1. Fiscal Year 2016 Budget Hearing Office of Management and Budget
Legislative Hall
Senate Chambers
Thursday, November 20, 2014
Rita Landgraf
Cabinet Secretary
Good Afternoon Director Visalli, Kimberly Reinagel-Nietubicz of the Controller General’s Office, OMB personnel and members of the public, who represent our stakeholders, partners and the media. On behalf of the Department of Health and Social Services (DHSS), I am here today to present our Operating and Capital Budget requests for Fiscal Year In addition, we will continue to evaluate and transform our delivery systems to provide services in the most cost effective manner, with a primary focus on gaining positive outcomes for the population, and whenever possible to meet the needs and desires of the population served. As you know all too well, the more efficient we are from an administrative perspective, the greater impact our system will have on those who find themselves in need of our support.
In the chamber, my leadership team, inclusive of my Deputy Secretary Henry Smith is present and I ask them to stand to be publicly acknowledged. They represent this department, our personnel and most importantly our constituents. All of them standing, and those they represent, rely on the partnerships within the government, across the Cabinet, and in concert with the Legislative and Judicial Branches, and in alignment with our community partners and constituents. As you know, DHSS continues to face many challenges. Because of the talents and dedication of our personnel, we continue to respond to these challenges. This includes: executing of the Affordable Care Act (ACA) insurance marketplace; being a key stakeholder in the transformation of the health care delivery system; and providing services to an increasing number of Delawareans in a caring, time-sensitive, and professional manner with static, sometimes diminishing resources. Several slides follow that highlight a sampling of these efforts.
DHSS OMB FY 16 BUDGET HEARING

2. OFFICE OF THE SECRETARY
Improve the quality of life for Delaware’s residents by promoting health and well-being, fostering self sufficiency and protecting vulnerable populations
OFFICE OF THE SECRETARY
Management Services
State Service Centers
Public Health
Social Services
Medicaid and Medical Assistance
Long Term Care Residents Protection
As you are aware, the Department of Health and Social Services fulfills its mission To improve the quality of life for Delaware’s citizens by promoting good health and well being, fostering self-sufficiency, and protecting vulnerable populations through the work of our 11 divisions and the Office of the Secretary.
The Department remains committed to meeting the challenges and creating opportunities to advance our worthy mission. We continue to work within our means, while attempting to preserve the core services, and executing innovative, best practice measures that truly do impact those we serve in a responsible way.
Over the past six years, the Department of Health and Social Services has provided the following:
achieved more community-based services for Delaware’s seniors and for people with disabilities;
carried out important changes throughout the health care system;
achieved critical reforms of the state’s mental health system;
enhanced opportunities for people with disabilities;
provided a strong safety net for Delawareans who never imagined the economic challenges they would face because of the Great Recession; and
supported people moving out of poverty by empowering them to improve their own financial security.
DHSS has done all of this – and more – while at the same time reducing staff by more than 530 positions, an 11 percent decrease. Providing needed government services and being good stewards of taxpayer money are not mutually exclusive goals. We can have a smarter, more efficient government.
Substance Abuse and Mental Health
Child Support Enforcement
Developmental Disabilities
Aging and Adults with Physical Disabilities
Visually Impaired
DHSS OMB FY 16 BUDGET HEARING

3. DHSS Accomplishments Health Care Reform (ACA)
Medicaid Expansion and Health Insurance Marketplace
DHSS and Dept. of Insurance Policy Changes
Information Technology
Outreach and Marketing
Prior to highlighting the FY 16 Budget Request, I wish to highlight the Department’s focus, investments and accomplishments. This is merely a sampling, not to be viewed as an inclusive list and lays the foundation for the continued work of the administration in the area of health and social service transformation.
As you are aware, beginning in March 2010 when the Affordable Care Act was signed into law, Delaware has been on the super-highway of health care reform. As the lead state agency, DHSS has worked to implement its state-federal partnership Health Insurance Marketplace, which launched on October 1, 2013, and the expansion of Medicaid, with coverage beginning on
January 1, Through October 31, 2014, 9,000 individuals have enrolled in health insurance through the Medicaid expansion. Combined with the insurance Marketplace, 23,298 Delawareans have enrolled in health care coverage since October 1, 2013, far surpassing the CMS estimate of 8,000.
But as I often say, if all we do is connect people to coverage, we have failed. That is why, along with Bettina Riveros and others at DHSS, I am deeply involved in an unprecedented, collaborative effort to develop and implement a multi-stakeholder plan to improve health outcomes for Delawareans, health care quality and patient experience, and reduce the growth rate in health care costs. Delaware’s costs are 25 percent above the national average, and 22 percent of the State budget is devoted to health care, but outcomes and the health of many Delawareans remain at or below average on many measures. With more than 100 stakeholders involved, including those representing hospitals, providers, insurers, educational institutions, patients, and government, Delaware is awaiting word on a four-year, $39.9 million competitive grant application through the Centers for Medicare and Medicaid Innovation (CMMI) that would implement the transformation of the state’s health care delivery system.
DHSS OMB FY 16 BUDGET HEARING

