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Minutes Not Final Until Approved By LGAC

Local Government Advisory Committee
Minutes–April 12, 2002

Room 473, Human Services Building, Salem




Cindy Becker, DHS — Chief Administrative Officer

Lennie Bjornsen, DHS — Assistant Director, Continuous System Improvement

Ben Boswell,Wallowa County Commissioner

Anne Brand, DHS — Administrator, Office of Mental Health & Addiction Services, Health Services

Barbara Cimaglio, DHS — Special Assistant for Child and Adolescent Services, Health Services

Larry Cole, League of Oregon Cities

Jean Cowan, Lincoln County Commissioner

Herschel Crawford, DHS — Administrator, Office of Medical Assistance Programs, Health Services

Ron Dodge, Polk County Commissioner

Barry Donenfeld, Mid Willamette Valley Senior Services

Vic Falgout, Douglas County Juvenile Department

Bill Fink, DHS — Assistant Director, Community Human Services

Gina Firman , Association of Oregon Community Mental Health Programs

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

Sharon Guidera, Mid-Columbia Center for Living

John Hartner, Oregon Community Corrections

Julie Jackson, DHS — Chief Audit Officer, Director’s Office

Chris Johnson, Yamhill County Health and Human Services

Lisa Joyce, DHS — Legislative and Intergovernmental Relations Manager, Director’s Office

Barry Kast , DHS — Assistant Director, Health Services

Mickey Lansing, State Commission on Children and Families

Linda Ludwig, League of Oregon Cities

Bobby Mink , DHS — Director

Linda Modrell, Benton County Board of Commissioners

Mike Morgan, Jefferson County Administrative Officer

Jim Neely, DHS — Deputy Assistant Director, Children, Adults and Families

Gillian Nicolaides, Douglas County Commission on Children and Families

Ann Peltier, Conference of Local Health Officials

Alicia Philpot, Governor’s Office

Paul Snider, Association of Oregon Counties

James Toews, DHS — Deputy Assistant Director, Seniors and People with Disabilities

Bill Wagner Cascades West Council of Governments

Michele Wallace, DHS — Deputy Assistant Director, Continuous System Improvement

Doug Wilson, DHS — Assistant Director, Finance and Policy Analysis

Minutes: Dena Comer, DHS - Director’s Office Administration and Staff to LGAC


Handout #1Poverty in Oregon: A Call to Action

Handout #2April 16, 2002 DHS Reorganization Task Force, Agenda

Meeting called to order by Jean Cowan, Co-Chair. Roundtable introductions were made.

Cowan referred to the upcoming conference sponsored by the Community Action Directors of Oregon (Handout #1), and that it will be held November 6-8, 2002.

Director’s Report and Budget Update

Bobby Mink reported that a Legislative Special Session is planned for June, and that DHS will be prepared to identify the impacts of any proposed reductions.

There will be a hearing next Tuesday, April 16, regarding the Department’s reorganization. Representative Winters will chair the hearing, and has outlined a proposed agenda (Handout #2). Mink will provide an overview of the reorganization, and of the challenges DHS has addressed thus far, as well as future challenges it must overcome. DHS Community Human Services (CHS), and other cluster representatives including Administrative Services, will be on hand to provide reports to the committee.

Mink also reported on the DHS budget meetings, which have been occurring around the state in March, and continuing in April and May. At the meetings, the Department is asking for suggestions as it prepares for the 2003-05 session. Thus far, meetings have taken place in Medford, Eugene, Pendleton, Bend and Salem. Additional meetings have been scheduled for Wilsonville on Monday, April 15, and in Portland on May 1.

  • Budget

Handout #3Policy or Budget Package Ideas from Public Meetings

Doug Wilson asked the group for their ideas on policy packages, in addition to those received at the public DHS budget meetings (Handout #3).

Furlow suggested that DHS consider expanding mental health, and alcohol and drug services into the corrections environment for adults and youth. The corrections environment includes probation, parole, and institutions and detention centers.

