Last month, 31,741 Pennsylvanians were cut from Medical Assistance, the insurance that covers people who are disabled, poor, or gravely ill. Almost 18,000 children lost their benefits.
The reduction is a point of pride for state Department of Public Welfare officials, who are trying to cut the budget by clearing out ineligible recipients whose paperwork was not complete.
But workers and advocates say that in many cases, the fault doesn't lie with the recipients but with the Welfare Department. Its stepped-up reviews of backlogged cases have combined with a shrinking staff, computer issues, and an increase in applications for assistance because of the high unemployment rate to create a wave of terminations.
"Because of our rigorous program-integrity efforts to enforce current rules and regulations, the result of these reviews has been the closure of over 100,000 individuals from Medical Assistance," Tim Costa, executive deputy secretary of the Welfare Department, testified Wednesday before the House Republican Policy Committee in Harrisburg.
The stepped-up review cut 19,619 people in July, the start of the state's new fiscal year, which included heavy budget cuts, and 15,337 in August, Costa said.
Anne Bale, a spokeswoman for the Welfare Department, said the reviews of the backlog were being conducted because "we're required to follow the law."
One nonprofit that provides care for severely disabled people says termination letters come in now at a rate of five a week; before the summer, it rarely received five a year.
"These are people who are severely disabled. They are not going to get better, their situations are not going to change," said Lucy Spruill, director of public policy at UCP/CLASS, an affiliate of United Cerebral Palsy that provides attendant care for severely disabled clients.
Clients and Welfare Department workers say some of the missing paperwork is, in fact, at welfare offices - sitting in boxes waiting to be reviewed.
Bale said the department was not aware of the problems with the computers and did not know about the boxes of forms that had not been scanned.
"It wasn't brought to my attention that this is a problem," she said. "If they're having problems, we would hope they would come to us."
Linda Torres, a caseworker in the Strip District county assistance office and an officer in Local 668 of the Service Employees International Union, said there was a management push to clear out backlogged cases, but cases in which the paperwork was not scanned or those in which it was scanned but not attached to the system were flagged because workers reviewing cases can only go by what is in the system.
Those cases that were flagged were ultimately terminated.
The numbers bear that out.
Over the last fiscal year, from July 2010 to June, an average of 16,668 Medical Assistance cases were closed in any given month for "failure to furnish required information," according to a report the state provided to health-care advocates.
That number jumped from 18,662 in June to 33,453 in July.
The numbers are being carefully tracked by the Pennsylvania Health Law Project in Philadelphia. Ann Bacharach, the special projects director there, said because spending on a case can go into the next month, cases that are terminated may take a month or two to show up in the data.
Although the Medical Assistance caseload has been rising overall by more than 5 percent a year for the last two years as the economy has sputtered, in September, enrollment sharply declined by 1.4 percent.
In his testimony, Costa said workers went through 154,000 cases that were overdue for eligibility review to find 100,000 cases in which the recipients were no longer eligible.
Laval Miller-Wilson, executive director of the Pennsylvania Health Law Project, said many of those who lost their benefits would wind up reapplying, further adding to the backlog.
"It's a vulnerable population that received these notices," he said.