4. DHSS Accomplishments State of Delaware and US DOJ Settlement
A large piece of that transformation will involve better integration of behavioral health care with primary care, especially in the community. From day one, my team and I have been committed to improving conditions at the Delaware Psychiatric Center (DPC). A pivotal benchmark in our commitment came in July 2011 when the State of Delaware entered into a Settlement Agreement with the U.S. Department of Justice, which resolved a three-year investigation of DPC. More importantly, the agreement became the blueprint for how Delaware would provide mental health services to the more than 9,000 individuals identified today with Serious and Persistent Mental Illness (SPMI).
Today, the changes at DPC have kept pace with our commitment: the daily census is down about 50 percent from 2008, with many individuals leaving after years or decades to live fulfilling lives in the community; the use of seclusion and restraint has been almost eliminated; new services and supports, including mental health screeners and peer supports have been created and enhanced in the community; and housing and employment opportunities are increasing. The administrative changes have been supported by legislative action, so that instead of a bias towards institutional treatment for people with mental conditions, the preference for community-based treatment is now the law of Delaware. The Court Monitor wrote in May 2014, “… from the Governor’s Office on down, there is a commitment to serve people with SPMI, as well as other disabilities, in ways that promote their full participation in community life.”
The first three years of the Settlement Agreement have been filled with important steps forward in reforming Delaware’s mental health system. We thank the consumers, families and advocates for helping to inform our implementation. We will need their continued assistance going forward. And we thank all of the other stakeholders who have worked with passion, dedication and commitment to carry out these changes with us.
State of Delaware and US DOJ Settlement
Reforming Delaware’s Mental Health System
DHSS OMB FY 16 BUDGET HEARING

5. DHSS Accomplishments
First let me share with you how DHSS is leveraging the fiscal resources to embrace and develop this community based opportunity.
The chart above highlights our success in reducing reliance on facility based care, with enhanced capacity in the community. This enhanced community capacity allows for more individual choice and for services to be delivered in the most natural setting.
As the chart demonstrates above, Delaware was recognized by CMS as the number one state from federal fiscal years 2010 through 2012 with the greatest increase in Medicaid Home and Community Based Services expenditures as a percent of overall total Medicaid Long Term Support Services Expenditures. Delaware demonstrated a 10.9% increase that has been devoted towards enhancements in community based supports, offering those who are aging and those with disabilities enhanced options and supports to remain in their communities.
We could not make these options a reality without the assistance of our stakeholders, inclusive of individuals and their families; advocates; professionals in long-term care and the acute care hospitals; and housing and community organizations.
DHSS OMB FY 16 BUDGET HEARING

6. Employing People With Disabilities
To promote an open atmosphere statewide in which our employees feel comfortable in disclosing their disability. 
To provide education and support on accommodating people with disabilities and the benefits of doing so. 
To provide individuals with disabilities with the same opportunities and environment to succeed as everyone else.  
Employment is a critical element of financial security. In July 2012, Governor Markell signed the Employment First Act, requiring state agencies to consider, as their first option, competitive employment for persons with disabilities.  As Governor Markell has stated, “Advancing employment opportunities for individuals with disabilities is the right thing to do as a society, it’s the smart thing for government to do and it makes good business sense.”  Governor Markell made this a priority with the National Governors Association (NGA) and this initiative continues nationwide. As Cabinet Secretary for DHSS - the largest state agency employer and provider of services for people with disabilities - and a long time advocate for people with disabilities, I have a three-prong vision:
To promote an open atmosphere statewide in which our employees feel comfortable in disclosing their disability. 
To provide education and support on accommodating people with disabilities and the benefits of doing so. 
To provide individuals with disabilities with the same opportunities and environment to succeed as everyone else. [One thing that separates people with disabilities from the rest of society is financial security, and the only thing that can reduce that gap is providing individuals with disabilities with the same opportunities and environment to succeed as everyone else.]
DHSS OMB FY 16 BUDGET HEARING

