DHSS LEGACY MEMO 1 The Legacy of the Department of Health and Social Services During the Markell Administration When people look at how the policies and programs of the Department of Health and Social Services (DHSS) have improved the lives of Delawareans during the Markell Administration they will find a common theme – we meet communities where they are. And when we meet individuals and organizations, we typically have the same goal: to support them or their clients in living engaged lives in the community among their peers. That DHSS legacy also will include: • Fewer institution-based services and more community-based services for seniors, people with disabilities, and individuals with behavioral health challenges, assuring that people get access to the right level of care. • A mental health care system that has achieved critical reforms, while better supporting people with serious and persistent mental illness as they live in their own homes in the community. • Momentum for ongoing change in the way health care is delivered and paid for in our state, tying payments to an increase in positive outcomes. • An urgent and growing response to the addiction epidemic, which continues to take too many lives and impact too many families. • Enhanced opportunities for people with disabilities to live, work, and participate as active members of the community. • Support for more individuals and families to move out of poverty by empowering them to improve their own financial security. • A strong safety net for tens of thousands of individuals and families who continue to face economic challenges.
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TheLegacyoftheDepartmentofHealthandSocialServicesDuringtheMarkellAdministration
WhenpeoplelookathowthepoliciesandprogramsoftheDepartmentofHealthandSocialServices(DHSS)haveimprovedthelivesofDelawareansduringtheMarkellAdministrationtheywillfindacommontheme–wemeetcommunitieswheretheyare.Andwhenwemeetindividualsandorganizations,wetypicallyhavethesamegoal:tosupportthemortheirclientsinlivingengagedlivesinthecommunityamongtheirpeers.ThatDHSSlegacyalsowillinclude:
• Fewerinstitution-basedservicesandmorecommunity-basedservicesforseniors,peoplewithdisabilities,andindividualswithbehavioralhealthchallenges,assuringthatpeoplegetaccesstotherightlevelofcare.
• Amentalhealthcaresystemthathasachievedcriticalreforms,whilebettersupportingpeoplewithseriousandpersistentmentalillnessastheyliveintheirownhomesinthecommunity.
• Momentumforongoingchangeinthewayhealthcareisdeliveredandpaidforinourstate,tyingpaymentstoanincreaseinpositiveoutcomes.
• Anurgentandgrowingresponsetotheaddictionepidemic,whichcontinuestotaketoomanylivesandimpacttoomanyfamilies.
• Enhancedopportunitiesforpeoplewithdisabilitiestolive,work,andparticipateasactivemembersofthecommunity.
• Supportformoreindividualsandfamiliestomoveoutofpovertybyempoweringthemtoimprovetheirownfinancialsecurity.
• Astrongsafetynetfortensofthousandsofindividualsandfamilieswhocontinuetofaceeconomicchallenges.
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Community-BasedServices
In2009,Delaware’slong-termcareexpendituresweretiltedtoofartowardfacility-basedcareovercommunity-basedcare.Today,thoseexpendituresareshiftingawayfromfacilitiesandtowardthecommunity,whereconsumerswanttobeserved.
WHATCHANGED
• InFiscalYear2009,spendingatDHSS’threelong-term-carefacilitiestotaled$64million.ByFY2016,spendingwasdown33%to$42.8million,acceleratedbythedecisiontocloseEmilyP.BissellHospitalinSeptember2015becauseofongoingbuildingmaintenanceproblemsandadecliningcensusoverall.Thatongoingshiftisalsomorecost-effective:ForeverypersonDHSSservesinafacility,wecanservethreeinthecommunity.
• SinceFebruary2011,DHSS’CareTransitionsTeamhasdiverted86%ofindividuals(631individualsasofSeptember2016)tothecommunitywhohadbeenreferredtoDHSS’threelong-termcarefacilities.Withthecostcuttoone-thirdoftheaverageannualnursinghomecostof$100,000perperson,theshiftsaves$41.6milliononanannualizedbasis.• SinceFY2009,thetotalcensusatEmilyBissellHospital,GovernorBaconHealthCenterandtheDelawareHospitalfortheChronicallyIllhasbeenreducedby45%from
354residentstotoday’scensusof194,betterleveragingthestate’sresourcesandfacilities,andsatisfyingthedesiresofDelawareanstoremainengagedmembersofthecommunity.
• InSeptember2015,citingthedesiresofresidentstoremainwheretheyhadbeentemporarilyrelocatedafterawaterboilerfailureinFebruary2015andadecliningcensus,SecretaryLandgrafmadethedecisiontocloseEmilyBissellpermanently.Adecisiononrepurposingthebuildingswillbemadeinconcertwithstakeholders.
• Medicaid-eligibleDelawareansreceivinghomeandcommunity-basedservicesincreasedfrom1,688inJanuary2009to3,619inJuly2016,a114%increase.AsofSeptember2016,another195DelawareansarereceivingservicesattheLIFECenterontheRiverfrontthroughProgramforAll-InclusiveCarefortheElderly(PACE),whichbeganin2013.And263individualshavetransitionedfromfacility-basedcaretocommunitysettingsthroughtheMoneyFollowsthePersonprogram,whichbeganin2008.
