Joseph Chelli, Director 2011-12 2012-13 2013-14 2013-14 Increase/ General Fund Actual Approved Requested Recommended (Decrease) Expenditures Salaries & Benefits $67,774,167 $81,390,796 $91,435,339 $91,435,339 $10,044,543 Services & Supplies 39,741,247 43,838,743 44,500,142 44,500,142 661,399 Other Charges 163,766,073 181,184,090 173,478,209 173,478,209 (7,705,881) Fixed Assets 200,976 408,500 612,500 612,500 204,000 Operating Transfers Out 594,023 0 0 0 0 Total Expenditures $272,076,485 $306,822,129 $310,026,190 $310,026,190 $3,204,061 Expenditure Reimbursements (2,184,370) (664,867) (2,907,451 ) (2,907,451 ) (2,242,584) Total Appropriations $269,892,115 $306,157,262 $307,118,739 $307,118,739 $961,477 Earned Revenues By Source Aidfrom Other Governments $256,950,392 $292,740,749 $295,721,383 $295,721,383 $2,980,634 Miscellaneous Revenues 436,497 96,304 88,920 88,920 (7,384) Operating Transfers In 1,129,873 1,060,000 1,110,000 1,110,000 50,000 Total Revenues $258,516,762 $293,897,053 $296,920,303 $296,920,303 $3,023,250 Net County Cost $11,375,353 $12,260,209 $10,198,436 $10,198,436 ($2,061,773 ) Allocated Positions 901.0 940.0 1,067.0 1,067.0 127.0 Temporary (Full-Time Equivalent) 12.1 13.0 6.2 6.2 (6.8) Total Staffing 913.1 953.0 1,073.2 1,073.2 120.2 Purpose The Human (HSA) provides State and federal-mandated public assistance and a variety of social service programs for the citizens of San Joaquin County. Programs include: California Work Opportunity and Responsibility to Kids (Cal WORKs), Foster Care, Food Stamps, General Assistance, Medi-Cal, Adoptions, Child Protective Services, Adult Protective Services, Refugee Assistance, and the Mary Graham Children's Shelter. Federal and State legislation and local regulations govern the methods by which resources of the Agency are allocated. This budget reflects the combined administrative and financial assistance program costs, and funding for the public assistance programs administered by the HSA. Major Budget Changes Salaries & Employee Benefits ~ $1,606,599 Negotiated salary and benefits adjustments. ~ $8,465,588 ~ ($268,172) Services ~ $247,764 ~ $355,486 ~ $529,923 ~ $666,164 ~ ($2,253,865) ~ $1,018,041 ~ $174,283 & Supplies Add 127 new positions. Decrease in extra-help. Increase in office supplies and furniture to accommodate increased staffing and services. Increase in network expenses for State required call center. Increase in computer equipment and software expenses. Increase in Child Welfare community outreach and implementation of automated time study software. Decrease in child care needs based on actual experience. Elevator and public address system replacement, and pressure wash building exterior. Increase in utilities based on actual experience. G-5
~ $5 I9,564 Additional rent for Call Center. ~ ($602,23 I) Cost Allocation Plan adjustment. Other Charges ~ ($7,215,342) Decrease in CalWORKs reflecting an overall 7% decrease in case load and programatic changes. ~ $472,620 Increase in Foster Care expenses related to caseload growth of 4.5% pursuant to the implementation of AB 12 Extended Foster Care. ~ ($ 1,187,329) Decrease in In-Home Supportive Services (IHSS) assistance payments reflecting 3.6% reduction in authorized hours. Fixed Assets ~ $580,000 ~ $32,500 Expenditure ~ $2,121,670 Modular furniture (100). Security cameras (10). Reimbursements Increase in foster care pass through charges due to accounting change. Revenues ~ $9,589,533 Increase in Administration federal and State reimbursements. ~. ($7,034,959) Decrease in Cal WORKs Assistance federal and State reimbursements. ~ $2,670,007 Increase in Foster Care Assistance federal and State reimbursements. ~ ($2,25 I,857) Decrease in IHSS federal and State reimbursements. Program Discussion The 20 I3-14 recommended budget for the Human totals $310,026,190, which is an increase of$3,204,061 from 2012-13. Administration The Administrative budget contains administrative costs for the operation of all Agency programs and totals $137,657,981, which is an increase of$10,953,942 from 2012-13. The increase is primarily due to negotiated salary and benefits, the addition of 127 positions, of which 114 are needed to support Medi-Cal program expansion resulting from the implementation of Affordable Care Act (ACA), and an increase in operating costs related to ACA, capital projects, and equipment leases. These increases are Workload Data* Actual Est./Act. Projected 2009-10 2010-11 2011-12 2012-13 2013-14 Cal WORKs Assistance 200,640 207,653 205,252 230,119 213,720 Foster Care Foster Home 5,278 5,309 5,449 5,354 5,743 Institutions 2,320 2,010 1,866 1,785 1,736 Foster Family Agencies 6,118 6,030 5,190 5,610 5,877 Adoption Assistance 24,406 21,325 24,324 24,124 24,592 General Assistance 20,181 18,995 19,459 22,976 24,014 In-Home Supportive Services 75,649 71,310 69,250 66,135 67,920 Refugee Cash Assistance 71 37 21 29 29 Temporary Homeless Shelter 5,709 5,973 6,265 6,960 7,407 *All Workload Data represent case months of service delivered. G-6