Barry Donenfeld commented that a weakness in long-term care within the adult protective services system is the low staffing standard. Improvement of the caseload standards might be a way to resolve the issue, although determining the requirements of meeting the statutory staffing mandates would be ideal.

Furlow relayed his concern for adequate cost of living allowance (COLAs) increases for community partners. Adequate funding must be provided at all the various levels, including local governments and provided services.

Gordon Fultz suggested that Public Health be added to the Local Government Infrastructure category, and Cowan concurred.

Lisa Joyce added that, while on the road for budget meetings, representatives of local government were not aware that they could provide an avenue for county systems to voice their concerns.

Furlow expressed his concern surrounding Health Insurance Portability Accountability Act (HIPAA) issues. Local partners are not in a position to allow DHS to set standards.

Mink responded that these requirements come from the federal government, not from DHS.

Furlow replied that there is a need for discussion surrounding how the HIPAA implementation costs will be met, and how they will be addressed in the budget.

Cindy Becker explained that HIPAA-related items reach every part of the county government system, and should be addressed as part of a larger system, not just DHS impacts.

Furlow replied that the cost should be on the state’s budget screen, as it relates to the delivery of services to DHS clients.

Mink assured the group that these issues are addressed at every Emergency Board, as well as at DHS budget meetings, from the county perspective as well as the Department’s.

Cowan commented that the focus of the discussion should be around the local governments’ ability to be a partner with DHS, and how responsibilities can be met under the current budget restrictions. Additionally, the infrastructure needs can be overlaid with the work completed by the Social Support Investment Workgroup (SSWiG).

Alicia Philpot reported that the Governor’s Office is currently conducting a review of the Oregon strategy, which is the outgrowth of the SSWiG project. The review includes the status of recommendation implementation, and they will be contacting the group for more about this.

Wilson explained that DHS has had preliminary discussion surrounding what could be done concerning local capacity, COLAs, and planning funds for the public health system.

Bill Wagner commented that meeting the cost of health benefits is particularly difficult, resulting in layoffs.

Donenfeld suggested that, while it’s unrealistic to expect to receive more funding, money can sometimes be made by changing the way people actually do their work, or by helping them to do more work by taking away certain cumbersome tasks. An example is financial eligibility bureaucracy, which is an area requiring numerous staff.

Cowan agreed that this is an area of concern, and asked the group for more ideas on how to change the way work is done.

Fultz suggested the elimination of the silo-funding stream at the local level, which would allow more flexibility throughout the counties. Additionally, the Association of Oregon Counties (AOC) is currently conducting a review of the human services system to determine their focus for the next session.

Sharon Guidera suggested finding a new way to package administrative infrastructure costs. These costs include competitive wages, benefit packages, utility costs, etc. and add up to a large percentage of administrative dollars received.

Vic Falgout suggested a method for coordination of efforts across the three different branches of government, to avoid duplication. He used as an example the current campaign by the judicial branch, the Children’s Plan, Senate Bill 555, and DHS integration, all appearing to pursue similar goals.

Ann Peltier asked what the time frames for these suggestions might be, and what other opportunities exist outside of the regional budget meetings, to make suggestions.

Wilson replied that the DHS Cabinet will begin to examine these suggestions within the next two weeks, and brought to the next LGAC meeting. Packages and their pricing need to be ready by the first of June. Wilson invited the group to e-mail him, or the other Assistant Directors within the next seven to ten days with their suggestions. Wilson reminded that group that administration costs were difficult to prove in the last session.

Fultz commented that the verbiage in the last budget referred to "local" administration, when it was actually state administration, resulting in the perception of excessive costs.

Cowan suggested that the term "administrative costs" be better defined so that its true costs are better understood.

Chris Johnson suggested that if service rates reflected the true cost, the problem might be eliminated.

Gina Firman explained that the usual contract funding for administration is 8-15 percent, yet the counties receive an inadequate 1.9 percent. The line item referred to by Fultz listed $20 million for administration, which was interpreted by the legislature to be divided between 36 counties. In fact, most of the funding was for state administrative costs for dealing with local counties. This wording surrounding this funding must be clarified.

