Support
Adequate Funding for Human Services
The MICA Board
of Directors supports adequate state and federal funding for human services,
which are delivered predominantly by counties at the direction of the state and
federal governments. The Board
urges the Legislature and the Governor to fully fund basic services that protect
the life and health of vulnerable children and
adults.
The MICA Board of Directors urges the Legislature and
the Governor to allocate sufficient funds for the delivery of social services
the state and the federal government have directed the county to provide. Protecting vulnerable citizens and
supporting individual and family self-sufficiency is a foundation of
State and federal funding cuts to counties for health
and human services over the last several budget cycles have forced counties to
prioritize basic core services that are essential to maintaining a humane
quality of life for all state residents.
Resources for services such as child protection and licensing activities
related to providers who care for vulnerable children and adults are stretched
ever thinner. Prevention and early
intervention efforts, which save money in the long run and preserve quality of
life, are being squeezed out of county budgets. Counties have creatively pursued
efficiencies, streamlining administrative functions, combining similar services
and in many instances, working cooperatively with other counties to maximize the
benefit of services to their communities.
At a time when federal Medicaid matching funds to counties has been
drastically cut the state needs to step up, not back from its partnership with
counties.
Replace
Lost Federal Funding for Child Support Collections
The MICA Board
of Directors supports permanent state funding to replace federal funding cuts
for the child support collection system.
The federal
government requires that states provide child support collection services to all
families requesting them. In
Without the addition of ongoing state funding, counties
will be pressured to decrease staff and increase worker caseloads, making it
more difficult to meet performance standards, resulting in the loss of
additional federal funds. Even more
disturbing is the impact on low income families. Statewide, over 60% of families who got
help from their counties in collecting child support are former welfare
recipients. Another 18% are
currently receiving MFIP (2005). A
high proportion of these mostly low-income families depend on their child
support to move from welfare to self-sufficiency. The loss of regular monthly child
support will push a significant number of these families back on welfare. An increase in the state's welfare rolls
would not only demand more state funds, it would make it more difficult for the
state to meet its federal welfare work participation targets, thus jeopardizing
another federal bonus (about $24 million per year).
Assist
Counties with Targeted Case Management Costs
The MICA Board
of Directors urges the 2008 state Legislature to make permanent financial
assistance to counties for the lost federal funding for targeted case
management.
Targeted case management provides for
the effective coordination of health and social services that allows
The 2007 Legislature provided $32.7
million of one time funding to replace the lost federal dollars over the next
two years. The 2008 Legislature now
needs to step-up and permanently replace the lost federal funding to minimize
the adverse impacts on the affected individuals and moderate the property tax
increase that would otherwise ultimately occur without the state’s assistance.
Provide Adequate
Funding for Child Protection System
The MICA Board
of Directors supports the appropriation of adequate, stable state funding to
support the delivery of basic child protection services to all children and
families needing them.
In
2003 the Legislature consolidated multiple
funding streams into the new Children and Community Services block grant (CCSA).
While CCSA gave counties more flexibility in tailoring services to meet local
needs, that gain was significantly eclipsed by the $25 million per-year base cut
in CCSA funding. At the same time,
county social services budgets have been battered by federal cuts - in Medicaid,
the Social Services Block Grant, and Title IV-E foster care reimbursements. While the one-time funding of $32.7
million provided by the 2007 legislature will help ease the impact of cuts for
one year, counties need ongoing state funds to address the federal cuts.
Currently, counties fund nearly
half of the costs for child protection, foster care, adoption and other child
safety services. The federal
government provides 36 percent and the state only 14 percent.
Pay the State Share of
the Civil Commitment
Hold Costs for Sex
Offenders
The MICA Board of
Directors urges the 2008 Legislature to pay the state’s statutory share of 50%
of the “hold” costs for sex offenders being petitioned for civil
commitment.
