1 Department of Health and Human Services FY17 Budget Forum October 26, 2015.

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Department of Health and Human Services

FY17 Budget Forum

October 26, 2015

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County Executive’s Policy Priorities

A Responsible and Accountable County Government

Affordable Housing in an Inclusive Community An effective and efficient transportation network Children Prepared to Live and Learn Healthy and Sustainable Communities Safe Streets and Secure Neighborhoods A strong and vital economy Ensuring Vital Living for All of Our Residents

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FY16 Approved HHS Budget Overview

FY16 County General Fund Approved Expenditures = $209,253,900 (1% increase from the FY15 Approved budget of $208,197,960)

FY16 Approved budget from all revenue sources = $288,993,599 and a total of 1,593.66 work years (2% increase from FY15 level of $284,561,313)

The Department manages 640 active contracts valued at $107,880,000.

There are 117 grants totaling $79,739,700 supporting the Department’s mission.

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Our transformation work will focus on four key themes. These themes will organize goals, objective and strategies over the next three years. They are: Service Delivery Transformation Effective and Equitable Service Delivery Capable and Engaged Workforce Strong Collaborative Relationships

 The following sections outline our strategic themes in more detail. The strategic themes and goals specify what we want to achieve. The objectives and high-level priorities lay-out how we plan to achieve our goals. The following diagram shows how the elements fit together.

Our vision: We envision a healthy, safe and strong community. Our mission: To promote and ensure the health and safety of the residents of Montgomery County and to build individual and family strength and self-sufficiency. 

GOALS 

key elements of each goal

GOAL ONE: An integrated service delivery system supported by technology, which enables staff to share information and work collaboratively. 

Implement technology that supports a fully integrated system Establish a clear set of expectations that outline how we will work collaboratively

GOAL TWO: Align people and financial assets so that we are investing the necessary level of resources to ensure effective and equitable service delivery. 

Provide staff with information and tools that support collaboration Use data to inform decisions: client, program & organizational Ensure investment in programs that focus on the community’s safety, health and well-

being

GOAL THREE: Recruit, develop and maintain a workforce that is engaged, accountable, responsible, respected, recognized and prepared for critical and emerging roles within the Department and is representative of the community we serve. 

Redesign human resources processes Provide training and development opportunities focused on use of technology,

collaboration and practice/clinical issues  

GOAL FOUR:Strengthen internal and external relationships to offer a full range of coordinated programs and services focused on reducing redundancy, improving client outcomes, and eliminating disparities. 

Further define, refine and develop partnerships that will reduce redundancy, improve client outcomes, and eliminate disparitites

Implement DHHS Contract Management process reforms Strengthen Partnerships with our public and private partners

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DHHS Strategic Areas of Focus

Service Integration Process and Technology Modernization Implementation of Equity Value Principle Contracts and Monitoring Reform Affordable Care Act Implementation –

eligibility and enrollment access to care and strengthening safety net services implementation of Waivers behavioral health integration improving population health

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Over 1 Million Residents__________

31% Foreign Born

50.6% Ethnic

Minority

95% growth in the senior population

between 2010 - 2030

54,000 out of 153,000

children in the public school

system receives FARMS

6 Zip Codes of Extreme

Need — Poverty on

the Rise

Served 70,000 Households in

Fiscal Year 2009 and 39,000

used more than two services

from DepartmentA Staff of

1,600 with over 80

Programs

TANF | SNAP, MA and EA Caseload

Growing — Application

volume grew by almost 42%

Serving almost 34,000

uninsured adults, children and pregnant

women

Montgomery County At-a-Glance

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2012 County Self-Sufficiency Standard

            Adult + Adult +  

    Adult + Adult + Adult + Adult + infant + infant +  

Monthly Costs Adult infantpreschool

er schoolage teenager schoolage teenager 2 Adults

Housing $1,479 $1,677 $1,677 $1,677 $1,677 $1,677 $1,677 $1,479

Child Care $0 $1,049 $1,174 $608 $0 $1,656 $1,049 $0

Food $256 $382 $389 $457 $486 $576 $604 $506

Transportation $181 $181 $181 $181 $181 $181 $181 $362

Health Care $155 $393 $393 $405 $424 $417 $436 $443

Miscellaneous $207 $368 $381 $333 $277 $451 $395 $279

Taxes $727 $1,245 $1,322 $1,070 $844 $1,557 $1,240 $793

Earned Income Tax Credit (-) $0 $0 $0 $0 $0 $0 $0 $0

Child Care Tax Credit (-) $0 -$50 -$50 -$50 $0 -$100 -$50 $0

Child Tax Credit (-) $0 -$83 -$83 -$83 -$83 -$167 -$167 $0

Self-Sufficiency Wage (per adult)            

