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An Inside Look at the World of Public Assistance

This blog entry was inspired by Deborah Grabien's comment on her problems with the system, but it's really for everyone who's ever had any contact with the public assistance system, and anyone whose friend or relative has had any contact with the public assistance system, and anyone who pays taxes that help fund the public assistance system.

My credentials for writing this are that I worked in the system for ten years, in a small county and in a large one (and yes, those are official designations).  I was a Medi-Cal worker, the last six years just for pregnant women and girls and their families. 

The dirty little truth is:  The system really is stacked against you, the people at the front windows really don't know what they are talking about, and the workers really wish you would go away.  Not a news flash to some, but it may be for others. 

Here are some of the things I saw along the way:

In the small county where I worked, there was a Medi-Cal worker who was recognized as the expert on the program.  Everyone, including the supervisors, went to him for help.  But guess what?  He had one thing wrong that affected benefits for women in that county for years.  Pregnant women on certain long-term visas, such as college students or the wives of visiting scholars, were as eligible to maternity benefits as were legal immigrants and citizens, but this worker didn't know that.  He believed that if someone were in the country on a visa, they were ineligible.  During the time I worked for that county, many women were denied benefits they were actually entitled to, and that denial of services probably continued through the later eighties through the nineties.  Can you spell class action lawsuit? 

When I worked in the pregnancy unit, I had a co-worker who refused to see Spanish speakers who spoke English.  Her feeling was that because there were Spanish-speaking workers available, she should not have to see anyone who spoke Spanish.  One week I had so many clients, I had to refer some out, including to her.  She refused to see a U.S. citizen who spoke English and Spanish fluently, and an immigrant from South America who spoke clear English.   They both spoke Spanish, so she wouldn't see them, and yes, she got away with it.

Because pregnancy care was so important, the State of California had a special program to help pregnant women access prenatal care.  If a woman was applying for only prenatal benefits, not complete care, the only eligibility rules she had to meet were those regarding income; none of her property assets applied.  But, this woman would not process applications only for prenatal benefits.  She explained that she didn't want to do that program only because it was inconvenient--if the woman later changed her mind and wanted full benefits, she (the worker) had to do additional work to get the property information.  To avoid that inconvenience, she wouldn't do the limited program at all, no matter how many women asked to her to do so or how many times our supervisor told her she was supposed to.

When I worked for one county, I knew someone who worked in that county but who lived in an adjacent county and so had to apply for benefits through that county.  We used to talk and she told me one day about her husband needing heart surgery and their experiences applying for Medi-Cal benefits for him.  It was clear she was dealing with a worker who was giving her bad information, so I told her the real rules.  I used to see her every week or so, each time learning what she was being told and countering that with the real information.  I went so far as to copy pages of the regulations for her, so she could argue her case better with her worker.  She was given the runaround for so long that I finally told her she needed a lawyer.  She and her husband got an attorney and sued the state; they won their case, changing a bit of the Medi-Cal regulations for the entire state.

I came in contact with the Legal Aid system when KidThree became disabled and we had to leave our apartment, leaving KidTwo there.  When the legal aid attorney found out that I worked for the public assistance department, he asked if I would be willing to talk to a lawyer who was putting together a class action lawsuit on behalf of a certain population.  I jumped at the chance and later spent several hours with the other lawyer, telling her all--that was a tremendous amount of fun.

Clients were routinely turned away by personnel at the front windows, personnel who were not trained in eligibility but instead were there to give out the applications to the clients.  Those workers, despite being unqualified and actually forbidden from making eligibility determinations, did so anyway.  Sometimes clients were applying for Medi-Cal only, which had different rules than the cash programs; the clients could well be ineligible for cash assistance but still eligible for Medi-Cal.  The front-line clerical staff would turn those clients away, telling them they were ineligible and flatly refusing to take their applications.  I once dealt with a client from another county.  She was supposed to go through their system as she was a resident in their county, but she couldn't get the front-line clerical personnel to let her apply.  She never even got to an actual eligibility worker because those in the front would not take her paperwork.  This client finally gave up and I let her apply with me under the pretence that I was taking a courtesy application for that county.  That's another class action lawsuit, because you know she wasn't the only one turned away by that other county's personnel.

One trick workers used to use to get rid of annoying clients was to send a request for information that was not required; then if the client failed to return the information, the worker would close that client's case, not for the client's failure to send in the requested information (because it was not required) but instead for loss of contact.

Workers routinely sent out requests for information that is not required.  Some workers preferred certain verifications and would refuse to handle those they didn't care for, or to grant a case until their preferred verification was provided, despite the fact that the client may have sent in verifications that were legally sufficient.

