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B021709 New Hanover County Board of Social Services Budget Retreat Minutes New Hanover County Library February 17, 2009 9:00a.m. - 3:00p.m. The New Hanover County Board of Social Services met in open session on Tuesday, February 17, 2009 at 9:00 in the New Hanover Room of the New Hanover County Main Library. ATTENDING: John Craig, Chairman; Bill Caster, Vice-Chairman; Minerva Glidden; Patrick Riley; Evelyn Bryant ALSO ATTENDING: LaVaughn Nesmith, Secretary to the Board; Stephanie Monteath, Assistant to the Director The Chairman called the meeting to order at 9:05 a.m. Mr. Caster moved for approval of the agenda. The motion was seconded by Mr. Riley and passed unanimously. Ms. Bryant led the invocation. Ms. Glidden led the pledge of allegiance. CONSENT AGENDA Ms. Glidden moved for approval of the consent agenda. The motion was seconded by Mr. Caster and passed unanimously. INFORMATION AGENDA SSDI Mr. Caster noted how the numbers of clients coming to DSS for services has increased. Mr. Lane noted there was no longer a waiting list for Child Care Subsidy. Ms. Marino shared that the Work First numbers are increasing as people are staying in the program longer. County Budget Expenditures Mr. Caster asked about the TANF Domestic Violence fund numbers. Mr. Nesmith explained the funds are capped and Ms. Marino said DSS is hoping for a re-allocation. Mr. Nesmith explained that the State has asked that over 200 thousand dollars of New Hanover County day care subsidy funds be given back to the State. Mr. Nesmith has asked the State to give DSS an additional 25 thousand dollars to assist with administrative costs of the day care subsidy program. Mr. Caster asked about the included Child Welfare Staffing Survey. Ms. Glidden suggested a glossary of words like CPS (Child Protective Services) be included in the Page 2 of 9 back of the board books for board member clarification. Mr. Nesmith asked the board to note page 24 of the information agenda which notes the social worker to intake ratio. Mr. Nesmith noted that as the economic downturn worsens the chance for CPS intake increases due to family stressors. Mr. Nesmith is waiting to see how the stimulus affects programs of DSS. Medicaid transportation is a huge expense currently and the agency is looking at ways to offset costs. Mr. Nesmith reviewed the 2007-2008 Annual Report which is distributed throughout the State to other Social Service agencies, libraries etc. Mr. Nesmith and Wanda Marino brought a new NHCDSS Medical Transportation Policy for the Board's approval. Ms. Marino noted all changes in wording and reviewed policy and procedure. Ms. Glidden asked that section 3 be changed to "-documentation from a medical provider explaining the "urgent" status of the visit, before the visit" for clarification. Mr. Craig asked if the Medicaid Transportation Coordinator position really required 2 staff. Ms. Marino explained that absolutely the two full time staff were needed and possibly a third. Ms. Marino noted the new policy has a lower reimbursement rate dropping from .55/mile to .35/mile which is more in line with other counties. Ms. McNamee explained that New Hanover County is lucky that bus transportation is available for Medicaid Transportation and medical providers available in town. Mr. Nesmith asked the Board to take action on the proposed policy. Mr. Riley suggested that DSS follow the even lower Federal reimbursement rate for medical transportation. The motion was seconded by Ms. Glidden and passed unanimously. Currently, the Federal rate is .27/mile and it's subject to change. Ms. Glidden motioned to accept the policy as amended. The motion was seconded by Mr. Caster and passed unanimously. STRATEGIC ACTION AGENDA LaVaughn Nesmith reviewed the mission statement for New Hanover County DSS. Mr. Nesmith challenged the Board and DSS staff to meet the needs of the citizens of New Hanover County despite the economic climate. Mr. Nesmith read his state of the agency letter. Mr. Nesmith introduced Bill Ouzer in the Business and Planning Unit. Mr. Nesmith justified the need for a Program Compliance Monitor position. Mr. Nesmith explained that services must be delivered by DSS with limited resources and asked the Board to help balance resources with a slim budget. Ms. McNamee explained the roadmap of the DSS budget process. All budget requests follow Leading By Results strategies and guiding principles which mirror DSS's mission statement. Ms. McNamee talked about agency successes such as meeting participation goals, moving persons from welfare to employment, decreased recidivism and innovative