Director's Message

June 29, 2007

To: All DHS employees

From: Bruce Goldberg, M.D., Director

"There will come a time when you believe everything is finished. That will be the beginning."
~Louis L'Amour

The legislative session concluded yesterday. Many, many individuals in DHS worked very hard preparing budgets, bills and fiscal impact statements, responding to legislative requests for information, and providing testimony. Thanks to everyone for your outstanding work. Your efforts highlighted the commitment, passion and expertise we bring to our jobs and to the people of Oregon. Thank you. Also, thanks to our many community partners with whom we work closely and who deliver many of our frontline services. Our strong partnerships and collaborative relationships help make this a better state.

Following several years of cuts to human services programs, we now have the resources to do more and to better meet the needs of Oregonians. For the people we serve -- who include everyone in this state -- the accomplishments of this legislative session provide the kinds of solid opportunities our state hasn't seen in years. Of course, as you know all too well, too many unmet needs remain. Probably nothing is more indicative of that than the fact that this Legislature was unable to restore access to basic health care for any of the almost 100,000 individuals cut from OHP Standard several years ago or to pass outright the Healthy Kids Plan. If we are a just and caring society, then we must ensure a basic level of health care for all Oregonians.

Fortunately, yesterday the Healthy Oregon Act (SB 329) was signed into law. This establishes the Oregon Health Fund Board, which will develop a comprehensive plan to reform Oregon's health care system and move Oregon toward being a state in which affordable and effective health care is available and accessible to all. In short, hope is on the way.
Following on that theme, today I would like to focus on the many accomplishments of this legislative session and, indeed, there are many. Although what follows are only some of the highlights and not a complete list, this is much longer than my usual message. This may be too much information for some and too little others, but I feel it is important that you have this information. So, I apologize in advance for the length of this message and the many acronyms.

KEY SERVICE AREAS

Ten months ago when we submitted our agency request budget it detailed the more than 300 separate programs through which we serve the public. However, in a continuing effort to organize our work around our clients and move toward a more integrated approach to service delivery, we organized our policy option packages around six key areas. I'd like to return to those areas today as I summarize just some of the accomplishments of the legislative session.

IMPROVING CHILDREN'S HEALTH AND SAFETY

Oregon's Temporary Assistance for Needy Families (TANF) program was substantially improved, allowing us to focus on getting better outcomes for the more than 30,000 children served in this program, and improve employment opportunities and prospects for success for the more than 11,000 parents and family members served by TANF. The Legislature invested more than $34 million to redesign and enhance the services provided by the TANF program. These services will help low-income families with children achieve family stability and economic security, while also meeting federal work participation rate requirements. The funding also expands investments in screening/evaluation, JOBS services, child abuse prevention, Transitional Medical Assistance and child support.

The Healthy Kids Plan (HKP) will provide affordable, accessible health care for Oregon's 117,000 uninsured children. The plan, along with the 84.5-cent tobacco tax to fund HKP, was referred to voters to decide in the November election. In addition, with the additional resources, we will be able to increase outreach, cover more uninsured adults in the OHP Standard Program, expand tobacco-use reduction programs, and provide grants to safety-net clinics and rural health clinics.

The Legislature invested almost $9 million to improve our child welfare system and our ability to keep children safe. The funding adds caseworkers, improves supervisor-to-caseworker ratios, and pays for legal consultation to help caseworkers and managers meet the increasing legal complexities in child welfare cases.

To help address some of the root causes of child abuse and help keep children safe, more than $10 million was invested to support intensive outpatient and residential drug and alcohol treatment for families involved with, or at risk of becoming involved in, the child welfare system.

To help us keep families together, we can now reimburse relative foster parents. This brings Oregon in line with the rest of the nation in regard to reimbursing relatives at the same rate as non-relative foster parents.

The Legislature also invested nearly $40 million in child care improvements to give low-income families access to better child care as a means of strengthening families by helping parents stay employed.

The Legislature passed and funded a bill (HB 2406) that enables DHS to develop a new CMS model waiver for children with significant medical needs. The waiver will provide Medicaid supports to help families keep children with physical disabilities at home rather than in an institution.

IMPROVING OUR MENTAL HEALTH CARE SYSTEM

We made great strides in our work toward creating an integrated, culturally competent continuum of mental health treatment and support services designed to help individuals avoid disruptive and costly hospitalization in the first place, offer the highest quality community and state hospital-level services, and help individuals transition back into their communities when hospitalization is unavoidable.

The Legislature invested more than $20 million to improve our community mental health system and provide the resources necessary to identify and treat people in the community before their illness reaches a level requiring a more intensive level of care. This includes a statewide expansion of proven early intervention and treatment services for children, youth and young adults showing early signs of psychosis; increased mobile outreach and respite services for people in crisis; more out-patient and residential treatment for adults and children; more resources for local hospitals, including those in rural areas, to manage the increasing demand for mental health services; strengthening of Oregon's community-delivered services to help people with mental illness transition from hospital-level care back to living as independently as possible; new programs designed to keep people with mental illness out of local jails; and more employment and housing supports for individuals with mental illness.

