Board of Social Services Minutes
May 19, 2014

Commissioners' Conference Room
Second Floor – County Administration Building
10 a.m. – 12 p.m.

In Attendance: Commissioner Lew Gaiter, Commissioner Steve Johnson, Commissioner Tom Donnelly, Linda Hoffmann, Laura Walker, Marsha Ellis, Kelly Morrison, John Gillies, Tamara Schmidt, Lori Metz, Ann Marie Grobarek

A recording of this worksession is available at: http://larimer.org/bcc/list_worksessions.cfm

Introductions & Announcements
Commissioner Donnelly welcomed everyone and called the meeting to order.

Deputy Director Laura Walker asked if there were any additions to the agenda and mentioned that she wanted to report on the Department possibly taking over Medicaid application processing currently being done by Maximus.

Adult Protection Update
Adult Protection Manager, Lori Metz, reported on changes Colorado law requiring mandated reporting for at-risk elders and the new computer system that will track and record Adult Protection work starting July 1, 2014.

Colorado had been one of three states that did not mandate reporting for Adult Protection concerns. Starting July 1, 2014, certain professional people are mandated reporters when they suspect physical or sexual abuse, caregiver neglect, or exploitation of "at-risk elders", meaning anyone over the age of 70.

  • The process requires the reporter to call law enforcement, who must share the information with Adult Protective Services (APS) and the District Attorney's office within 24 hours.
  • The law mirrors a number of details that are in the child protection statutes, like penalties for false reporting.
  • Still unclear on how law enforcement will forward information on reports to APS, but Lori and John Gillies, Deputy Division Manager, are meeting with law enforcement agencies to clarify that process.
  • The State has provided funding to train mandated reporters, work with elderly people, and allow APS to add one more caseworker to bring caseloads to 25 cases per employee.
  • Larimer County generates 10% of the total APS referrals for the State, which is the second highest number of referrals for the counties in Colorado.
  • APS estimates referrals will increase 15-20% with mandated reporting.

Commissioner Gaiter asked that next quarter the Client Activity Report separate Adult Protection cases from the Options for Long Term Care cases to report on the effect of mandated reporting.

Commissioner Donnelly asked who investigates these referrals. Lori responded that the idea is to put crimes into the hands of law enforcement first, and then Adult Protection investigates cases of people who are unable to care for themselves or choose not to.

Commissioner Gaiter asked if a "caretaker" is defined as someone who is licensed or if that includes someone else. Lori replied that the definition is still unclear but a "clean-up" bill is already in the works to clarify the statute and provide definitions.

Lori explained that the State provided one million dollars to counties to provide services to at-risk elders. Larimer County had approximately $73,000.00 of that money, and we have distributed it by providing services like deposits for assisted living and paying for utility bills or legal fees for clients. Larimer County has provided the most services out of all the counties. Services offered are voluntary for the families, and some adults may choose not to take advantage of our involvement even though their community may want them to do so. Frequently the community is concerned about someone they see in the neighborhood, but adults have the right to make their own decisions about how to live their lives and may reject services we offer. This is sometimes difficult for communities to understand, so Lori has done at least 13 presentations educating the public on this topic in 2014.

Caseworkers will start using a new computer system, Colorado's Adult Protection System (CAPS), to track Adult Protection referrals and cases starting on July 1, 2014. Lori was very involved in discussing APS needs during the development of the system. The system is web-based, which means that caseworkers can add to it in the field. The state APS office will maintain and support CAPS. Historical information will not transfer over from CBMS, but the system will allow Lori to do things like get a report on a caseworker's current caseload, provide canned and ad hoc reports, and allow for a number of things that are not currently available through CBMS.

Temporary Assistance Needy Families (TANF) Funding Update
Deputy Director Laura Walker thanked Commissioner Johnson for his efforts in working with Joni Friedman, the Workforce Center Director, and DHS to get additional funding from the State. Over the last four years, the State decreased funding for Larimer County TANF by 20% due to changes in the allocation formula. Because the amount of cash assistance provided to those who qualify for benefits is the same or higher, DHS has had to make tough decisions on where to cut back expenses. Commissioner Johnson worked with Senators John Kefalas, Kevin Lundberg and Vicki Marble to add to the Long Bill (the General Appropriation Act) that Colorado use two million dollars of federal incentives previously paid to the State for meeting the work participation requirements of the TANF program to assist counties pursuing a jobs-focused strategy in facing the challenge of reduced allocations.

