1695163 Social Services
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DEPARTMENT OF SOCIAL SERVICES FINANCIAL SUMMARY FY 2014 APPROPRIATION FY 2013 EXPENDITURE Office of the Director Family Support Division Children's Division Division of Youth Services MO HealthNet Division DEPARTMENTAL TOTAL General Revenue Fund Federal Stimulus-Social Services Fund Department of Mental Health - Federal Funds Title XIX - Federal Funds and Other Funds Temporary Assistance for Needy Families - Federal Funds DSS - Federal and Other Funds Uncompensated Care Fund Pharmacy Rebates Fund Third Party Liability Collections Fund Intergovernmental Transfer Fund Federal Reimbursement Allowance Fund Pharmacy Reimbursement Allowance Fund MO HealthNet Managed Care Organization Reimbursement Allowance Fund Family Services Donations Fund Child Support Enforcement Fund Nursing Facility Federal Reimbursement Allowance Fund Nursing Facility Quality of Care Fund Health Initiatives Fund Gaming Commission Fund Missouri Senior Services Protection Fund DSS Administrative Trust Fund DSS Educational Improvement Fund Blind Pension Fund Healthy Families Trust Fund Long Term Support UPL Fund Blind Pension Premium Fund Blind Pension Healthcare Fund Life Sciences Research Trust Fund Youth Services Products Fund Missouri Rx Plan Fund Youth Services Treatment Fund Early Childhood Development, Education and Care Fund Premium Fund Blindness Education, Screening and Treatment Program Fund Alternative Care Trust Fund Ambulance Service Reimbursement Allowance Fund Recovery Audit and Compliance Fund Foster Care and Adoptive Parents Recruitment and Retention Fund Medicaid Provider Enrollment Fund Total Full-time Equivalent Employees General Revenue Fund Federal Funds Other Funds GOVERNOR RECOMMENDS FY 2015 FY 2015 REQUEST $ 25,396,922 531,883,860 504,817,540 58,222,051 6,610,101,732 $ 42,103,444 741,403,021 552,005,918 60,258,201 7,152,037,737 $ 44,008,649 747,174,100 562,638,975 60,699,772 7,320,275,199 $ 44,197,258 750,741,476 572,420,324 62,077,736 8,828,014,421 $ 7,730,422,105 1,493,480,833 63,720,970 2,235,856 3,066,113,214 $ 8,547,808,321 * 1,561,796,448 100,000,000 0 3,393,343,293 $ 8,734,796,695 1,713,434,507 85,000,000 0 3,471,239,701 $ 10,257,451,215 1,572,843,130 85,000,000 0 5,151,340,355 141,239,052 594,836,648 92,364,914 169,129,885 20,550,271 63,711,589 1,320,014,485 157,689,859 183,139,559 818,473,051 92,794,914 200,005,110 19,922,082 70,948,801 1,305,533,811 179,113,896 183,326,767 834,186,015 92,794,914 185,054,205 19,928,494 70,948,801 1,305,534,321 179,114,029 183,603,148 846,904,573 92,794,914 176,213,315 19,737,035 70,948,801 1,278,899,964 185,753,546 385,067 8,375 7,879,500 0 143,994 12,243,574 0 143,994 12,243,574 0 143,994 12,357,672 295,314,697 91,621 27,859,805 473,235 0 808,828 6,548,899 32,255,308 64,818,585 0 0 18,045,720 33,000,000 0 12,324,108 0 311,758,016 93,125 30,022,958 500,000 24,759,941 1,504,323 6,975,195 33,965,228 57,984,660 17,502,101 3,632,576 0 32,000,000 5,000 17,508,489 999 311,758,016 93,749 29,536,068 500,000 0 1,504,347 6,995,905 34,313,866 57,984,660 17,502,101 0 0 32,000,000 5,000 17,512,745 999 321,192,673 94,982 29,383,238 500,000 0 1,504,402 7,039,131 34,313,866 57,984,660 17,502,101 0 0 32,000,000 5,000 17,523,628 999 4,977,122 10,230,392 9,307,920 22,230,392 9,308,169 22,230,392 9,308,792 12,131,660 134,762 13,191,794 16,983,012 3,699 349,000 15,000,000 18,561,986 6,631,379 349,000 15,000,000 18,562,111 6,633,745 349,000 15,000,000 18,381,557 6,638,579 0 0 5,000 51,500 5,000 51,500 5,000 51,500 7,197.96 2,112.10 4,730.21 355.65 7,158.33 1,788.39 4,835.55 534.39 7,035.33 1,775.69 4,725.25 534.39 7,037.33 1,784.59 4,718.35 534.39 ∗ Does not include $84,772,782 recommended in the Fiscal Year 2014 Supplemental Appropriations. See the Supplemental section of the Missouri Budget for details regarding the Department of Social Services supplemental appropriations. 11-1 DEPARTMENT OF SOCIAL SERVICES DEPARTMENT SUMMARY The Fiscal Year 2015 budget provides $10.3 billion for the Department of Social Services. Department of Social Services include: • • • • The core functions provided by the Protecting the welfare of Missouri’s children through foster care, child abuse and neglect investigations, children’s treatment, purchase of child care, and adoption assistance. Administering income support programs and many of the state’s child support enforcement functions, such as, Temporary Assistance for Needy Families, Food Stamps, Energy Assistance, Blind Pension, Supplemental Aid to the Blind, Domestic Violence, and Medicaid eligibility. Providing case management, community care, and aftercare to youth committed to the state’s custody for various crimes. The Juvenile Court Diversion Program works with local communities to help prevent juvenile crime and provide treatment for youth in their own communities. Administering health care delivery to low-income Missouri citizens, including the elderly, people with disabilities, children, and pregnant women. The Medicaid Program (Title XIX of the Social Security Act) is a federal-state effort to meet the health care needs of those who cannot pay for their own care. The health care services include hospital, physician, pharmacy, skilled nursing home care, home health care, mental health, and managed care. While states must meet certain minimum criteria, each state can establish eligibility guidelines, benefit packages, and provider payment rates for its Medicaid Program. Governor Nixon’s Fiscal Year 2015 budget expands and reforms Medicaid – 25 other states have already made the commitment to cover additional uninsured individuals. By doing so, Missouri taxpayer dollars will stay in Missouri, providing health care for an estimated 300,000 Missourians, rather than having those tax dollars flow to other states. The Governor’s proposal to expand and reform Medicaid is a fiscally responsible move for taxpayers. Federal funding will cover 100 percent of the costs through 2016, phasing down to 90 percent in 2020. Expanding access to Missouri’s Medicaid system will infuse nearly $2 billion of federal funds into the economy of Missouri. 