1695163 Social Services
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11-1
DEPARTMENT OF SOCIAL SERVICES
FINANCIAL SUMMARY
GOVERNOR
FY 2013 FY 2014 FY 2015 RECOMMENDS
EXPENDITURE APPROPRIATION REQUEST FY 2015
Office of the Director 25,396,922$ 42,103,444$ 44,008,649$ 44,197,258$
Family Support Division 531,883,860 741,403,021 747,174,100 750,741,476
Children's Division 504,817,540 552,005,918 562,638,975 572,420,324
Division of Youth Services 58,222,051 60,258,201 60,699,772 62,077,736
MO HealthNet Division 6,610,101,732 7,152,037,737 7,320,275,199 8,828,014,421
DEPARTMENTAL TOTAL 7,730,422,105$ 8,547,808,321$ * 8,734,796,695$ 10,257,451,215$
General Revenue Fund 1,493,480,833 1,561,796,448 1,713,434,507 1,572,843,130
Federal Stimulus-Social Services Fund 63,720,970 100,000,000 85,000,000 85,000,000
Department of Mental Health - Federal Funds 2,235,856 0 0 0
Title XIX - Federal Funds and Other Funds 3,066,113,214 3,393,343,293 3,471,239,701 5,151,340,355
Temporary Assistance for Needy
Families - Federal Funds 141,239,052 183,139,559 183,326,767 183,603,148
DSS - Federal and Other Funds 594,836,648 818,473,051 834,186,015 846,904,573
Uncompensated Care Fund 92,364,914 92,794,914 92,794,914 92,794,914
Pharmacy Rebates Fund 169,129,885 200,005,110 185,054,205 176,213,315
Third Party Liability Collections Fund 20,550,271 19,922,082 19,928,494 19,737,035
Intergovernmental Transfer Fund 63,711,589 70,948,801 70,948,801 70,948,801
Federal Reimbursement Allowance Fund 1,320,014,485 1,305,533,811 1,305,534,321 1,278,899,964
Pharmacy Reimbursement Allowance Fund 157,689,859 179,113,896 179,114,029 185,753,546
MO HealthNet Managed Care Organization
Reimbursement Allowance Fund 385,067 0 0 0
Family Services Donations Fund 8,375 143,994 143,994 143,994
Child Support Enforcement Fund 7,879,500 12,243,574 12,243,574 12,357,672
Nursing Facility Federal Reimbursement
Allowance Fund 295,314,697 311,758,016 311,758,016 321,192,673
Nursing Facility Quality of Care Fund 91,621 93,125 93,749 94,982
Health Initiatives Fund 27,859,805 30,022,958 29,536,068 29,383,238
Gaming Commission Fund 473,235 500,000 500,000 500,000
Missouri Senior Services Protection Fund 0 24,759,941 0 0
DSS Administrative Trust Fund 808,828 1,504,323 1,504,347 1,504,402
DSS Educational Improvement Fund 6,548,899 6,975,195 6,995,905 7,039,131
Blind Pension Fund 32,255,308 33,965,228 34,313,866 34,313,866
Healthy Families Trust Fund 64,818,585 57,984,660 57,984,660 57,984,660
Long Term Support UPL Fund 0 17,502,101 17,502,101 17,502,101
Blind Pension Premium Fund 0 3,632,576 0 0
Blind Pension Healthcare Fund 18,045,720 0 0 0
Life Sciences Research Trust Fund 33,000,000 32,000,000 32,000,000 32,000,000
Youth Services Products Fund 0 5,000 5,000 5,000
Missouri Rx Plan Fund 12,324,108 17,508,489 17,512,745 17,523,628
Youth Services Treatment Fund 0 999 999 999
Early Childhood Development,
Education and Care Fund 4,977,122 9,307,920 9,308,169 9,308,792
Premium Fund 10,230,392 22,230,392 22,230,392 12,131,660
Blindness Education, Screening and
Treatment Program Fund 134,762 349,000 349,000 349,000
Alternative Care Trust Fund 13,191,794 15,000,000 15,000,000 15,000,000
Ambulance Service Reimbursement Allowance Fund 16,983,012 18,561,986 18,562,111 18,381,557
Recovery Audit and Compliance Fund 3,699 6,631,379 6,633,745 6,638,579
Foster Care and Adoptive Parents Recruitment and
Retention Fund 0 5,000 5,000 5,000
Medicaid Provider Enrollment Fund 0 51,500 51,500 51,500
Total Full-time Equivalent Employees 7,197.96 7,158.33 7,035.33 7,037.33
General Revenue Fund 2,112.10 1,788.39 1,775.69 1,784.59
Federal Funds 4,730.21 4,835.55 4,725.25 4,718.35
Other Funds 355.65 534.39 534.39 534.39
∗ 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.
