CHAIRMEN: Senator Bye
SENATORS: Gerratana, Kane, Markley
REPRESENTATIVES: Abercrombie, Betts, Dillon, Flexer, Lavielle, Lesser, Miner, Ritter, Ryan, Sampson, Wood
SENATOR BYE: -- Appropriations hearing on, well, first, Department of Children and Families, and then the Department of Social Services to order. And we're joined this morning by DCF Commissioner Joette Katz.
Members will be joining us. I know there was some challenges getting out this morning, and we appreciate people's efforts to get here and try to keep us on schedule.
And thank you for joining us, Commissioner.
COMMISSIONER JOETTE KATZ: Thank you. Earlier, I walked by Judiciary for old time's sake.
Good morning, Senator Bye, Representative Walker and distinguished members of the Appropriation Committee. My name is Joette Katz. I'm the commissioner of the Department of Children and Families. With me today are various Department staff who are here to assist me in answering questions that members of the committee may have. They're all seated behind me and, at the appropriate times, I would ask -- time -- I would ask them to introduce themselves to you.
Thank you for the opportunity to speak with you regarding the Governor's proposed midterm budget adjustments for Fiscal Year 2015 for the Department of Children and Families. As the Department assesses its need for the coming year, it has given us the opportunity to review the progress we have made towards achieving our goals and to note how our budget reflects that progress and supports our ongoing efforts.
At the beginning of my term -- of my term, I established several goals intended to improve services to our children and families so as to achieve better outcomes. I'm proud to say that the Department has made great progress in those areas, and I would like to update you on our efforts.
The Department strived to decrease the number of children in congregate care settings, especially out-of-state placements that separate children from their families and decrease the likelihood of successful reunification at the end of treatment. At the beginning of my term, the Department had 1,062 children and youth placed in in-state congregate settings and 362 in out-of-state congregate settings. We currently have 820 children and youth placed in state and 34 in out-of-state settings. These reductions have been made possible by the Department's shift from viewing congregate care as a placement setting to, now, relying upon it only as a necessary treatment resource.
Out-of-state congregate settings are only used after close examination with consideration given to the impact this will have on family reunification and overall outcome success. This not only leads to better outcomes but also results in a savings to the State, because congregate care is typically the most expensive form of care.
As the Department drives towards its ultimate goal of having no more than 10 percent of the population served in congregate care, we need to invest in community services to care for children who have historically received treatment in these settings. The Governor's midterm budget will enable us to further our work in that direction.
The reduction in residential placements this past year has allowed us to re-estimate the baseline budget for the Board and Care for Children - Residential account for Fiscal Year 2015, reducing it by approximately $9.7 million. It has also led to a reduction in the Department's spending under the No Nexus Special Education account, which is adjusted downward by $1.3 million. We believe that we will be able to further reduce the use of congregate placements next fiscal year, resulting in over $5 million in additional savings.
Finally, we will promote utilization of private insurance coverage when available to cover cost of residential placements.
Investments in community-based, in-home care will be needed to ensure our continued success. Two million dollars in newly recommended funding has been included under the Community KidCare account to enhance our development of a strong continuum of in-home or family-setting treatment alternatives. This programming will be aimed at allowing children to return home or to a family setting from their current congregate placement. Ultimately, developing these types of services will mean that, in the future, children will be much less likely to need to leave a family setting in order to receive services. It is essential that the Department be able to make this investment in community services. It is not only the best thing for our families and children, but it generates one of the strongest returns on investment that the State can make. Building a network of critically necessary services will produce long-term outcomes that promote a healthy population, while producing the short-term effect of reducing the cost of care overall. This investment is necessary before utilization of more expensive forms of care can be reduced.
The Department is working to increase placements in family settings and move children to permanency through increased use of kinship placements and providing a higher level of therapeutic care. Since the beginning of my term, the Department has increased kinship placements from 21 percent of all placements to 32.5 percent. Studies show that children placed with kin are less likely to have a disruption in placement. These types of disruptions can lead to very poor outcomes and negatively impact the child into adulthood.
We have recently rolled out services, specifically, designed to support kinship families in caring for children. We have also launched a new type of foster care that provides families with an unprecedented amount of support and services to fall back on as they foster children with the highest level of need. These children present a variety of challenges. And, in the past, they would've been cared for in congregate care settings and would not have benefited from living in a home and being part of a family.
The Governor's midterm budget reflects these increased placements and service enhancements by adding $4 million under the Board and Care for Children - Foster account and an additional $900,000 under the Board and Care for Children - Adoption accounts.
The need to increase spending related to foster care and adoption, as well as under the Community KidCare account, reflects an anticipated budgetary redirection away from spending for residential care, boarding care costs. The net reduction across the four budget line items related directly to the shift in placements creates a net savings of approximately $6 million in this midterm budget.
Thank you -- implementation of the Family Assessment Referral system, otherwise known as FAR -- a program that assists low-risk families that come to the attention of the Department by providing services and support to help them meet their children's needs -- has reduced the overall caseload from 15,268 at the program's inception in January 2012 to 13,714 as of January 2014. This has contributed to a reduction in spending under the Individualized Family Supports account of $1.8 million.
FAR implementation has resulted in good outcomes for our families and for the Department. No longer are families tied to the Department for support. They are able to get the assistance they need and maintain their households independent of DCF.
The FAR program has impacted the Department in another way. It has removed from caseworkers' caseloads low risk, low intensity cases. This means that the average case has become higher risk and more labor intensive. The cases require a higher level of service delivery and risk factors needed to be considered carefully. An average case, prior to FAR implementation, required approximately eight hours of labor a month, with some cases requiring as little as three hours a month, while others needing as much as 14 hours a month; in other words, there was a range.
Now, the majority of cases on the worker's caseload require in the range of 12 to 14 hours of work monthly. The impact of FAR on a worker's caseload has been compounded by the Department's goal of keeping children out of congregate care settings. For workers, children placed in congregate care settings, represent low risk and, therefore, less labor intensity. Only placing children in congregate care when it's absolutely necessary for treatment purposes is the correct thing to do but no doubt, it does effects a caseload worker's -- a worker's caseload and workload and obvious risk considerations.
The Department is analyzing the impact that these factors and others have had on the workforce and staffing needs. We will continue to make adjustments that will allow our workers to fulfill their duties and keep our children safe, while providing our children with every opportunity to be healthy and to thrive.
Although the Department considers every opportunity to reduce the use of congregate settings, there has been one population group that requires this level of care but has not been adequately served in state for several years. Historically, many girls having contact with the Juvenile Justice system have been sent out of state to be assessed and to receive treatment. Sadly, many have ended up in York. These girls have been sent hundreds and in some cases thousands of miles away from their families. The lack of an appropriate setting in Connecticut has caused this portion of the population to be unable to benefit from family therapy or contact with community providers during discharge planning. Successful family reunification has also been a challenge.
Several attempts have been made over the years to provide this level of service in-state, but, ultimately, there continued to be a void that has resulted in undesirable outcomes for the girls. The Department has considered several plans over the past decade and saw an opportunity to utilize existing physical plant resources. To that end, we will be opening a 12-bed -- it's actually ten beds with two emergency beds, units – unit -- I'm sorry -- on the grounds of the Solnit Center's South Campus, in what's called the Pueblo Building, to serve girls with complex needs who have had Juvenile Justice involvement. The unit will place a heavy emphasis on treatment and education. During the girls' stay, they will be assessed and received treatment. A comprehensive treatment plan will be developed to support them postdischarge and to ensure their successful transition back into the community.
The midterm budget adds 30 positions and $2.6 million in annualized funding to support the operation of this unit. We will closely monitor the girls' outcomes and progress to ensure that the appropriate level of care and services are provided, so they can achieve success and be ready to lead happy and healthy lives.
Along with considering how the Department functions in the area of service delivery, we also consider how we operate administratively and have integrated both LEAN processes and a continuous improvement model of management in our daily business operations, examining how we do things, how we can do them more efficiently, and how to achieve better outcomes. We have benefited from partnerships with other state agencies to further our efforts to improve, and the following initiatives will allow the Department to achieve savings, revenues, and efficiencies.
When the Connecticut Juvenile Training School was built, fuel cell technology was installed to provide electricity to the campus. Over the years, the useful life of the fuel cells was depleted and a substantial capital investment would be required to continue to support this technology. This potential expense, along with ongoing comparatively high maintenance and operation costs, caused the Department to seek expertise from DEEP to assist in evaluating the viability of continuing to use the plant and to conduct a cost-benefit analysis of its operation.
An alternative was recommended that requires the addition of two employees, at a cost of approximately $117,000 and will result in a savings of $1.2 million in other expenses, for a net savings to the State of just over $1 million.
The Department has enjoyed a strong relationship with the Office of the Healthcare Advocate, OHA. During this past year, OHA has assisted families, with DCF involvement, access their private insurance for services that would otherwise have been paid for by the Department in past years. We estimate that the resulting savings to the State has been approximately $2.2 million.
OHA has identified for DCF two new savings' initiatives that are reflected in the Governor's midterm budget. First, OHA has been provided an additional employee to assist private providers and families receive -- to make sure that they receive -- those families -- I'm sorry -- who already have private insurance and make sure that they get coverage for the medically necessary residential stays as required. The process for receiving approval from insurance companies, as we all know, I think, is often complicated and cumbersome. OHA is expert in being able to assist both providers and families in meeting approval requirements. And it's estimated that this -- that this will result in a savings of $1.4 million by reducing cost shifting to the state budget.
The second initiative involves the ability to maximize reimbursement of services provided at the Solnit Center's South Campus that have been court ordered. OHA investigated the reasons for the lack of reimbursement for these services in instances in which they are medically necessary. OHA and DCF have created a plan that will allow the State to recoup significant revenue from the investment of $150,000 by validating those court ordered stays that are medically necessary and, therefore, eligible for federal reimbursement and private insurance coverage.
The Department regularly monitors its use of overtime and how we can more efficiently provide services. Our regular offices identified the need for more case aide positions to provide various services that are appropriate to that level of worker. These services are now being provided by higher paid employees on overtime. The Governor's midterm budget expands the number of case aide positions, which will allow for a reduction in payroll expenditures by just under $900,000.
The Department has also worked to eliminate injuries in the workforce and time lost from work, resulting in a savings under the Workers' Compensation Claims account of just over $500,000.
We continue to investigate revenue enhancement opportunities. The Fostering Connections to Success and Increasing Adoptions Act has given states the opportunity to be reimbursed for services provided to children over the age of 18. Connecticut has always provided a high level of programming to children that stay with the Department over the age of 18, so this gives us the opportunity to gain considerable revenue without incurring large new costs. Fostering Connections requires that a small population that we did not serve in the past now be served in order to be able -- to enable Connecticut to claim federal Title IV-E reimbursement. The necessary statutory changes were made last session to permit us to claim for programming that we currently provide.
A budget adjustment of $350,000 is made -- I'm sorry -- has made the area of adoption and subsidized guardianship more reasonable, more feasible, and more cost efficient. This will allow the State to receive approximately $15 million in revenue annually, all of which, as you know, goes into the General Fund.
Finally, as in the previous example, we believe we can leverage a relatively small investment of $145,000 to allow us to claim millions more in federal revenue in future years. This will involve seeking reimbursement for services DCF is already providing. This investment will position DCF to meet federal regulations around service delivery and reporting requirements and facilitate future revenue initiatives.
Thank you again for the chance to speak about the DCF budget. My staff and I, again all of whom received -- many of whom are seated behind me, and all of whom are here to answer your questions, welcome the opportunity to address your questions both today and then when we meet again in subcommittee. Thank you.
SENATOR BYE: Thank you so much, Madam Commissioner, that was very thorough.
REP. WALKER: Thank you and good afternoon. I -- I have a lot of questions so I'll just start out with a couple first.
In the budget, you -- you talked about the $16 million reduction in the residential line item, and you sort of touched on that. Can you give me a little bit more detail as to what that actually is and what -- what are the reductions in that? And then I'll lead to my next question.
CINDY BUTTERFIELD: Hi, I'm Cindy Butterfield. I'm the chief fiscal officer of DCF. The first $9 million is actually a re-estimate of our budget for savings that we've already achieved in this year that we will plan on carrying forward into the next year. That's a reduction in the overall use of residential care that the Commissioner touched on during her -- during her comments. There's another $5.4 million which is a projected opportunity for more reduction in -- in congregate care settings. That will require, though, that we receive a $2 million investment in the KidCare fund. This will allow us to provide more comprehensive services in the community to our families and allow children to be served at home instead of in a congregate care setting and, hopefully, you know, build upon that so kids don't have to go into congregate care to receive -- receive services in the future.
There's a couple of other -- I'm sorry -- a couple other small re-estimates in there.
REP. WALKER: Okay. So -- so you said that $2 million of the -- of the $16 million is going to the KidCare, is that what --
CINDY BUTTERFIELD: Well, we -- in our -- in our budget option that's been put into the Governor's budget, we have requested $2 million investment in Community Services so we could move more kids out of congregate care.
REP. WALKER: Okay, okay. So the $9 million that was for the residential was that because of out-of-state placements?
CINDY BUTTERFIELD: Out-of-state placements and in-state placements, they both declined our use of -- both areas have (inaudible).
REP. WALKER: So you're census has declined?
CINDY BUTTERFIELD: Yes, in residential and congregate care settings, it has.
REP. WALKER: Okay. So your census has declined in residential but, at the same time, the community services in the community have -- has increased?
CINDY BUTTERFIELD: Yes. And that's why we're asking for the reinvestment in the community services. We overall -- our overall caseload has declined over the past couple years since we instituted FAR. We've had sharp --
REP. WALKER: FAR -- FAR --
CINDY BUTTERFIELD: I get --
REP. WALKER: Family --
CINDY BUTTERFIELD: -- so use to those.
A VOICE: DRS.
CINDY BUTTERFIELD: DRS.
A VOICE: (Inaudible.)
CINDY BUTTERFIELD: Yes, thank you, you got it.
REP. WALKER: So -- wait -- so let me get -- so FAR is -- is equivalent to DRS?
CINDY BUTTERFIELD: Yes, that's what --
REP. WALKER: So is this -- is this -- is this the fidelity of DRS or is this our hybrid DRS?
CINDY BUTTERFIELD: This is DRS. As we've called it Family Assessment Referral. It is DRS, though.
REP. WALKER: So that -- the DRS that we all know well and love is this.
CINDY BUTTERFIELD: Yes.
REP. WALKER: And who -- who did you contact that out to?
CINDY BUTTERFIELD: There are several providers in the community. I can get you the list.
REP. WALKER: Okay. I would like to know was -- was given the -- the DRS. So the -- the way FAR works is that you get a referral and you then connect it to the agency that is in that location. Is that the way it works?
COMMISSIONER JOETTE KATZ: Yeah. What -- what's happened is we call it FAR because it really, I mean, differential response is something that people, unless they really know the language, don't really know what it means. Families understand family assessment response, and it really is -- it's about assessment as opposed to an investigation.
So calls come in and, historically, they only had track. They came into investigations, we opened up a file, they -- they became part of our caseload, et cetera. And what we concluded early on was we -- and we went to national models, and I think I -- I mentioned this last year -- this had been going on for ten years, and we finally said this is foolish and we just pulled the trigger, it is -- it is true to the model, and we found out that actually close to 40 percent of our cases really can go the FAR track. We can meet families' needs without them becoming part of our family and that's exactly what's happened, so you have that shift.
I want to just add, if I may, to what Cindy was just talking to about the reduction in -- in numbers. We clearly have gone down significantly. When I came in we had about 4800 kids in care, we're now down to about 3900. And that's -- that's part of FAR, that's a result of FAR. It's a result of a lot of the work that we're doing. But the challenge is the children who remain with us -- just like I was talking about our caseload -- it's like when you go to a pediatrician. If a pediatrician had a mixed caseload of being able to do inoculations, as well as heart-lung transplants, you get the range, and that's what our workers were previously doing. Well, now, they no longer have the inoculations. They no longer have the routine, you know, kind of case that -- that can now go to FAR, so consequently what they're left with is that much more intense. Everything they're doing is a heart-lung transplant; they don't have the inoculations anymore. And the cases that they're handling not only are they much more labor-intensive, the children's needs remain the same as they always were. Historically, those kids were going into congregate settings because we didn't properly work with families, we didn't engage them, we didn't take risks, we didn't engage our kin and our relatives to the degree that I felt we needed to, and they went into congregate settings.