505010100o-Human partially offset by a decrease in subsidized Cal WORKs child care costs and a decrease resulting from a shift in Foster Care cost accounting. The 127 additional positions recommended for 2013-14, at an estimated cost of $8.5 million, include the following classifications: ~ Management Analyst (I) ~ Eligibility Workers (88) ~ Eligibility Supervisors (12) ~ Program Managers (2) ~ Social Workers (10) ~ Social Worker Supervisor (1) ~ Senior Office Assistants (8) ~ HSA Staff Analyst (4) ~ Crafts Worker (1) Affordable Care Act HSA is preparing for changes in programs and service delivery as a result of the federal ACA, which becomes effective January I, 2014. This new mandate changes the environment and manner in which HSA will be required to provide service to Medi-Cal applicants. In preparation for the implementation of ACA, the State ceased enrollment of new children in the Healthy Families low income health care program effective January 1,2013. Children previously eligible under the Healthy Families Program are now covered under Medi-Cal. As a result, HSA has received approximately 900 additional Medi-Cal applications per month. In addition to processing new applications and providing ongoing case management for these new cases, approximately 20,000 children in the County are currently receiving Healthy Families coverage who will be transitioned to Medi-Cal by July 2014. Under ACA, there are significant changes and expansions of health coverage programs (Expanded Medi-Cal). The California Health Benefit Exchange, also known as Covered California, is a new entity involved in delivering health coverage programs. Covered California will establish three centralized call centers to receive calls from individuals who apply for health coverage. Those callers identified as potentially eligible for Expanded Medi-Cal will be transferred directly from the Covered California call centers to the county call center for eligibility determination. County call centers must be operational by October I, 2013 and must meet specific service delivery goals established by Covered California. The Covered California call center network, including HSA's call center, is just one of the cornerstones of the "No Wrong Door" principle of ACA. Applicants and ongoing participants will receive services regardless of where they seek assistance: in person; through the mail; over the phone; through the internet; or through a community-based partner. HSA will be responsible for eligibility determination for Expanded Medi-Cal for all applications received, determination of initial eligibility for those who apply for health care premium tax credits through the County and help with health plan selection, and ongoing case maintenance for all Medi-Cal cases. HSA expects a significant increase in applications and requests for general information. ACA will create greater movement between public assistance programs and low income private insurance programs as the circumstances offamilies change. New knowledge and skills for HSA staff will be required to assist individuals and families in navigating the complexities of health coverage options presented under ACA. HSA is organized into five bureaus: Income Maintenance; Child Welfare Services; Employment and Youth Services; Adult and Community Services; and Administrative Services. Income Maintenance Bureau The Income Maintenance Bureau is responsible for determining, issuing, and maintaining the correct and timely federal and State mandated benefits for the Cal WORKs, CalFresh, Medi-Cal, General Assistance, Foster Care, and Refugee Assistance programs. As a result of the transition of the Healthy Families program to the Medi-Cal program, the continued economic recession, outreach efforts, and the changes in the State regulations, HSA has experienced significant increases in applications for assistance and continuing caseload maintenance. In response to the low CalFresh program participation Statewide, HSA has been working closely with the Hunger Task Force to increase the program accessibility in San Joaquin County. HSA has been collaborating with community partners to conduct outreach to the underserved population and to assist with the application process. HSA has also conducted outreach to different communities by leveraging the network of Community Centers operated by the Aging and Community Services Bureau. Eligibility workers are now colocated at the Boggs Tract, Garden Acres, Kennedy, Larch Clover, Lodi, and Northeast Community Centers to provide County residents with increased access to the Cal WORKs, CalFresh, and Medi-Cal programs. In collaboration with San Joaquin General Hospital (SJGH), HSA continues to provide enhanced access to the Medi-Cal program for patients of SJGH. An on-site Medi- Cal eligibility unit has been established to process Medi- Cal applications for those served at the SJGH. HSA also continues to work with Health Care Services to assist with the implementation of the Low Income Health Program (UHP) in San Joaquin County which began in May 2012. In addition, in January 2013 the Healthy Families program G-7
