NORTH DAKOTA LEGISLATIVE COUNCIL
Minutes of the
BUDGET COMMITTEE ON HUMAN SERVICES
Monday and Tuesday, September 22-23, 1997
Southeast Human Service Center and
Cass County Social Services
Fargo, North Dakota
Senator Tim Mathern, Chairman, called the meeting to order at 9:00 a.m. on Monday, September 22, 1997, at the Southeast Human Service Center, Fargo.
Members present: Senators Tim Mathern, Bill L. Bowman, Tom Fischer, Jerome Kelsh, Judy Lee, Rod St. Aubyn; Representatives Leonard J. Jacobs, Roxanne Jensen, Connie Johnsen, James A. Kerzman, Clara Sue Price, Ken Svedjan, Gerald O. Sveen, Janet Wentz
Members absent: Senator Russell T. Thane; Representative Wanda Rose
Others present: See attached appendix
It was moved by Representative Svedjan, seconded by Senator Fischer, and carried on a voice vote that the minutes of the July 29-30, 1997, meeting be approved as mailed.
SOUTHEAST HUMAN SERVICE CENTER BUDGET TOUR
Mr. Douglas Seiler, Director, Southeast Human Service Center, provided the committee with a packet of information regarding the center's operations, and containing related agency testimony, a copy of which is on file in the Legislative Council office. Mr. Seiler discussed the human service center goals and an overview of programs at the center.
Mr. Paul Elliott, Coordinator, Sexual Abuse Treatment Program, discussed the treatment program available for people in Region V and in Clay County, Minnesota. He said the program is available through the cooperative efforts of several area agencies, including the Southeast Human Service Center and Cass and Clay County Social Service and state's attorney agencies. He said the program focuses on sexual offenders who have abused children. He said individuals who have sexually abused adults or are in strong denial of their offenses are generally excluded.
Mr. Jim Gebhardt, Business Manager, Southeast Human Service Center, discussed the 1997-99 appropriation for the center. Mr. Gebhardt said the center's 1997-99 biennium budget, which totals $16.7 million, has a $603,000 budget shortfall. He said this is due to several factors, including $357,000 relating to anticipated vacant positions and $138,608 relating to a reduction in the social service block grant funds.
In response to questions from committee members, Mr. Gebhardt said the center opens approximately 150 new cases each month and closes 100 existing cases.
Mr. Seiler discussed the mental health partnership grant, funded with federal funds that are scheduled to end in 1999. He said the human service center needs to convince other participants, including the school district and county social services, of the cost-effectiveness of providing the intensive case management to encourage their continued financial participation in the program.
Mr. Seiler discussed the program changes and programs being evaluated at the human service center. He said an evaluation of 249 extended care cases indicates that 94 percent of the participants decreased their number of hospital days following center intervention. He said the total number of hospital days for the 249 cases prior to intervention was 31,600 and was reduced to 11,074 days following intervention.
Mr. Seiler said the center has been working with Clay County, Minnesota, on an interstate compact to allow for the treatment of Minnesota residents at Fergus Falls rather than at the North Dakota State Hospital. He said the southeast outreach services have been expanded to put a larger number of clinicians in the field more often and on a more regular basis.
Mr. Michael Leier, Program Administrator, Extended Care Program, discussed the cooperative arrangement developed at the North Dakota State College of Science.
Mr. Clay Myers-Bowman, Flood Coordinator, Village Family Service Center, Fargo, presented an update regarding the impacts of the flood on the Fargo-Moorhead area.
In response to a question from Representative Svedjan, Mr. Seiler agreed to provide the committee with information regarding the estimated cost savings resulting from the reduction in admissions to the State Hospital from the Southeast Human Service Center.
Mr. Seiler said a concern of the southeast region is the demographics which reflect a strong economy and population growth. He said, however, the region's population growth without an increase in center staff has resulted in waiting lists for certain services. He said historic funding patterns do not allow for increases due to population changes and increased demand for service. He said in addition as the economy grows it becomes more difficult to retain and recruit staff. He said salary surveys in a strong economy must be current and done at least annually to be effective in competing for personnel.
DEPARTMENT OF HUMAN SERVICES STUDY
Ms. Yvonne Smith, Deputy Director, Department of Human Services, presented information regarding programs the Department of Human Services interacts with or provides services similar to those provided by the State Department of Health, a copy of which is on file in the Legislative Council office. She said in general the Department of Health operates within a public health model concentrating its efforts upon primary prevention and public education while the Department of Human Services concentrates primarily upon the delivery of service to eligible individuals. She said while issues may be similar, with appropriate attention to collaboration and planning, joint efforts between the two agencies have been very successful.
