Last week, Cranston Mayor and Republican candidate for Governor of Rhode Island Allan Fung released a television advertisement attacking incumbent Gov. Gina Raimondo for mismanaging the United Health Infrastructure Program, a Department of Human Services and Executive Office of Health and Human Services initiative.
An integrative online portal that combined 15 programs was launched in September 2016 as the UHIP program expanded to distribute health care, food stamps and benefits to over 300,000 eligible citizens. UHIP, created in 2011, had successfully implemented a health exchange program to a more limited base in the first phase of its implementation.
The online portal suffered significant technical failures, which meant that some benefit recipients were unable to access the web page. Eligibility was incorrectly evaluated under the new guidelines, benefits were delivered late and thousands of applications were not processed at all.
Raimondo endorsed the integration of welfare services through a single platform at the time, but Fung has taken issue with the program’s flawed implementation and ballooning costs.
History of the program
Then-Governor Lincoln Chafee ’75 P’14 began UHIP to integrate social programs, save the state money and save benefit recipients time and effort.
In 2012, the Affordable Care Act incentivized states to overhaul their benefit systems by requiring “updates to technology and an integrated eligibility system for federal funding,” wrote Department of Health and Human Services Chief Public Affairs Officer Alisha Pina in an email to The Herald.
Federal funding would “cover up to 90 percent of digital infrastructure costs,” according to a 2015 EOHHS press release. Rhode Island was among several states to seize this opportunity to modernize, and the state began replacing its 30-year-old collection of computer systems, Pina wrote.
“It’s about government efficiency; it’s about customer service and ease; and it’s about continuity of coverage. If it functions right, it has a lot of benefits,” said Anya Wallack, professor of the practice of health services, policy and practice. Wallack, a former UHIP steering committee member, also formerly served as HealthSource RI chief and Medicaid director for Raimondo’s administration.
“The idea was to have a unified system,” Wallack said. She applauded the idea but cautioned that “there’s a fair amount of risk involved” in any revamp of that scale, especially one that is time-sensitive and heavily reliant on a single vendor.
Chafee signed a state contract with private contractor and consulting firm Deloitte to build the online system.
It is standard for states to hire external experts for projects that require specific technical knowledge. The government often lacks the resources to “properly staff and oversee these projects because they’re often so strapped and so sensitive to the taxpayer burden,” Wallack said.
“States don’t pay like high-tech firms do, so attracting and retaining the kind of talent that you need to oversee enormous information technology projects is just a real challenge for state governments,” she said. This issue is “not in any way unique to Rhode Island,” she added.
The state divided UHIP’s implementation into two phases. During the first phase, which the state launched in 2015, Rhode Island set up a health insurance coverage exchange by creating a portal intended only to process “simple Medicaid” requests, making the care available to people below a certain income level.
UHIP outperformed equivalents in other states, including Vermont, in timeliness and accessibility at this stage, Wallack said.
UHIP’s roadblocks in Phase II
Phase II was launched in autumn 2016, two years after Raimondo’s election. This second stage was much more “complex,” since it served as a joint platform for other benefits and increased the number of people it served. Unlike “simple Medicaid,” which requires only a certain income level to establish eligibility, Phase II’s Medicaid component covered a wider base.
Federal overseers warned Rhode Island to wait before it rolled out Phase II, but Deloitte and the state deemed the program ready for expansion.
The Rhode Island chapter of the American Civil Liberties Union has co-sponsored two lawsuits against UHIP. The ACLU filed the first with the National Center for Law and Economic Justice in December 2016 because applications to the Supplemental Nutrition Assistance Program were not being processed in a timely manner.
The ACLU will continue to monitor the state until it demonstrates that it has processed 96 percent of applications on time over the course of 11 to 12 months, The Herald previously reported.
“They have yet to make it to 96 percent on either (expedited or non-expedited application rate processing), a whole year beyond where they are supposed to be. So we have been very actively involved,” said Lynette Labinger, an attorney for the ACLU. “They’re still processing around 4,000 applications a month.”
The state and Deloitte have implemented significant technical improvements to the system, Pina wrote.