strategies. As well, DSS has been working on customer service initiatives such as cultivating courtesy and enhanced community partnerships. Mr. Lane told the Board that Wilmington Health Access for Teens (WHAT) and New Hanover Regional Medical Center (NHRMC) out posted Medicaid positions will no longer be supplemented by DSS. If NHRMC and WHAT do not pick up their portion, it could potentially mean there may not be out posted positions in those locations in the future which will create a lot more work within DSS and potentially a loss of service for eligible adolescents. Page 3 of 9 Ms. McNamee reviewed the proposed new expenditures: Two new Food and Nutrition Services Zone 2, Foster Care/Adoption Assistance Funding and Capital Improvement (lobby renovations, records compliance). Beth Schrader noted there will be direct County costs associated with the above. The proposed FY09/10 Budget is as follows: Proposed FY09/10 Financial Resources $73, 118,328.00 Federal $47,945,886.00 State $5,775,996.00 County $15,844,024.00 Other $3,552,422.00 Ms. McNamee introduced Mr. Ouzer again and Ms. Graham to the board. The board recessed at 10:35 a.m. The Board reconvened at 10:45a.m. Administrative Support Chris McNamee reviewed the financial data for Administrative Support. Ms. McNamee reviewed the targets for Administrative Support. Mr. Nesmith explained that we continue to meet shortfalls with expected revenues. This affects man power utilization as we can not utilize temporary positions and overtime to accomplish our tasks/goals. Ms. McNamee explained when we cut back on man power, we also cut potential draw downs of revenue. Mr. Coudriet asked for clarification and identification of areas that do not draw down revenue. Beth Schrader noted the County does not want to cripple DSS's ability to provide service or create bad morale. Ms. Schrader reiterated the number of people coming through the doors of DSS are huge and have not been that large in the last decade. Mr. Coudriet agreed that DSS needs to be a priority as the economy declines. Ms. McNamee talked about customer service and one method to increase customer satisfaction by renovating the lobby creating a single portal of entry and re-distribute the staff currently working in three different clerical pods. Stephanie Monteath reviewed personnel data and turn over rates. Ms. Monteath explained that having employees leave within the first 6 months of employment is a really good thing as people and managers realize non-compatibility before the employee becomes a regular, benefit collecting member of the staff. Turn-over rates are decreasing as fewer jobs are available outside DSS. Mr. Nesmith and Chris Coudriet will ask the County to share their exit interviews with DSS. DSS is also conducting Stay Interviews to check on staff satisfaction and increase retention. Ms. McNamee reviewed the financial data for Administrative Support. A big change in budget took place when Alltel merged with Verizon. This will create an increase in cost for DSS. As well, postage has increased and equipment costs will have a one time increase which will, in the long run, cut costs as scanners are put into use for intake Page 4 of 9 workers and facsimile functions on individual computers are made available. Equipment costs for the contract with Young Williams will be rolled into County IT. Food and Nutrition Services Sam Lane discussed outreach efforts with the Food Bank and other resources in the community. Mr. Lane noted that one person in a family used to come in to apply for benefits. Now the entire family is coming in for service as the entire family is unemployed. As well, there are families that have never been in the agency before because for the first time in their lives, they need assistance and do not have the basic necessity of food. Currently NHCDSS is serving 58% of the people in New Hanover County who are eligible for Food and Nutrition services. DSS expects this percentage to increase to 62% by June. Mary John Brantley explained that percentage comes from the State. Ms. Brantley noted the Food and Nutrition section is averaging 50 new applications each day. People are not only becoming eligible, but they are staying on longer, increasing on-going numbers tremendously. Mr. Lane pointed out that in July 2007 DSS had 7000 on-going caseloads. It is projected that in June 2009, there will be 9000 on-going caseloads while there has only been 1 additional case worker added to the staff. It is important to be able to process applications timely to get people an electronic benefits card which can be used at grocery stores which are always open as opposed to