The VA Isn't the Only Agency Mismanaging Waiting Lists

Many state and local agencies fail to properly oversee waiting lists for government programs.
September 2014
Barrett and Greene
By Katherine Barrett & Richard Greene  |  Columnists
Government management experts. Their website is

Government waiting lists made headlines in May when the inspector general for the U.S. Department of Veterans Affairs (VA) blew the whistle on the agency. Some 1,700 veterans at its Phoenix hospital who believed themselves to be on the medical facility’s waiting lists were not.

Worse, that was just the tip of the iceberg. Apparently several VA facilities across the country had mucked around with their waiting lists to make it appear that veterans were receiving services in quick and efficient order, which, as we learned, was not remotely true.

It struck us at the time that perhaps the VA wasn’t the only agency experiencing waiting list challenges. We looked into entities at the state and local levels and discovered that this is an area in which many agencies fall short in their managerial oversight. Fortunately we heard of nothing that went to the extremes of the VA’s situation. However, the problems and shortcomings were certainly big enough and widespread enough to merit more attention.

Of course, there would be less need to worry about managing waiting lists fairly and effectively if the states were able to provide their service agencies with enough funding to take care of anyone in need. But that’s frequently not the case. And so waiting lists become necessary, many of which are susceptible to mismanagement.

Consider Kansas, which suffers such a gap. Let’s say someone is on the waiting list for several Medicaid services and the state’s Medicaid office is able to provide them with only a portion of those services. You would think that the state would keep track of the remaining services these recipients need -- a secondary waiting list of sorts. But that’s not how it works. Once a patient receives one service, they are dropped from the waiting list. The result: “You get them off the waiting list,” says Scott Brunner, senior analyst at the Kansas Health Institute, “but they don’t get what they need.”

Brunner says there have been more than 1,700 people underserved in Kansas for developmental disabilities. This has been a problem for some time. Thankfully, it may soon end. One result of the state’s move to a managed care system is that it will be precluded from continuing with the practice.

In Tennessee, according to a performance audit of the Department of Intellectual and Developmental Disabilities, the state hasn’t been keeping its waiting list up to date. Waiting lists for those with intellectual disabilities are supposed to divide potential recipients into four categories of need: crisis, severely threatened, active and deferred. Presumably regular updates move clients up and down through the four categories. But in Tennessee, “the list itself doesn’t reflect actual changes in the level of need,” says auditor Laura Isbell.

This is pretty serious stuff. If someone is supposed to be on the severely threatened list, they should be monitored regularly to make sure they don’t fall into crisis and need immediate help. Of course, there’s an alternative to flawed or unmonitored waiting lists that’s even more pernicious. That is the absence of waiting lists altogether.

In New York, state Sen. David Carlucci, chair of the mental health and disabilities committee, is concerned about the absence of a waiting list for men and women who need specialized, state-funded housing. “Without a true, up-to-date waiting list and knowing what the need is, it’s hard for policymakers to make the right decision,” he says. He adds that there are “so many good advocates working toward improving the lives of people with mental illness. But if we don’t have the right information, we’re just treading water.”

Carlucci has introduced legislation to establish a waiting list. Why hasn’t one existed in the past? He speculates that governments are afraid to have this kind of information. They’re worried about what they might find out, namely that there are thousands of people going unserved. “But if it’s good, bad or ugly,” he says, “we need to know the truth.”

There are other waiting list issues -- not all of them within a government’s control to manage. A common one is pre-signers. When people think they’ll need a service sometime in the future they’ll often put themselves on a list immediately, particularly for nursing home beds. They’re not ready for such a facility yet, but they fear that eventually they’ll need one. When they reach the top of the waiting list, they turn down the offer and start all over again. This is not the kind of thing that makes for an accurate waiting list, because, in truth, these people are really not waiting but dreading.

States and cities don’t intentionally want to keep their citizens waiting for needed services. But if that’s necessary, the least they can do is to make sure that they manage the list protocol fairly and efficiently in order to provide services to citizens and data to policymakers.