Called to Order

 The meeting was called to order at 1:03 p.m.

Changes to Agenda

 The order of business was amended so that the County Administrator's Report will follow the discussion of Committee Goals and Cabinet Work Plan.

Human Services Coalition Report

 Ms. Robertson introduced Ms. Dill, Executive Director of the Human Services Coalition, who retires on April 29th after a long tenure at the agency.  Ms. Robertson thanked her for her work with the Coalition and other human service agencies.

 Ms. Dill provided the Committee with a report on the work that has been accomplished at the Human Services Coalition as well as her opinion on what can help the agency in the future.  She gave a brief history of the development of the Coalition and spoke of the work done behind the scenes, including the HSC Forum, the Homeless and Housing Task Force, major grant funding for homeless services, technology for human service agencies, rural health care, services for the elderly, and volunteer recruitment.  In addition the HSC also aids in the evaluation and stewardship of agencies for the county and the City of Ithaca.  Upcoming site visits by staff of the Coalition will be April 27 for the Drop-In Center and Offender Aid and Restoration, and April 29 to the Advocacy Center.

 Ms. Dill said if she had a recommendation to make it would be to increase staffing, noting that budget restrictions have caused stress as well as missed opportunities.  The second recommendation is increased advertising for the Information and Referral service and Volunteer Tompkins.

Debunking Myths about Universal Health Care Under a Single-Payer Plan

  Ms. Elgie, member of the Tompkins County Health Care Taskforce, spoke to the Committee regarding what is perceived as a dysfunction in the present health care system and the need to develop universal health care under a single-payer system.  She reviewed information distributed to the Committee, specifically the present bill in the State Assembly (A6575) being presented by Mr. Gottfried. The bill would set up a commission to evaluate alternatives to the current system in New York as well as expand traditional health care coverage.  She spoke of support of a single-payer system by Attorney General Spitzer as well as Senator Schneiderman, although no bills have been presented in the Senate as of yet.  The Committee was informed that at present California, Minnesota, and Maryland have a single-payer system and others are looking into it.  She said that at present, New York spends twice as much per person on health insurance as Canada and there is a need to spend money more wisely.

Ms. Kiefer spoke of her surprise at the amount of money being spent for marketing and advertising of health care plans.  She also said that many single-payer plans require small co-pays from participants, which she did not believe was clearly outlined in the material received.

Health Department

WIC Presentation

Ms. Gump provided a handout that summarized WIC, its history and service statistics, and described the process of going to a WIC appointment. She gave examples of people they have served.

She said typically people find out about WIC from a friend, or from their doctor or human service agency.  Ms. Gump explained the process of applying for WIC and examples of ways this program has assisted mothers and children.  She said that in Tompkins County, more than 1,550 people participate in WIC on a monthly basis.  Ms. Gump explained how WIC also reviews the needs of individuals to determine what other services they may be eligible for.  Additionally, she said when women deliver prematurely, the neonatologists strongly encourage breastfeeding to minimize health problems caused by formula feeding.  WIC has a hospital grade electric breast pump program for participants.  Women who deliver prematurely are the highest priority for receiving one of these pumps.  Almost all women on WIC who deliver prematurely in Tompkins County are able to borrow one of the breast pumps.

Ms. Gump said many people have benefited from participation in WIC, and the County benefits too.  Research has shown that women who participate in WIC deliver healthier babies; for example, 81% of women in WIC initiate breastfeeding of their babies. This translates to fewer Medicaid dollars to treat infants in neonatal intensive care units.  Additionally, the nutritious food package brings more than $850,000 federal food dollars to area grocery stores each year.

She said this year is the 25th anniversary of WIC in Tompkins County.  The Health Department has sponsored WIC for all these years. The program has benefited by being co-located with the MOMS program, Children with Special Care Needs, the Maternal Child Unit nurses, and the Lead program, among others.

Position Request

 Ms. Cole, Public Health Director, withdrew the position request at this time to consider restructuring.