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WHATWASDONE
• LaunchedDelawareAging&DisabilityResourceCenter(www.DelawareADRC.com)inSeptember2011.
1,688 36%
3,057 64%
January2009
Community
Facility
3,619 56%
2,881 44%
July2016
CommunityFacility
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
Jan2000 Jan2009 Jul2016Community 980 1,688 3,619
Facility 2,857 3,057 2,881
Eligibles
IndividualsReceivingMedicaidLong-TermServicesandSupports
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• MovedMedicaidlong-termcarepopulationfromfee-for-servicetomanagedcareinApril2012,increasingthemenuofservicesforindividualsoverthepreviousfee-for-servicemodel.
• UsedhousingvouchersthroughtheDelawareStateHousingAuthority’sStateRentalAssistanceProgram(SRAP)tosupportthetransitionof705individualsfromDHSS’facilitiestothecommunity,asofJuly2016.
SAVINGS
• Startingin2011,thediversionof631individuals,asofSeptember2016,tothecommunitywhohadbeenreferredtoDHSS’threelong-termcarefacilitiessaves$41.6milliononanannualizedbasis.
• TheclosingofEmilyB.BissellHospitalinSeptember2015isestimatedtosave$2.83millionayear,withoutlayoffs,byreducingstaffing,facilityupkeepandovertimeneedsatDHSS’otherfacilities.
WHATITMEANSTODELAWAREANS
JohnTaloneofClaymontisamongthehundredsofDelawareanswhohavebeendischargedordivertedfromDHSS’threenursingfacilitiestoliveinthecommunitywithwrap-aroundsupportsandservices.JohnlikeshisownItaliancooking,andafterspendingfour-and-halfyearsintheDelawareHospitalfortheChronicallyIllinSmyrna,henowcancookandeatthosemealsonhisscheduleathisClaymontapartment.
BYTHENUMBERS
• 1,042:TotalcensusofDHSS’fivefacilitiesin2000.
• 662:TotalcensusofDHSS’fivefacilitiesin2009,down36%from2000.
• 358:TotalcensusofDHSS’nowfourfacilitiesin2016,down46%from2009.
DivertingpeoplefromDHSS’long-termcarefacilitiestothecommunity,withnecessarysupports,givesDelawareanswhattheywantandsaves$41.6milliononanannualizedbasis.
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THEYSAIDIT
“Weareallonestepawayfromhomelessness.Weareallvulnerable.”~CharlesJohnson,SRAPrecipientandfounderofHomelessPeopleAreRealPeople,Too(H.A.R.P.)
MentalHealthSystemReform
FromdayoneoftheMarkellAdministration,DHSShasworkedtoimproveconditionsattheDelawarePsychiatricCenter(DPC)andreformhowmentalhealthservicesareprovidedinthecommunity.ApivotalbenchmarkinthatcommitmentcameinJuly2011whentheStateofDelawareenteredintoafive-yearSettlementAgreementwiththeU.S.DepartmentofJustice,whichresolvedathree-yearinvestigationofDPC.Moreimportantly,thatagreementbecametheblueprintforhowDelawarewouldprovidementalhealthservicesinthecommunitytothemorethan10,000peopletodayestimatedtobelivingwithseriousandpersistentillness.
InSeptember2016,CourtMonitorRobertBernsteinissuedhis10threporttotheU.S.DistrictCourt,writing,“TheMonitor’sfindingthattheStateisinSubstantialCompliancewiththeAgreementisbasednotonlyontheextensivedatapresentedhere,butalsoupontheself-reportsofindividualsservedbyDelaware’spublicmentalhealthsystem.”ThenextstepwouldbefortheU.S.DepartmentofJusticetorecommendtotheCourtthattheStatehasmetitsgoalsandreleasetheStatefromthetermsoftheagreement.SecretaryLandgrafagreesthatthesystemisnotperfectandneedsongoingimprovementsandconstantvigilance,butsheispleasedwiththeconclusionoftheCourtMonitor,“TheState’sservicesforpeoplewithSPMIarenotflawless,butthereisincreasingunityandmomentumregardingthegoalofenabling
40%
57%
3% DelawarePsychiatricCenter
CommunityServices
CommunityMentalHealthInpatient
DSAMHFY10EXPENDITURES
28%
70%
2% DelawarePsychiatricCenter
CommunityServices
CommunityMentalHealthInpatient
DSAMHFY16EXPENDITURES
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theseindividualstomovefromthesocialmarginsandtoliveasordinaryDelawareansasfullmembersoftheircommunities.”
WHATCHANGED
• In2008,only3,700peoplewerebeingservedinthecommunity,andtoomanypeoplewithseriousandpersistentillnesswereinstitutionalized,homeless,forgotten,ortheirfamiliesweredoingthebesttheycouldtopatchtogethersupportforthem.By2015,morethan8,000Delawareans–anincreaseofmorethan116%–werereceivinganoutpatientservice.