We -- we're moving them out of congregate settings, both out-of-state, as well as in-state, but that doesn't mean that they don't have the needs that they -- that they have. They still have the same needs. The goal is to be able to treat them in the community, either with their families, if not with their biological families, with kin, with relatives; and if not, with core foster families, but again, in families in their communities. And part of that infusion of the $2 million is to be able to go back into the community settings with our providers to be able to serve them.
The other thing I just wanted to add, and I'm sorry if I'm taking too much time, but you -- there's a lot in your question. You were asking about our providers. So when we put out the RFP, we went through the normal process we're supposed to, and then I read all of the applications, and I selected the providers myself based on the criteria that have been imposed. And then, fortunately, you all gave us a little additional money and we were able to increase those contracts, and I -- and I chose two additional providers -- is my recollection it's now two years, March 2012 -- so that we were making sure that our providers were, I don't know that they were ever adequately, really adequately funded but we were able to spread the money around and do -- and one of the things, obviously, I took into account was the geography. Were the providers in the communities where our families live, so that we could serve them, and also eliminate the middleman so that the money wasn't eaten up in administrative costs. So I hope that answers your question.
REP. WALKER: That -- that helps.
I want to go -- part of this conversation. So in your testimony you talked about the fact that you had an increase in caseloads more intensive care so, therefore, the hours for a case to be handled has increased. Yet, with the adjustment, because we are bringing them back and we are doing more community service-based, you know, support, I don't see any increase in caseworkers in here. I see only JJ workers but I don't see any increase in caseworkers. So if -- if that's the case, then I should have seen something in that regard, I think, because I'm, you know -- it's wonderful that you're able to reduce your budget, because we all want to reduce costs for agencies, and it's very important, but at the same time, providing the services because we're bringing the kids back -- which we all cried for several years in bringing our kids -- and servicing here and having our staff and our citizens care for our own kids, all well and good. But the savings, I think, should be reinvested in giving you the people that are necessary to actually make sure that they -- the services that we're doing are there and that the people are there. Because, as you've heard, when we talked about the kids with foster care, many of them said sometimes they did not see their workers very often, and I know -- I noticed that you had down here they do 14 to 16 hours of work a month, but is that with the kids or is that with paper? And so I would like to know where are the plans for increasing the caseworkers so that the kids get the services and the contact? Okay. That will be a question I guess I'll get later. Okay.
Moving right along, let's go on to JJ. What are the recidivism rates for the committed delinquent kids in your care for six, 12 and 24 months after their commitment has ended?
DR. BRETT RAYFORD: Hi, Representative Walker, this is Dr. Rayford. Can you repeat that question?
REP. WALKER: Could you repeat your name please, sir?
DR. BRETT RAYFORD: Dr. Rayford, Brett Rayford.
REP. WALKER: Thank you. What is the recidivism rates for the committed -- committed delinquent youth after they've left your care six, 12 and 24 months after? Do you have those statistics?
DR. BRETT RAYFORD: We do not. First, we need to make sure that we have a clear --
REP. WALKER: -- understanding of recidivism? Okay, well, I'll be very clear. Recontact.
DR. BRETT RAYFORD: We don't -- we don't have those numbers. I would need to go back and take a look at a way to measure that for the young people who matriculate through the system. So CSSD has a definition of recidivism that has to do with 12 months out and then 24 months out. As you know, we're interested in having a statewide definition of recidivism that everybody adheres to. So, with your permission, I'd like to go back and see if we can capture that data using our data system which is, you know, is fairly marginal. It would mean some collaboration with DOC, some collaboration with CSSD, as well, so if recidivism is contact with the police department or re-arrest or re-incarceration, you see how you sort of have to splice that to get at the true number.
REP. WALKER: I guess I'm looking for recidivism in relating to DCF. I mean, are we -- we talking, I mean, when we -- when we take a young lady in because of the fact that she's got personal issues at home and she can't stay at home, we put her in a group home. She runs away. We then place her in a foster care, she runs away. She goes to one of the proposed secured facilities, she -- she gets out. She comes back, and those, to me, are the recidivism with -- when it regards to DCF.
I mean, if we -- if you have a definition of recidivism that we have not discussed, we've had many platforms and, you know that, where we could talk about a definition of recidivism. One of them is the Results First. We could have talked about that in collecting the data, but I never heard that we needed a better definition so we need to have that --
DR. BRETT RAYFORD: Yeah.
REP. WALKER: -- now.
DR. BRETT RAYFORD: I can -- I actually can capture the data of the youth who come back into our services while they're on parole. It's once they left care that's -- that's really the challenge, because they may migrate to a different system, and if our systems don't talk, which they don't very well today, it's hard to capture that data. But with some time, I can go back and look at kids who come back in, what we might call a regressive movement, back into a more structured environment after they've been in the community. We can't capture that. I wouldn't technically call that recidivism because it's not a new arrest.
REP. WALKER: Okay, okay. All right. Okay. Recontact.
DR. BRETT RAYFORD: Yeah --
REP. WALKER: Then we -- we can -- we can --
DR. BRETT RAYFORD: -- we can pull that information today.
REP. WALKER: -- a variety of it, but the thing that we need to look at, I've looked at some data on some facilities, but it hasn't been on your facilities because we don't have the data, and I think we've -- we've been talking about this for a little while now and trying to get that information. So what are your plans for -- where in your budget here that we have before us calls for dollars to be put in to help you collect data so that we and you can very honestly look at what is working and what isn't working and where do we need to shift dollars, because if we want to be effective, you know that we need that. So are there dollars in his budget for that?
DR. BRETT RAYFORD: Well, two things.
REP. WALKER: So, no.
DR. BRETT RAYFORD: I believe we are looking at a new database system, you know, our LINK system is from 1994 and fairly antiquated, and so there's an effort to bring the new LINK on board, which would allow us to capture data, not only internally but interface with other state systems. But I do want to underscore that -- that statewide definition for recidivism is something that we need. Connecticut is one of a few states that -- that doesn't have a definition that everybody honors across the state.
REP. WALKER: And I -- and I, you know what? We would be -- we would welcome it, but we need it. We need to have what you want to have in the definition of recidivism, and I'm sure that DOC, because we've worked with DOC and we worked with CSSD in capturing a lot of the data that -- that's out there, but we need to have DCF be part of that conversation also.
DR. BRETT RAYFORD: I agree.
REP. WALKER: And we need it yesterday, okay?
DR. BRETT RAYFORD: Okay.
REP. WALKER: So what -- what are the projections you have for -- that -- that you have used to show that the 12-bed secured facility for the girls is a way of addressing the servicing gaps? I don't understand how that is going to be in the continuum for the committed delinquent girls.
And I'll pass so that other people can ask questions, and I'll come back, so I'll start with that and then go a little further. So we want to talk about the 12-bed -- the 10-bed plus two emergency bed facility.
COMMISSIONER JOETTE KATZ: So the decision to open the facility, as you know better than I, has a very long history. There was lengthy discussion about opening a similar facility in Bridgeport for anywhere between 24 and 30 beds. And every -- everything I read about that at the time everybody said we need ten, we need ten, we don't need 30, so I listened. And my own experience at the agency, both looking at the length of time, they're always about 30 girls in detention at any given time. We have -- so that's one issue. I can tell you from my own experience, because I review all the out-of-state placements, so in the last three years, in reducing the numbers from 364 down to 33, consistently, there is an issue with girls who -- many of whom have been adjudicated delinquent, many of whom have not been adjudicated delinquent because a deal was cut -- essentially, quite frankly, because I would be contacted, that's how I would know that -- well, okay, we'll only adjudicate a delinquent if you her in -- if you -- we'll put her in an out-of-state facility, because a lot of the out-of-state facilities didn't want delinquent -- a child who had been adjudicated. They wanted to be able to treat her. And really all I really cared about was getting the child the treatment. So the point of this is to create some level of parity with boys, because this is a population that has not had its needs met.
Similarly, I looked at the numbers, we have over the years probably, recently anyway -- probably 60 girls who have been sent to York. Now, not all of them, but certainly, and many of them -- and I can tell you this again from my past life -- many of these girls were sent to York because judges didn't have an option. And the only way that these girls could be treated in a locked facility was through York. And obviously, -- and nobody wanted to see that happen -- so I looked at all of this, although you have identified, clearly, a deficiency in our system in terms of our ability to collect data, both from a staffing and as well as a technological -- technology standpoint, but there was enough out there for me to feel very comfortable in this decision both looking at the previous discussions about a 30-bed unit, 60 girls in York, 30 girls in detention -- and when they're in detention -- and this is not at all to disparage what goes on in detention or my colleagues at CSSD -- but it's not meant to -- to be a treatment facility. And so those items combined, as well as everything else I read and -- and the girls' profiles -- I brought two with me now, frankly, that I would -- I mean, I would have -- could have easily have filled these beds in the last six months, and I have profiles of two girls now who are extremely complex.
One I did not have an in-state facility. I will not, obviously, identify her by name, but she is a duly committed young girl. She's 16. And my last best option was a wonderful out-of-state facility where she was going to get significant treatment. And shortly within a couple of months of her being there she -- and she's extremely assaultive and she has put several of our own staff in jeopardy and, most recently with this, again, wonderful out-of-state facility with whom we are now very likely burning bridges, she broke the jaw of one and blinded her. So these are -- not all girls, obviously, but there are many who because of their traumas, because of their history, can be extremely assaultive and dangerous.
My goal is to get them treatment, but it's also to do it in a place where they are safe and they are not exposing other young ladies to risk. Because the last time this particular child was in a less secure setting, she got a two -- a couple of other young ladies to run away with her, so then not only was she putting herself at risk, she was putting them at risk. So all of this combined made me feel comfortable in looking at this facility on our campus for ten beds. And I've said publicly and I've written several letters about it, I have no intention of expanding it, I'm not looking to expand it, I'm not looking to run a -- a larger unit for these girls. I think ten beds -- and if we do our job right, and if we really do our job right, and we've already hired, happily, a wonderful superintendent and are busy staffing it and really getting some of the best treatment models that we've been able to find from out-of-state, if we do it right, that's all we're ever going to need. And -- and quite frankly, and my -- and the last thing I want to say on this subject is, you know, nothing would make me happier not to need this. And if we get to the point where we don't need it, it's called turning the lock and unlocking it and it's just that simple. And that's really the goal.
REP. WALKER: And I -- I commend you. I do remember when we started down this road. And it was -- it was a 30-bed, and then it got down to 25, and -- and I do remember the discussion about the multilevels. But one of the things that we talked about way back was that we had to make sure that we had the community services to back them up when they got discharged. And I'm going to be really candid. I don't see in your budget those services. I see staffing for the facility, I see the facility renovations, but I don't see those -- those connected services that are necessary.
Now, I know that you have some, but again, you brought these kids and you want to keep them in the state. I can't tell you -- I don't see those services needed for those 200-and-some-odd kids that we have brought back in here, in your budget. I see reductions and, you know, that's all well and good, but those reductions are going to translate into cost, because these kids, whichever way we define recidivism, are going to recidivate, whether they come back to you or go back to DOC. And that's where I'm really -- I'm terrified, and so -- and especially, if they are so fixed on institutional care as their -- their panacea of -- of adjustment. So we -- we need more detail and we need to -- we need to see in our group meeting, in our committee meeting, we need to see the services, how many services are out there for community settings and how, if we don't have enough, where are they going to be and what do we need to do to do this, because we need to stop the treadmill and -- I mean, moving them out of state, moving them back into state, moving them out-of-state, if we're not going to fix it here then, you know, it's going to be futile.
So, Madam Chair, I'll stop and let you -- somebody else speak.
SENATOR BYE: Thank you.
I just want to follow up on that point of my cochair for when we have follow-up meetings. I think there are pretty general concerns about the savings from congregate care, and I think you have broad support for the mission of bringing kids back to the state and keeping kids in families, whenever possible, so we commend you on that. But I think there's a lot of broad base concern about, are the community base support in place before that 9, 10 million dollars goes back in the General Fund. We're trying to build a community-based system that will allow kids to be successful. And we know now, as some of these close, kids are cycling through emergency rooms more, Children's is losing over $2 million a year in kids who are psychiatric referrals who are involved with DCF because they need more support. And these aren't your problems that you've created, but I think we really want to hear about, in our small group meetings, what's going on at the community-based level to support these kids who are in less restrictive environments, which is everybody's goal. And so I just wanted to echo that an echo my cochair's point about data-informed decision-making, because we're making a lot of these policy shifts based on data, based on national data about how kids do best, but we have to know, as we make these shifts, are that Connecticut programs we've set up working, so we have to define recidivism and then we need to know what's working and what's not. And with all the savings and the shift, it seems like a good time to make the investment in a data system that works as Representative Walker was saying. So that's just a follow-up to Representative Walker.
I have other committee members with questions.
I want to ask Representative Wood, if you would like to ask your question now (inaudible)?
REP. WOOD: Sure, I'd actually -- thank you, Madam Chair. I -- it does follow up on what Representative Walker was asking about, the Solnit Center.
First of all, thank you, Madam Commissioner, for your report and always for your good work and innovations. I think many of us appreciate them very much.
On the Solnit Center, and perhaps you said this, how many young women does this involve? What are the numbers you're looking to fulfill?
COMMISSIONER JOETTE KATZ: It's a ten-bed facility with two emergency beds. And the hope is that girls will be there for anywhere between a month to six months, and then when they're discharged, those services -- they'll be able to build up because for many of these girls they've really had significant issues of trust and trauma, hopefully, they will be able -- the expectation is that they will be able to receive, not only community services, but that there be a real continuum, because I think their needs range the whole spectrum.
REP. WOOD: Right. Thank you. What -- I should rephrase that. How many young women need this service right now? Is there a way -- are there 30, are there 40, are there 100?
COMMISSIONER JOETTE KATZ: Well, currently, we have one other lock facility that is -- being run by a private provider and there's a waitlist and we have -- they're at capacity, and there's a waitlist there of three and then we have 30 girls in detention, and not all of them would be suitable for this, not all of them need this level of care, but I could fill those beds.
REP. WOOD: So 12 is -- is a good number to start this.
COMMISSIONER JOETTE KATZ: I believe so.
REP. WOOD: Great, thank you. And next question is how many people -- is Solnit still up and operating?
COMMISSIONER JOETTE KATZ: Oh, yes. The rest of it -- we -- absolutely. It's -- it's a hospital and it's a PRTF, and there's Solnit South and Solnit North. It's for children 13 to 18 years of age who have psychiatric issues but do not have delinquency adjudications.
REP. WOOD: I know a concern in the past is the expense of Solnit at 7 to 800,000 per patient; is that still the case?
CINDY BUTTERFIELD: The (inaudible) for DHMAS is approximately $2400 a day. That, also, does have a lot of additional expenses that aren't actually part of Solnit because it has the state slide cap, a percentage of all other state agencies and support state agencies and things like that. Solnit is a very large revenue generator. It -- Medicaid, we receive approximately $1100 of the per diem rate back in revenue. We also are going to be able, with one of our initiatives, to be able to start getting reimbursement on court-ordered evaluations, too. So the entire per capita is set and that's the set for the reimbursement rate, and we get 50 percent back on that -- and private -- and it is also covered by private insurance.
REP. WOOD: Okay. Thank you. I think I'll wait. I know there are other questions. I will wait until the private meetings, but I also wanted to applaud your effort on adding someone else to OHA. They do wonderful work, and I think someone to help families navigate the private insurance, go get them. Thank you.
Thank you, Madam Chair.
SENATOR BYE: Thank you, Representative.
Representative Abercrombie followed by Senator Kane.
REP. ABERCROMBIE: Thank you, Madam Chair.
Good afternoon, Commissioner. Thank you for being here and thank you to your staff for being here today.
