99071

Prepared by the North Dakota Legislative Council staff for the Budget Committee on Human Services July 1997

SOCIAL SERVICES AGENCIES IN NORTH DAKOTA AND SELECTED OTHER STATES

This memorandum summarizes the following information for the social services agencies in North Dakota, South Dakota, Minnesota, Montana, Wyoming, Kansas, Iowa, Nebraska, Kentucky, Florida, Illinois, Maine, New Mexico, and Tennessee:

• Organizational structure;
• Service delivery responsibilities of the state and counties;
• Recent studies of the organizational structure or service delivery system;
• Recent reorganizations of social services agencies;
• General fund and other fund appropriations;
• Full-time equivalent positions;
• Number of recipients for aid to families with dependent children (AFDC) or temporary assistance for needy families (TANF), Medicaid, and food stamps; and
• State population.

The states listed above were selected because of their proximity to North Dakota, their similarity in state size or social services agency organizational structure, or because of recently completed studies or reorganizations of the state's social services agencies.

SOCIAL SERVICES AGENCIES - ORGANIZATIONAL STRUCTURE AND RECENT STUDIES OR REORGANIZATIONS

	Economic Assistance, Medicaid, and Major Social Services Programs Administered by Single Agency 1	Agency Administrator Appointed by Governor	Agency Advisory Committee	State or Counties Primarily Responsible for Service Delivery 2	Recent or Current Studies of Human Services Organizational Structure 3	Recent Reorganization of Social Services Agencies 3
North Dakota	Yes	Yes	No	Counties	No	No
South Dakota	No	Yes	Yes	State	No	No
Minnesota	Yes	Yes	No	Counties	No	No
Montana	Yes	Yes	Yes	Counties	No	Yes
Wyoming	No	Yes	Yes	State	No	No
Kansas	Yes	Yes	No	State	No	No
Iowa	Yes	Yes	Yes	State	Yes	No
Nebraska	No	Yes	Yes	State	No	Yes
Kentucky	No	Yes	No	State	Yes	Yes
Florida	No	Yes	Yes	State	Yes	Yes
Illinois	Yes	Yes	No	State	No	Yes
Maine	Yes 4	Yes	No	State	No	No
New Mexico	No	Yes	No	State	No	No
Tennessee	No	Yes	No	State	No	Yes
1 See Appendix A for information on the organizational structure of the social services agencies in each state. 2 See Appendix B for information on the service delivery responsibilities of the state and counties in each of the states listed. 3 See Appendix C for information on recent human services reorganization efforts or related studies in the states listed. 4 Mental health and substance abuse services in Maine are provided by a separate agency, the Department of Mental Health, Mental Retardation, and Substance Abuse Services.