Mr. Mike Schwindt, Chief Financial Officer, Department of Human Services, provided information regarding matching percentages, maintenance of efforts, and future matching percentages for various federal programs within the Department of Human Services, a copy of which is on file in the Legislative Council office. He said total federal funds expected to be received for the 1997-99 biennium are $769.2 million, requiring a $326.4 million minimum nonfederal match.
In response to a question from Representative Kerzman regarding the "SWAP" status, Mr. Schwindt said that financially some counties are perhaps doing okay while others are not doing as well as expected. He said the department is tracking the situation and reviewing the issue of possible increased property taxes as a result of the SWAP of state and county financial and administrative responsibilities.
The committee recessed at 11:45 a.m. for lunch. The committee toured the Young Women's Christian Association (YWCA) child care facility at 3100 12th Avenue North, Fargo. The committee reconvened at 1:00 p.m.
The Legislative Council staff presented information regarding the Department of Human Services staff and client satisfaction survey. The memorandum discusses the survey conducted by Dr. Kenneth J. Dawes, committee consultant during the 1985-86 interim study, and indicates Dr. Dawes sent approximately 2,300 surveys, had an overall response rate of 44 percent, and conducted the survey on a confidential and statistically valid basis.
Ms. Carol Olson, Executive Director, Department of Human Services, presented information regarding potential internal changes within the Department of Human Services to improve effectiveness and efficiency. A copy of her presentation is on file in the Legislative Council office. She said ideas for change include disseminating decisionmaking authority to allow program managers more responsibility and accountability, finding innovative means of blending funding to achieve the goals of addressing family needs in a timely, cost-effective, cost-efficient manner, keeping the focus on the client, presenting the programs and services of the department in a way that is more meaningful and more understandable, and facilitating the flow of communications between the central office and field personnel. She said in addition the department will be establishing quarterly joint meetings with the leaders of various advocacy groups to provide a forum for discussion of shared ideas and concerns.
Ms. Smith discussed Dr. Dawes' recommendations that have not been fully implemented at this time by the department. A copy of her presentation is on file in the Legislative Council office.
In response to a question from Senator St. Aubyn, Ms. Smith said timelines for implementing the changes suggested by Dr. Dawes that are not yet implemented will be shared with the committee at its next meeting.
In response to a question from Representative Jensen regarding program evaluative research, Ms. Smith said the estimated cost of conducting evaluative research could be determined by the department.
In response to a question from Representative Johnsen regarding the estimated 50 children's programs within the Department of Human Services, Ms. Olson said that as the department builds its budget for the 1999-2001 biennium, it will look at the potential for streamlining the administration of children's programs.
Senator Mathern distributed copies of a letter from Ms. Donna Rae Jacobson, Family Science Specialist, North Dakota State University Extension Service, a copy of which is on file in the Legislative Council office.
Senator Mathern invited individuals in attendance that wish to submit proposals for consultant services for a study of the organizational structure of the Department of Human Services to present their proposals.
Mr. Jeff Gendreau and Ms. Faith Claflin, Deloitte and Touche, LLP, Minneapolis, Minnesota, presented a proposal for a study of the organizational structure of the Department of Human Services. A copy of the proposal is on file in the Legislative Council office. Mr. Gendreau said he would be the project manager and Ms. Claflin would be a consultant with experience in human resources strategies. Mr. Gendreau said the project cost would be $95,500 without the conduct assessment workshop step which is an optional but recommended part of the study approach. Mr. Gendreau said the estimated project cost including expenses and including the conduct assessment workshop is $125,500.
Representative Svedjan said some of the reasons for the study include the size of the Department of Human Services, the department's budget complexity, and service delivery.
In response to questions from Mr. Chester E. Nelson, Jr., Legislative Budget Analyst and Auditor, Legislative Council, Mr. Gendreau said he would be the contact person in charge of the onsite work, the firm would provide tentative findings and periodic reports to the committee, and the proposed bid is a maximum amount not to be exceeded and if actual work is less than estimated billings would be reduced.
Mr. George Hubler, Assistant Director, Public Administration Service, McLean, Virginia, presented a summary of the proposal to study the North Dakota Department of Human Services, a copy of which is on file in the Legislative Council office. A more detailed proposal, mailed to committee members in advance of the meeting, is also on file in the Legislative Council office. Mr. Hubler's presentation includes a summary of his understanding of the project, the firm's qualifications to conduct the study, the experience of the consulting team to conduct the study, and the firm's approach to the project. The estimated contract amount by the Public Administration Service totals $99,546.
In response to questions from committee members, Mr. Hubler said a new executive director of the Department of Human Services may provide a unique opportunity to conduct a study of the department and to bring about recommended changes.
