1. Annual Report Rowan County Department of Social Services Fiscal Year 2009 July 1, 2008 – June 30, 2009

2. Introduction Rowan County Department of Social Services is dedicated to providing services that improve the quality of life in Rowan County, by promoting personal responsibility and by preserving and strengthening the family. Rowan County DSS administers federal, state, and local funds and provides benefits and services under the authority of the North Carolina General Statutes, policies and procedures of the NC Division of Social Services, and directives from other state and local entities. Fiscal year 2009 was an extraordinary year, with economic turmoil affecting our country, our state, and our local businesses and households. The high unemployment rate in Rowan County impacted many families who, for the first time, turned to DSS for help. The role of DSS was crucial in addressing financial needs of these citizens through public assistance programs and in helping to solve their complex personal problems, many resulting as a by- product of a poor economy.

3. Introduction Continued Like our citizens, DSS felt the financial strain because government funding was reduced. Yet this was the very time that DSS programs and services were most relevant and critical in helping citizens face uncertain times. The power of DSS’ partnerships with others has always been extremely important, as it was in fiscal year 2009. DSS is not a stand-alone agency. We recognize and thank the Rowan Board of Commissioners, the Rowan Board of Social Services, other county governmental departments, community service organizations, the school system, medical providers, law enforcement, and individuals for being our partners in helping those in need. Beyond fiscal year 2009, the DSS staff looks forward to new opportunities and successes as we continue to work together to address human service needs of children, the elderly and disabled, and families.

4. Public Assistance Benefits and Services (p.1 of 2) Medicaid Food and Nutrition Child Support Enforcement Child Day Care Subsidy Foster Care and Adoption Assistance Special Assistance (Adult Care Home) Emergency and Seasonal Assistance Work First Family Assistance

5. Public Assistance Benefits and Services (p.2 of 2) Medicaid Transportation Donated Funds In-Home Aide Services Adult Day Care Food/Nutrition Employment and Training Program LINKS Purchases for Foster Children Leaving the System

6. Numbers of Citizens Served in Major Assistance Programs 23,759 households and 41,145 individuals served in FY 2009 in Medicaid, Food and Nutrition, and/or Work First (44% of Rowan County households) 23,823 individuals authorized for Medicaid (17% of population) as of June 2009

7. Assistance Issued in FY 2009 (1 of 3) Medicaid for Rowan Citizens $146,530,663 Food and Nutrition Benefits, USDA21,914,764 Child Support Collections10,275,552 Child Day Care Subsidy4,271,602 Foster Care/Adoption Assistance3,472,375 Special Assistance – Adult Care Home 2,555,650 Emergency and Seasonal Assistance1,527,532 Work First Benefits1,102,735

8. Assistance Issued in FY 2009 (2 of 3) Medicaid Transportation$388,460 Donated Funds$106,918 In-Home Aide Services$99,353 Adult Day Care$71,035 Food/Nutrition Employment and Training Program $19,825 LINKS Purchases for Foster Children Leaving the System $9,464 TOTAL ASSISTANCE ISSUED$192,345,928

9. Assistance Issued in FY 2009 (3 of 3)

10. Medicaid Program Medicaid is a health insurance program for low- income individuals and families who cannot afford health care costs. Medicaid serves low-income parents, children, seniors, and people with disabilities. Expenditures are shown by type of service received, individual recipient categories, and type of providers in Rowan County, based on reports from the Division of Medical Assistance.

11. Medicaid Services Provided (1 of 3) HMO Premiums for Mental Health $28,026,288 Long-Term Care-Nursing Home 24,674,247 Prescription Drugs 17,413,171 Physician 17,073,539 Hospital-Inpatient 13,293,252 Home Health/CAP/Personal Care 13,017,608 Hospital-Outpatient 11,845,940 Medicare Premiums 5,992,792 Dental 4,639,104 Adult Care Homes 3,319,830 Clinics 1,506,924 Practitioner, Non-Physician 1,204,180

12. Health Check/Education 1,192,185 Lab/X-Ray 1,035,860 Family Planning 725,169 Hospice 613,559 Optical 433,549 Ambulance 329,935 Podiatry 63,771 Case Management 61,818 Chiropractic 31,300 Hearing Aids 18,340 High Risk Intervention 18,302 TOTAL MEDICAID PROVIDED$146,530,663 Medicaid Services Provided (2 of 3)