• Asmentalhealthsystemreformswereinstitutedandtheshifttocommunity-based
servicestookhold,DPCshiftedtobecomingtheacute-carepsychiatrichospitalitalwaysshouldhavebeen,licensedfor200beds.Individualswhohavebeendischargedafteryearsor,insomecases,decadesatDPCarereceivingintensivetreatmentinthecommunitywithaccesstohousing,employment,clinicalservices,medicationsandotherservices.
WHATWASDONE
232
204 200
162146 136
113 112 110
0
50
100
150
200
250
FY2008 FY2009 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015 FY2016
Num
bero
fClients
DecliningCensusatDPC
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• CreatedAssertiveCommunityTreatment(ACT)teams–consistingof10membersplusapsychiatrist–whoprovide24/7servicesinthecommunityinsteadofinanofficesetting,plusIntensiveCaseManagement(ICM)andCommunityReintegrationSupportProject(CRISP)teamsdirectedanindividualswithlevelsofneedbeyondwhatisavailablethroughACT.AsofFiscalYear2016,DHSShas15ACTteams,twoICMteamsandtwoCRISPteams,allofwhommustrespondtoclientswhoareincrisisregardlessofthetimeofday,therebyincreasingthechanceofde-escalationandreducingunnecessaryhospitalizations.
• Reducedby25%thenumberofinpatientbeddaysfrom55,785inFY11to41,515inFY16.
• OpenedRecoveryResponseCenter(RRC)inSussexCountytosupportpeopleexperiencingabehavioralhealthcrisis.FromitsopeninginSeptember2012throughJune2015,DHSS’MobileCrisisandRRCinEllendalehaveworkedtogethertodivert74%ofclientsfromhospitalization.Asimilarcrisiswalk-incenteropenedinAugust2016inNewarktoserveNewCastleCounty.
• AsofFiscalYear2016,funded812housingunits–abovethetargetof650setintheSettlementAgreement–forindividualswithseriousandpersistentmentalillnesssotheycanleadstablelivesinthecommunity.
• DevelopedcrisisapartmentsinNewCastleCountyandKentandSussexcountiesthatprovide24/7supervisioninastableenvironmentforuptosevendayssotheclientcanworkthroughacrisiswiththesupportoftheACTteam.InFiscalYear2016,21bedsareavailablestatewide,exceedingthetargetoftheSettlementAgreement.
• ExpandedMobileCrisisServicesstatewideto24/7,withateammemberrequiredtorespondanywhereinthestateinlessthananhour.InFiscalYear2016,theaverageface-to-faceresponsetimewas40minutes,exceedingtheone-hourtargetoftheSettlementAgreement.
• UpdatedDelaware’scivilmentalhealthlawsforthefirsttimein50years.• WonapprovalinJanuary2015toimplementPROMISE(PromotingOptimalMental
HealthforIndividualsthroughSupportsandEmpowerment).Anestimated3,000Delawareanswithbehavioralhealthneedsandfunctionallimitationswillbeeligiblefor
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thisManagedCareOrganizationbenefitpackage,betterleveragingMedicaiddollarsandincreasingemploymentopportunities.
• Createdthepositionofpeersupportspecialist,someonewithasharedlifeexperience,tosupportindividualsinrecoveryastheynavigatethehealthcaresystemandliveinthecommunity.
• SupportedlegislationsignedbytheGovernorinSeptember2016toestablishtheBehavioralandMentalHealthCommission,includingtheAdultMentalHealthPeerReviewSubcommitteetomonitorthetreatmentservicesprovidestoadultswithSPMI.
WHATITMEANSTODELAWAREANS
WilliamandSteve,bothofwhomhaveaseriousmentalillness,shareanapartmentandareservedbyaSussexCountyACTteam.Williamhasahistoryofinvolvementwiththecriminaljusticesystem.Steve,whohasbeeninthecriminaljusticesystem,too,hasaco-occurringaddictiontoalcoholandhasbeenhomeless.Likeotherroommates,WilliamandStevesharetheshoppingandcooking.ACTteammembersvisittwotothreetimesaweektosupportthem.Today,inrecovery,theyarelivingordinarylivesinthecommunity.
BYTHENUMBERS
• 12,826:Delawareansidentifiedasmembersofthetargetpopulationofindividualswithseriousandpersistentmentalillness,asofDecember2016.
• 28,262:MobileCrisiscallsstatewideinFY16.Withskillsinde-escalationandknowledgeofservices,MobileCrisisTeammembersaremakingadifferenceinourcommunities.
• 45peers:Certifiedwiththestateboard,asofSeptember2016.99peoplehavecompletedPeerSupport101,and122havecompletedcertificationtraining.Inhis10thReporttotheU.S.DistrictCourt,CourtMonitorRobertBernsteinwrote,“Inshort,PeerSupportservicesandthelargerpeermovementinDelawarehavebecomeavibrantcomponentoftheservicesystemforpeoplewithSPMI.”
• DHSS’24/7MobileCrisisServicesinNewCastleCounty:1-800-652-2929.InKentandSussexcounties:1-800-345-6785.
