Windfall (dollars for more services)

Good news was announced by Community Human Services (CHS) at the 7/10/01 Board meeting by Interim Service Director Monty Martin. Martin explained that through improved time reporting, increased reimbursement rates, and the conversion of individuals to the Medical Assistance "waiver", that CHS has earned federal and state revenue above the amounts projected for the 2001 budget. In short, through the hard work of the CHS social service staff approximately $3.7 million annual revenue will be added to the department. This revenue carries federal and state requirements that the new funding be utilized to either expand needed service or pay for increased costs of existing services.

The maximum dollars allowed to decrease future costs will offset local levy dollars. Approximately $1.69 million will be reduced from the local tax levy in 2002. Paul Kirkwold, County Manager in his supporting comments said, "This is a unique opportunity to meet several goals; 1) reducing the local levy, 2) reducing caseloads, 3) improving service to individuals in need within Ramsey County, and 4) creating the staff complement needed to continue earning this level of reimbursement in future years.

As the presentation continued, Martin explained how the dollars would be applied to the three social service areas: Adult Mental Health, Children's Mental Health and Developmental Disabilities.

In the Adult area, the goal is to lower caseloads to 28 and to add nursing services to the intensive teams that work with clients in the community. Medication monitoring is a major factor in improving adult mental health. Janice asked about the relationship and coordination with Public Health in the hiring of nurses.

Kirk Fowler, Health Case Management Manager, stated that as CHS has moved toward a community treatment model it has been imperative that the nurses on the teams are there 24/7. Janice continued and asked, "if this should be an integrated model I would like some information on how this will be done." Chair Ortega stated he believes that this population needs a multi-professional team to address the problems and should be done on a consistent basis rather than contracting out with Public Health. Commissioner Reinhardt clarified nursing would be a common component. There may be a family or individual who would cross over and receive services from both Public Health and from CHS. There should be some way of making certain only one nurse is providing services.

Fowler responded that most of their client needs are not being met. Bringing those disciplines to the teams as much as possible is what CHS is trying to do. Kirkwold said he has had a concern for some time about possible duplication of services around the public health and human services issues. This is being discussed with public health and human services directors to make sure the division of responsibilities is appropriate not only in this area but in other areas. Currently, there is a shortage of nursing services in this area. Staff will have to be hired so those services can be provided.

Chair Ortega hoped that the "Model Employer Initiative" (see RRR, March/April, 2001 "Respect") would be part of the new hiring for all three services. Ortega would like a report back on how the new 39 positions are filled.

All Commissioners were pretty much in agreement to the rest of the plan as presented. Martin explained that in the Child Mental Health area an additional 75 children can be assisted per year.

Martin said, the area where the greatest amount of new revenue will be generated is that of developmental disabilities (DD). Through the efforts of DD staff over 600 individuals have been approved for the State medical assistance waiver program. The impact is such that they will have a full range of community services available to them and an increased choice of services. Martin said the financial impact on the County is very positive and comes in two ways; one is in increased case management revenue. The County can be reimbursed at the rate of $78 per hour from medical assistance on the amount of time spent on a case. The other portion of increased revenue relates to Day Treatment and Habilitation Services (DT&H), where many individuals with developmental disabilities go during the day for vocational assistance training and development. Staff is projecting $3.2 million of increased revenue per year. To obtain the new revenue, staff (28), must be added. The County dollars (local tax levy dollars) earmarked for DT&H services can be spent on other services. Staff is proposing a mix of increased staff and money returned to lower the County levy for 2002 in the amount of $1.7 million.

Janice asked if these dollars are sustainable. Martin answered in the affirmative and added that the increase of staff is the optimum number to maximize revenue.

And for the more difficult question, this year's budget: will we be seeing cuts in existing programs because of these funds. Martin said the County Manager's budget would be presented on July 24, but there should not be the same issues faced last year; i.e. reduced services for adult mental health and the near closing of Apollo (see RRR, Fall 2000, Budget 2001). Director Tom Fashingbauer said these revenues do not reflect a cut in any other service area.

Commissioners Rettman and McDonough requested clarification as to why the County is not able to take a $1.89 million tax levy cut. Instead, the County would take a $1.733 million reimbursement, but the extra $100,000 is basically needed to recapture all of this revenue to get it to the highest and best capacity. All the new staff will be County employees. The revenue would be sustainable. Another positive is that the County would be getting nearer to the standard caseload size, which is better for the staff in order to be productive. Martin responded in the affirmative. Martin said this is a "win, win" for many reasonsóclients will be much better off than in the past; the CHS department levy increase will be reduced; and it is good for staff. They have a commitment to work with the "Model Employer Initiative;" i.e. hiring of color, promotions from within etc. (see RRR, March/April 2001, Respect).

As euphoric as everyone was, reality is that many, many more dollars are needed for Adult and Child mental health as well as developmental disabled individuals.


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Author: Commissioner Rettman's Office / Information Services