7. Why This Focus Is Critical:
Highest unemployment/ under-employment rate of any minority population;
Individuals with disabilities face a high level of poverty; and
Individuals with disabilities are an untapped, under-tapped resource.
As a key component of the State’s overall workforce strategy, Delaware is building innovative programs to increase the options available in the State, bringing together numerous state agencies around the common goal of ensuring the Delawareans with disabilities have the options and supports they need to work. Utilizing options available through the Medicaid program to expand community resources and services to eligible persons, Delaware’s Pathways to Employment program will:
Serve individuals age 14 to 25, across disabilities who have a desire to work in a competitive work environment.
Provide individually tailored services to assist individuals to explore and plan career paths.
Include services, such as on the job supports, transportation, personal care, orientation and mobility training, assistive technology, and other supports to support individuals to maintain employment based on their specific needs.
Our ability to leverage Medicaid dollars in the provision of these services, not only creates career based opportunities for adolescents and young adults with disabilities but also strengthens the workforce pipeline.
A similar program, Promise, with comprehensive community based services, has also been designed to support individuals with mental health and substance abuse needs age 18 and older, providing an array of employment supports. These programs are slated to begin early in 2015.
DHSS OMB FY 16 BUDGET HEARING

8. Expectation Is for World of Work
U.S. employment rates for people age (March 2013)
24.7% people with disabilities
61.1% people without disabilities
Delaware has been working with the US Department of Labor’s Office of Disability Employment Policy (ODEP) where the state is benefiting from technical assistance and best practice expertise. The initial engagement invited the State of Delaware to participate as one of the six states in the Employment Resources Rebalancing Initiative (ERRI), and an evaluation was conducted relative to our current systems, policies, and practices in order to determine if they are in alignment with the employment first priority. The workgroup learned that much needs to be accomplished on a variety of levels to fulfill the employment first transformation.
We are currently working on a communication plan focused on the employment first transformation to be directed towards consumers and students with disabilities, parents and families of individuals with disabilities and the workforce inclusive of those who work in early intervention programs, schools and the adult service delivery system. Delaware was recently awarded another technical assistance grant from ODEP that will focus on “Capacity Building in Effective Practices” to ensure that the state’s training protocols and workforce skillsets support the Employment First model.
DHSS OMB FY 16 BUDGET HEARING

9. Employment Focus
Collaboration with the Healthcare Association to develop internships.
UD conducted comprehensive survey of state employees.
Governor launched a partnership between Specialisterne and CAI. SAP, GlaxoSmithKline and Walgreens all made hiring commitments.
Employment for individuals with disabilities increased 8.6% between 2011 and 2013.
Governor Markell has focused like a laser beam on finding win-win solutions for employers and potential employees with disabilities. He launched a partnership that illustrates the potential for putting more people with disabilities to work.  The state helped bring together the IT firm CAI and an international organization Specialisterne, which is dedicated to employment of individuals with autism. CAI, a company that employs thousands of people across the country, is committed to hiring people who have autism for more than 3% of its workforce by 2015, recognizing that these individuals are especially qualified for technology roles like software testing, data quality assurance, programming, data mining and data entry.  The Governor has advanced the Specialisterne model within his administration and several departments have hired or are actively recruiting through Specialisterne.  
Governor Markell’s initiative created a major spark in Delaware’s Department of Labor with an increase of 8.6% of individuals with disabilities becoming actively employed from 2011 to 2013.  Delaware has seen an increase in the number of employers engaged and in the number of individuals with disabilities actively seeking employment.
The Healthcare Association, made up of Delaware’s hospitals, has signed on to the Governor’s initiative and is developing internships, expanding internships and building recruitment from these efforts into employment.
The University of Delaware, in collaboration with the State of Delaware, conducted a comprehensive survey of state employees to determine the needs of the State, as an employer, with respect to evaluating the attitudes of and hiring practices toward state employees with disabilities.  The two key areas that were identified as a need in response to this survey were: HR training initiatives related to disability awareness, and refinement of state hiring practices/systems for recruiting qualified applicants with disabilities. 
DHSS OMB FY 16 BUDGET HEARING