First of all, I'm really excited about the new name for differential response. You know that it's something that many of us up here have supported through the years so it's a long time coming, but it's here, and your numbers are impressive, so kudos to you and your staff for that. It's exciting.
I'm hoping in the subcommittee that we can drill down a little bit more under the residential. For example, safe homes, you know, how many -- how many, you know, are we not funding any more, what's the reason, what's the alternative? Maybe give us more of a detailed in that area, you know, what determines that a group home is no longer going to be active, where are they going, what communities does it impact? That would be really helpful, because that's a lot of money there, you know, and if it's -- and what are we doing, you know, are we putting it -- and I think Representative Walker hit on it a little bit, you know, are we putting it back into the community and other programs? What are we doing? If we are that's great, but if we're not, you know, we should take a look at that.
And I think, for me, that's -- that's the biggest part of it in this budget is the residential, and like I said before, kudos to the FAR program. I think that's -- I think we're moving in the right direction with that, so thank you and to your staff who's worked on it.
Thank you, Madam Chair.
COMMISSIONER JOETTE KATZ: Thank you. If I could just respond briefly, and thank you so much, and I'm happy to give you more detail and data when -- in the small group but just -- just so you know now, so one of the -- one of the issues around Safe and Star Homes is really just vacancies. I mean, the good news is we didn't need them because of this shift so it's not like we're putting people out of business because we can. It's really an issue of as our population needs have changed, and so that -- that went into the thinking.
The other piece of it is I want -- when I first came in I said I don't want little kids in congregate, period. And we've sort of fought those battles back then and, happily, I mean, we had at the time almost 40 children under the age of six in congregate settings, and we're down to six now. And the only ones who -- at that age group who are in a congregate setting are either -- it's almost always because there's a medical need that requires it.
Same thing with children under 12, we had about 200 kids under 12, and we're down to low fifties and, again, that's because of what the -- either a medical need or large sibling groups. So that's -- I just point that out as an example of -- of why we no longer need those settings. But to your point, absolutely, these kids are going in the families. Some of the money that we've -- that's been appropriated is around what we're doing with foster families and kin because, as our numbers -- and I think I mentioned this in my testimony -- when I came in we were -- we were really -- I thought it was shameful the number of children who were going to families and to kin and we've increased those numbers by almost 60 percent. But the families who are taking in their children need the same services, need the same supports, and, in fact, even more so, quite frankly, because they didn't sign up to be foster families, they didn't go -- they didn't wake up one morning and say I want to be a foster parent and go through all of the training and preparations. It's more often they're getting a call in the middle of the night, and so the work that they need and the supports that they need are -- are just as important, in fact, more so and quite costly.
REP. ABERCROMBIE: Thank you and just if I could just to follow up on that. So on the safe homes part of it, you know, and as an example, do we do like a cost analysis as far as once we take them we decide to close a safe home, and then where do those individuals normally go from a safe home? Because I know in Meriden, for example, you know, we've closed a safe home, and I've heard from some of the people there that they're very upset because they thought it was a very cost-effective way of providing a service. So that -- that's kind of my question, where do we go from here and if we are swinging a little bit to the left here, you know, into other areas, what's the cost analysis that we're doing to prove that that's a better way to spend our money? So -- and we can do this -- if you want to respond now that's fine, if not, in the small group, that's fine also.
CINDY BUTTERFIELD: I think I can respond now but I can give you much better detail in the smaller group where the children ended up going. Many times, it's into foster care settings so we can provide that for you.
REP. ABERCROMBIE: That'd be great. Thank you very much.
Thank you, Madam Chair.
SENATOR BYE: Thank you, Representative.
Senator Kane followed by Representative Dillon.
SENATOR KANE: Thank you, Madam Chair.
Going back to the Solnit Center real quick, in our write-up, it says, "provide funding of $150,000 to support medical consultation in order to increase Medicaid and third-party reimbursements totaling five-point million dollars annually." How is that figure determined?
CINDY BUTTERFIELD: What we did is we averaged the last three years children that went to Solnit on court orders that were not reimbursable. OHA investigated those cases and determined what portion of them would have been medically necessary. So based on that averaging and a decrease, actually, in the number of kids that were going there for that reason, we came up with what the reimbursement would be based on whether they had private insurance or if they would have been Medicaid HUSKY, and came up with the revenue that we would have gotten on the average of the last three years.
SENATOR KANE: So those individuals that you speak of, we were not getting any reimbursement for?
CINDY BUTTERFIELD: No. Because they weren't -- because of the way they came into Solnit, there was never a determination that it was medically necessary that would have been approved by an insurance company. So what we want to do is put in a layer of -- a layer of approval that will allow us, then, to be able to seek reimbursement.
SENATOR KANE: And what does that 150,000 do? Where -- like what is --
CINDY BUTTERFIELD: This will be, probably, for contracts for MDs to be able to evaluate the evaluation that's already done by a psychologist to make a determination if it was appropriately being placed there and if it was medically necessary.
SENATOR KANE: Thank you. And there's another $150,000 for a revenue consultant. That's a -- that's a new position?
CINDY BUTTERFIELD: No. It's not a position. We're going to seek consultation on what we need to do with expenditures that we're already making and what regulations we need to put in place and -- and cost-benefit analysis and time studies to be able to allow us to receive revenue on services that we're providing there of a therapeutic nature.
SENATOR KANE: But isn't that what you're doing already with the Solnit situation?
CINDY BUTTERFIELD: This will be for services, like therapeutic foster care, that we've never received revenue back on and a multitude of other services whether it's better to go with PNMI or Medicaid or --
SENATOR KANE: And how much do you think that will return?
CINDY BUTTERFIELD: I think that's going to -- that's going to bring in a very, very nice revenue.
SENATOR KANE: Okay. And -- and one last question on the -- the federal Fostering Connections, that foster care program, I believe, is that? How many people does this actually effect, this $350,000? How many? Do you know?
CINDY BUTTERFIELD: That is six new children being served, and it's six added on each year from the ages of 18 to 21. So the initial will be six; and then, for the next year, it will be 12; and then, it'll be 18. It'll never pretty much go past 20, though, because they'll age out by the time it goes past 20.
SENATOR KANE: So will that 350 stay the same, or will that increase as well?
CINDY BUTTERFIELD: That is our -- that's the outside amount.
SENATOR KANE: Okay. Thank you.
Thank you, Madam Chair.
SENATOR BYE: Thank you, Senator.
Representative Dillon to be followed by Representative Lavielle.
REP. DILLON: Thank you very much, Madam Chair.
Good afternoon. Just a few quick questions. On the -- on the -- the testimony already was, I believe Dr. Brett Rayford (inaudible) what -- what are you using from 1994? That kind of jumped out. Is it a Legacy IT system?
CINDY BUTTERFIELD: Yes. It's the Department's LINK system. It's our case management mainframe system.
REP. DILLON: Could we have a conversation about that at the subcommittee level because it seems like, you know, in the years I've been here since a consent decree was signed, an awful lot of money has gone into different functions, and I'm always surprised to hear things like that. Thank you.
SUSAN SMITH: Let me just address that about the LINK system. I'm Susan Smith, and I'm the DCF -- I'm sorry, I'm Susan Smith, and I'm the DCF chief of quality and planning. And we, actually, are looking to contract for a new SACWIS system so that's a child welfare information system because, as Dr. Rayford indicated, and, as you know, Representative Dillon, that our system is quite antiquated on -- technology has obviously progressed quite rapidly over the years. So we're looking to create a system that will allow us to better collect a lot of the data that I heard folks speak about today, and also to support our -- our staff to access information and input information on -- in the field and be much more web-based, so that's actually is an endeavor that -- that we're working on that we've also engaged in a survey of our staff to get a sense of what they would like in this new system so that is actually an endeavor that we are -- we're working upon to develop and enhance a LINK system to -- to collect better information about our families and, also, in turn to report.
REP. DILLON: Just a follow-up. I'm sorry. I didn't hear your name and your position.
SUSAN SMITH: I'm Susan Smith, and I'm the DCF chief of quality and planning.
REP. DILLON: So, now would you be the person I would ask my second question to about the definition of recidivism?
SUSAN SMITH: I don't know if I'm the best person for that, per se, because I think that that has, you know, does have some others -- program-related components of it, so I'll ask Dr. Rayford to participate in that, but I'm certainly happy to talk about how we can provide the necessary data to -- to answer that question.
REP. DILLON: Right. No. I remember a five-year discussion with another department about --
SENATOR BYE: Before you leave, if you could stay there just for a follow-up --
SUSAN SMITH: No. I'm not going to leave.
SENATOR BYE: Okay. You continue (inaudible).
SUSAN SMITH: I was just trying to let Dr. Rayford --
REP. DILLON: I -- I was just trying to figure out, because I'd sort of went through this with DSS for five years about whether or not we could identify people who had military experience when they came to emergency rooms, and it didn't seem to me that it should be that hard.
Are -- are -- is it possible to -- following up on Representative Walker's question -- to -- given the tools you have now, to, let's say, take a definition from one state that's two hand -- that you -- we can -- and then take another and see how the numbers would vary on our own kids?
DR. BRETT RAYFORD: It would be a challenge because we're, essentially, talking about a hand count. And often, I mean, if you're looking at whether kids move from DCF to DOC, you know, there's a -- a question about whether we can actually get what we call a data dump in order to get that information. So it's complicated.
So –- so, could we find out? You know, we could put in a Herculean effort to try to get as much effort as possible to report back, which is what we intend to do for you. But if we had an updated data system, where it was a push of a button to be able to track a kid like that, you know, these wouldn't be hard questions for us.
REP. DILLON: Right. Except in the beginning, we have to do the thinking, and we have to have the case definition, and we have to have certain thresholds that you have to, you know -- and I think you and I talked over the years about definitions of who, in corrections, was mentally ill, if you can remember the hours we've spent together? Yes. And so, at I -- it -- let's say we could get to the point of pushing the button, we still have to have a good definition. And we have to know what other people are doing.
I was stunned today, and I -- and I'm -- I'm so excited about a lot of things that have happened in the Department and very impressed that at some of the savings that have come through with OHA but was still surprised to hear some of the testimony, because, obviously, a lot of what we're doing we want to know what the outcome is in terms of coming back because we're not doing all this just to kick the cost over to somebody else.
DR. BRETT RAYFORD: That's right. Well, to your point, you know, the more we are able to capture that data, it better informs our decision making. So I know that there's an effort now to sort of organize the agencies around what that state definition should be in order to select that data, and we really need to push that forward. We've been talking about it for a while. Yeah.
REP. DILLON: Okay. Great. And -- and the next is -- these should be easy, but workers' comp, which would be, I don't know who, -- and it's really just for follow-up not for answers necessarily today.
Over time, I think most of the workers' comp cases were in the Juvenile Training School; is that true? There usually was a cluster?
CINDY BUTTERFIELD: I think there's a -- I can give you the exact numbers of where -- where the division is. It is in congregate care settings. It is in our Solnit North, South and CJTS. I don't know that CJTS represents a bigger portion at this point, and then there is a good-sized group in our regional offices, but we could get you the exact breakdown of the figures.
REP. DILLON: Well, right, because I'm thinking -- well, the story of the broken jaw, obviously, you know, if it's helpful to the conversation, but what kinds of injury prevention you're doing and what else can be done and -- and given the -- the clinical background, the clinical makeup of some of the young people, if they've been sexually assaulted, for example -- and a lot of them have been -- they -- they would be at risk for assaulting someone else while they're in a congregate setting. Right? So --
CINDY BUTTERFIELD: Certainly, we'll get you that detail.
REP. DILLON: Okay. Great. And I think we're going to probably have other -- a court-ordered reimbursement, do you have a number on what you think will come into this state as a result of that --
CINDY BUTTERFIELD: We believe it'll be about $5 million.
REP. DILLON: And when will that start?
CINDY BUTTERFIELD: Soon.
REP. DILLON: That's really good. Thank you.
SENATOR BYE: Thank you, Representative.
A follow-up from my cochair, quickly.
REP. WALKER: Very quickly, so talking about the case management system, how much is that going to be -- is it in the budget, and can we bond it?
CINDY BUTTERFIELD: We've been talking with OPM about it. We believe it can probably be bonded. There is opportunities right now with the Affordable Healthcare Act, I believe, that will allow us to get up to 90-percent reimbursement, so it is a good time to be looking at doing this. We do -- need to have some linkage with the DSS system to be applicable to do that, and we're going to be putting out our RFI very soon to be able to investigate what the opportunities are and how much the total cost might be.
REP. WALKER: If we do an RFI, let's say, April -- so for everybody's purposes, request for information -- it's not the bill -- it's not the actual request for proposal. It is only just the information. How long do we need to collect information before we get to the RFP?
CINDY BUTTERFIELD: We're hoping to have the RFI out by the end of this month and hoping to have a real direction by April.
REP. WALKER: Okay. So we should be seeing an RFP by April?
CINDY BUTTERFIELD: I -- I think so, yeah.
REP. WALKER: Boy, that was interesting.
CINDY BUTTERFIELD: I hope so, yes.
REP. WALKER: I mean it -- it really would benefit us to see the planning in that because we've asked for data and data and data as long as I've been here, and I've been here about maybe -- whoa, about 15 years. So I'm -- I -- I mean, we need to get to that point now more than anything because our budget -- your budget is disappearing, and which is not necessarily a bad thing, but it's -- it's disappearing, and we want to make sure that it's going -- it's disappearing and still maintaining the right things.
I'm sorry, Madam Chair. Thank you.
SENATOR BYE: Thank you for that follow-up.
Representative Lavielle followed by Representative Lesser.
REP. LAVIELLE: Thank you very much, Madam Chair.
Thank you all for your presentation.
I just have one quick question that's on a slightly different subject. As and -- and really just want to know about impact of some of these changes on another area. As you know, one of the deep and abiding concerns that we have and have to an increasing degree, I think, since the past couple of years are the services our communities provide to children and youth in the area of mental health. And -- you're looking for someone else to come up and answer the question -- the -- I know Commissioner Katz is aware because we've discussed it and I'm sure most of you are, as well -- the Child Guidance Centers across the state, I think, are all kind of in the same situation. They are bursting past capacity. There are many people in the community of all income levels who need to be served, and because of various funding constraints, the centers just haven't been able to have the staff and the facilities and the circumstances to do it. And it's a -- we all know the consequences of not -- of not ministering to these needs and, unfortunately, the way the system is structured without going into the details, these community organizations actually are required to have a certain percent of their funding come from the state. They can't make it up with philanthropy or anything else. They've got to have it.
So my question is very simple. This is not my particular area of specialty on the budget, so I'd -- I am unable, personally, to sort out whether any of the changes you've discussed and the shifting around of money and some of the savings will have any impact on the areas of the budget that help to fund these centers. Will we see any change -- as far as I can tell in my OFA budget sheet, I don't see any change from the proposed budget, but I am curious to know if there is, if there is any discussion, any possibility and just exactly -- if you could just kind of qualify first what that situation is. Thank you.
TIM MARSHALL: So I, -- my name is Tim Marshall. I'm a clinical manager at DCF Central Office, and I help to manage the community-based system for the behavioral health network of -- of services that we have. I think I can answer that question, and I think a number of comments earlier about what is the Department doing about the community-based system when we continue to reduce numbers in congregate care and are we actually building up the community-based system. So if you would allow me a few minutes, I could give you some updates on about 8 and a half million dollars worth of community services and then talk a little bit about two or three other things that we're doing to try to make that happen.
Many of you may be aware that we executed a contract in mid-December for our Access Mental Health, which is a program that provides psychiatric consultation services to primary care providers throughout the state of Connecticut. So that service is currently in the process of being completely executed. Value Options is the lead contractor in that. They have posted for RFP for the three consulting hubs that will provide this service throughout the state of Connecticut, and we anticipate the consultation services beginning in June.