SOCIAL SERVICES AGENCIES - APPROPRIATIONS, FULL-TIME EQUIVALENT (FTE) POSITIONS, AND PROGRAM RECIPIENTS

	1997-99 Biennium Appropriations 1				AFDC or TANF		Medicaid		Food Stamps
	General Fund	Other Funds	Total	FTE Positions	Monthly Individuals	Monthly Cases	Monthly Individuals	Monthly Cases	Monthly Individuals	Monthly Cases
North Dakota Department of Human Services	$334,897,564	$835,337,624	$1,170,235,188	2,237.4	11,2752	4,1622	45,5593	N/A	36,912	15,227
South Dakota Department of Social Services	$237,500,000	$498,600,000	$736,100,000	912.5
South Dakota Department of Human Services	116,600,000	147,100,000	263,700,000	1,363.3
Total South Dakota	$354,100,000	$645,700,000	$999,800,000	2,275.8	13,3802	5,1252	60,3883	N/A	48,155	18,295
Minnesota Department of Human Services	$5,325,300,000	$4,992,000,000	$10,317,300,000	5,828.0	155,058	52,959	405,4803	N/A	261,374	109,721
Montana Department of Public Health and Human Services	$448,100,000	$981,200,000	$1,429,300,000	2,796.8	24,633	8,392	70,117	N/A	68,017	27,106
Wyoming Department of Family Services	$76,800,000	$96,500,000	$173,300,000	665.0	N/A	4,525	23,065	N/A	N/A	12,069
Kansas Department of Social and Rehabilitation Services	$1,170,900,000	$1,759,100,000	$2,930,000,000	7,313.0	71,697	26,057	195,1393	N/A	175,490	70,290
Iowa Department of Human Services	$1,510,400,000	$2,564,000,000	$4,074,400,000	5,411.2	77,979	28,732	219,9033	N/A	156,472	64,392
Nebraska Health and Human Services system (3 agencies)	$1,168,400,000	$1,630,100,000	$2,798,500,000	5,800.0	N/A	25,120	185,983	N/A	N/A	42,542
Kentucky Cabinet for Families and Children	$614,300,000	$1,069,700,000	$1,684,000,000	5,755.0
Kentucky Cabinet for Health Services	1,615,400,000	4,837,600,000	6,453,000,000	3,482.0
Total Kentucky	$2,229,700,000	$5,907,300,000	$8,137,000,000	9,237.0	156,511	63,467	527,2113	N/A	N/A	168,434
Florida Department of Children and Families	$2,800,000,000	$3,200,000,000	$6,000,000,000	26,993.0
Florida Agency for Health Care Administration	4,376,000,000	9,714,500,000	14,090,500,000	2,120.5
Total Florida	$7,176,000,000	$12,914,500,000	$20,090,500,000	29,113.5	503,7182	N/A	N/A	N/A	1,297,262	560,676
Illinois Department of Human Services	$6,624,900,000	$1,803,700,000	$8,428,600,000	20,307.3	622,189	N/A	1,260,918	N/A	1,002,023	N/A
Maine Department of Human Services	$782,000,000	$2,177,600,000	$2,959,600,000	2,406.5	N/A	N/A	N/A	N/A	N/A	N/A
New Mexico Human Services Department	N/A	N/A	N/A	1,522.0	90,722	30,305	218,314	N/A	219,769	80,864
Tennessee Department of Human Services	$279,700,000	$2,271,300,000	$2,551,000,000	4,010.0	N/A	64,731	839,518	N/A	567,011	242,769
1 For comparative purposes, the appropriation amounts for states with annual appropriations are doubled to reflect an approximate biennial appropriation amount. 2 Includes AFDC basic and unemployed parent programs. 3 Total number of residents eligible to receive Medicaid. N/A Not available at this time.

SOCIAL SERVICES AGENCIES - GENERAL FUND APPROPRIATIONS AND PROGRAM RECIPIENTS AS A PERCENTAGE OF STATE POPULATION

	State Population	Approximate Annual General Fund Appropriation Per Resident	AFDC or TANF Individual Recipients As a Percentage of Population	Medicaid Individual Recipients As a Percent age of Population	Food Stamps Individual Recipients As a Percentage of Population
North Dakota Department of Human Services	644,000	$260	1.8%	7.1% 1	5.7%
South Dakota Department of Social Services		$162
South Dakota Department of Human Services		80
Total South Dakota	732,000	$242	1.8%	8.2% 1	6.6%
Minnesota Department of Human Services	4,658,000	$572	3.3%	8.7% 1	5.6%
Montana Department of Public Health and Human Services	879,000	$255	2.8%	8.0%	7.7%
Wyoming Department of Family Services	481,000	$80	N/A	4.8%	N/A
Kansas Department of Social and Rehabilitation Services	2,572,000	$228	2.8%	7.6% 1	6.8%
Iowa Department of Human Services	2,852,000	$265	2.7%	7.7% 1	5.5%
Nebraska Health and Human Services system (3 agencies)	1,652,000	$354	N/A	11.3%	N/A
Kentucky Cabinet for Families and Children		$79
Kentucky Cabinet for Health Services		208
Total Kentucky	3,884,000	$287	4.0%	13.6% 1	N/A
Florida Department of Children and Families		$97
Florida Agency for Health Care Administration		152
Total Florida	14,400,000	$249	3.5%	N/A	9.0%
Illinois Department of Human Services	11,847,000	$280	5.3%	10.6%	8.5%
Maine Department of Human Services	1,243,000	$315	N/A	N/A	N/A
New Mexico Human Services Department	1,713,000	N/A	5.3%	12.7%	12.8%
Tennessee Department of Human Services	5,320,000	$26	N/A	15.8%	10.7%
1 Based on the number of residents eligible to receive Medicaid. N/A Not available at this time.

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APPENDIX A

ORGANIZATIONAL STRUCTURE

NORTH DAKOTA

The North Dakota Department of Human Services is organized in the following four major divisions:

Office of Economic Assistance

Training, Education, Employment, and Management (TEEM) Division - This division is involved in the development and coordination of the state's welfare reform efforts and administers the state's welfare reform demonstration project.