11-2 DEPARTMENT OF SOCIAL SERVICES OFFICE OF THE DIRECTOR FINANCIAL SUMMARY FY 2013 EXPENDITURE Office of the Director Federal Grants and Donations Human Resource Center Missouri Medicaid Audit and Compliance Recovery Audit and Compliance Finance and Administrative Services Revenue Maximization Neglected and Delinquent Children Legal Services TOTAL PERSONAL SERVICE General Revenue Fund Federal Funds Other Funds EXPENSE AND EQUIPMENT General Revenue Fund Federal Funds Other Funds PROGRAM SPECIFIC DISTRIBUTION General Revenue Fund Federal Funds Other Funds TOTAL General Revenue Fund Federal Funds Other Funds Total Full-time Equivalent Employees General Revenue Fund Federal Funds Other Funds $ $ 246,474 7,907,407 490,861 4,229,050 3,699 4,140,756 899,000 1,677,116 5,802,559 25,396,922 GOVERNOR RECOMMENDS FY 2015 FY 2014 APPROPRIATION $ $ 257,360 9,477,551 515,741 12,184,742 1,200,000 5,071,009 5,250,000 1,900,000 6,247,041 42,103,444 $ $ 334,548 9,477,551 525,098 14,028,314 1,200,000 5,128,868 5,250,000 1,900,000 6,352,879 44,197,258 5,047,965 5,627,061 744,316 5,032,399 5,906,825 1,167,274 5,143,560 6,107,544 1,189,123 1,012,091 3,633,115 837,908 1,311,168 11,950,898 7,974,595 1,373,145 13,649,006 7,974,595 1,677,116 6,817,350 0 1,900,000 6,826,300 33,985 1,900,000 6,826,300 33,985 7,737,172 16,077,526 1,582,224 8,243,567 24,684,023 9,175,854 8,416,705 26,582,850 9,197,703 277.76 119.97 139.66 18.13 294.74 128.02 138.77 27.95 294.74 128.02 138.77 27.95 Office of the Director – The Office of the Director includes the director, the director’s staff, the Human Resource Center (HRC), and the Missouri Medicaid Audit and Compliance Unit (MMAC). The director provides leadership for over 7,000 employees and the divisions of the Department of Social Services. The HRC plans, develops, and implements statewide human resource programs and training curriculums, giving direction and coordination to all divisions in the Department of Social Services. The MMAC ensures Medicaid provider payments are in compliance with state and federal requirements, thereby helping to ensure the efficiency of the Medicaid Program. Division of Finance and Administrative Services – The Division of Finance and Administrative Services provides centralized financial and administrative support to all divisions. Financial related functions include audit support and contract compliance, budgeting, expenditure review and control, federal grants management and reporting, implementation of the department’s fiscal policies, and responding to changes in federal and state fiscal policy. Administrative support services include emergency management, telecommunications, warehouse/inventory coordination and distribution, fleet management, and research and data management. 11-3 DEPARTMENT OF SOCIAL SERVICES OFFICE OF THE DIRECTOR Division of Legal Services – The Division of Legal Services provides comprehensive legal support to all divisions in the department. The division’s responsibilities include due process hearings for public assistance and child support recipient appeals, legal advice and representation for the Children’s Division investigating fraud and abuse of public assistance programs, and conducting background investigations on department employees. The division also includes the State Technical Assistance Team which is responsible for assisting in investigations of child abuse, neglect, exploitation, child fatality, and management and training of Missouri’s Child Fatality Review Program. The division also coordinates the department’s compliance with applicable federal and state privacy laws, such as the Health Insurance Portability and Accountability Act. Fiscal Year 2015 Governor’s Recommendations • • • • • $1,760,085 for a provider enrollment system and a fraud and investigation program for Medicaid, including $61,977 general revenue. $168,732 for pay plan, including $69,760 general revenue. $72,620 for the remaining pay periods of the Fiscal Year 2014 approved pay plan, including $32,199 general revenue. $19,877 to increase salaries for recruitment and retention as recommended by the Personnel Advisory Board, including $9,202 general revenue. $72,500 federal funds reallocated from various divisions within the department. 11-4 DEPARTMENT OF SOCIAL SERVICES FAMILY SUPPORT DIVISION FINANCIAL SUMMARY FY 2013 EXPENDITURE Family Support Administration Income Maintenance Field Staff and Operations Family Support Staff Training Community Partnerships Missouri Mentoring Partnership Adolescent Boys Program Family Nutrition Program Temporary Assistance for Needy Families (TANF) Adult Supplementation Supplemental Nursing Care Blind Pension Refugee Assistance Community Services Block Grant Emergency Shelter Grants Emergency Solutions Program Food Distribution Programs Energy Assistance Domestic Violence Blind Administration Services for the Visually Impaired Business Enterprises Child Support Field Staff and Operations Child Support Distributions Blind Pension Medical TOTAL PERSONAL SERVICE General Revenue Fund Federal Funds Other Funds EXPENSE AND EQUIPMENT General Revenue Fund Federal Funds Other Funds PROGRAM SPECIFIC DISTRIBUTION General Revenue Fund Federal Funds Other Funds TOTAL General Revenue Fund Federal Funds Other Funds Total Full-time Equivalent Employees General Revenue Fund Federal Funds Other Funds $ $ 19,979,357 76,095,851 206,387 8,083,909 1,241,045 186,840 8,652,119 108,462,615 37,994 24,673,423 