When I first started working with the small county, eligibility workers had supervisors who knew their program.  Medi-Cal workers had supervisors who knew Medi-Cal, Food Stamps workers had supervisors who knew Food Stamps, etc.  But, that changed later on.  The State of California decided to institute a two-tiered eligibility system, one in which workers doing Medi-Cal and General Assistance/Food Stamps were paid less than those working in the AFDC (now CalWORKS) program.  Since supervisors' pay was linked to the highest paid worker they supervised, all the supervisors wanted to supervise at least one AFDC worker.  The way to do that was to mix up most of the units, putting workers from the different programs together under one supervisor.  The problem then was that the supervisors didn't know the minutiae of all the programs they supervised (and the regulations varied considerably).  I spent a couple of years in one such unit with a supervisor who had no Medi-Cal experience.  His method of handling complaining Medi-Cal clients was to wander back to my desk, ask me whatever the question was, and take my answer back to the complaining client.  (Yes, I usually had the answer, but that wasn't the point.) 

At one point during my tenure, the application itself was revamped to make it more intelligible.  One of the questions read: "Is there one car or more in the household?"  This was because one program might allow any number of cars, while another might allow only one car of any value, or one car of limited value, or even no car at all.  But, the Spanish application was mistranslated.  The question read: "Is there more than one car in the household?"  Clients would answer "no," because they had only one car, and then receive benefits on the belief that there was no car in the household, because that was the real intent of that question.  Families routinely received benefits to one program to which they were actually ineligible, this with no intent on their part to commit fraud.  This was the case for years and so far as I know, is still the case.

Workers were not allowed to help clients who cases were with other workers, but I used to do it anyway.  Clients who had me as a worker would have their friends call me to find out what was wrong with their cases and how to get them fixed.  I'd tell the client what the particular rule was that applied to them, then would give them the magic words to get help from their worker. And yes, I got in trouble for that on more than one occasion.

One more than one occasion, I told clients (whom I was unable to help because I was in the wrong office) to burst into tears at the application window, because anger would get the client escorted out but tears would bring supervisors out of the woodwork.  Can you imagine working for a system so screwed up that you had to tell people to CRY to get the help they were entitled to get?  Yes, there was fraud out there, but workers recognized it when they saw it, and for the most part, the clients were in real need.  Over the years, I gave away my lunch and my coat and bus money and Christmas presents intended for my children, and did everything I could to help as many people (primarily pregnant women) as I could, but it was never enough.  The system was not consumer-friendly, not all staff were ready and willing to help, and whistle-blowers received the usual reward for whistle-blowing.

This is a general rant, not one to change anything, but just one intended to let people know that the system I worked in really was stacked against the clients, that clients really were lied to, and that bad information was given out almost as often as good.  Reader, if you or anyone you care about ever has to deal with the system, go prepared.  Ask why, keep asking for explanations until you get one, ask to see the actual regulation if need be.  Ask to talk to supervisors, and if they are of no help, go to their managers.  Keep going up the chain of command until you get answers, all the way to the director of the department in your particular county if you have to.  (Directors HATE to be bothered, so they will light fires down the line until you or whoever gets the information or other help you need.)

Don't take your first answer as gospel.  It's going to be wrong as often as not, and you may be the only one working to your benefit.

A

Comments
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Insane, isn't it?

Deborah Grabien
www.deborahgrabien.com
author of the Haunted Ballad series, the Kinkaid Chronicles, five standalone novels, numerous short fiction and essays, and a lot of snippy opinions.

When I first applied for SSI and SSDI - multiple sclerosis - a very nice, very sympathetic woman asked me questions on the phone for just over two hours. At the end of it, she said - this is not a precise quote, but trust me, it's effin' close: "You appear to qualify for SSI, but we tell everyone no on the first application - we'll get back to you in about 180 days. I can give you a list of lawyers who specialise in this field - it will cost you between $500 and $5000, depending on the lawyer."

Seriously. Mind-blowing. "Oh hai, we're a government bureaucracy supposedly designed specifically to help a small disabled section of the population. We say no every time. Go find five grand and buy legal representation - wait, did you say you own a car...?"

A writer friend in the UK says that the European perception of American bureaucracies is that they exist to do one thing: deny the people they're supposed to serve.

I have not, to date, seen one damned thing that in any way contradicts that point of view.

