Local Government Advisory Committee
Room 473, Human Services Building, Salem
Minutes March 8, 2002
Minutes Not Final Until Approved By LGAC
Cindy Becker, DHS Chief Administrative Officer
Lennie Bjornsen, DHS Assistant Director, Continuous System Improvement
Anne Brand, DHS Administrator, Office of Mental Health & Addiction Services, Health Services
Jean Cowan , Lincoln County Commissioner
Ron Dodge, Polk County Commissioner
Vic Falgout, Douglas County Juvenile Department
Bill Fink, DHS Assistant Director, Community Human Services
Gina Firman, Assoc of Oregon Community Mental Health Programs
Ramona Foley, DHS Assistant Director, Children, Adults & Families
David Foster, Oregon Housing and Community Services
Gordon Fultz, Association of Oregon Counties
Robert Furlow, Douglas County Health and Human Services
Donnie Griffin, DHS Deputy Director
John Hartner, Oregon Community Corrections
Chris Johnson, Yamhill County Health and Human Services
Lisa Joyce, DHS Legislative and Intergovernmental Relations Manager, Directors Office
Barry Kast, DHS Assistant Director, Health Services
Lydia Lissman, DHS Assistant Director, Seniors and People with Disabilities
Bobby Mink, DHSDirector
Linda Modrell, Benton County Board of Commissioners
Paul Snider, Association of Oregon Counties
James Toews, DHS Deputy Assistant Director, Seniors and People with Disabilities
Bill Wagner , Cascades West Council of Governments
Kathryn Weit, DHS Health Services
Doug Wilson, DHS Assistant Director, Finance and Policy Analysis
Minute-Taker: Dena Comer, DHSDirectors Office Administration and Staff to LGAC
Meeting called to order by Jean Cowan, Co-Chair. Roundtable introductions were made.
Donnie Griffin introduced Anne Brandt, who has recently joined DHS Health Services, where she will serve as Administrator of Mental Health and Addiction Services.
Griffin explained that the document, Remaking DHS Phase III, is not yet available in print, however will be on the Departments website soon. Bobby Mink and Griffin have been meeting locally with DHS employees and partners to discuss DHS reorganization progress. Mink will be continuing these meetings throughout the state over the next three months.
Budget Update & Special Session
Handout #1DHS February 2002 Special Session II Adjustments
Wilson provided a review of his first Special Session document (Handout #1), and explained that, at the present time, Mink is attending a budget "kick-off" meeting with other agency heads and the Department of Administrative Services (DAS) Mike Greenfield. Wilson further explained that DAS and their budget managers office, and the Governors Office largely determine the direction of Special Session, and that DHS participates as a resource.
Handout #2Budget Report and Measure Summary
2002 Second Special Session
Wilsons first handout reflects the current status of the budget, and is formatted using DHS former "divisions," as the Departments budget currently operates based on that structure. The top of the first page indicates the outcomes of late Januarys Emergency Board, and the bottom of the page indicates the results of Special Session. Wilson explained that Special Session, in some cases, restored the results of the Emergency board, in that the Governor cannot veto Emergency Board determinations, unlike his veto power during Special Session.
With respect to adjustments to Alcohol and Drug Abuse Programs, Wilson explained that the $2.8 million (approximate) reduction was not in the Governors original plans. This is a significant reduction to the programs.
Cowan asked for clarification on what programs would be affected within Lincoln County.
Gina Firman replied that the reductions would affect outpatient alcohol and drug programs.
Wilson further clarified that the reductions apply to the non-Medicaid population.
Chris Johnson commented that a lot of the counties are expressing concern as to how the reductions will be distributed. As counties have had historically wide variances in the allocation of alcohol and drug resources, some counties, on a per-capita basis, will have two-to-three times the amount of other counties. Yamhill county members may approach DHS regarding changing the reduction allocation.
Wilson responded that DHS would be open to discussion.
Johnson replied that, if the counties can come to a consensus on their own, then DHS would probably not have to be involved.
Cowan suggested that it is premature to identify layoffs until it is known what the actual per-county reductions are going to be.