THEYSAIDIT
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“…fromtheGovernor’sOfficeondown,thereisacommitmenttoservepeoplewith[seriousandpersistentmentalillness],aswellasotherdisabilities,inwaysthatpromotetheirfullparticipationincommunitylife.”~CourtMonitorRobertBernstein
UrgentResponsetoAddictionEpidemic
ThenumberofDelawareansimpactedbyaddictionhasbeenrisingfortwodecades,mirroringtherapidlyrisingincreaseinprescriptionsforopioidpainmedications.Thousandsofpeoplearefacingaddiction,impactingtheirfamilies,thetreatmentandcriminaljusticesystems,andcostinghundredsofpeopletheirlivesfromoverdoses.
WHATCHANGED
In2010,Delawarerankedfifthintheper-capitarateofopioidpainrelieversales,andthestatehadtheninth-highestdrugoverdosedeathrateinthenation.By2010,thenumberofoverdosedeathsinDelawarehadsurpassedcaraccidentsastheleadingcauseofdeathbyinjury.
By2012,thethousandsofindividualsandfamiliesimpactedbytheaddictionepidemicwerestrugglingtogetthetreatmentservicestheirlovedonesneeded,andDHSSwasstrugglingtomeetthedemandfortreatmentandrecoveryservices.
ForDelaware,itwasanall-hands-on-deckmoment.Aswithanypublichealthcrisis,weareworkingonthreefronts–topreventdrugabuseandtoeducateaboutthedisease;toexpandtreatmentandrecoveryservices;andtocontrolthecrisisfromacriminaljusticestandpointbyworkingtounderstandhowitoriginated.
WHATWASDONE
• In2012,theDepartmentofStateestablishedthePrescriptionDrugMonitoringProgramwiththerequirementof24-hourpharmacyreporting.
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• InFebruary2012,Gov.MarkellestablishedthePrescriptionDrugActionCommitteeofstakeholdersfromacrossthespectrum,chargingthecommitteewithdevelopingaplantocombattheabuseandmisuseassociatedwithprescriptionpainkillers.
• InMarch2012,theDivisionofMedicaidrequiredprescribingproviderstogetpreauthorizationforlong-actionopioidmedicationsforMedicaidpatientsandplacedannuallimitsforshort-actingopioidmedications.Thenewrequirementaffectedanestimated3,500Medicaidclients.
• InJuly2013,Gov.Markellsignedthe911/GoodSamaritanLaw,whichencouragespeopletocall911toreportanoverdosewithoutriskingarrestforlow-leveldrugcrimes.
• InJune2014,asDHSSbegantoaddressbothcapacityandredesignissues,theGeneralAssemblyadded$1millioninnewresourcestoDHSS’budgetforincreasedtreatmentservicesthroughtheDivisionofSubstanceAbuseandMentalHealthandincreasedpreventionservicesthroughtheDivisionofPublicHealth.
• InJuneandAugustof2014,Gov.Markellsignedtwobills–oneexpandingtheuseoftheoverdose-reversingdrugnaloxoneinthecommunityandoneallowingittobeusedbylawenforcementagencies.Today,sixpolicedepartmentsarecarryingthemedication,andalldepartmentshaveusedittosavepeople’slives.
• InOctober2014,DHSSlaunchedwww.HelpIsHereDE.com,aone-stopwebsiteforinformationaboutprevention,treatmentandrecoveryservices.
• InhisStateoftheStateinJanuary2015,Gov.Markellpledgedtomakeasubstantialinvestmentinservicesforthosestrugglingwithaddiction.InFebruary,hisrecommendedbudgetincluded$4.45millioninnewresourcesforwithdrawalmanagement,residentialandoutpatienttreatment,andrecoverylivingservices.• WiththeadditionalresourcesintheFY16budget,DHSSincreasedwithdrawalmanagementservices,residentialtreatmentandyoungadultopiateresidentialbeds,outpatienttreatmentslots,and
soberlivingbedsacrossthestate,whilereformingourtreatmentsystemtoebbandflowwithanindividual’sneeds,embracingtheAmericanSocietyofAddictionMedicinemodel.Whenindividualsinactiveusearereadyfortreatment,DHSSmusthavethecapacitytosupportthematthattime.
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• InApril2015,aspartofourpreventioninitiatives,DHSSlaunchedanunderageandbingedrinkingpreventioncampaignaimedatteens,theirparentsandotherinfluencers,andcollege-agebingedrinkers.
• TheGeneralAssemblypassedaresolutioninApril2015permittingschoolnursesinhighschoolstocarryandadministernaloxone.DHSSandtheDivisionofPublicHealthhavesecurednaloxonetosupplytheschools.
• InAugust2015,theWhiteHouseOfficeofDrugControlPolicyannouncedfiveHigh-IntensityDrugTraffickingAreas(includingPhiladelphia/Camden,whichincludesNewCastleCounty)wouldformanunprecedented15-stateHeroinResponseStrategy.Delawarenowhasapublichealthanalyst(atDHSS)andapublicsafetyanalyst(atDIAC)analyzingdata,spottingtrendsandinformingresponses.