10. Changing State Government Culture
New OMB training module:
Message from Governor.
A snapshot of the
Americans with Disabilities
Act.
Information on interacting
with colleagues who have disabilities.
Resources, including delaware.gov employment page.
Information on hidden disabilities.
Statistics and studies.
HR Training Initiatives
The State of Delaware has created an online class available to all State employees, which is required for all hiring managers as a prerequisite for additional classroom training. The State of Delaware piloted the online training, with the classroom training beginning in October 2014.
State of Delaware Hiring Practices - Selective Placement
The State Office of Management and Budget in collaboration with the Division of Vocational Rehabilitation and the Division for the Visually Impaired has worked to ensure that the Selective Placement program is one hiring option for individuals with disabilities who seek employment in state government.  Governor Markell’s initiative to employ people with disabilities has brought heightened awareness to the Selective Placement program, which allows a qualified individual with a disability to apply, be screened and matched for a state job.
In addition, non-profit organizations that work closely with DVR and DVI received training on the Selective Placement Program in order to assist in qualifying eligible applicants. Resources include a publicly-available training video on the OMB website (“Untapped Talent Ready to Work”) that provides information about including people with disabilities in the workforce and the accomplishments that can be gained from utilizing this resource.  OMB has also developed a webpage (Selective Placement for Job Seekers), which provides information about how to become certified, meet the requirements, the application process, and contact information.
DHSS OMB FY 16 BUDGET HEARING

11. DHSS Accomplishments
Increased education and awareness about the dangers of smoking and the importance of cancer screening.
Modernized the Mental Health Commitment Law.
Development of a medical marijuana compassion center.
Established the Office of Animal Welfare into DPH.
Created a background check dashboard for employers and law enforcement.
In addition to those big-picture items, since 2009, DHSS has:
Increased education and awareness about the dangers of smoking and the importance of cancer screenings. Delaware’s cancer mortality rate, which had been as high as No. 2 in the country, has declined to No. 14.
Worked with advocates, consumers, hospitals, mental health professionals, attorneys and judges to update and modernize the state’s civil mental health laws, the first update in more than 50 years, in order to reduce the number of involuntary commitments and to increase due process for people once they are involuntarily committed.
Awarded the first license for a medical marijuana compassion center, which is expected to open early next year on Germay Drive in Wilmington.
Incorporated the Office of Animal Welfare into the Division of Public Health to better coordinate animal services across the state.
Created a background check dashboard for employers and law enforcement to use when investigating potential employees of nursing homes and other facilities.
DHSS OMB FY 16 BUDGET HEARING

12. DHSS Accomplishments I-ADAPT team Volunteerism Telehealth
Community Garden
Contributed (I have served as Chair from the beginning in 2010) to the cross-Cabinet I-ADAPT team.
Helped to promote volunteerism through its State Office of Volunteerism, which included the greatest increase in volunteering from 2010 to 2011, up 5.3%, according to the Corporation for National and Community Service.
Expanded the use of Telehealth in July 2012 by approving reimbursement through Medicaid of Telehealth delivered care.
Created a Community Garden for people of all abilities in 2010 on the Holloway Campus, in partnership with the Department of Agriculture, called Planting Hope in Delaware.
DHSS OMB FY 16 BUDGET HEARING

13. DHSS Accomplishments
Expanded uses of Stockley Center’s state-of-the-art medical facility and 750 acres.
Developed a plan to serve people who will be diagnosed with Alzheimer’s disease.
Launched PEDS Online.
Implemented the Civil Union and Marriage Equality laws.
Strengthened patient safety laws in partnership with the Department of State.
Worked with the people of Sussex County to map out a plan for expanded uses of Stockley Center’s state-of-the-art medical facility and 750 acres.
Developed a plan to serve the thousands of additional people who will be diagnosed with Alzheimer’s disease, a disease that increases with age.
Launched PEDS Online, a secure portal for pediatricians and parents to use for developmental screening measures for newborns.
Implemented both the Civil Union and Marriage Equality laws on time and with a smooth transition for Delaware citizens.
In partnership with the Department of State, strengthened laws related to patient safety, including requirements that offices where invasive procedures are performed are accredited, inspected, and subject to closure if safety violations are found.
DHSS OMB FY 16 BUDGET HEARING

14. Moving Forward Build Upon Our Successes: Affordable Care Act mandates
US DOJ Settlement
LTC Transition
DHSS Mission
Best Practices
Moving forward, we will continue to focus our efforts on building upon our successes and ensuring that our services and our budget advance the DHSS mission.
Our fundamental sense of purpose must always be to:
facilitate and empower individuals and
communities to gain healthy outcomes, both in
physical wellness and emotional well being; to gain
economic self sufficiency, which will eliminate or
limit long term reliance on government, and to
protect and support those citizens most vulnerable
due to advanced age, disabilities, and produce
positive outcomes for the individuals we serve
Therefore, our primary focus, through our intervention shall be inclusive and responsive to best practices and continue to evaluate and re-engineer for enhanced performance.
DHSS OMB FY 16 BUDGET HEARING