In addition to that, we have about $3.5 million in expansion of a number of community-based services. Some of them, again, you may have been familiar with, but there's a $1 million investment in what we refer to as MATCH-ADTC, which is a Module Approach to Therapy for Children with Anxiety, Depression, Trauma or Conduct Problems. And that is a $1 million expansion, and we executed that contract in early September and selected four clinics. So a number of clinics had a chance to respond to the RFP for that for intensive training for this in evidence-based practice in the outpatient arena. So that program is well on the way, and we have done some extensive work for that.
There is, in addition to that, a $1 million trauma focus cognitive behavioral therapy expansion that's occurring that a number of the community-based providers that you're -- made reference to have access to that and they -- they have access to that by selecting clinicians and having them participate in the learning collaborative, and they're -- the time that they're investing in new training staff on this evidence-based practice is also reimbursed by these dollars. So it helps them to recuperate cost while their staff is out and not, you know, seeing billable sessions.
In addition to that, we have a $1 million New Haven Trauma Coalition that we have been in the midst of executing, and we're just in the process of executing the contract there. There are four primary parts of that for the City of New Haven. It's a collaborative experience between Clifford Beers, the Board of Education, six schools, United Way of Greater New Haven and a number of other community-based systems. And there are four major components to that: there's care coordination; there's workforce development and training for -- on trauma and foreign practices; there is a trauma assessment screening and direct service intervention; and the final piece on that is network development and infrastructure support to that mini network that's being developed in -- in New Haven.
And, finally, of that original 3.5 million expansion, there's $500,000 that will be invested in Bridgeport that -- on a new evidence-based practice that we're bringing to the state that's a school-based intervention and that is called -- we refer to that as CBITS, C-B-I-T-S, but that stands for cognitive behavior intervention for trauma in schools. That 500,000 will be earmarked and rolled out in Bridgeport, but, in addition to that, there was $1.2 million in an expansion that was originally slated for ICATS which we diverted to the CBITS because there was such a need for the school-base intervention, and so that $1.2 million would be put to an expansion for the remaining parts of the state that -- so that that intervention can be engaged in some of the more needing -- needy schools who have high levels of traumatized kids in their population. So that's -- 3.5 of that plus that 1.2 -- 8 million, and finally, there was a $2 million of -- we're in the midst of a $2 million expansion of the MST evidence-based practice. And, of that, 275,000 went to an expansion of the Problem Sexual Behavior, and that allowed us to add one more team and that team services about 50 percent of the state. And that 50 percent of the state was the area of the state that had the higher rates of referrals for that intervention. And, currently, we are actually posting an RFP today for the expansion of MST Building Stronger Families, which is a $1.8 million investment.
So those are about $8.5 million in activities that are occurring in terms of investing in the community-based system, but those are not the only things -- you -- the -- we made reference to the $2 million in the KidCare account. We have some ideas about how that could be a -- spent, but some of that needs to be determined about what areas of congregate care reduction will actually occur, so if it's a reduction in subs abuse, then we'll need to build subs abuse.
But one of the things we know already is that intensive care coordination works, and many people think about that as case management. But there are really two main components of care coordination that are highly effective. One is that it's not just the case management. It is the child and family team meeting process in facilitating that and making sure families' needs -- the true needs are met, but the magic, if you will, of the team process is that we help families rebuild bridges and connections back to their natural and informal supports. That we don't buy the professional intervention all the time, and that many families who have struggles with behavioral health challenges, children in that -- in that range or other issues, very often have broken relationships with their informal network and so the care coordination piece is a really vital point in terms of helping to rebuild those natural, informal connections so that families can support families with taking care of their kids.
In addition to what was mentioned already in that 2 million and the others, as the Commissioner shared in her priority area, getting to a 10-percent reduction means that we need to be doing lots of thinking about how to continually build a comprehensive integrated behavioral health system. So there's lots of thinking that going -- that has been going on in terms of the continued reduction that's happening, so it's not like we are not thinking about this.
And, finally, many of you are familiar with Public Act 13-178, which requires us to facilitate a process with multiple stakeholders, and it's in that that we are hope to articulate -- articulate that very thing that I think we are all are talking about and, that is, can we be sure that Connecticut has a fully integrated comprehensive network of care for kids and families so that no kid falls between the cracks if they have behavioral health needs of any kind. And so there's lots of work being done on those initiatives. And so, I think, that may answer some of the questions that were posed earlier but, specifically, also gives a number of the community providers opportunities to expand the service array that they have to offer.
REP. LAVIELLE: Thank you for that very comprehensive review.
Just a clarification, out of all of the things that you mentioned and the 8 and a half million dollars, and so on, does any of this actually represent an increase or change or even decrease in funding to these community providers, or does it's -- the way this is presented is always somewhat opaque in the budget sheets, and I'm sure it is to everyone at some stage. It's just a question of the way things are done, but does it represent any change to that funding one way or the other from the original proposed -- from the original adopted budget?
MICHAEL WILLIAMS: Hi, I'm Michael Williams, the (inaudible) commissioner for operations for the Department. If I understand your question correctly, at the beginning, it was the line item for Child Guidance Centers, and these don't change that line item one way or another.
REP. LAVIELLE: Thank you very much. That's very clear.
TIM MARSHALL: And I would just add that as I go through the whole list of things, none of these preclude any of them from applying for or having an opportunity to apply for some of these procurements.
REP. LAVIELLE: Yes. And I -- I'm sure that they will. It's an area that really -- I -- I think desperately needs some attention, and I hope that that will be forthcoming. Thank you.
SENATOR BYE: Thank you. That -- I think a lot of committee members appreciated your really comprehensive explanation of the community-based supports. And a couple have asked if -- if we could have a write-up for committee members of the various systems, and I think in the small group, we'll be following up about is this enough, is there more we could be doing in the same? So, I really appreciate your answers.
And some information about the evidence-base practice. I mean, we've heard about the trauma informed care, we know how well that's going in some of the places but -- and how we're tracking the success of these interventions here.
So thank you so much for that.
And Representative Lesser had a question.
REP. LESSER: Yes. Thank you, Madam Chair.
And thank you, Commissioner, for your testimony, and I -- everyone else from DCF. I want to first thank you Commissioner for meeting with me about the girls' juvenile justice facility at Solnit. I appreciate the information on that and, as well, on the work that you've done to bring -- for the psychiatric portion, bring back patients from out of state. I think that's gone a long way to easing concerns about underutilization of the facility.
I have some questions that were -- been raised since our meeting, largely by members of the child advocacy community, both in official settings and for nonprofits that I would hope that you could provide some clarity on. First of all, could you -- and I apologize, I missed your oral testimony. I was in another meeting, but I did -- I did review it. If you haven't already said so to the committee, do you have an update on the time line on when this facility is likely to be opened?
COMMISSIONER JOETTE KATZ: We're having an open house in early March.
REP. LESSER: So that -- that would be when the -- the girls would be transferred to --
COMMISSIONER JOETTE KATZ: Yes.
REP. LESSER: -- Solnit, early March?
COMMISSIONER JOETTE KATZ: We will then be able to start accepting the girls into the facility. The superintendent has been hired, staff has spent hired, everyone is in the process of being trained, and the final renovations are being -- being done as we speak.
REP. LESSER: So when we have in the budget a request for 30 positions at Solnit, those positions have already been hired or has --
COMMISSIONER JOETTE KATZ: My CFO is going to tell you how she works her magic.
CINDY BUTTERFIELD: We -- we did have vacancies in our -- already in our count that allowed us to be able to move forward on this. So, yes, we do -- you need the funding that is in this group to be able to maintain staffing levels throughout the rest of the Department, but we did have this staffing levels and the funding for the immediate hire. And this is out of the (inaudible) budget.
REP. LESSER: So -- so this is -- so the 30 positions we would be authorizing would not be for the girls' facility? They would be for other positions that are currently vacant in DCF?
CINDY BUTTERFIELD: No, they would be for the girls' facility. We would be able to support the hiring of the positions in the girls' facility.
REP. LESSER: But, presumably, this budget won't be adopted between now and the beginning of March so I -- I'm just a little confused as to how, procedurally, you would be able to hire folks before we authorize the positions.
CINDY BUTTERFIELD: The Department has positions already in its -- its authorized position count. We are below our authorized position count right now, and we are also -- have money in our -- in our money -- in our budget this year for personal services. We are actually going to lapse some funds so we're able to do it this year.
REP. LESSER: Is this the first public hearing that the Legislature has had to consider this proposal?
COMMISSIONER JOETTE KATZ: In thinking back, probably yes.
REP. LESSER: So where -- you know, my concern is, I've been reading in the papers in the last few months, a number of concerns brought to us from the child advocacy community. I don't know whether those are valid or not. I've met with you. I've heard a very cogent case for why this is necessary, but I think the purpose of the public hearing process and the purpose of the, you know, the legislative oversight that we provide is to be able to vet concerns and to find out what the best process is. And now sitting here in mid-February being told that this facility is going to be open in March, I'm concerned that we just haven't had the opportunity, as a legislature, to -- to vet this proposal to see whether or not these concerns hold merit and to decide whether or not opening a new facility is in the best interest of the state. I'm not saying it's not, but I -- I just don't know if we -- I don't know if you have a response that why this wasn't brought to us in the last legislative session?
COMMISSIONER JOETTE KATZ: This -- this is on me. Heavy is the head that wears the crown, and today I'm wearing the crown.
Quite frankly, there have been 2500 girls who have been referred to the juvenile justice system in 2013 alone. I review all the out-of-states, I review many of the delinquencies, I review the most troubling children. And after three years I decided, just like with DRS with that it had been discussed and kicked around for ten years and I finally just said enough, process at a certain point really there has to be some implementation and there has to be some action, and I concluded that based on my review of both the literature, the population, the girls that I had been seeing, the testimony that had been offered years ago in connection with the Bridgeport facility seeking -- their first 30 beds, then 24 beds at which all of the advocates at the time spoke frankly and openly, and many of them have spoken to me privately that everybody recognizes -- I shouldn't say everybody, it's too generic a term -- but many recognized the need for a small facility, hence, ten beds. I have not only given you tours -- you a tour but several other people. I have conferred both with politicians as well as two unions, staff, and girl experts -- when I say "girl experts," on services that these challenging girls need, and at the end of the day, I pulled the trigger.
It's on state property. It's a unit that's on the campus of Solnit. It's a state-owned facility, and it's an issue of converting the beds. I couldn't do it as part of Solnit because it would lose the hospital accreditation. It had to be done as a juvenile justice facility under the auspices of somebody who's -- who can run it, hence, Bill Rosenbeck, who oversees CJTS.
He has consulted with national experts, as I indicated. Tammy Sneed, who oversees our girl services, Doctor Linda Dixon, there are a number of people both in the facility -- in -- I'm sorry -- CO at DCF, as well as external to the agency, who helped guide me in making this decision. I did not make it lightly. It is not something I'm happy about. I'm not happy about the need. Frankly, I'm not happy about the need for an agency, such as DCF, but at the end of the day somebody, I felt, had to make a determination as to what to do with these girls as I was sending them out of state.
You missed testimony -- and I completely understand the obligations of having to be in many places at the same time -- many of these girls are extremely assaultive, extremely dangerous. They have -- they have experienced their own traumas, but at the end of the day many of them need to be in a facility where they can be treated. And sometimes that means confined so that they can receive the treatment. It is not a placement, it is not a correctional facility; it is a treatment facility. And what I'm really trying to do, frankly, is -- and I'm showing my age here -- is sort of think of it as Title IX. I am trying to afford the same opportunities for girls that boys have always had. And so, again, at the end of the day, after looking at 30 girls in detention where they are not getting treatment, 60 girls in York, many of whom should not be there, several girls who have -- whom I have had to send out of state because we do not have facilities, and 2500 girls in 2013, alone, who have been presented to juvenile court, I felt a ten-bed facility was the best option I had.
REP. LESSER: Thank you for that answer, and it's very helpful, but one thing that I -- I read the papers and I hope this will be illuminated if we -- if we do have public hearing testimony later on is a question about an existing -- a contracted private facility that DCF currently has, I believe called Journey House. And my understanding is that part of the need for this new facility is because of overstays and other issues at Journey House; is that correct?
COMMISSIONER JOETTE KATZ: Is it part of that? No. That's what you're hearing from the advocate.
REP. LESSER: That's what I'm hearing from the advocate, so I haven't heard the other side.
COMMISSIONER JOETTE KATZ: I don't -- I would not concede to that. What I will tell you is Journey House is full. There are three girls on a waiting list. And could we do a better job at discharge planning, sure. Could we always do a better job, absolutely. Do we need to do a better job of working with our families to be able to help some of these girls transition, you bet. But is the overstay at Journey House directly responsible for this unit, no.
REP. LESSER: Has the Department undertaken any kind of comprehensive analysis of girls' juvenile justice planning, not just with regard to the girls who would be at Solnit South, but with regard to the whole system. And if so, does that -- taking into account the other facilities that are available in -- taking into account community placement, because I'm really curious, responding to something that Representative Walker said, is this $2.6 million that spent here as opposed to community placements as opposed to rehabbing or re-imagining the role of Journey House? I'm curious if any kind of comprehensive analysis has undertaken?
CINDY BUTTERFIELD: As far as the girls in Journey House, you know, people point to an overstay, their average length of stay is -- is rather long, but there is a monthly process, the value options, goes through with each one of our placement. And at the end of every month the provider puts in a report and the determination is made as if medically necessary for the child to remain in the placement, and there are no children on overstays that are not said to be medically necessary for them to remain at Journey House. So others may look at the length of stay and say it's long, but the treatment needs to continue according to our behavioral health partnership.
REP. LESSER: Well, I'm going to shorten my questions there. I would just say that I do have concerns about this proposal. I'm not ruling it out, but I want to make sure that the process -- I would emphasize that the process is at least as important as the policy, and I want to make sure that were considering folks from the community and that we're fully vetting this, and it's concerning to me that this is the first public hearing we've had on this proposal considering we're just weeks away from it opening. So thank you.
SENATOR BYE: Thank you, Representative.
COMMISSIONER JOETTE KATZ: Oh, I'm sorry -- I just would add although it's the first hearing at the legislature, there have been numerous hearings in the community. I want to be really clear about that at which the advocates have had an opportunity, private providers have been there, as well as a number of DCF employees, including Bill Rosenbeck, both explaining the nature of the facility and the need for its existence. So while it is true that this is the first legislative hearing, there have been several, because I really do think that we need the community, not -- I also want to be really clear, my feeling about this and on the risk of sounding arrogant, it wasn't really for permission, but it was for blessing, and it was about to be able to collaborate because our girls are going to be returning to those communities, to families in those communities and we need to partner, and so we had a number of forums throughout the region to discuss very largely these issues, quite frankly, but, again, this is the first hearing at the legislature at which this has been discussed.
SENATOR BYE: Okay. Just so committee members know, we are -- we are getting ready to wrap up, we may have a couple of closing questions for you to get back to us on, but Senator Markley has been waiting and I'd like to have him ask his question.
SENATOR MARKLEY: And I have two questions -- and with apologies for the fact that I've just came in from the (inaudible) meeting -- and one is very specific, one is general, and I don't know if they came up before, so if they did, I'm sorry.
One was -- back to the question of the Solnit Center, I understand from -- from the budget people that I've talked to that there's $150,000 maximization of reimbursement number added in. That's a -- there's a consultant -- a revenue consultant that's being hired in that case, or what is that expenditure?
CINDY BUTTERFIELD: No. In the case of $150,000 for the Solnit Center, what that represents is the Office of Healthcare Advocate has investigated the children that were not receiving reimbursement and now who have been court ordered into the facility. We need to have a medical doctor sign off on evaluations that have been done by psychologists that actually prompted the placement in Solnit South. And once we have that done, it's determined to be medically necessary, we can then seek reimbursement.
SENATOR MARKLEY: Very good. Thank you. That answers that perfectly.
And the second was partly of kind of -- something that was prompted by the program review study that was done recently on Aging Out and DCF's handling of that, and one of the things that was brought up, especially by young people that testified was homeless problems for -- for youth. And it was brought to my attention that there was a program that was established before I was here in 2010, a homeless youth program that was not funded as a result of deficit mitigation. I didn't know if that was something that might -- were that funding to be made available, be something that would be useful to address that problem, address some of the things that we heard about on program review, or what other barriers you're aware of that might be susceptible to programmatic -- to be addressed by programs that exist?