• DelawarewasoneoffourstatesselectedinAugust2016toparticipateinaNationalGovernorsAssociation(NGA)LearningLabondatasharingrelatedtoaddiction.Delawarewillsharetreatment,lawenforcement,EMSandMedicalExaminerdata.
WHATITMEANSTODELAWAREANS
TimMillertookapathtoomanyyoungadultsaretakingtoday.Inmiddleschool,hetriedalcohol.Thenhetookhisgrandfather’sprescriptionpainkillersfromthemedicinecabinet,sayingtheymadehimfeellesssociallyawkward.Yearsafterhighschool,havingbecomeaddictedtoheroin,hewassenttoHowardYoungprisononaburglarycharge.Today,heislivinginlong-termrecovery.
BYTHENUMBERS
• 10,000:NumberofDelawareadultswhosoughtpublictreatmentin2015,withaboutone-thirdindicatingheroinastheirprimarydrugatthetimeofadmission.
• 228:Thenumberofpeoplewhodiedfromsuspectedoverdoseofanysubstancein2015–that’smorethanoneson,daughter,mother,father,sisterorbrothereveryotherday.Theyoungestpersontodiefromanoverdosewas15;theoldestwas87.Theaveragepersontodiewasa42-year-oldwhitemalefromsuburbanNewCastleCounty.
• 2,380:NumberofpeoplewhohavebeenadministerednaloxonebyEMSandpoliceofficersfrom2014throughMay2016.
• 1,576:Numberofpeopleinthecommunitywhohavebeentrainedtousenaloxone,asofFebruary2016.SecretaryLandgrafisamongthosewhohavebeentrainedtoadministernaloxone.
• 14:Numberofpolicestationswith24/7DrugTake-Backcollectioncontainerstoencouragethedisposalofunwanted,unnecessaryorexpiredmedications.
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• 15:Beginningin2015-2016schoolyear,numberofhoursofdrugandalcoholeducationrequiredbeforegraduationforeverypublichighschoolstudent.
THEYSAIDIT
"IneverwantedanythingmorethanhowbadIwantedtobecleanandsoberinthatmoment,”saidTimMiller,whounderwentdetoxinprisonandnowhasfouryearsinrecovery.
EnhancedOpportunitiesforPeoplewithDisabilities
WiththeAmericanswithDisabilitiesActcelebratingits25thanniversaryin2015,thecivilrightsfortheoneinfiveAmericanswithadisabilityareevenmoreentrenched.Whileinclusiongrowswitheachsuccessivegeneration,thereisstillmuchmoreworktodointermsofhealthequity,housingoptions,transportation,education,financialself-sufficiencyandespeciallyemployment.
WHATCHANGED
• UnderGovernorMarkell’sleadershipandinpartnershipwiththebusinesscommunity,Delawarereportedan8.6percentincreaseinactiveemploymentfrom2011to2013amongthe187,000peoplewithdisabilities.TheGovernoralsohasmadethehiringofpeoplewithdisabilitiesapriorityforstategovernment,usinghiringpracticesandprogramstoincreaseemploymentlevels.
• AsChairoftheNationalGovernorsAssociationfrom2012to2013,GovernorMarkellmadeadvancingemploymentopportunitiesforpeoplewithdisabilitieshisyearlonginitiative.Withhisbusinessbackground,heknowsthatcompanies’bottomlinesshouldbeaboutembracingaperson’sability,nottheirdisability.TheGovernorlaidouthowtoadvanceemploymentopportunitiesinhisblueprinttohisfellowgovernors,“ABetterBottomLine:EmployingPeoplewithDisabilities.”
• AstheformerdirectorofTheArcofDelawareandNAMIDelaware,SecretaryLandgrafhasspentmorethan30yearssupportingindividualswith
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disabilities.SheservedasakeyadvisertotheGovernorduringhisNGAinitiative,andwasappointedinJanuary2015totheU.S.DepartmentofLabor’sU.S.AdvisoryCommitteeonIncreasingCompetitiveIntegratedEmploymentforIndividualswithDisabilities.
• AsSecretary,sheisdedicatedtoincreasingopportunitiesforallpeoplewithdisabilities.Opportunitybeginswithajob,aplacetolive,goodhealth,supportsandservices,andfinancialwell-being.
WHATWASDONE
• InJuly2012,theGovernorsignedtheEmploymentFirstAct,requiringstateagenciestoconsider,astheirfirstoption,competitiveemploymentforindividualswithdisabilities.
• Toincreasehiringofqualifiedindividualswithdisabilities,theStateusessuchtoolsasSelectivePlacement,TemptoPerm,casualseasonalhires,andinternshipsandcareer
exploration.• In2013,aworkgroupwastaskedwithadvancinghiringopportunitiesforpeoplewithdisabilitiesinstategovernment.• Aspartofthatwork,thegroupcommissionedtheUniversityofDelawaretoconductanonlinesurveyofstateemployeestobetterunderstanddisabilityawareness.Morethan5,000stateemployeesresponded,
identifyingtwokeyareasforimprovement:HRtrainingrelatedtodisabilityawarenessandrefinementofstatehiringpracticesinordertorecruitqualifiedapplicantswithdisabilities.
