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State takeover of Medicaid administration may affect NNY Social Services offices

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The state’s takeover of Medicaid administration by 2018 will echo through county Department of Social Service offices, although the effect on jobs remains uncertain.

“There’s so much that’s still unknown about it,” St. Lawrence County Social Services Commissioner Christopher R. Rediehs said. “We do know that the departments of social service will have a role change. It isn’t clear how that will unfold. At this point, we haven’t seen a decrease in work.”

The state already has taken over the administration of Medicaid transportation and is implementing a managed care plan as part of a system redesign. The advent of managed care has increased the complexities for local administrators, who are determining which applicants are eligible for which plans, helping clients navigate the state exchange and enrolling more than half of all applicants — those in nursing homes and those who receive Social Security and Supplemental Security Income — through local applications.

“I think there will always be a role for local Medicaid. It may be diminished,” said Heather L. Wenzel, county medical services supervisor. “The regulations change on a daily basis. That takes a lot of time training people. We’re having to constantly learn new procedures.”

St. Lawrence County has been upfront with its full-time Medicaid staff of 45 people, who administer the medical program for nearly 22,000 people, that not all of their jobs — which are 100 percent reimbursed by the state — may exist within the next few years, Ms. Wenzel said. The state plans to locate its administrative jobs in either Albany or Latham, she said.

Some employees already have moved to other county jobs.

“Our hope is that the transition is done in a way that we don’t have to lay anyone off,” Mr. Rediehs said. “It’s too early to be nervous.”

The state may take over incrementally, so that counties can absorb the employees into other vacancies, Ms. Wenzel said.

“It may be we retain some of this work,” she said. “I think the staff is confident the county will find a place for them.”

The county replaces a dozen people in different jobs annually through normal attrition, said Legislator Alex A. MacKinnon, R-Fowler.

Even if the county is able to transfer employees in the Medicaid unit elsewhere, the bulk of the Medicaid unit positions likely will be gone.

“The state will have the jobs,” said Legislator Frederick S. Morrill, D-Dekalb Junction. “The county won’t.”

Teresa W. Gaffney, commissioner of the Jefferson County Department of Social Services, said staffing is one of the biggest challenges she is facing with the looming change.

“That takes a lot of planning,” she said. “We don’t want to lose staff; we don’t want to lay off any staff. That’s not what the county wants to do.”

Mrs. Gaffney said she did not want to talk about how many staffers handle Medicaid administration at the county level, but said she hoped if there had to be reductions, it would be through natural attrition.

She said 20,110 people in the county received Medicaid benefits at the end of January, a 15.5 percent increase from the 17,412 people who received the benefits in January 2010.

Lewis County, where the state began handling new applicants Jan. 1, also has been straightforward with its employees about the uncertainty of the future. The state is expected to take over renewals in Lewis County later in the year.

A lessened workload for caseworkers would be somewhat of a relief as the staff is working overtime to keep up, said Caroline J. Virkler, principal social welfare examiner.

However, by the year’s end, it could translate into lost jobs.

“The last three people hired knew when they applied this was a possibility we would lose those positions,” Mrs. Virkler said.

A state takeover of the entire cost of Medicaid — now shared by counties — would be welcome news, Mr. Rediehs said. A state plan will cap St. Lawrence County’s local cost for Medicaid at $26 million annually within a few years, but residents would see their property taxes take a steep slide if the state picked up the entire tab.

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