Minutes Not Final Until Approved By LGAC
Local Government Advisory Committee
Room 473, Human Services Building, Salem
MinutesMay 10, 2002
Cindy Becker, DHS Chief Administrative Officer
Anne Brand, DHS Administrator, Office of Mental Health & Addiction 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
Barry Donenfeld, Mid Willamette Valley Senior Services
Vic Falgout, Douglas County Juvenile Department
Ramona Foley, DHS Assistant Director, Children, Adults and Families
Gordon Fultz, Association of Oregon Counties
Sharon Guidera, Mid-Columbia Center for Living
John Hartner, Oregon Community Corrections
Shirley Iverson, DHS Deputy Assistant Director, Community Human Services
Chris Johnson, Yamhill County Health and Human Services
Margy Johnson, DHS Deputy Assistant Director, Health Services
Lisa Joyce DHS Legislative and Intergovernmental Relations Manager, Directors Office
Bobby Mink (phone), DHS Director
Gillian Nicolaides, Douglas County Commission on Children and Families
Ann Peltier, Conference of Local Health Officials
Alicia Philpot, Governors 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, DHSDirectors Office Administration and Staff to LGAC
Meeting called to order by Jean Cowan, Co-Chair. Roundtable introductions were made.
Minutes of the April 12 meeting were approved.
Budget Development and Local Infrastructure
Handout #1: Selected Budget Packages for LGAC
Doug Wilson distributed two handouts, the first listing local government-oriented budget packages, and the second addressing county capacity. As to the package schedule, the Department will complete budget package concepts by May 17, when staff will begin the pricing process. Departmental prioritization of the packages will begin within two weeks following the pricing. The Departments "current service level" is approximately $320 million, which will be represented in the budget packages.
Handout #2: Letter to Bobby Mink for Linda K. Fleming, May 9, 2002
Handout #3:County Capacity Budget Package Concepts
Major increases in the Departments service level have been driven primarily by inflation of caseloads. A forecast of caseloads is scheduled for early fall, entering into the Governors process earlier than usual. DHS is working toward entering the actuarial work of the Oregon Health Plan (OHP) into the Governors process earlier, as well.
While reviewing handout #1, Wilson explained that while they are not listed in the handout, DHS is currently working on a global system for provider wages and rates.
Wilson further reported that the revenue source for tobacco education prevention programs is falling. Reserves, which have been used for these programs, will run out in the next biennium.
Cowan asked why, if the revenues are falling, funding is still being used for these programs.
Wilson replied that DHS is currently below the set of standards from the Centers for Disease Control (CDC) for these programs.
Wilson explained that handout #1 represents a sampling of budget packages, which affect local government and have had the most interest thus far. He invited the group to suggest additions or offer comments.
Referring to the Mental Health and Alcohol and Drug Safety Net (HS-2) package and the HB3024 planning, Sharon Guidera reported that a drop-dead date of June 15 has been established, as a result of a meeting held yesterday. In this meeting, it was determined that the June 15 date was determined due to the timing of DHS and the Department of Administrative Services (DAS) budget process. She asked for an explanation.
Wilson responded that DHS process is mostly complete, yet the Governors process still exists. There are two places where funds can be accessed: Special Session or the late June Emergency Board (E-Board). A letter requesting those funds will be submitted to DAS for the June E-Board.
Margy Johnson commented the package should remain on the table, and that need assumptions will be made. Once plans are submitted there may be adjustments as to the actual dollar amount.
Wilson added that mental health is a high priority in this budget, and the Governor will use the plans as he creates his overall budget. The plans are crucial to budget development.
Cowan commented that while the Association of Oregon Counties (AOC) adopted a resolution not to do the planning without funding, they have considered backing away from it, on an emergency basis. Counties may submit their plans if they wish to do so, with three caveats. The first is that those plans be scaled down, with a reduced level of obligation. The second is that there be recognition that some counties will be unable to complete the work, and without funding are unable to contract out to have them completed. These counties should not be penalized. The third issue is whether or not the state has the ability to retroactively reimburse the counties for some of the planning expenses.