The Long Bill passed, so now the Works Allocation Committee (WAC) is responsible for deciding how to distribute the available funds. Larimer County recommends a county have the following criteria in order for a county to receive funds from the two million dollars. These recommendations will be made to the WAC at the CCI Conference in June. If accepted, it will slow down some funding cuts in the Workforce Center:

  • An employment-focused Memo of Understanding with the State for TANF
  • Over 50% of the monthly allocation amount for TANF that is committed to cash assistance
  • A projection that their allocation will be overspent for the fiscal year of 2013-2014, not returning any allocation money at the end of the year
  • No other TANF mitigation options

Marsha Ellis, Benefits Planning Division Manager, then explained how the funding cuts have affected the TANF program and how our clients work with the Workforce Center at this time. The Department has submitted a proposed employment-focused Memo of Understanding to the State, but there has been no feedback on the memo yet. The State invited Larimer County to training for counties considering being part of a new MOU not focused on work participation.

The Workforce Center has submitted a plan for their Reduction in Force, and sent a letter to the TANF participants informing them of the reduction in services and staff. The Workforce Center reports that the reaction from clients is mostly concern that their cash benefits will end.

Commissioner Gaiter asked how often you have to reapply for the program. Marsha responded that recertifications happen every six months. The TANF program has a cap on participation of 60 months for most people. The program requires the participant complete 32 hours a week of qualified activities, and they lose their cash assistance over three months if they do not participate. Clients can apply for extensions, although applications do not happen frequently and are rarely approved.

CCAP Legislative Update
Deputy Division Manager, Kelly Morrison, provided an update on the Child Care Assistance Program (CCAP) waiting list, explaining that there are 103 families with 153 children on the list, which started in February of 2014. Kelly explained that the CCAP allocation has dropped 19% since the fiscal year 2009-2010. The 2014 allocation was 3.6 million dollars, and we have spent 87.5% as of March, which is nine months into the fiscal year. In comparison, the other large counties have spent an average of 69% of their allocation. Other counties who have spent over 80% include Arapahoe County at 80.8% and Boulder County at 95.6%. Larimer County expects to overspend the allocation by $631,791.00, which the State has verbally promised to cover from a twelve million dollar reserve that the State has and can only keep for three years. The State makes this decision annually and it is not determined until late in the fiscal year.

Tamara Schmidt, Income Maintenance Manager, explained that the priorities set for the current waiting list would bring families with teen parents off the list first, but only three families are in that category. Commissioner Donnelly asked why teen parents are prioritized, and Tamara explained that teen parents are considered “per rule” to be a “special population. The other category listed as a special population per rule requires being under 130% of the Federal Poverty Guidelines (FPG), and the other 100 families on the waiting list meet that criteria.

County Manager, Linda Hoffmann, asked if the need for child care assistance has increased because employment is up. Laura indicated that the demand for child care assistance is strong in Larimer County because of the number of people aware of the program. Changes in who is eligible for the program will only increase the demand, which will result in larger waiting lists. Tamara said that historically waiting lists have resulted in potential clients either not applying for assistance or finding other means of providing child care. Commissioner Donnelly asked for clarification on how often we have had a waiting list, and Tamara explained that the first waiting list was in 2010, but it has been 1-2 years since our last waiting list.

Tamara explained some items from the Child Care Omnibus Law that will impact our County:

  • A tiered reimbursement system for providers will start in 2016. Counties can opt out of the requirement but would have to go through a number of steps.
  • The following items will increase the number of families who qualify for the program, which will most likely increase the number of people on a waiting list.
    • Raising the entry level into the program to 165% of FPG,
    • Covering families for an additional 90 days if a family is over the threshold amount at the twelve month recertification, unless they exceed 85% of the Median State Income,
    • Making the exit level higher than 165% of FPG if the county has an entry level at less than 185%,
    • Providing coverage for 60 days of job search activities instead of 30 days, within a twelve month period,
    • Requiring coverage for parents enrolled in post-secondary education for up to two years, subject to appropriations.
  • Statewide, a one-time allocation of 75 million dollars is available for the program, which results in approximately $300,000.00 for Larimer County.
  • In addition to regular daily rates, the County will be required to pay absences and holidays, depending upon the quality of the provider (from six to fifteen days per year).

The handout shows the percentage used to determine allocation, which was changed for the 2013-2014 fiscal year. Commissioner Donnelly asked how many families are currently covered, and Tamara said that as of last week, approximately 548 families were covered, 661 families including those covered through TANF for job-searching activities. Commissioner Johnson asked about the belief that some advocates for these changes were trying to increase the number of people on the waiting list in order to capture metrics to determine the need for child care. Laura replied that this will not be effective because less people apply for the program when they know there is a waiting list.