32,255,308 1,695,163 15,507,311 444,008 0 1,209,958 66,800,806 6,386,479 3,506,521 6,100,470 26,498,979 30,724,521 69,141,869 23,992,927 531,883,860 GOVERNOR RECOMMENDS FY 2015 FY 2014 APPROPRIATION $ $ 98,191,505 82,498,062 254,924 8,103,085 1,293,700 300,000 11,181,261 146,753,972 38,665 24,909,384 33,964,470 3,806,226 19,637,000 0 2,630,000 1,500,000 114,547,867 8,466,524 4,657,876 8,399,614 30,000,000 35,661,136 104,607,750 0 741,403,021 $ $ 101,920,756 85,215,222 254,924 8,104,904 1,293,700 300,000 12,981,261 146,753,972 35,665 25,107,395 34,313,866 3,806,226 19,637,000 0 2,630,000 1,500,000 114,547,867 8,466,524 4,735,278 8,399,614 30,000,000 36,129,552 104,607,750 0 750,741,476 16,882,855 76,769,921 6,913,833 17,952,152 84,808,572 8,836,449 17,439,976 82,888,373 8,963,159 12,895,099 31,203,486 1,479,495 20,732,811 102,205,591 4,307,161 24,172,584 130,603,664 4,306,994 40,823,006 293,374,793 51,541,372 39,663,572 427,832,486 35,064,227 38,929,626 408,023,310 35,413,790 70,600,960 401,348,200 59,934,700 78,348,535 614,846,649 48,207,837 80,542,186 621,515,347 48,683,943 3,204.11 545.54 2,444.72 213.85 3,316.39 406.23 2,540.34 369.82 3,146.39 374.13 2,402.44 369.82 Administrative Services/Eligibility and Enrollment System – Management, coordination, and general direction are provided to all Family Support Division programs. The division director and staff monitor the efficiency and effectiveness of and provide policy direction for Income Maintenance and Child Support programs. Administrative Services also provides operational services, human resource support, and systems support to Income Maintenance and Child Support Enforcement field staff. The division manages Missouri’s eligibility and enrollment system for income maintenance and Medicaid services. The federal government has made enhanced federal matching funds available through December 31, 2015 to upgrade state eligibility and enrollment systems. The department’s four-year technology investment plan will improve workflows and business processes and allow for significant staff efficiencies. 11-5 DEPARTMENT OF SOCIAL SERVICES FAMILY SUPPORT DIVISION Income Maintenance Field Staff and Operations – Staff provides intake services, information and referral, and eligibility determinations for applicants of services provided by the department. Funds in these sections support the salaries, general operating expenses, and training for Income Maintenance eligibility specialists, administrative and supervisory staff, and clerical support positions in Family Support offices. Family Support Staff Training – This funding provides training for income maintenance and child support enforcement staff as well as community representatives. Proper training is key to ensuring program compliance and developing effective staff. Community Partnerships – Twenty organizations partner with the department and other state agencies to plan, develop, finance, and monitor strategies to achieve specific core results. These core results include safe and healthy children and families, children ready to enter and succeed in school, youth ready to enter the workforce, and parents as a part of the workforce. Missouri Mentoring Partnership – The program provides intervention programming and offers worksite and teen parent mentoring to youth at risk of entering the welfare system or the justice system. Adolescent Boys Program – Federal dollars are utilized to help boys age 11-14 understand healthy relationships, respect for females in their lives, and the responsibility fatherhood brings. The program also explores the risk factors related to teen fatherhood and increases young fathers’ involvement with their children. Family Nutrition Program – The department partners with the community to deliver information and training on nutrition and food budgeting for food stamp eligible individuals, especially women; people with children in the home; at risk, pregnant, and parenting teens; youth; and seniors. Temporary Assistance for Needy Families (TANF) – TANF is a program designed to provide temporary assistance/relief to families to promote self-sufficiency so parents do not remain dependent on government payments and children do not grow up in poverty. Under federal welfare reform, TANF is designed to be a temporary assistance which, coupled with a myriad of other support services, enables parents to find and retain employment; thereby, enabling them to support their families without government assistance. Adult Supplementation – The federal government assumed responsibility for Old Age Assistance, Aid to the Permanently and Totally Disabled, and Aid to the Blind programs in January 1974 when it created the Supplemental Security Income (SSI) Program. Recipients who are eligible for SSI, but who receive smaller benefits than their December 1973 payments, receive payments from the state equal to the difference. Recipients who are not eligible for SSI, but who received payments under one of the earlier programs, receive payments from the state equal to the amount they received in December 1973. The caseload has been declining since 1973 as recipients die, become ineligible through income changes, or leave the state. Supplemental Nursing Care – This state-funded program makes monthly cash payments to residents of residential care, assisted living, and non-Medicaid nursing facilities for use in paying for their care. The type of facility appropriate for clients is dictated by their level of need for care. Minimal medical care is provided in Residential Care, more in Assisted Living, and significantly more in Nursing Facilities. Supplemental Nursing Care recipients also are provided an allowance each month for personal needs such as toiletries, transportation, and hair care. Blind Pension and Supplemental