Budget Committee Presentation December 2, 2008 Family and Social Services Administration

1. Budget Committee PresentationDecember 2, 2008Family and Social Services Administration Draft

2. FSSA: A Healthcare Financing OrganizationSFY10 and 11General and Dedicated Fund requests, excluding HB1001 impacts ($ millions) $287 Mental Health Disabilities & Rehabilitation $182 Medicaid Admin $44 Maternal & Child Health Aging $68 2009 State Medicaid Assistance Appropriation $1,617 Million Draft

3. General Fund Budget • Three components • Operating Budgets • Healthy Indiana Plan (HIP) • Medicaid Assistance • Will be reviewed on December 11 Draft

4. Division of Aging Initiatives • Created on July 1, 2006 • Expanded community opportunities • OPTIONS program created, promoting community alternatives for those unable to reside in own homes • “Money Follows Person” grant to transition over 1,000 to community from nursing homes • R-CAP – rate increases (effective 7/1/08) • Room and Board Assistance to $43.95/day (+12%) • Assistance to Residents in County Homes to $37.00/day (+37%) • C.H.O.I.C.E. waitlist reduced • Medicaid waiver funding increased • Expanded access to transportation through partnership with INDOT (88 communities have purchased accessible vehicles) • Eliminated waitlist for Aged & Disabled waiver through targeting (August, 2008) Draft

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7. Closure & Conversion Fund Highlighted area under the curve represents $85M in additional expenditures (state and federal) over the biennium. Pulling $9M in FY08 and $22M in FY09 would entirely deplete the Closure and Conversion Fund. Draft

8. C.H.O.I.C.E.“Medicaid Fail First” Draft

9. Total $5.9 million Draft

10. FY08 Unspent AAA Allocations and CHOICE Waitlist Draft

11. Division of Disabilities and Rehabilitative Services (DDRS) - Initiatives • 19,289 consumers served (9/08) vs. 18,057 at 7/05 • Eliminated outdated institutional care model • Closed Muscatatuck SDC (2005) • Silvercrest Children’s SDC closed (2007 by ISDH) • Closed Fort Wayne SDC (2007) • Reduced General Fund budget impact • Transitioned ICLB recipients to waivers • Transitioned “Title XX” recipients to waivers • Person-centered reimbursement Draft

12. Division of Disabilities and Rehabilitative Services (DDRS) – Initiatives (continued) • Savings reinvested in wait list reductions • Targeting initiated – August, 2006 • Added priorities for waiver services • Those with caregivers over age of 80 • Children aging out of school • Redesigned community infrastructure • Outreach (for caregivers) • Health Assurance • Crisis management (replaces institutions) • INTrain (professionalizing direct care) • DOJ action settled (suit filed in 2000) Draft

13. Division of Disabilities and Rehabilitative Services (DDRS) – Initiatives (continued) • Person-centered service planning/delivery • Targeted case management consolidation (from 400 individual case managers to 1 organization) • OASIS – consistent funding for similar needs • Integrated Case Management System • Redefined quality assurance paradigm • Professional quality assurance surveyors • Outcome focused survey tool designed • Adult guardianship expanded Draft

14. Division of Disabilities and Rehabilitative Services (DDRS) – Initiatives (continued) • “Results Based Funding” – paying for success, not just attendance • Reduced General Fund budget impact • Centralized hearing aid purchases • Medical procedures billed at Medicaid rates Draft

15. FWSDC Closure Revisited Draft

16. DDRS: Residential Stateline Costs (SFY02 to SFY09 Forecast) Draft Source: DART

17. DDRS: New Consumers in Waiver Services (SFY05 – SFY09 to Date) Source: INsite Draft

18. VR Life of Case Costsfor closures in SFY04 vs. SFY08 Draft Source: IRIS

19. BRS Fiscal Efficiencies Account ExpendituresSFY04 versus SFY08 Draft Source: IRIS/Financial Management

20. Vocational Rehab Applicants by Outreach Category ( Comparison by SFY) Source: IRIS Draft

21. DDRS - First Steps Initiatives • Consistent State-wide eligibility determination • Income-based co-pay • Reimbursement from private insurers • External audit of program Draft

22. Source: First Step Audit Presentation to (MR) DD Legislative Commission Located at: www.firststeps.in.gov Draft

23. First Steps Number of Children with an Individualized Family Service Plan Source: Cognos Draft

24. State of Indiana 2005 First in child deaths, last in welfare to work Draft

25. Disaster Assistance Twenty Indiana counties received disaster assistance. Clark, Crawford, Dearborn, Floyd, Harrison, Jackson, Jefferson, Jennings, Knox, Lake, La Porte, Lawrence, Martin, Perry, Pike, Porter, Scott, Spencer, Switzerland, Washington To date, FSSA has processed food stamp applications for over 50,000 households. Representing ~$20m in benefits. On average, FSSA does approximately 24,000 re-determination and new applications per month. They doubled their monthly productivity during the disaster recovery. Over 22,000 FEMA applications were completed. In 2006, FSSA completed 86 applications after severe storms. FSSA utilized 400 employees during this time. Approximately 32,000 hours (17,000 regular work hours and 15,000 overtime hours) were dedicated to this disaster outreach. Draft

