HUMAN SERVICES AND THE NONPROFIT SECTOR IN HOWARD COUNTY

1. HUMAN SERVICES AND THE NONPROFIT SECTOR IN HOWARD COUNTY

2. Nonprofit Sector in Howard County • Comprised 8% of the employment (13,923) and accounted for 9% of the wages • 89% have budgets under $250,000 with only 6% having budgets over $1 Million. 67% have budgets under$25,000 • 29% are human service providers; 16% are health service providers; 28% are educational organizations

3. Challenges for Nonprofits • Limited funding opportunities • Rising cost of doing business • Attitudes toward nonprofit “overhead” • Increased demand for accountability & reporting • Attracting & retaining workforce with low wages and limited benefits • Limited capacity for strategic planning and development • NIMBY-ism

4. A Network of Partnerships Government • Faith-based Civic Groups Non-profit Agencies 501(c)3 s Faith-based For-profit Businesses

5. Examples of Network Members Children & Youth • HCPSS, Dept of Social Services, Child Advocacy Center, Recreation & Parks, DCRS – Office of Children and Families • Voices for Children, Family & Children’s Services, FIRN, Family Resiliency Center, Columbia Assn • Various youth programs/ministries • Child care providers, mental health counselors, tutors

6. Housing Dept Housing & Community Development, Dept of Community Resources and Services Howard County Housing Commission Grassroots, Bridges to Housing Stability, ReBuilding Together, Habitat for Humanity, Arc of Howard Co, Adaptive Living Multiple faith groups participating in the Cold Weather Shelter, Day Resource Center Nursing homes, assisted living facilities – also landlords, builders, realtors

7. How are Services….

8. Challenges for Service Providers • Increased demand for services • Complexity of cases which require intensive and comprehensive service plans • Funding that limits the flexibility of a service plan • Increasing diversity – language & cultural issues • Projected growth in older adult population • Lack of awareness among County residents that needs exist (i.e., homelessness and poverty) • High cost of “self-sufficiency” in the County

9. Howard County Household Income, 2012-2016 Table 1: Howard County Household Income, 2012-2016 Source: U.S. Census Bureau American Community Survey, 5-year estimates, http://factfinder.census.gov.

10. Howard County 2106 Self-Sufficiency Standard for Selected Family Types • Source: Center for Women’s Welfare, University of Washington; 2016

11. Bridging the Benefits Cliff When a raise means that you begin to lose benefits that keep you afloat, how do you make up for the loss of food stamps, childcare, health benefits….? • Gradual decrease in benefits • Benefit transition navigators to advise and support • Align timelines so people don’t lose all benefits at once

12. Health Policy Tracy NovakHoward County General Hospital Glenn E. SchneiderHorizon Foundation

14. We Share Similar Health Goals

15. Issue #1: Quality, affordable health insurance coverage

16. Issue #1: Quality, affordable health insurance coverage

17. Issue #1: Quality, Affordable Health Insurance Coverage

18. Issue #1: Quality, Affordable Health Insurance Coverage BLAH Behavioral Health

19. Issue #1: Quality, affordable health insurance coverage Picture Credit: www.medicaldaily.com/racial-disparity-health-care-high-costs-insurance-lack-access-keep-minorities-371452

20. Policy suggestions • [STATE] Protect Medicaid – nearly 45,000 low-income county residents depend on Medicaid for their care. • [STATE] Shore up the Exchange – nearly 7,000 residents in 2017 purchased insurance through the Maryland Health Benefit Exchange. Most received federal subsidies that reduced their overall insurance premium. • [STATE] Ensure network adequacy – continue to monitor and improve so that county residents can receive the right care, at the right time, in a language they understand, without undue travel.

21. Policy suggestions • [STATE] Support adequate reimbursement for providers – primary care and mental health providers are not adequately paid for the services they provide. • [STATE] Add a comprehensive dental benefit to Maryland Medicaid – all Medicaid enrollees should be provided a comprehensive dental benefit to improve oral health. • [COUNTY] Invest in behavioral health – ensure that treatment gaps in mental health and substance abuse disorder systems are filled, that navigation services exist to help residents who seek care, that community mental health services are available to families, that crisis services are available 24/7, and work to destigmatize seeking help for mental illnesses.

22. Policy suggestions • [COUNTY & BOE] Expand in-school mental health services pilot – if proven effective, the BOE and County should budget appropriately to expand services to students in all schools. • [BOE] Improve HCPSS data sharing – improved data sharing between HCPSS and the health department will lead to improved health and better service coordination for families.

23. Issue #2: Reduce chronic disease deaths through the enactment of policy changes, system reforms, and sustainable budgets.

24. Bucks and brains

25. Chronic disease deaths still high

26. Howard County AdultsHCHAS, 2016 * Of those who remembered getting their cholesterol checked

27. Howard County Weight Status TrendMD BRFSS 1995-2014

28. Issue #2: Reduce chronic disease Picture Credit: www.medicaldaily.com/racial-disparity-health-care-high-costs-insurance-lack-access-keep-minorities-371452

