Status Quo is Not Sustainable Status Quo is Not Sustainable • Increased demand; decreased funding • Un-funded mandates, maintenance of effort and administrative requirements • Regulatory focus on compliance rather than outcomes Regulatory focus on compliance rather than outcomes • Ineffective reporting requirements and redundant audits • Policy decisions are made without input from counties • Policy decisions are made without input from counties • Legislation creates added burdens without improving outcomes • Data systems and staffing levels are inadequate D t t d t ffi l l i d t
REAL Vision REAL Vision Responsive, Efficient, Accountable human p , , services system delivered through Local-State Partnership • Responsive • Efficient • Efficient • Accountable • Local State Partnership • Local-State Partnership
Let’s Get REAL Let s Get REAL • Decisions based on data and measurable outcomes t • Reducing unnecessary and un-funded mandates • Streamlining processes • Streamlining processes • Maintaining funding flexibility • Fiscal responsibility and efficiency p y y • Transparent planning and reporting • Culture change among state and local governments governments • Education and communication with stakeholders
What Are We Seeking? What Are We Seeking? Local Control + Funding Flexibility + Mandate Relief + Administrative Simplification + Performance Accountability = Strategically Reformed Health and Human Services System + Improved Outcomes for Colorado Families
Key Players in Strategic Reform State Departments Human Services Services Clients Board of Human Board of Human State Services (Rules) Legislature Real (Laws) Colorado Counties Governor’s Office Office Advocates and Community Partners
REAL Successes To Date REAL Successes To-Date • REAL Materials Developed REAL Materials Developed • Executive Order 2011-005 • State Review of Rules/Agency Letters St t R i f R l /A L tt • State Staff Committed to REAL Funding Analysis • Legislators Using REAL Bookmark g g
System Improvements System Improvements • Unanimous passage of House Bill 1196: Front- end prevention services to families before children are at imminent risk of removal • Passage of SB 124: Preserved TANF reserves to allow counties to serve more families • Strengthened Partnerships with State Partners, Casey Family Programs, Advocacy Groups
Mandate Reform Mandate Reform • Is the mandate a federal requirement, state law, or q , , rule? • Is it linked to funding and if so, are the funds adequate to meet the mandate? d t t t th d t ? • Does the mandate lead to desired results (outcomes) or just create make work? or just create make work? • Are there administrative efficiencies to be gained by changing the mandate? • Will changing the mandate have a significant impact on county government or human service clients?
MANDATE MATRIX EXAMPLE- CHILD WELFARE Mandate Federal/State Rule Outcome/Result Impact on Counties Recommendation NCFAS State Rule There is no link This is a make work form that is Recommendation: Review the between out-dated and is not used to make evidence regarding the continued This assessment form is required completing the any decisions. county use of the NCFAS in its only by rule and no data or NCFAS and It is incredibly time consuming and present form. information about the assessment desired child data from the tool has not been Determine if it should be or changes has ever been welfare outcomes produced in years. The tool may discontinued or modified without communicated to counties or nor case have been useful 10 years ago but degrading quality of child welfare statewide to assess families in our management t practice changes and tools address ti h d t l dd i t interventions. ti system. decisions. the same issues. Consider reducing the domains to those that are useful, specifically the 6th and 7th domains are not very helpful. Or continue use but eliminate requirement. It is used on occasion, esp for case closure decisions esp. for case closure decisions. NCFAS State Rule The requirement for the NCFAS to Recommendation: If the NCFAS is be completed before the 3A can be to continue, a recommendation difficult if the disposition is set would be that the initial NCFAS be before the 60 day deadline for the due with the first 90 day review to NCFAS. allow the caseworker ample time to gather all information to complete it accurately. Timing of Medical & Dental 7.708.41D There is no link to Counties are consistently found to Recommendations : Adjust the time having a short time be out of compliance with this frames or eliminate requirement and Appointments frame and safety arbitrary deadline. consider offering exceptions for The time frames for children of children. If there is a medical or dental children who have been assessed entering care to have an initial emergency, children are taken in for hild t k i f and do not need treatment. d d t d t t t medical and dental appointment medical or dental care. Note: The appointment must be scheduled was set by the State and scheduled within 10 days. is not a Federal time frame. Adjust the time frame but cannot eliminate this due to the CFSR. It is important to have medical checkups.
