1. 1 Department of Health and Human Services FY17 Budget Forum October 26, 2015

2. 2 County Executive’s Policy Priorities  A Responsible and Accountable County Government  Affordable Housing in an Inclusive Community  An effective and efficient transportation network  Children Prepared to Live and Learn  Healthy and Sustainable Communities  Safe Streets and Secure Neighborhoods  A strong and vital economy  Ensuring Vital Living for All of Our Residents

3. 3 FY16 Approved HHS Budget Overview  FY16 County General Fund Approved Expenditures = $209,253,900 (1% increase from the FY15 Approved budget of $208,197,960)  FY16 Approved budget from all revenue sources = $288,993,599 and a total of 1,593.66 work years (2% increase from FY15 level of $284,561,313)  The Department manages 640 active contracts valued at $107,880,000.  There are 117 grants totaling $79,739,700 supporting the Department’s mission..

4. Our transformation work will focus on four key themes. These themes will organize goals, objective and strategies over the next three years. They are: Service Delivery Transformation Effective and Equitable Service Delivery Capable and Engaged Workforce Strong Collaborative Relationships The following sections outline our strategic themes in more detail. The strategic themes and goals specify what we want to achieve. The objectives and high-level priorities lay- out how we plan to achieve our goals. The following diagram shows how the elements fit together. Our vision: We envision a healthy, safe and strong community. Our mission: To promote and ensure the health and safety of the residents of Montgomery County and to build individual and family strength and self-sufficiency.

5. GOALS key elements of each goal GOAL ONE: An integrated service delivery system supported by technology, which enables staff to share information and work collaboratively. Implement technology that supports a fully integrated system Establish a clear set of expectations that outline how we will work collaboratively GOAL TWO: Align people and financial assets so that we are investing the necessary level of resources to ensure effective and equitable service delivery. Provide staff with information and tools that support collaboration Use data to inform decisions: client, program & organizational Ensure investment in programs that focus on the community’s safety, health and well- being GOAL THREE: Recruit, develop and maintain a workforce that is engaged, accountable, responsible, respected, recognized and prepared for critical and emerging roles within the Department and is representative of the community we serve. Redesign human resources processes Provide training and development opportunities focused on use of technology, collaboration and practice/clinical issues GOAL FOUR: Strengthen internal and external relationships to offer a full range of coordinated programs and services focused on reducing redundancy, improving client outcomes, and eliminating disparities. Further define, refine and develop partnerships that will reduce redundancy, improve client outcomes, and eliminate disparitites Implement DHHS Contract Management process reforms Strengthen Partnerships with our public and private partners

6. 6 DHHS Strategic Areas of Focus  Service Integration  Process and Technology Modernization  Implementation of Equity Value Principle  Contracts and Monitoring Reform  Affordable Care Act Implementation – eligibility and enrollment access to care and strengthening safety net services implementation of Waivers behavioral health integration improving population health

7. 7 7 Over 1 Million Residents __________ 31% Foreign Born 50.6% Ethnic Minority 95% growth in the senior population between 2010 - 2030 54,000 out of 153,000 children in the public school system receives FARMS 6 Zip Codes of Extreme Need — Poverty on the Rise Served 70,000 Households in Fiscal Year 2009 and 39,000 used more than two services from Department A Staff of 1,600 with over 80 Programs TANF | SNAP, MA and EA Caseload Growing — Application volume grew by almost 42% Serving almost 34,000 uninsured adults, children and pregnant women Montgomery County At-a-Glance

8. 8 2012 County Self-Sufficiency Standard Adult + infant + Monthly Costs Adultinfantpreschoolerschoolageteenagerschoolageteenager2 Adults Housing $1,479$1,677 $1,479 Child Care $0$1,049$1,174$608$0$1,656$1,049$0 Food $256$382$389$457$486$576$604$506 Transportation $181 $362 Health Care $155$393 $405$424$417$436$443 Miscellaneous $207$368$381$333$277$451$395$279 Taxes $727$1,245$1,322$1,070$844$1,557$1,240$793 Earned Income Tax Credit (-) $0 Child Care Tax Credit (-) $0-$50 $0-$100-$50$0 Child Tax Credit (-) $0-$83 -$167 $0 Self-Sufficiency Wage (per adult) Hourly $17.07$29.33$30.59$26.12$21.62$35.50$30.48$10.97 Monthly $3,005$5,161$5,384$4,597$3,806$6,249$5,365$3,862 Annual $36,060$61,936$64,606$55,161$45,666$74,983$64,378$46,340