• InOctober2014,theOfficeofManagementandBudgetlaunched“FocusonAbility,”disabilityawarenesstrainingforallemployees,withaseparatemoduleforhiringmanagers.
• WorkingwiththeGovernor,SecretaryLandgrafhelpedtofacilitatearelationshipwithSpecialisterne,aglobalorganizationdedicatedtotrainingandpromotingthehiringofindividualsontheautismspectrum,andCAI,aglobalITcompanywithofficesinDelaware.
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• DHSShashiredseveralSpecialisternecontractorstododocumentscanning.OnegraduateofSpecialisterneisnowastateemployeeinthematerialscenterforthe
DivisionfortheVisuallyImpaired.• Bytheendof2015,CAIhascommittedthat3percentofitsworkforcewillbeindividualsontheautismspectrum.• Inlate2015,DHSScreatedavideotopromoteemploymentforindividualswithdisabilitiesthathighlightsthejobsorexpectationsoffiveDelawareans.Thevideowillbeshownanddiscussedwith
individuals,familiesandprospectiveemployers.• In2015,Delaware’sDisabilityMentoringDaywasexpandedfromNewCastleCountyto
allthreecounties.Morethan60studentsparticipatedinjob-shadowingatnearbyworkplaces.
• Tosupportyoungpeoplewithdisabilitiesandtheirfamilies,DHSSearnedapprovalfromtheCentersforMedicareandMedicaidServicesinJanuary2015forPathwaystoEmployment,becomingthefirststatetosupportyoungpeoplewithdisabilitiesastheymakethetransitionfromschooltotheworldofwork.AsofSeptember2016,248youngpeopleage14-25haveenrolledinPathways,with180moreidentifiedaspotentialcandidates.TheMedicaidprogramhelpstoreducethebarrierstoemploymentthoughsuchservicesasassistivetechnology,non-medicaltransportation,careerexploration,personalcareandfinancialcoaching.
• Thefinancialempowermentprogram,$tandByMe,createdin2011inpartnershipwiththeUnitedWayofDelaware,supportspeoplewithdisabilitiesinmanagingtheirfinanceswithfreeone-on-onecoaching.
• MedicaidforWorkersallowspeoplewithdisabilitiestobuyintoMedicaidinordertokeepthesupportstheyneedwhiletheyareemployed.
• InJune2015,Delawarebecamethe19thstatetocreateanAchievingaBetterLifeExperience(ABLEAct)program,followingaDecember2014federallawcreatingtheprogram.ThestateDepartmentofFinanceisdevisingrulesforthetax-freesavingsaccountsfordisability-relatedexpenses.
• BecauseaDelawarepublichealthassessmentfoundanumberofhealthdisparitiesamongpeoplewithdisabilities–includingobesityrates,higherratesofsmoking,andhigherratesofchronicconditionssuchasdiabetes,heartdiseaseanddepression,DHSSisrequiringitsdivisionsandprogramstoincludeaperson’sdisabilitystatuswhen
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demographicinformationiscollected.ThatinformationwillallowDHSStoremovebarrierstocareandincreaseaccess.
• InAugust2016,theGovernorsignedlegislationsupportingthehiringofpeoplewithdisabilitiesbyprovidingtaxcreditstoDelawareemployerswhohirepeoplethroughtheDivisionofVocationalRehabilitation.Thetaxcreditwillbeginin2017.
• Tosupportpeoplewithdisabilities,theGovernorsignedlegislationinSeptember2016providingtheoptionofasupporteddecision-makingagreementforadultswhodonotneedaguardianbutwhoneedassistanceingatheringinformation,makingdecisions,andcommunicatingthosedecisions.
WHATITMEANSTODELAWAREANS
• JessicaHengst,whohasDownsyndrome,foldstowelsandcleansthepoolareaatMainstaySuitesinDoverandhasasecondjobatOldNavyintheDoverMall.Oneday,hermomsaidshewouldlikehertoliveonherown.• AgunincidentinPhiladelphialedtoDwayneAdamslosing
hislefteyeandhavingonlypartialvisioninhisrighteye.Jobspecialistsaskedhimifhewantedtosellnewspapersatastand.Hetoldthemhewantedtobecomeamassagetherapist.Hebuiltonthatinterestinphysicalhealth,andtodayownsBreakingBarriersfitnesscenterinWilmington.
• Establishinganexpectationofalifetimeofworkiscrucialforyoungpeoplewithdisabilities.ForRickandAmyKosmalskiofBear,theexpectationsforKayla,their10-year-olddaughterwithDownsyndrome,arenodifferentthantheyareforLogan,their5-year-oldsonwithoutadisability.TheKosmalskisbelieveKaylaandLoganeachcanbewhatevertheywanttobe.
BYTHENUMBERS
• 36.4%:PercentageofDelawareansage18to64withdisabilitieswhoareemployed.
• 248:Numberofyoungpeopleage14-25enrolledinPathwaystoEmploymenttosupportthemintransitionfromschooltotheworldofwork.
• 5,000:Numberofstateemployeeswhorespondedtoa2013UDsurveyaboutdisabilityawarenessintheworkplace.