In response to questions from Mr. Nelson, Mr. Hubler said, if selected, he would have no concern with the contract providing for payment to reflect actual billings in an amount not to exceed the proposed amount, the steering committee would be the Budget Committee on Human Services, and the consultant would work with a Department of Human Services staff committee and the Legislative Council staff in conducting the study. Mr. Hubler said he would be directly involved as project manager onsite, would report to the Budget Committee on Human Services, and provide sufficient copies of the final report to the committee.
Ms. Susan Rae Helgeland, Regional Director, North Dakota Mental Health Association, testified regarding the committee's study of the Department of Human Services. A copy of her presentation is on file in the Legislative Council office. She said the Mental Health Association recommends the department provide a forum for consultation with advocacy organizations and that prevocational training and transitional employment programs be extended statewide. She said the North Dakota partnerships project results in cost savings to the Department of Human Services, and that a plan for downsizing the State Hospital should be developed, with timelines, to return the hospital's patients to their respective communities.
Ms. Jackie Brodshaug, West Fargo, provided testimony regarding previous Legislative Council studies of the Department of Human Services and regarding reimbursement for human service centers. A copy of the information provided the committee is on file in the Legislative Council office.
COMMITTEE DISCUSSION
The committee discussed the proposals submitted by the two consultants regarding a study of the Department of Human Services. Chairman Mathern said that if the committee is interested in one of the consultants, a motion would be in order to recommend the consultant be hired, subject to the approval of the chairman of the Legislative Council. In response to questions from committee members, Mr. Nelson said that the committee could make its selection subject to contacting some of the references included in the proposal. Representative Johnsen questioned whether a consultant would be necessary and said that the department could conduct a less formal internal study. Representative Kerzman said an outside consultant could provide an unbiased and objective viewpoint and recommendations.
In response to questions from committee members, Senator Mathern said the Legislative Assembly, reflected by the study resolution, has come to the conclusion that a study of the structure of the Department of Human Services is necessary. Senator Fischer said the use of a consultant could be considered an investment with the cost potentially recouped through savings from the recommendations. Representative Jensen said the need for the study still exists due in part to the department's budget complexity. Representative Svedjan questioned if the consultant selection was delayed to the October 1997 meeting if the study could be completed in a timely manner. Senator Mathern said he expects the committee will find that even with the given timeframe it will be a challenge to get the necessary input and complete the study.
It was moved by Senator Lee, seconded by Representative Jensen, and carried that the Budget Committee on Human Services support the selection of the Public Administration Service as a consultant in the committee's study of the organizational structure of the Department of Human Services, subject to reference inquiries and subject to the approval of the chairman of the Legislative Council, and that Deloitte and Touche LLP be selected as an alternate. Senators Mathern, Bowman, Fischer, Kelsh, Lee, and St. Aubyn and Representatives Jacobs, Jensen, Johnsen, Kerzman, Svedjan, Sveen and Wentz voted "aye." Representative Price voted "nay."
The committee recessed at 4:49 p.m. and reconvened at 8:30 a.m. on Tuesday, September 23, 1997, at Cass County Social Services.
CASS COUNTY SOCIAL SERVICES
Ms. Kathy Hogan, Director, Cass County Social Services, distributed a document listing the services provided, the administrative structure, and the budget for Cass County Social Services, a copy of which is on file in the Legislative Council office. Also distributed was a copy of testimony provided by representatives of the Cass County Commission and Cass County Social Services, a copy of which is on file in the Legislative Council office.
Mr. Alon Wieland, Chairman, Cass County Commission, discussed the social service programs provided by Cass County and said the property tax mill levy for social services in Cass County will increase from 16.88 mills to 18.16 mills for 1998, an increase of 1.28 mills. He said the primary reason for the increase in county costs is the regional child support costs becoming a total county responsibility.
Mr. Wieland's presentation also included a financial report comparing actual county expenses and revenues for 1996 to those budgeted for 1997 and 1998.
Ms. Alice Swenson, Supervisor, Economic Assistance Unit, Cass County Social Services, discussed the county's economic assistance services. She said the economic assistance unit has 39 staff and had an average of 440 aid to families with dependent children households during the 12 months ending June 1997, with average monthly household grants of $345. She said the August 1997 caseload was 341 households. She said the county in August 1997 served 5,700 residents whose only medical coverage was provided through the Medicaid program, of which 1,900 were either aged, blind, or disabled. She said the food stamp program had 1,830 households for August 1997. She said since April 1997 the county has processed 92 refugee assistance applications and although caseloads are small interpreters are required, creating an additional expense for the county.
In response to a question from Representative Kerzman regarding caseloads per worker, Ms. Swenson said workers in the aged and disabled program have approximately 300 cases each, those in the economic assistance area have approximately 120 cases, and the training, education, employment, and management program caseload is 65 cases per worker.
Representative Sveen asked that the Department of Human Services be asked to explain to the committee at its next meeting the reasons for caseload reductions reflected in the department's monthly At A Glance report.