11-2
DEPARTMENT OF SOCIAL SERVICES
DEPARTMENT SUMMARY
The Fiscal Year 2015 budget provides $10.3 billion for the Department of Social Services. The core functions provided by the
Department of Social Services include:
• 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 $2 billion of federal funds into the
economy of Missouri.
11-3
DEPARTMENT OF SOCIAL SERVICES
OFFICE OF THE DIRECTOR
FINANCIAL SUMMARY
GOVERNOR
FY 2013 FY 2014 RECOMMENDS
EXPENDITURE APPROPRIATION FY 2015
Office of the Director 246,474$ 257,360$ 334,548$
Federal Grants and Donations 7,907,407 9,477,551 9,477,551
Human Resource Center 490,861 515,741 525,098
Missouri Medicaid Audit and Compliance 4,229,050 12,184,742 14,028,314
Recovery Audit and Compliance 3,699 1,200,000 1,200,000
Finance and Administrative Services 4,140,756 5,071,009 5,128,868
Revenue Maximization 899,000 5,250,000 5,250,000
Neglected and Delinquent Children 1,677,116 1,900,000 1,900,000
Legal Services 5,802,559 6,247,041 6,352,879
TOTAL 25,396,922$ 42,103,444$ 44,197,258$
PERSONAL SERVICE
General Revenue Fund 5,047,965 5,032,399 5,143,560
Federal Funds 5,627,061 5,906,825 6,107,544
Other Funds 744,316 1,167,274 1,189,123
EXPENSE AND EQUIPMENT
General Revenue Fund 1,012,091 1,311,168 1,373,145
Federal Funds 3,633,115 11,950,898 13,649,006
Other Funds 837,908 7,974,595 7,974,595
PROGRAM SPECIFIC DISTRIBUTION
General Revenue Fund 1,677,116 1,900,000 1,900,000
Federal Funds 6,817,350 6,826,300 6,826,300
Other Funds 0 33,985 33,985
TOTAL
General Revenue Fund 7,737,172 8,243,567 8,416,705
Federal Funds 16,077,526 24,684,023 26,582,850
Other Funds 1,582,224 9,175,854 9,197,703
Total Full-time Equivalent Employees 277.76 294.74 294.74
General Revenue Fund 119.97 128.02 128.02
Federal Funds 139.66 138.77 138.77
Other Funds 18.13 27.95 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.
11-4
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.
• $72,500 federal funds reallocated from various divisions within the department.
11-5
DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
FINANCIAL SUMMARY
GOVERNOR
FY 2013 FY 2014 RECOMMENDS
EXPENDITURE APPROPRIATION FY 2015
Family Support Administration 19,979,357$ 98,191,505$ 101,920,756$
Income Maintenance Field Staff and Operations 76,095,851 82,498,062 85,215,222
Family Support Staff Training 206,387 254,924 254,924
Community Partnerships 8,083,909 8,103,085 8,104,904
Missouri Mentoring Partnership 1,241,045 1,293,700 1,293,700
Adolescent Boys Program 186,840 300,000 300,000
Family Nutrition Program 8,652,119 11,181,261 12,981,261
Temporary Assistance for Needy Families (TANF) 108,462,615 146,753,972 146,753,972
Adult Supplementation 37,994 38,665 35,665
Supplemental Nursing Care 24,673,423 24,909,384 25,107,395
Blind Pension 32,255,308 33,964,470 34,313,866
Refugee Assistance 1,695,163 3,806,226 3,806,226
Community Services Block Grant 15,507,311 19,637,000 19,637,000
Emergency Shelter Grants 444,008 0 0
Emergency Solutions Program 0 2,630,000 2,630,000
Food Distribution Programs 1,209,958 1,500,000 1,500,000
Energy Assistance 66,800,806 114,547,867 114,547,867
Domestic Violence 6,386,479 8,466,524 8,466,524
Blind Administration 3,506,521 4,657,876 4,735,278
Services for the Visually Impaired 6,100,470 8,399,614 8,399,614
Business Enterprises 26,498,979 30,000,000 30,000,000
Child Support Field Staff and Operations 30,724,521 35,661,136 36,129,552
Child Support Distributions 69,141,869 104,607,750 104,607,750
Blind Pension Medical 23,992,927 0 0
TOTAL 531,883,860$ 741,403,021$ 750,741,476$
PERSONAL SERVICE
General Revenue Fund 16,882,855 17,952,152 17,439,976
Federal Funds 76,769,921 84,808,572 82,888,373
Other Funds 6,913,833 8,836,449 8,963,159
EXPENSE AND EQUIPMENT
General Revenue Fund 12,895,099 20,732,811 24,172,584
Federal Funds 31,203,486 102,205,591 130,603,664
Other Funds 1,479,495 4,307,161 4,306,994
PROGRAM SPECIFIC DISTRIBUTION
General Revenue Fund 40,823,006 39,663,572 38,929,626
Federal Funds 293,374,793 427,832,486 408,023,310
Other Funds 51,541,372 35,064,227 35,413,790
TOTAL
General Revenue Fund 70,600,960 78,348,535 80,542,186
Federal Funds 401,348,200 614,846,649 621,515,347
Other Funds 59,934,700 48,207,837 48,683,943
Total Full-time Equivalent Employees 3,204.11 3,316.39 3,146.39
General Revenue Fund 545.54 406.23 374.13
Federal Funds 2,444.72 2,540.34 2,402.44
Other Funds 213.85 369.82 369.82
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.
