HEALTH AND HUMAN SERVICES COMMITTEE APRIL 14, 2004 11:30 A.M. SCOTT HEYMAN CONFERENCE ROOM
Present: M. Robertson, Chair; T. Todd; B. Blanchard; N. Schuler; M. Koplinka-Loehr
Staff: S. Whicher, County Administrator;
N. Zahler, Youth Services Director; M. Dill, Human Services Coalition; J.
Johnson, Youth Services; S. Allinger, Health Department; J. Taylor, Health
Department; B. Crosby, Health Department; M. Banks, Social Services Department;
K. Schlather, Social Services Department; I. Stein, Office for the Aging
Called to Order
The meeting was called to order at 11:30 p.m.
Additions to the Agenda
A budget adjustment and transfer for the Office for the Aging were added to the agenda.
Chair's Report
Ms. Robertson said she did not have a report.
Report from the County Administrator
Prescription Drug Program
Mr. Whicher said he has been investigating proposals for
prescription drugs and updated the Committee on his progress. The counties
of Ulster, Broome, and Westchester are currently participating in a countywide
Rx program, including non-county employees. Mr. Whicher reported on a meeting
with a representative from Eckerd and said he discussed and explained the
County's situation. Eckerd provided excellent information and expressed
interest in administering a countywide program, but would not support the
purchase of Canadian drugs. He feels it is time to take this to the
next level and have an elected official become a spokesperson. Counties
have been preparing Requests for Proposals and Eckerd has been responding.
Mr. Whicher said one problem area identified in the budget last year was
the increased cost of prescription drugs which is driving up the health insurance
and fringe costs. He commented that more than $2 million in County
dollars are spent on prescriptions.
Mr. Whicher spoke specifically about a proposal and said
one idea is to bring everyone in the County into one group. He described
how prescription drug programs are set up. An average wholesale price
is established and a discount is negotiated, generally dependent on the size
of the group covered by the policy. The County's current program with
Eckerd is a 14 percent discount from the wholesale price if the prescription
drug is purchased at a pharmacy (30-day supply). If the prescription
drug is mail ordered, the discount is 16 percent. In the Westchester
County proposal, it appears the discount is 9 percent for prescriptions filled
at a pharmacy and 18 percent if the prescription is mail ordered (90-day
supply). In general, Canadian drugs are priced at 35% discount from
the average wholesale price. Mr. Whicher said the more people in the
prescription drug program, the higher the discount is. He feels the
County (a population of 100,000) should strive to get a 25-30 percent discount
and he will continue to pursue this until he is satisfied. County Administrators
throughout the State are meeting in early May to discuss this and County
Executives are already working on proposals. He hopes to bring a majority
of the counties together and make a recommendation; he was optimistic that
this could be implemented by 2005. Mr. Whicher said he is considering
contracting with the Human Services Coalition to assist with this.
Ms. Robertson commented on a meeting she had with several
individuals (Joe Scaglione, Maria Coles, and Jeff Furman) to discuss some
of these issues and feels there is significant public concern about health
care costs and people being uninsured.
State Budget Update
Mr. Whicher said he has nothing new to report about the
State Budget. Departments have submitted their estimates on the impacts
and said the Legislature will discuss that further at the retreat on April
27th. Currently, he is estimating a $1 million increase (10%) in overall
Medicaid expenses.
Mandated and Locally Controlled Spending
Mr. Whicher gave a brief overview of the Mandated and
Locally Controlled Spending (2002-2004) information being reviewed by the
Budget and Capital Committee. Ms. Robertson said she would like to
have the numbers for 2001 added to the list and will ask Ms. Thomas to provide
that information. She feels having those numbers will show a better
picture as she feels that was the last budget before mandates started to
dramatically increase.
Mr. Koplinka-Loehr summarized the Budget and Capital Committee's
review of the list and said a recommendation was made to move programs 4016
- Community Health Services and 4095 - Public Health State Aid from Locally
Controlled Spending to the Mandated Responsibility list. Following
a brief discussion, it was the consensus of the Committee to accept this
recommendation of the Budget and Capital Committee.
Ms. Robertson said she will work with Jackie Thomas about
including 2001 information and moving the two items as recommended above.