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• 12%:Percentageofindividualswithdisabilitiesamongallpeopleservedbythefinancialempowermentprogram$tandByMesince2011.
• 1,008:EstimatednumberofpeoplewithdisabilitiesexpectedtocreateABLEsavingsaccountsinDelawarebyFiscalYear2017.
THEYSAIDIT
“DisabilityMentoringDayisagreatopportunityforkidstolearnaboutdifferentjobs,tobeinvolvedwiththecommunity.”~JaySiegel,a2014DisabilityMentoringDayGraduate
HealthCareReformandInnovation
BeginninginMarch2010whentheAffordableCareActwassignedintolaw,Delawarehasbeenonthesuperhighwayofhealthcarereform.Astheleadstateagency,DHSShasworkedtoimplementitsstate-federalpartnershipHealthInsuranceMarketplace,withcoveragebeginning
Jan.1,2014,andtheexpansionofMedicaid,withcoveragebeginningonthesamedate.DHSShasbeenasignificantpartnerindesigningaplanandapplyingforafederalCenterforMedicareandMedicaidInnovation(CMMI)grantandimplementingtheplantochangethewayhealthcareisdeliveredandpaidforinDelaware.
WHATCHANGED
• In2008,Delaware’sinsuredratewasestimatedat11.2percent,or101,000individuals.ThatraterankedDelaware33rdamongthestates.By2015,thatpercentagewasdownto5.9percent,withanestimated54,000Delawareanswithoutcoverage.Delawarenowhasthe9th-lowestuninsuredrateinthecountry.
• Delaware’shealthcarecostsare25percentabovethenationalaverage,with$8billionspentannuallyonhealthcareand22percentoftheStatebudgetdevotedtohealthcarecosts.
• Thoseexpenditureshavenotresultedinahighrateofpositiveoutcomes.Delaware’srateforsuchdiseasesasdiabetes,obesityandcancerareabovetheU.S.average,andthehealthofmanyDelawareansremainsatorbelowaverageonmanymeasures.
WHATWASDONE
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• Delawareadoptedastate-federalpartnershipforitsHealthInsuranceMarketplace,meaningDelawarewouldretainresponsibilityforplanmanagementandconsumerassistance,whilethefederalgovernmentwouldberesponsibleforinformationtechnologythroughHealthCare.gov.
• Throughthefirstthreeyears,28,256Delawareansenrolledforprivatehealthinsuranceplans,withenrollmentalmostdoublingfromYear1toYear3–oneofthehighestincreasesinthecountry.
• InJuly2013,Gov.MarkellexpandedeligibilityforMedicaidupto138percentoftheFederalPovertyLevelbeginningJan.1,2014.ThroughJanuary2016,9,896Delawareadultswereeligibleforcoveragethroughtheexpansion.
• Beginningin2013,morethan100stakeholders,includingthoserepresentinghospitals,providers,insurers,educationalinstitutions,patients,andgovernment,cametogethertodevelopDelaware’shealthinnovationplan.
• Basedonthatplan,Delawarewasawardedafour-year,$35milliongrantfromtheCentersforMedicareandMedicaidInnovation(CMMI)totransformthestate’shealthcaredeliverysystembyusingatotalinvestmentof$130millionoverfouryears.
• In2015,theDelawareCenterforHealthInnovation,anot-for-profitorganization,wascreatedtocarryouttheinnovationwork.TheDCHIBoardcreatedsixcommittees:Clinical,WorkforceandEducation,Payment,HIT,HealthyNeighborhoods,andPatient/ConsumerAdvisory.Twomulti-payer,value-basedpaymentmodelswillbeofferedstatewide:Pay-4-ValueandTotalCostof
Care.• Delaware’sgoalsby2018aretobecomeoneofthefivehealthieststatesintheU.S.;to
achievetopperformanceforqualityandpatientexperience;andtobringhealthcarespendinggrowthmorecloselyinlinewiththegrowthoftheeconomy.
WHATITMEANSTODELAWAREANS
FelipeHernandez,a26-year-oldmachineoperatorfromWilmington,didnothaveinsurancecoveragelikehiswifeanddaughterdid.RelativestoldhimabouttheHealthInsuranceMarketplaceandheenrolledforcoveragebeginningin2014andre-enrolledfor2015.Hernandez,whopaysamonthlypremiumofabout$73,saidheisnowmorehopefulaboutthefutureforhimandhisfamily.
BYTHENUMBERS
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• 38,152:NumberofDelawareanswhohavegainedaccesstocarethroughtheMarketplaceandMedicaidexpansionasofJanuary2016.
• 82%:PercentageofDelawareanseligiblefortaxsubsidiesontheHealthInsuranceMarketplace,withtheaveragemonthlypremiumaftertaxcreditat$150asofJanuary2016.
• $35million:AmountoffederalgrantDelawarereceivedtochangethewayhealthcareisdeliveredandpaidfor.