9. 9 Housing Costs Source: U.S. Census Bureau, American Community Survey 2000, 2005, 2008, 2011, 2013

10. HHS Budget Facts From FY15 CC Approved to FY16 CC Approved the tax supported budget for HHS increased by $1.1M. This includes: An increase to personnel cost totaling $2.7M— compensation increases account for $4.8M and we assumed -$2.3M in additional lapse savings. a net decrease in operating expenses totaling -$1.6M. The increases and decreases to the overall budget are highlighted in the service areas slides. After the FY16 Budget was approved, lower revenue projections plus the Supreme Court decision Wynne v. the Comptroller of MD tax case required the County to implement a savings plan for FY16. The HHS savings plan reduced our FY16 approved budget by 1.3M. 10

11. HHS Budget Facts  The FY17 Maximum Agency Request Ceiling (MARC) for HHS is $209,756,705. The FY16 CC Approved budget is $209,253,900 an increase of $502,805. 11

12. 12 FY 16 Budget Overview Budget increased to $288,993,599 ($4.4 million more than FY15 funding levels) Total $288,993,599 Federal & State Grant Funds 43,830,516 15.2% State HB669 Grant Funds 35,909,183 12.4% County General Funds 209,253,900 72.4%

13. 13 FY16 DHHS Budget by Service Area

14. Senior Initiative  Add funds to provide Senior Village start-up grants for low and moderate income diverse communities.  Continue providing nurse monitoring services to more than 2,000 senior and disabled clients receiving services through State’s new Medicaid waiver program, Community First Choice.  Maintain the raised Adult Foster Care reimbursement rate to reduce the gap between the County and State subsidy for senior assisted living group homes.  Continue funding support for Adult Day Care subsidies to increase the number of clients able to attend an Adult Day Care program two days per week for socialization and medical supervision.  Continue support in the Adult Protective Services/Social Services to Adults Program to address an increase in investigations of financial exploitation resulting from new bank mandatory reporting requirements.  Commit continuous support for a Caregiver Support Fellow and operating costs to coordinate outreach to seniors and persons with disabilities regarding the available services to ease the burden on caregivers.  Continue funding for a Program Manager in the Long Term Care Ombudsman Program, allowing the program to add volunteers and provide more long-term care facility residents with protection and advocacy. 14

15. 15 Aging and Disability Summary Program AreaFY16 BudgetFY16 WYs Community Support Network for People with Disabilities$ 15,638,26636.50 Assessment and Continuing Case Mgmt Svcs7,954,70363.55 Assisted Living Services2,090,2447.57 Home Care Services4,489,85015.00 Community First Choice2,744,81313.00 Aging and Disability Resource Unit867,9679.00 Ombudsman Services777,6466.50 Respite Care984,1060.00 Senior Community Services2,804,9479.31 Senior Nutrition Program2,622,7473.00 Service Area Administration478,8803.00 Total$ 41,454,169166.43

16. 16 Aging & Disabilities Services HIGHLIGHTS  Add funds for the Developmental Disability Supplement to reflect increase in minimum wage, $969,420.  Add funds for the Developmental Disability Direct Service to reflect worker wage at 125% of minimum wage, $146,688.  Add Village Start-up grants to low and moderate income and diverse communities, $10,000. FY16 Savings Plan reduction of ($2,500).  Inflationary adjustment of 2% to non-profit contracts in A&D, $53,350.  Reduce Developmental Disability Resource Coordination capacity to 2800 clients by transitioning clients to State Providers ($2,292,685).  Reduce nurse monitoring services to reflect current client load in Community First Choice program ($1,029,908).  Shift Supports Planning activities from Community First Choice to existing private sector providers ($411,622).  FY16 Savings Plan reduction to Home Care Services-Increase waitlist for IHAS-Personal Care Services ($100,000).  FY16 Savings Plan reduction to Occupational Therapy Services ($150,000).