Cowan concurred, and suggested that DHS consider problems such as this when developing next session’s budget.

Mike Morgan suggested that the staff and administrative talent being spent in attempting to reduce costs be acknowledged, and that masking such costs is counter-productive.

  • Emergency Board
Wilson explained that the Emergency Board (E-Board) will meet next week, however many of the dollar items have been removed pending Special Session. There will be discussion on a bio-terrorism grant, as well as a number of reports and grant requests from DHS.

  • Reductions to Children’s Plan

Handout #4OCP Funding Cut Options

Barbara Cimaglio explained that in the originally approved budget for this biennium, $11 million was allocated to counties for increased services for alcohol and drug and mental health treatment in a fee-for-service (the amount available to be billed for specific services) model. Rollout of the alcohol and drug and mental health components for the Children’s Plan began January 1, when conservative projections were made for the remaining 18 months of the biennium. The results indicate a final amount, following the two special sessions, of $5.5 million. Cimaglio distributed a document (Handout #4) indicating the amounts, of the $5.5 million, which have been allocated for each county. Cimaglio’s group will be visiting each county to explain these rollouts. Four county groups started in January, including Clackamas, Jackson, Lane and Mid-Columbia. The second tier, including Deschutes, Linn, Douglas, Marion, Polk and Umatilla, began in March. Cimaglio reported that, as of April 1, all of the rollout counties have working systems in which clients are being served.

Cimaglio added that the Governor’s Office has reported that they will include the entire $11 million in the plan for the next biennium, as originally approved.

With regard to the fee-for-service model, Fultz asked how, in the event that clients from one county go to another county for services, adjustments would be made.

Cimaglio explained that she is working with the Association of Oregon Counties Mental Health Programs (AOCMHP) to address the issue. The intent is to manage the funds to ensure adequate access to services.

In response to Peltier’s question as to time frame on first births, Cimaglio explained that she would get the specific information to her.

Guidera asked if administrative costs would be included in the plan for the next biennium.

Cimaglio replied that the direction from Legislature was that the model be fee-for-service.

Fultz suggested that structure needs to be built into the budget to address administrative costs.

With respect to allocation to counties, Johnson commented that there does appear to be a larger adjustment for square miles than he has seen before in DHS.

Cimaglio replied that the square mileage issue has examined for a couple of years, and that there are challenges for the rural counties, related to distance. She will continue to work with AOCMHP to resolve the issues.

Griffin explained that the document, which Cimaglio has distributed, is a working document, and more work will be done surrounding the concerns.

  • Senate Bill 555 Update
Mickey Lansing joined the group and began by explaining that, in the first phase of the Senate Bill 555 rollout, all counties were asked to map their resources, and to identify barriers, strengths, and priorities. The second phase involved working with partners in three main systems, including alcohol and drug, general crime prevention, and the State Commission on Children and Families (CCF). The state partners involved signed a letter, which went to counties last week and either approved, conditionally approved, or did not approve their Phase two plans. Of the thirty-six counties, which submitted their phase two comprehensive plans in mid-January, only 10 plans were approved. The remaining 26 counties were either conditionally approved, or not approved. The main reason for this is the area of cultural competency, which includes access, priorities and strategies, etc. Final approval is not until September, and these preliminary steps allow the CCF to support the counties with technical assistance and training. Lansing added that the counties provided excellent information, the data from which is currently being analyzed and will be completed within the next four weeks.

Lansing further reported that a partnership conference was held at the end of February, which included the United Ways of Oregon, and the foundations of Oregon and southwest Washington. The conference focused on aligning resources, and one of the foundations has already asked, based on the information provided by the counties, how they could be involved in funding.

Nicolaides explained that her county’s plan was conditionally approved due to cultural competency, and yet her county had worked with the CCF’s cultural competency person to correct it prior to submission. Of additional concern is that it is difficult for the county to control the local service providers, and to ensure that they perform as the state requires. She added that there seem to be differences in how cultural competency is measured by county, and provided Wallowa as an example, whose plan is case-by-case. The tools are needed to provide what is being requested.