Guidera added that there are a number of counties that cannot make the May 15 deadline for the reduced plan, and that there is still the December 1 deadline for submitting their larger, comprehensive plans. She referenced the 2003-05 budget package, and if actual distribution of the funds would take place after the plans are submitted, expressed confusion as this relates to any drop-dead dates.
Wilson clarified that this relates to 2003-05, and any funding for this will not be available until after July 1, 2003.
Chris Johnson commented that he understood a lack of a plan by the June 15 date would impact distribution of service delivery funds for 2002-03, not 2003-05. He asked Wilson if this budget package is in addition to the continuing service level from HB3024.
Wilson replied yes, adding that $750 thousand has been allotted for planning, and $2.4 million for service. The question is what the service dollars will roll up to; whether it will be based on the $2.4 or some other number is unknown at this time.
Cowan asked for clarification on the December 1 requirement for a larger plan.
Guidera responded that there is a June 15 date for the short version, and any counties who do not make that date would not be considered for funding from funds allocated this biennium. The December 1 formal plan due date applies to 2003-05.
Cowan asked if there will be any funding for retroactive reimbursement, for the initial effort as well as for the December 1 plans.
Cindy Becker responded that reimbursement can be made retroactive one year under Intergovernmental Agreements (IGAs).
Gordon Fultz asked if no plans are submitted by June 15, then no funds would be available until the next biennium.
Guidera answered, yes.
Cowan commented that this does not satisfy the AOCs caveat regarding counties being held harmless if they are unable to submit plans by June 15.
Fultz added that there is specific language in the budget note that calls for special consideration for at least six counties. In addition, there are other counties who have said they would be unable to meet the deadline. It now appears as if no consideration will be given to those counties.
Cowan commented that some flexibility is needed on states side, to recognize the challenges that small counties face.
Becker suggested that the deadlines, and for which biennium, be clarified.
Margy Johnson agreed to follow up with Madeline Olson to do so.
Cowan added that this information is critical, and that her understanding is that, if the plans are not submitted, the Governor would be unable to consider additional funding for mental health, for the next biennial budget. If the majority of counties submit their plans for initial consideration, the Governor could then build mental health into the upcoming budget process. The remaining $2.4 million service implementation funds for this biennium is a separate issue. If a county is unable to submit a plan by the drop-dead date, does this mean the Governor would then be unable to add a mental health package into the next budget, and there would be no 36 county distribution of funds, or does it mean that that county would not receive any part of the $2.4? Or, can an exception be made, which states that if the majority of the counties submit their plans, either the $2.4 (or the next biennial budget) still be divided amongst the 36 counties?
Margy Johnson replied that she would talk to Madeline Olson to clarify this.
Chris Johnson understands that the issues are separate, and that the state agreed to move forward with a package, based on the majority of submitted plans. For those counties not able to meet the deadline for 2003-05, the only impact would be that their needs would potentially be considered "unique." HB3024 linked the funds with the plans.
Margy Johnson added that the plan referred to is a streamlined version.
Fultz suggested that, since the planning funding was not released, those counties not able to complete their plans by the drop-dead date would still be eligible for their share of the $2.4 released in this biennium.
Paul Snider expressed his concern regarding the time available between now and June 15.
Margy Johnson agreed to get the information from her meeting with Madeline Olson out to the counties by early next week.
Guidera asked Wilson, if the Special Session does not occur in June, would a request go to the E-Board for the planning funds?
Wilson replied, yes, as these funds are in control of the Legislature and E-Board at this time.
Cowan reported that the AOC Legislative Committee is meeting on Monday, and clarification of the issue would be helpful at that time.
John Hartner asked if DHS has ever made technical assistance money available to smaller counties, to provide a framework by the June 15 deadline? If not, could it?
Margy Johnson agreed to include this question in her discussion with Madeline Olson.
Anne Peltier distributed a May 9, 2002, letter addressed to Bobby Mink from Linda Fleming, Director of the Conference of Local Health Officials (CLHO). The letter addresses the concern that public health had not been well represented in DHS budget discussions held throughout the state. The letter clarifies the efforts CLHO has made toward the budget process.
