Commissioners’ Conference Room
Second Floor – County Administration Building
10 a.m. – 12 p.m.
In Attendance: Commissioner Lew Gaiter, Commissioner Steve Johnson, Ginny Riley, Jim Drendel, Marsha Ellis, Ed Rutherford, Thad Paul, Laura Walker, Lynda Meyer, Cheryl Smith, Angela Korthaus, Kelly Morrison, Ann Marie Grobarek
A recording of this worksession is available at: http://larimer.org/bcc/list_worksessions.cfm.
Introductions & Announcements
Commissioner Johnson welcomed everyone and called the meeting to order.
Everyone in attendance introduced themselves and stated their position for the listening audience.
Director Ginny Riley asked the Commissioners if they had any other agenda items. The Commissioners had no additional items.
Child Welfare Budget Cuts
Child Welfare Division Manager Jim Drendel opened with his experience serving over 300 families Thanksgiving dinner at the Matthews Settlement House, which is one of the organizations affected by budget issues. Child Welfare has over 130 community contracts with 66 different service providers.
Jim provided a presentation that illustrated the Child Welfare Block Allocation for Larimer County from 2012 through 2014, and for comparison presented the allocations for Boulder County and Weld County. The amount of the allocation for 2013 was adjusted because the state had determined they had less money than they thought they did, so the budgeted amount was cut by $400,000.00. In addition, there has been no confirmation of the allocation amount for 2014, so Human Services is working with estimates for the first half of next year. They are estimating up to $400,000.00 in cuts for 2014.
Jim and Child Welfare Deputy Division Manager Thad Paul showed data that compared Boulder County, Weld County and Larimer County in the following:
· Number of referrals
· Number of assessments
· Number of new cases opened
· Services provided
· Number of children in out of home care
· The cost of out of home care
· Outcome statistics
Jim explained that our Core Allocation money is based on reunification and is roughly the same as the other counties in the comparison, and IV-E waiver money has to be used for new programs, not replacing things that have been cut. The state still has not confirmed how the IV-E waiver will be funded, but it appears it will be based on the total number of days that children have been in out of home care in the county. This number is decreasing for us, so the funding will decrease too.
In order to plan for our estimate of the budgeted amount, Jim is working to find ways within the agency and structure to be more efficient without affecting safety. There are ten prioritized possibilities that are currently being reviewed. Ginny commended our staff for stepping up and being aware of the tradeoffs that need to be made with budget cuts.
Commissioner Johnson and Commissioner Gaiter discussed the need to improve Larimer County representation on the Child Welfare Allocation Committee in order to present our position that children who remain in the home be added to the model used to calculate this allocation. Commissioner Gaiter indicated he is on the Board of Directors for CCI and is involved in making recommendations for who is on CWAC. He requested that a meeting be set up for him to learn more in order to be more effective in that role. Ginny agreed and said that we need representation on CWAC to advocate for things like an earlier confirmation of allocation amounts. Commissioner Gaiter recommended that Reggie Bicha, Executive Director of the Colorado Department of Human Services, be shown the presented information, specifically the cost per child served and the information about the percentage of cases that result in no re-abuse, no re-entry into the system, and where the children remain home. Jim was asked to provide a graph of these outcomes to the Commissioners for the last five to ten years or whatever could be provided.
Temporary Assistance to Needy Families (TANF) and Child Care Assistance Program (CCAP) Expenditure Projections
Ginny explained that Temporary Assistance for Needy Families (TANF) allows the ability to transfer unspent TANF money into the Child Care Assistance Program (CCAP) or Child Welfare. A few years ago, legislation put a cap on the amount of TANF money that could be put into a reserve fund and saved. The department used to have twelve million in a reserve fund, but now there is only 2.5 million in the fund, so there is no extra money that can be used for CCAP and Child Welfare. As the new formula to determine the TANF allocation from the state rolls out, about five percent is lost each year. This effects the reserve too because the cap is a percentage of the allocation. Because there is an increase in the number of families applying for TANF, there is an increase in the amount of money from the allocation being used for the payment of benefits that are set by federal mandates. This reduces the amount of money left to put into the reserve fund.
