South Carolina Department on Aging

1. South Carolina Department on Aging FY 2019-20 Budget Hearing

2. Agency Information • The South Carolina Department on Aging adheres to the core mission of the federal Older Americans Act (OAA) to meet the present and future needs of South Carolina’s seniors. Through its programs and services the agency enhances the quality of life for seniors through advocating, planning, and developing resources in partnership with federal, state, and local governments, nonprofits, the private sector, and individuals. • The vision set forth by the South Carolina Department on Aging allows for seniors and vulnerable adults to enjoy an enhanced quality of life, contribute to communities, have economic security, and receive supports necessary to age independently with choice and dignity by adhering to the core mission established by the federal Older Americans Act (OAA).

3. Department on Aging Overview • South Carolina Department on Aging has the following programs: • South Carolina Vulnerable Adult Guardian Ad Litem • Senior Community Service Employment Program • Medicare and State Health Insurance Assistance Program • Senior Centers • Long Term Care Ombudsman and State Ombudsman • Healthy Connections Prime Ombudsman • Nutrition • Legal Assistance for Seniors • Elder Care Trust Fund • Evidence-Based Disease Prevention and Health Promotion • Geriatric Physician Loan Forgiveness • Silver Haired Legislature • Permanent Improvement Project • Family Caregiver Support • Alzheimer’s Resource Coordination Center • Home and Community-Based Services • Home and Congregate Meals • Transportation, Home Modification, Home Chore, Personal Care, Homemaker, and Assessments

4. Recurring Budget Requests • Priority Number 1: State Ombudsman Program • Total Request: $93,750 General Funds • In Fiscal Year 2008, the State Ombudsman Program budget was reduced; however, the state requirements to investigate DDSN and DMH facilities were still required by state statute Section 43-35-15. The funds were never restored and the administration offset the reduction by using federal funds. • As of Fiscal Year 2018, the federal final rule does not permit the use of federal funds to fulfill state mandates to investigate DDSN and DMH. Therefore, the South Carolina Department on Agingwill need $93,750 to cover the actual cost to administer the program. The agency has adjusted the budget as much as possible to minimize the amount of the request to ensure compliance with all state and federal laws, regulations, and requirements. • The funding will assist in ensuring timely response to complaints filed on behalf of the vulnerable adult. The staff will be more visible in the respected areas and is a more proactive approach.

5. Recurring Budget Requests • Priority Number 2: Salaries and Employer Contributions • Total Request: $179,200 General Funds • When the agency budget was reduced in Fiscal Year 2008, the administration offset some of the reduction to federal funds. It has been determined that the shift was not allowable. The agency has realigned the budget to ensure compliance as well as reduce the amount of the request to the lowest amount; however, will need state funds to assist to offset. Total of $98,648 of salaries had to be reassignedto state funds. • A full evaluation of all staff salaries was conducted and realignments were made within compliance to federal and state regulations to reduce the amount of the request as possible. • The agency had to make several restructuring changes to best utilize the staff and ensure compliance with the federal regulations. • As the agency becomes a cabinet agency on January 1, 2019, the agency is expected to restructure to other similar size cabinet agencies. The agency relied on the Lieutenant Governor’s office to manage the agency communication and attorney duties, which are no longer available.

6. Recurring Budget Requests • Priority Number 3: Federal Matching Funds • Total Request: $734,998 General Funds • The agency has received the following awards from the U.S. Department of Health and Human Service: • In order for the agency to use the federal funds to provide services, it is required to provide matching funds or risk returning the unused funding, which could reduce future awards to provide services to the seniors of South Carolina. • As of October 1, 2018, U.S. Department on Health and Human Service reduce the grant period from three years to two years. Due to the overlap of the Federal Fiscal Year and State Fiscal Year, the agency needs the match for current funds as well as October 1, 2019 federal award in order to provide services. • The agency has taken into account of current appropriations and other funds available funds to offset the impact of the request.