Wilson explained that his comment reflected his surprise at the smaller numbers of public health representatives who attended the budget meetings, as compared to the past.
Cowan added that there was a budget note after last session relating to local government involvement in the budget development process. A better understanding of the process is needed. She explained her frustration surrounding public health not being at the meetings, the need to be involved at the policy-setting discussions, and expressed the desire for interconnectivity.
Wilson briefly explained the different levels of budget development. DHS clusters have been instructed to work with their local groups, the results being reflected in policy packages. DHS then looks to LGAC for more of the department-wide issues and discussion.
Lisa Joyce reported that a person in Pendleton commented that they didnt know that LGAC existed and was an avenue to raise concerns.
Referring to handout #3, Wilson asked for input regarding adequate administration funding, and ensuring that it is characterized as funding going to local governments to administer state programs. There is $23.5 million, in one line for county administration, in the 2003-05 budget.
Fultz commented that $23.5 million seems high.
Wilson explained that the allocated total funds are approximately $11.8 million for DD, $6.8 million for Staley funds, and $4.9 million for mental health.
James Toews commented that for Staley funds, there is not a line item for county administrative funds. The Staley brokerages were not contracted through the counties, so a misunderstanding may exist there.
Wilson clarified that the dollars that are allocated for the local administration of state programs, not for administrative costs.
Guidera suggested agreeing on a certain amount and deciding on how to get to that figure.
Becker explained that part of the problem with a percentage is that infrastructure items must occur, regardless of the amount of funding for a program. The core expectations and their costs must be considered before an amount is determined.
Donenfeld commented that there are traps within the budget guidelines, which do not reflect reality of the costs that exist.
Wagner expressed his appreciation that DHS is recognizing local administration. There is a danger in cutting administration so that most of the funding goes to programs, so utilizing other options may be beneficial. Administration involves case management, especially in the Area Agencies on Aging.
Wilson explained that it is important to establish common definitions of administration. He is looking for ideas, in addition to those listed in handout #3, in order to provide framework for the issues.
Peltier reported that CHLO is very concerned about the administrative funding, and she will take the concepts in handout #3 to them for consideration.
Cowan asked that Fultz take this to his committee meeting this afternoon, and Wilson asked to be informed of the results. Gordon agreed to do so.
Wagner asked how the PERS pool, which will be substantially higher than a cost of living allowance (COLA), will be built into the budget package.
Wilson replied that a separate package must be requested. One approach might be to create a package, which recognizes increased cost due to PERS and health care for local partners. A strategy would have to be determined for this.
Peltier commented that counties have considered reducing services to pay for administration.
Chris Johnson suggested brainstorming ideas and getting them to Wilson.
Wilson replied that these would be helpful, either as a group discussion or via e-mail.
Joyce agreed to e-mail any ideas to the group.
Oregon Health Plan
Handout #4:Recommendations for OHP2 Waivers
Hershel Crawford distributed a document on OHP2 Waivers (handout #4), which was presented to the May E-Board, and briefly described the results and direction of OHP2. DHS has been working toward approval of waivers for the expansion and reform of OHP. Legislative Leadership Commission meetings in March resulted in a proposal, which was submitted to the E-Board on May 1. OHP2 would continue current benefits for seniors, disabled, pregnant women, children, and the General Assistance population, and is referred to as OHP Plus. The population covered under the waiver, including single adults and couples without children, would see a reduced benefit package, referred to as OHP Standard. The E-Board approved changes to the waivers, originally submitted to the Leadership Commission by the Waiver Application Steering Committee, which was established out of HB2519.
Resulting from this process was a decision to move more of OHPs expansion to the Medicaid, OMAP side onto the private side. The way this is done is to expand the Family Health Insurance Assistance Program (FHIAP). DHS original proposal was to expand FHIAP by 10 thousand people, and the final agreement was for an expansion of 25 thousand. In order to pay for this additional expansion on the private side, the public expansion has been reduced.
The proposal also establishes a priority for covering additional people as a result of the expansion. This group would include children and parents of children who are eligible under a first-priority basis. It would also continue to cover those people eligible under 100 percent of poverty that would otherwise lose coverage due to an increase in income. The second priority would address those who couldnt be covered due to an expansion to 110 percent of poverty.