CINDY BUTTERFIELD: Although that funding was taken from the Department, the Department did work with -- with its contractor that is providing our supportive housing programs to make up the difference and use money from other accounts to be able to fund the million dollars that we were cut. We can give you a comprehensive look at the homeless problem and the housing issues the Department has, and we can report that out at the next committee meeting.
SENATOR MARKLEY: I would be very interested in it, yes. Thank you.
SENATOR BYE: Thank you.
And Senator Markley raised one of the last issues we were going to raise with you, which are some real concerns around teen homelessness and some of the waiting lists for families who need RAPs who are -- you know, the RAPs will help them maintain custody of their children and what can happen there.
And one other question, which is, a lot of the programs helping children in DCF who are teens, in terms of housing, start at 18. And there's a real need it seems like among 16- and 17-year-olds to be able to access some of those programs. So we're short on time today, but I think in our small workgroup, following up on Senator Markley's question and real concerns on this committee about youth homelessness, if you can give us a picture of what's happening now and then really on all of this, if we're finding savings in reducing congregate care, how can we shift it to supporting people in homes? I know we're all under budget restrictions, but I know I've had conversations with Secretary Barnes about when we're finding savings, whether it's with DCF or DDS or DHMAS, because we're doing less congregate care, we need to make sure that those dollars don't just get shifted back in the General Fund and that they stay and are supporting people who are living in the community, but who will need community-based services if they are to stay out of emergency rooms, shelters, corrections and coming back into DCF care. So I think that's like a broad-based concern on this committee related to DCF, but not just DCF.
So I want to just go over the list with you of what we have for follow-up so there's that issue of homelessness, but you were going to get back to us about how we're going to -- how you're working to define recidivism, and as best you can, get us some data about recidivism in the new programs, staffing, DCF staffing, given that your caseload is more demanding. There wasn't a request in the budget. Is there a reason for that? Are you retooling, or is that a need for the more severe kids? More detail about the community-based services for committee members; some more detail on the cost savings of the closing of the safe homes, has that worked out; information for committee members about some data system improvements you're hoping to get to; and I think I already said this, a write-up of the support services in place as -- as children are coming out of care.
So we really appreciate your testimony today. It was extremely helpful, and it -- you can tell we still have work to do in the small committees but then we can drill down into those details.
REP. MINER: Madam Chairman, not to prolong this -- and thank you. I don't have any questions of the folks here, but my question is to you. It seems to me that we -- we generate a lot of interest during these public hearings and the public, certainly, has an opportunity to watch this. When we migrate to the next phase of our process, it becomes much more -- must less public, and so for that reason, I would like to strongly suggest that if there are some issues that people feel need to have another public opportunity, that the chairs consider that. But beyond that the request for information that these public meetings, I would hope that it actually gets funneled through our administrators so that they don't become the property of me or anyone else, because I think only through shared information will we be able to get to the point that I think all of us are trying to get with some of these issues. Thank you.
SENATOR BYE: I think that's an excellent suggestion, Representative. And we'll make sure committee members have it, and maybe what we should really, also, do is consider a way to post some of the follow-up information on the website, and we can talk -- to legislative management and our administrator about that so it becomes more public. And if members are feeling, after the next phase, that we need another hearing, I think we should definitely consider that.
So thank you so much, Madam Commissioner, and -- the committee is going to take about a 10- or 15-minute break. What if we say we come back at ten of two because we need to set up a power -- the Commissioner has -- Commissioner Bremby has a PowerPoint, so thank your much.
COMMISSIONER JOETTE KATZ: Thank you so much for your time and attention.
SENATOR BYE: Good afternoon. We're ready to reconvene the public hearing and hear from Commissioner Bremby from Department of Social Services.
COMMISSIONER RODERICK L. BREMBY: Good afternoon, Representative Walker, Senator Bye, members of the Committee. We decided to not use the PowerPoint projection today but we do have the slides and we'll just talk from the slides.
SENATOR BYE: Can you -- can you hold one minute, Commissioner?
COMMISSIONER RODERICK L. BREMBY: Sure.
SENATOR BYE: Could we have copies of those? All right, they're coming.
So -- so you can start.
COMMISSIONER RODERICK L. BREMBY: Okay.
SENATOR BYE: We just need the slides he said, thank you. I'm sorry about that.
COMMISSIONER RODERICK L. BREMBY: Not a problem. Please to have the opportunity to testify this afternoon on behalf of the Department of Social Services and the Governor's mid-term budget adjustments for the Department of Social Services.
The -- the presentation is lengthy. We will not be going through the slides. I got the instruction set on the 20 minutes so I'll just hit the highlights.
The -- the summary is provided on page 2 and it pretty much outlines how we wanted to proceed in the conversation this afternoon. The next slide just articulates that we serve one out of every five Connecticut residents, 600,000 for healthcare and 400,000 for SNAP.
We wanted to convey that DSS is currently mapping three key transformations. The first in Medicaid that many of you have heard about. The second is in eligibility processing which is currently under way and we're still trying to refine and the last is integrating our service delivery framework which we've not talked about very much but you'll see traces of that in our budget.
The next slide, five, just speaks to some of the highlights. Long-term care rebalancing continues under this budget. We will continue to map diversifying the nursing home industry. Our Money Follows the Person Program is one of the best in the nation. We transition more than 2,100 people to community and seven -- several thousand more are in the assessment or case management process.
We also want to talk about the balancing incentive program. It's a great opportunity for additional federal revenue.
On page six, we begin the -- the narrative about the budget. The state fiscal year budget, 2015, is an increase of $28.9 million above the original appropriation when compared to the current year's budget. We see a decrease of 9.6 percent for state fiscal year 2015. This decrease is largely due to increased F match on Husky D population to 100 percent.
Slide seven just outlines the mid-term budget adjustment. It reflects the 3 billion for state fiscal year 2015 and again the slide is affected by the impact of net funding Medicaid.
On slide eight, as the recommended -- as recommended, the DSS budget would constitute about 17 percent of the state general fund allocation.
On slide nine, we start teasing out portions of the budget. The state general fund budget directs about 82.3 percent of our resources to health services, administrative and field operations (inaudible) --
REP. WALKER: Excuse me, Commissioner, we don't have eight so just to let you know that.
COMMISSIONER RODERICK L. BREMBY: You do not have --
REP. WALKER: Eight, slide eight.
COMMISSIONER RODERICK L. BREMBY: Okay. I apologize for this. I think that you will not have the even numbered pages if my understanding is correct. In the copying perhaps a double-side was only copied on one side. We will get out -- so I'll make a note of that as I go through.
The admin and field operations expenses constitute 9 percent and lastly the DSS budget for temporary family assistance, state supplement and SAGA cash assistance programs is at 7.1 percent.
The next slide would have just showed a pie chart of what I just talked about. Slide number 11, we identify some key strategies. First and foremost is continuing support in the Medicaid program for the administrative service organization structure to make sure that we're able to manage our medical behavioral health, dental and non-emergency medical transportation functions in a more holistic integrated way.
We enable the use of preventative and primary care and we are shifting from institutional to home and community-based services where the customer or the citizen so chooses.
Page 12 just highlights that we are promoting efforts to ensure that provider payments are free of fraud, waste and abuse. We speak to pursuing additional opportunities under the Affordable Care Act.
We are continuing to invest in our technical infrastructure. The ConneCT was the initial project. The ImpaCT is the replacement of EMS and that project is well underway.
Lastly we're investing in additional resources and operating expenses with the recent Access Health and ConneCT rollouts.
Back to page 13, we point out that Medicaid constitutes 76 percent of the DSS budget. Fifteen, the Department now supports the federal share, the program -- Medicaid program by placing the federal reimbursement related to the DSS Medicaid in a dedicated account. This is in relationship to Medicaid net funding.
We continue to report expenses in aggregate to ensure transparency and to allow for an accurate assessment of costs of the total program.
In terms of our overall Medicaid expenditure growth, the expenditures are increasing slightly due to caseload growth but we have stable trends in costs per person.
On page 17 we show a slide with the Medicaid caseload growth. We're projecting a 6 percent caseload growth over the 5 percent that we experienced in calendar year 2012.
While caseloads have continued to increase, overall Medicaid expenditures were rarely -- relatively stable in calendar year 2013.
Slide number 19 speaks to the caseloads again. A relative stable PMPM or per person per month cost at 1.4 percent over the previous calendar year.
Slide 20 would have shown that 31 percent of our expenditure costs go to hospitals, 24 percent go to long-term care in terms of category of service and 2 percent for administrative costs.
Slide number 21 just lays out the key strategies for our Medicaid budget: continuing the ASO, enabling preventative and primary care and supporting Meaningful Choices in long-term care services and supports and a significant anti-fraud initiative.
Slide 23, the central hypothesis for the Medicaid program, is that we will centralize the services in a self-insured managed fee for service arrangement with all of our ASOs. We're going to use predictive analytics and modeling to -- and data to best inform and target beneficiaries who need the most assistance and who will be yielded improved health outcomes and -- in order to control the rate of the Medicaid spending.
Slide 24, we'll pass on that. Slide 25, data integrity, under the ASO we're been able to develop with CHN a single integrated data set which includes a wealth of claims and encounter data and this data is more reliable and complete than what we had available to us under the multiple managed care organizations.
CHN has been using the data to not only attribute members to primary care practices but to support members through intensive care management. They also are supporting providers in understanding and tracking the needs of health services for the members for whom they care.
Twenty-seven, the ASO provides for centralized member services as well as centralization of provider services. So we support the providers with prior authorization requests, coverage requests and referrals.
Slide 28 calls out something that we have noticed and are giving significant attention to but CHN in their care coordination has begun to recognize and realize that our customers are presenting with food and security questions as well. So it's more than just medical. It's what's happening in their environment that they're needing assistance with and so CHN is providing some of that assistance.
We have developed culturally attuned conversational scripts as well as chronic disease management scripts so that people at CHN are getting a complete touch. CHN CT has deployed teams of nurse care managers geographically across the state so that we can be quick to be responsive to our customers who are in need.
I'm going to skip that one. I'm going to go to 30 which is the medical ASO accomplishments. So over the period from January 12 -- or January 2012 through October 2013, January 2012 is when we launched this ASO framework. Per member per month costs have decreased by 2.7 percent. Hospital inpatient per member per month costs have decreased by 6.5 percent. Emergency department visits per 100 member months has increased by .2 percent.
The next slide, 31, shows the claim experience. We can show members engaged in intensive care management through January to December 2012. All claims paid decreased by 12 percent. Medical claims decreased by 13 percent.
Behavioral health claims did increase by 4.4 percent. ED visits decreased by 6.9 percent and inpatient admissions decreased by almost 40 percent for the medical ASO for members engaged in ICM.
Looking at a lull in 12 months, members who were engaged in the intensive care management between April 2012 -- yeah that should be 2012 and not 2102, at March 2013 realized a 15 percent reduction in claims, 16 percent reduction in medical claims, a slight increase in behavioral health claims, 1.6 percent, 7.6 percent drop in ED visits and a 44.2 percent reduction in inpatient admissions.
The next slide speaks to behavioral health accomplishments. Value options is driving the ICM program and we realized a 72.7 percent in total days in confined setting, 73.5 percent reduction in psych days, 69.2 percent reduction in inpatient detox days and a 10.5 percent increase in total days in community.
This is what you might expect if we're able to address the in -- in-facility treatment and provide options for community-based care.
Slide -- slide 33 represents some really good accomplishments of the Connecticut Dental Health Partnership. We're really proud that this program has been recognized as one of the best in the nation. The number and percentage of children and parents who receive dental services increased for the third consecutive year.
The number of children under three who received preventative dental care increased by nearly three fold or 300 percent. The next issue is access. One hundred percent of the beneficiaries have the choice of at least two dentists within a 20 mile radius of their home, 99.7 percent have two providers within a 10 mile radius and 97.7 percent have a -- one dentist available within a 5 mile radius.
This access is due, in part, well due in large measure to the dental partnership and we're deeply appreciative of being able to continue that.
I'm going to skip 34. Thirty-five speaks to enabling the use of primary care. Under the ACA we were able to increase Medicaid payments for identified services to primary care docs to 100 percent of the Medicare payment rate. This is financed with 100 percent of federal funding and the person -- and the provider has to self-attest.
On page 36, we have identified 200 -- 2,277 approved providers who have attested to eligibility and beginning July 1, 2013 they began receiving the enhanced payment which again is 100 percent of the Medicare rate.
Thirty-seven just identifies that we've seen a substantial increase in the number of participating providers and this budget maintains funding for that primary care rate increase to continue after December 31, 2014.
I'm going to skip 38. Thirty-nine speaks to rebalancing. The Governor's proposed budget adjustments further rebalance -- further the rebalancing agenda by incorporating Community First Choice initiative as well as proposing to expand participation in the Katie Beckett Waiver and the Connecticut Home Care Program for Adults with Disabilities.
If we skip over to -- was that a yes?
A VOICE: (Inaudible).
SENATOR BYE: Just so you know, Commissioner, we -- we did get a new PowerPoint that had a number of missing pages but did not have all the missing pages and so Committee members are balancing back and forth and we are -- we are working on getting a complete -- so you can just -- it's fine if you just continue reviewing --
COMMISSIONER RODERICK L. BREMBY: If I go over the 20 minutes --
SENATOR BYE: -- reviewing the issues --
COMMISSIONER RODERICK L. BREMBY: Okay.
SENATOR BYE: -- and then we'll -- we'll catch up when we get a complete set.
COMMISSIONER RODERICK L. BREMBY: Okay. Again I apologize for that.
SENATOR BYE: That's okay. I think, you know, if you provide the overview then there will be questions and you'll have a chance to clarify so no worries.
COMMISSIONER RODERICK L. BREMBY: The Balancing Incentive Program allows the agency to qualify for a 2 percent federal reimbursement increase by targeting 50 percent of our spending on community-based long-term care services and supports by October 1, 2015 and receive, as a result of that, $72.8 million in additional revenue through the state fiscal year 2016. The BIP, or the Balancing Incentive Program, is a key initiative or goal for us.
The Community First Choice also permits us to provide community-based personal care assistance and other services to individuals with disabilities who otherwise would require institutional level of care. This qualifies Connecticut for an additional 6 percentage points in federal matching funds.
The Katie Beckett Waiver, under the Governor's proposed budget, is poised to expand by 100 slots for children with severe disabilities. The current waiver is capped at 200 slots with a significant waiting list. The expansion will allow more medically fragile children to access services in a more timely way and support parents as primary caregivers.
The budget also permits the expansion of the Connecticut Home Care Program for Adults with Disabilities to serve an additional 50 adults with neurodegenerative disorders such as MS and Parkinson's disease.
This will open up opportunities for people who are currently waitlisted for these services and will prevent nursing home placement for individuals who would quickly turn to Medicaid as their payment source.
The anti-fraud initiative is one that we've been talking about for quite some time but the Governor's budget proposes to include an aggressive fraud detection initiative. The contractor is already on board.
The underlying budget assumes that we will generate $1.4 million in savings due to this effort. The contractor will use predictive analytics using network analysis and looking for patterns of fraud.
Let's see the budget also provides for funding six new staff people to help support fraud recovery efforts.
Moving over to the Office of Child Support Services, and this is one of those transformation efforts of trying to integrate more of our Social Service supports. We're asking legislatively for a name change to the Office of Child Support Services but we're trying to array all of the necessary services around this mission so that we can better support children and families.
Performance metrics are being identified in paternity establishment, support order establishment -- or enforcement, collections, arrearage collections and cost-effectiveness.
We believe that by adding these seven additional people, at a net cost of $190,000, we will increase the support order and establishment, increase collections, avoid penalties and also generate about $1.7 million in new revenue by way of bonuses -- performance bonuses.
The Governor's mid-term budget recommendation supports are continued infrastructure enhancements through staffing, ConneCT, ImpaCT, which is the EMS replacement, and the Access Health CT cross portal operations.
Personal services line we're showing that the authorized account has been increased by 103 positions in the Governor's mid-term budget along with associated funding.