Public Assistance Division - This division is responsible for the administration of cash assistance programs for low-income individuals and families through the county social service boards. The following programs are administered by this division:

• Aid to families with dependent children (AFDC) basic and unemployed parent.
• Basic care assistance.
• Early intervention for pregnant women.
• Refugee assistance.

Medical Service (Medicaid) Division -

This division administers the federal Medicaid program.

Energy and Nutrition Division - This division administers the federal food stamps program and the federal low-income home energy assistance program.

Child Support Enforcement Division - This division collects child support payments from parents who are legally obligated to pay.

Office of Program and Policy

Children's Special Health Services Division - This division provides services for children with special health care needs.

Disability Services Division - This division provides services to individuals with mental retardation and related conditions who live in community settings.

Aging Services Division - This division administers programs that serve the elderly and persons with physical disabilities.

Mental Health and Substance Abuse Services Division - This division monitors federal block grant and licenses alcohol and drug abuse treatment programs and residential treatment centers for youth with serious emotional disorders.

Children and Family Services Division - This division administers, funds, and licenses services to children who have become or who are at risk of becoming neglected, abused, deprived, or delinquent and administers various child welfare programs.

Field Services

This division includes the eight regional human service centers, the State Hospital, and the Developmental Center.

Staff Support

This division includes the Information Management Division, Legal Advisory Unit, Communications Division, Human Resources Division, and Executive Secretary.

South Dakota

In South Dakota, economic assistance and human service programs are delivered by two agencies--the Department of Human Services and the Department of Social Services.

Department of Human Services

Division of Alcohol and Drug Abuse - This division provides prevention and treatment services to reduce the prevalence of substance abuse disorders.

Division of Developmental Disabilities - This division provides services to promote the inclusion of and meet the various needs of people with developmental disabilities.

Division of Mental Health - This division provides services to promote the independence of adults with severe and persistent mental illness and children with emotional disorders.

Division of Rehabilitation Services - This division provides services to disabled individuals to allow them to obtain employment, economic self-sufficiency, and personal independence.

Division of Blind and Visually Impaired Services - This division provides rehabilitation services to individuals who are blind or visually impaired. The services assist individuals in obtaining employment and independent living skills.

Developmental Center - This institution provides services to persons with developmental disabilities when community-based options are not available.

Human Services Center - This institution provides individualized treatment to persons who are mentally ill or chemically dependent.

Department of Social Services

Program Management Division - This division administers all service delivery programs through district program supervisors located in each of the state's four districts. The programs administered include the following:

• Adult and aging services,
• AFDC,
• Child care services,
• Child protection services,
• Community assistance program,
• Child support enforcement,
• Domestic abuse program,
• Energy assistance,
• Family independence program,
• Food stamps,
• Medical services,
• Medicaid,
• Automated eligibility program, and
• Quality control.

Field Management Division -

This division coordinates the department's statewide service delivery through four district managers.

Management Services Division - This division provides the department's budgetary, financial, purchasing, contracting, auditing, personnel, planning, and reporting services.

Minnesota

The Minnesota Department of Human Services has the following divisions:

Health and Continuing Care - This division provides the following services: continuing care for persons with disabilities, including the operation of 11 state-operated regional human services and treatment centers; health care for families and children; performance measurement and quality improvement; purchasing and service delivery; and the office of the state Medicaid director.

Economic and Community Support - This division provides the following services: assistance payments, food stamps, child support enforcement, self-sufficiency programs, and community support programs, including services to the deaf and hard of hearing.

Children's Initiative - This division provides the following services: children's mental health services, family and children's services, community services, and social services information system management.

Aging Initiative - This division provides the following services: community support, including aging services and adult protective services; and continuing care for the elderly, including long-term care ratesetting and policy coordination.

Finance and Management Operations - This division provides the following services: internal audits, financial operations and reports, health care systems development and operations, office of legal management, and management services.

Montana

The Montana Department of Public Health and Human Services has the following divisions:

Addictive and Mental Disorders Division - This division provides services through three state-operated facilities and through private service providers to assure a statewide continuum of effective prevention, treatment, and rehabilitation services for people with chemical dependency and mental illness. The state operates a state hospital, a chemical dependency center, and a mental health nursing care center.

