|Minutes Not Final Until Approved By LGAC
January 10, 2003 - Minutes
Room 473, Human Services Building, Salem
Lennie Bjornsen DHS – Assistant Director, Continuous Systems Improvement
Ben Boswell Wallowa County Commissioner
Ann Brand DHS – Health Services
Kevin Campbell Eastern Oregon Human Services Consortium
Joe Corsiglia Columbia County Commissioner
Jean Cowan Lincoln County Commissioner
Dwight Dill Union County
Ron Dodge Polk County Commissioner
Vic Falgout Douglas County Juvenile Department
Gina Firman Association of Oregon Community Mental Health Programs
Irene Fischer-Davidson Clackamas County Human Services
Ramona Foley DHS – Assistant Director, Children, Adults and Families
David Foster Oregon Housing & Community Services
Gordon Fultz Association of Oregon Counties
Robert Furlow Douglas County Health & Social Services
Sharon Guidera Association of Mental Health Program Directors
John Hartner Oregon Association of Community Corrections Directors
Shirley Iverson DHS – Deputy Assistant Director, Community Human Services
Chris Johnson Yamhill County Health & Human Services
Margy Johnson DHS – Acting Assistant Director, Finance & Policy Analysis
Lisa Joyce DHS – Director’s Office
Sue Kupillas Jackson County Board of Commissioners
Lydia Lissman DHS – Assistant Director, Seniors & People with Disabilities
Diane Lund Oregon Health Forum
Jim McConnell Area Agencies on Aging
Linda Modrell Benton County Board of Commissioners
Bart Murray New Directions, Northwest
Jim Neely DHS – Deputy Director
Gillian Nicolaides Douglas County Commission on Children & Families
Anne Peltier Conference of Local Health Officials
Clyde Saiki Chief Administrative Officer, Administrative Services
Greg Schneider Lifeways, Incorporated
David Still Union County
Jean Thorne DHS – Director
James Toews DHS – Deputy Assistant Director, Seniors & People with Disabilities
Bill Wagner Cascades West Council of Governments
Michele Wallace DHS – Deputy Assistant Director, Continuous Systems Improvement
Minutes: Dena Comer, DHS – Director’s Office Administration and staff to LGAC
INTRODUCTIONS/APPROVAL OF MINUTES
Jean Cowan called the meeting to order, and roundtable introductions were made. The minutes of the December 13 meeting were approved.
DIRECTOR’S OFFICE REPORT
Jean Thorne introduced herself, providing an overview of her career in state service, which began in 1976. During her career, she served DHS as its Medicaid director from 1987-1995, and in 1995 was appointed the acting director of the Department during the first six months of the Kitzhaber administration. Following her appointment, she served in the Governor’s office on federal policy issues, and later as the Governor’s education and workforce policy advisor. Over the last year and a half, Thorne added working on health plan waivers to her duties in the Governor’s office. In September 2002, she returned to DHS as the administrator to the Office of Medical Assistance Programs, until her current appointment as the director of DHS.
Thorne briefly outlined the careers of Jim Neely and Margy Johnson. Neely brings an extensive background in child welfare to his position as DHS deputy director, having served for the past two years as the DHS deputy assistant director for Children, Adults, and Families. Johnson has agreed to fill the role as acting assistant director of Finance and Policy Analysis through the legislative session. Johnson transitions from her position as DHS deputy assistant director for Health Services. Additional experience includes serving as the assistant administrator of mental health services. With Johnson’s assistance, Thorne anticipates a tighter connection between the budget and program “shops.”
Thorne outlined her support of service integration, asserting that co-location does not equal service integration, and service integration does not equal reorganization. It is important that DHS pause and assess the reorganization process, to determine if any mid-course corrections should be made. Thorne invited response from LGAC, as they represent service delivery for DHS.
Thorne continued by explaining there are no good choices to be made as the Department moves through the latest HB 5100 reductions, in addition to cuts already made. Holding one program harmless will mean a deeper reduction to another. The Governor has made it clear that he will be focusing on the ‘03-‘05 biennium, and will not consider one-time fixes. Thorne added she looks forward to the partnership with LGAC.
Cowan commented on the need to examine what LGAC and the Department are trying to accomplish, and that reorganization is not about saving money, but about delivery of service. She added that with all of the reductions, elected officials must be able to explain what is being done, and what is left, in order to develop public trust at the local level.
Handout #1: AOC Human Services System Approach Model
Core Social Support System
Cowan invited the organizations represented at the table to provide their reports, and to share any comments within the context of the previous discussion.
Douglas County Health and Social Services: Robert Furlow expressed his hope to overcome the disconnect with the Governor’s Office; local governments partner with DHS on issues, yet different outcomes result from the Governor’s Office.
Douglas County Juvenile Department: Vic Falgout explained that his organization is “sandwiched” between other agencies. When there are cuts to state agencies, his department is negatively impacted, as well.