Since 1999, MS 253B.185 has required
the state to pay for 50% of the costs of “holds’ (temporary confinement) of sex
offenders being petitioned for civil commitment. The state’s obligation is limited to the
amount appropriated. In only one
year since 1999 has the legislature appropriated any money for this
purpose. As a result, counties have
ended up paying the full costs of holds, costs that have risen dramatically -
nearly 10-fold from FY 2003 to 2006.
Changes in the state’s policy for referring imprisoned sex offenders for
civil commitment have largely precipitated the increase. Legislators may naively believe that the
statutory requirement that the Department of Corrections make their referrals
one year before a sex offender’s release from prison addresses the counties’
cost concerns. The reality is that
many referrals are not made within this deadline.
The MICA Board of Directors supports the repeal of the Mental Health maintenance of effort (MOE) imposed on counties by the state.
Prior to the 2006 Legislative session, counties were required to maintain their spending at a certain level for three different mental health programs. These required maintenance of efforts (MOEs) were based on the amount a county spent on a service during a specified time prior in the past - usually the year each MOE was adopted into law. The three MOEs applied to: 1) adult and children's mental health targeted case management, 2) adult mental health rehabilitation services, 3) children's Rule 5 residential treatment. As part of the mental health reformed passed by the 2006 Legislature, these individual MOEs were repealed. Unfortunately, a new, more comprehensive MOE was enacted. Then in 2007, the legislature expanded the mental health MOE by including community support program services.
Because the MOEs are based on historic spending by each county, the amount a county must continue to spend varies widely across the state. In those counties that had very high mental health expenditures - either due to unusually high mental health needs or due to progressive programming by the county to deliver services to a broader population - the MOE is particularly burdensome.
Counties should not be locked into spending for specific programs based on historic outlays. Needs for services change, as does the availability of local funds. Given the steady, deep cuts in the overall human services funding from the federal and state governments in recent years, counties need to have increased - not decreased - flexibility in their human service budgets. Requiring that a county spend a minimum amount on mental health, when basic child protection budgets are being severely cut, is not productive, and perhaps detrimental to the well being of children and families at risk. Additionally, a repeal of the MOE is budget neutral to the state.
Conform
Treatment of
Overages
with Other
The MICA Board
of Directors supports the forgiveness of the repayment MR/RC Waiver
over-expenditures by
Beginning in 2003, counties were assigned full
responsibility for any costs for MR/RC waivered services that exceed the
allocation set by the state. In
calendar years 2004 and 2005, counties overspent their allocation by a combined
$5.5 million. The 2006 legislature
provided a one-year delay of the repayment of over expenditures. Last session, the legislature cancelled
the repayment of over expenditures of 3 of the 4 over-spending counties.
Allow
Voluntary Expansion of County-Based
Purchasing
as a Single-Payer Plan
The MICA Board
of Directors supports state policy that allows all counties the option to
develop county-based purchasing (CBP) as a single plan whenever possible. Clearer direction to the Department of
Human Services (DHS) need to be established in law to facilitate county
expansion of this option for the delivery of health care services to their
residents.
Currently, 25
State law gives the Commissioner of the Department of
Human Services the authority to allow more counties to offer county-based
purchasing. A change in statute is
needed to direct the commissioner to support single-payer plans over multiple
payer plans in counties where federal regulations can be
satisfied.
Improve Access to Basic Sliding Fee
Child Care Subsidies
The MICA Board of Directors supports the restoration of funds for the Basic Sliding Fee (BSF) Childcare Subsidy program. Further, the Board supports simplifying the administration of the BSF child care program and increasing equity and access across the state through allocation formula changes Childcare costs are a major barrier for low and moderate-income families in reaching and maintaining family self-sufficiency. Employment is threatened and the health and safety of children is put at risk when reliable, quality childcare is priced beyond the means of low and moderate income working families. Funding for childcare subsidies was cut by 50 percent in 2003. These cuts withdrew significant support for many marginally self-sufficient working families, and for counties, intensified the difficulty of balancing budgets. Restoration of funding, and re-expansion of eligibility would enable more working families to secure the child care they need to safely care for their children while they work. The 2003 cuts also exacerbated a flaw in the current structure of the program that results in unequal access to childcare subsidies. Under the current system, each county receives a portion of the state allocation, based on a "snap-shot" of participating and wait-listed families. Due to the dynamic nature of enrollee and applicant eligibility, this allocation formula makes it difficult for counties to anticipate expenditures. In 2006, 19 counties exceeded their allocation, while 43 under spent, leaving over $9 million of state funds unspent. If county allocations were based on the average of the last 6 months of their wait list and the number of transition year families, allocations would more closely mirror needs. These formula changes would not require any additional state expenditure.