was replaced with a new Medi-Cal program. Once fully implemented in January 2014, ACA will expand HSA's Medi-Cal workload by an estimated 29,000 applications, and 42,000 ongoing cases in 2014 alone. The recommended budget adds 112 positions (88 Eligibility Workers, 12 Eligibility Supervisors, 2 Program Managers, 2 HSA Staff Analysts, and 8 Senior Office Assistants) to address the anticipated workload increase. The cost for these positions is fully offset by State and federal funding. Child Welfare Services Bureau The Child Welfare Services (CWS) Bureau is responsible for services that ensure the safety, permanency, and wellbeing of children who have been abused or neglected. The major components of the CWS programs include: Child Abuse Prevention; Emergency Response; Family Preservation; Family Maintenance; Family Reunification; Permanent Placement; Adoption, and Independent Living. Each CWS component requires specific in-person service delivery by social worker staff to prevent or remedy neglect or abuse. Ongoing case management services assist in the development of basic life skills of the family to keep the family intact or to develop alternate family structures when the child cannot safely remain at home. Adoption services provide permanency options for children who are unable to be reunified with their birth families. The Independent Living program provides foster youth with education and other supportive services designed to help transition youth from foster care to living independently. Assembly Bill 12, passed in 2010, extends foster care services from the age of 18 to 21. For San Joaquin County, AB 12 adds approximately 90 cases per year. The recommended budget adds a Social Worker Supervisor and seven Social Worker positions to address the growing demand for CWS services. Employment & Youth Services Bureau The Employment and Youth Services Bureau provides employment, education, and training services under the Cal WORKs program. Federal and State assistance available to CalWORKs participants is subject to time limits of no more than four years for able-bodied adults, with stringent requirements for participation in Welfare-to-Work (WTW) activities leading to self-sufficiency. Participation includes job preparation and placement services, work experience, employment activities, vocational training and education, mental health and substance abuse treatment, and community services. To compliment ongoing WTW services, a partnership with the Greater Stockton Chamber of Commerce, and the Employment and Economic Development Department was developed to provide the Stockton Chamber Apprenticeship Program (SCAP) for Cal WORKs participants. Under SCAP, the Chamber identifies potential job openings in the area and works with the case managers to place Cal WORKs participants with employers. Employers who hire Cal WORKs participants through SCAP may be reimbursed for up to 50% of the wages paid, for up to six months. The employer is expected to retain the participant upon successful completion of SCAP. Programmatic changes to the CalWORKs program enacted by the passage of Senate Bill 1041 include the reengagement of those cases that had previously been exempt under the short-term young child exemption. The Governor's January 2013 budget includes resources necessary to implement the expansion and enhancement of employment services and job development activities for program participants and to intensify case management efforts for non-participating individuals. Adult & Community Services Bureau The Adult and Community Services Bureau provides mandated services to abused, neglected, exploited, and disabled adults to prevent or reduce inappropriate institutional care. The Bureau also helps individuals achieve and maintain the highest level of independence, self-support, and self-sufficiency within their range and scope of their capabilities. Mandated services for adults include: infor-. mation and referral services, IHSS, and Adult Protective Services. With the implementation of ACA, the State has implemented the Coordinated Care Initiative (CCI) to coordinate care for individuals eligible to both Medi-Cal and Medicare, commonly referred to as "dual eligibles". Under CCI, dual eligibles must enroll into a Medi-Cal managed care plan in order to receive their long-term care benefits, including IHSS. In addition, dual eligibles will have their medical, behavioral health, and long-term supports and services, including home and community-based services, coordinated through a single health plan. HSA staff will continue to perform intake and assessments, eligibility determinations, and program administration, in coordination with the local health plan, Health Plan of San Joaquin. It is anticipated that a larger number of community members in the County will be eligible to medical coverage, which will increase the number of IHSS cases substantially. The recommended budget includes three Social Worker positions to address the increased workload anticipated with the implementation of CCI. The cost for these positions is fully offset by State and federal funding. G-8
Administrative Services Bureau T?e Administrative Services Bureau provides support services throughout the Agency and includes the following functional areas: Policies and Procedures; Staff Development and Training; Information Systems; Fiscal and Accounting; Quality Control; Fair Hearings; Benefit Recovery; Collections; Personnel; Reception and Benefit Issuance; and Staff Support. The recommended budget adds a Management Analyst, a Crafts Worker, and two HSA Staff Analyst positions. The Management Analyst will assist the Director in all aspects of Agency operations. The HSA Staff Analysts will increase the training capacity allowing HSA to conduct concurrent Eligibility Worker induction training classes to meet the staffing requirements of the ACA and the demand for services administered by HSA. The following are changes projected for the various assistance programs administered by HSA: CalWORKs Assistance ($94,036,800) The Cal WORKs program is the largest cash assistance program for children and families, providing financial