15. Moving Forward Emerging Issues
Addictions Services
We know that untreated, or poorly treated, substance use disorders cause suffering, illness, loss of human potential, damaged families, weakened communities, and extraordinary costs to the state and the nation at a higher rate than other serious illnesses.
U.S. COSTS
Cancer (15% tobacco) $128B
Diabetes $245B
Heart Disease & Stroke
(30% tobacco and drugs) $444B
Substance Abuse $559B
At the same time that reforms continue in our mental health system, we will continue to reform our substance usage treatment system to build a system in which care is coordinated across the spectrum and when individuals relapse, services are intensified, not ended. The work we are doing in DHSS is being coordinated with the Department of Correction, the Children’s Department, the Department of Education, the courts, law enforcement, school nurses, providers, insurers (both Medicaid and commercial), families, advocates, consumers, physicians and the Prescription Drug Action Committee (PDAC). With suspected overdose deaths climbing to 16 deaths per month and demand for treatment services far outstripping what our Division of Substance Abuse and Mental Health can offer, we will work to add and reform our services as the DHSS and State budgets allow.
In FY 2015, additional funds are allowing us to open a new detox center in Sussex County, to create 23-hour assessment and observation services, to double the number of slots for coordinated care management, and to increase capacity in sober-living by 20%. In FY 2016, I plan to seek budget increases that would increase the State’s capacity for residential treatment; sober living residential beds; coordinated care management; and assertive community treatment team slots. These new services, combined with what we have begun in FY 2015, will establish a solid foundation for our approach to address substance misuse going forward.
In addition to increased treatment, we will increase awareness. Our Division of Public Health funded a new website, HelpIsHereDE.com, to connect people to prevention information, along with treatment and recovery services. The website is being supported by a $75,000 public awareness ad campaign. Our goal is to connect people who are ready for treatment to available services across the spectrum. It is a significant challenge to both expand services to meet the demand for services relative to the treatment of this disease, especially during an epidemic, while simultaneously reforming the system so that people can access the level of care they need at the time it is needed. We are committed and determined to address this issue and continue to work with our legislative branch and community stakeholders to combat this devastating disease.
DHSS OMB FY 16 BUDGET HEARING

16. Continued Focus Community-Based Services: DSAMH DDDS DSAAPD
Coalition of Caring
We continue to provide Community-Based Services as evidenced in the decreased reliance on facility based care and increases in the community based infrastructure. As you also heard we are leveraging our Medicaid dollars further to provide flexible supports and services that will enhance the employability of individuals with disabilities, provide care coordination, that increases the seamlessness of services and financial coaching to name a few. As you will see later in my presentation, we are requesting funds to continue our efforts in promoting community based services, supports and options throughout the Department.
Meet our 5 year strategic plan for individuals with serious and persistent mental illness as identified within the USDOJ Settlement Agreement.
Increase the availability of housing vouchers – that bridge the financial gap relative to the affordability of housing for individuals in poverty and fixed incomes.
Expand family support services to family caregivers of children and adult children with developmental disabilities.
Expand personal attendant services to adults with physical disabilities. For example, the number of Delawareans with attendant services went from 77 in 2010 to 655 in 2012.
Expand Community-Based Services overall.
We are also continuing our work with the Coalition of Caring, a newly formed coalition, to focus on the need to support homeless Delawareans, with an initial pilot in the City of Wilmington. The focus will be an integrated approach to service delivery access inclusive of access to existing services that meet individualized needs and enhanced services both of a crisis nature and those that would promote longer term healthier outcomes.
DHSS OMB FY 16 BUDGET HEARING

17. Delaware’s Health Care Innovation Work
Continued Focus
Delaware’s Health Care Innovation Work
As noted earlier since Spring 2013, representatives of physicians, hospitals, other providers, insurers, businesses, consumer advocates, educators, researchers and government officials have collaborated on the state’s Health Care Innovation Plan, which will focus on care that is coordinated and team-based; adapt training programs to ensure that healthcare professionals have the skills and abilities to deliver team-based care; support insurance carriers, healthcare sponsors such as employers or unions, and other payers as they move to payment models that reward high-quality, cost-efficient care; create a “common scorecard” that will measure provider’s performances and outcomes; promote “healthy neighborhoods,” coalitions that work together to address community health needs; and, above all else, focus on the patient.
If Delaware earns one of the federal innovation (CMMI) grants, the goals to be achieved by 2018 are robust:
to be one of the top five healthiest states;
to be in the top 10 percent for health care quality and patient experience; and
reduce growth in health care costs by 1 percent to 2 percent.
All of this will link to expected growth in enrollment in Delaware’s Health Insurance Marketplace and through the Medicaid expansion. New Medicaid three-year contracts that go into effect Jan. 1, 2015, require the managed care organizations (MCOs) to participate in the Innovation Plan. Remember the triple aim approach here is to promote better patient health outcomes, better experience with interfacing with the health system and lowering the cost of health care delivery.
DHSS OMB FY 16 BUDGET HEARING