Hourly $17.07 $29.33 $30.59 $26.12 $21.62 $35.50 $30.48 $10.97

Monthly $3,005 $5,161 $5,384 $4,597 $3,806 $6,249 $5,365 $3,862

Annual$36,06

0$61,93

6$64,60

6$55,16

1$45,66

6$74,98

3$64,37

8$46,34

0

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Housing Costs

Source: U.S. Census Bureau, American Community Survey 2000, 2005, 2008, 2011, 2013

21.825

37.8 36.7

29.035.3

4751.5 51.7 50.6

0

10

20

30

40

50

60

2000 2005 2008 2011 2013

Pe

rce

nt

Percent of Households Spending More than 30% of Income on Housing Costs

OwnerOccupied

RenterOccupied

HHS Budget Facts

From FY15 CC Approved to FY16 CC Approved the tax supported budget for HHS increased by $1.1M. This includes:

An increase to personnel cost totaling $2.7M—compensation increases account for $4.8M and we assumed -$2.3M in additional lapse savings.

a net decrease in operating expenses totaling -$1.6M. The increases and decreases to the overall budget are highlighted in the service areas slides.

After the FY16 Budget was approved, lower revenue projections plus the Supreme Court decision Wynne v. the Comptroller of MD tax case required the County to implement a savings plan for FY16. The HHS savings plan reduced our FY16 approved budget by 1.3M. 10

HHS Budget Facts

The FY17 Maximum Agency Request Ceiling (MARC) for HHS is $209,756,705. The FY16 CC Approved budget is $209,253,900 an increase of $502,805.

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FY 16 Budget Overview

Budget increased to $288,993,599 ($4.4 million more than FY15 funding levels)

Total $288,993,599

Federal & State Grant Funds

43,830,516 15.2%

State HB669 Grant Funds

35,909,183 12.4%

County General Funds

209,253,900 72.4%

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FY16 DHHSBudget by Service Area

41,454,169 14.3%

42,536,06814.7%

78,785,23627.3%

70,719,459 24.5%

20,677,750 7.2%

34,820,917 12.1%

Aging and DisabilityServicesBehavioral Health andCrisis ServicesChildren, Youth, andFamiliy ServicesPublic Health Services

Special Needs Housing

Administration andSupport

Senior Initiative

Add funds to provide Senior Village start-up grants for low and moderate income diverse communities.

Continue providing nurse monitoring services to more than 2,000 senior and disabled clients receiving services through State’s new Medicaid waiver program, Community First Choice.

Maintain the raised Adult Foster Care reimbursement rate to reduce the gap between the County and State subsidy for senior assisted living group homes.

Continue funding support for Adult Day Care subsidies to increase the number of clients able to attend an Adult Day Care program two days per week for socialization and medical supervision.

Continue support in the Adult Protective Services/Social Services to Adults Program to address an increase in investigations of financial exploitation resulting from new bank mandatory reporting requirements.

Commit continuous support for a Caregiver Support Fellow and operating costs to coordinate outreach to seniors and persons with disabilities regarding the available services to ease the burden on caregivers.

Continue funding for a Program Manager in the Long Term Care Ombudsman Program, allowing the program to add volunteers and provide more long-term care facility residents with protection and advocacy.

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Aging and Disability Summary

Program Area FY16 Budget FY16 WYs

Community Support Network for People with Disabilities $ 15,638,266 36.50

Assessment and Continuing Case Mgmt Svcs 7,954,703 63.55

Assisted Living Services 2,090,244 7.57

Home Care Services 4,489,850 15.00

Community First Choice 2,744,813 13.00

Aging and Disability Resource Unit 867,967 9.00

Ombudsman Services 777,646 6.50

Respite Care 984,106 0.00

Senior Community Services 2,804,947 9.31

Senior Nutrition Program 2,622,747 3.00

Service Area Administration 478,880 3.00

Total $ 41,454,169 166.43

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Aging & Disabilities Services

HIGHLIGHTS

Add funds for the Developmental Disability Supplement to reflect increase in minimum wage, $969,420.

Add funds for the Developmental Disability Direct Service to reflect worker wage at 125% of minimum wage, $146,688.

Add Village Start-up grants to low and moderate income and diverse communities, $10,000. FY16 Savings Plan reduction of ($2,500).