There is a slide 55, I don't know if you have it or not, but it lays out the allocation of those 225 positions from the July 2013 1,722 count to the 2015 that is in the Governor's recommended budget.
IT supports and investments continue. I'm skipping through these to get to ConneCT on page 59 if you have that. Again those components included Web Service, Telephony, document management and workflow and we have about $6.5 million in operational costs included in state fiscal year 2015.
The integrated eligibility platform we can talk about in greater detail as -- as you have questions. Access Health same way.
But moving on to slide 62, the mid-term adjustments include a half million dollar reduction related to a -- a capturing of efficiencies. The agency has deployed a robust lien incentive and we believe that we will be able to achieve $500,000 in reductions looking at a number of opportunities.
In closing, I'd like to express my gratitude to Governor Malloy for supporting our efforts and to provide critical services to our neediest of citizens. I recognize the challenges we face and we are committed to providing the highest level of support for our customers.
At this time we are standing available for your questions. I have Mike Gilbert who is the director of fiscal services for DSS as well as Kate McEvoy who is leading our Medicaid transformation as our Medicaid director. We also have Deputy Commissioner Ray Singleton to pick up on some of the integrated services questions and so we'll just stop there.
SENATOR BYE: Thank you for your testimony and for Committee members' information the complete PowerPoint can be found on the Appropriations website with -- with all the parts. And you have most of the parts if you put it together but -- but we apologize for that but you can access it.
I'm going to turn it over to my Co-Chair who has some questions.
REP. WALKER: Good afternoon and thank you for your testimony and thanks -- and I look forward to kind of looking it over later on. I want to talk to some of the -- the line item adjustments that you have in your budget.
And my first one I'm going to go to is your staffing and I'm glad we got that -- we had that -- that PowerPoint -- I mean that slide. So the majority of the positions are going to go into field operations?
COMMISSIONER RODERICK L. BREMBY: That is correct.
REP. WALKER: Okay. And field operations are -- are those the people that when people make applications to DSS for Medicaid placement or for child care those are the -- that's where the field operations is?
COMMISSIONER RODERICK L. BREMBY: Yes. We have 12 regional offices and out of those offices we perform most, if not all, of our eligibility determination work. We also have investigators stationed there as well as folks who work in social work in the child support.
But most of these positions will go there as well as to support the IT project to replace EMS. So there's a project team with a set of positions that enable us to design the system so that it is properly replacing EMS.
REP. WALKER: Well I'm glad to hear that they're going into the eligibility because I -- I'm going to be honest. I think at least the -- the two Co-Chairs of Appropriations have heard over and over again from numerous people, numerous people that eligibility is a real problem, that the timeframe for people getting processed is really way longer than -- than it's -- it's acceptable.
I mean it becomes critical in some areas and -- and I really am -- I really am glad to hear that you are doing that.
The others, the -- the fraud investigation, the accounts investigation, I think those are great for us if -- if our objective is to -- to continually recoup all of the dollars that we give people. I think those are great but eligibility I think is really one of the biggest important areas that -- that I can ask for.
Okay going on to some of the line items in here. You have a -- a line item reduction in TANF which was really concerning to me because -- I mean when -- when we look at -- at where Connecticut is in their TANF spending versus like national spending, just a -- just a little information, basic assistance, 16 percent of it we spend in Connecticut and the national average it's 29 percent.
Work-related activities, 4 percent, national, 8 percent. Child care, 7 percent, average 16 percent. So the amount of money that we invest in the safety net that we have talked about and the importance of it for -- for people to get off of TANF, we spend very little and -- and I think 66 percent of our money goes to -- to DCF and, you know, I -- I apologize that we didn't get -- talk to DCF about it.
But in looking at that and the fact that we spend so much less than other states on the national average, where is this $4 million coming out of? And it says that we have a reduction in caseloads but is it because -- I don't see how we could have such a reduction when I -- when I -- I look at my constituent and it's not just my constituent.
Senator Beth -- Senator Bye and I get -- yes Senator Beth and I -- get calls -- we get calls from people all over the state. People think Appropriations, they're the people to call when it comes to DSS. We are like your gatekeepers I guess and it is -- the number of people that are looking for assistance and support is like continuous.
So tell me where is this $4 million reduction?
COMMISSIONER RODERICK L. BREMBY: The $4 million reduction is based upon a declining engagement in our TANF program by customers. That's not to say that the need doesn't exist. It's just that the caseloads continue to drop. We have begun to form a team to look at resetting our TANF program to sure that we can put in place a TANF program that fits this environment instead of the environment in late 1990s which is what was in place when TANF was first launched.
REP. WALKER: Right.
COMMISSIONER RODERICK L. BREMBY: So with that we have the shortest timeframe of just about any state in the nation --
REP. WALKER: We are.
COMMISSIONER RODERICK L. BREMBY: -- for our TANF program. We know that we need to use different models and accountability models for trading so that people can get jobs where they can sustain themselves and their families.
So there's a lot that we're looking at now. We've looked at some of the best practices from Oregon's reset, Colorado's reset, D.C. has had a reset, Pennsylvania has had a reset. We're engaged with the ACF staff at National for some technical assistance but we haven't forgotten this.
This is something that we are working on. It's one of the three transformations that are underway in the agency. It's how do we integrate our services in a way to better address the needs of the neediest people within our communities.
So this just reflects a drop in caseload. This does not match up with need but we're just trying to be responsible in terms of the allocation.
You may recall my first year here. We had a -- as a matter of fact my first week here, we had a budget adjustment where we were moving TANF dollars into other locations within the budget.
REP. WALKER: Uh-huh.
COMMISSIONER RODERICK L. BREMBY: And again that was because of the shortfall. This budget just tries to recognize what is happening in terms of expenditures.
REP. WALKER: So I mean when I -- when I look at the -- the average client that you -- you work with in DSS, I -- I -- are we looking at all the services and how we deliver our services to these clients also? I mean I understand the caseload is dropping but are we, in the services that we provide the TANF clients, how many of them, once they've gone through the 21 months, do we follow up to see how successful the clients are once they get off of TANF?
COMMISSIONER RODERICK L. BREMBY: Overall we have not developed a strategy to report out on success or hold accountable our partners for that success of this population. So the integrated services delivery transformation that's being led by Ray Singleton, as well as Dakibu Muley, who is heading up that division, is trying to put our arms around -- wrap our arms around not only who we're serving but with whom are we serving them.
REP. WALKER: Uh-huh.
COMMISSIONER RODERICK L. BREMBY: Our -- we're trying to build out a -- a theory of practice for social work to make sure that they way we engage is the proper way to engage and we also use our strategic partners in the best possible way. We contract with I would dare say dozens of organizations --
REP. WALKER: Uh-huh.
COMMISSIONER RODERICK L. BREMBY: -- nonprofits, locally, on the ground --
REP. WALKER: Uh-huh.
COMMISSIONER RODERICK L. BREMBY: -- but we've not integrated that case management in a way that produces the results that we need to drive towards.
So that's what's on their plate. That's what's on the agenda. That's why we've got this transformation issue underway.
Now in order to move us a little bit further, and I picked up on a little of the conversation that you had with our sister agency, DCF, because of a lack of -- historic lack of investment in the infrastructure, it is very difficult, if not impossible at this point, without a tremendous amount of effort, to determine whether a family or an individual is accessing services across a number of agencies.
REP. WALKER: Uh-huh.
COMMISSIONER RODERICK L. BREMBY: And we know that they do. But we also have to work together to make sure that we're providing those services in a uniform way. So those are the -- there are things that we're driving towards. We trying to make sure that we build out this technology in a way that we can share this information to be helpful to individuals and families and not be harmful or hurtful by all of the services that we provide.
We have strategic partners known as community access agencies that have consolidated services across a variety of programs and so we're going to continue to support their operations. We're going to continue to partner there.
But we've got a lot of work to do with this population, the -- the neediest people that we serve. Yesterday I listened to a little bit of a -- a program on the 50th anniversary of the war on poverty.
REP. WALKER: You had a lot of time yesterday to listen to it. We all did.
COMMISSIONER RODERICK L. BREMBY: So anyway that is a population that we really need to give additional attention to.
REP. WALKER: Well -- I -- Commissioner, can I just jump in real quickly because we -- we -- I know we are holding the hospitals now accountable for frequent flyers and -- and we actually have turned that around and started to penalize the hospitals and I'm -- I'm not trying to -- but if we can do that process for the hospitals, we should be doing it as part of the contracting that we do with the providers too.
We need to look at are the providers delivering the services that we need for the clients and are -- are we getting what we expect out of those services and we need to put an evaluation component in there that's going to help us understand are we in the right direction because I think we have the same providers out there doing the same things just like everybody else and we're not really looking at, you know, what is the need of the population that we've got now versus when we did -- in '94 when we did redetermination -- not redetermination, you know, TANF development -- welfare reform.
And I'm sure we're at this point now where we need to do welfare reform again and -- and change the way our -- our plan is defined and how we get the services to them to meet the needs of the population.
COMMISSIONER RODERICK L. BREMBY: So let me just say that under holding hospitals accountable under Medicare, there are penalties. Under Medicaid there are not.
REP. WALKER: There are not.
COMMISSIONER RODERICK L. BREMBY: We have been -- we have been working with the hospital association and our partners in trying to continue to drive down the costs and the rehospitalization through qualitative measures. There's a lot more we can do there.
The State of Massachusetts, for example, will not pay for a readmission that is avoidable. We have not taken those steps but there are a lot of policy options available but pivoting back to the social service organizations, a lot of them do extremely good work.
CAA, for example, is a community action agency.
REP. WALKER: Uh-huh.
COMMISSIONER RODERICK L. BREMBY: They have a -- they are using metrics. We hold them accountable and the question you really want to ask is anyone -- is anyone better off? We're not just looking at the number of units served.
REP. WALKER: Uh-huh.
COMMISSIONER RODERICK L. BREMBY: Or the cost per unit but truly is anyone better served or better off?
REP. WALKER: But that's the -- the thing is community action agencies aren't the only people who you contract.
COMMISSIONER RODERICK L. BREMBY: Yes.
REP. WALKER: I -- I probably would guesstimate that community action agencies are about 20 percent of your delivery system and -- and then you've got a lot more out there that are not community action agencies that are delivering services.
Community action agency gets federal and state and -- and local and they are a lot more scrutinized than some of the others. So I just -- but anyhow okay, we'll -- we'll talk about that.
Now my final question right now is you also have $20 million that you are -- that's coming out of your budget from -- 2.9 coming from Husky, 17 coming from Medicaid and 100 from community services which is $20 million.
In our work group, because I'll -- I'll cut to the chase, in our work group we would like to know how each one of those is being determined that is possible for a reduction and what is being reduced. Are these services? Are these -- what -- what is the reduction that we're -- we're having in -- in each one of these line items?
And that Medicaid we'd like that broken out so that it's not just Medicaid and I -- I'm sure Secretary Barnes is hearing this right now. We would like to know what -- what lines in Medicaid they are being -- that are being affected by that 17 million.
So that -- I -- I -- that's a longer conversation and my colleagues all have questions so we'll talk about that.
COMMISSIONER RODERICK L. BREMBY: We can definitely do that. Primarily is caseload reductions but we can do that.
SENATOR BYE: Thank you for those questions, Madam Co-Chair.
REP. WOOD: Thank you, Madam Chair.
And thank you, Mr. Commissioner, for all this good information. I have two focuses that I'd just like some brief answers on and then really drill down during the work session.
One is on the Medicaid combating fraud. It's going to save $104 million for fiscal year '15. When do you plan on implementing that and can you give us three or four sentences on how they decided how to focus on this. Not -- not why, but why haven't -- you know what I'm trying to say. What we're looking at, thank you.
COMMISSIONER RODERICK L. BREMBY: The -- the primary group or the lead group that is heading up this fraud detection work, the contract, has already been led. The organization is 21CT out of Austin, Texas. They are very good at predictive analytics as well as looking at networks -- network analysis to find fraud not only from the individual aspects but also in terms of colleagues or groups.
Large fraud operations rarely work in isolation. They're groups that work together and so they have this network analysis refined as an art. So they have already begun to receive and position and clean DSS claims data. It's already in their system.
They are beginning to run analyses against that and so we believe that these targets are appropriate at this time. But just to say that the project is already underway.
REP. WOOD: Great. Thank you very much. How much are we paying them to do this service?
COMMISSIONER RODERICK L. BREMBY: Off the top I don't have that but before we leave today we will have that for you.
REP. WOOD: Or in the work group, thank you. And the other questions I have are on the PCAs. How many PCAs are going to -- are covered under the current agreement and I would love to get a contract of the union agreement with the PCAs and how much are the increases in the compensation?
COMMISSIONER RODERICK L. BREMBY: I take it this is a work group series of items.
REP. WOOD: That would be fine. Thank you.
SENATOR BYE: Commissioner, can you -- can you let us know is there an agreement with the PCAs because I -- I wasn't under the impression there was? Maybe there is at this point.
COMMISSIONER RODERICK L. BREMBY: Yeah it's still pending.
SENATOR BYE: Okay. So I think Representative Wood is saying when -- when it's ready, when there is an agreement, we'd like to know because there are implications for this -- for this work group. Thank you.
REP. ABERCROMBIE: Thank you, Madam Chair.
Good afternoon, Commissioner. Thank you for being here especially for this morning for the presentation. That was awesome.
It might be in the slides and if it is if you can just show me what page it is because I just have way too much paperwork up here today. I'm looking at the updated personnel services, the $9.2 million. If you could do a breakdown of -- under the staff, how many people are going to -- oh it is in there already?
Is this the breakdown, sir, of what we're going to do on this page for 9.2? It is.
COMMISSIONER RODERICK L. BREMBY: That is -- yes.
REP. ABERCROMBIE: Okay. Thank you. No further questions, Madam Chair.
SENATOR BYE: Senator Gerratana followed by Representative Lavielle.
SENATOR GERRATANA: Thank you, Senator Bye. Thank you, Madam Chairwoman.
Commissioner, I had a question on the updated estimates for supplemental assistance programs. Basically you're reducing funding of $1,000 per person. Could you explain to me why? I may not have been here and I apologize. Maybe you were -- you had during the slide presentation.
COMMISSIONER RODERICK L. BREMBY: I'm sorry, you're referring to the state supplement program?
SENATOR GERRATANA: Supplemental assistance for old age assistance, aid to the blind and aid to the disabled for a total of $5.7 million cut.
MICHAEL GILBERT: Yes. Those were also all expenditure caseload updates. So there are no programmatic changes to those accounts. They simply reflect changes in trends on both the cost side and the (inaudible).
SENATOR GERRATANA: Are you saying that there's a reduction from the caseloads?
MICHAEL GILBERT: There has been. Well let me -- in some cases it may be a reduction to the amount that was appropriated for the biennium. So it may not necessarily be a reduction in the -- in the caseloads other than the base underlying budget may have overfunded the programs based upon current trends.
SENATOR GERRATANA: So this -- you're saying then you explanation is that this may have been in the -- you're revising of course the 2015 budget and it may be an over-expenditure in this case of some kind.
MICHAEL GILBERT: Well it's a correction to the budgeted amount. It may not necessarily be a reduction --
SENATOR GERRATANA: Yes I understand.
MICHAEL GILBERT: -- to a level of service.
SENATOR GERRATANA: Right.
MICHAEL GILBERT: For example in 2013 the spending for aid to the -- or old age assistance, I'm sorry, was in the 35 million range. So in 2015 I believe the -- the appropriation is -- the revised appropriation would be almost 39 million. So it's not necessarily a reduction in -- but a correction to the budgeted amount (inaudible).
SENATOR GERRATANA: Oh in the narrative it -- it showed the amount going down by $1,000 per person. So I'm just going by what the narrative said.
MICHAEL GILBERT: That would be -- we can take a look at that narrative. We don't yet have that.
SENATOR GERRATANA: Thank you.
MICHAEL GILBERT: But we'll try to (inaudible).
SENATOR GERRATANA: Thank you very much.
