providers

Matthew C. Katz
Connecticut State Medical Society

Anne Hughes
Coordinator, Center for Elder Abuse Prevention & IOA
Jewish Senior Services

Donna Spellman
River House, Greenwich

Lewis Bower
Keep Me Home