Laura Walker, Deputy Director, presented that changes were made starting in September of 2013 when it was determined that spending had to be cut in order to prevent being over budget by $750,000.00 at the end of the year. Cuts made included the following:
· Reducing payments to the Workforce Center by $185,000.00 for job search services provided to TANF participants
· Eliminating a program called the Family Resource Program, which included reducing one staff person
· Suspending Diversion payments starting October 1, 2013
However, reports in October of 2013 indicated that the basic cash assistance caseload was increasing so dramatically that we would be overspent by 1.1 million at the end of the year, despite these cuts. There may have to be a waiting list for CCAP if things continue this way.
Marsha Ellis, Benefits Planning Division Manager, explained that additional efforts to reduce costs include the following:
· Tracking TANF cases to make sure they close on a timely basis and do not receive benefits longer than is necessary
· Not requesting to replace staff that leaves the division
· Leveraging technology more efficiently by using computers provided by the State instead of County provided equipment and considering using the Shoretel phone program through the computer instead of paying a regular fee to have a telephone at each employee’s desk
· Maximizing workspace issues and reducing the cost of office space
· Using process improvement suggestions from the Change and Innovation Agency (CIA) to be more efficient
Commissioner Johnson asked about the State’s allocation model for TANF. Laura and Ginny explained that the poverty level in Larimer County is not increasing as quickly as the rest of the counties, so this drives the allocation away from us to other counties. Commissioner Johnson said he thought the allocation formula could be changed, and Laura explained that the formula could be changed if you are spending more than 70% of your allocation on basic cash assistance, but we are not there. Commissioner Gaiter recommended we formally put in a request to consider process improvement through David and Daniel in order to be consistent with County-wide efforts, and Laura indicated she would contact Mark Pfaffinger to do so.
Options for Long Term Care
Cheryl Smith, Options for Long Term Care Manager, provided an overview of the Options for Long Term Care (OLTC) program, which is contracted with the Colorado Department of Health Care Policy and Financing. Cheryl has been with the County for 42 years, and has worked with Options since it began. There are five federal waivers that provide Home and Community Based Services (HCBS) and one state program called Home Care Allowance (HCA) that allow people with significant functioning challenges, from young children through to seniors, to stay in their homes or assisted living for as long as they can. Cheryl explained the following:
· Intake team screens 130 calls a month and provides community service information
· 105 assessments done per month at homes, hospitals, nursing facilities or long term residences to assess functional and financial eligibility
· Ongoing workers have almost 100 clients each and do annual re-assessments for each
· OLTC shares about 61 clients with Adult Protective Services (APS)
· Work with the Office on Aging and the ARCH program who refer clients to OLTC to transition people from nursing homes to community settings and to assist people at accessing Medicaid benefits
Angela Korthaus, Options for Long Term Care Manager, has been with the County for nine years. She provided the following information:
· A client in a nursing home costs $230 per day
· A client on a HCBS waiver costs $50 a day or less – sometimes as low as $15 per day
· Services we provide include:
o Electronic monitoring (life line systems)
o Electronic medicine boxes
o Do grocery shopping for clients, run errands, house keeping
o Provide personal care needs like bathing and dressing
o Adult daycare – supervision while family is at work
o Support people in assisted living situations
Commissioner Johnson remarked that it is amazing that we are able to move people from $230 a day to $50 a day or less and asked about the number of people who have done this move. Angela replied that 138 people were de-institutionalized in the first ten months of 2013, so about 14 people per month. Nursing homes in the area are at approximately 87% capacity. Commissioner Gaiter asked for clarification of the difference between a nursing home and assisted living. Angela explained that assisted living is considered community based care. The goal as the elderly population rises is to see most people age in place with dignity. Consumer Directed Attendant Support Services allows a person to hire anyone they choose to care for them, including family members. Ginny added that HCPF has the ability to run this program out of their offices, but there are benefits to administering the program here because of the added efficiencies and communication available as a result of having local resources. Ginny explained that if there should ever be a shortage of grant funding, it would be up to the Commissioners to decide whether or not to keep the program with the County or give it back to the state.