11-6
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.
11-7
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 ($3,000) general revenue.
11-8
DEPARTMENT OF SOCIAL SERVICES
CHILDREN’S DIVISION
FINANCIAL SUMMARY
GOVERNOR
FY 2013 FY 2014 RECOMMENDS
EXPENDITURE APPROPRIATION FY 2015
Children's Administration 6,475,820$ 6,788,675$ 6,841,989$
Children's Field Staff and Operations 74,621,641 78,389,567 87,806,729
Children's Staff Training 1,112,052 1,124,758 1,124,758
Children's Treatment Services 13,029,592 18,143,525 18,718,021
Crisis Care 1,513,567 2,050,000 2,050,000
Foster Care 52,988,199 53,690,110 57,439,413
Foster Parent Training 400,250 576,399 576,399
Adoption and Subsidized Guardianship 74,132,218 78,042,242 77,584,277
Adoption Resource Centers 222,750 800,000 800,000
Independent Living 2,264,865 2,999,900 2,999,900
Transitional Living 2,060,431 2,918,887 2,918,887
Children's Programs Pool 15,666,377 0 0
Child Assessment Centers 2,740,000 2,800,000 2,298,952
Residential Treatment 55,788,852 63,108,551 65,124,109
Foster Care Case Management Contracts 24,357,066 29,533,794 35,086,903
IV-E Court Contracts 316,342 400,000 400,000
Child Abuse and Neglect Grant 156,658 188,316 188,316
Foster Care Children's Account 13,191,794 15,000,000 15,000,000
Head Start Collaboration Office 0 300,000 300,000
Purchase of Child Care 161,586,283 192,522,346 189,458,323
Home Visitation 1,105,997 1,190,000 4,264,500
Foster Youth Educational Assistance 1,069,833 1,238,848 1,238,848
IV-E-CASA Training 16,953
200,000 200,000
TOTAL 504,817,540$ 552,005,918$ 572,420,324$
PERSONAL SERVICE
General Revenue Fund 27,842,873 28,848,954 33,296,615
Federal Funds 45,183,696 46,544,705 49,459,226
Other Funds 67,154 115,079 117,382
EXPENSE AND EQUIPMENT
General Revenue Fund 3,222,948 4,768,045 6,321,104
Federal Funds 7,291,393 10,197,579 11,330,988
Other Funds 394 1,040,303 385,303
PROGRAM SPECIFIC DISTRIBUTION
General Revenue Fund 225,592,587 226,842,035 232,603,667
Federal Funds 176,961,562 209,842,842 214,945,711
Other Funds 18,654,933 23,806,376 23,960,328
TOTAL
General Revenue Fund 256,658,408 260,459,034 272,221,386
Federal Funds 229,436,651 266,585,126 275,735,925
Other Funds 18,722,481 24,961,758 24,463,013
Total Full-time Equivalent Employees 2,178.19 2,033.88 2,056.88
General Revenue Fund 835.94 689.55 704.85
Federal Funds 1,340.26 1,341.53 1,349.23
Other Funds 1.99 2.80 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.
11-9
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, in-
home 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.
11-10
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.
• ($24,167) federal funds reallocated to the Office of the Director.