Client Activity Report
Ann Marie Grobarek, Business Operations Coordinator, presented an overview of the department's client activity. Ann Marie reviewed: monthly average caseloads, program activity, complaint totals, and client follow-up survey regarding complaints from January 1, 2014 through March 31, 2014.

During the 1st Quarter of 2014:

  • The 3rd Quarter number for Food, Medical & Financial Assistance programs was changed to 29,960 for a more accurate estimate. Previously, the number reported had been an average of two months, but the corrected number is an average of three months, with an estimated number created for the third month.
  • The percentage of increase or decrease from quarter to quarter is now marked on the monthly average caseload graph.
  • The total number of Benefits Information Center calls will no longer be on the report as the business process now in place no longer uses the 5-9 software and has distributed phone calls away from a call center model. BPD is saving $25,000.00 a year by removing the software.

The Commissioners asked if the marked increase in number of cases from the 3rd Quarter of 2013 to the 4th Quarter of 2013 was due to Medicaid. Laura confirmed that it was, explaining that March of 2014 had 25,000 cases just for Medicaid. Commissioner Gaiter asked that Adult Protection cases be broken out from Options for Long Term Care cases starting next quarter. Commissioner Johnson asked why we had moved away from a call center. Laura explained that now that the department is catching up with the backlog, there are less phone calls from people asking what is going on with their case, and the call distribution through Shoretel allows a few people on each team to take calls.

Commissioner Gaiter asked if there is a pattern of complaint numbers spiking at the beginning of each year. Laura promised that Ann Marie would collate the numbers and report to the Commissioners, County Manager and Assistant County Manager after the meeting.

Commissioner Gaiter also wanted to know if there is any way to measure if people do not complain because they are afraid of retaliation. Laura replied that anecdotally that would make sense, but it would be difficult to measure. Commissioner Johnson replied that people could go to the independent ombudsman or the State Department of Human Services. Marsha added that BPD clients have the ability to have a County evidentiary hearing and they can call the State if they feel the County is not handling their case appropriately. Laura said that she is the Goal Steward for Customer Service for the County, and one of her Objective teams is working on finding a tool that will be applied across the County to get customer service feedback. Laura said it would be nice to know that people are not afraid to complain. Ann Marie added that there is a clear message on how to complain that is on our Website and that is distributed to clients on a regular basis.

Other Business
Laura explained that staff from the Colorado Department of Health Care Policy and Financing (HCPF) had come to the CHSDA Economic Security Sub-PAC meeting in March to let the counties know that the contract for Maximus ends in June 2014. They wanted to know if the counties would be interested in taking back the processing of Medicaid only applications because of problems with Maximus, including poor customer service, processing backlogs, and errors. Laura explained that our experience is that we get about 350 cases back from Maximus a month, and about 50% of them have errors. Sometimes the error is not a mistake in processing, but a different way of entering information in CBMS that negatively affects eligibility for other programs. So Larimer County is already spending some workload supporting Maximus work without being paid for it. An informal vote of about 35 counties resulted in the majority agreeing to pursue processing Medicaid only applications.

Rough estimates are that it would be an increase of about 14% of our volume and the State would provide an additional $200,000.00 for the work. The State wants to have only one contract that includes all the counties, so the next step is for a formal vote at the CHSDA summer conference. Additional funding cannot be used for capital expenditures, but can be used for extra employees. Maximus will still collect fees for CHP+ and provide phone support for questions related to fee collection.

Linda wanted to thank us for the invitation to see the speaker from Child Protection, Naomi Griffin. Linda said she was struck by how perfect her comments were for our employees because of how stressful the work can be and how close to our clients our employees can get. Naomi showed a lighter side to the work and that a great sense of humor can help alleviate stress. It was a good management move to bring in such a perfect speaker.

Commissioner Johnson asked about the County Administration money in the budget. He said the State had really underfunded it before, but he wanted to know why there was a big increase this year and if it was a one-time increase. Laura explained that it was an 8 million dollar individual grant in order to make up the lack from previous years. Commissioner Johnson suggested that we might want to talk about it during the next BOSS meeting.

Laura said that the next BOSS meeting will also include a presentation on how far we have come with the changes in BPD. There will be enough data to show the effect of the process changes.

Commissioner Johnson asked that we also present on the real time child protection information available on the State Website that is searchable by county.

Meeting adjourned.