Child and Family Services Division - This division administers programs to help protect vulnerable children, youth, and adults who suffer from poverty, abuse, or neglect. The division administers the following services and programs: child protection, child care, foster care, adoption, family preservation and support, domestic violence prevention, refugee assistance, AFDC, Medicaid eligibility determination, employment and training programs, food stamps, low-income energy assistance, food and commodities distribution, and child and adult food programs.

Child Support Enforcement Division - This division collects financial support for children by establishing, enforcing, and increasing public awareness of parental obligations.

Disability Services Division - This division is responsible for coordinating, developing, and implementing rehabilitation and independent living programs to assist Montanans with disabilities.

Health Policy and Services Division - This division is responsible for the planning and implementation of statewide health policy and the administration of public health programs and the acute and primary care components of the Medicaid program.

Operations and Technology Division - This division provides operational support services for the department, including accounting and budgeting, and maintenance of the department's information technology system.

Quality Assurance Division - This division administers the department's quality assurance program, which utilizes comprehensive reviews, fiscal evaluations, and performance measures to evaluate the delivery of the department's services.

Senior and Long-Term Care Division - This division plans and coordinates the delivery of publicly funded long-term care and support services to elderly and disabled Montanans through the following six major programs:

• The Office on Aging,
• The state Veterans Home,
• Medicaid community services,
• Medicaid nursing facility services,
• Adult protective services, and
• The state supplemental payments program.

Wyoming

The Wyoming Department of Family Services administers economic assistance and social services programs. The Department of Health administers the state's Medicaid program.

Department of Family Services

Juvenile Services Division - This division provides services to juveniles, including community juvenile justice programs and residential boys' and girls' schools.

Information Services Division - This division provides information technology system analysis and programming services for the department.

Financial Services Division - This division provides quality control, budgeting, and accounting services for the department.

Field Services Division - This division delivers services through four regions and 23 field offices.

Programs and Policy Division - This division administers all assistance programs and consists of the following four subdivisions:

• Economic Assistance - This subdivision administers the food stamps, energy assistance, and AFDC programs and determines eligibility for Medicaid benefits. However, Medicaid funds are appropriated to the Department of Health and distributed by that agency.
• Social Services - This subdivision administers child protective services, child abuse prevention services, child care, adoption, independent living, child psychiatric care, and adult protection services.
• Child Support Enforcement
• Support Staff

The Wyoming Department of Health consists of seven divisions--administration, aging services, behavioral health - community programs, developmental disabilities, health care financing, preventive medicine, and public health. The department administers the state's Medicaid program and five state institutions--Pioneer Home (available to residents age 55 or older, regardless of income), Retirement Center (Medicaid- and Medicare-certified nursing home for residents who suffer from chronic diseases relating to aging), State Hospital (diagnostic and treatment facility for mentally ill patients), State Training School (provides services to the developmentally disabled), and Veterans Home.

Kansas

The Kansas Department of Social and Rehabilitation Services has the following divisions:

Administrative Services - This division provides information technology, strategic planning, financial operations, reporting, auditing, and ratesetting services.

Adult and Medical Services - This division provides managed care, Medicaid, and adult protective services.

Alcohol and Drug Abuse Services - This division provides community-based prevention, assessment, and treatment services.

Children and Family Services - This division provides family preservation, foster care, and adoption services.

Income Maintenance and Employment Preparation Services - This division administers the following programs: temporary assistance for needy families (TANF), food stamps, general assistance, energy assistance, refugee assistance, burial assistance, child care, and employment preparation.

Legal Services - This division provides child support enforcement, fraud investigation, and state institution abuse investigation services.

Mental Health and Developmental Disabilities - This division administers state mental health institutions and mental health state aid and provides homeless, sexual predator treatment, and home and community-based services.

Rehabilitation Services - This division provides vocational rehabilitation, blind, deaf, independent living, and disability determination services.

The Kansas Department of Social and Rehabilitation Services also administers the following seven state institutions:

• Kansas Neurological Institute.
• Larned State Hospital.
• Osawatomie State Hospital.
• Parsons State Hospital and Training Center.
• Rainbow Mental Health Facility.
• Topeka State Hospital.
• Winfield State Hospital and Training Center.

Iowa

The Iowa Department of Human Services has the following divisions:

Data Management - This division provides information technology management services to the department.

Fiscal Management - This division provides accounting and budgeting services to the department.

Support Services - This division provides purchasing and other support services to the department and the state institutions affiliated with the department.

Adult, Children, and Family Services - This division provides adoption, foster care, child care, and child abuse prevention services. This division also administers two juvenile facilities, one for delinquent juveniles and one for children in need of assistance.

