Colorado Benefits Management System case
New CBMS settlement requires meeting performance targets
Colorado must show regular improvement in how it processes applications for public benefits programs such as Medicaid under a lawsuit settlement reached recently between the state government and plaintiffs and their attorneys, including the Colorado Center on Law and Policy.
The settlement arises from problems with the Colorado Benefits Management System (CBMS), a computer system that administers many of the state's public benefits programs. After CBMS launched in 2004, glitches in the system resulted in wrongful terminations, huge backlogs and other negative consequences for public benefits recipients. CCLP sued, and the case originally settled in 2007.
CCLP proceeded to monitor progress in the Department of Human Services (DHS) and the Department of Health Care Policy and Financing (HCPF) of timely processing of benefits applications. In 2010, CCLP again called the departments' attention to their continued failure to timely and accurately process applications and redeterminations. CCLP proceeded to mediation and settled with DHS. When it became evident CCLP would not reach a settlement with HCPF, CCLP filed a motion for enforcement and contempt in Denver District Court. The parties reached a settlement with HCPF before a court hearing took place.
Under the terms of the new settlement with HCPF, CCLP will continue to monitor client telephonic access to customer service, systemic computer problems with CBMS and problems with CBMS and its various interfaces. CCLP will also continue to monitor timely processing, and the department will be held to specific performance standards.
Beginning in June 2011, HCPF must show it is processing 75 percent of Medicaid and Child Health Plan Plus (CHP+) applications timely. Every six months after that, the department must show 5 percent improvement until it reaches 95 percent timely processing. HCPF is currently timely processing 64 percent of new applications. If the department can sustain 95 percent timely processing for 12 months, it will be deemed to have complied with the agreement.
With regard to redeterminations, the department must show it is timely processing 65 percent of redeterminations by Sept. 30. Currently, 51 percent of redeterminations are timely processed. Also, by the end of 2011, the department must implement administrative renewal of CHP+ and Medicaid recipients and remove the auto-termination feature from CBMS. The autotermination feature automatically terminates a client on a set date if the client's redetermination packet has not been processed, regardless of whether the client has turned in the packet.
By annualizing data from January 2011 and applying the settlement's performance targets, CCLP estimates that if HCPF meets its performance targets in 2011, at least 27,000 more new applicants and at least 39,000 more existing clients will have their applications and redeterminations processed timely than is the case at current processing levels. With the implementation of administrative renewal and elimination of autotermination, there should be virtually no untimely redeterminations after 2011, keeping more than 100,000 people annually entitled to medical care who would otherwise be unfairly cut off.
Check the publication library for background documents on the Colorado Benefits Management System case.
Released March 11, 2011