Office on Aging Update
Lynda Meyer, Office on Aging Manager, said she is a recent transplant from Anchorage, Alaska, where she was Senior Services Coordinator for the city. The goal of the Office on Aging is to keep Larimer County seniors independent for as long as they can.
· By 2015, 19% of Larimer County will be over the age of 60
· 25% of the population in Estes Park is over 65 years of age currently
· Mandated by Title III to provide services under certain categories, including:
o Information, assistance and outreach services, including most recently the online directory called Network of Care
o In-home services include those provided by the Rehabilitative Visiting Nurses Association (RVNA), legal assistance and others
o Ombudsman services
o Nutrition services including Meals on Wheels and congregate meal plans
o The national family caregiver support program
· County program of the Senior Tax workoff program
The Office on Aging does a four-year plan mandated by the state, so planning the next one will start early in 2014, which will include the Commissioners’ input. There is an advisory council that provides input and is very committed. The OOA recently had to take a decrease in federal funding, but the state came back and matched the decrease plus gave more funding. This year, the OOA established the Network of Care, strengthened their ability to be reached via phone, created the Senior Transportation Coalition, and developed a partnership with the Foundation on Aging as one of six communities in the nation to make this an aging friendly community. There will be a work session in February to work on this collaborative with a facilitator in Washington from the federal government, so perhaps a Commissioner would want to be involved in that event.
Commissioner Johnson asked for more information on the Senior Transportation Coalition. Lynda explained that this is an outgrowth of the Silver Tsunami which is a very active group in attempting to address transportation and mobility options for seniors and naturally occurring retirement communities. There will be a meeting on December 4th that will be a facilitated discussion about the issues facing the aging population regarding mobility.
Client Activity Report
Ann Marie Grobarek, Business Operations Coordinator, presented an overview of the department’s client activity. Ann Marie reviewed: monthly average caseloads, program activity, complaint totals, and client follow-up survey regarding complaints from July 1, 2013 through September 30, 2013.
Laura Walker provided information about the reported numbers for Benefits Planning changing due to the Affordable Care Act (ACA). Medicaid breakdowns are no longer available so the category is now called Medical Assistance, so for now we are limited in the numbers we can provide. However, we know that the Medicaid caseload has not decreased at all. Commissioner Johnson asked if the Medicaid numbers meant that cases had been double-counted at any time. Laura responded with an example to explain that individual cases within the same household should be counted as separate cases but the system is counting them as one case because they are in the same household.
During the 3rd Quarter:
· The Benefits Information Center took 9,805 calls and 95% were resolved on the 1st contact
· Child Support collected a total of $4,503,664
· Children, Youth and Family (Child Protection) received 1,388 referrals, 604 were assigned for assessment, with 96% of children involved with our services remaining in their homes when that was the case plan
· The Director’s office received 15 formal complaints
Ann Marie explained that the Food Assistance complaints were related to an increase in their Food Assistance amount followed by a decrease the next month that had to do with legislation changes in the amount of Food Assistance available. Commissioner Gaiter asked for a general overview of the pattern of Child Welfare complaints. Ann Marie responded that complaints for communication had to do with employees not returning calls in a timely manner, service delivery had to do with the timing of actions taken on a case, and Ginny explained that professional judgment had to do with the clients not liking what we are doing on their case.
Commissioner Gaiter asked if we had any response to concerns that have been raised with him about the complaint numbers being low because clients are afraid to complain. Ginny responded that many complaints are resolved at a lower level and do not get to the Director’s Office. Laura added that we have several specific places in the process where we ask for feedback, but some people do not come forward even when asked. Ginny explained that we do everything we can to make people comfortable coming forward with complaints, but we cannot compel them to come forward.
The next meeting in February will most likely involve a review of legislation. It is scheduled for February 10, 2014 from 10 a.m. to 12 p.m., in the Commissioners Conference Room.