Resolutions

RESOLUTION NO. - APPROPRIATION FROM CONTINGENT FUND -   REPLACEMENT PAY - HEALTH DEPARTMENT

 It was MOVED by Mr. Winch, seconded by Ms. Kiefer, and unanimously approved by voice vote of members present, to submit the following resolution to the full Legislature for approval.    MOTION CARRIED.

 WHEREAS, the Health Department has an employee out on medical leave for greater than two months in Children With Special Care Needs Program, and
 WHEREAS, the Fiscal Policy of Tompkins County allows for replacement pay from the Contingent Fund, now therefore be it
 RESOLVED, on recommendation of the Health and Human Services and Budget and Capital Committees, That the Director of Finance is hereby authorized to make the following budget appropriation:
 FROM: A1990.54440 Contingent Fund $2,405

 TO: A4047.1000519 Senior Typist  $1,730
  A4047.58800 Fringes   $   675
SEQR ACTION:  TYPE II-20

RESOLUTION NO.         - RESOLUTION URGING AMENDMENT OF NEW YORK STATE PUBLIC HEALTH LAW 4173 TO INCREASE VITAL RECORDS FEES – HEALTH DEPARTMENT

 It was MOVED by Mr. Winch, seconded by Ms. Kiefer.  Ms. Cole explained not all counties have a Vital Records department. Of those that do only Monroe County has received State approval to allow an increase in fees.  This resolution asks for support of the State legislation offered to allow the remaining counties, including Tompkins, to have this ability.  Ms. Cole said that while the legislation would allow an increase up to $30 (as the State charges), she does not expect that the County would charge the $30 fee at this time.

Mr. Proto arrived at this time (2:20p.m.).

In response to a question from Mr. Winch regarding the cost of genealogy searches, the Committee learned there is no charge unless the document is certified; however, these searches are set aside during busy times.  Additionally, it was noted that the full fee is charged for each certified copy of a document if multiple copies are requested.

A voice vote resulted as follows:  Ayes - 4; Noes - 0; Excused - 1 (Legislator Blanchard).  MOTION CARRIED.

WHEREAS, vital records are documents such as birth and death certificates that can be obtained directly from the State, under the jurisdiction of the Commissioner of Health, or from the “primary registrant” of a municipality, and
 WHEREAS, the State Commissioner can charge $30 per document, yet under Public Health Law, Tompkins County is only able to charge $10 per document, and
 WHEREAS, historically, the amount that the State has charged and the amount localities have charged for vital records have been in statutory lockstep and amending the Public Health Law would eliminate the current discrepancy between the fees charged by the State and the County of Tompkins for the same documents and establish a new permissive standard which would allow the County of Tompkins to charge up to the amount charged by the State for vital records, and
 WHEREAS, in July of 2004 the State amended the Public Health Law to allow Monroe County to charge up to the amount charged by the State for vital records, now therefore be it
 RESOLVED, on recommendation of the Health and Human Services and Budget and Capital Committee and the Tompkins County Legislature, That this Legislature urges the New York State Legislature and the Governor to amend Section 4173 of the Public Health Law to allow Tompkins County to charge up to the amount charged by the State for vital records, and
 RESOLVED, further, That the Clerk of the Legislature is hereby directed to send a certified copy of this resolution to the Governor, the New York State Legislators representing Tompkins County and all others deemed necessary and proper.
SEQR ACTION: TYPE II-20

Explanation:  The State has the ability to charge $30 per document when an individual requests the documents from Albany.  This legislation provides the same fee capability, if desired, for the remaining counties in the State with vital records departments.

Office for the Aging

 The Committee reviewed and unanimously approved budget transfers submitted by the Office for the Aging.

Committee Goals and Cabinet Work Plan

 Ms. Robertson met with the Human Services cabinet to discuss their goals for the year and coordinate their plans with the goals of the committee.  Included among the departments’ work plans was the task to monitor demographic trends, identify impacts on health and human services departments, and share findings with the Health and Human Services Committee.