Mr. Rainer Lobitz, Supervisor, Family Service Unit, Cass County Social Services, discussed the services provided children and families. He said the services that assist in reducing the number of children placed outside their homes are stressed and there is a lack of local community resources for children who need out-of-home placement. He said the rate of reimbursement for child abuse and neglect services was last increased five years ago and the county is required to supplement the cost of child abuse assessments. He said Cass County Social Services provides almost 25 percent of the child welfare services in North Dakota.
Ms. DeLana Duffy-Aziz, Supervisor, Adult Service Unit, Cass County Social Services, discussed the services provided to the adult population in Cass County. She said in the area of adult protective services the county serves an average of 91 vulnerable adults per month. Ms. Duffy-Aziz provided information comparing the cost of home and community-based care to that provided in a basic care facility, a copy of which is on file in the Legislative Council office. The information indicates for 187 clients the cost of in-home services is approximately $360,000 per year compared to a projected cost of $2.4 million for basic care.
Ms. Donna Schneider, Chair, Cass County Social Service Board, provided summary comments and said the county has a good working relationship with the Southeast Human Service Center, citing the Region V Welfare Reform Task Force as a strong example of cross-systems/cross-county collaboration.
STUDY OF COUNTY SOCIAL SERVICE AGENCIES RESPONSIBILITIES
The committee recessed at 10:00 a.m. and reconvened at 1:00 p.m. Ms. Michon Sax, Williams and McKenzie County Social Service Board, Watford City, presented testimony prepared by Mr. Larry Bernhardt, Cochair of the Department of Human Services and County Social Service Board Directors Children and Family Services Committee, a copy of which is on file in the Legislative Council office. Mr. Bernhardt's testimony includes a status report on the Children and Family Services Committee, the committee's development of a time study process, and identification of core services and contract services provided through county social services to children and families. Ms. Sax indicated the committee plans to meet in mid-November and make its recommendations to the Budget Committee on Human Services at a later meeting.
Mr. Don Schmid, Director, Children and Family Services Division, Department of Human Services, and Cochair of the Children and Family Services Committee, presented information regarding the status of the task force study. A copy of his testimony is on file in the Legislative Council office. Mr. Schmid said the department has made changes to allow for Medicaid reimbursement of county administrative costs relating to foster care case management which could generate approximately $200,000 per year in additional federal revenue for the counties. He said in addition effective July 1, 1997, county social service offices became Medicaid providers to generate Medicaid reimbursement for two optional services, parent aide and family-focused services. He said family social work is also being reviewed to determine if costs could be billed to Medicaid as well. He said beginning in October 1997, the department will reimburse counties for conducting early childhood licensing studies at a rate of approximately 50 percent of the cost of the study. He said the committee plans to receive a report from a consultant on the feasibility of counties becoming accredited by the National Council on Accreditation and reviewing national caseloads standards.
Mr. Terry Traynor, Assistant Director, North Dakota Association of Counties, testified regarding the impact of 1997 House Bill No. 1041, the "SWAP" bill. A copy of his testimony is on file in the Legislative Council office. Mr. Traynor said at the conclusion of the 1997 legislative session an analysis suggested a statewide net savings for counties of $2.5 million as a result of "SWAP." He said based on a recent analysis the savings has eroded to less than $1.5 million, with a number of counties reporting significant property tax increases for fiscal year 1998 to cover increased costs. He said as a result counties as well as the Department of Human Services are extremely concerned and said at least two factors are responsible for the cost shift, the counties' handling of November and December 1997 costs as calendar year 1998 budget items that were not anticipated in the earlier analysis and the administrative costs of child support. Mr. Traynor said counties, as a result of welfare reform changes, have been instructed to hire, by July 1, 1999, an additional 24.75 FTE positions relating to the child support program, an increase of 25 percent. He said in addition the impact of welfare reform on counties with Indian reservations is more costly than anticipated, with Benson, Sioux, and Rolette Counties anticipating property tax increases in the 15- to 20-mill range. He said the increased state funds dedicated to these counties appears to be insufficient to meet the increased administrative burden. He said the Department of Human Services has been "proactive" in responding to county concerns.
Senator St. Aubyn asked that the contract developed for the consultant's study of the organizational structure of the Department of Human Services include the consultant seeking the input of county social service agencies.
Ms. Verna Weber, St. Anthony Church, Fargo, discussed the transportation and other needs of individuals on fixed incomes.
Senator Mathern indicated the committee would meet October 29-30, 1997, in Bismarck. The committee adjourned at 2:20 p.m. subject to the call of the chair.
______________________________________________
Jim W. Smith
Assistant Legislative Budget Analyst and Auditor
______________________________________________
Chester E. Nelson, Jr.
Legislative Budget Analyst and Auditor