Economic Assistance Services - This division administers the AFDC, food stamps, and homeless grants programs.

Medical Services - This division administers the Medicaid program.

Mental Health and Developmental Disabilities Services - This division provides mental health diagnostic and treatment services and administers four state mental health institutions.

Policy Coordination Services - This division provides information to the department on federal regulations and state administrative rules. This division also administers the child support enforcement, case management, and refugee assistance programs.

Nebraska

Three agencies in Nebraska are involved in the administration and delivery of social services programs--the Department of Health and Human Services, the Department of Health and Human Services Finance and Support, and the Department of Health and Human Services Regulation and Licensure. The directors of the agencies constitute a health and human services policy cabinet which reports to the Governor.

Health and Human Services Finance and Support - This agency has the following divisions: financial services, support services, computer systems and technology, human resources, staff development, strategic and financial planning, Medicaid, legal services, and long-term care.

Health and Human Services - This agency has the following divisions:

• Administration - This division provides the following services: management support, developmental disabilities planning, minority health, and migrant health.
• Preventive Health and Public Wellness - This division provides the following services: disease prevention, family health, health promotion and education, population safety, and population self-sufficiency.
• Community Support - This division provides the following services: technical assistance and support to communities, community health, rural health, community aging services, community services block grant administration, and community resource development.
• Office of the Chief Deputy - This division administers the state veterans homes and state aging services.
• Individual and Community Services - This division administers the following programs: protection and safety, health and well-being, maximum independence and long-term care, children and family services, special services for children and adults, juvenile services and parole, mental health and substance abuse, and regional service delivery centers.
• Self-Sufficiency - This division administers the following programs: child support, child care, and economic assistance.
• Health and Human Services Regulation and Licensure - This agency has the following divisions:
• Public Health Assessment - This division administers the following programs: administrative assistance, state laboratory, public health technical assessment, consumer health services, environmental health services, and environmental disease, data services.
• Regulatory Analysis and Integration Division - This division provides the following services: policy development, developmental disabilities, substance abuse, health and well-being, child care, foster care, and public assistance regulation.
• Performance Accountability Management - This division provides quality control services for the agency.
• Investigations
• Credentialing - This division provides professional and facilities licensing services.
• Office of the Chief Medical Officer

Kentucky

The Kentucky Cabinet for Families and Children administers economic assistance and social services programs. The Kentucky Cabinet for Health Services provides public health and Medicaid services.

Cabinet for Families and Children

Office of Communications - This office responds to media inquiries, prepares news releases, and produces newsletters, pamphlets, and public awareness campaigns for the department.

Office of Program Support - This office provides administrative support to the other departments of the Cabinet for Families and Children, including personnel administration, operations and resource management, and financial management.

Department for Social Services - This department of the cabinet develops and implements human services programs through divisions of family services, aging services, and program management.

Department for Social Insurance - This department administers benefit programs that provide assistance to needy families through divisions of administrative review, child support enforcement, disability determinations, field services (determines eligibility for cash assistance, food stamps, and Medicaid), and management and development.

Office of Technology Services - This office develops and administers the cabinet's information technology system.

Office of the General Counsel - This office provides legal advice and assistance to all departments and divisions of the Cabinet for Families and Children.

Office of Family Resources and Youth Services Centers - Family resource centers serve children through 12 years of age and youth services centers serve children over 12 years of age.

Office of the Ombudsman - This office handles complaints and inquiries from citizens pertaining to programs administered by the Cabinet for Families and Children and the Cabinet for Health Services.

Cabinet for Health Services

Department for Mental Health and Mental Retardation Services - This department provides mental health, mental retardation, substance abuse, and developmental disabilities programs through four state institutions providing inpatient psychiatric services, two intermediate care facilities, and seven facilities providing institutional care for those patients unable to live in the community.

Department for Public Health - This department develops and operates all health-related programs provided by the state, including clinical services, vital statistics, communicable disease control, enforcement of the sanitary code, and general surveillance on the health of Kentucky citizens.

Department for Medicaid Services - This department administers the Medicaid program. Eligibility for Medicaid is determined by the Field Services Division of the Department for Social Insurance of the Cabinet for Families and Children.

Office of Inspector General - This office conducts internal audits of the department and audits of service providers.

Office of Certificate of Need - This office approves or disapproves certificate of need applications.