Inflationary adjustment of 2% to non-profit contracts in A&D, $53,350. Reduce Developmental Disability Resource Coordination capacity to 2800

clients by transitioning clients to State Providers ($2,292,685). Reduce nurse monitoring services to reflect current client load in Community

First Choice program ($1,029,908). Shift Supports Planning activities from Community First Choice to existing

private sector providers ($411,622). FY16 Savings Plan reduction to Home Care Services-Increase waitlist for

IHAS-Personal Care Services ($100,000). FY16 Savings Plan reduction to Occupational Therapy Services ($150,000).

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Behavioral Health & Crisis Services

Budget by Program AreasProgram Area FY16 Budget FY16 WYs

Behavioral Health Planning and Management $8,087,059 15.50

Access to Behavioral Health Services 3,647,704 32.00

Treatment Services Administration 5,904,516

3.00

Forensic Services-Adult 2,374,604 19.00

Outpatient Behavioral Health Services-Adult 3,238,771 19.50

Outpatient Behavioral Health Services-Child 5,582,100 28.25

Trauma Services 4,960,349 29.55

24-Hour Crisis Center 4,824,892

36.90

Mental Health Svcs: Seniors & Persons with Disabilities 786,692 2.00

Specialty Behavioral Health Services 2,567,716 21.50

Service Area Administration 561,665 3.50

Total $42,536,068 210.70

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Add 2% inflationary adjustment for Residential Treatment Providers, $20,950.

Defer execution of contract for the Child and Adolescent Mobile Crisis Team until January 2016, ($200,000).

Defer implementation of Adult Behavioral Health Enhancement until January 2016, ($112,500).

Defer implementation of shared contractual Outpatient Psychiatrist contract until January 2016, ($110,000).

Inflationary adjustment of 2% to non-profit contracts in BH, $92,192.

FY16 Savings Plan reduction to Mental Health Emergency Preparedness contract ($20,000).

Behavioral Health & Crisis Services

HIGHLIGHTS

Positive Youth Development

Establish the Children’s Opportunity Fund jointly with Montgomery County Public Schools to support policy priorities related to addressing the social determinants that impact the achievement gap for vulnerable children and the barriers faced by their families ($250,000).

Add positive youth services at Wheaton High School Wellness Center beginning in January 2016 ($271,300)

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Children, Youth, & Family Services

Budget by Program AreasProgram Area FY16 Budget FY16 WYs

Child Welfare Services $ 23,555,426 206.80

Linkages to Learning 6,170,422 5.00

Positive Youth Development 4,731,160 11.00

Early Childhood Services 3,530,181 13.00

Infants and Toddlers 5,550,308 13.03

Child Care Subsidies 4,752,860 15.50

Office of Eligibility and Support Services 26,475,615 250.10

Child and Adolescent School and Community Based Services 3,313,857 6.50

Service Area Administration 705,407 4.50

Total $ 78,785,236 525.43

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Increase cost for Child Care Subsidies for children ages 2-5 in the lowest income brackets, $550,880.

Add funds for Positive Youth Programing at the Wheaton High School Wellness Center, $271,300.

Add funding to establish the Children’s Opportunity Fund jointly with Montgomery County Public Schools to support policy priorities related to addressing the social determinants that impact the achievement gap for vulnerable children and the barriers faced by their families, $250,000. FY16 Savings Plan reduction contract by ($125,00).

Annualize funding for South Lake Linkages to Learning Program, $122,377.

Add funds to the Reginald S. Lourie Center contract to address a growing caseload for attachment and bonding services, $49,910.

Inflationary adjustment of 2% to non-profit contracts in CYF, $279,166.

Children, Youth & Family Services

HIGHLIGHTS

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Delay implementation of the Kennedy Cluster Early Childhood Services until January 2016, ($104,156).

Eliminate funding for contractual MCPS suspension program, ($82,240). Eliminate the MCPS contract to provide social workers at the Ewing Center,

($64,000). Reduce business counseling and support services for child care providers,

($50,000). Eliminate funding for the Community Educator contract in Child Welfare Services,

($24,000). FY16 Savings Plan reduction to the African Immigrant and Refugee Foundation

contract, ($22,560). FY16 Savings Plan reduction to Parent Resources Centers, ($52,170). FY16 Savings Plan reduction to playground equipment for Early Childhood

Services, ($20,000).