Douglas County Commission on Children and Families: Gillian Nicolaides reported that her organization has citizen involvement at the local level, including school superintendents, police chiefs, retired educators and retired mayors, etc. There is a need for local and state government to work together so the local pieces are not lost.
Oregon Association of Community Corrections Directors: John Hartner suggested taking a long-term view of the system, in order to keep communities in tact.
Conference of Local Health Officials: Anne Peltier reported that they have the public trust at the community level, and that impacts of reductions are felt are felt at local as well as at the state level.
Association of Oregon Counties: Gordon Fultz reported that his association has begun work on a systems approach to problems, which was narrowed to include providing better access and early intervention programs. Encouragement for this approach is waning; in addition to a rumored “plot” that there should be blood in the streets in order to favor a future sales tax. Whatever the case, the counties must be included in the plans, and we must work together towards a common message.
Association of Community Corrections Directors: Sharon Guidera reported that the association does not believe DHS has investigated methods to prevent the most serious program consequences from occurring. Direct service providers need to be protected, and a better understanding is needed regarding the positions DHS has cut. A partnership is needed between the local government, DHS, and the Governor’s office.
Columbia County: Joe Corsiglia explained his concern over a state system “torn to shreds” due to program reductions and retirements, which affects relationships. Communication is difficult, resulting in incomplete information. Many dynamics, including his county’s public opinion that DHS has cut its “tentacles” and not its “body,” do not bode well for Ballot Measure 28.
Wallowa County: Ben Boswell reported on the development of the Eastern Oregon Rural Forum meeting regularly in John Day, consisting of elected officials and community stakeholders. With respect to mental health authority being returned to the state, authority without resources is frustrating. Additionally, he suggested Doug Wilson’s $90 million local infrastructure proposal be integrated into DHS’ budget. He referred to the AOC Systems Approach Model (handout #1), and suggested that DHS utilize the principles to guide reductions.
Benton County: Linda Modrell suggested this time be used as an opportunity to assess what the state and local governments should be doing, and to make necessary changes.
Yamhill County Health and Human Services: Chris Johnson suggested that once needs have been identified, discussion is needed in order to direct limited resources to the best solutions. Regarding crisis funding reductions, there are no state dollars left in contracts; only federal block grant dollars are left. There may be legal questions regarding what the state can expect with respect to mental health authority.
Polk County: Ron Dodge reported that his county has a $15 million mental health program, utilizing no county general fund dollars. The county has no plans to backfill any loss of state dollars.
Cascades West Council of Governments: Bill Wagner shared his frustration over the work being done in DHS’ Seniors and People with Disabilities (SPD). The federal government has blocked three reduction plans in the last month, and there seems to be an overall avoidance of the reduction impacts. He suggested that DHS not cut field staff in the next six months, as crisis will occur when reductions are implemented. However, assuming cuts go forward, he is concerned about how we get beyond the cuts and effectively involve local partners in the process.
Association of Oregon Community Mental Health Programs: Gina Firman provided an update on the results of the recent Emergency Board (E-Board). Legislative members are concerned about deeper cuts than expected to mental health and chemical dependency, and DHS has 30 days to report on how it plans to mitigate its disproportionate cuts. She added her desire to work with Thorne on addressing mental health issues.
Area Agencies on Aging: Jim McConnell shared his concern regarding community-based programs. As reductions are made, pieces of programs must be kept. The elimination of general assistance funding will destabilize those unable to meet their financial burdens. Another concern is reductions to the Oregon Health Plan (OHP) and the impacts to seniors.
Oregon Housing and Community Services: David Foster reported his agency utilizes little general funding, thus the current budget reductions impact them mostly through "collateral" damage, that is, through cuts at partnering agencies and organizations. Though small, the agency’s homeless and food programs were hit hard. He urged DHS, as it faces budget reductions and proceeds with staffing changes, not to lose the "client-centered" focus it embraced during the reorganization efforts. He suggested DHS prioritize reductions and select options that will do the least damage. In times of
diminishing resources, he observed that our challenge must be to determine the appropriate role of government in the lives of those we serve. He added we must also remember federal reauthorizations for major social support programs are up this year, and national and international events well beyond state and local government control will likely alter our options during the coming months.
Union County: David Still expressed his concern over layoffs, and the need for maximizing available resources.
Clackamas County Human Services: Irene Fischer-Davidson outlined the services in her county. With respect to the operational level, she suggested that local government receive notices before they go out to clients or providers, and have a more meaningful role in selecting Service Delivery Area (SDA) managers, staff, etc.
Kupillas commented that this is a time to determine what the system needs to accomplish in the future. She suggested examining integrated sites, and their relationship with the community. Instead of focusing on maintaining the current system, we need to look at opportunities for change and improvement.
TRANSITION TEAM REPORT
No report given; Gary Weeks was unable to attend due to the Governor’s budget meeting.