help to families to meet basic needs (shelter, food, and clothing) when they are unable to meet those needs on their own. The program represents a welfare system based upon principles that place high value on recipients obtaining work. Eligible families must include a child under age 18, who lacks parental care and support due to absence death incapacity, or the unemployment of one or both pare~ts. CalWORKs assistance is time limited for most adults, and most recipients are required to work or participate in WTW activities for a minimum number of hours per week. The necessary supportive services, including child care, are provided to ensure employment is possible. The amount ofa family's monthly assistance payment depends on a number of factors, including the number of people who are eligible, and the special needs of any of those family members. The income of the family is considered in calculating the amount of cash aid the family receives. The recommended budget includes a decrease of $7,215,342 from 2012-13. This decrease reflects an overall 7% reduction in case load and programmatic changes that became effective July I, 2012, which restructured the CalWORKs program into three components: Cal WORKs Basic, CalWORKs Plus, and the Child Maintenance Program. ~ Under Cal WORKs Basic, the time limits were reduced from 48 to 24 months for all recipients not meeting the federal Work Participation Rate (WPR) through unsubsidized employment. ~ Under Cal WORKs Plus, recipients meeting the federal WPR through unsubsidized employment will be able to continue to receive up to 48 months of aid and services. Recipients in Cal WORKs Plus will receive a higher earned income that will remain in effect for recipients in the safety net as long as they continue to meet federal WPR. ~ Under the Child Maintenance Program, aid is provided for children whose parents are not eligible for aid under Cal WORKs Plus. These child-only grants were reduced by 27% in 2012-13, which added to the overall decrease in program payments. Recipients in the Child Maintenance Program who meet the federal WPR and who have not exhausted 48 months of aid can re-enter CalWORKs Plus. The budget estimate does not include the potential cost savings from a programmatic change requiring the reengagement of individuals currently exempt from participation in WTW activities under the short-term young child exemptions. These individuals are required to reengage in a WTW plan by January 1,2015, unless an applicable exemption applies. This potential savings is not reflected in the recommended County budget, as reengagement is not required by participants until mid-way through 2014-15. Foster Care ($36,979,692) The Foster Care program provides support payments for children in out-of-home care. This program is administered by counties in accordance with regulations, standards, and procedures set by California Department of Social Services (CDSS) as authorized by law. The Out-of- Home Care System is designed to protect those children who cannot safely remain with family. Most are removed from their parents and made dependents of the court. A smaller number are wards of Juvenile Probation or live with legal guardians. Some are voluntarily placed in outof-home care by their parents. Currently, these children are placed in family homes with relatives, in licensed foster family homes, in homes certified by foster family agencies, and in group homes. Relatives are given preference over other types of ~lacements. All providers for these children, except relatives and legal guardians, are studied and licensed to provide care. A written case plan is developed for each child and family to ensure care and protection consistent with the best interests and special needs of the child in mind. The plan includes a judicial or administrative review every six months to determine if out-of-home care is still required. Independent living training and services are available to G-9
teens ages 16 to 24, providing job and career development skills. Assembly Bill 12 (20 I 0) extends foster care benefits from age 18 to 21. To be eligible to ~eceive Extended Foster Care benefits, youth must be in foster care prior to age 18. AB 12 is being implemented gradually. The extension of benefits up to age 19 went into effect January I, 2012. The extension of benefits increased to age 20 became effective January I, 2013. Contingent on the availability of funds and approval of the legislature, CDSS may extend benefits up to age 21 on January 1,2014. The recommended budget includes an increase of $472,620 from 2012-13. The increase is due to a 4.5% growth in projected caseloads, a statutory 2.65% cost-ofliving adjustment for children in foster family home and group home placements effective July 1,2013, and costs associated with the continued implementation of AB 12 Extended Foster Care. The increase is partially offset by a projected 6% cost per case reduction. This reduction is attributed to decreases in group home and foster family agency placements which have a higher cost rate per placement than County foster family homes. Adoptions Assistance ($21,699,156) The Adoptions Assistance Program (AAP) was developed to encourage the adoption of special needs children and remove the financial disincentives for families to adopt. If the child is deemed eligible, an adoption assistance agreement, or a deferred adoption assistance agreement is executed