Federal changes to aid programs and rising demand for services have pushed up the workload of the Arapahoe County Department of Human Services over the past few years.
“We’ve seen some pretty unprecedented times in terms of working with an extremely large volume of people in need, and also complexity of the (Medicaid) program,” Human Resources Director Cheryl Ternes said at a recent public hearing.
She said the county’s workload has increased for the Supplemental Nutrition Assistance Program (SNAP) and Medicaid, both federal programs administered by the county.
SNAP assists low-income families and individuals with the costs of purchasing food. Medicaid, known in the state as Health First Colorado, is free or low-cost public health insurance for low-income individuals and families.
From 2019 to 2023, the department’s SNAP caseload steadily increased from 19,281 cases to 32,597 cases, according to county data.
Bob Prevost, the county’s human services deputy director, said part of this increase in demand for food assistance could be due to economic factors.
“Grocery prices have gone up, inflation, and a lot of folks are hurting out there,” he said. “We’re at the front line of that help, that social safety net.”
He also said awareness of the SNAP program has increased over the years due to marketing efforts from the federal level, specifically during the COVID-19 pandemic.
In 2020, when the COVID-19 pandemic and the federal public health emergency began, the federal government gave families and individuals on SNAP temporary additional food assistance benefits. People who normally wouldn’t have applied for SNAP before the pandemic may have signed up for benefits during this time because of the increase in benefits, Prevost said.
For example, a person on Social Security who received about $18 in food assistance per month before the pandemic could have seen that amount raised to $275 per month during the pandemic, he said.
In March 2023, those extra aid dollars ended, Prevost said, but the awareness stuck.
“Even though (the extra benefit amounts) ended, because of that marketing campaign nationally that occurred with several of our programs, a lot more folks who are out there were interested in seeing what we could do for them,” he said.
Medicaid program becomes more complicated
The county’s Medicaid caseload is a slightly different situation. After increasing since 2019, the number of Medicaid cases seems to have fallen from 103,873 in 2022 to 85,632 in 2023.
Part of this decrease could be from people who went back to work and got employee-sponsored insurance after the pandemic, no longer needing Medicaid, Prevost said.
But there’s also a chance the county’s number of active cases is not the full picture, he said. During the pandemic, eligible Medicaid recipients were “locked-in” to the program, meaning it was easier to get into the program and no action was necessary to maintain coverage. Now, due to federal changes after the public health emergency, these cases have a 90-day grace period to be verified and renewed.
Arapahoe County staff members are now in what they call an “unwind period,” where they have to work with families and individuals to review the locked-in cases for eligibility.
Currently, there are about 10,000 cases still in the 90-day grace period, with people who may or may not choose to renew their coverage. Prevost said he calls these “invisible cases” because they are not included in the county’s current case numbers, but they could become active cases at any moment within the grace period.
“Once we’re done with the redeterminations for the locked-in caseload and we have a little bit more time go by, then we can see what the trend will be,” Ternes said.
Despite the Medicaid caseload not increasing between 2022 and 2023, Prevost said the workload for staff has still increased. He said federally required steps to process cases have become more complicated — meaning it takes a lot more time for county employees to process each one.
One of the main changes over the past few years has been the renewal process. Prior to February 2022, Medicaid coverage auto-renewed, Prevost said. Now, renewal requires county and client action.
“Unless there was a change reported to us, the case would just automatically re-enroll” in the past, he said. “Now we have to touch every single case.”
Medicaid members must submit a renewal application every 12 months to continue receiving benefits. This goes for all cases, not just ones that were locked-in during the pandemic.
The renewal process now requires a phone interview and a “signature” provided over the phone, which adds extra time to process each case. The state and federal departments that manage these programs have also made dozens of eligibility rule changes in the past few years.
“Once upon a time, the renewal packet was five, six pages long — now, it’s 55 pages long,” he said. “Folks needing help completing that packet, bringing it into our office, just requires a lot more staff time.”
Prevost said the department gets 9,000 more phone calls per month than it did before the “unwind period” began.
Efforts to maintain timeliness
Despite the increase in workload, Arapahoe County meets the required timeframes for processing SNAP and Medicaid applications more consistently than many neighboring counties.
In February, it met required processing timelines for 89% of all kinds of SNAP and Medicaid cases on average, according to state data. This number was a fraction of a percentage point behind Larimer County and was more timely than averages in neighboring Adams, Denver, Boulder, Jefferson and Weld counties.
For the past six years, Arapahoe County has been the leader in timeliness for processing new SNAP applications, compared to neighboring counties Adams, Denver, Jefferson, Weld and others, according to state data.
For SNAP and Medicaid renewals, the county meets required timelines at a slightly lower rate than for new cases. Still, its timeliness is equal to or better than many of the other populous counties in Colorado, according to state data.
Prevost said this is because renewal cases can be more complicated, highlighting the “invisible caseload” and the constant changes over the past couple of years. He said the county made a commitment to process new applications as timely as possible.
“We didn’t want to chase our tail trying to always keep up with the federal changes on renewals and sacrifice the front end of the work we do,” he said.
Prevost said his team treats every new SNAP application like an expedited case, meaning it needs to be processed within seven days. This helps them meet timeliness standards, he said, and ensures the staff doesn’t miss any emergency applications.
“If somebody fills out their application incorrectly, our system looks at it and says ‘No, this is not expedited, it’s regular,’” he said. “But when we do the interview, (say) we find out they put in the wrong information — it’s actually an expedited case. If we didn’t do it within that seven days, then we’re not timely. So we just treat them all like emergency situations.”
To keep up with increasing demands, the human resources department requested more staff members in the county’s 2024 budget. Because the state government increased its funding for the administration of these programs, the Board of Commissioners granted the division that manages SNAP and Medicaid 25 more full-time equivalent employees.
Prevost said the county also has a system that helps create a more efficient workflow for processing cases.
Prevost said delays in processing can often be tied to system issues with the Colorado Benefits Management System, a statewide database that determines eligibility for many assistance programs.
The Medicaid division employees have sent out their last batch of renewal notices to clients and are waiting on responses from the “invisible cases” that are still out there, Prevost said.