DCFS FY2010 BUDGET UPDATE Challenges & Opportunities

1. DCFSFY2010 BUDGET UPDATEChallenges & Opportunities ERWIN McEWEN DIRECTOR, DCFS MATTHEW A. GRADY III DEPUTY DIRECTOR, BUDGET & FINANCE January 28, 2010

2. STATEWIDE BUDGET DEFICIT $12 billion +

3. DCFS FY10 BUDGET OVERVIEW • The end of FY10 forecast remains balanced. • The balance of DCFS appropriations will be funded through a CSF supplemental since the State cannot provide any additional GRF support. • DCFS has not experienced any budget cuts affecting service, but there is no margin of error for cost overruns or revenue shortfalls • Every effort is being made to increase federal funding to the Children’s Services Fund (CSF) just to meet FY10 obligations

4. DCFS FY10 Achievements • Protect Core Services • Safety • Permanency • Well-Being • Maintain Benchmark Caseload Ratios for Frontline Staff • Fund & Support Key Programs: • Program Improvement Plan • Integrated Assessment • Trauma Informed Practice • Residential Performance Based Contracting • Family Advocacy Centers

5. DCFS Challenges Must Earn $26 m in New Revenue FY10 Budget Depends Upon Generating $26m Medicaid Counseling Expansion - $17 m Home of Relative Licensure - $9 m Increase Efficiency Control I/GH Spending Frontline Focus for New Hiring Procurement Savings Facility Consolidations

6. I/GH Cases Trending Up

7. DCFS Challenges – YTD Progress Must Earn $26 m in New Revenue FY10 Budget Depends Upon Generating $26m Medicaid Counseling Expansion - $17 m On track, but billing progress is slow. Home of Relative Licensure - $9 m Off track, trend is approx. $5 m. New Performance Foster Care Intake Goals (PROs) drafted to spur licensure achievement.

8. Childrens Services Fund (CSF)FY10 Cash Position Zero Margin for Error Projected Revenue: $406 m Projected Spending: $406 m Cash flow Challenges Critical Payments Prioritized Non-Critical Payment Delays Likely Critical Payment Delays Possible if GRF Cash is Low

9. Revenue Initiatives Efforts Needed to Maximize Base Federal Revenue Document services with client detail (ID, etc.) Respond accurately and timely to Random Moment Survey (RMS) Inquiries Maintain case files with all proper documentation Medicaid Counseling Expansion (by Line): Foster Care: $12.9 m Adoption: $ 2.2 m Counseling: $ 1.9 m

10. RMTS Foster Care Candidacy • Foster Care Candidacy is the provision under Title IV-E that allows DCFS to claim administrative costs for intact family case management. However, • To qualify, the child / family must be documented as a “Candidate for Foster Care” in SACWIS. • Thanks to training and collaborative efforts, the formerly low Candidacy Percentage has been growing (see chart on following page). • Our goal is to reach 70% or better in FY10 • Our goal is to reach 80% or better in FY11

11. RMTS Foster Care CandidacyDoubled in One Year, More to Come

12. HMR Licensure Progress

13. Medicaid Mental Health Services (I/GH) • April 2007—Federal mandate to move from comprehensive rate to Fee for Service • FY08–-Last Year for Comprehensive Rate; Fee for Service Development • Developed and tested Medicaid Web-Based Billing System • Staff training • Practice Month/Year – used the Billing System to practice claiming Fee for Service • Developed and received IPI approval of required Fee for Service Documentation • FY09–-Fee for Service Implementation; Providers Held Harmless • Full year of Fee for Service • Documentation Issue- Review of all documentation and resubmission • Extensive TA and training for staff for documentation of Fee for Service • Targets set based on not claiming RSA level staff • Hold Harmless year for meeting targets • FY10—Full Fee for Svc Implementation; No Hold Harmless • First year for full claiming and requirement to meet target – no hold harmless for existing programs

14. Medicaid Counseling Expansion • Expansion to enhance revenue from Children’s Mental Health Services • FY09 • January: began Medicaid certification of new agencies and sites for claiming of Medicaid services in foster care and counseling programs. • New Programs Held Harmless for Claiming • Began review for enhancing Administrative Claims • RMS Pilot • Reviewed All Contracts for Additional Claiming Potential • FY10 • Full Year of Claiming for New Programs • Adoption Preservation, System of Care (SOC) Pilots Begun

15. Medicaid Implementation Challenges • Fee for Service Documentation and Staff training • Fire Marshal Delays • National Provider Identification (NPI) numbers and Healthcare & Family Services (HFS) Enrollment numbers • Budget and Cash Flow Challenges • New Department and agency Policy and Procedures around providing and claiming Medicaid Mental Health Services

16. Medicaid Status Update • Newly Certified & Billing Begun: • 14 New Counseling and Post Adoption Counseling Providers • 43 New Foster Care Providers • 7 Independent / Transitional Living Providers • 58 New sites certified • 51 New contracts converted • 40+ Pending sites to certify • 30 Providers certified but not yet claiming • 15 Agencies slowly moving towards certification and claiming • 18 Providers not participating • Detailed Service Delivery data was previously unavailable, and has only been generated by the implementation of Medicaid Mental Health Fee for Service billing. This data has given providers information to improve the mental health delivery program within their agencies and given the Department the ability to analyze the effectiveness of Mental Health models and treatment programs.

17. Questions & Answers