And then just quickly a case -- excuse me, a question on the Connecticut Home Care program. There is -- you're providing funding of $1.5 million to reflect updated costs and caseload projections. Would those include PCA costs or are the costs for the personal care attendants included in that? I should ask for -- could you explain please from what the narrative says what that means.
MICHAEL GILBERT: And I apologize. I -- I was writing a note and I missed the very first part of your question. Which program?
SENATOR GERRATANA: Just that you're providing 1.5 million to reflect updated costs and caseload projections. Could you define for me what those are?
MICHAEL GILBERT: Once again the update to caseload and cost projections are simply a reflection of current trends. I believe in addition to that there are funds added to reflect, you know, the potential PCA agreement above and beyond that amount.
SENATOR GERRATANA: There -- so it does reflect the PCA agreement. It may.
MICHAEL GILBERT: The current budget reflects some additional funds for that agreement.
SENATOR GERRATANA: That's what I was wondering. Thank you.
Thank you, Madam Chairwoman.
SENATOR BYE: Thank you, Senator Gerratana.
Senator Gerratana, can you summarize what you're waiting -- what you're going to get more information about from the first part of your question? I'm just trying to keep a list of what we're going follow up with.
SENATOR GERRATANA: That was on supplemental assistance program. There was an explanation that the expenditures were overfunded. So the gentleman who spoke, who is assisting the Commissioner, said that he would look at the narrative that is here in -- at least the document I downloaded the other day. Maybe there's an update on that.
SENATOR BYE: No, that's all. I just wanted -- thank you. Thank you for that reminder.
SENATOR GERRATANA: Certainly.
SENATOR BYE: Representative Lavielle.
REP. LAVIELLE: Thank you, Madam Chair.
Thank you, Commissioner. I -- I just have a couple of quick questions on an item that you didn't touch on and I'm sure you're responding to all this in another manner somewhere.
But a number of folks from my part of the state are just very interested in the ABI waiver, the -- the brain injury waiver and I'll just -- I'll just keep the two questions really simple and then ask you how the other answers are going to be provided.
The first one is really how much is in the budget for -- at the moment for the folks who are currently on the -- the current waiver and how much for the folks on the proposed changed new waiver, if any? Of if not, when is that supposed to kick in? So that's my first question.
My second question is will the addition of the 50 clients from DMHAS to -- if I understand this properly, to the DSS budget affect the budget for either of those waivers in any way?
Those are -- those are my two questions and I'll ask you the one about the timing and form afterwards.
COMMISSIONER RODERICK L. BREMBY: I think the first question, we're still looking for the actual allocation that's in the budget for both of those waivers. The second, the 50 DMHAS clients, would benefit from the -- the new waiver and, as such, that cost would no longer be a state general fund cost.
MICHAEL GILBERT: We will confirm this number but we believe that 51 million is in the current budget for the ABI waiver.
REP. LAVIELLE: That would be for any -- either type of waiver of all folks combined.
MICHAEL GILBERT: I believe that's the case but we need to confirm that.
REP. LAVIELLE: If -- if that -- would that represent a change from the -- from the budget as it was originally constituted for the coming fiscal year?
MICHAEL GILBERT: Yes that does. It looks like it's approximately a $3 million increase for that particular line item.
REP. LAVIELLE: Thank you.
I think -- I'm not on this particular subcommittee so I don't want to belabor any of this but what I would ask you is in -- how -- what is the process for your providing further very detailed information on both of those cases? How are you going to do it? What's the timing? When can -- can these folks expect to know more budgetarily about what's going on and how?
COMMISSIONER RODERICK L. BREMBY: So the next step is a hearing and I don't have that in front of me but the material I believe has been disseminated in terms of the waiver modification. But we will get information back to you on the timeframe for -- or process steps from here that might be helpful.
REP. LAVIELLE: And so that -- so that would be completely separate from the regular budget hearing which, in fact, is this afternoon.
COMMISSIONER RODERICK L. BREMBY: So my understanding is that we will publish in the Law Journal in two weeks and the goal is to implement May 1st. So we will develop additional information on process steps and get that information out to you.
REP. LAVIELLE: So we'd expect to know in the next two or three weeks, something like that?
COMMISSIONER RODERICK L. BREMBY: We would hope so, yes.
REP. LAVIELLE: I appreciate it. Thank you very much, Commissioner.
Thank you, Madam Chair.
SENATOR BYE: Thank you, Commissioner.
I think that is an issue that is important to a lot of members here of what Representative Lavielle is raising. So as soon as you have information about that and some of the changes, we would really appreciate getting it to this Committee and then we can let other Legislators know as well.
So thank you for that question, Representative.
Representative Dillon followed by Senator Kane.
REP. DILLON: Thank you.
Good afternoon. It's good to see you. I wanted to ask about SNAP. As you probably may remember when they did I think what they called welfare reform, there were very dramatic changes to the -- the cash system and that was one of the reasons theoretically that there were extra dollars built into the SNAP system during the recession in the -- in the (inaudible) whatever because -- because the cash benefits were not going to be available in the same way. It was one of many reasons.
And I guess part of this isn't a question but a -- but a statement. You know we could see when that stimulus dollar stopped November 1st. You could measure really what was happening in our town and -- and it was the caseloads for the food pantries and the safe community that were not really intended to be tremendously robust. They operate on a volunteer way.
I know it really went through the roof and one of them in New Haven ran out of food last week and -- and ended up unfortunately on CNN not really the way we want to be on CNN.
I'm really worried about -- about the decision about heat and eat in the farm bill and I don't know if you can do all of this today because I know some of these things were in flux but -- but what -- to look at what kind of strategies we can have to make sure that the families that are -- that -- especially because a lot of them lost unemployment benefits too so they've -- they've just fallen off a cliff.
And if there's a -- what kind of plans we have for increasing capacity or, you know, whatever judgments the Governor makes I don't -- I don't know if you can do all that today and it wouldn't maybe be fair to everyone to do that, if you or Mike could provide us with that follow up information that would be really helpful.
COMMISSIONER RODERICK L. BREMBY: We would be happy to follow up. What I can tell you is that there is an active conversation underway and we understand that concern.
REP. DILLON: And -- and the second question, which again is not really something for extended discussion here, it's just a follow up of some of the conversation that's already happened about behavioral.
I know that your department and DMHAS shifts persons back and forth all the time. So that's not tremendously -- it's -- it's really part of the clinical picture and it's an artifact really of our reimbursement system, but -- but there were some assumptions built into the changes made in the DMHAS budget that -- that may or may not have something to do with -- with what goes on in your department and I -- I am concerned about what I'm hearing from providers especially if -- if they're doing more in-hospital because -- because the capacity isn't there maybe with the smaller providers.
And I don't have an extensive survey on that. I just -- in fact some of it isn't even really coming out of testimony, it's -- it's clinicians I know that work at these places.
So if we could later, you know, in the work sessions, follow up on the (inaudible) relationship between you and DMHAS and what's happening to the behavioral part and what's happening to people on the ground.
COMMISSIONER RODERICK L. BREMBY: It's a very good question. I know that we've had many conversations with DMHAS and we are also engaged in conversations with DCF. We really are looking at this network to make sure that it is a comprehensive integrated network and it's funded properly.
And so it is a challenge but it's a great opportunity especially in light of a state innovation model grant that we're pursuing. So that would allow for private payers to also contribute to that net worth to ensure that the state is not just picking up the cost or the feds are not picking up the cost for all of our children who need the same sets of services.
SENATOR BYE: Thank you, Representative.
Senator Kane to be followed by Representative Flexer.
SENATOR KANE: Thank you, Madam Chair.
Commissioner, if I could go back to that TBI waiver one more time. Two part quick question. Why is DSS seeking a modification and what will that do to the population it serves?
COMMISSIONER RODERICK L. BREMBY: Excellent question. We are pursuing a second ABI waiver to permit an expansion of the number of people who are served. In the second waiver there are 50 people that we know of that we will move over from the DMHAS served population to remove that cost from the SGF.
What will happen to the people that are on the existing waiver --
SENATOR KANE: SGF, SGF?
COMMISSIONER RODERICK L. BREMBY: State general fund.
SENATOR KANE: Oh.
COMMISSIONER RODERICK L. BREMBY: -- what will happen to the people on the existing waiver is nothing. There are no changes in the original waiver. The second waiver has some slight differences but we would like to make sure that we distribute a fact sheet in the next week or two to help describe the differences. We will publish in two weeks and we hope to implement this waiver by May -- May 1st.
It represents a significant opportunity to expand the number of slots for ABI constituents as well as reduce the overall cost to the state budget.
SENATOR KANE: And -- and why are we moving it from the general fund? No, I was just asking why we're moving it from general fund spending.
COMMISSIONER RODERICK L. BREMBY: Well we think that it is appropriate for federal funding support as opposed to state general fund support. The other key difference that Kate whispered in my ear because I -- I failed to talk about this is the waiver amount is different between the first and the second.
So the cost of services would be less under the second versus the first in terms of cost cap. But fundamentally the waiver options are very similar.
SENATOR KANE: The population won't see a decrease in the services though, correct? In fact you're expanding the population, is that true?
COMMISSIONER RODERICK L. BREMBY: We are expanding the number of people served under the ABI waiver.
SENATOR KANE: But their -- my question was their services, their care, won't be affected, those in the program.
COMMISSIONER RODERICK L. BREMBY: We think the -- talking about the people who are under the current waiver? Yes, they will not be affected, correct.
The people who would go onto the second waiver we believe would be materially enhanced by the extension of this waiver.
SENATOR BYE: Just for clarification, Representative Abercrombie has a follow up.
REP. ABERCROMBIE: So just for clarification for people that are watching this, some people are under the assumption that Human Services has received this waiver. We have not to date, just for clarification.
The Commissioner is hoping, as he said, within the next couple of weeks. My understanding is you're still in the process of looking at some of the changes that people wrote in which is the process we have in place. Once that's completed, then Human Services and Appropriations will be receiving a copy of it but to date, Human Services and Appropriations have not received the revised ABI waiver.
SENATOR BYE: Thank you, Representative Abercrombie.
Representative Flexer to be followed by Senator Markley.
REP. FLEXER: Thank you, Madam Chair.
Good afternoon, Commissioner. I just have a quick question regarding the Fatherhood Initiative. I'm reviewing some of the testimony that we've received for the public hearing this evening and -- and some of the agencies that run those programs are concerned that they're -- that $195,000 should be restored to that program. I'm wondering if you can tell me the details of that and how that decision was made.
COMMISSIONER RODERICK L. BREMBY: I believe that they are referencing a rescission amount from a couple of cycles ago where that was removed from the program. We attempted to make them whole in other ways but fundamentally there was a reduction in that program and that reduction has not been restored.
REP. FLEXER: The initiative has been cut by $195,000 and -- and this budget maintains that cut.
COMMISSIONER RODERICK L. BREMBY: That's correct.
REP. FLEXER: And what will that mean for the -- the agencies that currently run those programs?
COMMISSIONER RODERICK L. BREMBY: It has different impacts and implications. What we do know is that the fatherhood programs that the state has sponsored are very well intentioned and very good programs. They provide an awful lot of support for noncustodial parents to ensure that the -- the father stays engaged in the life of his child.
We know that that helps with long-term educational outcomes. We know that that helps with stability for the family. Fathers who are engaged in that way are also ones who tend to provide more support, fiscal support, in addition to emotional support.
We simply moved the fatherhood initiative over to the Child Support Division in recognition of that critical link. We would hope to be able to invest at some point in time, or reinvest at some point in time, in those entities at least back to the level where they were, if not more.
But that's not represented in this current budget so I can't tell you specifically each and every program what the impacts are. All I know is that they do good work.
REP. FLEXER: Well just trying to understand the math, does that mean that potentially these agencies would be serving a third less people, perhaps half?
COMMISSIONER RODERICK L. BREMBY: I -- I don't know in terms of units because they operate differently but what I can tell you is that when there is a reduction, it typically results in fewer people served but I don't know the numbers.
Again these are providers that we have certified as a state. They're good partners. We maintain the network and we're trying to embrace them as a part of that fundamental infrastructure of supporting families.
REP. FLEXER: Thank you.
SENATOR BYE: Thank you, Representative.
Senator Markley to be followed by Representative Ritter.
SENATOR MARKLEY: Thank you very much, Senator Bye.
I have a -- kind of a segue back to where we were a couple of hours ago. I noticed on the -- under general fund update other expenses expenditure. There's about $26 million to meet anticipated agency requirements including 16 million for IT software maintenance and support.
And I wondered if that had anything to do with the ConneCT program and the conversation we were having this morning?
MICHAEL GILBERT: Yes it does relate to additional funds for the ConneCT program but it also relates probably even more so to additional funds for the operating expenses that are associated with the partnership on the Health Insurance Exchange or Access Health CT.
Actually the predominance of additional funds built into this budget were more to support the maintenance and operational expenses for the Access Health CT system more than the ConneCT system.
The ConneCT system actually had approximately $5 million in the base budget already and this adds a small increment to -- to meet the full requirements for ConneCT. But as I said the -- the predominant piece is the Access Health CT and there is also some additional implementation dollars associated with the implementation of our replacement EMS system or the ImpaCT system.
COMMISSIONER RODERICK L. BREMBY: Just to segue back to the conversation, some portion of the Access Health CT O&M, operation and maintenance costs, is because the systems are not fully integrated.
When the system is fully integrated, some of that O&M cost can be avoided. I think that we spoke very clearly about what happens, in fact it was Marc Shok in his testimony, that talked about what happens when a -- when an application goes in to the marketplace to be get determined and it generates a PDF and that PDF then moves over to Xerox. That's a lot of the O&M costs that we are seeking to avoid by consolidating the systems with the EMS build out.
SENATOR MARKLEY: Last question on ConneCT for today with apologies but just to follow up on one thing that came up in the meeting this morning that I hadn't -- well was new to me during the discussion about the work pools and task type versus program type I had written down.
There was mention of change in innovations agency. Having been involved in -- in part of the -- the work on this, with that -- that ominous acronym of but I wondered if -- I -- I didn't know where they fit into this and if this payment has anything to do with them or where they're -- what they're doing or where they're getting their money from.
COMMISSIONER RODERICK L. BREMBY: Great question. In terms of the change in operations, we executed an agreement with an organization that is called Change & Innovation Agency. They are the lead lean business process reengineering firm for eligibility processing nationally.
So they have come into the state. They have trained our staff. In fact they conducted a lean initiative with our staff to identify what's the best pathway for connecting with people in our offices.
As I mentioned earlier this morning, last year we received almost 400,000 visitors to our 12 offices and unfortunately their offices were working a little differently. We were using a 40 year old welfare model where a person would come in and they would wait or the -- first-in, first-out.
So what we're doing now is greeting the customers. We are trying to process them for determination at that visit to avoid five or six additional contacts but Change & Innovation was the group that identified the model, allowed us to create those -- those -- I call them buckets so that we could make sure that if a particular task was identified, we would put enough resources on that task rather than putting resources aligned by program.
Programs change but the tasks are similar. So if it's an application, we've got people who can just function on applications. If they're just read as, read as. And so that's part of the process of business process reengineering that we accomplished.
SENATOR MARKLEY: Let me just touch on a couple of other things I noticed in going through the OFA analysis of this. There's indication of a -- there's 4. -- $17 million expenditure reduction on Medicaid. I'm not -- I'm not finding it now as I'm looking for it. Well I'll skip that one.
Let me go to the -- to the -- I'm not even -- I'm not finding any of them right now, Commissioner. I'll ask you a completely different question then. Let me ask you about -- returning to the ABI waiver which has come up before, my understanding from the people who are looking at this for me was that the -- previously each waiver program was broken down individually but that this year's budget provides a -- a single number for all the waivers.
Is that the case? Am I missing something? And if that is the case, has there been a conscious decision to make a change and what would the rationale for that be?
MICHAEL GILBERT: In the current budget, the detail continues to be provided by waiver. So, for example, there are separate distinctions for the PCA wavier, the ABI waiver. So I'm not aware that there is any change in the way that those items are budgeted.