The second lawsuit was filed in January 2018 on behalf of customers whose health insurance access was blocked by a computer glitch, The Herald previously reported.
Besides experiencing technical failures, the program has also exceeded its budget. Originally intended to save the state “over $90 million a year,” the current total projected cost of UHIP is $647.7 million, according to WPRI. The program is expected to be completed in 2020.
According to the most recent EOHHS Oversight report, dated Oct. 19, the number of reported issues with the online system has dropped from 7,649 in December 2017 to 2,217 as of Sept. 29 this year, which is “a 71 percent decrease.”
At least 90 percent of SNAP applications have been processed on time over the past six months, Pina noted, compared to 56.5 percent in November 2017. Timeliness for all programs stands at 77 percent, she added, compared to 66 percent nearly a year ago.
“Rhode Island has one of the lowest uninsured rates in the country at 4.3 percent. The state is third in the nation for children’s health coverage, with 98 percent of children covered,” she wrote, crediting UHIP and its online portal as “an important factor.”
But the difference between a 90 percent timely processing rate and a 96 percent rate is “still a significant number of households,” said Greg Bass, senior attorney for the National Center for Law and Economic Justice.
“Our top priority has always been ensuring people have access to benefits,” Pina wrote. While the platform has “largely stabilized and is not affecting access for the majority of customers, we remain focused on ensuring all Rhode Islanders have timely access and on bringing the system into compliance with all federal rules and regulations.”
Many individuals employed by the state and Deloitte share responsibility for UHIP, Wallack said. “Deloitte is actually building the system, but state people are involved to try to make sure that they’re adhering to the state specifications and building the system so that it works,” she added.
“Every governor ultimately bears responsibility for what’s going on within their government when they’re the boss,” Wallack said. Even so, “any governor that undertook this worthy project would find it difficult because it’s a difficult project,” she added. “The project was laudable – many parts of it went well, and I think every state that got into this space faced challenges to a greater or lesser degree.”
Raimondo has apologized repeatedly for UHIP’s unanticipated failures. “Mistakes were made, which I own,” she acknowledged in the first gubernatorial debate, The Herald previously reported.
In comparison to the rest of the country, “the scope (of UHIP) is broader than most states, … and the success is probably about average,” Wallack said. Other states either did not implement programs that were as ambitious as Phase II or also experienced significant technical issues, she said.
Deloitte has partnered with other states including Georgia, according to Bass.
Outcomes have varied, Wallack said. “Some Deloitte states went disastrously, and some Deloitte states went really well. … It’s hard to blame it on any particular vendor in different circumstances,” she said.
Raimondo “continues to hold Deloitte accountable to delivering the system we asked for,” Pina wrote. “We are in a much better place today than we were at go live. This past year, for instance, we had the largest year-over-year growth of insured Rhode Islanders through the state’s health exchange.”
Looking toward election day
“The governor should be directly involved in contractual negotiations related to high costs and high risks projects, which have a direct impact on the lives of thousands of Rhode Islanders,” wrote independent candidate for governor Luis-Daniel Muñoz in an email to The Herald. “The governor also has a role in establishing leadership and structuring initiatives within EOHHS. The governor also sets forth expectations around project management and project outcomes.”
More transparency and piloting of the program were called for, Muñoz added. Nevertheless, he supports the idea of an integrated system for benefits, he added.
“Whenever comparing technology solutions, it is important to measure success on the basis of whether we’ve improved the lives of those using the solution, and based on the challenges resulting from the UHIP system, I think that we still have a lot of work to do,” he wrote.
“I believe in small, local implementation of community self-help, and my ReGenerative Funding plan will eliminate the need for centralized software of service providers which are too big and too easy to corrupt,” wrote Compassion Party gubernatorial candidate Anne Armstrong in an email to The Herald.
Candidates Raimondo, Fung, William Gilbert and Joe Trillo did not respond to requests for comment.
Correction: A portion of a quote attributed to Lynette Labinger about technical improvements to UHIP has been removed over concern that it was misleading. The Herald regrets the error.