Administrative Support - This division provides support services to all departments of the cabinet, including budgeting, personnel, and information technology services.

Commission for Children with Special Health Care Needs - This commission provides certain medical services to needy children under 21 years of age whose functions and movements are impaired.

Florida

The Florida Department of Children and Families administers economic assistance and social services programs. The Florida Agency for Health Care Administration administers the Medicaid program.

Department of Children and Families

Office of the Secretary - This division provides legal services, communications, legislative planning, standards and evaluations, and internal audits.

Administration - This division provides the following services to the department: budgeting, grant management, human resources, financial management, general services, and information technology system management.

Economic Self-Sufficiency - This division administers the following programs: WAGES, adult assistance payments, food stamps, and Medicaid eligibility determination.

Developmental Services - This division administers the following programs or institutions: intermediate care facilities for the developmentally disabled, developmental services institutions, home and community-based waivers, community supported living programs, and individual and family support programs.

Family Safety and Preservation - This division administers the following programs: child day care, out-of-home care, family preservation services, child and adult abuse investigations, child and adult protective services, domestic violence prevention, disabled adult protective services, and adoption services.

Substance Abuse - This division administers child and adult substance abuse programs.

Mental Health - This division administers the following programs: children's mental health services, adult mental health services, state mental health institutions, and forensic services.

The Florida Agency for Health Care Administration includes divisions of health quality assurance, health policy and cost control, administrative services, state health purchasing, and medical quality assurance. The Division of State Health Purchasing includes the administration of the Medicaid program. Medicaid eligibility is determined by the Economic Self-Sufficiency Division of the Department of Children and Family Services.

Illinois

The Illinois Department of Human Services has the following divisions:

Community Health and Prevention - This division administers the following programs: addiction prevention, community health, family and youth development, and violence prevention and intervention.

Transitional Services - This division administers the following programs: adult employability, child care, food and shelter assistance, income assistance, refugee services, and special social services projects.

Disability and Behavioral Health Services - This division administers the following programs: addiction treatment, developmental disabilities, disability determination, mental health services, and rehabilitation services.

Community Operations - This division administers the delivery of services through the department's regional staff located in the six regions of the state.

Support Services - This division provides the following services to the department: administration, auditing, finance, legislative planning, legal services, information technology management, and public information.

Maine

The Maine Department of Human Services has the following divisions:

Bureau of Elder and Adult Services - This division administers the following programs: advocacy and community services, adult protective services, long-term care, and administration.

Bureau of Family Independence - This division has the following subdivisions:

• Policy and Programs - This subdivision is responsible for the development and implementation of the rules, regulations, policies, and procedures used to determine eligibility for AFDC, food stamps, Medicaid, general assistance, and emergency assistance programs.
• Regional Operation and Management Information Systems - This subdivision provides services through the five regions of the state, oversees quality control activities, and the design and development of management information technology systems for program eligibility and support enforcement.
• Support Enforcement - This subdivision administers programs to ensure that absent parents contribute to the economic support of their children.

Bureau of Medical Services -

This division has the following subdivisions: information management, managed care, Medicaid policy and programs, quality improvement, reimbursement and financial services, surveillance and utilization review, and licensing and certification.

Bureau of Child and Family Services - This division provides child welfare services, foster care, adoption, child protective services, and family preservation services.

Mental health and substance abuse services in Maine are provided by the Department of Mental Health, Mental Retardation, and Substance Abuse Services.

New Mexico

In New Mexico, economic assistance and Medicaid programs are administered by the Human Services Department. Social services programs to children and adults are provided by the Department of Children, Youth, and Families.

Human Services Department

Office of the Secretary - This division provides administration for the department.

Income Support - This division administers the following programs: AFDC, energy assistance, general assistance, homeless programs, refugee resettlement, and food stamps.

Medical Assistance - This division administers the Medicaid program.

Child Support Enforcement - This division administers programs to collect child support from absent parents.

The New Mexico Department of Children, Youth, and Families administers programs to protect children and adults from abuse, reduce crime, provide quality child care, support families, and operates the juvenile corrections system. The department has five divisions--financial services, human resources, protective services, prevention and intervention, and juvenile justice.

Tennessee

In Tennessee, economic assistance, and adult social services programs are administered by the Department of Human Services. Mental health services are provided by the Department of Mental Health and Mental Retardation. Children's social services programs are administered by the Department of Children's Services. The Department of Health administers the state's managed care plan.