Aid to Blind – Three separate programs assist blind persons. The first, Supplemental Aid to the Blind, pays benefits to those who meet certain income requirements. The second, Blind Pension, aids the blind who do not qualify for Supplemental Aid to the Blind and who do not own property – excluding homes – worth more than $20,000. The third program, Adult Supplemental Payments, aids those who received Aid to the Blind before the federal SSI Program began in 1974, but who receive less from SSI than from the earlier program. New cases that meet the state’s 1973 guideline also may be certified for Supplemental Aid to the Blind. All of these programs are funded from an earmarked state property tax that provides revenue to the Blind Pension Fund. Community Services Block Grant (CSBG), Emergency Solutions Grants, and Refugee Assistance – CSBG funds are used to address six causes of poverty: unemployment, inadequate education, malnutrition, inadequate housing, unmet emergency needs, and poor use of income. Federal statutes require that 90 percent of CSBG funding be passed through to Community Action Agencies. The Emergency Solutions Grants Program provides grants to local governments for renovation or conversion of buildings for emergency shelters and to help meet the cost of emergency shelter operations. The Refugee Assistance Program provides services to help refugees overcome language barriers, acquire or adapt vocational skills, and adjust to their new environment. Food Distribution – The federally funded Food Distribution Program enables Family Support to provide USDA commodities and administrative funds to not-for-profit food banks to store, ship, and distribute food to eligible individuals and families. The Food Distribution Program also provides commodities for the Summer Food Service Program and other charitable institutions. Energy Assistance – The Low-Income Home Energy Assistance Program is a federally funded block grant which provides heating assistance payments and winter and summer crisis assistance to low-income households. Domestic Violence – This program issues contracts to local family violence shelters. Funds may be used for emergency shelters, counseling, and services for families in community-based shelters. 11-6 DEPARTMENT OF SOCIAL SERVICES FAMILY SUPPORT DIVISION Services for the Visually Impaired/Business Enterprises – Professional staff in Rehabilitation Services for the Blind counsel and train blind and visually impaired Missourians, arrange for the purchase of other services, and help the visually impaired find jobs. Services include rehabilitation, vocational rehabilitation, diagnosis and treatment of eye disease, equipment and supplies for blind preschool children, the Public Building Vending program, and the Readers for the Blind Program. The Blind Enterprise Program facilitates a contract arrangement between Fort Leonard Wood and a blind vendor to provide full food service. Payments from the Department of Defense are received by the Department of Social Services, deposited into the State Treasury and paid to the subcontractor for its services under the contract. Child Support Field Staff and Operations – Child Support Enforcement staff provide services to locate missing parents; establish paternity, medical support, and financial child support obligations; and enforce the collection of support payments for TANF, MO HealthNet and for non-TANF families that apply for child support services. The state retains approximately 36 percent of all assigned child support collected on current and former TANF cases. Child Support Distributions – Distributions are made to reimburse counties that have signed a cooperative agreement with the Department of Social Services to provide judicial assistance in the establishment and enforcement of child support obligations. Child support collection and prosecution costs incurred by the counties are reimbursed by the federal government at a rate of 66 percent. This funding also supports contractual agreements with local governments to assist the division with paternity and other types of child support referrals through the establishment of multi-county, full-service centers. Counties pool resources to establish service centers dedicated to child support work. Distributions are also made to families when the payment is collected by the department on behalf of the family and to refund overpayments from federal income tax refund intercepts. This appropriation also provides a mechanism for reimbursing non-custodial parents for child support payments over-collected from state income tax refund intercepts. Fiscal Year 2015 Governor’s Recommendations • • • • • • • • • • • $2,496,883 and 23.45 staff to replace one-time funding for blind administration and services for the visually impaired. $2,085,000 for eligibility-related public assistance fraud prevention, including $1,042,500 general revenue. $349,396 Blind Pension Fund for a rate increase pursuant to Section 209.040, RSMo. $198,011 for Supplemental Nursing Care personal needs allowances. $1,482,376 for pay plan, including $236,546 general revenue. $757,444 for the remaining pay periods of the Fiscal Year 2014 approved pay plan, including $105,327 general revenue. $2,694,153 transferred to the Department of Social Services for fringe savings from staff reductions due to modernization of its eligibility and enrollment system, including $614,267 general revenue. $1,800,000 federal funds transferred from the Department of Economic Development for administration of the Missouri Employment Training Program. ($2,496,883) and (23.45) staff core reduction for one-time expenditures. ($24,167) federal funds reallocated to the Office of the Director. ($3,758) and (170) staff core reduction from the Fiscal Year 2014 appropriation level, including ($3,000) general revenue. 