Lansing replied that she would get back to Nicolaides regarding her county’s cultural competency needs.

Furlow suggested that, if only a small number of counties were approved, perhaps the system needs to be improved, using technical assistance as an example.

Lansing agreed and will continue to be in dialogue with the counties with respect to guidelines. There is room for improvement, and the CCF will look to local partners to help. CCF’s intent is for all thirty-six counties to be approved.

Guidera suggested that the state consider how culturally-appropriate services are funded, providing a current recruitment issue as an example

Lansing replied that they are recruiting and retaining for competent bilingual and bicultural staff, and agrees that it is a huge issue.

Cowan suggested that the CCF’s bureaucratic language be translated into a more understandable dialogue.

Lansing concurred, adding that the CCF will call upon its local partners for assistance.

Donnie Griffin applauded the CCF’s efforts toward cultural competency, and suggested that the systemic issues be addressed, in addition to dialogue issues.

Ben Boswell commented that all counties need to be recognized for the good work they have done.

Lansing replied that everyone, without fail, did good work, and that this was meant to be an exercise to prepare for September submission of final plans.

AOC/DHS Systems/Gap Discussion

Cowan referred to the public health planning that was done prior to the last legislative session, from which there was no apparent result. She asked that the planning efforts be utilized, and that those issues remain on the table. The Association of Oregon Counties (AOC) suggested examining whether or not someone else can offer services in better, cheaper ways. The Steering Committee on Human Services will meet this afternoon, and will address implementing ideas as a result of the planning. The steering committee has asked Cowan to bring ideas from LGAC, and ultimately from DHS.

Firman reported that she and Fultz have been in partnership with DHS on these issues. DHS is in the process of gathering, and has received, information from the communities with regard to budget packages and areas of concern. She and Fultz have gathered information from county commissioners, and plan to have a document to provide Cowan by the next LGAC meeting. There are many common issues emerging as a result of these conversations with the public and the county commissioners, and perhaps a team could come together from AOC and DHS to outline the issues.

Griffin responded that DHS would like to bring a team together to identify the gaps. At issue is funding, as well as federal regulations, however frustrating and distancing they may be. Any gaps that can be closed must be addressed, and as quickly as possible.

Furlow asked that someone from the Governor’s Office, as well as the Legislature, be involved in this team.

Griffin concurred, and Cowan suggested that, following discussion in today’s steering committee, the next LGAC Executive Committee include the additional parties necessary, bringing the discussion to the May LGAC meeting.

Survey: Multiple DHS Contracts and Counties

Julie Jackson reported that the County Contracts Workgroup approached DHS Audits with the concern that DHS conducts audits as often as every month, creating workload issues. Jackson asked the group if whether or not a survey should be done, addressing the counties’ experience with DHS audits. The survey’s time frame would be the last six months, and include questions such as when DHS last conducted an audit in the county, who conducted it, and the county’s understanding of the audit’s scope. The survey would also include a general comment section.

The group voiced no objection, and Cowan suggested that the survey include a cover letter outlining the intentions behind it, and that Jackson coordinate her efforts with Fultz.

DHS Community Human Services Review Committees Update

Cowan explained that a question was asked of the AOC as to whether or not the Boards of County Commissioners have a role in appointing people to these review committees. While the Commissioners would have an opportunity to review the selected candidates, final appointment would come from the state.

In response to the concern that committees already exist which have been working on similar issues, Bill Fink reported that he has met with service delivery area (SDA) managers and explained that those committees should remain in place, and that any new appointments to those committees be discussed with the Chair of their county commission.

Cowan suggested that the discussion be addressed to their county’s commission, not the Chair.

Modrell explained that her concern is that the counties have input into the appointments, not total control.

Fink responded that, in a number of the SDAs, there has been discussion that many of the existing committees be utilized, and that creating a new committee for each area may not be necessary.