29. Key risk factors?

30. Raise the price of tobacco and sugary drinks

31. Fight state preemption of public health Blue colored states Preempt public health laws related to nutrition

32. Increase the budget for local public health Budget

33. Reduce sugary drink consumption

34. Be more walk & bike friendly

35. Continue to improve and implement Policy 9090

36. Issue #3: Support Investment in HCGH operating and capital programs • Like schools and public safety, healthcare is critical for building a strong and safe community. • HCGH is only hospital in a county that is growing and aging at twice the statewide average • HCGH is not the right size for the community we serve, but also strives to keep residents OUT of the hospital • Current state regulation does not allow HCGH to recoup cost of capital, and does not provide revenue for population health, behavioral health and other programs to keep county residents healthy, well and disease free. • A non-profit organization, HCGH is a partner in care with many other entities, including the health department, the fire department and HCPSS

37. Howard County 5-Year Population Forecast (2018-2023)

38. State support • Capital funding for HCGH through MHA bond program • Support a fully integrated system of care to fund behavioral health services and somatic services in the same manner, and increase access to care for behavioral health patients in emergency rooms. • Support expansion of Medicaid coverage of telemedicine • Opposes changes to current law that prohibits physicians from “self-referral” – referring patients to imaging centers or other services where they have a financial interest in equipment. • Liability: Support creation of no-fault birth injury fund

39. Workforce Development

40. Middle Skill Jobs • Howard County has a need for additional middle skill family supporting jobs. • Education more than a high school diploma but less than a bachelor’s degree • Jobs lead to a family-supporting wage (Baltimore region is $22.28/hr) • In-demand Family supporting occupations (2016-2026) • Heavy and tractor trailer truck drivers • Bookkeepers/Accountants • Trades These are jobs that low-wage workers can obtain with additional training and/or certification beyond high school, and fill the anticipated demand in the workforce.

41. Apprenticeships • Apprenticeship is an underused business model that can fill the skills gap for business and create more family supporting job opportunities. • Learn-while-you-earn” model combines on-the-job training, provided by the employer, with job-related instruction. • Apprenticeships are not limited to the trades. • Wages increase at pre-determined benchmarks as the apprentice’s skill level develops.

42. Childcare • Childcare costs may not be affordable for those earning less than a family supporting wage. At a family supporting wage the cost is challenging without supplemental financial support. • According to the Maryland Family Network 2016 Childcare Demographics report average annual cost for center-based care: • Infants - $19,150 • 2-4-years old - $13,555 • School aged children - $6,502 • Unaffordable childcare affects the business community, and has a significant impact on workforce participation, and can be a drain on US employers’ bottom lines.

43. How Can You Help? • Some individuals working low wage jobs may not be eligible for federally funded training based on family income guidelines. The county and state may identify ways to assist individuals that fall above eligibility guidelines but still may not be earning a family supporting wage. • Strengthen the region’s economy by securing Howard County’s share of family-supporting jobs by providing incentives for businesses to create middle-skilled jobs. • Encourage businesses to apply for funding through the state Department of Labor’s Innovation fund for new and innovative apprenticeship models. • Continue support for the state Apprenticeship tax credit thru which employers may be eligible to claim $1,000 per new registered apprentice per year. • Consider expanding after school care to include evening and weekend hours for individuals working those shifts. • Encourage businesses to create childcare facilities, that accommodate shift workers in county employment centers. Give priority to employees of those businesses. • Support continued funding for Head-Start. Introduce the Early Head Start programs for infants and toddlers. This creates the opportunity for more low-income workers to enter the job market.

44. Lack of Affordable Housing

45. Lack of Affordable Housing – Having a Home Is Out of Reach Estimated 27% of all households are renters in Howard County (29,000) • Of those, approx.33% have incomes below $50,000. For these families, there is a shortage of 6,600+ affordable rental homes. • The 2018 mean wage for Howard County households that rent a home is $19.98. At this wage, an affordable rent (not more than 30% of income) is approximately $1,039. The least expensive one bedroom for Howard County on Rent Café (on 9/10) was $1,066. • The maximum monthly rent that someone earning minimum wage ($10.10) can afford in the County is $525, but the average market rent for a studio is $918

46. Lack of Affordable Housing – Hurts Vulnerable Populations: Children, Seniors and the Disabled • HCPSS reported in May that there were 540 school students (approximately 235 families) who were homeless or experiencing housing instability and at risk of homelessness. • Seniors (65+ yrs.) comprise 13.4% of the Howard County population and 4.8% live below the poverty line. • In the State of MD, based on April 2018 data from the Social Security Administration, the average senior receives $1,482.87. Meaning they can afford a rent no higher than $422 a month without being rent burdened. • There are 22,089 individuals with disabilities who live in Howard County and 140 on the Maryland Department of Disabilities’ waiting list for project based rental assistance.

47. Lack of Affordable Housing - Contributes to Homelessness • More than 200 persons each day are homeless and a similar number are at-risk of losing their housing. • There have been between 330 and 430 households evicted each year for the past 8 years • Characteristics of the homeless population: • Situational - temporary/short-term, due to adverse events - loss of income, sudden expenses (particularly medical or major car repair), temporary disability, abandonment by a partner or fleeing domestic violence, often in combination. • Chronic (long-term), often suffering from addictions and/or mental illness, some living outdoors.

48. Opportunities • Create a task force focused on ways to house the County’s 540 homeless students currently enrolled in the public school system • Increase affordable housing development requirements through the upcoming rewrite of the County’s zoning code • Strengthen the Moderate Income Housing Unit (MIHU) program (including the fee-in-lieu component) to finance affordable housing. • Expand development fees, excise taxes & transfer taxes to finance affordable housing • Establish a local Housing Trust Fund • Fully-fund the soon-to-be updated Plan to End Homelessness (adopted in 2011) • An update to the Plan is underway &expected to be presented in November