food banks which are not open every day of the week. Mr. Coudriet asked what the average benefit amount is for a family. Mr. Lane shared the average benefit amount per family is about $235.00 per month. While this amount should be considered a supplement to income, families not employed or laid off, do not have extra income to spend toward food and families are in crisis. Mr. Lane reviewed the high caseload numbers and shared that to meet the standard set Federally; DSS would need 5 additional caseworkers immediately. With the budget the way it stands, DSS is asking for 2 additional caseworkers and a realignment of staff currently employed. Chris Coudriet asked how often cases have to be recertified in Food Stamps. Ms. Brantley said it varies between every three, six and twelve months. Ms. Schrader clarified that were the renovations to the lobby not to happen, DSS would need to ask for more than 2 additional caseworkers. Ms. Schrader noted that it would not be inappropriate to hire caseworkers while the need is great and reduce the work force when caseloads decrease. Medicaid and Health Choice Sam Lane shared the vision and goals for Medicaid and Health Choice. Ms. Brantley noted caseloads are growing in Adult Medicaid in New Hanover County as a larger portion of the community ages. More and more families are becoming eligible for Medicaid and/or Health Choice as economic downturn continues. In FY07/08, 59.95% of the eligible population received Medicaid and Health Choice. FY 08/09, the expected percentage to be served is 70%. FY09/10, DSS will strive to serve 85% of the eligible population. Ms. Heslin explained the North Carolina Kids Count Medicaid program which passed in recent legislation. A family of four can make up to $63,500.00 and be eligible for services based on a sliding scale fee. Community members are already calling to see how they can apply. Ms. Heslin added that even when some families know they are not eligible for Medicaid, they apply with DSS so they can get a denial letter and be eligible for some sort of charity care. Ms. Glidden advocated DSS speak with the Page 5 of 9 hospital to explain how this process creates a lot of additional work for DSS staff. At this time, DSS is not asking for additional staff in this program. Ms. McNamee reviewed financial data for Medicaid. The proposed budget only shows administrative costs of the staff used in the Medicaid programs. Beth Schrader explained Article 44, which took away County share of Medicaid costs. Article 44 provided a hold harmless period over a 4 year period. This 4 year period is coming to an end. Child Care Subsidy Mr. Lane shared the vision and goals for Child Care Subsidy ensuring safe, quality, accessible and affordable child care for children in New Hanover County, supporting the independence of families. In FY07/08, 73.41% of persons received child care subsidy. The benchmark for 09/10 is 65% with a target of 70%. There have been some cuts and money reverted by Smart Start. Service delivery will be based on the amount of available dollars for NHCDSS. This year, families receiving subsidy, must verify wages each month. That has reduced the number of eligible families for those folks that quit their jobs during the month they receive subsidy. Currently there is no waiting list as more and more families are unemployed. Mr. Caster asked how the amount of subsidy is calculated. Ms. Heslin explained the sliding scale fee and the market rate. Mr. Nesmith added that occasionally the provider is not charging the client their portion of the fee. This is a disservice as then clients are not eligible for subsidy through DSS. The State's estimate and Smart Start were decreased. The Board recessed for lunch atl2:00 Noon. The Board reconvened at 12:30 p.m. Ms. Glidden noted she is uncomfortable with cutting the out-posted Medicaid position at Wilmington Health Access for Teens (WHAT). Ms. Glidden feels teens are an unhealthy population and cutting the position works against the goal of keeping children healthy and will cost more in the long term. Child Support Enforcement Sam Lane shared the vision for Child Support Enforcement to ensure that non-custodial parents acknowledge and accept responsibility for the care and well being of their children through the payment of child support payments on a regular and consistent basis. This will help children, families and adults to become economically secure. Carla West shared Child Support Enforcement is on target with collection goals. However, payments from income withholdings have decreased due to unemployment. The payments from unemployment insurance have increased nearly 