Developmental Disability Program Update

James Toews reported that an inventory of issues has been created, in response to concerns over the program’s unmet costs and escalating workloads and other demands. Meetings have occurred to address the budget issue, which is crucial in establishing a page holder, as well as the Staley lawsuit and how it has affected many areas. Staley issues include major caseload responsibilities remaining with the counties while the roll-up is beginning, and interim solutions or allocations are being sought to ease this burden. Additionally, the meetings have addressed the true cost for case management within the counties, and the possibility of tiering costs between rural and urban areas. An updated budget model is needed, and DHS will continue to update its case management model as part of second phase of the Staley lawsuit. Toews will bring resulting data to the next LGAC meeting. Local administration was also discussed at the meetings, and that of the 1.9 percent of county funding (as described by Firman earlier in this meeting), 75 percent has historically been generated by developmental disabilities (DD). Whether or not there will be a placeholder added for DD has yet to be determined. Finally discussion has also included COLAs, and actual case management ratios as they currently exist by counties, in order to re-project the model budget. These are some of the many issues in a lengthy list that DD programs will continue to address.

Mental Health Planning

Kast introduced Ann Brand, DHS’ Administrator of Office Mental Health and Addiction Services, Health Services. Ann brings a remarkable record in administration of mental health, both in public service and the private sector.

As a result of House Bill 3024, mental health plans were originally due in March, but now have a due date of May 15. Brand reported that a document went out from her planning offices this week, providing the guidelines for compliance with the bill. The four content areas for the plans include 1) consumer-centered, community-based services for children and families, adults and seniors, 2) consumer-centered intensive services including acute extensive and intensive services for adults and children, including but not limited to the state hospitals, 3) suicide prevention for children adults and seniors, juvenile and adult corrections including juvenile justice, Oregon Youth Authority, and 4) community corrections for adults and local correctional facilities and jails. The requirement is that the plans are closely coordinated with the results of the Oregon Children’s Plan, SB555, local public safety coordinating councils, and the local alcohol committees. Brand noted that the compliance process does need to move forward.

Cowan reviewed the history of her frustration with the planning requirements of HB 3024, and the existing AOC position that such planning cannot be accomplished unless the funds promised for this purpose are released. She asked how the planning is expected to move forward without funding.

Firman explained that her understanding of the due date is that if the planning money was received in the February E-Board, it would be moved to May 15. The money was not received in February, and it was DHS’ intention to ask for it at the April E-Board. This plan has changed, as it is the Governor’s intention to ask for the full $1 million for planning at the June special session. The dilemma is that the Governor would like to include this in the next biennium budget as a roll-up; however, the service dollars are based on the plans.

Johnson explained that his understanding is that the plan has been broken into two parts, one that would be completed by May 15, and a full report on the four service areas would be due the first of December. Additionally, Johnson asked how DHS plans to address the Attorney General’s decision that they will not contract retroactively. If plans are submitted in May, will the money actually be received in June or July?

Kast replied that legislative intent is that there be a reimbursement, yet he will have to get the exact answer. To the extent that we move forward, there is a claim on resources. To the extent that we don’t move forward, it then becomes easier to cut funding.

Firman asked that county plans be released if completed by May 15, so that they can be presented to the Governor in good faith and illustrate that the funds are expected. It was acknowledged that at least one county has already submitted a plan, but Guidera commented that other County Commissioners will not allow staff to submit a plan unless the AOC position is modified.

Cowan commented that some counties do not have adequate staffing at the local level to complete the planning, in addition to the other things being asked of them. Boswell agreed, adding that his county does not have the capacity to complete the planning, and was counting on the funding in order to contract to have it done.

Cowan will raise the issue at the AOC Human Services Steering Committee meeting this afternoon for further discussion.

Health Plan Waiver Status

Handout #5Oregon Health Plan (OHP2) Waiver Amendment and Application

Hersch Crawford distributed his handout, which was used at the Legislative Leadership Commission on March 26 (Handout #5). It explains that House Bill 2519, which is the reform and expansion of the OHP, basically reduces benefits for some on the plan, and allows DHS to receive better federal matching rates on other programs. It creates financial flexibility by reducing benefits 20 percent for some, and allows the Office of Medical Assistance Programs’ (OMAP) portion of OHP to be expanded up to 185 percent of the federal poverty level. It also expands the Title XXI (CHIP) portion to 185 percent, expands coverage of pregnant women to 185 percent, and expands the Family Health Insurance Assistance Program (FHIAP) to 185 percent.

