Despite hearing from Pennsylvanians who say they are getting the run-around when trying to get services for elderly or disabled adults through third-party service provider Maximus, Pennsylvania’s Department of Human Services wants to expand the company’s role.
Pennsylvanians gave testimony on Monday at the state House in Harrisburg, a joint, bipartisan hearing of the following committees was held: House Aging and Older Adult Services; House Human Services; Senate Aging and Youth and Senate Health and Human Services.
Imagine trying to bring a loved one home from the hospital for hospice care, but waiting so many months to hear back on approval that the loved one dies in the hospital before any service is obtained. Or trying to keep a sick family member at home, but because it is so difficult to navigate the approval process, their health declines while waiting for answers and home care is no longer an option. These stories were shared during the hearing.
Those seeking financial assistance must contact independent enrollment broker Maximus to set up hospice services, transition from home or hospital to a nursing home, or like Tammy Schwab of Mercer County, set up in-home care.
Schwab is caregiver and mother to Teneille, age 20, who lost nursing services partly due to COVID-19 in September. Schwab has been trying to arrange new nursing services so she can return to work while he daughter receives care. Teneille has multiple disabilities including a chromosome disorder, muscle, and mobility issues. She requires full-time care and help with everyday tasks such as eating and dressing.
When she applied through Pennsylvania Independent Enrollment Broker (PA IEB), operated by Maximus, a phone agent hung up on her and another promised to send an application packet but never did, Schwab testified. She called back many times, retelling her complicated story and finally receiving a packet of papers. She filled out the packet, sent it back, and again waited to hear from PA IEB.
Hearing nothing, she called again and found they had no record of her previous calls and lost her packet. They mailed out another packet. Eventually, she heard back, first that she hadn’t filled out the packet properly, and later that services were denied, but she could appeal. Now, 11 months later, through more rounds of lost paperwork and phone calls, Schwab has gotten nowhere. Without care for her daughter, she can’t return to work.
“At this point, I feel like I’m failing my child, because I can’t physically perform her physical therapy. Because she doesn’t have a nurse, and because of COVID, she can’t go to school,” Schwab said. “And then the school district stopped paying the physical therapist to come to the house. Because I didn’t have services to send her to school, they ceased the other services as well,” Schwab said. “The whole system is wrong.”
Before any of this happened, Schwab injured her arm and requires surgery which will be delayed until she can arrange nursing for her daughter. She can only use one arm to feed, bathe and change her adult daughter’s diaper.
“You call in. You leave a voicemail on a computer. And you pray to God that someone who cares stumbles across it and forwards it to the next department,” Schwab said.
New Contract for Maximus
Maximus is in the process of negotiating a new procurement contract through the Department of Human Services to continue enrollment work and take on additional duties. The company did not have a representative at the hearing.“Maximus is proud of our decades-long work with the Pennsylvania Department of Human Services to improve the lives of individuals and families. Our dedicated and passionate team of experts takes a comprehensive, person-centered approach to health and human services in every aspect of our work serving the people of Pennsylvania. Maximus is aware that the federal government rules require eligibility assessment to be independent of Medicaid service delivery,” Eileen Cassidy Rivera, Maximus vice president of public relations and communications, told The Epoch Times in an email.
The company has had contracts with Pennsylvania since 1986, Cassidy said, starting with its first state contract with the Superior Court of Pennsylvania and in 1989, with the Erie County Domestic Relations office.
In 2012, the federal Centers for Medicare and Medicaid Services (CMS) directed states like Pennsylvania to separate enrollment and assessment services from the delivery of Medicaid reimbursable services. The federal government raised concerns about a potential conflict of interest with one agency handling enrollment and assessment services as well as providing Medicaid reimbursable services.
In Pennsylvania, the 52 county-level Area Agency on Aging (AAA) offices handled enrollment, assessments, and Medicaid reimbursable services. Then in 2016, Maximus took over enrollments.
In the new contract, Maximus is expected to also take over assessments, while the AAA will continue to provide Medicaid reimbursable services working with managed care organizations.
The new contract may mean many AAA workers across Pennsylvania, who currently conduct face-to-face and often in-home assessments, would lose their jobs. These are the people who intervene when applicants have trouble navigating Maximus.
“Awarding Maximus a contract that expands its scope of work with Pennsylvania’s seniors would be a bad decision for seniors, their families, and the workers who support them,” Steve Catanese, President of SEIU Local 668, the union representing AAA workers told The Epoch Times. “Maximus has a long, documented history of failure when it comes to serving America’s most vulnerable citizens. The Commonwealth of Pennsylvania should not award this contract to Maximus and, instead, keep services in the hands of local community aging offices where this vital work is already being performed with more expertise, care, and cost-efficiency.”
The AAA applied to offer services for the next contract, but Gov. Tom Wolf’s administration already decided to go with the Maximus expansion. It’s unclear when the new contract will go into effect because the AAA filed a bid protest with the state to put the contract on hold, typically for 60 days, which would be up until Sept. 28.
“My primary focus is ensuring that we have personal, responsive, and knowledgeable brokers working with our seniors and adults with disabilities,” state Senator Michele Brooks, Chairwoman of the Health and Human Services Committee, told The Epoch Times. “They need local, individualized support that will never be accomplished by a 1-800-nowhere number. The AAA has provided these services for many years and were paid under $100 per successful enrollment; yet, the state replaced them with a call center and a multi-million dollar contract with Maximus that’s quality fails in comparison.”
Bucks County opened a phone hub in January for people unable to get the assistance they need, testified Bucks County Commissioner Diane Ellis-Marseglia, who is also a social worker. The Bucks County Area Agency on Aging has received 842 calls since January from people asking for help with Maximus.
“It’s unbelievable [the AAAs] have to spend double time doing something they could have done on their own,” Ellis-Marseglia said. “The people calling, who have to deal with Maximus, are people at the worst point of their lives. Some of them were just widowed and they were not the person dealing with the paperwork in their family. Now they are trying to get assistance for themselves and they don’t know where everything is. Sometimes they’re sick, or in a hospital. Lots of times they are struggling with dementia. And we can’t assume everyone has a child living in their county. Some people are truly all by themselves, and there’s where the AAAs have come in and been like a family member. They literally will crawl under the bed, pull out those boxes and find the missing bank statements that are out there. That isn’t what happens when you call Maximus.”
The Department of Human Services did not respond to requests for comment.
