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GATESVILLE – With Medicaid expansion set to start on Dec. 1, Gates County DSS Director Willie Smith III is signaling for “all hands on deck” to hopeful usher in a smooth transition.

But the question is, are their enough “hands” inside the local Department of Social Services to handle the expected increase in the workload. And if there are any new DSS staffers hired between now and Dec. 1, is there enough time to train them?

Smith was on the agenda at the Oct. 18 regularly scheduled meeting of the Gates County Board of Commissioners to address how Medicaid expansion will impact his department.

At the outset of his presentation, Smith said his current staff totals 21 employees (19 full-time; 2 part-time). There is one current position available to hire. That position is within Adult Protective Services.

In regards to the way Medicaid services are currently handled, Gates County DSS has a supervisor and three income maintenance caseworkers that take care of Family and Children Medicaid. There are three income maintenance caseworkers for Adult Medicaid. The same supervisor oversees Family and Children Medicaid and Adult Medicaid.

Others employed within Gates County DSS are four individuals (a supervisor and three caseworkers) taking care of Food and Nutrition Services, and four working in Protective Services (a supervisor and three Social Workers: two for children and one for adults).

Smith detailed the number of Medicaid cases (1,938, which includes adult) handled by his department as of this month. He said those cases represent a total of 2,585 participants.

Currently, each caseworker for non-adult Medicaid handles, on average, 505 cases. Smith said he expects that average number to increase to 539 per caseworker when Medicaid expansion launches Dec. 1. That, he said, is a 27 percent increase in the workload of each caseworker.

Smith said with the anticipated increase of Gates County residents qualifying for Medicaid, there would be a need for additional staff to support this expansion.

“One of the things we’re struggling with in that need for additional staff is, and I’m saying this with all due respect for those that live here, convincing someone to move to Gates County,” Smith said, adding that roughly 70 percent of those employed by DSS already live in the county.

Once a position is filled, Smith said it takes a minimum of two-to-three months worth of training before that individual is assigned their first case.

“It takes six-to-nine months to fully train a new employee,” Smith stated.

He emphasized once again the estimated increases to the department’s caseload due to Medicaid Expansion.

“But they’re just that, an estimate,” Smith observed. “We expect a significant increase in new applicants, of which some will apply to see if they are eligible due to a change in their life’s circumstances.”

That rise in the number of applicants increases the number of people visiting the DSS office, thus straining an already limited number of employees.

Smith briefed the commissioners on what he saw as possible solutions to the areas of concern he just talked about. Among those solutions is hiring temporary workers as well as seeking to hire or contract with former or retired DSS employees to work in the office after hours or at home.

He added that the state could help by allowing Medicaid re-certifications (individuals with no changes to their life’s circumstances) to be handled online.

Smith announced his support for the state to think about developing training and caseload standards that are the same in each county, thus eliminating the time it takes to train someone who may choose to transfer from one DSS office to another.

Medicaid Expansion expands the eligibility age range from 19 to 64 who have a household income that is below 138 percent of the federal poverty level.

“That’s about an annual salary of $20,000 for an individual or about $34,000 for a family of three,” Smith noted.