17. 17 Behavioral Health & Crisis Services Budget by Program Areas Program AreaFY16 BudgetFY16 WYs Behavioral Health Planning and Management$8,087,05915.50 Access to Behavioral Health Services 3,647,70432.00 Treatment Services Administration 5,904,516 3.00 Forensic Services-Adult 2,374,60419.00 Outpatient Behavioral Health Services- Adult3,238,77119.50 Outpatient Behavioral Health Services- Child 5,582,10028.25 Trauma Services 4,960,34929.55 24-Hour Crisis Center 4,824,892 36.90 Mental Health Svcs: Seniors & Persons with Disabilities 786,6922.00 Specialty Behavioral Health Services 2,567,71621.50 Service Area Administration 561,6653.50 Total$42,536,068210.70

18. 18  Add 2% inflationary adjustment for Residential Treatment Providers, $20,950.  Defer execution of contract for the Child and Adolescent Mobile Crisis Team until January 2016, ($200,000).  Defer implementation of Adult Behavioral Health Enhancement until January 2016, ($112,500).  Defer implementation of shared contractual Outpatient Psychiatrist contract until January 2016, ($110,000).  Inflationary adjustment of 2% to non-profit contracts in BH, $92,192.  FY16 Savings Plan reduction to Mental Health Emergency Preparedness contract ($20,000). Behavioral Health & Crisis Services HIGHLIGHTS

19. Positive Youth Development  Establish the Children’s Opportunity Fund jointly with Montgomery County Public Schools to support policy priorities related to addressing the social determinants that impact the achievement gap for vulnerable children and the barriers faced by their families ($250,000).  Add positive youth services at Wheaton High School Wellness Center beginning in January 2016 ($271,300) 19

20. 20 Children, Youth, & Family Services Budget by Program Areas Program AreaFY16 BudgetFY16 WYs Child Welfare Services$ 23,555,426206.80 Linkages to Learning 6,170,4225.00 Positive Youth Development 4,731,16011.00 Early Childhood Services 3,530,18113.00 Infants and Toddlers 5,550,30813.03 Child Care Subsidies 4,752,86015.50 Office of Eligibility and Support Services 26,475,615250.10 Child and Adolescent School and Community Based Services 3,313,8576.50 Service Area Administration705,4074.50 Total$ 78,785,236525.43

21. 21  Increase cost for Child Care Subsidies for children ages 2-5 in the lowest income brackets, $550,880.  Add funds for Positive Youth Programing at the Wheaton High School Wellness Center, $271,300.  Add funding to establish the Children’s Opportunity Fund jointly with Montgomery County Public Schools to support policy priorities related to addressing the social determinants that impact the achievement gap for vulnerable children and the barriers faced by their families, $250,000. FY16 Savings Plan reduction contract by ($125,00).  Annualize funding for South Lake Linkages to Learning Program, $122,377.  Add funds to the Reginald S. Lourie Center contract to address a growing caseload for attachment and bonding services, $49,910.  Inflationary adjustment of 2% to non-profit contracts in CYF, $279,166. Children, Youth & Family Services HIGHLIGHTS

22. 22  Delay implementation of the Kennedy Cluster Early Childhood Services until January 2016, ($104,156).  Eliminate funding for contractual MCPS suspension program, ($82,240).  Eliminate the MCPS contract to provide social workers at the Ewing Center, ($64,000).  Reduce business counseling and support services for child care providers, ($50,000).  Eliminate funding for the Community Educator contract in Child Welfare Services, ($24,000).  FY16 Savings Plan reduction to the African Immigrant and Refugee Foundation contract, ($22,560).  FY16 Savings Plan reduction to Parent Resources Centers, ($52,170).  FY16 Savings Plan reduction to playground equipment for Early Childhood Services, ($20,000). Children, Youth & Family Services HIGHLIGHTS

23. 23 Public Health Budget by Program Areas Program AreaFY16 BudgetFY16 WYs Health Care for the Uninsured $14,193,1436.00 Communicable Disease and Epidemiology 2,092,36217.50 Community Health Services 4,729,85243.80 Dental Services 2,454,47016.00 Environmental Health Regulatory Services 3,603,56530.00 Health Care and Group Residential Facilities 1,695,37512.00 Cancer and Tobacco Prevention 1,210,7433.00 STD/HIV Prevention and Treatment Program 7,627,43642.65 School Health Services 25,545,680258.45 Tuberculosis Services 1,899,36417.00 Women’s Health Services 2,657,61020.65 Public Health Emergency Preparedness & Response 1,181,3999.30 Service Area Administration 1,828,46012.85 Total$ 70,719,459489.20