18. Continued Focus Staff and Client Security Continued Efficiencies
Physical Plant
Staff and client security issues - these past years we have an enhanced awareness relative to the safety and security of both our personnel and those who visit with us. As we reported last year, a workgroup, with representatives from divisions reviewed and updated our safety plan, with a comprehensive approach to safety. Our budget request does identify some immediate needs in order to make our environment a safer one.
Continued efficiencies encompass computer upgrades including the Eligibility Modernization and Medicaid Enterprise system.
Staffing efficiencies - we continue to look to redeploy our vacant positions, especially from institutions. A recent example is using filled dental positions at DPC to serve DSAMH community clients, as well as DPC clients.
Physical Plant improvements are on-going and include: MCI (Minor Capital Improvements); M&R (Maintenance and Restoration); roofs; HVAC; and electrical systems, as well as continued adaptive reuse efforts to use existing space efficiently and effectively.
DHSS OMB FY 16 BUDGET HEARING

19. Medicaid Growth
When the Markell administration took office, there were about 160,000 Delawareans receiving Medicaid benefits and 85,000 receiving food benefits. The economic impact of the Great Recession impacted thousands of individuals and families who were accustomed to helping others, not being the ones in need of support. Today, while the growth of enrollment has slowed, the projected numbers remain high: 230,000 enrolled in Medicaid; 150,000 receiving food benefits.
DHSS is keeping its commitment to people in need to provide a strong safety net. But we have also been concentrating on extending supports to prevent individuals from slipping into poverty whenever possible, as well as, assisting individuals with advancing out of poverty.
One of these initiatives began in May 2012, $tand By Me, the financial empowerment program, has served more than 13,000 people with one-on-one coaching, free online tax filings, college financial aid applications and more. Through August 2014, the 4,200 coaching customers have seen their debt decrease $1.2 million, their savings increase $472,000 and their credit score go up by 85 points. In addition to its employer- and school-based programs, $tand By Me has special programs for those 50 and older; Hispanics; people with disabilities; and child care employees. Because of the number of low-income employees in DHSS, $tand By Me coaching was also added as an employee benefit.
DHSS OMB FY 16 BUDGET HEARING

20. The presentation thus far as been geared towards establishing the framework for the emerging issues and focus of the Department.
I now would like to review our current FY 15 budget and the allocations of these resources across our programs. As you can see by this pie chart, Medicaid is 61% of the overall DHSS budget, Personnel represents 18%, and all other programs within the Department represent 21%. Now, let us share with you our FY 16 budget request.
DHSS OMB FY 16 BUDGET HEARING

21. Budget Process (in thousands)
FY 15 GF Budget $1,113,633.8
Requested New Dollars $ ,696.1
FY 16 Door Openers
Resources needed for increased
volume, annualizations
FY 16 Total GF Request $1,135,329.9
[1.9% Increase over FY 15]
Our current General Fund (GF) budget is over $1.1 billion.
The operating budget includes $21.7 million in new dollars which represents a 1.9% increase over FY 15. This amounts to $1.135 billion in GF’s requested for FY 16. The following slides will provide greater insight into our request.
DHSS OMB FY 16 BUDGET HEARING

22. FY 16 GF Budget Request - $1,135,329.9 Door Openers
USDOJ/DPC Settlement $3,214.0
Housing Vouchers [$1,125.0]
Coordinated Care Management [$100.0]
Supported Employment [$100.0]
Assertive Community Treatment [$954.0]
Peer Supports [$175.0]
Crisis Services [$760.0]
Our FY 16 Budget request includes approximately $11.1 million for Door Openers:
$3.214 million for meeting the benchmarks established in the 5 year USDOJ Settlement - In order to advance our mental health reform, the State must prevent unnecessary institutionalization by offering agreed upon community-based services to the target population. The target population is a subset of individuals with SPMI who are at the highest risk of unnecessary institutionalization. The agreed upon plan requires Delaware to support individuals moving from Delaware Psychiatric Center (DPC) into the community and for added and enhanced community supports and services that will support their stabilization within their community. The FY 16 request includes funding to continue our efforts in the provision of:
Housing Vouchers [$1.125 million]
Coordinated Care Management (Targeted Case Management) [$100.0]
Supported Employment [$100.0]
Assertive Community Treatment [$954.0]
Peer Supports [$175.0]
Crisis Services [$760.0]
DHSS OMB FY 16 BUDGET HEARING