MANDATE MATRIX EXAMPLE- PUBLIC ASSISTANCE Mandate Federal/State Rule Outcome/Result Impact on Counties Recommendation Citizenship Verification HCPF Rule 8.100.53 Delays in Obtaining birth certificates for Recommendation: An HCPF Rule 8.100.53 states, processing all applicant household alternative is to create an “To be eligible to receive applications for members is a physical interface between the county medical assistance, an eligible clients and county hardship and expensive for systems and the Vital person shall: 1. Be a citizen or staff. low-income families. Statistics database . This has national of the United State, County staff must wait to been done in several the District of Columbia, Puerto receive documents that could states. Through this method, Ri Rico, Guam, . . .” G ” be pulled up electronically on a b ll d l t i ll counties can verify citizenship ti if iti hi Section A2 of this rule goes on read-only basis. for many applicants to say, “For determinations of online. This saves time, initial eligibility and re- money, and work. determinations of eligibility for HCPF offered counties the medical assistance made on or opportunity to be part of a pilot after July 1, 2006, provide interface project with Vital satisfactory documentary satisfactory documentary Statistics twice over the past Statistics twice over the past evidence of citizenship or few years. The first such offer nationality and identity . . .” was accompanied by a In summary, Medicaid concomitant offer from the applicants must provide proof Colorado Health Foundation to of citizenship to qualify. This fund the pilot. On each generally requires presentation occasion there was no follow up of a certified birth certificate of a certified birth certificate by HCPF and no by HCPF and no issued by the Bureau of Vital pilot. Medicaid applicants Statistics at the Colorado continue to have to go to a Vital Department of Health & Statistics site, pay for each birth Environment. certificate, and present those birth certificates to a county human services worker.
REAL Opportunities REAL Opportunities • Removing State’s 45-day IV-E determination deadline. Artificial deadline results in loss of d dli A tifi i l d dli lt i l f significant federal child welfare IV-E funds. • Reviewing state requirement to conduct redundant Reviewing state requirement to conduct redundant diligent searches for adoptable children, beyond federal requirement • Removing requirement for needless subsidy forms that are not needed to sustain adoption subsidies • Streamlining timeframes for eligibility determinations and re-determinations for entitlement benefits
Levels of Mandate Review Levels of Mandate Review Federal Mandates Federal Mandates State Statutes Interpretations and Expansions of Original Intent State Rules State Agency Letters
Phases of Mandate Reform Review of Federal Program Requirements & Funding Streams Phase I 90-120 Days Survey of Federal Mandates CDHS Review of Program Mandates Due Date 6/2011 Due Date 6/2011 CHSDA & Sub-PAC Program Mandate Review Phase II Mandate Reform Quick Opportunities & Long-Term Opportunities State Statutes – Fall 2011 before legislative session and thereafter 3- 5 Years State Statutes Fall 2011 before legislative session and thereafter 3 5 Years State Rule – Present and ongoing through Joint Workgroups NACO – Conference 2012
Phases of Mandate Reform Phases of Mandate Reform Phase III Ongoing State Board of Human Services and State Legislature Mandate Reviews Legislative and State Board of Human Services reviews of existing statutes and rules, as well as, proposed bills or rules should answer basic questions such as: • Is it relevant? • Does it meet legislative intent? • Does the cost of the proposed or existing rule exceeds its benefits? • Is the process for meeting the rule’s mandate is ineffective or inefficient? • Is it not adequately funded, therefore not adequately implemented?
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