11-7 DEPARTMENT OF SOCIAL SERVICES CHILDREN’S DIVISION FINANCIAL SUMMARY FY 2013 EXPENDITURE Children's Administration Children's Field Staff and Operations Children's Staff Training Children's Treatment Services Crisis Care Foster Care Foster Parent Training Adoption and Subsidized Guardianship Adoption Resource Centers Independent Living Transitional Living Children's Programs Pool Child Assessment Centers Residential Treatment Foster Care Case Management Contracts IV-E Court Contracts Child Abuse and Neglect Grant Foster Care Children's Account Head Start Collaboration Office Purchase of Child Care Home Visitation Foster Youth Educational Assistance IV-E-CASA Training TOTAL PERSONAL SERVICE General Revenue Fund Federal Funds Other Funds EXPENSE AND EQUIPMENT General Revenue Fund Federal Funds Other Funds PROGRAM SPECIFIC DISTRIBUTION General Revenue Fund Federal Funds Other Funds TOTAL General Revenue Fund Federal Funds Other Funds Total Full-time Equivalent Employees General Revenue Fund Federal Funds Other Funds $ $ 6,475,820 74,621,641 1,112,052 13,029,592 1,513,567 52,988,199 400,250 74,132,218 222,750 2,264,865 2,060,431 15,666,377 2,740,000 55,788,852 24,357,066 316,342 156,658 13,191,794 0 161,586,283 1,105,997 1,069,833 16,953 504,817,540 GOVERNOR RECOMMENDS FY 2015 FY 2014 APPROPRIATION $ $ 6,788,675 78,389,567 1,124,758 18,143,525 2,050,000 53,690,110 576,399 78,042,242 800,000 2,999,900 2,918,887 0 2,800,000 63,108,551 29,533,794 400,000 188,316 15,000,000 300,000 192,522,346 1,190,000 1,238,848 200,000 552,005,918 $ $ 6,841,989 87,806,729 1,124,758 18,718,021 2,050,000 57,439,413 576,399 77,584,277 800,000 2,999,900 2,918,887 0 2,298,952 65,124,109 35,086,903 400,000 188,316 15,000,000 300,000 189,458,323 4,264,500 1,238,848 200,000 572,420,324 27,842,873 45,183,696 67,154 28,848,954 46,544,705 115,079 33,296,615 49,459,226 117,382 3,222,948 7,291,393 394 4,768,045 10,197,579 1,040,303 6,321,104 11,330,988 385,303 225,592,587 176,961,562 18,654,933 226,842,035 209,842,842 23,806,376 232,603,667 214,945,711 23,960,328 256,658,408 229,436,651 18,722,481 260,459,034 266,585,126 24,961,758 272,221,386 275,735,925 24,463,013 2,178.19 835.94 1,340.26 1.99 2,033.88 689.55 1,341.53 2.80 2,056.88 704.85 1,349.23 2.80 Children’s Administration – The Children’s Division Administrative Services provides management, coordination, and general direction for all Children’s Division programs. The division director and staff monitor the effectiveness of programs that promote safety, permanency, and well-being for Missouri’s children served by the division. Administrative Services provides policy direction, operational services, and human resource support to field staff. 11-8 DEPARTMENT OF SOCIAL SERVICES CHILDREN’S DIVISION CD Field Staff and Operations/Staff Training – This funding covers salaries, expenses, and training for Children’s Service workers and support staff to maintain the Children’s Division programs in each of the state’s 45 judicial circuits. Front-line staff respond to allegations of child abuse or neglect, provide assistance for families in need of services to keep or return children home safely, secure appropriate out-of-home placements for children placed in the division’s custody, and locate permanent homes when it is in the best interest of children. In 2009, the Children’s Division obtained national accreditation by the Council on Accreditation (COA), in accordance with Section 210.113, RSMo. To achieve accreditation, Missouri’s child welfare system was reviewed and measured against nationally-recognized standards of best practice established by COA. Children’s Treatment Services, Crisis Care, and Prevention Programs – The Children’s Treatment Services funding provides a variety of contracted services to child abuse victims and their parents. Specific services include family therapy, homemaker services, respite care, parent aides, child care, and crisis care services. Children’s Treatment Services funding also provides for intensive, inhome services to help prevent placement of children in foster care and keep children with their families. Prevention programs such as Crisis Care Centers and home visitation provide services for families and children to prevent child abuse and neglect and to divert children from the state’s custody. Foster Care, Foster Parent Training, Children’s Account, Adoption Subsidy, and Subsidized Guardianship – The Foster Care Program provides monthly room and board payments for children in the custody and care of the Children’s Division. Types of placements include traditional foster care, relative care, and kinship care. For children with intensive behavioral or medical needs, specialized placements are provided. Payments are made for non-Medicaid medical and dental services, clothing, transportation, foster parent training, respite care, and other needs. Children in state custody may receive funds from a variety of sources, including child support payments. These monies are used to offset the cost of maintaining the child in foster care and to pay for any special expenses of the child. The Adoption Subsidy Program and Subsidized Guardianship Program provide financial assistance to parents who adopt or become legal guardians of special needs children in order to move these children from foster care into permanent family arrangements. Children’s Programs Pool – This pooled appropriation allows flexible spending for Children’s Program areas. These dollars have been reallocated back to the program area, as used in Fiscal Year 2013. Child Assessment Centers – Child Assessment Centers provide a child friendly setting where children, reported to have been sexually abused, can be interviewed by multi-disciplinary team members and