Department of Health and Social Services Joint Finance Committee Fiscal Year 2013 Budget Hearing Rita Landgraf Cabinet S

1. Department of Health and Social Services Joint Finance Committee Fiscal Year 2013 Budget Hearing Rita Landgraf Cabinet Secretary February 21, 2012

2. OFFICE OF THE SECRETARY Management Services State Service Centers Social Services Public Health Medical Examiner Medicaid and Medical Assistance Long Term Care Residents Protection Substance Abuse and Mental Health Child Support Enforcement Developmental Disabilities Aging and Adults with Physical Disabilities Visually Impaired

3. Our Services DHSS provides services that Delawareans consume every day across the life spectrum – Birth to Death Medicaid; TANF; SNAP; CHIP, LIHEAP, AmeriCorps Subsidized child care and cash assistance; death and forensic testing; marriage and birth records; restaurant inspections; water safety testing; immunizations, monitors and control disease, cancer screening and treatment, provide substance abuse and mental health treatment, child support enforcement Services for: the aging, adults with developmental and physical disabilities, visually impaired, and other vulnerable populations Manages four long term care facilities and the state's only psychiatric hospital, the Delaware Psychiatric Center.

4. Our Services Must facilitate and empower individuals and communities to gain healthy outcomes, both in physical wellness and emotional well being; to gain economic self sufficiency, which will eliminate or limit long term reliance on government, and to protect and support those citizens most vulnerable due to advanced age, disabilities; and produce positive outcomes for the individuals we serve

5. LEVERAGING THROUGH COLLABORATIONS ACHIEVING GREATER GAINS FOR DELAWARE

6. Focus and Accomplishments Workforce Resource Alignment and Focus on Succession Planning Growing Together Portfolio

7. Focus and Accomplishments • Health Care Reform • Program Integrity • Tobacco Cessation • Emergency Diabetes Medical Care • Community Blood Screenings • Combining the CHAP and SFL Programs

8. Focus and Accomplishments • Mobile Crisis Service Partnership • Peers/Consumer Affairs • DOJ Settlement

9. Focus and Accomplishments • ADRC • Care Transitions

10. OUR CURRENT AND PROJECTED ENVIRONMENT CHALLENGES

11. Medicaid Eligibles

13. The Solutions Smarter Budgeting Core Service identification; triage; and partnerships Efficient Sizing Through strategic reviews, rightsizing and implementing non-traditional practices to support workforce and advance the Department to better meet the needs of our citizens Smarter Spending Rewarding performance, not just good intentions. Advancing evidence based practices leading to better outcomes for Delaware’s citizens Smarter Management Using flexibility, supporting each other across the Department and across the administration. Ensuring resources are expended where needed and avoiding unintended consequences

14. Solutions to Gain Self Sufficiency and Advancement TYPICAL FINANCIAL CHALLENGES of Some of Our Clients • The following financial issues affect thousands of Delawareans struggling to make ends meet, pay bills, and survive: • High debt for medical, student loan, and credit cards • Low credit scores • Lack of access to financial services and products • Exploitation by the “fringe” financial sector • Monthly expenses that exceed income • No savings or safety net

15. FINANCIAL EMPOWERMENT SERVICE PACKAGE Goal: Increase financial capability and management of personal finances Personal Financial Coaching and Education Budgeting, debt, financial goal setting, savings, and personal money management Financial Services Work with banks, credit unions, and non-profits to develop and increase access to consumer-friendly savings, loan, and transaction products Post Secondary Education Services Financial planning for post-secondary, FAFSA applications, managing student loan debt Community Referrals Debt consolidation, foreclosure assistance, free tax preparation, matched savings programs, tax problems, home ownership counseling

16. Our Prioritization Rationale

17. Top Priorities • Improving the health of Delawareans and show through statistical analysis - Health Care Reform opportunities • Streamline service delivery to meet the demands of increasing population - to effectively collaborate within DHSS so that customers receive the maximum possible service as seamlessly as possible • Preserving services to our most vulnerable populations • Community living focus – re-alignment and re-allocation • access for those who are at DPC clinically ready for discharge • State operated LTC and diversion supports • Provide high quality customer service – both in interpersonal interactions and in addressing the concern presented • Strive to offer programs that empower or assist clients in self-improvement and to rely less on entitlements – engage peer specialists

18. Top Priorities Community-Based Enhancements • Systemic practice in discharge/transitional planning • Flexible budgeting between facilities and community programs - building the continuum • Continued assessments to ensure appropriate levels of care • Transforming wrap around services to meet people where they are, rather than transferring person in need, unless it becomes a necessity

20. DHSS State Budget Overview

21. Other Cost Saving Means Including The Use of Technology

22. Other Cost Saving Means Including The Use of Technology (cont’d)

23. Building a Healthier Future Together we will create a culture of health and wellness in Delaware

24. Budget (in millions) FY 12 GF Budget $997,995.1 FY13 Budget Adjustments Base, Structural & Inflation Adj. $ 31,071.1 New/Expanded Programs $ 19,934.4 FY 13 GRB $1,049,000.6 (5.1% Increase)

25. FY13 - Governor’s Recommended Budget GF Base, Structural, Inflation/Volume Adjustments - $31,071.1 & (10.4) FTE’s DSS Childcare Fair Market Rate and Caseload DDDS Annualize FY12 Special School Grads DDDS Annualize FY 12 Residential Medicaid Increase Provider Increase New/Expanded Programs $19,934.4 & (3.3) FTE’s DSAMH Community Expansions DDDS FY13 Special School Grads DDDS FY 13 Residential

26. FY13 - Governor’s Recommended Budget (cont’d) Appropriated Special Fund Allocation DPH Medical Marijuana includes 4 FTE’s and a $480.1 allocation