The last significant change is a request that the Health Services Commission, which designs the OHP benefit packages, investigate additional cost reductions in the OHP Standard and OHP Plus packages, by up to 10 percent. This is a planning action, which could result in eventual consideration by the Legislature. Additionally, there are monthly reporting requirements for the Legislative Fiscal Office (LFO), and to an interim Legislative oversight committee on a quarterly basis, addressing the expansion of FHIAP.
At this point, DHS is in the process of modifying the waivers and the budget neutrality pieces of them, in order to conform with the new proposal. It is anticipated that the process will be complete by June 1.The negotiation process will begin, and at least partial implementation is expected by the end of this year.
Regarding the insurance pool governing board, Guidera asked about funding for the establishment of 23 permanent positions at 2.9 FTE.
Crawford replied that 2.9 may be a typographical error, but the 23 positions are related to the expansion of 25 thousand people in FHIAP, to encourage employers to offer group health insurance, and to process those applications. There is a real need for employers to offer insurance to those employees below 185 percent of poverty.
Referring to OHP Standard, Guidera commented that part of the cost reduction will include co-pays. Collection of the co-pays will be the responsibility of the provider, which will add administrative costs to do business. She asked if there is any consideration for the increase costs to the providers.
Crawford replied that most of the expansion occurs on the FHIAP side, which is commercial insurance where reimbursement is better. The co-pays have been a part of doing business with providers for some time now, and OHP has been unique in that it doesnt currently have them. Providers know how to handle co-pays. The co-pays will be difficult to collect from low-income people, however, these are people who are not insured today. The Safety Net program, which uses sliding scales and co-pays, and which is similar to the income scale for OHP, has had a good record of collecting co-pays. The trade-off for having fewer co-pays would have been fewer benefits for those in the OHP Standard population. Dental benefits would have been the first to go.
Cowan commented that this is a difficult situation that advocates have expressed their concerns about.
Chris Johnson expressed his concern over the impression that co-pays only apply to those who have not been insured before. The OHP Standard package will go to those who are currently on OHP, and the other co-pay waivers apply to those on the traditional disabled, and other lists. The co-pays will affect a broad range of people.
Crawford reported that for those who are incarcerated and otherwise eligible for the Medicaid program, while the federal language is such that they continue to remain eligible, there isnt a way to get federal funds. The result is that they are not eligible for Medicaid coverage.
OHP Eligibility for Those in the Criminal Justice System
Becker asked if there is a way to make them eligible as they are transitioning out of the criminal justice system.
Hartner explained that the issue, especially in the area of mental health, is that frequently people are being prescribed medications while incarcerated. These people do not leave the institution with sufficient medication to carry them to the point at which they can establish eligibility.
Crawford replied that a better job could be done to facilitate OHP enrollment for people transitioning out of incarceration. The issue is priority. There is a limited amount of funds, and as a result of covering those coming out of jail, other people are pushed out of the system. If this is a priority, it needs to be addressed with the Legislature for coverage under OHP. This was discussed in the last session, and resulted in a priority for treating pregnant women in the criminal justice system. OHP Mental health services are delivered, by most counties, by the county mental health system. Most county health departments do outreach and receive applications for OHP. If county corrections wishes to use some of those resources to facilitate eligibility for transitioning inmates, that decision can be made at the county level.
Hartner explained his understanding that OHP officials are telling the incarcerated that they cant apply until after the release date. Is there a way to inform all the local offices that the application can be made?
Crawford answered that anyone can apply. DHS has two pilot projects with the Department of Corrections, and County Health Department employees in every county have OHP applications, and have the ability to date-stamp those applications.
Fultz asked if the Legislature is the only means for prioritizing this issue.
Crawford responded that it could be done administratively, however that would mean denying coverage for someone who already has Legislative priority.
Wilson explained that having the correct all of the information about an applicant who is transitioning out of incarceration is a concern.
Hartner asked if DHS is willing to take applications for those still incarcerated who have a release date.
Wilson replied that as long as everything is being done in the application process, the applications can be date-stamped, as in all other program applications.