The Legislature also financed the first phases of our plans to replace the outdated Oregon State Hospital and improve the care of those Oregonians with mental illness who require hospitalization. Work now can proceed on the design and early phases of construction of new state facilities designed for healing and recovery. In addition, the Legislature approved the Governor's recommended $13 million investment to improve the quality of care currently delivered at the Salem hospital campus, including hiring additional staff and creating additional training opportunities for existing staff to improve the hospital's ability to serve increasing numbers of psychiatric patients who also are addicted to alcohol and other drugs, as well as additional resources to help individuals transition back into community placements when it is safe for them to do so.

INCREASING PUBLIC HEALTH, PREVENTION, PREPAREDNESS AND HEALTH PROMOTION SERVICES

Likewise, we made great strides at improving our public health system and our ability to protect the public and promote health.

The Legislature improved our capacity to protect people and communities by doubling the per capita funding for local health departments, investing more than $4 million in the local public health infrastructure.

The Legislature also increased funding for the state Drinking Water Program by more than $2 million and authorized the establishment of a state drinking water advisory committee to assist with development of policies related to the protection, safety and regulation of public drinking water in Oregon.

Our public health laws were updated and strengthened to better protect the public in the event of a range of emergencies.

In addition, great strides were made in our ability to prevent two of the leading causes of disease and disability in our state -- tobacco use and obesity. The Legislature passed a bill to protect us from second-hand smoke, making all bars and restaurants smoke-free by 2009. In addition, Tobacco Prevention and Education Program funding was restored. Finally, children will be healthier now that HB 2650, which eliminates junk food in schools, was passed.

The Legislature also provided nearly $2 million for youth and family substance abuse prevention, which will enable DHS to work with prevention system partners to implement an evidence-based, family focused prevention strategy, fund a suicide prevention hotline, and increase state level prevention coordination capacity.

IMPROVING ACCESS TO HEALTH CARE

The Legislature extended the tax on Medicaid managed care organizations and hospitals to October 1, 2009, which will enable approximately 24,000 OHP Standard clients to retain medical coverage. In addition, the Legislature raised the Diagnostic-Related Group component of the Oregon Health Plan managed care capitation rates from 72 percent to 80 percent of cost.

The 2007-2009 budget includes $7 million to develop an incentive program to increase access to physicians for clients enrolled in Oregon Health Plan managed care organizations.

The Legislature increased funding for School-Based Health Centers by $2 million to add centers to areas of the state where they are most needed.

The new Pharmacy Incentive Program will help keep drug costs down by encouraging pharmacies to dispense generic drugs and drugs from the state's Practitioner-Managed Prescription Drug Plan List. In addition, designated drugs will be exempt from co-payment, which saves money for clients and for those pharmacies that often have absorbed the cost of the co-payment.

New legislation also will bring long-term care partnership programs to Oregon, creating incentives for people to get this insurance by allowing DHS to exempt from estate recovery an amount equal to the benefits paid by certain long-term care insurance policies.

IMPROVING THE COMMUNITY INFRASTRUCTURE

The Legislature invested approximately $20 million for raises for providers of developmental disability services and additional support for local administration of developmental disability services. The Legislature also expanded the department's protective services for adults with developmental disabilities to include people who no longer receive developmental disabilities services.

Most of our budgets included funding for cost-of-living adjustments for many of our providers of services. The last three legislative sessions did not include such funding.

The Legislature also provided $4 million to help address disparities and funding inequities between counties and tribes through increased funding for outpatient substance abuse treatment capacity in those counties where funding is below the statewide average and by bringing all tribes up to a base level of funding.

The Legislature approved approximately $3 million to increase the number of certified nursing aide staff in nursing facilities, and added staff to DHS to strengthen our ability to enforce quality of care standards in community-based facilities.

IMPROVING OVERALL EFFICIENCY

The Legislature invested nearly $2 million to improve program integrity for all of the programs administered by the Office of Self-Sufficiency. This investment will add staff to perform program reviews, and is expected to generate approximately $10 million in cost avoidance through increased accuracy.

We also received funding for several positions to achieve better financial oversight and accountability. Positions include a deputy director of Finance, a controller, an internal control officer and an internal auditor. The Legislature also established an internal actuary unit, which will improve service and response to inquiries while reducing costs.

And finally, the Legislature funded an enterprise criminal record information system to replace the department's current 11 systems used to perform criminal background checks on potential employees and providers.

Overall, this has been a legislative session that will benefit everyone in Oregon. Again, I thank all of you for your help in making this session possible.

To provide feedback email: DHS.Directorsoffice@state.or.us

This message is intended for all department employees. Please read it electronically, if possible. Managers and supervisors are asked to share the message each week with employees who do not have email access.