23. FY 16 GF Budget Request - $1,135,329.9 Door Openers (Cont’d)
DDDS - FY 15 Placements (FYF) $2,124.8
DDDS - New Community Placements/ $3, Special School Grads
DDDS - Rebase Direct Support $1, Professional Rates
DSAAPD - Community Svcs. Wait List $
DHSS - Lease Escalators $
DHSS - FY 15 Salary Policy Contingency $
For FY 16, the Department will also need:
$2,124.8 for Full Year Funding (FYF) for FY 15 DDDS Placements;
$3,111.6 in DDDS’ budget to support 75 new Community Residential Placements and 150 Special School Graduates entering the adult service system;
$1,169.9 for DDDS’ ICAP Rebasing. This request represents a six (6) mos. annualization for the ICAP Rebasing. The total funding available in the base will be $2,339.8, of which $300.0 is designated to cover a paratransit ticket increase;
$910.0 for DSAAPD’s Community Services’ Wait List;
$119.1 for DHSS’ Lease Escalators; and
$447.6 for FY 15 DHSS Salary Policy Contingency.
DHSS OMB FY 16 BUDGET HEARING

24. FY 16 GF Budget Request - $1,135,329.9 Enhancements
Substance Use Disorder Programs (DSAMH) $3,635.0
Addiction Prevention & School Based Educations (DPH) $
Eligibility Modernization System Maintenance & $2,358.3
Operations (DMS)
Data Warehouse Maintenance & Operations (DMMA) $
Child Care Sliding Fee Scales (DSS) $1,139.3
Department-wide Security Initiatives (DMS) $
SIM Care Coordination Fees (DMMA) $1,300.0
Family Support Waiver (DDDS) $
Our FY 16 Budget request also includes approximately $9.9 million for enhancements:
$3.635 million is requested for the Division of Substance Abuse and Mental Health’s Substance Use Disorder programs. The following programs are part of the redesign for the substance abuse treatment programs:
$ funds the Adult Withdrawal Management (Detoxification) programs to transform the current New Castle County program and open a downstate program.
$ funds the expansion of the Sober Living Residential programs for an additional 60 beds which would provide a safe, secure and drug/alcohol free housing for substance abusers (10 mos.)
$1.150 million - expands the Young Adult Residential Opiate Treatment program for an additional 16 beds (11 mos).
$ funds will be used to increase the residential treatment program for an additional 16 bed program (10 mos).
$100.0 is requested to initiate a prescription drug abuse education program in the schools.
$2.358 million is requested for maintenance and operational contractual support for the DSS Eligibility system.
$275.0 is requested to maintain and operate DMMA’s Decision Support and Data Warehouse system to meet Medicaid data needs.
$1.139 million is requested to fund the implementation of federal mandated changes related to the Child Care Sliding Fee Scale (co-pays).
$193.0 is requested to increase the safety of our employees and clients through various security initiatives.
$1.3 million is requested to implement care coordination fees in Medicaid as part of the State Innovation Model (SIM).
$944.2 is requested for personnel and dental services related to the development and establishment of the Family Support Waiver.
DHSS OMB FY 16 BUDGET HEARING

25. FY 16 GF Budget Request - $1,135,329.9 One-Time
Substance Use Disorder Programs (DSAMH) $815.0
Department-wide Telephone $288.5
Upgrades (DMS)
Our FY 16 Budget request also includes approximately $1.1 million for one-time items related to:
$815.0 is requested to fund the start-up costs for the following Substance Use Disorder programs:
$165.0 for the Sober Living Residence program to fund the initial program costs and bedroom furnishings for an additional 60 beds;
$150.0 for the facility preparation and furnishings for the additional beds required for the Young Adult Opiate Residential Treatment program; and
$500.0 to fund the Residential Treatment program’s facility preparation and furnishings for DHCI and one additional 16 bed program.
$288.5 is requested to upgrade and convert the phone systems of the remaining field offices within the Department.
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26. FY 16 GF Budget Request – $1,135,329.9 Structural Changes
Reallocate Child Care funding to the Dept ($500.0)
of Education
Reallocate Medical Examiner operational funds to ($ 37.2)
OMB in support of the Dept. of Safety Homeland
Security, Forensic Sciences unit
Other items included in the DHSS budget request include structural changes. The net of these changes is a decrease to the DHSS budget of about $540.0.
For our structural changes, it includes:
Reallocation of Child Care funding to the Department of Education.
Reallocation of operational funds to the Office of Management & Budget in support of the Department of Safety and Homeland Security, Division of Forensic Sciences.
DHSS OMB FY 16 BUDGET HEARING