Reduce
and Equalize or Eliminate Direct Service
Match
for Childcare BSF Subsidies
The MICA Board
of Directors supports the equalization or elimination of the required direct
service match for Basis Sliding Fee (BSF) Childcare.
The required direct service match for BSF makes it
necessary for counties to spend a state-required amount of local money as part
of their eligibility to receive state dollars appropriated for this
program. Counties, therefore,
cannot reduce their level of funding even when state dollars are reduced. This limits the amount of local
flexibility counties have as they adjust budgets and service delivery levels in
response to large cuts in state funding.
In addition, state formulas used to determine required
levels of county funding have caused inequities in state allocations and
availability of subsidies to eligible families from county to county. The average statewide local match for
BSF childcare is 3 percent, but some counties pay as much as 14 percent.
Equalization of the county match would reduce state funding inequities across
counties.
Improve Background Studies for
Licensing
by Allowing Access to Corrections
Data
The
MICA Board of Directors supports county social services department access of the
Department of Correction’s Statewide Supervision system to improve background
studies done by counties as part of foster care, child care and adoption
licensing activities.
On behalf of the state, counties conduct licensing of foster care and some child care providers and assess prospective adoptive families for children who are wards of the state. A major part of the licensing activity is focused on background studies, which include criminal records checks. The current protocol checks finger prints obtained by the counties against the state's BCA and the federal government's FBI data bases. The BCA system does not include many older prints. Additionally, it takes 4-6 weeks before counties get results from the state. Under this system, vulnerable children could be exposed to care involving people not eligible under licensing exclusions. To minimize this risk, the Statewide Supervision System - or S3 - maintained by the Department of Corrections could be made available to county social services departments. The S3 system contains lists of every individual on probation in the state and includes criminal histories and the names and contact information of assigned probation officers. Access to S3 would provide more timely, accurate and complete information, ensuring safer care for our most vulnerable children and adults.
Increase Insurance Limits for Foster
Care Homes
The
MICA Board supports an increase in the amount of liability insurance provided by
the state to foster care homes.
Liability insurance is provided by the state to foster
care providers caring for a child or adult in their homes. The insurance covers up to $250,000 for
each occurrence involving bodily injury, property damage or personal injury
involving the providers and the foster child or adult. Without this insurance, foster families
would be faced with prohibitive increases in their homeowner's insurance. Far fewer families would open their
family home to take in foster children.
The monetary per-incident coverage has not kept up with inflation or
expanding liability exposure. An
increase in the tort limitations to $300,000 and a per occurrence limit of $1
million is needed to address the liability exposure of providers. The annual estimated cost to the state
for this change - of $127,000 - is wise investment to protect the valuable
resource of licensed foster care homes throughout the
state.
Expand MSA Eligibility for
Individuals Moving Out
of Corporate Foster Care
The
MICA Board supports expanded
Currently, Minnesota's Supplemental Aid (MSA) provides
additional cash assistance to SSI recipients under the age of 65 who are moving
into less restrictive community settings from regional treatment centers (RTCs),
nursing facilities (NFs) or Intermediate Care Facilities for the developmentally
disabled (ICF/MRs). The additional
cash assistance allows these individuals to secure adequate housing so they can
live more independently in the community.
Individuals moving from corporate foster care facilities into the
community are not eligible for additional cash assistance under the current
"shelter needy" provisions of MSA.
Eligibility for additional cash assistance should be expanded to include
individuals who want to move out their current corporate foster care settings
when they are capable of living more independently in the community. The expansion would be budget neutral to
the state and counties because the newly-eligible individuals receiving MSA cash
assistance would move out of the MA waivered services program.
