Fiscal Year 2013 Budget Hearing Office of Management and Budget Legislative Hall Senate Chambers Wednesday, November 2,

1. Fiscal Year 2013 Budget Hearing Office of Management and Budget Legislative Hall Senate Chambers Wednesday, November 2, 2011 Rita Landgraf Cabinet Secretary

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. Focus and Accomplishments • Workforce Resource Alignment and Focus on Succession Planning • Quality Control/PERM • Growing Together Portfolio

4. Focus and Accomplishments • Health Care Reform • Program Integrity • Diamond State Health Plan Plus • Electronic Health Records • Tobacco Cessation • Emergency Diabetes Medical Care • Community Blood Screenings • Combining the CHAP and SFL Programs

5. Focus and Accomplishments • Mobile Crisis Service Partnership • Peers/Consumer Affairs • DOJ Settlement • Eliminating the drug felony bar • DACSES Replacement Project,

6. Focus and Accomplishments • New Certification Standards • Established an internal Protection and Advocacy Team • ADRC • Care Transitions • Diamond State Health Plan Plus-

7. Managing In This Economy Balancing the Demand with Supply While Advancing the Mission

8. Financial Challenges Intractable? A “perfect storm” – the convergence of: • Inexorable cost drivers: • Double digit annual increases in health care costs. • Pension (and Social Security) obligations as population ages. • Rising debt and debt service.

9. Federal Fiscal Picture

10. 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 – re-alignment of human resources within priorities of service • 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

12. Cost Avoidance/Cost Savings Right Care, Right Time, Right Place – Building Access to Community Managed LTC

13. State LTC Picture

14. Cost Avoidance/Cost Savings • Continuum of Care Contracting in Mental Health • Promotion of Self Sufficiency through Financial Empowerment

15. Cost Avoidance/Cost Savings • Contract Management • Training

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 • Consolidate financial services management in all divisions under one umbrella/ DHSS unit • Use technology and human resources to maximize efficiency, productivity and service delivery • Create employment opportunities, enhance education and promote a more efficient government • Maximize federal and state funding to help Delaware residents achieve maximum independence

19. 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. Our Services and Our Budget 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.

21. CHALLENGES: OUR CURRENT AND PROJECTED ENVIRONMENT

22. Special Guest Appearance Lily

23. Medicaid Eligibles

27. Budget Process • FY12 GF Budget $997,995.1 • FY13 Door Openers - Resources needed for increased volume, annualizationIncrease of 6% needed • Requested New Dollars $ 69,482.2 • FY13 GF Target = $1,067,477.3 7% Increase over FY12

28. Door Openers - $59,557.6 DMMA – Medicaid $30,509.2 FY 13 Budget Request - $1,067,477.3

29. FY 13 Budget Request - $1,067,477.3 Door Openers (Continued) DOJ/DPC Settlement $10,660.1

30. Door Openers (Continued) DSS – Purchase of Care $ 8,549.6 DDDS - FYF FY 12 Placements FYF $ 2,897.3 DDDS - New Community Placements/ $ 3,938.5 Special School Grads FY ‘12 Salary Policy Contingency $ 3,002.9

31. Major Enhancements ADRC (DSAAPD) $1,326.0 DHIN Transaction Fees (DMMA) $1,018.8 Disproportionate Share Match (DMMA) $4,000.0 DIMER/DIDER (Off. o/t Secretary) $ 507.5 Reduce Community Based Services Waiting List (DSAAPD) $ 500.0 Electronic Medical Records (one-time) (DSAMH) $ 500.0 Delaware Community Cooperative Agreement (DPH) $ 333.5 Increase Personal Needs Allowance (DMMA) $ 74.6 Other $1,719.6 FY 13 Budget Request – (cont’d)

32. FY 13 Budget Request – (cont’d) Structural Changes ($42.9) & (13.0) FTE’s • Mail Services to OMB (DMS) (1.0) FTE’s and ($42.9) • Vacant FTE’s to Dept of State (DSAMH-DPC) (12.0) FTE’s • IRM Consolidation (DMS, DPH, DCSE) • DSSC IPU Consolidation

33. FY 2013 Capital Budget Request Project Name • Maintenance & Restoration • Minor Capital Improvement • Roof Replacement • IT Projects

34. Capital Budget Request (cont’d) • DPC Deferred Maintenance • DHSS Carvel • Drinking Water • Water Management Account • EMS Renovations • Psychiatric Hospital

35. Remaining Challenges: • Super Committee Deliberations – Potential Forced Federal Budget Reductions • Economic Spillover Impacts – Euro Zone Issues Continued Domestic Economic Fragility • Shift from Institutional Based to Community Based Services • Meeting USDOJ Mandates • Preparing the Department and State for Healthcare Reform

36. Partnerships • Delaware State Housing Authority State Rental Assistance Program • Early Childhood Education – Providing cross cabinet support with a focus on Kindergarten readiness • I-Adapt – Individual Assessment and Discharge Planning Teams • Workforce • Community Partners