Children, Youth & Family Services

HIGHLIGHTS

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Public Health Budget by Program Areas

Program Area FY16 Budget FY16 WYs

Health Care for the Uninsured $14,193,143 6.00

Communicable Disease and Epidemiology 2,092,362 17.50

Community Health Services 4,729,852 43.80

Dental Services 2,454,470 16.00

Environmental Health Regulatory Services 3,603,565 30.00

Health Care and Group Residential Facilities 1,695,375 12.00

Cancer and Tobacco Prevention 1,210,743 3.00

STD/HIV Prevention and Treatment Program 7,627,436 42.65

School Health Services 25,545,680 258.45

Tuberculosis Services 1,899,364 17.00

Women’s Health Services 2,657,610 20.65

Public Health Emergency Preparedness & Response 1,181,399 9.30

Service Area Administration 1,828,460 12.85

Total $ 70,719,459 489.20

Public HealthHIGHLIGHTS

• An overall reduction to funding for Montgomery Cares of ($288,525) includes:• Increase Montgomery Cares reimbursement rate to $2 per visit, $160,056.• Add funds to Montgomery Cares Holy Cross at the Aspen Hill Clinic for a

Behavioral Health Specialist, $50,000. FY16 Savings Plan reduction, ($50,000).

• Enhance Project Access, $50,000.• Enhance the Catholic Charities Health Care Network, $25,000.• Reduce Montgomery Cares to reflect lower client utilization, ($500,000).

FY16 Savings Plan additional reduction to Primary Care visits, ($207,700).• The reduction or elimination of: support for Electronic Health Records,

Pharmacy Assessment, Patient Satisfaction Survey, Training for Medicaid Participation, ($255,581).

• Add funds to the Muslim Community Dental Clinic, $182,000. FY16 Savings Plan reduction, ($12,500).

• FY16 Savings Plan reduction to Pharmacy Services, ($72,850).• FY16 Savings Plan reduction to Primary Care Coalition Indirect Rate,

($38,400).24

Public HealthHIGHLIGHTS (continued)

• Enhance Care for Kids enrollment growth, $125,000.

• Enhance County Dental Clinics, $100,000.

• Inflationary adjustment of 2% to non-profit contracts in PH, $16,842.

• Eliminate matching funds for Reproductive Health Services that were shifted by the State to private providers, ($170,133).

• Reduce funding for Food Recovery Program, ($40,000).

• Reduce funding for miscellaneous operating expenses in the School Based Health Centers, ($50,000).

• FY16 Savings Plan reduction to mammograms and colorectal screenings to two grant funds and other community resources, ($120.000).

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Special Needs Housing Budget by Program Areas

Program Area FY16 Budget FY16 WYs

Rental & Energy Assistance Program $ 4,796,382 14.00

Shelter Services 7,113,335 3.00

Permanent Supportive Housing Services 2,526,249 9.90

Housing Stabilization Services 5,842,800 34.60

Service Area Administration 398,984 3.00

Total $ 20,677,750 64.50

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Special Needs HousingHIGHLIGHTS

• Eliminate the subsidy to the Maryland Energy Assistance Program, ($500,000).

• Inflationary adjustment of 2% to non-profit contracts in SNH, $179,560.

• FY16 Savings Plan reduction to the Handicap Rental Assistance Program (HRAP), ($50,000).

• FY16 Savings Plan reduction to the Supportive Services for Emergency Family Shelter, ($38,420).

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Office of the DirectorHIGHLIGHTS

Add funds to create an Office of Child Care to implement Child Care Expansion and Quality Enhancement Initiative Bill 13-15, $253,095.

Add funds to the Outreach to County Contractors for Bill 14-14, Health Insurance Reporting, $30,000.

Inflationary adjustment of 2% to non-profit contracts in OD, $3,278.

FY16 Savings Plan Reduction to reduce contractual IT services, ($40,000).

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Office of Community AffairsHIGHLIGHTS

Add funds for Anti-Poverty Pilot Program, $32,700. Inflationary adjustment of 2% to non-profit contracts in OCA, $57,512. FY16 Savings Plan reduction to African American Health Program

contractual services, ($20,000). FY16 Savings Plan reduction to Latino Youth Wellness Program Services,

($20,000). FY16 Savings Plan reduction to Asian American Health Initiative

Contractual Service-Mental Health, ($10,000).

HHS Process and Technology Modernization Effort

Enterprise Content Management System Allows staff to scan

documents for storage, so clients don’t have to provide the same information repeatedly

Deployed to eligibility programs only

Electronic Health Record Allows DHHS staff to treat

clients more effectively and seek greater reimbursements for services by providing an integrated health record for clients across multiple programs

Keeps DHHS in compliance with changing federal regulations

Deployed across all DHHS clinics in Spring 2015

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HHS Process & Technology Modernization efforts continue:

What does FY17 hold for us? Budget Cuts Urgency and Complexity from our

customers/clients and patients A shared problem solving agenda on how to

deliver on the value proposition Imperative to move upstream – increase our

prevention incentive Become more outcomes focused/more efficient

and more effective in our service delivery and demonstrate a strong return on investments as funding diminishes

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Questions?