Firman responded that, while for the most part this is true, there are some smaller counties who will have to layoff staff regardless. Some counties have already notified staff that layoffs will occur, however it is not known if they will occur this month or next.
Paul Snider asked how to identify those clients who would no longer have treatment available, and what happens to them?
Wilson explained that the counties have latitude on determining how their dollars are spent, and the counties could provide that information.
Continuing his overview of handout #1, Wilson explained that the $7.5 million package, provided at the end of the last regular legislative session for county mental health programs, was significantly reduced in Special Session. The last page of Wilsons second document (Handout #2) outlines the package as $1 million for planning and $6.5 million for services. Those amounts have been reduced to $750 thousand for planning and $2.4 million for services. DHS plans to go to the Emergency Board in April to release the planning dollars as quickly as possible, and to address the reduction to service dollars.
With respect to the mental health programs, as well as the $5.5 million reduction to the Childrens Plan, the question remains as to how these reductions will be "rolled up" into the next biennium. As the current budget has been reduced, so will the next bienniums budget. Wilson has been, and will continue, talking with the LFO and DAS Budget and Management Division (BAM) as well as with the Governors Office, regarding the process.
Cowan suggested that the April LGAC agenda include the results of the next Emergency Board, especially the outcomes regarding the planning piece.
Firman added her concern that Association of Oregon Counties (AOC) decided in November to not complete their planning until the funding was available. As a result, some counties have gone forward with their planning with a deadline of May 15, and other counties are waiting for funds. Some counties, therefore, will not have their planning completed by the deadline.
Wilson responded that this issue would be brought to the April Emergency Board.
Firman explained that while Sharon Guidera, and others from mental health and addictions, met to discuss the guidelines for planning, other tasks will need to be completed prior to the April LGAC meeting.
Cowan suggested that the outcomes of those tasks, as well as the Childrens Plan reductions, be brought forward at the April LGAC meeting.
Firman added that there is a budget note attached to the Childrens Plan, ensuring that the smaller counties are addressed. DHS Barbara Cimaglio will be meeting with the AOC and the AOC Mental Health Programs to discuss how to proceed under the current budget restrictions.
Griffin suggested that Cimaglio be present at the next LGAC meeting to join the Childrens Plan discussion.
Wilsons second handout is a budget report prepared by the LFO, and provides the background material for the legislative budget bills. Page 23 of the document lists the Safety Net reduction of $1 million, as well as the Home Care Commission reduction from an original $300 thousand to $100 thousand. DHS plans to address the Safety Net reduction at the April Emergency Board, and DHS will keep the group informed as to the results of the Home Care Commission reduction. Wilson added that the Governor has expressed his plan to call the legislature back into session in June, if they dont call themselves back prior to that time, to deal with one-time budget solutions to an ongoing budget problem.
Snider asked Wilson if he is aware of any additional cuts to DHS that the Governor may make.
Wilson responded that different agencies are not in the "loop" regarding any planned reductions. The Governor may ask the larger agency directors to meet within the next week to discuss any additional reductions, however Wilson has not yet been informed of a time or place.
In regard to the second handout, John Hartner asked Wilson to clarify which of the reductions leverage the largest federal funds.
Wilson replied that the Health Plan reductions are the largest. He explained that he plans to add the federal funds to this chart and release it within the next week. The Department, when addressing the legislature, makes it a practice to present the importance of federal funds. Significant changes to the DHS budget cannot be made without impacting federal funding.
Wilson explained that, in preparation for the 2003-2005 budget, DHS has requested the various advisory groups to include ideas for budget packages and expansion as agenda items for the next six weeks. LGACs April agenda should therefore include this discussion. The needs of local government, providers, and other partners should be addressed so that Mink can review them and the pricing process can begin. Mink is also scheduled for DHS budget meetings throughout the state beginning next week in Medford. All meeting dates and locations will be posted on the DHS website, www.hr.state.or.us. Once the initial information and draft prioritization has been completed, DHS will bring the results back to the advisory groups for further discussion. Wilson added the warning that, due to the probability of a tight 2003-2005 budget, there may not be much room for significant increases in resources.
Lisa Joyce commented that the current budget climate has highlighted parts of the system which are very stressed. DHS is asking its partners to investigate directing resources from stronger areas in order to strengthen those areas which have been weakened.