24. Public Health HIGHLIGHTS An overall reduction to funding for Montgomery Cares of ($288,525) includes: Increase Montgomery Cares reimbursement rate to $2 per visit, $160,056. Add funds to Montgomery Cares Holy Cross at the Aspen Hill Clinic for a Behavioral Health Specialist, $50,000. FY16 Savings Plan reduction, ($50,000). Enhance Project Access, $50,000. Enhance the Catholic Charities Health Care Network, $25,000. Reduce Montgomery Cares to reflect lower client utilization, ($500,000). FY16 Savings Plan additional reduction to Primary Care visits, ($207,700). The reduction or elimination of: support for Electronic Health Records, Pharmacy Assessment, Patient Satisfaction Survey, Training for Medicaid Participation, ($255,581). Add funds to the Muslim Community Dental Clinic, $182,000. FY16 Savings Plan reduction, ($12,500). FY16 Savings Plan reduction to Pharmacy Services, ($72,850). FY16 Savings Plan reduction to Primary Care Coalition Indirect Rate, ($38,400). 24

25. Public Health HIGHLIGHTS (continued) Enhance Care for Kids enrollment growth, $125,000. Enhance County Dental Clinics, $100,000. Inflationary adjustment of 2% to non-profit contracts in PH, $16,842. Eliminate matching funds for Reproductive Health Services that were shifted by the State to private providers, ($170,133). Reduce funding for Food Recovery Program, ($40,000). Reduce funding for miscellaneous operating expenses in the School Based Health Centers, ($50,000). FY16 Savings Plan reduction to mammograms and colorectal screenings to two grant funds and other community resources, ($120.000). 25

26. 26 Special Needs Housing Budget by Program Areas Program AreaFY16 BudgetFY16 WYs Rental & Energy Assistance Program$ 4,796,38214.00 Shelter Services 7,113,3353.00 Permanent Supportive Housing Services 2,526,2499.90 Housing Stabilization Services 5,842,80034.60 Service Area Administration398,9843.00 Total$ 20,677,75064.50

27. 27 Special Needs Housing HIGHLIGHTS Eliminate the subsidy to the Maryland Energy Assistance Program, ($500,000). Inflationary adjustment of 2% to non-profit contracts in SNH, $179,560. FY16 Savings Plan reduction to the Handicap Rental Assistance Program (HRAP), ($50,000). FY16 Savings Plan reduction to the Supportive Services for Emergency Family Shelter, ($38,420).

28. 28 Office of the Director HIGHLIGHTS  Add funds to create an Office of Child Care to implement Child Care Expansion and Quality Enhancement Initiative Bill 13-15, $253,095.  Add funds to the Outreach to County Contractors for Bill 14-14, Health Insurance Reporting, $30,000.  Inflationary adjustment of 2% to non-profit contracts in OD, $3,278.  FY16 Savings Plan Reduction to reduce contractual IT services, ($40,000).

29. 29 Office of Community Affairs HIGHLIGHTS  Add funds for Anti-Poverty Pilot Program, $32,700.  Inflationary adjustment of 2% to non-profit contracts in OCA, $57,512.  FY16 Savings Plan reduction to African American Health Program contractual services, ($20,000).  FY16 Savings Plan reduction to Latino Youth Wellness Program Services, ($20,000).  FY16 Savings Plan reduction to Asian American Health Initiative Contractual Service-Mental Health, ($10,000).

30. HHS Process and Technology Modernization Effort Enterprise Content Management System  Allows staff to scan documents for storage, so clients don’t have to provide the same information repeatedly  Deployed to eligibility programs only Electronic Health Record  Allows DHHS staff to treat clients more effectively and seek greater reimbursements for services by providing an integrated health record for clients across multiple programs  Keeps DHHS in compliance with changing federal regulations  Deployed across all DHHS clinics in Spring 2015 30 HHS Process & Technology Modernization efforts continue:

31. What does FY17 hold for us?  Budget Cuts  Urgency and Complexity from our customers/clients and patients  A shared problem solving agenda on how to deliver on the value proposition  Imperative to move upstream – increase our prevention incentive  Become more outcomes focused/more efficient and more effective in our service delivery and demonstrate a strong return on investments as funding diminishes 31

32. 32 Questions?