Falgout expressed that in juvenile incarceration, OHP looks at the individual, not the family, so the application process may not work very well. Another critical issue involves sex-offenders, who receive unfunded treatment in the communities. There is not an OHP solution, but it is a General Fund issue.
Cowan responded that it is important not to lose track of this issue, and the continuity of care between the juvenile and adult system ties into the bigger connectivity conversation.
Becker explained that yes, the incarcerated can apply for OHP, but cannot receive services until released.
Hartner asked for clarification as to whether or not serving one population with OHP would eliminate coverage for another. His understanding has been that the idea behind OHP is not to restrict coverage, rather to eliminate a service if funding runs short.
Wilson replied that if the caseload increases, funding runs low, the E-Board may be addressed, and reductions may occur in eligibility at that point. DHS is limited as to its reduction to services, as the federal government must be approached to move the line.
Cowan suggested that Crawford come back at a future LGAC meeting to address any remaining questions.
Becker suggested that questions be sent to Crawford so the can be prepared to answer them.
Fultz commented that its not just the Legislature that determines priorities. There are a lot of other system costs with the clients being discussed, and are those figured into the discussion surrounding who receives coverage?
Becker suggested that a Health Services Commission member be invited to a meeting to address that issue.
Falgout asked DHS to facilitate the possibility of Behavior Rehabilitation Services (BRS) funding availability at the county level. Many counties are willing to match funding if the resources could be made available to them.
Wilson reminded Falgout that BRS funding is Medicaid dollars, so there may be obstacles due to incarceration.
Falgout replied that a waiver exists, so this may change, and urged DHS to facilitate the possibility.
Wilson asked Falgout to talk to him directly, following the meeting, about the funding issue.
Cowan asked Falgout and Wilson to inform her if there are any issues, resulting from their conversation, which might need to be brought to an LGAC meeting.
Bobby Mink joined the meeting via telephone, and Cowan explained that issues for discussion include the larger picture of DHS and its reorganization, and the AOCs concerns about systems and gaps and the representation of local government in terms of the employees and the council of governments at the table.
Mink explained his expectation that DHS service delivery managers be involved with county commissioners about these issues. He reported that he met with county judges from Wasco, Sherman, Wheeler, and Gilliam counties yesterday, connecting with them about local issues surrounding the reorganization. Mink suggested two tracks for addressing the local issues, one being the continuation of work being done, and the other being a possible subcommittee to address statewide policies.
Mink reported on the results of a statewide DHS employee survey, where 74 percent believe the Department will end up with improved client outcomes. While it appears that confidence exists on employee side, he is willing to do whatever is necessary to encourage confidence with local partners, as well.
With respect to the budget, Mink outlined two priorities. The first is adding back those important programs that the Legislature has cut. The second is building the infrastructure for human services in Oregon. Mink would like to focus on infrastructure for DHS partners, not just for seniors and people with disabilities, but also the Departments mental health, developmental disability (DD), and public health partners. A good continuum of care is needed throughout the state. Mink suggested that a group get together to strategize about how this would be packaged, so that the message is brought forward as a team.
Cowan explained that at Mondays meeting, Sue Kupillas expressed her concern that local partners were mentioned in the Departments March 2002 Progress Report, on the last page. It is important that DHS partners be included in the discussion at an earlier stage. Also at the meeting, Gina Firman reported that shes often heard from legislative representation that when DHS presents its budget issues, there is an absence of local partners. This is reflected in the AOC discussions that they and DHS are not separate entities; both delivery of services and the message that all levels of government are working together need to be represented in the development of the budget.
Mink concurred, and replied that as DHS develops its budget, it will go to the Governor, and he will do everything he can to advocate for local partners. If a profile of the clients served, at both the state and local level, is presented to the Governor, the continuum of service will be evident. DHS needs it partners at the table when it comes time to present the information. Presenting the issues as a team is something that needs to worked on.
Cowan explained that her goal is to determine how to come together to do this.
Mink replied that he would like to have Firman, Fultz, DHS staff, and county commissioners there, as well.
Cowan suggested a meeting take place, and Mink assured that it would occur.