receive a single medical examination. Residential Treatment, Transitional Living, Independent Living, and Title IV-E Court Contracts – Residential facilities are used when foster family care cannot meet the children’s treatment needs. The division contracts with a wide range of residential programs, ranging from small group homes to large, self-contained, resident campuses. Facilities must be licensed or be accredited by one of three nationally recognized accrediting organizations. Independent Living programs assist foster care children, ages 15 to 21, in learning the necessary skills for the transition from foster care to adult independent living in the community. Transitional Living placement programs assist foster care children ages 16 to 21 by placing youth in their communities with support services. Court contracts through the Title IV-E Program allow the Children’s Division to pass through federal funds to be used for reimbursement to juvenile courts for children in the court’s custody placed in juvenile court residential facilities. Foster Care Case Management Contracts – The Children’s Division contracts with private agencies to provide foster/adoption case management services to children who have been removed from their homes and are under the jurisdiction of the Juvenile Court. These children have been abused and/or neglected or were found to be at serious risk of such. The goal of the foster care case management contracts is to improve safety, stability, and timely permanency for these children. Purchase of Child Care – A key to successful welfare reform and the prevention of abuse and neglect is access to quality, affordable child care. Without child care assistance, many parents could not participate in job training or education, or maintain employment in order to become self-sufficient and end their dependence on government assistance. Without such assistance, the risk of children being left in unsafe environments also increases. The Early Childhood Development, Education and Care Fund supports programs to improve the availability of, and access to, quality child care and programs that prepare children to enter school ready to succeed. Because children learn more from the ages of zero to five than during any other developmental period, the availability of quality child care is essential to preparing children for school. Foster Youth Educational Assistance – This funding provides financial assistance for tuition and other fees related to post-secondary education and vocational training to youth in foster care and former foster care youth. The program gives the Division the opportunity to provide funding to assist eligible youth interested in pursuing higher education to reach their goals. 11-9 DEPARTMENT OF SOCIAL SERVICES CHILDREN’S DIVISION Fiscal Year 2015 Governor’s Recommendations • • • • • • • • • • • • $11,128,578 and 23 staff to serve the increasing number of children in state custody, including $6,187,672 general revenue. $10,345,000 federal funds to increase traditional child care eligibility, provide a three percent rate increase for licensed and licensed-exempt child care providers, and expand before and after school programs. $2,987,542 for a two percent rate increase for foster care and residential treatment services, including $1,731,013 general revenue. $2,704,930 for child welfare staff support, including $1,539,642 general revenue. $500,000 federal funds for adoption resource centers. $2,269,764 to increase salaries of front-line children’s services workers and supervisors to improve recruitment and retention, including $1,509,620 general revenue. $1,896,072 to increase salaries for recruitment and retention as recommended by the Personnel Advisory Board, including $1,261,077 general revenue. $1,102,176 for pay plan, including $437,138 general revenue. $508,524 for the remaining pay periods of the Fiscal Year 2014 approved pay plan, including $172,410 general revenue. ($10,345,000) federal funds core reduction for lapsed child care appropriations. ($2,659,013) core reduction for one-time expenditures, including ($1,076,220) general revenue. ($24,167) federal funds reallocated to the Office of the Director. 11-10 DEPARTMENT OF SOCIAL SERVICES DIVISION OF YOUTH SERVICES FINANCIAL SUMMARY FY 2013 EXPENDITURE Administrative Services Youth Treatment Programs Juvenile Court Diversion TOTAL PERSONAL SERVICE General Revenue Fund Federal Funds Other Funds EXPENSE AND EQUIPMENT General Revenue Fund Federal Funds Other Funds PROGRAM SPECIFIC DISTRIBUTION General Revenue Fund Federal Funds Other Funds TOTAL General Revenue Fund Federal Funds Other Funds Total Full-time Equivalent Employees General Revenue Fund Federal Funds Other Funds $ $ 2,034,491 52,447,747 3,739,813 58,222,051 GOVERNOR RECOMMENDS FY 2015 FY 2014 APPROPRIATION $ $ 1,987,214 54,191,501 4,079,486 60,258,201 $ $ 1,997,757 56,000,493 4,079,486 62,077,736 17,867,132 22,256,980 2,971,611 18,172,530 23,251,931 3,253,379 19,161,866 23,984,921 3,320,752 555,941 4,598,330 2,618,914 991,848 6,559,101 3,861,406 631,146 4,907,263 2,579,820 4,580,809 1,215,971 1,556,363 3,590,625 71,380 506,001 3,981,163 1,723,218 1,787,587 23,003,882 28,071,281 7,146,888 22,755,003 29,882,412 7,620,786 23,774,175 30,615,402 7,688,159 1,331.76 548.74 690.24 92.78 1,279.21 500.06 689.94 89.21 1,279.21 500.06 689.94 89.21 Youth Services Administration – The youth services administrative unit assumes overall responsibility for designing, implementing, managing, and evaluating all programs operated by the Division of Youth Services (DYS). Five regional offices work with central office staff to ensure program efficiency and effectiveness at the local level. Youth Treatment – Youth treatment is composed of residential services and non-residential services. Residential