13. Medicaid Services Provided (3 of 3)

14. Medicaid Eligibility Categories (1 of 2) Disabled $59,354,851 Aged 33,939,180 Infant/Children 21,482,459 Work First Over 21 15,039,140 Work First Under 21 7,974,535 Pregnant Women 4,567,459 Medicare Qualified Beneficiaries 1,260,588 NC Health Choice 1,188,498 Illegal Aliens 676,240 Blind 452,882 State Foster Home Children 429,813 Legal Aliens 173,877 Claims Adjustments (8,858) TOTAL MEDICAID PROVIDED$146,530,663

15. Medicaid Eligibility Categories (2 of 2)

16. Long-Term Care - Nursing Home$ 24,912,910 Prescription Drugs 15,978,783 Hospital 12,958,757 Physician 10,674,017 Dental 4,189,007 Residential Child Care 3,895,958 Community Alternatives Program 2,739,186 Personal Care Services2,550,069 Adult Care Homes 2,339,150 Private Duty Nurse 2,206,861 Health Check/Education 1,409,506 Home Health 855,192 Practitioner-Non-Physician580,316 Rowan County Provider Earnings (1 of 3)

17. Durable Medical Equipment $ 438,787 Optical 363,926 Dialysis331,731 Hospice300,331 Ambulance 242,300 Mental Health Providers 130,548 Community Intervention Services 98,730 Case Management 32,040 Chiropractic 19,722 Podiatry10,975 Hearing Aids 9,377 TOTAL REVENUE TO ROWAN PROVIDERS $87,268,182 Rowan County Provider Earnings (2 of 3)

18. Rowan County Provider Earnings (3 of 3)

19. Medicaid Transportation $388,460 paid to vendors and family members to transport Medicaid- eligible clients for medical services 15,744 trips serving 419 recipients

20. Food and Nutrition Benefits Food and Nutrition Services (FNS) is a federal food assistance program that helps low-income families. Monthly allotments of FNS benefits are issued via Electronic Benefit Transfer cards (EBT cards). The purpose of Food and Nutrition Services is to end hunger and improve nutrition and health. $21,770,978 was issued to an average of 6,852 Rowan County households per month in FY 2009 (13% of households in county). $143,786 was dispensed in USDA surplus commodities. 2002 Economic Census shows Rowan County grocery sales were $204,573,000. Food and Nutrition Benefits represent over 10.6% of those sales.

21. Food/Nutrition Employment & Training Able-bodied adults between 18 and 49 who do not have any dependent children can receive Food and Nutrition benefits only for 3 months in a 36- month period, if they do not work or participate in the Employment and Training program. $19,825 spent in SFY 2009

22. Low Income Energy Assistance Program The Low Income Energy Assistance Program(LIEAP) is a Federally-funded program that provides for a one-time cash payment to help eligible families pay their heating bills. $740,083 issued in FY 2009; 3,729 households received assistance (7% of county)

23. Crisis Intervention and Share the Warmth Programs The Crisis Intervention Program (CIP) is a Federally- funded provides assistance to low-income households that are in a heating or cooling related emergency. Share the Warmth is funded by Piedmont Natural Gas and its customers. 2,752 households and 7,017 individuals were served in FY 2009 (5% of county population) $643,951 was paid to 19 businesses in Rowan County

24. Children’s Protective Services The Child Protective Services program strives to ensure safe, permanent, nurturing families for children by protecting them from abuse and neglect while attempting to preserve the family unit. Child Protective Services help prevent further harm to children from intentional physical or mental injury, sexual abuse, exploitation, or neglect by a person responsible for a child's health or welfare. Child Protective Services also help protect children who have no parent, guardian, or custodian to provide care and supervision, or whose parents or guardians or custodian is unable to provide for the care or supervision and lacks an appropriate alternative child care arrangement.

25. Child Protection Statistics Reports Received in FY2009 – 2,787 Physical or Emotional Abuse – 96 Sexual Abuse – 116 Abuse and Neglect – 19 Neglect – 1,434 Dependency – 65 Screened Out (did not meet criteria in law) – 1,055

26. Foster Care Placement Services Foster Care is a temporary living arrangement for abused, neglected and dependent children who need a safe place to live when their parents or another relative cannot take care of them. Often their parents face issues such as illness, alcohol and drug addictions, family violence or homelessness. Length of stay in foster care varies from a few days to much longer. The foster family, the Department of Social Services, and the birth family work together to return children to their own homes when it is safe for them to return.

