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Application delays: A serious barrier to health access

The Massachusetts state auditor’s office is well-known for its work in utilizing sophisticated data analysis to uncover public benefit fraud. This work is continuing, but the office has focused lately on several other aspects of the social service safety net that relate much more to the quality of services.

A key issue is access to service. As auditor Suzanne Bump said last fall, “It is essential that these programs operate with integrity. That means fighting abuse and fraud, but it also requires that we work to identify the barriers that prohibit Massachusetts residents from accessing benefits for which they are eligible.”

The first of several planned audits on barriers to access came out last month and focused on the Catastrophic Illness in Children Relief Fund, which helped 500 families with about $5.4 million in assistance between July 1, 2012 and June 30, 2015, the period covered by the audit. The program is designed to help families deal with seriously ill children who have expenses that aren’t covered or have been denied by health insurance. These medical expenses may include hotel stays for medical visits far from home or costs for equipment, medication, or home/car modifications.

Bump said the audit showed the program is doing “the good work it was intended to do.” But, as with so many excellent public policy ideas, there are some aspects of implementation that fall short. The audit found that families, on average wait 289 days from the time they apply to application approval. During most of this period, applications “sat idle” waiting to be assigned to staff. Only when a staff assignment was made were applicants informed that additional financial or other information was needed. “Families of children with catastrophic illness face immense financial and emotional hardship,” auditor Bump said. “Our audit found that long delays in application processing is unnecessarily extending this financial and emotional burden.”

The auditor’s office looked at the timing for processing applications in six other states that had similar programs. It found that Alaska, Idaho, Virginia and West Virginia processed applications in one to three months. New Jersey and New Mexico fell in a range more similar to Massachusetts, between 8 and 11 months.


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