Fully
Fund Family Stabilization Services Program
The MICA Board
of Directors supports adequate and ongoing funding to support the Family
Stabilization Services (FSS) Program.
Under the new federal welfare work participation rates
that states must achieve in order to earn TANF incentives, it was apparent that
almost all states would miss the mark - including
Unfortunately, the legislature only provided one-time
funding for the service-intensive FSS program. The Department of Finance estimated that
counties statewide would have to spend $16.6 million each biennium to assist the
estimated 6,200 eligible families.
County efforts to strengthen challenged families, as mandated by this new
program, need to be funded by the state.
Reform
Consolidated Chemical Dependency Treatment Fund
The MICA Board
of Director supports reforms to the Consolidated Chemical Dependency and
Treatment Fund (CCDTF) that provides sufficient and flexible state funding for
the proactive treatment of chemical dependency.
Since its creation in 1986, the Chemical Dependency
Treatment Fund has provided vital funding for treating chemical dependency. Unfortunately, funding cuts, restricted
use of funds and structural problems in the funding formula have created
barriers to effective treatment for many who depend on the fund for access to
treatment. The maintenance of
effort (MOE) requirements included in the original legislation have compounded
funding inequities across
1.
Increase funding to enhance access to treatment: The elimination in 2003 of sliding fee
funding for individuals with moderate incomes and those without insurance
coverage, limited access to treatment for a significant number of people. Currently, CCDTF funding is only
available for no or low income individuals who qualify for MA, GAMC or
MinnesotaCare. For all others
without insurance who are placed in treatment by the counties or the courts, the
counties pay 100 percent of the treatment costs.
2.
Allow reimbursement for services related to positive treatment
outcomes: If counties could use the
CCDTF for services that support treatment - like detox, intensive case
management, transportation services, rent deposits and other one-time services -
treatment outcomes would improve.
Additionally, services related to mental health needs of those with
chemical dependency issues need to be considered. A large segment of the treatment
population has a dual diagnosis requiring chemical dependency treatment geared
toward treating other behavioral health problems as well.
3.
Eliminate or reduce county maintenance of effort requirements: Under the current parameters of the
CCDTF, each county must spend a set amount of county taxpayer dollars each year
relative to the state dollars they receive. The requirements from county to county
vary widely - from 4 to over 60 percent.
In the least, MOEs should be equalized across counties. A graduated equalization that does not
raise the current rates of any counties (holds harmless) should be instituted to
provide for uniform access to treatment across the state.
Provide
Dedicated Funding for Social Services and
Public
Safety Costs Related to Alcohol Abuse
The MICA Board
of Directors supports the enactment of an alcohol beverage tax to generate
funding dedicated to addressing problems associated with the over-consumption of
alcohol. The Board supports
the allocation of these funds to counties, who are required to provide a vast
array of services related to the abusive consumption of alcohol.
Nationally, to cover the costs associated with alcohol
and other drug use, each man, woman and child in the
A per-drink tax would provide funding that could be used
across the state where the need arises.
Dedicating these taxes to a statewide fund would provide stable funding
and tie the source of revenue to the source of costs.
The MICA Board
of Directors supports the processing of MinnesotaCare applications by counties
and the direction of funding to counties for that
processing.
All
Assign
Responsibility for Investigation of Reports of
Maltreatment
of
Juveniles to Agencies with Oversight Jurisdiction
The MICA Board
of Directors recommends that the investigation of maltreatment reports of minors
in corrections facilities be the responsibility of the Department of Corrections
and for school-based reports to be the responsibility of the Department of
Education. Alternatively, if the
responsibility remains with counties, under the direction of the Department of
Human Services, the Board supports the allocation of additional funding to
counties to pay for training and the expanded responsibility of counties for
these investigations.
Under current state laws and rules, counties are
responsible for assessing or investigating reports of maltreatment of minors in
foster care, family and legally licensed child care and juvenile correctional
facilities. The responsibility for
in-school reports are assigned to the Department of Education. Responsibility for reports involving
after-school activities that take place on school property is not clearly
defined in state statute.