300%. New Hanover County is above the statewide average in determining paternity for children and thus collecting child support. New Hanover County is slightly under the statewide average in closing cases under order. To increase the percentage, they have reorganized staff and are adding manpower. Currently collections for New Hanover County are 69% and the statewide average is 64%. Payments toward arrears are at 58.77% of collections for New Hanover County and the statewide average is 56.3%. The goal for the year is 65%. The Page 6 of 9 goal is to move cases to order as quickly as possible to collect payments. Mr. Nesmith thanked Carla West for working on State initiatives and the Fatherhood initiative which was not part of her job description as Ms. West is moving on to work in Iowa. Ms. West noted that New Hanover County is now 18th in the state on the 9 factor report. The State pays incentive money to Counties based on performance. The deficit reduction act had taken that incentive away. Two months ago the Federal government reversed that decision. Now, any money spent on incentives can be submitted and will be matched at 66% by the Federal government. This is good news for New Hanover County. Ms. McNamee noted this is a flat expense for New Hanover County. Children's Services Ms. Marino introduced her chiefs. Ms. Marino explained that the children being served by her unit are changing. There are more complex issues and often the children coming into custody are older, dually diagnosed and dealing with family substance abuse issues. The agency is being directly impacted by mental health reform. Kari Sanders shared the vision for Children's Services: Each child in New Hanover County shall achieve a permanent sense of belonging to a family that gives security, good health, adequate nutrition, a safe environment, a quality education and hope for the future. The goal is 76.2% of children achieving permanence. Domestic violence and substance abuse impact this goal greatly. There are record lows in foster care as there have been more family placements and reunifications with family. However recently there has been an influx of youth involved with substance abuse issues or who have been involved in criminal activity. It is difficult to place these children with foster parents and placement options are very costly. Also costly for DSS, the foster care board rates have increased this past year. DSS is required to upfront the costs to providers (group homes/foster care) and be reimbursed by the State. DSS is involved with the Family Finding pilot which allows DSS to use a nationwide search engine to find family members of a child in foster care. In theory, this search engine should find 40 family matches for the child. So far it's working well and provides connections for a child. The next target focuses on finalizing adoptions. It continues to be a challenge for DSS. The department has made great progress in reducing the backlog of children waiting for adoption orders. Ms. Talbutt explained that Regina Davis, the third attorney now employed by DSS and Dean Hollandsworth working from home on the weekends have made great strides in producing orders and clearing the backlog making children available for adoption. Ms. Sanders explained the various reasons foster homes have closed. In large part, foster care parents are not economically stable enough to take in another child. New Hanover County is ranked 4th highest in the state for the number of foster homes which have been recruited. Mr. Nesmith also explained that another reason foster home numbers decrease is because foster homes become adoptive homes, which is a good thing. Ms. Sanders talked about the success of the LINKS program. The program coordinator has identified areas of risk and tracks successes of aged out foster care children aged 18- 20. Mr. Nesmith has been mandated to talk with foster care kids aged 13-18 as a group. Page 7 of 9 His first meeting takes place March 6, 2009. Providing an in-house therapeutic care home was discussed. While it could be a great resource, it does not look financially feasible at this time. Ms. Marino gave some case examples of children needing therapeutic care, with no alternative to the extremely costly. Mr. Coudriet asked if all children in DSS custody are eligible for Medicaid. Ms. Marino said a majority of children are but one example on an ineligible child is a child who is undocumented; another example is a child who receives death benefits, making them over the income limit. There were no additional questions. Prevention Services Ms. Marino introduced Prevention Services. The Prevention