Ms. Stein was asked to speak to the Committee about the impact of the "baby boomers" and elderly service needs.  Ms. Stein said the Cabinet has set up a Demographic Planning Committee which will look ahead at the next ten years, regarding what kind of services need to be reviewed and what agencies should provide them.  Age projections for the next ten years will be provided to the departments and agencies, as well as information on health trends, disability projections, expectations regarding State and Federal funding, workforce issues, dependency issues due to fewer workers, diversity, sexual orientation, and technological developments.  To the extent possible local data will be used although some information may require State or Federal data.  Ms. Stein said the departments and agencies will be asked to provide information on how the trends would affect their services and an estimated cost of services.  The project will be completed in approximately one year's time; the cabinet will work intensively on this project.

 Mr. Proto asked if the study will consider long-term health policies.  Ms. Stein said local and state departments will be polled.  She stressed the goal of the study is to create a practical plan for anticipated needs of residents in the next ten years.  This is a level up from the planning they usually do.  Mr. Winch asked whether the demographics would enable planning for the percentage of individuals in certain ages who would be disabled.  Ms. Stein and Ms. Cole said some of the information should be available but there may not be data specific to types of disability.  Mr. Winch said the information should indicate whether new nursing homes or hospital beds are necessary.  Mr. Proto asked what "holes" there are in long-term care.  Ms. Stein said she believes that would be a level of specificity the study may not achieve.  Mr. Proto spoke of financial difficulties facing nursing homes and potential closings and asked if they close how will it affect other services.  Ms. Stein said it is difficult at times to obtain statistical information from this group but enough may be provided to indicate trends.

 Ms. Robertson said this study will provide a model that will assist in making informed decisions in the future.

 The Committee discussed other goals noted in the work plan.  Ms. Kiefer asked if the listed goals were the same as previous years and was informed they are the general guideline that is followed.  Ms. Kiefer spoke of being able to compare work year-to-year.  Mr. Winch asked that Goal II, number 5 be amended to reflect "other additions," specifically noting a concern with gambling.  Mr. DeLuca said gambling is moving from mental health to substance abuse agencies.  At this time local providers are not doing a great deal of work in this area.  It is anticipated future funding will be provided to the substance abuse agencies for this service.

 Ms. Robertson asked the Committee to review the information provided and come back with suggestions.

County Administrator's Report

 Mr. Whicher reported that Ken Crannell of New York State Association of Counties reported in the Weekly Wire that the budget is the best budget for counties that he's ever seen; however there are problem areas such as Temporary Assistance for Needy Families (TANF) and Fund For Family Services (FFFS).  In addition, Workforce Development has been hit hard on the federal level.  Mr. Whicher had prepared a preliminary budget estimate for 2006, in which he added $300,000 for increases in mandates.  He said $2 million dollars is included for over-target requests and $1.5 million to address salaries.  He said that normally there has been at least a $1 million dollar increase and this year may be $3 million.  He also noted that Assigned Counsel came out alright this year.

Social Services

 Ms. Carey said she is unable to report on the impact of the new budget yet as she still hasn’t received information on the allocations from Albany.  She is sure there will be less money, so programs and contracts with agencies will be impacted. She expects child-care reimbursements will be hit the hardest, which could impact the ability of parents to obtain or maintain a job.  Mr. Whicher said Mr. Crannell has said the programs will be cut back; he anticipates the loss of TANF funding.  Ms. Carey will report back to the Committee following her meetings in Albany.

 The Committee reviewed the monthly reports.  It was noted that thus far, 2005 appears to be on track.  Ms. Carey said the budget the state just passed is for the year of July 2005 - July 2006.

 Ms. Carey said there may be increased expenditure in the institutional care budget line due to a placement of a youth in the Office of Children and Family Services, the most expensive institutional care.

Position Requests

 It was MOVED by Mr. Proto, seconded by Mr. Winch, and unanimously approved by voice vote of members present, to approve the filling of the Financial Investigator position in the Department of Social Services.