with the adoptive parents, prior to the adoption finalization. A reassessment of the child's needs and family's circumstances is conducted every two years. The amount of financial assistance is determined based on the special needs of the child and circumstances of the family. Foster care youth adopted after age 16 who receive AAP benefits may continue to receive the benefits through age 21. The intent of the extended AAP benefits is to help youth with special needs maintain a safety net as they transition to independence. The recommended budget includes an increase of$27,480 from 2012-13. This increase reflects a 2% caseload increase and costs associated with the ongoing implementation of AB 12. The budget also includes a statutory 2.65% cost-of-living increase. These cost increases are partially offset by an estimated 4.5% cost per case reduction associated with the periodic reassessment of Adoptions Assistance to ensure funding for services are reflective of the needs of the children. General Assistance ($3,902,035) The General Assistance (GA) program provides relief and support to indigent adults who are not supported by their own means, other public funds, or other assistance programs. California counties are required to administer a GA program. The authority to define and develop the GA program is delegated to each County Board of Supervisors. Participants repay GA payments by working a specified number of hours each month in the GA Work Program. Repayments may also be made by collecting proceeds from the sale of real property, withholding an amount equal to the GA interim assistance payments from a lump sum Social Security award, or collecting from a sponsor. The GA program is funded 100% by the County. The recommended budget includes an increase of$168,636 from 2012-13 reflecting an anticipated 4.5% case load growth. This increase is primarily due to the continued impact of AB 109 Public Safety Realignment. AB 109 continues to increase the number of offenders released from State prison to County-level supervision. In an effort to assist the offender to productively re-enter society, HSA screens them for potential eligibility to public assistance programs, including Cal WORKs, CalFresh, and GA in the AB 109 Assessment Center. In-Home Supportive Services ($14,990,789) The IHSS program provides specified supportive services to enable eligible persons to remain in their own homes as an alternative to out-of-home care, such as nursing homes, or board-and-care facilities. Eligible persons are aged, blind, or disabled recipients of public assistance and similar persons with low incomes. Disabled children are also eligible for IHSS. Services include domestic services; meal preparation; laundry; shopping and errands; personal care services; assistance while traveling to medical appointments or to other sources of supportive services; protective supervision; teaching and demonstration directed at reducing the need for supportive services; and certain paramedical services ordered by a physician. In 2012-13, CDSS changed the local financial obligation for the IHSS program from a percentage-based payment structure to a Maintenance-of-Effort (MOE). The IHSS MOE includes the County's required match for negotiated salary and benefits for IHSS providers, Public Authority operations, and administrative costs. The recommended budget includes a decrease of $1,187,329, which is a net result of a decrease in projected hours for 2013-14; restoration of a 3.6% across-the board reduction to recipient hours; and projected Statewide caseload increase of 2.7%. The Governor's January 2013 budget proposes a 20% across-the board reduction in authorized hours effective November 1,2013. This change is not reflected in the recommended budget as it has been stayed by the courts since December 20 II. G-10
Temporary Homeless Shelter ($749,737) Families who are eligible for CalWORKs and are homeless can apply for a special need payment to meet costs for temporary and permanent housing. The maximum homeless assistance payment is based on the size of Cal- WORKs family. Homeless Assistance is available only once-in-a-lifetime, unless the family is homeless due to domestic violence, natural disaster, un inhabitability, or a physical or mental disability. All exceptions must be verified by a third-party agency. CalWORKs families may be eligible to apply for homeless assistance benefits to assist with the payment of rent arrearages. Payment of arrear ages is considered a family's once-in-a-iifetime Homeless Assistance payment. The recommended budget reflects a decrease of$15,946 compared to 2012-13. This decrease is related to the net effect of an 8% reduction in the average cost per day and an estimated 6% increase in case load based on actual experience. Refugee Cash Assistance ($10,000) Refugee Cash Assistance provides up to eight months of cash assistance to needy refugees without children who are not otherwise eligible for any other cash aid. These refugees are unable to return to their country of origin because of persecution or a well-founded fear ofpersecution on account of race, religion, nationality, or political opinion. These individuals may also be eligible to receive employment and other social services during the same eight-month period. Funding of the Refugee Cash Assistance Program is 100% federally-reimbursed. The recommended budget reflects no change from 2012-13. G-11