Furlow relayed his concern that the budget process and the Oregon benchmarks and other desired outcomes are connected.
Wilson replied that BAMs budget process outlines a strong link to the 34 benchmarks and other desired outcomes. Wilson plans to address those outcomes and their connections to the budget process at the upcoming budget meetings, which Mink has scheduled.
Cowan concurred with Furlow on the need for making connections, and suggested that the April LGAC agenda be expanded to include the budget preparation and links to the performance measures.
Linda Modrell added that, in making connections, it would be useful to use as an overlay the work that the Governors Social Support Investment Work Group accomplished. The group helped identify the responsibilities of local communities and individuals, and responsibilities of state government.
Cowan expressed her concern that all available resources be used prior to beginning a new planning process.
DHS Community Human Services Review Committees
Handout #3Draft (March 5, 2002) DHS
Cowan explained that she had an opportunity to review Bill Finks draft document
Community Human Services
(Handout #3), which is also being presented at todays Stakeholders meeting. The DHS Reorganization process, and the newly developed service delivery areas (SDAs), have been moving forward quickly. Cowans question, while acknowledging the advocates need to have their concerns heard, is whether or not creating the new Community Human Services (CHS) Review Committees is happening too quickly. Is it too soon to be developing new groups, when programs are not yet completely up and running?
Fink responded that Cowans concern is valid, and DHS desire is to that the SDAs grow from the communities, rather than from the Department. Fink acknowledged that the CHS Review Committees would add one more group to the mix. There are groups however, including Stakeholders, who have expressed the need to keep processes moving, and immediately, with their input. If the new Review Committees do not form, the process will move forward without the partners voices being heard, which both excludes the partners and leaves DHS without the benefit of their input. The committees will allow SDA managers to receive input in a more organized and even geographic process. Partners need to be heard, and the committees will provide a systematic way to accomplish that.
David Foster applauded DHS efforts, especially considering the amount of issues on their "plate."
Modrell asked Cowan if the proposed 14 members could be divided by county and appointed as needed.
Cowan replied that if members are appointed, the risk is that the right members may not be at the right "table."
Johnson echoed Cowans concern, and suggested that one member from each local delivery system be included, rather than one from each SDA. For example, Marion, Polk, and Yamhill Counties have very different systems.
Joyce explained that the structure of the committees is not statutory, and can be adjusted if need be. The handout represents the thoughts of a lot of advocates and partners, and DHS goal is to see the process work for its partners.
Cindy Becker asked if, in the event the SDA came to CHS and wanted to change the number of members for a committee, that would be okay.
Fink replied that the concept is for local representation in the development of the system. If a group came back with an adjustment that makes the committee more effective, then it will be supported.
Furlow commented that there is nothing to preclude ad-hoc groups from forming within the counties. Perhaps representatives from those groups could be members of the Review Committees.
Johnson added his concern that state guidelines on how the committees should form not direct the local SDAs and change their planning.
Fink replied that his expectation is that on the state-represented committee, there will be a single representative from SDA 3.
Cowan suggested that as Fink meets with the SDA managers, he share LGACs concerns. It would be productive to have SDA development updates periodically on the agenda.
Modrell asked who appoints the members to the committees.
Fink replied that the SDA managers make the appointments.
Modrell asked if county commissioners could appoint them.
Fink explained that the advocacy groups interpret the issues as broader than the county level.
Cowan concurred with Fink.
Fink asked that if this group, along with the Stakeholders, know of any interested parties, to please let CHS know.
Hartner expressed his concern regarding the list of partners and the word "must" surrounding representation. He also suggested that Community Corrections be added to the list.
Cowan suggested building flexibility to the document by changing the wording, such as "shall" becoming "may," and a "minimum" of 14 members, etc.
Foster shared his concern regarding flexibility, in that an SDA manger could have the opportunity to exclude a person who LGAC feels should be at the table. Foster would have no problem with additional parties, however.
Modrell commented that, with the SDA manager appointing everyone, input could be controlled.
Wagner asked how to address the image that DHS wants to take over issues that have already been addressed in existing groups. For example, there is an excellent group of human services people in Lincoln County who have been meeting for many years, and have addressed the same issues as listed in the handout.