27. Foster Care Placement Services $1,998,493 spent in FY 2009 $1,408,988 paid to Rowan County providers; $589,505 out of county 270 children served 50 licensed foster homes in Rowan County

28. LINKS Purchases for Foster Children Provides financial assistance in preparing youth who have been in foster care for independent living. Foster care youth between the ages of 13-21 are eligible for assistance with expenses such as car insurance, furnishings for new living arrangements, employment expenses, educational expenses, and the like as they develop new skills for living outside of the foster care system. $9,464 spent in SFY 2009

29. Adoption Assistance Program Adoption is the legal and social process in which a child who is born to one set of parents becomes the child of another parent(s). The adoptive parents then assume all legal rights, obligations, and responsibilities of parents to the child.

30. Adoption Assistance Payments $1,473,883 was issued in FY 2009 $142,500 more was earned for success in number of adoptions, to reinvest for children 235 children served 43 children adopted (including 21 step-parent adoptions)

31. Child Support Enforcement Child Support Enforcement works to ensure that both parents are responsible for the financial support of their children. Services are provided to the custodians of minor children, regardless of income level. County agents help locate non-custodial parents, establish paternity of the child, and petition the court to order child support payments and to enforce compliance.

32. Child Support Enforcement $10,028,061 was collected on behalf of Rowan County children in FY 2009 Paternity was established for 244 children $247,491 was saved in medical costs, paid by absent parents or insurance rather than Medicaid

33. Adult Services The Division of Aging and Adult Services supports older and disabled adults and their families through a community-based system of opportunities, services, benefits, and protections. Services administered through Rowan County DSS include protective services, case management, home management, in-home aide, adult day care, placement services, guardianship, and other services for elderly or disabled adults.

34. Adult Protective Services Protective Services Reports Received in FY2009 – 316 Abuse – 15 Self-Neglect – 59 Caretaker Neglect – 19 Exploitation of Assets – 31 Already receiving services – 29 Psychological Evaluations - 6 Screened Out (did not meet criteria in law) - 157

35. In-Home Aide Services Provided to assist families with attaining and maintaining self- sufficiency and improving quality of life for the elderly adult to stay in their homes as long as possible to avoid premature substitute care and unnecessary out-of-home placement. These services assist with home management tasks and personal care tasks for adults who cannot carry out the tasks essential to the activities of daily living. $99,353 spent in SFY 2009

36. Adult Day Care Provided to monitor adult day care centers in order to ensure program quality. Our agency may also provide limited funding and case management services to disabled adults who need this program but are unable to pay for it. $71,035 spent in SFY 2009

37. Special Assistance Programs State-County Special Assistance for Adults (SA) provides a cash supplement to help low-income individuals residing in adult care homes (such as rest homes) pay for their care. Adult care homes are unlike nursing homes in that medical care is not provided by home staff. Designated staff may administer medications and provide personal care services such as assistance with bathing, eating, and dressing. Aged and disabled adults in adult care homes receive their supplement from State/County Special Assistance. Adults and children who are visually impaired receive their supplement from Special Assistance for the Blind.

38. Special Assistance Programs Personal Care Services : Provides for the verification of the need for additional personal care assistance for Medicaid eligible residents in adult care homes. A resident must meet Medicaid criteria as a heavy care resident and require extensive or total assistance in ambulation/locomotion, toileting, and/or feeding. SA In-Home : Provides an option for in-home care for older and disabled adults who are in need of placement in an adult care home, but who desire to live in a private living setting and can be maintained safely in that setting. A social worker develops a care plan based on client assessments and planning with the clients, family members, and others and determines how the Special Assistance In-Home payment is to be used to enable the client to live at home safely.

