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Social
Services Consortium Members,
The House is most likely going to complete their budget this week. PLEASE,
PLEASE, PLEASE!!! make sure you contact your House members (especially the
full appropriation chairs listed at the end of the e-mail) to let them know:
Don’t keep the Senate’s cuts to Medicaid.
- This cut hits only the poorest of poor: Currently,
elderly, blind, or disabled North Carolinians can get Medicaid only if their
income is less than $9,570 a year (100% Federal Poverty Level). The Senate
changes this limit so only people making less than $6,948 a year (73% Federal
Poverty Level) can get Medicaid.
- The most frail and at-risk people Medicaid covers:
These are people in poverty, many unable to leave home, and many may need
institutionalization in a nursing home. Just because we cut them off of health
coverage doesn’t mean their medical needs go away. They’ll delay
care and maybe die earlier or show up in a county hospital emergency room
or clinic with even more serious medical problems.
- 57,000 will lose in-home personal and nursing care, dental
services and more: Elderly, blind, or disabled residents in poverty
who are currently on Medicare and Medicaid will still have most hospital,
doctor, and (as of 2006) prescription drug services covered even when they
lose Medicaid. However, they will lose all other services not covered by Medicare
that were covered by Medicaid. As anyone who is on Medicare knows, there are
huge gaps in the health services provided by Medicare – especially if
you have a serious disability. For example, in-home nursing care keeps people
who are very sick at home with their families and out of expensive institutions
like nursing homes.
- 8,000 will lose all health care: Blind or disabled
residents who are on Medicaid but have not yet gotten on Medicare will be
the worst hit. While many folks will have applied for Social Security disability
and Medicare, the minimum waiting time for Medicare health coverage is almost
two and a half years (29 months). This assumes that the person with the disability
has immediately applied for Social Security disability and Medicare, gotten
a very quick hearing from the federal government and the federal government
has almost immediately made a decision. The less-than-speedy reality of the
federal government’s action in these cases means that almost everyone
will wait longer than the current two and a half year minimum. In North Carolina
we don’t wait years for federal government action before we take care
of our poorest and most vulnerable residents. We make a commitment to all
our blind and disabled residents living in poverty that they can at least
get Medicaid health coverage as they wait for the federal government’s
slow decisions and actions.
Provide $5.692 Million in Funding for Child Protective Services Workers
Caseloads are Too High
North Carolina has implemented a system reform effort in 52 of the 100 counties
called the Multiple Response System (MRS). This new way of responding to reports
of abuse and neglect has been shown to be more proactive and provide better
outcomes through the interventions it employs to protect children and help
families succeed.
- A caseload of 1:10 is needed to effectively implement MRS.
A Duke University study of MRS recommended that an effective caseload size
under MRS should be 1:8 worker/client ratio. We are striving to reach a 1:10
ratio which has been achieved in the 52 MRS counties but still have a 1:12
ratio in the remaining 42 counties.
- Caseloads that are too high contribute to turnover. The
national turnover rates of child welfare staff—which affect both recruitment
and retention efforts—has been estimated at between 30 percent and 40
percent annually nationwide, with workers’ average tenure being less
than two years. The inability to retain staff contributes to the existing
unmanageable caseloads.
- Caseload sizes must be reduced to effectively impact the well-being
of families. The amount of caseworker contact has shown to directly
impact the permanency outcome of child welfare cases.
- Caseloads are high, but workloads are even higher due to
the growing complexity of each case. Substance abuse most often occurs
with a finding of abuse or neglect, but mental illness, domestic violence,
HIV/AIDS, other poverty-related problems are also often present.
- For every change in caseworker, there is a significant increase
in the time a child spends in the system. Caseworker consistency
is essential to the successful outcome of child welfare services.
Support Funding for NC FAST
We need to modernize the antiquated DSS Welfare Automation system
to help children and families and to meet federal requirements.
- The General Fiscal Research demands more information about
the cost of the various deliverables for the project. We will not
know specific costs until we receive responses to the Request for Proposal
(RFP) which will be released in July. We must exercise caution in publicizing
our estimated costs for the NCFAST initiative implementation. If not, vendor
responses to the RFP could include higher costs being submitted as part of
their proposals. Cost estimates provided for implementation include both projected
vendor and state costs to be incurred.
- Prior to posting an RFP with the intent of awarding a contract,
we need to have funding allocated for this initiative. If insufficient
funding is available for this initiative for the next biennium, we will either
be unable to move forward with the project or be forced to enter into a longer
contractual situation, which could in turn increase the overall project implementation
costs.
- Negotiations with our Federal Partners to provide funding
for implementation are underway. There have been two prior attempts
in past years to move this initiative forward and due to inadequate state
funds and county buy-in, these efforts resulted in failure. For the current
NCFAST initiative, we have county commitment and participation. If the state
does not make it a priority to move the current NCFAST initiative forward,
then our Federal Partners will likely not support this initiative moving forward.
This could ultimately result in a loss of Federal funding for implementation
estimated to be in excess of $22 million over the next biennium.
- NC FAST vastly benefits a multitude of programs and reduces
the error in data collection. NC FAST is being developed to assist
in Work First, Food Stamps, Child Welfare (CPS, Foster Care, Adoption, etc),
Emergency Assistance, Medicaid, NC Health Choice, Child Care Subsidy Program,
Adult and Family Services, Child Support. Currently, many of these programs
require “pen and paper” tracking and data tabulations by hand
that increases the risk of errors. An automated system reduces error and also
allows more effective data collection to meet federal accountability requirements.
- NC FAST effectively streamlines work to increase productivity.
The mountains of paperwork facing child welfare workers is astounding. Much
time is spent filling out forms that then have to be duplicated if the child
moves to different county. This is time lost that should be spent working
directly with families.
- NC FAST allows statewide tracking of clients. In addition
to the duplication of work, we face a much graver problem of “losing”
children in the system. A child known to CPS in Wake County should
be easily identified in the computer in Buncombe County. Abuse or neglect
of a child should not be allowed to perpetuate simply by the inability to
track a case from county to county.
- NC FAST allows systems within DSS and their community service
partners to share information and in real time. In addition to tracking
clients between counties, this system would allow us to track clients across
programs within the DSS agency and with community service partners such as
the schools and mental health, thus sharing and improving communication that
results in time saved and better outcomes for clients.
FULL APPROPRIATION CHAIRS
Chairman - Rep. Clary
Chairman - Rep. Crawford
Chairman - Rep. Earle
Chairman - Rep. Nye
Chairman - Rep. Owens
Chairman - Rep. Sherrill
Co-Chairs of the HHS AppropriationSubcommittee
Chairman - Rep. Barnhart
Chairman - Rep. Insko