Fink replied that in most places groups like these have already been meeting, and that they tend to be focused at the county level rather than regionally.
Hartner commented that DHS has a lot of trust and confidence in the SDA managers as leaders; therefore he trusts that they are capable of developing the Review Committees as they will work best.
Cowan suggested that an update on CHS Review Committees be added to the May LGAC agenda.
County Developmental Disability Programs
Handout #4Developmental Disabilities
Cowan acknowledged Lydia Lissman and James Toews of DHS Seniors and People with Disabilities (SPD), and explained that they will address recent concerns surrounding local developmental disability issues.
Subcommittee Meeting, February 28, 2002
Firman provided the explanation that counties and the state have been working on ongoing challenges in the Developmental Disability (DD) system. Regardless, some issues have escalated to the point that one county has given the program back to the state, and another county is in the process of doing so. As both the counties and the state want the best for clients, having programs returned to the state is not the best solution. Lissman, Toews, and Firman, together with county mental health directors, organized a DD subcommittee meeting on February 28. The notes from that meeting were distributed (Handout #4).
Johnson expressed his belief that a county and state partnership is essential, yet when the state tries to operate things locally the issues can become bureaucratic and less "consumer-friendly." The issues in the handout have been around for many years, and Johnsons focus is that members of LGAC and DHS staff understand how serious the issues are. The two counties giving programs back to the state are just the tip of the iceberg, as there are other counties seriously considering doing the same. While the issues are not new, the intensity level is high, perhaps as a result of the Fairview closure. There is no state institution to send people to, and there is no way to remove such disabled citizens from the communities. As counties deal with people with developmental disabilities, there has been an increase in legal issues resulting in weekly court dates, which is time-consuming and overwhelming. The counties need assistance from the state to deal with the issue.
Lissman explained that the handouts comprehensive list of issues is a good start in addressing them. There was consensus regarding short-term solutions to be explored, as well as strategies that will need to be discussed in-depth and long-term. It is not DHS desire or intent to take the programs back, and DHS is not statutorily allowed to do so, unless as a "stopgap" measure.
Toews began by explaining that the issues can be categorized as a "piling on," as workload has expanded with the closure of Fairview, with the settlement of the Staley lawsuit on the waiting list, as well as with the addition of 5000 people requiring service, to name a few. There are also administrative issues between the state and county, one being that most are structured through the Medicaid program.
The federal government views the Medicaid program as a single state agency, with a specific rate and a direct contract between the Medicaid agency and the vendor. As DHS does DD work through local government, the money flows through local government. Local government, however, cannot capture a fee to pay its own infrastructure costs. The fees are paid independently from a line-item fund named "Local Administration," which historically has never been equitable.
Another administrative issue for DD is that the entire case management system has no caseload standards, resulting in an expanding workload and no mechanism for increasing staffing levels. There will be short-term resolutions, however the biggest issues will most likely not be solved in the short-term.
Firman added that some of the challenges include one countys 40 percent increase in the child caseloads. Another is the perception that brokerages are paid a higher rate than the counties. This may be the case in some counties, not in others. The point is to get all the facts on the table, and to identify the real issues. Additionally, counties are "stunned" by the lack of a raise in Cost of Living Allowances (COLAs).
Furlow asked for clarification as to why the DD program cannot be returned to the state.
Toews explained that while statutorily the county can return the program to the state, if the county doesnt administer the program directly, one of two things can happen: 1) the county commissioners can decide to contract the program to a public or private entity, or 2) the county gives the program back to the state, and the state is authorized by law to operate the program on an emergency, temporary basis. The state is then directed to seek a public or private entity to operate the program.
Cowan commented that when the Fairview closure was first discussed, the issue was the high cost of keeping people at the facility. The closure was intended to save money, however the perception is that those saved dollars have not been forthcoming.
Toews replied that every penny from the Fairview closure was reinvested in the communities. Another issue, however, is that juveniles as well as adults with disabilities are entering the correction system.
Lissman offered to return to LGAC and provide status reports on the DD issues.