Crawford reported that this presentation was made to the Commission, whose approval was needed in order to take these waivers to the E-Board. At the hearing, the Commission raised concerns over the waivers, the first being whether or not they can believe the Department’s assertions that they are budget-neutral. There were concerns about cost sharing, and they wanted to see more expansion on the FHIAP side. Additionally, they were concerned about the growth and the underlying cost of the OHP. The decision was made to refer those issues to the Oregon Health Council for review, with recommendations being made back to the Leadership Commission. The Health Council met on April 4, and was attended by the Speaker and the Senate President, who presented their proposal of HB 2519 implementation. Their proposal included more expansion of FHIAP than DHS, and less of an expansion on the OMAP side, and cap enrollment at 110 percent. The Health Council is currently in the process of making its recommendation back to the Commission, and DHS is working on a response proposal that will go back the Senate President and Speaker in an attempt to move it forward.

The waivers are currently structured today such that those in the general assistance program will continue with no reductions to their current benefit package. The Leadership’s proposal (that of the Speaker and Senate President) includes an 11 percent reduction in benefits, resulting in a savings of approximately $200 million in the OHP budget. Crawford suggested that the Governor would most likely not go along with a reduction of that magnitude. DHS is still hopeful that they will receive approval to take the waiver proposals to the April

E-Board. While the original goal for implementation was October, it will more likely happen at the end of 2002.

Cowan commented that if the waiver request is not submitted to the federal government in a timely manner, the window of opportunity will have passed. She explained her concern over whether or not the incarcerated would be eligible for the OHP. The 11 percent reduction request may be dealt with by recognizing the need to discuss which benefits are included. The issue is extremely complex.

Furlow suggested that when addressing the Leadership Commission, DHS include its partners to ensure accurate data with respect to cost. Perhaps there might be a tracking system which illustrates the impact of reductions.

County Contracting

Becker reported that there was very good attendance at the first meeting, and an excellent combination of both local and state program involvement. There is a budget note requiring DHS to implement a performance contracting system by the next biennium. There are two goals, the first being to ensure that all parties are moving in the same direction. The second involves five subcommittees which are 1) Structure, 2) Employment and Training,

3) Children Adults and Families, 4) Health Services, and 5) Seniors and People with Disabilities. These subcommittees will have a chair, a local chair, and a state chair. As they begin, there will most likely be a hold-harmless clause for at the least the first year. The meetings will continue, and will establish performance measures, penalties, and incentives for exceptional performance. While the process will include months of discussion, the overall goal is the get this into the 2003-05 biennium.

Furlow commented that at Tuesday’s Joint Legislative Session, Senator Morrisette remarked that he is very interested in pushing forward a bill, originally stalled in the Senate, regarding performance contracting.

Griffin replied that he would contact the Senator regarding the issue.

Organizational Updates

  • Outcomes: Workshop/Individuals with Mental Illness in the Criminal Justice System

Handout #6March 14, 2001 Letters to Governor, Crawford,
and Kast, from Senator Minnis

Paul Snider reported on a Judiciary Committee workshop held in March, which addressed people with mental illness in jails and prisons. Among others from throughout the state, testimony was received from sheriffs, a jail manager, a corrections manager, and Barry Kast of DHS. The suggestion was made that, for those mentally ill and in the jail system, had their mental health issues been addressed initially, they would not be in the jail system today. There is growing frustration among the sheriffs that jails are not designed to assist the mentally ill, nor are their corrections officers equipped to do so. Snider referred to letters (Handout #6), which address pre-qualification for the Oregon Health Plan (OHP) prior to release from prison or jail.

Kast explained that while pilots have been initiated, it is a budget and caseload issue for DHS.

Cowan asked how many incarcerated people with mental health issues will actually be qualified for the OHP?

Kast replied that DHS would bring information back to LGAC for presentation. He added that mental health services in custody are quite good; the question is, when people are released, how is continuity of care ensured?