7. Recurring Budget Requests • Priority Number 3: Federal Matching Funds • Total Request: $734,998 General Funds (Continue) • Factoring All Federal Funds and State Match, the agency will be able to provide additionalservice: • $3,366,449 additional funds will go towards: transportation, home care, home chore, assessments, legal assistance, homemaker, personal services, and modifications. • $2,060,657 additional funds will go towards Congregate Meals • $1,797,137 additional funds will go towards Home Delivered Meals • For $734,998 of matching funds can provide a total of additional services of $7,224,243. • Note: Unit rates for services vary across South Carolina. • $3,575,102 Administrative funds with 5% would be allocated to the South Carolina Department on Aging and remainder being allocated to the Area Agencies on Aging.

8. Recurring Budget Requests • Priority Number 4: Return Excess Authorization • Total Request: ($2,000,000) Earmarked Funds ($1,000,000) Restricted Funds • The agency no longer has the Veteran Directed Home and Community-Based Service Program; therefore, requesting the authorization in Earmarked funds to be reduced by ($2,000,000). • The agency has not received funds for the Emergency Rental Assistance Program for the second year as well as evaluated the restricted authorization funds to determine to request a reduction by ($1,000,000). • The agency supports the Executive Budget Office in preventing excess authorization in the budget. The agency will continue to monitor and evaluate the amount of authorization to ensure it properly reflects the amount the agency requires to operate.

9. New Proviso Requests • NEW: Information Technology Carry Forward • The agency received funds for Information Technology in the Appropriation Act in Fiscal Year 2018 based on the Department of Technology Operation determination. The agency is requesting that any unexpended funds from the appropriation shall be carried forward from the prior fiscal year and used for the maintenance of services as well as replacement of equipment. • NEW: State Ombudsman Program • The agency is requesting any unexpended funds from the appropriation for the State Ombudsman Program shall be carried forward from the prior fiscal year and used for the same purpose. The carry forward will continue to support the mandate from state statute 45-35-12 to investigate DDSN and DMH facilities.

10. Current Provisos • 95.1. (LTG: State Matching Funds Carry Forward) Any unexpended balance on June thirtieth of the prior fiscal year of the required state matching funds appropriated in Part IA, Section 95, Distribution to Subdivisions, shall be carried forward into the current fiscal year to be used as required state match for federal funds awarded to subdivisions on or before September thirtieth of the current fiscal year. Modify and Keep • 95.2. (LTG: State Match Funding Formula) Of the state funds appropriated under Distribution to Subdivisions, the first allocation by the South Carolina Department on Aging shall be for the provision of required State matching funds according to the South Carolina Department on Aging formula for distributing Older Americans Act funds. The balance of this item shall be distributed to the planning and service areas of the State. In the event state appropriations are reduced, reductions to the planning and service areas shall be based on amounts distributed in accordance with the previous requirements. Modify and Keep

11. Current Provisos • 95.3. (LTG: Registration Fees) The South Carolina Department on Aging is authorized to receive and expend registration fees for educational, training and certification programs. Modify and Keep • 95.4. (LTG: Council Meeting Requirements) The duties and responsibilities, including the statutory requirement to hold meetings of the Coordinating Council established pursuant to Section 43-21-120 and of the Long Term Care Council established pursuant to Section 43-21-130, both under the South Carolina Department on Aging, are suspended for the current fiscal year. Modify and Keep