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It IS mind-blowing, and to

It IS mind-blowing, and to those working within the system and trying to do what they can, frustrating as hell.  We Medi-Cal workers routinely worked with SSI and SSDI clients because of overlapping programs and yes, we would tell them their applications would be denied on the first go-round unless they had something truly horrible going on.  Loss of two feet would get immediate benefits, but loss of one foot wouldn't, unless that foot were attached to an entire leg that was missing, and "please, ma'am, could you provide verification of that?"  Honestly, I wrote on one such application (that I was sending to Social Security), "this worker sight-verified that client was missing his right leg at the hip," and gave him immediate benefits.  For HIV-positive clients, there were three lists of ailments, A, B, and C.  If a client had two ailments from one list, or one each from two others, or some other magic combination, they could get immediate benefits.  If not, then no, they couldn't.  If someone had cancer and six months or less to live, they could get immediate benefits, but if they were expected to hang on for seven months or more, they couldn't, and they had to go through the entire waiting period, which ranged from six to twenty-four months, by which time, they probably were dead.  I had one pregnant client who was eligible for benefits, as was her child, but her husband wasn't.  The next day, she called me to ask if there was any way I could get benefits for her husband, as he had been shot the night before.  (Honestly!)  I stared at the phone for a minute, then came to my senses and asked, "is he going to be unable to work to support himself for a period of thirty or more days and will a doctor verify that?"  I sent the paperwork to his doctor, got it back, got him enrolled, and got his care for the shooting covered.  And no, I never did find out why someone shot him, or who it was.  He seemed like such a nice guy, too.

Take a wild guess where this uninsured American voter stands on single-payer healthcare?

Susan

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Deborah

Deborah Grabien
www.deborahgrabien.com
author of the Haunted Ballad series, the Kinkaid Chronicles, five standalone novels, numerous short fiction and essays, and a lot of snippy opinions.

Susan, I'm guessing you stand exactly where I stand on single payer.

And what a shame the president ditched single payer before he ever got to the negotiating table.

I have no trouble at all believing those horror stories. One friend, with cerebral palsy from birth, has the public assistance agencies routinely staging piratical unannounced visits to their house, apparently to make sure she hasn't been miraculously been cured of her birth damage (!) Another friend, on the opposite side of the country, has spina bifida. They do the same thing to her.

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Deborah, Social Security

Deborah, Social Security does a lesser version of that with my KidThree--sending letters periodically and checking medical records to see if she is still paralyzed.  Maybe they know about some medical miracle that those of us dealing with paralysis have somehow missed hearing about?  Susan

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Deborah Grabien

Deborah Grabien www.deborahgrabien.com author of the Haunted Ballad series, the Kinkaid Chronicles, five standalone novels, numerous short fiction and essays, and a lot of snippy opinions.

 

Not to mention the fact that they're using tax dollars to fund that.

 

I've just signed on to help my friend with cancer, since the county of Marin has authorised her for help. The day I went in, Ahnuld had just implemented his brand new shiny "let's scare off as many potential helpers for people dying slowly or with painful diseases as possible!" regulations. I paid the $57 out of pocket for the Lifescan background check. I filled in thirteen - yes, thirteen - different forms. I went to my doctor and had her sign off on it. I went back in and they sat me down to watch a video. It was all about "WHAT HAPPENS TO PEOPLE COMMITTING FRADULENT BEHAVIOR".

 

That's not my typo - it was right their on the screen. "Fradulent". The video was nearly twenty minutes long, featured "Plan Nine from Outer Space" background music, and more views of handcuffs and jail cells than I've seen since I stopped watching Law and Order. Your tax dollars at work.

 

I guess Ahnuld is worried about having to spend money to help all those useless sick people. Or maybe he just doesn't want us to commit frad.

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I do think our governator

I do think our governator wishes all the sick and disabled would just drop dead or have the good graces to go into nursing homes where he can pretend they don't exist.  KidThree's disability benefits have been cut five times in the past year and a bit, while caring for her has gotten progressively more expensive.  But what does he care?  You know if one of his children got hurt, he could afford the best care available.  We deal with Victims' Comp for some things, as KidThree was shot during a Violent Crime, and what fun it was writing out twenty pages or so explaining the step-by-step of her personal care and getting letters from her doctor on what was medically necessary for her care.  One day last week we had run out of something urgently needed, so I went to a hospital at ten in the evening to talk them out of one.  I finally persuaded someone and got the item in question, then KidThree and I had a wonderful time all the way home, making bad jokes as to what other [non-medical and undoubtedly nefarious or perverted] uses someone could put it to.

 

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Deborah Grabien

Deborah Grabien www.deborahgrabien.com author of the Haunted Ballad series, the Kinkaid Chronicles, five standalone novels, numerous short fiction and essays, and a lot of snippy opinions.

 

I'm wondering, at this point, if there's any hope at all for anything to do with this system.

 

At the moment, I'm going with "no".

 

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Thank you, Susan

for this view into the abyss. I guessed as much. The picture you paint is much like Communist China.

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Hi Belle, What a comparison.

Hi Belle,
What a comparison. No wonder Europeans and Canadians think we're idiots. I had a wonderful time being a subversive force within the system while I worked in it and missed that aspect of the job when I had to leave it. At least I got one lawsuit done and likely another one in process. Susan