Department of Human Services

Administrative Services - This division provides administrative support, fiscal services, information technology support, investigation, and administrative review.

Family Assistance - This division determines eligibility for AFDC, food stamps, and Medicaid.

Community and Field Services - This division provides the following services: domestic violence prevention, victims' assistance, energy assistance, homeless programs, refugee assistance, summer food, adult homemaker, and child care

Rehabilitation Services - This division provides services to assist residents with disabilities to live independently and enter gainful employment.

The Tennessee Department of Mental Health and Mental Retardation provides services to individuals with brain disorders, mental illness, and developmental disabilities. The department administers five regional mental health institutes, four developmental centers, and three community mental retardation services offices.

The Tennessee Department of Children's Services provides child protective services, adoption, foster care, licensing of child welfare agencies, services for delinquent youth, youth probation, aftercare services, and managed care for children.

The Tennessee Department of Health administers the state's TennCare program which provides health care benefits for Medicaid-eligible individuals and those persons uninsured or uninsurable.

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APPENDIX B

SERVICE DELIVERY RESPONSIBILITIES OF THE STATE AND COUNTIES

NORTH DAKOTA

In North Dakota, assistance programs are supervised by the state but administered by 53 county social service boards.

SOUTH DAKOTA

In South Dakota, assistance programs are the responsibility of the Department of Social Services. Assistance programs are delivered by the state through local offices under the supervision of four state district supervisors.

MINNESOTA

In Minnesota, assistance and service programs are supervised by the Department of Human Services and administered by the county departments of human services and social services. Local administration is under the direction of county boards of commissioners.

MONTANA

In Montana, assistance programs are administered by the Department of Public Health and Human Services in 12 counties. In 44 counties, the state supervises the delivery of assistance programs by county departments of public welfare. The state is divided into five regions for the state supervision of county agencies.

WYOMING

In Wyoming, assistance and service programs are the responsibility of the Department of Family Services, which administers the programs through 23 regional offices.

KANSAS

In Kansas, assistance and service programs are administered by the Department of Social and Rehabilitation Services through 12 regional offices.

IOWA

In Iowa, assistance and service programs are administered and delivered by the Department of Human Services through state offices in each county.

NEBRASKA

In Nebraska, assistance and service programs are administered by three health and human services system agencies.

KENTUCKY

In Kentucky, assistance and service programs are administered by the Cabinet for Health Services and the Cabinet for Families and Children.

FLORIDA

In Florida, assistance and service programs are administered and delivered by the Department of Children and Family Services through 15 district offices.

ILLINOIS

In Illinois, assistance and service programs are administered and delivered by the Department of Human Services.

MAINE

In Maine, assistance and service programs are administered by the Department of Human Services through five regions.

NEW MEXICO

In New Mexico, most assistance programs are administered by the Human Services Department. Medical assistance, including Medicaid, is administered at the local level. The Children, Youth, and Families Department is responsible for the delivery of social services programs to adults and children.

TENNESSEE

In Tennessee, assistance programs are administered by the Department of Human Services through offices located in 95 counties.

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APPENDIX C

RECENT HUMAN SERVICES SYSTEM REORGANIZATION EFFORTS AND STUDIES OF THE ORGANIZATIONAL STRUCTURE OR SERVICE DELIVERY SYSTEM

MONTANA

The 1995 Montana Legislative Assembly passed legislation, which was introduced by the Governor, to consolidate all state-administered public health and human services programs in a single state agency. A new agency, the Department of Public Health and Human Services, was created on July 1, 1995. The justification for the consolidation was to improve services and more efficiently use state resources.

The consolidation was to meet the following goals:

1. To establish an organizational structure based on consumer needs rather than federal categorical designations.
2. To establish an organizational structure that will support decentralization of program administration between the state and county.
3. To facilitate client access to services by eliminating administrative barriers.
4. To establish a logical relationship among programs.

To assist the new department through the reorganization process, a 32-member advisory council was established, which included consumers, county commissioners, advocates, legislators, providers, and department staff. The advisory council made recommendations relating to service delivery, governance reform, finance, and planning and accountability.

Separate 1995 legislation required the Montana Public Health Improvement Task Force to develop a public health improvement plan and provide copies to the Governor and the Legislative Assembly by September 30, 1996. The report included 13 recommendations for consideration by the department for the improvement of public health services.

IOWA

The 1996 Iowa Legislative Assembly directed the creation of a Department of Human Services Restructuring Task Force. The task force of 12 people, including 10 legislators, met twice during 1996 and did not provide any recommendations.