Handout #2: $88m Reductions 1/3/03,
Agency: Department of Human Services - Overall
Margy Johnson explained the updated reduction list (handout #2). After the December economic forecast identified additional budget problems, Governor Kitzhaber required that all state agencies share proportionately in a new round of cuts. To come up with its share of the cuts, DHS pulled some items from its HB 5100 list and then updated this list. The latest version of the HB 5100 cut list has now been posted to the DHS Web site at www.hr.state.or.us/budget.
Furlow asked if the Governor’s office has considered suggesting that the legislature put a hold on reorganization, in order to provide more flexibility in how the cuts are determined.
Thorne responded that HB 5100 took the money out, as it was appropriated on the old division structure. DHS is stuck with regard to the budget structure. Jim Neely added that even if appropriated under the new structure, the general fund dollars follow the programs. The result is that some areas took a much smaller hit than others.
Johnson continued by explaining this list represents what is happening at this point in time, and doesn’t include recent events between SPD and the federal government. She provided an overview of specific items, including the 24-hour response system. Neely added a brief overview of the major cuts to the former Adult and Family Services (AFS) and Services to Children and Families (SCF). He also explained there shouldn’t be any major contract reductions in the JOBS program.
With respect to DHS’ Office of Mental Health and Addiction Services (OMHAS), Ann Brand explained the limited flexibility in reduction choices. She summarized the reductions taken on both the mental health and alcohol and drug sides. She included the total Oregon State Hospital (OSH) reductions and their impacts.
As to how the choices were made, Brand explained that DHS attempted to work with the counties to ensure a reasonable remainder, but it can only go where the general fund dollars exist. Johnson added that DHS tried to protect residential capacity and necessary 24-hour care.
Firman reported that a document from Senator Bill Fisher is circulating through the legislature, showing only a 5% cut in chemical dependency. This type of information needs to be tracked down.
In SPD, James Toews explained that since June, the general direction of reduction planning was more “discreet” programs. The balancer was the core of the long-term care system, where people were ranked according to eligibility. Only the highest of impairment levels would receive service at this point. Three weeks ago, as the federal government would not support cutting so deep into impairment levels, SPD changed direction, and explored using an income standard, affecting approximately two-thirds of the eligible population. After discussing this method with the federal government, the state would have been required to pick an income standard across all populations, to avoid becoming a special income category state. All waivers are built against this standard. This would have caused even deeper reductions in developmental disability and mental health services, beyond the HB 5100 reductions. SPD switched direction again, moving pricing to include less severe levels of impairment, as well as going deeper into provider rates, back to ’99-’01 levels. SPD is still working on ways to meet its target of $30 million, or one-third of its programs, in a five-month period. Toews added that weekly conference calls, netcasts, and other communication methods between SPD management and Area Agencies on Aging (AAA’s) are being utilized in an effort to keep all parties informed.
Thorne explained that had the Department known the depth of the state’s budget problems at the beginning of the biennium, things would have been done differently. The Governor released his balanced budget, and it is important to address the potential, deeper cuts going into the next biennium. The challenge for DHS and LGAC will be in finding new ways to get things done, with time to actually implement them.
Cowan asked how LGAC can effectively be part of the discussion, examining what the minimal amount of services looks like, as compared to those of other states. Public support cannot be achieved without public trust.
With regard to more immediate responses from LGAC, Kupillas suggested that DHS use e-mail to pose ideas, questions, or other concerns.
Fultz suggested the establishment of a working group, to address the issues as partners. LGAC represents DHS’ local delivery system, and therefore should be at all legislative budgetary forums together with the Department.
Thorne provided her e-mail address, firstname.lastname@example.org, and invited the group to send her any thoughts about a more inclusive process, in addition to what was shared today. DHS’ cabinet needs to work on these ideas, and to involve the Legislature.
Nicolaides asked Thorne to call upon LGAC for assistance, particularly in utilizing their relationships with legislators.
With respect to Staley, Toews explained that lawyers and legislators are still working on the next course of action. Thorne added that a meeting will occur to today addressing all potential lawsuits.
Kupillas closed the discussion by sharing her excitement about working with Thorne and her team, looking forward to the challenges ahead. This type of discussion is useful, and if Thorne has any questions she’d like answered, please let LGAC know.
Handout #3: E-mail from Lisa Joyce, 1/9/03, subject
DHS Budget Briefing Conference Call
Handout #4: E-mail from Karman Fore, 1/10/03,
Release of 2003-05 Budget/Budget Briefing for Agency Directors
Handout #5: HIPAA Alert No.5, January 2003
Handout #6: Packet of 9 Newspaper Articles, of interest to LGAC
Handouts #3-6 were distributed as informational only. No discussion of these items occurred.
FUTURE AGENDA ITEMS
The actual agenda is dependent upon the LGAC Executive Committee meeting.
Date: February 14, 2003
Time: 9:00 AM – Noon
Location: Room 473, Human Services Building
If you would like copies of the handouts, contact:
DHS Director’s 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, Director’s Office, (503) 945-6609, TTY (503) 947-5330.