unit came about as part of the Multiple Response System. Work First falls under the Prevention Unit. Ann Barkley discussed the Work First program. There has been a lot of success with employing a job coach/job locator in moving clients from Work First to employment. Pay for performance has enabled clients to get on a schedule with receiving a check for participating in countable activities. This more closely mirrors a real job. The target of not having work first participants return to the work first program after 6 months has been met. Ms. Barkley feels this is also related to the success of the job coach/job locator. County departments including DSS have given many work experience positions to Work First clients. Ms. Barkley discussed families accepting Prevention services and having a protective service report within six months was at 1.4%, which is very good. As part of Prevention services, the agency provides Emergency Assistance, such as General Assistance, Good Friends, Energy Neighbor Fund, Share the Warmth, LIEAP and Faith Community funds. Adult Services Ms. Marino introduced Adult Services, with a goal of keeping elderly and disabled citizens living safe and independently. Ms. Barkley explained the challenges of serving a growing aging community and many disabled adults needing service due to mental health reform. For FY07/08, 19.21% of aged and disabled adults were repeat victims of substantiated maltreatment. The target for FY 09/10 is less than 15%. The goal to decrease recidivism is to implement more preventative services. Adult Services is making a concerted effort to pull in more family guardianship as opposed to disinterested public agents. However, other disinterested public agents include the Health Department and Department of Aging and there is a push to include them as options to DSS guardianship. In 07/08, 1.81 % of aged and disabled adults living in a licensed facility were abused, neglected or exploited. During the first six months of FY08/09, 0.14% of aged and disabled adults living in a licensed facility were abused, neglected or exploited. The goal for FY 09/10 is less than 2%. Page 8 of 9 Mr. Nesmith noted that another function of Adult Services is unclaimed bodies. It costs $500.00 (it used to be $250.00) to take care of a body that a family does not claim. Often this happens because the family is unable to afford funeral expenses. Mr. Caster asked for clarification of the included chart. Ms. Barkley provided clarification about the number of reports received and public education. Child Protective Services Ms. Marino introduced Child Protective Services noting that in a six month time period, DSS was involved in investigating 6 child fatalities. Ms. Marino noted how important the partnerships with law enforcement and other partner agencies have been to investigation of fatalities and prevention of abuse. Ms. Jones looked at data over the past 12 months. In the last year, 49 cases of repeat abuse and neglect reports occurred. Ms. Jones' research found that 8 of those families had been in the welfare system for generations. The other cases were a result of substance abuse, mental health reform, domestic violence or a combination of all three. Mental health reform has made it very difficult for people to get counseling or legal medications to help them cope. Ms. Jones reiterated the trend of older youth coming into the agency with their own substance abuse, mental health and domestic violence history. A strategy the social work section implements is blended teams. This combines children services, prevention and child protective services to staff cases and come up with plans to work with repeat reports. This has been successful. Budget Approval Ms. Glidden motioned to approve the budget but keep the out-posted Medicaid position at WHAT. The motion was seconded by Ms. Bryant. Mr. Riley asked if the reduction in Medicaid transportation reimbursement would make up the difference in unpaid administrative costs. Ms. Glidden advocated for getting children into Medicaid and preventative services which could really be a value in the future. The motion passed unanimously. Next Meeting Objectives Child Abuse Prevention Month Proclamation 2010 Budget Update Board Self Evaluations The Board completed self evaluations. Additional Items As there were no additional items to discuss as provided in G.S. 154A-98 to consider information that is confidential pursuant to G.S. 108A-80 and or G.S. 154A-98, the board by consensus adjourned at 2:20 p.m. Page 9 of 9 Respectfully submitted, lav4law ` L- LaVaughn Nesmith, Secretary to the Board ohn E. Craig, Chairman LN: scm B02172009