Rollover Summary
Mr. Whicher briefly reviewed the rollover summary and
said the Public Health Department has a 2003 deficit of $400,000 in the Certified
Home Health Agency program. He said the deficit was anticipated by
the Department, but not to that extreme. The fact that their rollover
deficit is less than $250,000 is due to midyear cuts the department made
last year as it saw their revenues come in lower than budgeted. The
Department is reviewing and documenting their records. One question
that has been raised and is being explored is whether the Department was
cut too much. In other words, there is concern that nursing staff was
cut so low that revenue from clients was affected, or perhaps that billing
was slowed because of a shortage in clerical staff. An interim report
is expected to be filed with the County Administrator by Friday and a final
report will follow once the accountant has come in and done his review.
Mr. Whicher said there will need to be a discussion on how to handle this
deficit at a future meeting.
Ms. Robertson said this was discussed at the Board of
Health meeting yesterday at length. Ms. Crosby spoke about some of
things staff is working on and the reports they are running. She also
reported briefly on recent billings and accounts receivables and said that
if all that money is received, the Department will have 40 percent of its
revenue for this year. Staff is looking at new admissions and there
is a small increase in unduplicated caseloads. Ms. Robertson requested
this item be discussed at the next meeting.
Mr. Whicher said there was a small deficit in the Department
of Social Services but said it is not of concern.
Youth Services
Ms. Robertson briefly reported on questions raised about
whether or not the County could contract with Cooperative Extension to perform
the functions of a County youth bureau. She learned the State’s legal
opinion is youth bureaus must report directly to the chief executive or administrator
of the county. Core administrative duties and monitoring functions
assigned in law to youth bureaus cannot be contracted out to Cooperative
Extension. She said there is still the possibility of contracting some
functions and will continue to explore the options.
Municipal Youth Services System and Highlights of 2003
Ms. Zahler briefly reported on the Municipal Youth Services
System and said this year they are celebrating 15 years. She shared
a map outlining the changes in the system over the last 15 years, and said
that 300 youth were served in 1987 with 0.15 FTE county staff support, and
in 2003 there were 2,901 youth served with 1.65 FTE county staff.
Ms. Johnson said the system enables the program to seek
out young people who do not participate in traditional school programs, community
programs, or recreational programs. Anyone can participate in the programs,
but there is a recruitment effort to reach those young people at risk.
This program allows equitable distribution of programs and resources throughout
the County.
Ms. Johnson explained some of the duties the professional
staff provides such as grant writing, assisting with community needs assessments,
youth surveys, broader community planning, etc. One example cited was
the need in Groton for a local summer camp. With county staff assistance,
they have pulled together local resources to develop a program to meet this
need.
Ms. Schuler suggested the written information provided
to the Committee be shared with the full Legislature.
Ms. Blanchard stated that as long as the County keeps
providing, the population being served will continue to grow to respond to
what is available. This is a trend that is somewhat troubling to her
and she feels that some of these children are not desperately in need of
these programs.
It was noted that the total budget for youth programs
has not decreased, only the distribution has changed, but the County funds
have decreased.
Mr. Todd feels the numbers of youth in the County are
decreasing based on school enrollments. Ms. Zahler said in fact the
numbers of youth in the county, based on the 2000 census, have not changed,
though they have moved around. At this time, there is a bulge in the
middle and high schools and there is a smaller number of elementary children.
Independent Living Survey Project
Ms. Robertson deferred discussion on this item due to
lack of time. However, she noted the one item that kept coming up in
the survey was the statement that there is nothing cheap or free for kids
to do in the County, and she related this to the value of the Municipal Youth
Services program.
Summer Camp Guide
Ms. Zahler distributed copies of the 2004 Summer Camp Guide at this time.
Health Department
Transportation Services for Special Care Needs
Ms. Taylor reported the current contract expires at the
end of August. The Department needs to develop a new contract and would like
permission to develop an RFP (Request for Proposals) for transportation services.
Following a brief discussion, it was the consensus of
the Committee to authorize the Department to bid the service and the Committee
will award. It was noted that the county receives a 50% reimbursement
for transportation for Early Intervention services.
Department of Social Services
Consolidated Services Plan
Ms. Schlather said the County is required to submit a
three-year Consolidated Services Plan to the State Office of Children and
Family Services. There are two parts of the plan. One is the
Administrative component that reviews the regulations around child care services,
funding sources, legal assurances, memorandum of understanding with District
Attorney's office, domestic violence services, and program information.
The second part of the report is the strategic component which reviews the
services for youth and families and preventive services for adults. Feedback
on the plan was received at a presentation at the forum and the public hearing.