 It was MOVED by Mr. Proto, seconded by Winch, and unanimously approved by voice vote of members present, to approve the filling of the Caseworker position in the Department of Social Services.  It was noted that this position is the result of a promotion within the Department.

 A brief discussion occurred regarding the new State reporting system; Ms. Carey noted that to access this new program a caseworker must go through twenty-five separate functions. The software locks the computer if it is not used within a four-minute period.

RESOLUTION NO.     - APPROVING ACCEPTANCE OF LARGER GRANT FOR DAY CARE PROVIDER REGISTRATION, INSPECTION, AND COMPLAINT INVESTIGATION, WITH ASSOCIATED ADJUSTMENTS TO SUBCONTRACT TERMS AND COUNTY BUDGET – DEPARTMENT OF SOCIAL SERVICES

 It was MOVED by Ms. Kiefer, seconded by Mr. Winch, and unanimously approved by voice vote of members present, to submit the following resolution to the full Legislature for approval.    MOTION CARRIED.

 WHEREAS, the 2005 budget presently anticipates that the Department of Social Services will pass through to the Day Care and Child Development Council of Tompkins County $99,360 of 100 percent Federal funds to register, inspect, and investigate complaints regarding day-care providers, and
 WHEREAS, the Department has received notice that $8,391 in additional funding is available to support these activities, now therefore be it
 RESOLVED, on recommendation of the Health and Human Service Committee, That the Department of Social Services is authorized to accept and pass through to the Day Care Council the additional Federal funds through its “Day Care Provider Registration, Inspection, and Complaint Investigation” contract,
 RESOLVED, further, That, in order to reflect the increased value of the grant and contract, the Director of Finance shall make the following budget adjustment on this year’s books:

REVENUE   A6010.44610  Fed: Social Services Admin $8,391
APPROPRIATION  A6010.54442  Professional Services  $8,391
SEQR ACTION: TYPE II-20
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Mental Health Services

Approval to Apply - Clinical Case Management Grant

 Mr. DeLuca spoke of the opportunity to apply for a potential grant for the Medicaid Addition Treatment Services Program, which is a clinical case management program for persons with substance abuse disorders.  He explained this is a new clinical case management program being offered through the Office of Alcohol and Substance Abuse (OASAS).  The goal is to provide more seamless care by implementing a clinical case management program (case management has always been missing from the substance abuse system). One of the long term goals is to reduce Medicaid costs by providing timely services to reduce the need later for higher cost inpatient care.  Mr. DeLuca provided the following information:

"In State Fiscal Year 2002/2003 Tompkins County Medicaid spent $1,759,196 on OASAS substance abuse services for 510 different people. This includes inpatient, outpatient, methadone maintenance and detoxification services. 49 individuals (9.6%) accounted for $852,534 (48%) of this expenditure. Part of this goal of this program would be to prevent Medicaid costs through more timely interventions and to provide better coordination and appropriate services for individuals with frequent and costly inpatient utilization.

"It is a time sensitive new initiative with the application due to the state by May 20. We discussed this with you at our health and human services cabinet meeting on Friday April 8.   The state will pay 75% of the cost of this program but the county is required to provide a 25% match. We are exploring ways that we might be able to come up with this match.

"It is a collaborative project with DSS. Mental Health would write the grant and be the applicant. Yesterday, April 12, Patricia Carey and myself met with the OASAS regional director and field staff who felt that we would have a good chance in being successful with this application."

 Mr. Proto asked if a contingent fund request would be made in the event the twenty-five percent match is not obtained from other sources.  Mr. DeLuca felt the availability from OASAS would be expedient and he feels strongly the funds would be available.  Ms. Robertson inquired when the program would begin if this grant were received and was informed that it would be during 2005.  Mr. Winch asked what is being done at the present time for individuals with these problems and if in fact this would be a new program, and can it be done with present staff. Mr. DeLuca said some services are presently provided but this grant would provide for the care management.  He said that Substance Abuse Management has not occurred in the past.  The staffing for this program does not require county employees; it can be contracted with other individuals.

