State may study consolidation of county DSS admin functions

By Rebecca Troutman
Intergovernmental Relations Director

The Human Services Steering Committee met May 13 and discussed a special provision in the 2009-10 state budget that directs the General Assembly's Program Evaluation Division (PED) to study the consolidation of administrative functions in county departments of social services. Specifically, the provision calls on PED to identify opportunities for functional consolidation, affected administrative functions, estimated cost savings and requisite policy changes to accommodate consolidation.

Current law requires each county to have a separate board of social services. While separate social services boards are authorized to form a multi-county social services department led by a single director, no boards have adopted this model of organization.

The PED evaluation staff members were on hand to describe their draft evaluation plan and asked for the steering committee's input on defining "administrative functions." Carol Shaw, the principal evaluator, noted that she had the division's approval to include the NCACC as an "engaged" partner, along with the state Department of Health and Human Services (DHHS). Engagement allows the NCACC to preview and respond to the report's findings before they are released publicly.

For data gathering, all counties will be surveyed, and Shaw said her team will visit 10-15 county social services departments, with selections based on size, caseload and geography. She emphasized the need to talk with county managers and finance officers directly given that many administrative functions such as personnel and finance are handled at the county level.

Unlike child support enforcement, which can be functionally placed under any county department, delivered jointly by a number of counties or even outsourced to either public or private providers, Shaw noted that most other social services must be under the direction of a social services director. She described other organizational models that permit counties to selectively regionalize health departments and special authorization for counties with populations exceeding 425,000 to organize their human services functions with a great deal of flexibility and discretion.

Given that county and federal revenues largely fund county social services departments, county officials have expressed concern over any efforts to require – rather than incent – consolidation, especially in service areas that are funded predominantly by county monies. Shaw noted that any cost savings resulting from authorized consolidation would accrue to counties. PED has asked that the study be extended by two months, with a conclusion of Feb. 1, 2011, instead of the current date of Dec. 1, 2010.

Insko touts 1915 b/c waiver program

Rep. Verla Insko (Orange), chair of both the Appropriations Subcommittee on Health and Human Services and the Joint Legislative Oversight Committee on Mental Health, provided the steering committee with an overview of those health and human services issues to be considered by the General Assembly during the short session. Not surprisingly, budget woes were at the top of that list. Rep. Insko talked about the need to restructure personal care services to reign in Medicaid spending.

Consolidation of Smart Start and More at Four programs will also be under discussion, including recommendations for uniform regulations and uniform credentialing. Further merger may be possible, with a stated goal of one child, one team regardless of agency and one plan.

Rep. Insko then emphasized the importance of the 1915 b/c waiver to instill greater authority and responsibility to qualified local management entities. Acting Steering Committee Chairman Ronnie Beale (Macon County) cautioned about counties accepting greater financial liability under the expanded model, but Rep. Insko noted that the state could not allow those LMEs operating under the Medicaid waiver to fail. The new CABHA provider model will help counties refer clients to a physical presence in mental health once again, and will help waiver program counties by properly vetting quality service providers.

Rep. Insko cited the state's implementation of federal healthcare reform and state tax reform as two key future issues. To help counties cope with the large influx of newly eligible Medicaid clients under federal healthcare reform, Rep. Insko noted the need to streamline eligibility to limit county review to those clients near the income threshold.

Contact with legislators should be frequent, clear and concise

Rep. Insko, joined by NCACC Director of Government Relations Kevin Leonard, provided some pointers to help county commissioners become better advocates for county issues with their legislative delegation. Rep. Insko said she believes frequent and concise interaction is important, and suggests that e-mails, followed by personal phone calls, help legislators understand county concerns about proposed legislation.

It's important for counties to meet face-to-face with their delegation, but that only needs to occur periodically, Leonard said. Instead, targeted conference calls could help convey the county message without leaving home. Leonard emphasized the need to "bullet point" issues to keep the message clear and direct. Both panelists agreed that county officials should not only convey what is wrong but what needs to be done about it.

Food stamp eligibility change coming July 1

Maria F. Spaulding, deputy secretary of Long-Term Care and Family Services at DHHS, provided an overview of some statewide human services issues that are impacting counties and reported on individual departmental divisions' initiatives. The biggest change comes July 1 with the department's increase for food stamp eligibility to 200 percent of poverty.

County caseloads will increase, however DHHS has implemented measures to streamline all eligibility determinations. With regard to the state budget, she emphasized the need to restore the $40 million in funding to community mental health services. She also described the department's quality improvement initiative – DHHS EXCELS – to enhance coordination between divisions.

The transition of child support to counties appears on target and on schedule. Childcare subsidies are being reallocated, and Spaulding cautioned about the pending cliff effect – when $54 million of federal stimulus dollars are taken out of the childcare system.

Steering committee members set their next meeting for Thursday, Aug. 26, in Pitt County, site of the NCACC's 103rd Annual Conference.