SENATOR MARKLEY: I will -- I will tell them to go back and keep looking then. One last thing I wanted to ask you about which I -- I understand is not a major issue at all but I have no understanding of how it can't be important which was the auditor's last month, as I'm sure you're aware, came out and said there was a -- an accounting error in -- in two accounts of $576 million but that it didn't really mean anything.
And I certainly take their word for it. There was no panic about it. But I wonder if you could explain to me how a number like that could not be significant somehow.
COMMISSIONER RODERICK L. BREMBY: Yeah Mike can explain that much better than I.
MICHAEL GILBERT: Last year a new requirement was introduced by the State Comptroller by which agencies were required to submit information on the amounts that they had in what we call cash in custody which basically means we operate, on many of our programs, what we call our cash book which is actually a checking account.
Funds are moved from the core system into that checking account and then we're able to pay expenses from that checking account. Prior to that we only reported on how much was available as a balance in that checking account at the end of the state fiscal year and the Comptroller recorded that so we could have an accurate end-of-year number which took into account funds that we still retained in our checking account because obviously those would not have yet been expended.
So -- I'm sorry to return to the beginning, in last fiscal year we were asked to do that on a quarterly basis. So there was some confusion that arose over those transactions. Those transactions were only I want to say paper transactions. They didn't drive expenses per se and there was no overspending which is why I believe, from the auditor's perspective, it was not a significant issue.
It was more that there some, you know, entries that were made into the core system that didn't reconcile but they were, like I said, paper entries as opposed to real cash payments and cash transactions that obviously would have been significant on -- of that -- if they were of that magnitude.
SENATOR MARKLEY: Thank you very much. And one last one about the LIA Program. Is the -- we had a -- when that move was made to put it into a nonappropriated account, there were anticipated expenses. I think it was -- well I've got down 446 million in 2014, 1.136 billion in 2015.
Is -- is what you're seeing supporting approximately the numbers that we were discussing when that change was made?
MICHAEL GILBERT: We can get you the official numbers but I believe that the numbers are slightly under those targets on at least for 2015 but -- well it's not a significant difference but we can get you that -- get you those numbers.
SENATOR MARKLEY: Thank you very much and I hope you have a good evening, Commissioner.
COMMISSIONER RODERICK L. BREMBY: Thank you, I will.
SENATOR BYE: Next is Representative Ritter followed by Representative Miner.
REP. RITTER: Thank you, Madam Chair.
Good afternoon, Commissioner. I'm over here. Good to see you again today.
MICHAEL GILBERT: Good seeing you.
REP. RITTER: And -- and thank you for being here. I have a question about the rates for the Connecticut Home Care Program for the -- for Elders, okay? And it's my understanding that the 1 percent rate increase for the services would be about $3.25 million.
So my question is first if that number includes the actual rates for PCA services because it's my understanding that those are negotiated separately and that's -- and then, if they are not included in that, do you have an idea of what a 1 percent increase would be for all services including those rates? If you could just help -- help me understand that or get that to me.
MICHAEL GILBERT: If that's okay we'll get that to you in subcommittee.
REP. RITTER: That's fine. Not surprising.
MICHAEL GILBERT: I don't have that off the top of my head, sorry.
REP. RITTER: Do you know if it's include -- if that does include a 1 percent on the PCA rates? Okay, thank you very much.
MICHAEL GILBERT: We're not sure but we'll confirm.
REP. RITTER: I'll look forward to that.
SENATOR BYE: Thank you.
REP. MINER: Thank you, Madam Chairman.
COMMISSIONER RODERICK L. BREMBY: Good afternoon.
REP. MINER: I'm not sure to what degree this may have been covered already. I -- I know that I have sent a letter to your office on behalf of a constituent who has waited a long time, can't remember what the circumstance was to be honest with you today but curious as to how you see the number of complaints about service being dealt with.
Is that number going down? I -- I don't believe, to this point in time, I've received a response from your office. I know there are other caucus members that have expressed a concern to me that they have written about one matter or another and as yet have not received anything. So can you help me I guess.
COMMISSIONER RODERICK L. BREMBY: Sure. That is -- that is very surprising. I would like very much to hear from you about those letters that have not been responded to. We take that very seriously in our office.
But in terms of complaints, we have gotten a number of letters of late, most recently I would say beginning with the fall of last year. The complaints tend to focus on a couple of key areas and we've communicated back swiftly about those areas because the response is the same, the answer is the same.
So I would very much like to follow up with you to make sure that we haven't missed something or, if we have, we need to rectify that as quickly as possible.
REP. MINER: And -- and so when you say the response is the same, is the response thank you for communicating with us? Or is the response we've looked into the specific issue that you've asked us about and it has been resolved in this way?
COMMISSIONER RODERICK L. BREMBY: All of our responses are detailed inasmuch as we have the information available. If we don't have the information available, we will say so in the letter. I don't believe in the -- I think it was the Harry Truman response is you may be right. We believe in being very detailed in our responses.
REP. MINER: And I know that we -- you know we've kind of had this conversation over the last nine months because I know that staffing I believe was cited as one of the reasons why people may have gotten -- may not have gotten the result that they had anticipated and I don't -- I don't know how that's going.
Are there -- are you managing to fill positions? Is there ongoing training? Can we expect that fewer people will feel like they've fallen through the cracks and so on?
COMMISSIONER RODERICK L. BREMBY: Absolutely. Over the last year, 2012, yeah 2012, we have added 220 additional eligibility service workers. Those are net new positions that have been filled and are -- are working. It takes about six months to complete the training to become an eligibility service worker.
We can show definitively, in terms of the cases that are pending, those that have not yet been processed, those are going down, have been going down, and we've got good data on that. In fact, we're lower now than we were in January 2011 on pending cases.
In terms of timeliness, the timeframe by which we process out cases, those have also all improved, not at the rate that we want them and we're not there yet in terms of building out an eligibility determination system that is one of the best in the nation, we're not there yet.
We believe that there's some interventions that we're focusing on that will decrease the number of people who are calling to inquiry about the status of service or alarmed because they may have gotten a notice out of our old antiquated legacy system that is a very poor notice.
So, yes, we are managing the situation. We believe that by initiating some of these interventions, some as early as next month, we'll begin to see those numbers decrease, those calls decrease, the angst lessen.
But we still have a -- we still have some work to do, some serious work to do. The eligibility determination process, in and of itself, the one that's under transformation, has been broken for a very long time. Prior to 2011, there were literally no investments in terms of human capital nor investments in terms of technology despite the great recession.
So from 2002 to 2012 that -- this organization, under that -- that scheme, didn't see any additional resources. So we're well underway. We're acknowledging that we're not where we want to be but we're managing it and we think we can manage it to success.
REP. MINER: Thank you. And so when you talk about, you know, data that's being accumulated, is that something that we could look at and see -- is it fairly simple so that we could see a pattern of whether it's gotten better or worse?
COMMISSIONER RODERICK L. BREMBY: Yes. Earlier this morning we spent some time with (inaudible) to lay out for them some of the early results in assistance that we are unpacking. One of the documents that I think might be useful is the chart on total pending.
You probably can't see it from there but I'll leave this with you. Not only can you see a downward trend but you can see an actual net trend and this is just from 2012.
So yes we have really good data to back up the assertions that the timelines are improving, the pending applications are improving. Yes sir we do have that.
REP. MINER: And -- and is there someone in the office, you know, if I -- if I wanted to provide a list of names to that I can direct -- communicate directly with I guess? So if there is some misconnection, some misunderstanding about what my fellow caucus members are telling me and what folks might be telling you, we can get to the bottom of it.
COMMISSIONER RODERICK L. BREMBY: Yes. The person I would direct you to is Heather Rossi who is our legislative -- she may have stepped out but we'll make sure that -- in the meantime just --
REP. MINER: That would be great.
COMMISSIONER RODERICK L. BREMBY: -- (inaudible) to my office would be good.
REP. MINER: Thank you.
COMMISSIONER RODERICK L. BREMBY: Thank you.
SENATOR BYE: Thank you, Representative Miner.
And just as a follow up to -- to Representative Miner, Commissioner, I think that Representative Walker and I also share some of these concerns about processing with many of the populations but I think one that came across loud and clear in our many meetings with folks who are doing a lot of good work for our state, nonprofits, is seniors who need community-based services who have not yet been in a nursing home.
Now if that senior enters a nursing home, the nursing home can wait for Medicaid but the nonprofit providers cannot and so the senior cannot receive community-based services until things are processed.
And what happens then is sometimes by the time the services are able to be delivered, it can be a year later that senior may actually fall into a nursing home. So that's just an example of where the processing time becomes really important and, you know, nonprofits ready to help the senior, ready to go but they -- they just can't provide the services until -- until it's approved or under Title 19.
So I think that's important to all of us up here.
COMMISSIONER RODERICK L. BREMBY: Senator, that is one of the areas that we have not focused on as quickly or perhaps as aggressively. Of the 20,000 applications that we receive each month for Medicaid, about 1,300 of those are long-term care applications.
With these in particular they require an assessment and that's a little different than just the paper flow but we have looked at changing the process as well as aggregating functional staff in that area.
We're looking at reforming that as well. We've not touched that in a while. We've not looked at that in a while. We have waivers in different areas of our organization and they probably should be seated together.
And so those are the sorts of structural changes that we're looking at to make rather than to -- to band-aid it or to just kind of duct tape it until it, you know, kind of settles down. We're looking for long-term solutions and that's what we're trying to deploy.
There was a question earlier, and I don't remember who asked it, about 21CT -- okay -- I'm sorry, $8 million for three years, $24 million in total.
SENATOR BYE: Okay, thank you. I -- I have a couple of more questions and then I'm going to turn it over to my Co-Chair who also has some questions.
If we can switch gears a little bit and talk about Care 4 Kids. I want to start with the context that Representative Walker was talking about with the TFA cuts of $4 million. We were having a conversation up here trying to understand is that $4 million cut a cut that the feds send because you have fewer people in services or is it a cut by Connecticut and the general fund appropriation to TFA?
MICHAEL GILBERT: Yes that is a cut in the state general fund appropriation for the TFA program.
SENATOR BYE: So -- so when you make that kind of decision because of a reduced caseload, there's sort of an assumption built in that the people who are in the caseload are getting the services that they need and -- and some of the numbers we have, particularly around child care which, let's face it, you know, when you look at poverty and people in poverty, many are single mothers. Many of those have children.
Many of those women need child care and our TFA appropriation for child care is one of the lowest in the country. So when you say we're reducing this number because of caseload reductions, it's not taking those sorts of needs into account.
So what was the thinking there?
MICHAEL GILBERT: Do you know -- I would just add that the -- the appropriation for the Temporary Family Assistance program is guided by the particular requirements for that account and the statutory requirements for that account.
So, in essence, it sits by itself. So the appropriation for that program is guided by, you know, the benefit payments that are allowed under statute and the number of folks who come in and, of course, you know, the time limited nature of those benefits.
So it becomes a -- a calculation of anticipated clients who will come on the program and a calculation of the anticipated benefits for clients within that program. So in that particular account sits in isolation as does the child care services account.
I think, you know, in terms of why was that particular reduction in the budget, it reflects an estimate based upon the statutory parameters that exist for that account and the number of folks we believe who will enter the -- or -- or access those benefits.
SENATOR BYE: So -- so then your testimony is that the reason that's cut is that, given the statutory requirements, there aren't other ways that you could have -- you could have used these dollars to support individuals and families working to get out poverty?
MICHAEL GILBERT: I believe that's correct given the statutory guidelines for that particular account.
SENATOR BYE: Okay, so you're saying the very strict guidelines about how those dollars can be used. Are those guided by a state plan or just the statutes?
MICHAEL GILBERT: I believe those are specified in statute.
SENATOR BYE: Okay then and what I would ask you to do is, Commissioner, I think as you think about the TFA program, get back to us about those sort of statutory challenges that may get in the way of you helping families get up and out of poverty with -- with the dollars.
So -- so that's a first -- that's just a -- a first question. The second Care 4 Kids question is Majority Leader -- Leader Looney, he -- he has an interest, and I think a really, really important interest, in helping three to five year olds who are in Department of Children and Family care to get child care and have access to child care.
Does the Care 4 Kids program give any sort of priorities and, if so, are children in DCF care a priority currently or is that a way we could sort of attain Senator Looney's goal?
COMMISSIONER RODERICK L. BREMBY: I don't think -- I don't think I can answer that. Let us get back to you on that. I know that we have priorities based on tiers of family configurations and earnings. But specifically for a DCF group, I don't know but we'd like to get back with you on that.
SENATOR BYE: Okay. And I have just -- my last question related to Care 4 Kids and then I'm going to turn over to my Co-Chair, is for a long time the way that we reinforce school ready -- we reimburse school readiness providers is that they would get 8,300 from school readiness and then they could, if they qualified for Care 4 Kids, they could apply and the provider would receive a Care 4 Kids payment as well.
And this has been using up about, as I understand, about a fifth of the Care 4 Kids dollars. One thing that's been talked about year after year of trying to reduce the paperwork. These community-based providers get $8,300 a kid for a service that costs them over 10,000 and then we ask them to do all this paperwork.
So one of the things we've talked about for a long time is if it would be allowable for DSS to look at the amount of Care 4 Kids dollars that have been going to school readiness providers over the -- you know on a five-year window and set aside those dollars and work with the Office of Early Childhood so that that just became a part of the school readiness reimbursement.
So if it was an average of $1,500 per child, the school readiness gives preference to working families, is that possible? So you may not be able to answer now but my question is are you able to write a waiver to HHS on this issue that would allow you to set aside Care 4 Kids dollars to go to school readiness providers to save them writing down the hours that parents work?
You know -- I mean as -- as a child care director I can tell you it's very time-consuming and, in fact, to be -- to get school readiness you have to be NAEYC accredited so there are -- you know we know this is high quality care and so we want the Care 4 Kids dollars going to high quality care.
So I would just ask you to see if -- if that's the kind of thing other states have done to try to create a more uniform system and if you all would be willing to look into that.
COMMISSIONER RODERICK L. BREMBY: We'll definitely -- we could look into it.
SENATOR BYE: Thank you.
REP. WALKER: Thank you.
I just want to ask for -- a couple of questions and then things to bring to the work group. First of all, how much of the -- of your budget do the community action agencies get?
COMMISSIONER RODERICK L. BREMBY: Under the Human Service infrastructure line item, there's $3.4 million for state fiscal year 2015.
REP. WALKER: Okay. And -- and am I wrong in assuming that they are your main deliver -- service delivers? So they're your main services broker for community services?
COMMISSIONER RODERICK L. BREMBY: What I would say is that they are the most comprehensive in terms of all of the services that they provide. I believe that there are other entities that may receive more or groups that may receive more in terms of an allocation.
REP. WALKER: The 3.4 is not the actual -- the -- the service dollars, it's just the administration of the service dollars. Am I correct on that?
COMMISSIONER RODERICK L. BREMBY: That is a group of resources that go to help bundle services for the Human -- for the infrastructure but it's not just administrative. Those are service dollars. They also receive SSBG dollars from the federal government --
REP. WALKER: Right, right.
COMMISSIONER RODERICK L. BREMBY: -- to help deliver as well as CSBG dollars.
REP. WALKER: Right.
COMMISSIONER RODERICK L. BREMBY: So there's three --
REP. WALKER: Three other entities --
COMMISSIONER RODERICK L. BREMBY: -- allocation of the source.
REP. WALKER: -- that go in there. Okay. And of the 750,000 people that you serve, approximately how many of those are handled through the community action agencies?
COMMISSIONER RODERICK L. BREMBY: I don't have that number off the top. We can find that.
REP. WALKER: Okay. I'd be interested in finding that out. And my last question is for the -- the work group, could we get a list of all your lapsed dollars in the line items -- lapsed.
COMMISSIONER RODERICK L. BREMBY: Lapsed, okay.
REP. WALKER: All your lapsed dollars and their line items please. Thank you.
Thank you, Madam Chair.
SENATOR BYE: Any other questions from Committee members?
Seeing none, excuse me, I close the agency part of these public hearings and we'll reconvene at 4 o'clock for the community input on these budgets -- public hearing.