Ms. Banks said the plan is a small part of all the goals and trends in the
children's services division. There were three other plans that were
required last year and some areas of those plans were incorporated into this
plan. The Consolidated Services Plan does not reflect the changes and
requirements staff will have to fulfill this year toward building a system
with an electronic case record for all the children's services. The
Department will have to implement the Chaffee's Independence Act and health
requirements and contract planning for children in foster care. One
of the major focuses in children's services for the next three years is to
help New York State reach its child welfare targets which are set by the
Federal government. If New York State does not improve with meeting
its targets, there maybe some financial sanctions. The Department agrees
with the targets that children should be safe, have permanent housing within
a certain period of time, and stability. There was discussion during
the community meetings concerning child welfare goals and the need to have
partnerships with community providers. The Department has contracts
for preventive service with many providers and will be focusing on goals
and measuring outcomes.
One area of plan the Department will focus on this year in the Child Protective
Services unit is recurrence of abuse. When it is verified that a child
was abused, the Department does not want to have a recurrence of another
incident. This is one area Ms. Banks is concerned with and said she
is putting together a team and will be working on this immediately to reduce
the rate of recurrence of indicated reports. It was acknowledged that
some of the increase could be due to improved reporting.
Ms. Banks commented that fewer children were placed in foster care in 2003, but more were readmitted.
Mr. Koplinka-Loehr was excused at 12:55 p.m.
Ms. Banks continued to provide an overview of the plan and said in 2002,
25 percent of the children who were adopted were adopted within two years
of their foster care placement. In the preventive services area, she
would like to continue providing intensive preventive services and support
for the facilitated visitation service offered by Cooperative Extension.
The caseload is increased for the Intensive Prevention Case Manager, so Ms.
Banks is watching that program. She would also like to continue the
contracts with Liberty Resources for Multisystemic Therapy and Youth Advocacy
Program for wrap-around services for youth and their families; she believes
these community based service plans help avoid institutional placement.
In addition, the Department would like to continue the Therapeutic After
School Program, which is a collaboration among area schools, Social Services,
and George Jr. Republic for youngsters who would otherwise almost certainly
be expelled from school. The Salvation Army contract for respite for
adoptive families is expiring, but the Racker Centers may take it over.
Ms. Banks noted that the piece on detention is not included in this plan
as it has been incorporated into the Youth Services Plan.
She reported one concern raised at the public hearing was transitional services
for teens, as expressed in the homeless youth survey, and housing for adult
protective clients. A lot of the overall caseload is teenagers.
Ms. Schlather said that the comments made at the forum and public hearing
can be made available upon request.
Office for the Aging
Program Updates
Ms. Stein gave an update on the funding concerns raised
at a recent meeting by Foodnet. It was reported that Foodnet may have
a $40,000 deficit this year; however on April 1, $12,000 will be added to
their budget and $16,000 will be added April 1, 2005, as ongoing funding.
In addition, an application was filed to request funding from the Community
Development Block Grant through the City; that proposal made the first cut
so they are hopeful that they will receive $15,000. This would make up $31,000
of the $40,000 shortfall.
Ms. Stein reported the Department lost $3,000 in Federal
funding this year. There is a waiting list of 21 people for the in-home
personal care and assistance program (EISEP). She is about to begin
negotiating contracts with various agencies and if increases are negotiated
there will have to be more cut hours and more waiting list problems.
Ms. Stein said the client needs right now total about $30,000 more than the
Department has in its budget. The preliminary report that the Department
received is that there could be a cut in State funding as well.
Ms. Robertson commented on a letter she received from
the State Office for the Aging concerning the annual evaluation of the local
office. The County Office for the Aging received praise for consistently
being highly motivated, creative, and effective in building partnerships
with County, public, and private agencies. The staff is assertive and
persistent in finding ways to meet the needs of the elderly population in
the County. Amidst ever increasing fiscal constraints, each annual
evaluation conducted by the State finds the Department in compliance with
State and Federal regulations.
Transfer
It was MOVED by Ms. Blanchard, seconded by Ms. Schuler,
and unanimously adopted by voice vote by members present, to submit the following
transfer to the full Legislature for approval:
From Acct
Title
Amt
To Acct Title(s)
6783-51000571 Salary
$200
6783-54330 Printing
6783-51000571 Salary
$200
6783-54452 Postage
Explanation: Transfer needed to cover the printing and postage for Needs Assessment project.
Approval of Minutes
It was MOVED by Ms. Schuler, seconded by Ms. Blanchard,
and unanimously adopted by voice vote by members present, to approve the
minutes of the March 24th meeting as submitted.