Services provide youthful offenders with structured rehabilitation programs when placement at home is no longer an option. Services include academic and vocational education for youth in residential placement. The division operates 6 secure care facilities, 19 moderate care facilities, and 7 community-based facilities. Non-residential Services help youthful offenders adjust to community life and become law-abiding and productive citizens. The division provides: case management; community care which includes day treatment, intensive supervision, family counseling, and alternative living; and aftercare services. Case management involves evaluating youths’ needs and managing their service delivery plan. Community care involves treatment of youth without placement in a DYS facility. Alternative living includes foster care and independent living services for juveniles who cannot return to their homes. Day treatment programs provide education and treatment services for youth who continue to live at home. Family counseling is provided to strengthen the family structure, communication, and parenting. Intensive supervision provides mentoring to youth in the community. Aftercare is the provision of support services to help juveniles return to their families and communities as law-abiding and productive citizens. Juvenile Court Diversion – The Juvenile Court Diversion Program encourages local communities to develop programs to divert youth from commitment to DYS through contracts with local courts to provide early intervention services to first-time offenders to stop their delinquent behavior. Fiscal Year 2015 Governor’s Recommendations • • • • • $29,836 for a two percent rate increase for providers of residential treatment services. $864,445 to increase salaries for recruitment and retention as recommended by the Personnel Advisory Board, including $605,112 general revenue. $630,271 for pay plan, including $259,905 general revenue. $319,149 for the remaining pay periods of the Fiscal Year 2014 approved pay plan, including $124,319 general revenue. ($24,166) federal funds reallocated to the Office of the Director. 11-11 DEPARTMENT OF SOCIAL SERVICES MO HEALTHNET DIVISION FINANCIAL SUMMARY FY 2013 EXPENDITURE Administrative Services MO HealthNet Vendor Payments and Managed Care Blind Pension Medical Benefits TOTAL PERSONAL SERVICE General Revenue Fund Federal Funds Other Funds EXPENSE AND EQUIPMENT General Revenue Fund Federal Funds Other Funds PROGRAM SPECIFIC DISTRIBUTION General Revenue Fund Federal Funds Other Funds TOTAL General Revenue Fund Federal Funds Other Funds Total Full-time Equivalent Employees General Revenue Fund Federal Funds Other Funds GOVERNOR RECOMMENDS FY 2015 FY 2014 APPROPRIATION $ 140,681,431 6,469,420,301 0 $ 187,485,148 6,939,430,072 25,122,517 $ 185,426,016 8,613,445,179 29,143,226 $ 6,610,101,732 $ 7,152,037,737 $ 8,828,014,421 2,639,054 4,916,297 1,206,428 2,742,689 5,331,318 1,766,989 3,582,188 6,224,615 1,804,061 12,214,746 62,667,422 7,182,008 10,576,665 58,954,278 10,199,921 10,737,165 59,114,778 10,199,921 1,120,626,611 3,125,628,363 2,273,020,803 1,178,670,955 3,494,672,097 2,389,122,825 1,173,569,325 5,247,059,159 2,315,723,209 1,135,480,411 3,193,212,082 2,281,409,239 1,191,990,309 3,558,957,693 2,401,089,735 1,187,888,678 5,312,398,552 2,327,727,191 206.14 61.91 115.33 28.90 234.11 64.53 124.97 44.61 260.11 77.53 137.97 44.61 Administrative Services – The MO HealthNet Division is an intermediary for providing services to both participants and providers. The agency’s structure includes two major sections: Finance and Operations and Clinical Services. The Finance and Operations section works to incorporate the newest and best technology to accurately and efficiently pay providers in a paperless environment. Technology provides a robust reporting function that is critical to the management responsibilities of the division. The resultant database of paid claims is used to monitor the programs, provide program integrity, and compile data to project financial needs and trends. Provider relations, participant services, and premium collections are also functions under the Finance and Operations section. The Clinical Services section oversees pharmacy enhancement and rebates, the exception program, the psychology program, and the Missouri Rx Plan. The Clinical Services unit reaches out to organizations through existing contracts, such as the University of Missouri Health Management Team, to assist in needed data mining and analysis. The process allows for examination and analysis of performance in terms of efficiency of operations and anticipated health status outcomes. Utilizing a variety of sources, the Clinical Services section establishes best practices based on evidence-based reviews. Fiscal Year 2015 Governor’s Recommendations • • • • • • $7,735,000 and 26 staff for program implementation, integrity oversight, reporting, and information technology required to provide Medicaid coverage for Missourians up to 138 percent of the Federal Poverty Level, including $1,527,500 general revenue. $5,000,000 to sustain the MO HealthNet technology infrastructure, including $875,000 general revenue. $136,268 for pay plan, including $37,981 general revenue. $58,602 for the remaining pay periods of the Fiscal 2014 approved pay plan, including $16,144 general revenue. $10,998 to increase salaries for recruitment and retention as recommended by the Personnel Advisory Board, including $3,374 general revenue. ($15,000,000) federal funds core reduction from the Fiscal Year 2014 appropriation level. 