THEYSAIDIT
“I’vegonetothedoctorforexams,bloodwork,andmedicationstopreventfutureillness.Myhealthhasimprovedalot.I’mnotgoingtogobrokebecauseIgetsick.”~FelipeHernandez,whoboughtprivatecoverageontheHealthInsuranceMarketplace
FinancialEmpowermentandaStrongSafetyNet
SoonafterbecomingCabinetSecretary,Iaskedmyleadershipwhatthedepartmentwasdoingtofosterself-sufficiency.Theiranswerwas:Weprovidebenefits.
Ourmissionasadepartmentistofosterself-sufficiency,andwhilebenefitscansupplementinacrisisastheydidforsomanyfamiliesduringtheGreatRecession,theywillneverprovidefinancialsustainabilityorsecurity.
Delaware’shouseholdfinancialdemographicsspeaktotheneedforthisfocus.AccordingtotheU.S.Census,ofthe335,707householdsinDelawarein2013,42%hadincomesbelow$50,000,and29%hadincomesbelow$35,000.Manyofthesehouseholdshavetraditionallystruggledwithmonthlyexpensesthatexceedincome.Theyhavenosavingsorsafetynet,supplementtheirincomewithcredit,havelowcreditscoresandhighdebt,areexploitedbythe“fringe”financialsector,andlackaccesstomaintainfinancialservices.
WiththesupportofGovernorMarkell,welaunched$tandByMe,Delaware’sfinancialempowermentpartnershipwiththeUnitedWayofDelaware,in2011.$tandByMe,whichisheadquarteredinDHSS,hasasitscoreservicefreepersonalfinancialcoaching.Thecoachneverdictates,butratheraskseachcustomertoidentifytheirownchallengesandgoals,andcomewithacustomer-drivenactionplan.
WHATHASCHANGED
• ThroughJune2016,$tandByMehadservedalmost60,000Delawareansthroughfinancialcoaching,workshops,collegefinancialaidapplications,andfreetax
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preparation.Ofthose11,000haveparticipatedinpersonalfinancialcoachingtoimprovetheirfinancialwell-being.
• Collectively,$tandByMecoachingcustomershavereducedtheirdebtby$4.5million,increasedtheirsavingsby$2million,raisedtheircreditscorebyanaverageof52points,established5,056budgetsandestablished14,000personalfinancialgoals.Highschoolparentsandtheirstudentshavefilledout3,700collegefinancialaidapplicationsand7,409attendedfinancialaidworkshops.
• Inadditiontoitsemployer-andschool-basedprograms,$tandByMehasspecialprogramsforDelawareans50andolder,Hispanics,childcarefamiliesandemployees,aspiringhomeowners,veterans,peoplewithdisabilities,andstudentsincommunitycollegeandworkforcedevelopmentprograms.Becauseofthenumberoflow-incomeemployeesinDHSS,SecretaryLandgrafadded$tandByMecoachingasanemployeebenefit.
WHATWASDONE
• Tobuildsecurityforthefutureof$tandByMebeyondtheMarkellAdministration,legislationwasintroducedandpassedin2015tocodifytheOfficeofFinancialEmpowermentwithinDHSS.
• InMarch2015,DHSSwasoneof10statestoearnacompetitivefederalgrantforDelawareWONDER(WorkOpportunityNetworkstoDevelopEmploymentReadiness),aninnovativeprogramthatworkswithlocalpartnerstoprovidejobtrainingandintensivecasemanagementtoDelawareanswhoreceivefoodbenefitsandhavelimited
jobskillsorworkexperience.Throughthe$18.8milliongrant,about20percentofthe147,000Delawareanswhoreceivefoodbenefitswillbeeligibleforjobtraininginfourareas:constructiontrade,culinaryarts,manufacturingandbroadjob-placement.TheprogrambeganinFebruary2016andhas750peopleenrolledasofSeptember2016–halfparticipatinginthenewemploymenttracksandhalfinacontrolgroup.• TheeconomicimpactoftheGreat
Recessionaffectedtensofthousandsofindividualsandfamilieswhowereaccustomedtohelpingothers,notbeingtheoneswhoneededsupport.Today,whilethegrowthofenrollmenthasslowed,thenumbersremainhigh:222,000DelawareansareenrolledinMedicaidasofFiscalYear2017;147,000arereceivingfoodbenefits.UntilthefinancialchallengesthataffectsomanyDelawareansend–especiallythoseonthelowerendoftheincomescale–DHSSwillcontinuetoprovideastrongsafetynet.
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WHATITMEANSTODELAWAREANS
Threeyearsago,WaldemarColon,whoworksatDoverDownsHotel&Casino,andhiswifewantedtobuyahouse,buttheircreditscoresweren’thighenoughtogetamortgage.Waldemar,a$tandByMeclient,workedwithhisfinancialcoachand,together,theydevelopedastrategyforhimtoraisehiscreditscore.Withfinancialempowermentprovidedthrough$tandByMe,theColonsboughttheirhouse.
THEYSAIDIT
“Thisiswhywedowhatwedo.Itgivespeoplethefoundationandstabilitytotryandpursueabetterlife.”~GovernorJackMarkellattheJuly2015billsigningtocodifytheOfficeofFinancialEmpowermentwithinDHSS
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