Ms. Carey reported that OASAS believes this program will become Medicaid billable in the future, which would shift from State and County funding to Medicaid over time.  Mr. DeLuca said that if it does become Medicaid eligible the twenty-five percent funding from the county would be returned.  Ms. Zahler said the service providers indicated this would provide services that are needed and not presently funded.  Ms. Carey said this would provide the ability to look at the high-end users of Medicaid going in and out of the system.  She believes this may bring agencies together to determine if there is a better way to serve this population and if there is a cost benefit.

 Mr. Proto asked if there is a commitment to the program for more than one year.  Mr. DeLuca said it would be for at least three years and would have the increased cost but there is the possibility a cost savings may occur through better coordination of services.

 Mr. Winch said he will support the application, knowing that there is a chance the cost savings may not take place.  Mr. Proto said he does not feel he can support the application without a clear understanding of the county's share being reimbursed.

 A voice vote to determine Committee approval to seek the grant as described resulted as follows:  Ayes - 3; Noes - 1 (Legislator Proto); Excused - 1 (Legislator Blanchard).  REQUEST APPROVED.

Youth Services - Recreation Partnership Request for Proposal - Program Providers

 Ms. Zahler reported that last fall the Recreation Partnership (RP) voted to develop a competitive bid process to determine whether there are program providers other than the Ithaca Youth Bureau interested in providing services for youth through the Partnership.  The RP has reviewed all services and chosen a core set of programs not to be included in the bidding; another sub-set of activities that are smaller and specialized will be included in the RFP.  On April 29th a bidders conference will take place from 1 - 3 p.m. for any interested parties.  An area that would have to be reviewed is the oversight of programs; presently the Ithaca Youth Bureau does all registrations as well as covers safety and effectiveness of the program.  If programs are contracted out there needs to be a way to administer and oversee those programs.

 Although the Recreation Partnership may decide not to contract in this manner after reviewing proposals, they want to see the level of interest at this time.

Cooperative Extension

 Mr. Schlather, Executive Director, reported the 2004 Annual Report will be available shortly for review.  He said there were three areas within the report he would like to highlight.

[Mr. Proto left at this time - 4:00 p.m.]

 Mr. Schlather said within Tompkins County there are two main resources, the land and the people.  He spoke of the present energy crisis and referred to ways to develop cost-saving and income potential in the County.  Mr. Schlather said biomass as an energy source is less expensive than natural gas, oil, and propane; in some instances it is half the price of oil, and approximately sixty to seventy percent less than natural gas.  Additionally, if wood were converted to electric production there are many places in the county that could produce electricity from wood such as some farms in the County.  He said with the use of wood in this way it would also utilize forest management.  Mr. Schlather reported there is approximately 160,000 forested acres and the average income is $100 per year/per acre net; NYSERDA has said there are 28,000 sites within the State that could be used locally to produce their own energy.

Mr. Schlather then spoke of having started a loan program, with funds from USDA and NYSERDA, to provide low interest loans to elderly rural poor for energy conservation upgrades to their homes. He will meet with approximately thirty community partners to discuss this program.  He indicated that the program would also assist in hiring more people within the county.

 Mr. Schlather then spoke of the importance of people within the county as a resource.  He said following a discussion it was thought to be beneficial to better determine how to increase entrepreneurial skills and development through volunteer work, thereby allowing for more positive economic development within the county.  This summer a Cornell University student will be conducting a study of Cornell Cooperative Extension's contribution to the county.

 Ms. Robertson inquired about the energy program and eligibility requirements.  Mr. Schlather said that while the program is income-driven it has fairly flexible guidelines.  Mr. Winch spoke of the need to perform this type of work in Newfield.  Mr. Winch felt that energy conservation could extend grant funds tremendously.  Ms. Carey indicated some individuals might be able to seek assistance when applying for HEAP programs.

Adjournment

 The meeting adjourned at 4:25 p.m.