11-12 DEPARTMENT OF SOCIAL SERVICES MO HEALTHNET DIVISION MEDICAID EXPENDITURES SELECTED SERVICES AND ANNUAL TOTALS FY 2013 EXPENDITURE Pharmacy Physicians Dental Premium Payments Nursing Facilities and Home Health Rehabilitation and Specialty Services Managed Care Hospital Care Safety Net Hospitals FRA and NFFRA Health Care Access Children's Health Insurance Program School District Claiming MO HealthNet Supplemental Pool IGT Safety Net Hospitals IGT Health Care Home FQHC Long-term Care UPL Medicaid Expansion Blind Pension Medical Benefits TOTAL EXPENSE AND EQUIPMENT General Revenue Fund Federal Funds Other Funds PROGRAM SPECIFIC DISTRIBUTION General Revenue Fund Federal Funds Other Funds TOTAL General Revenue Fund Federal Funds Other Funds Total Full-time Equivalent Employees $ $ 1,218,714,523 607,139,141 16,416,524 178,886,284 555,017,395 295,808,508 1,099,483,313 782,377,548 5,588,529 1,296,168,097 9,262,406 171,919,507 19,622,983 31,659,577 168,379,866 2,575,887 10,400,213 0 0 0 6,469,420,301 GOVERNOR RECOMMENDS FY 2015 FY 2014 APPROPRIATION $ $ 1,287,242,318 671,056,989 17,978,686 181,712,730 583,957,865 318,347,035 1,182,760,062 813,770,245 8,000,000 1,323,846,451 10,540,915 180,875,309 54,723,724 35,698,082 199,854,549 7,600,000 15,570,000 45,895,112 0 25,122,517 6,964,552,589 $ $ 1,309,939,066 665,551,212 17,867,035 205,351,061 586,811,685 318,828,402 1,200,110,124 778,521,943 8,000,000 1,334,275,791 9,960,562 177,271,420 54,723,724 35,698,082 199,854,549 7,600,000 14,449,149 45,895,112 1,642,736,262 29,143,226 8,642,588,405 5,754,220 4,646,260 1,669,597 3,929,578 5,772,103 1,507,625 3,929,578 5,772,103 1,507,625 1,120,626,611 3,063,702,810 2,273,020,803 1,178,670,955 3,387,571,190 2,387,101,138 1,172,109,325 5,145,568,252 2,313,701,522 1,126,380,831 3,068,349,070 2,274,690,400 1,182,600,533 3,393,343,293 2,388,608,763 1,176,038,903 5,151,340,355 2,315,209,147 0.00 0.00 0.00 Vendor Payments – The Medicaid Program (Title XIX of the Social Security Act) is a federal-state effort to pay for the health care of those who cannot pay for their own care. Federal law sets the minimum services for any state that opts to administer the Medicaid Program. These include hospital; physician; Early and Periodic Screening, Diagnostic and Treatment; lab and x-ray; skilled nursing home care; home health care; Federally Qualified Health Centers; rural health clinics; non-emergency transportation; and family planning services. In addition to Medicaid State Plan Services, Missouri provides women’s health services for women with incomes no greater than 185 percent of the federal poverty level, through an 1115 waiver. Missouri also provides breast and cervical cancer treatment for uninsured women under the age of 65. Also, the State Children’s Health Insurance Program is the federal-state effort to pay for the health care of uninsured children up to 300 percent of the federal poverty level. Children receive a benefit package equal to Medicaid coverage, though non-emergency medical transportation is not available to children in families with income above 150 percent of the federal poverty level. Families with incomes above 150 percent of the federal poverty level, but below 300 percent of the federal poverty level must pay premiums to receive coverage for their children. The Blind Pension Medical Benefits Program allows individuals receiving blind pension benefits who do not meet categorical eligibility criteria for Title XIX to receive nearly all of the same services, which are reimbursed for Title XIX eligible’s, including non-institutional, nursing facility, and hospital care. Finally, this budget provides Medicaid expansion to approximately 300,000 Missourians. Through calendar year 2016, this expansion is funded entirely through federal dollars. The state match requirement increases over the next five years until reaching ten percent. 11-13 DEPARTMENT OF SOCIAL SERVICES MO HEALTHNET DIVISION Fiscal Year 2015 Governor’s Recommendations • • • • • • • • • • • • • • $1,619,053,604 federal funds to expand Medicaid coverage for Missourians up to 138 percent of the Federal Poverty Level. This will result in ($86,684,023) in savings to the state of Missouri, including ($56,210,439) general revenue. Additional savings are reflected in other departments’ budgets. $55,997,600 federal funds for an adjustment to address the change in the Medicaid federal participation percentage. $41,632,189 to replace other fund cash balances expended in Fiscal Year 2014. $37,510,503 federal funds to apply an actuarially required trend factor for both utilization and cost component increases for managed care in the eastern, central, and western regions. $27,017,398 federal funds to address the anticipated increases in the pharmacy program due to new drugs, therapies, utilization, and inflation. $24,161,444 for a $2.50 rate increase for nursing facilities and a two percent rate increase for hospice and home health services, including $8,916,781 general revenue. $11,386,451 federal funds for the additional cost of existing Medicaid programs. $10,429,340 Nursing Facility Federal Reimbursement Allowance Fund for a $1.25 trend factor increase for nursing facilities. $8,319,792 for anticipated increases in Medicare Part A and B premiums, including $3,070,419 general revenue. $2,049,459 for an increase in the number of participants and a change in the federal participation percentage for the health care home initiative through the Federally Qualified Health Centers. $343,078 for anticipated increases to Medicare hospice rates, including $126,613 general revenue. ($28,392,517) other funds for one time expenditures. ($28,133,165) federal and other funds core reduction from the Fiscal Year 2014 appropriation level. ($16,655,337) transferred to the Department of Mental Health for clients who transitioned from nursing facilities under the Money Follows the Person Program, including ($6,146,652) general revenue. 11-14
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