Counties, under the direction of the Department of Human
Services (DHS), oversee licensing and the ongoing operations of foster care and
child care providers. Juvenile
correctional facilities are licensed and regulated by the Department of
Corrections (DOC). Schools are
regulated by the Department of Education.
While county social service agency staff are familiar with the foster and
child care operations in their jurisdiction and are well-trained to assess and
investigate maltreatment reports in these facilities, they have not received the
specialized training required to assess and investigate reports involving DOC
and DOE facilities. Additionally,
funding is not provided by the state to provide the volume of correctional
facility and school-related reports.
Either funding needs to be provided to counties for the hiring and
training of staff to meet the expanded responsibilities or the state agencies
with oversight authority of the involved facility should be assigned to
investigate reports.
Change
Requirements Regarding PMAP Information Mailings
The MICA Board
of Directors supports a change in the required PMAP information mailings that
allow counties to mail health plan summaries to enrollees, followed by full
program brochures upon request.
Counties are required to send health plan booklets to
all Medical Assistance clients enrolled in Prepaid Medical Assistance Programs
(PMAPs) to inform them as to their available plan options. In some counties, there are up to five
options. The cost for these
mandated mailings approaches $6.00 per client.
The cost to continue these mailings exceeds the benefit
to clients. The booklets are
lengthy and difficult to read and understand. Summaries of the plans would be far
cheaper to mail, saving tax payer dollars, and would provide information that is
more likely to help clients make informed decisions. Booklets could then be mailed out only
to those clients requesting them.
OTHER H&HS ITEMS CONTAINED IN OTHER SECTIONS OF THE
MICA PLATFORM
FROM THE PUBLIC SAFETY AND CORRECTIONS
RECOMMENDATIONS
Provide Sufficient Funding for
Public Defender
Representation in Child Protection
Cases
MICA urges the 2008
Legislature to clearly identify the Public Defense Board as responsible for
providing representation of all parties in CHIPS cases and to provide necessary
funding for the Board to meet this responsibility.
Over the past decade, the Board of Public Defense has assumed responsibility for providing the representation of both children and adults of children in protective services (CHIPS) cases, but the statutory authority remains confusing. Counties gave up significant state aid in the 1990s in order to allow for the public defenders' budgets to be increased so they could handle these types of cases. Counties do not have the appropriate staffing to provide quality representation at affordable prices.
Proponents of county funding argue that requiring counties to pay for representation of adults in child protection cases will reduce the number and costs of cases. However, counties already pay for the social worker, prosecutor, probation officer, and out of home placements, so there is no fiscal incentive for counties to bring CHIPS cases in lieu of other forms of intervention. Counties are working hard to reduce the overall cost of child protection cases while still assuring the safety of children. Counties do not need additional unfunded mandates to motivate them to find efficiencies in CHIPS cases.
FROM THE TAX AND REVENUE SECTION OF
THE RECOMMENDATIONS
The
State Should Pay Its Share of the Hold Costs
for
the Civil Commitment of Sex Offenders
The MICA Board of
Directors urges the 2008 Legislature to pay the state’s statutory share of 50%
of the “hold” costs for sex offenders being petitioned for civil
commitment.
Since 1999, MS 253B.185 has required
the state to pay for 50% of the costs of “holds” (temporary confinement) of sex
offenders being petitioned for civil commitment. The state’s obligation is limited to the
amount appropriated. In only one
year since 1999 has the legislature appropriated any money for this
purpose. As a result, counties have
ended up paying the full costs of holds, costs that have risen dramatically -
nearly 10-fold from FY 2003 to 2006.
Changes in the state’s policy for referring imprisoned sex offenders for
civil commitment have largely precipitated the increase. Legislators may naively believe that the
statutory requirement that the Department of Corrections make their referrals
one year before a sex offender’s release from prison addresses the counties’
cost concerns. The reality is that
many referrals are not made within this deadline.