Cowan suggested that it is an access issue, as well.

Snider reported that he received a memo from Multnomah County, which addressed accessing federal funds for federally-authorized treatment services. He suggested that any savings created by the corrections system as a result of increasing services in the mental health system should flow to the mental health system.

Johnson explained that the framing of the letters might suggest that there is a single reason for people being incarcerated. Most people are in jail for many complex reasons, mental illness being only one issue. Medicine alone will not meet the needs of these individuals.

Additionally, with respect to bio-terrorism, the Judiciary Committee is meeting today to discuss substantive issues in Oregon law, which appear to be inadequate to address terrorism issues, and is DHS involved?

Kast replied that Grant Higginson, of DHS’ Health Services, has been involved with the Attorney General on these issues.

Cowan suggested that DHS be more involved than the discussion, and to perhaps bring the understanding to the local level.

  • Other Organizations

Handout #7Testimony of Barry Donenfeld, before the
Senate Special Committee on Aging

Joyce acknowledged Donenfeld and his testimony before the Senate Special Committee on Aging (Handout #7). His was the only local agency invited to testify, representing quite an honor.

Cowan asked Donenfeld to explain the issues surrounding Oregon Project Independence (OPI) eligibility versus Medicaid. Is there a choice, or a directive for those who are eligible to move into Medicaid, as opposed to receiving the more limited services from OPI? The downside from the state perspective is higher costs to serve clients through Medicaid than through OPI services. The downside of Medicaid, from the client’s perspective, includes income restrictions and impacts on estates, home ownership, etc.

Donenfeld replied that OPI is over 25 years old, with a long history of being run differently in different parts of the state. The primary difference between an OPI client and a Medicaid client is that the average OPI client has excess resources, taking them beyond Medicaid eligibility. He added that a better understanding of the programs is necessary, as the general sense is that OPI equates to health, while Medicaid equates to welfare. Those seniors who lived through the Depression will most likely opt to avoid "welfare" in favor of another alternative.

Cowan suggested that a better understanding in needed now, in order to address those growing older, and not just including the current group of seniors.

Joyce reported the Governor has a task force on services to seniors and people with disabilities, as well as the Speaker, whose own task force meets on April 16. The Speaker’s group is focusing on the system’s capacity to support providers, and both groups were created with long-term planning goals.

Morgan reported that there are two major issues arising locally, which affect systems throughout the state. The first is that currently the cost of benefits for employees is accelerating beyond the COLA increases. For every two employees hired, the benefit cost equals an additional employee. A method for slowing the growth of health care costs is essential, and is more global than the county or even the state systems. Secondly, Public Employee Retirement System (PERS) costs are out of control. The tier one money-match is the problem, which will require a legislative fix. The next increase in PERS will cost each agency between 2 and 3 percent of its Full-Time Equivalency (FTE) growth. Oregon’s PERS is the only retirement system in the United States where non-elected persons can make benefit adjustments and assumptions.

Cowan added that consumers must examine the cost of the insurance service they’re purchasing and select wisely. A medical savings account might be a solution, where spending is based on the amount of money available.

Other Items

Handout #8Commissioner Kupillas Update

Handout #9Five Oregon Newspaper Clippings from March, 2002,
Regarding DHS Reorganization

No discussion of these handouts occurred. Copies of these documents were distributed to group members as informational only.

Future Agenda Items*

    • Budget Suggestion Updates
    • OHP Qualifications/Mentally Ill in the Criminal Justice System — Update (Kast)
    • Systems/Gap Update (Firman/Fultz)
    • Staley Lawsuit Data/Update (Toews)
*Actual agenda is dependent upon a LGAC Executive Committee meeting.

Next Meeting

Date: May 9, 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:

Dena Comer
DHS Director’s Office, 4th Floor
500 Summer Street NE, E-15
Salem, OR 97301-1097
Telephone: (503) 945-6843
e-mail: dena.comer@state.or.us

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, Director’s Office, (503) 945-6609, TTY (503) 947-5330.