Barry Donenfeld commented that in his experience, the process breaks down whenever the Governor puts out the budget, and the priorities established by this group are not adopted. The state is then bound to establish those priorities, and local government continues to fight for its priorities.
Mink agreed that this happens, and made a commitment that the budget packages would be a priority.
Cowan replied that this is a good point, and suggested that the priorities be framed in such a way that they can be presented to the Governor.
Snider applauded the Departments commitment. He asked what could be done about the incarcerated person who has not been pre-qualified for OHP, resulting in another offense, and the impact this may have on the community or the providers, and other programs involved. The expense must be paid by someone.
Cowan explained her concern regarding getting people into treatment that works, in order to avoid the cost to the community.
Mink replied that a comprehensive strategy is needed, and suggested that a powerful argument be made surrounding an alcohol tax to help fund some of the needed programs. While Mink cannot make the argument, others can.
Cowan agreed that there are things which can be done by some that cannot be done by others.
Mink and Cowan agreed to meet Monday morning, to discuss framework of the issues, and possible workgroups for reorganization and the budget process.
Cowan asked the group if there is an interest in a subcommittee.
Fultz replied that he is interested.
Donenfeld expressed his interest, with the caveat that if a priority agreement cannot be reached, his association would continues on its own.
Joyce explained that while the Department must follow the Governor, and does have it limits, it does support its partners. Discussion in a subcommittee surrounding the nature of the Departments relationship with its partners would be helpful.
Guidera suggested that Firman be involved.
Peltier added her interested in the subcommittee, as well.
Cowan asked the group how they felt about working through their respective organizations to ensure connectivity, not creating a parallel subcommittee to other organizations work.
Donenfeld replied that some parallel efforts will be inevitable, but that the subcommittee would be valuable in that common priorities could be established and advocated for.
Bill Wagner added that understanding everybodys process would be helpful, resulting in the desired sequence.
Becker suggested that being able to recognize where the parties disagree would be helpful, especially when in front of the Legislature presenting issues.
Cowan expressed concern over fragmenting the work being done within each of the organizations represented in LGAC, and the need for DHS to respect those processes as a critical part of the budget development. She asked for clarification as to how an LGAC subcommittee would be helpful.
Gillian Nicolaides suggested looking beyond DHS to include the budget impacts on all levels, including the counties.
Cowan explained that LGAC members represent the organizations, as appointed to the Committee. Issues related to impacts on individual counties need to be presented to the AOC.
Joyce explained that this differentiation is written into the LGAC Bylaws.
Cowan agreed to meet with Mink Monday morning to discuss the subcommittee process, and invited others to attend. She also emphasized the need to move forward with the connectivity of all work being done.
Chris Johnson asked that all of LGAC be notified of any scheduled meetings, and Joyce agreed to do so.
Mink remarked that he is looking forward to the process, and to the learning that will result from it.
Cowan suggested that LGAC be notified of when the next subcommittee discussion will take place, so that all who are interested will have an opportunity to attend.
Donenfeld reported that Senator Smith is sponsoring S2221, to increase the federal matching rate for Medicaid. It would increase Oregons federal matching share by three percent, which equates to approximately $250 million per year.
Wilson added that versions of similar bills have varied significantly, whether they are one-time, or for use in new programs. He cautioned that the bill be carefully examined, so that expectations are appropriate.
Joyce reported that the Stakeholders meeting has been rescheduled to the fourth Friday of the month at 10 AM, effective in June.
Handout #5:Memo to LGAC from Barbara Cimaglio, May 6, 2002
No discussion of these handouts occurred. Copies of these documents were distributed to group members as informational only.
Handout #6: Packet of 15 Newspaper Articles, of Interest to LGAC
Cowan stated that while the June meeting will remain as scheduled, the July meeting is questionable, as she will not be able to attend. The July meeting will remain as scheduled until further notice.
Future Agenda Items*
*Actual agenda is dependent upon a LGAC Executive Committee meeting.
LGACs Role in the Reorganization
Date: June 14, 2002
Time: 9:00AM - Noon
Location: HSB 473
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) 947-5330.