Cowan replied that it would be a good idea, and suggested that Lissman and Toews decide the appropriate time to do so.
Mink joined the discussion in sharing his experience in the last regular session. He discovered that even when there is a caseload standard, there is no guarantee that the legislature will provide additional staff, as happened with Temporary Aid to Needy Families (TANF). Without caseload structure, it is difficult to determine that the infrastructure is sound.
Firman closed the discussion by reporting that Lissman and Toews will be working with the DD subcommittee. She will also be attending the meetings as staff, and the next update will probably not occur for two-to-three months.
Mink reported that with respect to the next budget cycle, DHS has, traditionally, always come forward with three or four items that need to be emphasized. The Department has not done this, as Mink would like to have a broad discussion to identify those items. Infrastructure is one topic, yet this is an opportunity to hear from LGAC about what the budget should include.
In returning from the biennial budget kick-off meeting, Mink explained that there is consensus that there will be additional Special Sessions in addition to the past two. There are two major issues to report: 1) After the last Special Session, the state is approximately $600 million short of a continuing service level, and all possible reserve funding has been used. The focus in on the June forecast to see if the economic forecast will improve. By law, the Governor is required to submit a budget with 10 percent reduction options. This time, there may be a requirement for 20 percent. 20 percent from DHS would solve the entire states budget problem, so it is not likely that the entire amount would be taken. 2) The budget will be created for the current Governor, and in November, a budget will have to be created for the new Governor.
Handout #5Workshop on Individuals With Mental Illness
Cowan reported that conversations at the Public Health Advisory Board have included incorporating the work of the Turning Point effort and improving Public Health systems.
In the Criminal Justice System
Snider distributed the announcement of an upcoming workshop (Handout #5). The issue being addressed at the event is a serious indication of problems needing to be addressed. The audience is the membership of the Judiciary Committee, but the broader audience includes anyone who wishes to attend.
Cowan asked that Snider bring the outcomes of the workshop be brought to the next LGAC meeting, and he agreed to do so.
Hartner added his concern over people in transition from the correctional facility to their communities. The idea is that treatment for people who have mental illness can be initiated in jail, or in the transition facility. If they dont have eligibility for the Oregon Health Plan (OHP), an absence of medication and services can last for 30-45 days. A two-week lapse in medication can negatively impact the persons ability to reconnect with their community and services.
Cowan commented that she has been part of this discussion in other meetings, and that a problem lies in the fact that federal money is not easy to get for transition programs.
Hartner reported that two things, which have been tried, include training people on the police force in understanding mental illness. Those individuals could then be called upon in mental illness-related issues, and would also assist in building compassion for mental illness within the force. Additionally, Community Corrections is funding a position, in the jail, which helps community providers come in and begin case management.
Mink commented that the work on processing eligibility is important, to eliminate a lapse in treatment as the transition takes place. Mink will talk with DD programs about how DHS can assist in starting the process for eligibility while incarcerated.
Handout #6Letter Dated February 28, 2002,
Becker referred to the letter regarding the County Contracts Task Force (Handout #6), and emphasized its critical nature. Group discussion will include developing performance measures, how they can be monitored, and roles and responsibilities. Becker encouraged LGAC to inform their respective people on the groups activities.
To LGAC Members from Cindy Becker
Future Agenda Items*
*Actual agenda is dependent upon a LGAC Executive Committee meeting.
Emergency Board Planning
Reductions to Childrens Plan
Budget Expansion and Links to Performance Measures
Outcomes Workshop on Individuals with Mental Illness in the Criminal Justice System
Date: April 12, 2002
Time: 9:00AM - Noon
Location: HSB 473
Note: 2:00PM-4:00PM Stakeholders/Partners Meeting
Location: HSB 137 A-D
If you would like copies of the handouts, contact:
DHS Directors Office, 4th Floor
500 Summer Street NE, E-15
Salem, OR 97301-1097
Telephone: (503) 945-6843
Americans with Disabilities Act Notice: Do you have a physical or mental impairment that makes it hard for you to communicate? If so, you can get this document in Braille, computer disk, large print or oral presentation by contacting Jessica Ferge, Department of Human Services, Directors Office, (503) 945-6609, TTY (503) 945-6214.