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27. DIVISION OF FAMILY RESOURCES TANF Federal Block Grant FFY 2008 Draft

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29. DIVISION OF FAMILY RESOURCES Vendor Managed Offices Customers Served • January 1, 2008 – September 30, 2008 • 267,324 customers signed in for service • 39,159 customers applied for benefits • 11,295 customers attended IMPACT orientation • 11,072 customers attended follow up IMPACT appointments • 3,479 customers attended IMPACT job readiness training Draft

30. DIVISION OF FAMILY RESOURCES Vendor Managed Offices Highlights • Grant Region • 99% Reduction in individuals awaiting services from 1,017 to 15 • 55% Reduction in TANF IMPACT caseload from 3,436 to 1,537 • 26% increase in Work Participation Rate from October 2007 through June 2008 from 20.5% to 27.6% • Lake County • 55% Reduction in individuals awaiting services from 3,463 to 1,545 • Vanderburgh County • 87% Reduction in clients awaiting services from 889 to 114 • 32% Increase in Work Participation Rate from June 2008 through September 2008 from 15.64% to 23.06% Draft

31. DIVISION OF FAMILY RESOURCES Vendor Managed Offices Highlights • St. Joseph County • 47% Reduction in clients awaiting services from 2,202 to 1,151 • Allen County • 88% Reduction in clients awaiting services from 944 to 114 • 10% Increase in Work Participation Rate from June 2008 through September 2008 from 21.2% to 23.6% • Clark Region • 99% Reduction in clients awaiting services from 8,698 to 76 • 7% Increase in Work Participation Rate from April 2008 through September 2008 from 18.24% to 19.58% Draft

32. DIVISION OF FAMILY RESOURCESCHILD CARE AND DEVELOPMENT FUND Authorized Children Draft

33. Mental Health and Addiction Transformation 4 Broad Areas of Focus Phase 1 January 1, 2006 – July 2007 • Consumer-Driven Care • Recovery as common goal • Results Management • Consumer Services Review as major tool to assess quality and effectiveness of Community Care • Relationship Management • Performance-based contracting which ties funding to performance using NOMS (National Outcome Measures) data as a model for performance measure design • Cross-Systems Work • CANS (Child and Adolescent Needs and Strengths Assessment) and ANSA (Adult Needs and Strengths Assessment) developed to standardize the assessment process and assist with treatment planning • Public Health • Forensics Draft

34. Mental Health and Addiction Transformation 6 Targeted Efforts Phase 2 July 2007 – Continuing • Consumer-Driven Care • Focus on Recovery Specialists • Forensics • Adoption of Sequential Intercept Model and Recommendations for Implementation • Health/Behavioral Health Integration • Development of goals and strategies to promote true integration at consumer level • Consumer Employment • Development of Statewide strategies to make employment a core service in the mental health and addiction service system • Permanent Supportive Housing (PSH) • Partner with Housing and Community Development to develop targeted PSH for persons with chronic addictions or serious mental illness • Delivery and Financing • Create and implement new delivery and financing model Draft

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37. DMHA – State HospitalsCurrent Patients Length of Stay Draft 37 Source: AVATAR

38. DMHA – State Hospitals Waiting for Admission Draft

39. HAP –Number of Clients Receiving Services by Month by SFY Draft Source: CSDS Database

40. DMHA – Medicaid Rehab Option Draft Source: MedInsight

41. Division of Mental Health and Addiction (DMHA) - Initiatives Grants Access To Recovery (ATR) Community Alternatives to Psychiatric Residential Treatment Facilities (CA-PRTF) Strategic Prevention Framework State Incentive Grant (SPF-SIG) Alcohol Cocaine Methamphetamine Draft

42. Family and Social Services AdministrationSFY10-11 Goals • Expand health insurance availability • Reduce wait lists for needed services • Increase emphasis on employment vs. direct support payments • Continue transforming service delivery models Draft

43. Family and Social Services AdministrationSFY10-11 General Fund Operating Budget ($000) SFY09 As Passed $716,655 Plus: State hospitals – Medicaid eligibility 8,700 HB1001 General Fund impacts 101,524 Medical Assistance to Wards $13,100 Children’s Psychiatric Treatment 20,424 Marion Co. Health & Hospital 40,000 Health Care for Indigent 30,000 Less: Transfers to Tobacco Settlement Fund (5,484) Other changes (21,554) SFY10 and 11 Requests $799,841 Draft