27. FY 16 Capital Budget Request
Project Name
Maintenance & Restoration $4,750.0
Minor Capital Improvements $6,000.0
Roof Repair/Replacement $2,300.0
Holloway Campus Electrical System Replacement $3,460.0
IT Projects $7,490.8
Our FY16 Capital Budget Request reflects the most urgent capital needs of the Department. They include:
Maintenance & Restoration ($4.75 million) - This is our number one priority. These funds are needed to help maintain the standards necessary for state and federal licensure and to eliminate the need to rely solely on Minor Capital Improvement and Equipment (MCI) funding for unexpected maintenance and repairs. This funding is used to maintain 133 buildings at current conditions and provides for the repair of life/safety systems, emergency and other critical building components and additional unanticipated needs.
Minor Capital Improvement & Equipment ($6.0 million) - These funds prevent further deterioration of buildings and grounds and allow us to continue to stabilize the Department’s backlog of deferred maintenance.
Roof Replacement ($2.3 million) - These funds are needed to continue to repair or replace aging roofs within the Department.
IT Projects ($7.49 million) – As noted earlier, DHSS has been making significant improvements to its Management Information Systems. Funding is requested for several projects currently underway including:
Replacement of the Medicaid Management Information System; and
Eligibility Modernization which will provide integrated eligibility/enrollment functionality for Medicaid and CHIP (with the new Health Insurance Marketplace), as well as maintain integration among Medicaid and other benefit programs including TANF, SNAP and Purchase of Care-Child Care. Part II will include modernization of the Child Care Management Information System (CCMIS) [Provider information and payments]; ARM$ system [Benefit recovery]; and PERM [Payment Error Rate Measurement system] for Quality Control; conversion of the DHSS Master Client Index for all 25 systems, as well as necessary software and hardware upgrades.
DHSS OMB FY 16 BUDGET HEARING

28. FY 16 Capital Budget Request (cont’d)
Project Name
Drinking Water State $1,850.0
Revolving Loan Program
Critical Equipment $
Replacement Program
We have some additional capital priorities. These include:  
Drinking Water State Revolving Fund ($1.85 million) - This request is the required 20% state match to provide low interest loans for improving drinking water systems. Funds will be used for some projects which include the City of Wilmington, the Town of Laurel and Lewes’ Board of Public Works.
Critical Equipment Replacement Program ($150.0) - Funding is requested to replace critical equipment for daily operations including the common area furniture for State Service Centers and Facility Operations equipment.
DHSS OMB FY 16 BUDGET HEARING

29. Important Partnerships
CROSS CABINET INITIATIVES
Delaware State Housing Authority - SRAP
Early Childhood Education
I-ADAPT - Individual Assessment and Discharge Planning Teams
Health Care Reform
Behavioral Health - Education and Prevention - Treatment and Recovery
COMMUNITY PARTNERS
The Department could not begin to meet the needs of Delawareans or arrive at effective public policy initiatives without the support of our multitude of partners within the Cabinet and those from our community. We are fortunate to have experts in the industry that provide hours of support and expertise to our task forces, advisory councils and consortiums. We rely on the countless number of volunteers and hours dedicated to providing direct service to those in need, who are facilitating better outcomes and ensuring basic needs are being met.
In order for DHSS to serve our clientele and lead them to enhanced self-sufficiency and better health outcomes, we continue to partner with community service providers. In fact, DHSS has over 1,200 contracts worth hundreds of millions of dollars. The success of our mission is dependent upon the engagement of many community organizations dedicated to a common purpose.
As mentioned throughout the presentation, we will continue to align our limited resources to the strategic focus of the Department and leverage the resources as best as possible. We need to engage all our partners in the roll out and cascade our focus throughout the organization in order to effectively execute and advance during these times of transition. The state cannot achieve this goal without the support and collaboration of all, our customers; our providers; our community developers; our education system; our health care system; our funders; our legislators; our advocates; and our workforce.
DHSS OMB FY 16 BUDGET HEARING

30. I and members of my team will be happy to answer any questions.
At a recent conference, I heard a panelist refer to this time in an administration as the fourth quarter. She said she planned to push ahead hard, knowing that much can be accomplished in two years. I share her commitment and her determination. With the Governor, I have set the Department’s priorities, and we will make every day count to improve the quality of life for Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.
Thank you for the opportunity to share with you the accomplishments, challenges and opportunities facing the Department of Health and Social Services. We look forward to the years ahead, and collectively working towards brighter tomorrows. We invite you to share your thoughts, recommendations and concerns with us as we move forward.
I and members of my team will be happy to answer any questions.
DHSS OMB FY 16 BUDGET HEARING