39. Special Assistance (Adult Care Home Payments) Payments for Disabled Adults in FY 2009 - $1,226,489 Payments for Elderly Adults in FY 2009 – $1,230,958 Payments for In-Home SA Care $92,760 for 28 clients Payments for Blind - $5,443 17 Adult Care Home Providers in Rowan County serving up to 732 residents

40. Child Day Care Subsidy Provides for the care, protection, and developmental experiences of children for a portion of the day or night. Services may be provided to families who demonstrate a need based on North Carolina Division of Child Development policy. Eligibility requirements also include a residency requirement in the county of North Carolina where they apply, citizenship requirements, an age requirement of the child, and income eligibility. Each type of child care arrangement must be licensed or meet all applicable Division of Child Development requirements for the type of arrangement.

41. Child Day Care Subsidy  $4,271,602 was issued in Fiscal Year 2009  An average of 1,125 children were served each month  131 child care providers in Rowan County received subsidy

42. Work First Benefits and Work First Employment Services Provides services focusing on employment and self- sufficiency for families with children who meet income eligibility guidelines. The program promotes work, requires personal responsibility, and helps families get and keep a job. Work First Family Assistance benefits provide short-term services with families expected to work actively towards becoming self-sufficient. The program is built on the premise that all families have a responsibility to their families and community to work and provide for their children.

43. Work First Benefits and Work First Employment Services $1,013,538 cash assistance payments issued in FY 2009 363 is the average number of payments each month (78% of these are for the child only) $65,281 paid to assist clients in finding and keeping employment $23,916 to Family Crisis Council, assisted 22 victims of domestic violence

44. Work First Emergency Assistance Provides benefits to families with children to alleviate an emergency situation defined as an unexpected, immediate crisis that is not expected to re-occur if assistance is provided. Citizenship and residency requirements apply as well as income and resource limits. Examples of situations where services may be provided are families in immediate danger of eviction or foreclosure or where a utilities cut-off notice has been issued. $133,738 paid for emergencies to ensure that families with children kept shelter and utilities

45. General Assistance $9,760 in assistance provided for multiple needs not covered by other programs 28 businesses and vendors paid

46. Donated Funds $106,918 in contributions from the community used for the following purposes: $102,865 for Christmas Happiness $3,320 for One Church, One Child $399 Public Assistance $133 Visually Impaired $101 Shoe Fund $100 Adult Services

47. Demographic Information Estimated 2009 population of Rowan County was 139,607 (53,834 households) Median household income in 2009 was $46,826 14% estimated poverty rate in 2006 2009 Unemployment Rate 12.5% From Charlotte Regional Partnership, NC Rural Center, and US Census Bureau

48. Projected Growth Projected population 2014: 144,784 Projected Household Income 2014: $48,963 From Charlotte Regional Partnership

49. Total Impact on Rowan County Economy $192,345,928 in benefits and services impacted our economy, with total County share for these benefits $5,246,539 in SFY 2009. Cost for administering these programs (not included in benefits and services above) was $11,486,192, or 5.6% of total costs. County share of administrative costs was $5,085,750. Chart on next slide lists administrative costs by program areas.

50. Administrative Costs by Program Area ProgramTotalFederalStateCountyPercent Economic Services 4,344,2492,186,18332,5572,125,50937.8% Children’s Services 4,003,9551,728,455526,3081,749,19234.9% Child Support 1,716,7351,129,9440586,79114.9% Adult Services 674,746314,655119,878240,2135.9% Child Day Care 405,711205,6500200,0613.5% Work First340,796156,8120183,9843.0% Totals11,486,1925,721,699678,7435,085,750100.0%

52. Leadership Team and Contact Information Sandra Wilkes, Director Jane Johnson, Budget Analyst 704-216-8422 704-216-8346 Sandra.Wilkes@rowancountync.gov Jane.Johnson@rowancountync.gov Pat Spears, Program Administrator for Economic Services (Medicaid, Food and Nutrition, Energy Assistance) 704-216-8407Pat.Spears@rowancountync.gov Tom Brewer, Program Administrator for Children’s Services, Foster Care, and Adoptions 704-216-8446Tom.Brewer@rowancountync.gov Barbara Sharpe, Program Administrator for Children’s Protective Services 704-216-8479Barbara.Sharpe@rowancountync.gov Nancy Brandt, Program Administrator for Child Support, Adult Services, Child Day Care, and Work First 704-216-8343Nancy.Brandt@rowancountync.gov Lillian Morgan, Chair, Social Services Board 704-639-6088morganll@rss.k12.nc.us