The 1997 Legislative Assembly requested that the Department of Human Services Restructuring Task Force continue its work during the 1997 interim and develop a proposal to accomplish the following:

1. Devolution of the control of service delivery to the local level.
2. Elimination of program duplication within the Department of Human Services and between the department and other state agencies.
3. Improve services delivery through the reduction of paperwork and bureaucracy.
4. Evaluation of the adherence of the department to the department's mission statement.
5. In addition, at the discretion of the task force, the following topics may also be included in its proposal: granting local authority to deliver public services, use of public institutions and facilities, the possibility of creating an agency for disability and rehabilitation services, and development of a seamless system for referral of families to child day care resources and public financial assistance.

The Iowa Legislative Council authorized the task force to meet monthly during the 1997 interim. A report will be presented to the 1998 Legislative Assembly in January or February 1998.

NEBRASKA

The 1996 Nebraska Legislative Assembly passed the Nebraska Partnership for Health and Human Service Act, which directed a consolidation of five existing state agencies. On January 1, 1997, the Departments of Social Services, Public Institutions, Health, and Aging and the Office of Juvenile Services were consolidated into three new agencies--the Department of Health and Human Services, the Department of Health and Human Services Regulation and Licensure, and the Department of Health and Human Services Finance and Support.

The reorganization:

1. Integrated services, financial support, and administration through state and local partnerships.
2. Developed a results-based accountability system.
3. Formed a health and human services policy cabinet to develop plans, prepare budgets, and establish consistent priorities and policies among the agencies.
4. Created a Health and Human Services Partnership Council to gather community input and link state agencies with communities.

The state employed the use of a consultant to develop specific proposals for the organization and service delivery responsibilities of the new agencies.

KENTUCKY

The 1996 Legislative Assembly of Kentucky passed a joint resolution directing the Families and Children Cabinet and the Health Services Cabinet to conduct a study of the health and human services delivery system in Kentucky. A report on the study is to be presented to the Governor and the Legislative Research Commission by October 1, 1997. The study and report must address:

1. The feasibility of adopting a single point of entry model for service delivery.
2. The possibility of consolidating federal and state funding sources.
3. The partial reallocation of resources from institutional settings to community-based settings.
4. The development of service delivery programs, including case management, in which the individual's independence and dignity are maximized.
5. The use of the least restrictive, humane, and cost-effective setting to receive services.
6. The available community-based resources and their relationship to the continuum of services available and needed to meet the needs of the citizenry.

Also in 1996, the Legislative Assembly approved an executive branch initiative to separate the services provided by the Cabinet for Human Resources and create two new agencies--the Families and Children Cabinet and the Health Services Cabinet.

FLORIDA

In 1996, the Florida Legislative Assembly divided the Department of Health and Rehabilitative Services, which was formed in the mid-1970s, into the following two agencies:

• The Department of Health.
• The Department of Children and Family Services.

The 1996 Legislative Assembly also established two task forces to examine any additional reorganization necessary to improve the delivery of health services and social services. The task force on social services submitted a report with its recommendations to the 1997 Legislative Assembly.

ILLINOIS

In 1996, the Illinois Legislative Assembly passed legislation completing an executive initiative to reorganize the human services agencies.

Effective July 1, 1997, the Department of Human Services was established by consolidating three former state agencies:

• Department of Mental Health and Developmental Disabilities.
• Department of Alcoholism and Substance Abuse.
• Department of Rehabilitation Services.

The Department of Human Services also includes programs previously administered by these agencies:

• Department of Public Aid - Cash assistance, food stamps, Medicaid eligibility determination, employment programs, child care, and social services programs.
• Department of Public Health - Women, infants, and children nutrition program, family case management, and other health-related direct service and prevention programs.
• Department of Children and Family Services - Employment-related child care and youth services.

The reorganization was determined necessary to reduce the fragmentation of service delivery, the duplication of intake and service coordination efforts among state agencies, overlapping assessments and recommendations, gaps in service delivery, and uneven outcome management which leaves many clients without realistic exit plans.

TENNESSEE

The 1996 Legislative Assembly passed legislation creating the Department of Children's Services which will consolidate services previously provided by portions of the following agencies: Department of Human Services, Department of Youth Development, Department of Mental Health and Mental Retardation, Department of Health, Department of Education, and the Department of Finance and Administration.

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