12. Current Provisos • 95.5. (LTG: Home and Community-Based Services) State funds appropriated for Home and Community-Based Services shall be used to fund those services that most directly meet the goal of allowing seniors to live safely and independently at home. Allowable services as defined in the South Carolina Department on Aging State Plan include: group dining, home delivered meals, transportation to group dining sites, transportation for essential trips, personal care (formerly Home Care Level I), homemaker (formerly Home Care Level II), Home Chore, Home Modification, Legal Assistance, and Assessments. Area Agencies on Aging (AAAs) may expend no more than ten percent for administrative services and one-quarter of one percent shall be retained by the South Carolina Department on Aging to provide monitoring and oversight of the program. However, up to three percent of the annual state appropriation for Home and Community-Based Services may be retained at the South Carolina Department on Aging to be allocated by the South Carolina Department on Aging to the affected regions in cases of an emergency and/or natural disaster recognized by the Governor. If these funds are not utilized in the fiscal year allocated, they are to be treated as carry forward funds and reallocated to the AAAs. The Interstate Funding Formula shall be used as a guideline for the allocation of state funds appropriated for Home and Community-Based Services. The South Carolina Department on Aging shall develop and implement a structured methodology to allocate the state Home and Community-Based Services funding. The methodology shall include flexibility to reallocate funds amongst the AAAs, and be composed of, at a minimum, the following factors: a minimum base amount, the fiscal years federally allocated funds, federal and state carry forwards funds, and an appropriate weighted proportion that will achieve the mission of the South Carolina Department on Aging to provide as many services as possible to the citizens of South Carolina. Each AAA shall submit a budget for approval by the South Carolina Department on Aging indicating the services to be provided. Any unexpended Home and Community-Base Services funds in this program shall be carried forward by the South Carolina Department on Aging and used for the same purposes. Funds may not be transferred from the Home and Community-Based special line item for any other purpose. Modify and Keep

13. Current Provisos • 95.6. (LTG: Geriatric Loan Forgiveness Program) In lieu of quarterly payments to a recipient of the Geriatric Loan Forgiveness Program, the South Carolina Department on Aging is authorized to make a single lump sum payment to the lending institution of up to $35,000 or the loan balance, whichever is less. Modify and Keep • 95.7. (LTG: Caregivers Carry Forward) Unexpended funds from appropriations to the South Carolina Department on Aging for caregivers shall be carried forward from the prior fiscal year and used for the same purpose. Modify and Keep • 95.8. (LTG: Vulnerable Adult Guardian ad Litem Carry Forward) Any unexpended funds from appropriation to the South Carolina Department on Aging for the Vulnerable Adult Guardian ad Litem Program shall be carried forward from the prior fiscal year and used for the same purpose. Modify and Keep

14. Wrap-up • Currently, there is discussion among legislators and policy makers to identify services and programs suitable for the new Department on Aging. The Joint Committee to Study Services, Programs and Facilities for Aging was required to submit a report to the General Assembly by January 1, 2019. • One of the options being discussed is moving Adult Protective Services (APS) from the Department of Social Services to the Department on Aging. • The Administration for Community Living (ACL) has expressed concerns about possible conflicts of interest with APS being housed within the State Unit on Aging because it houses the Long Term Care Ombudsman program. While ACL officials have expressed concerns with this proposal, it has provided guidance showing the measures that would be required for both APS and Ombudsman programs being housed in the same agency. • The South Carolina Department on Aging is responsible for the Vulnerable Adult Guardian ad Litem (VAGAL) program. The South Carolina Department on Aging has identified several conflicts of interest if the agency housed both VAGAL and APS. There is an obvious conflict in APS’ and VAGAL’s missions. The agencies are often on opposing sides of cases and previously have sought legal resolutions utilizing attorneys.

15. Wrap-up • There would be an undetermined fiscal impact associated with relocating APS to the Department on Aging. The South Carolina Department on Aging presently lacks a comprehensive statewide infrastructure to house APS. The move would require opening and staffing 46 county offices, hiring staff attorneys and numerous new FTEs, and developing a new database system that serves APS. In addition, APS is primarily funded by a block grant awarded to DSS and those funds also serve Child Protective Services. That block grant would likely continue to be awarded to DSS and DSS would be responsible for providing the APS funding to the hosting agency. • Under the Older Americans Act (OAA), the South Carolina Department on Aging is mandated to serve older adults, age 60 and over. APS is tasked with serving all adults, age 18 and over. A large percentage of APS cases are Criminal Domestic Violence (CDV).