11-11
DEPARTMENT OF SOCIAL SERVICES
DIVISION OF YOUTH SERVICES
FINANCIAL SUMMARY
GOVERNOR
FY 2013 FY 2014 RECOMMENDS
EXPENDITURE APPROPRIATION FY 2015
Administrative Services 2,034,491$ 1,987,214$ 1,997,757$
Youth Treatment Programs 52,447,747 54,191,501 56,000,493
Juvenile Court Diversion 3,739,813 4,079,486 4,079,486
TOTAL 58,222,051$ 60,258,201$ 62,077,736$
PERSONAL SERVICE
General Revenue Fund 17,867,132 18,172,530 19,161,866
Federal Funds 22,256,980 23,251,931 23,984,921
Other Funds 2,971,611 3,253,379 3,320,752
EXPENSE AND EQUIPMENT
General Revenue Fund 555,941 991,848 631,146
Federal Funds 4,598,330 6,559,101 4,907,263
Other Funds 2,618,914 3,861,406 2,579,820
PROGRAM SPECIFIC DISTRIBUTION
General Revenue Fund 4,580,809 3,590,625 3,981,163
Federal Funds 1,215,971 71,380 1,723,218
Other Funds 1,556,363 506,001 1,787,587
TOTAL
General Revenue Fund 23,003,882 22,755,003 23,774,175
Federal Funds 28,071,281 29,882,412 30,615,402
Other Funds 7,146,888 7,620,786 7,688,159
Total Full-time Equivalent Employees 1,331.76 1,279.21 1,279.21
General Revenue Fund 548.74 500.06 500.06
Federal Funds 690.24 689.94 689.94
Other Funds 92.78 89.21 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.
• ($24,166) federal funds reallocated to the Office of the Director.
11-12
DEPARTMENT OF SOCIAL SERVICES
MO HEALTHNET DIVISION
FINANCIAL SUMMARY
GOVERNOR
FY 2013 FY 2014 RECOMMENDS
EXPENDITURE APPROPRIATION FY 2015
Administrative Services 140,681,431$ 187,485,148$ 185,426,016$
MO HealthNet Vendor Payments and Managed Care 6,469,420,301 6,939,430,072 8,613,445,179
Blind Pension Medical Benefits 0 25,122,517 29,143,226
TOTAL 6,610,101,732$ 7,152,037,737$ 8,828,014,421$
PERSONAL SERVICE
General Revenue Fund 2,639,054 2,742,689 3,582,188
Federal Funds 4,916,297 5,331,318 6,224,615
Other Funds 1,206,428 1,766,989 1,804,061
EXPENSE AND EQUIPMENT
General Revenue Fund 12,214,746 10,576,665 10,737,165
Federal Funds 62,667,422 58,954,278 59,114,778
Other Funds 7,182,008 10,199,921 10,199,921
PROGRAM SPECIFIC DISTRIBUTION
General Revenue Fund 1,120,626,611 1,178,670,955 1,173,569,325
Federal Funds 3,125,628,363 3,494,672,097 5,247,059,159
Other Funds 2,273,020,803 2,389,122,825 2,315,723,209
TOTAL
General Revenue Fund 1,135,480,411 1,191,990,309 1,187,888,678
Federal Funds 3,193,212,082 3,558,957,693 5,312,398,552
Other Funds 2,281,409,239 2,401,089,735 2,327,727,191
Total Full-time Equivalent Employees 206.14 234.11 260.11
General Revenue Fund 61.91 64.53 77.53
Federal Funds 115.33 124.97 137.97
Other Funds 28.90 44.61 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.
• ($15,000,000) federal funds core reduction from the Fiscal Year 2014 appropriation level.
11-13
DEPARTMENT OF SOCIAL SERVICES
MO HEALTHNET DIVISION
MEDICAID EXPENDITURES
SELECTED SERVICES AND ANNUAL TOTALS
GOVERNOR
FY 2013 FY 2014 RECOMMENDS
EXPENDITURE APPROPRIATION FY 2015
Pharmacy 1,218,714,523$ 1,287,242,318$ 1,309,939,066$
Physicians 607,139,141 671,056,989 665,551,212
Dental 16,416,524 17,978,686 17,867,035
Premium Payments 178,886,284 181,712,730 205,351,061
Nursing Facilities and Home Health 555,017,395 583,957,865 586,811,685
Rehabilitation and Specialty Services 295,808,508 318,347,035 318,828,402
Managed Care 1,099,483,313 1,182,760,062 1,200,110,124
Hospital Care 782,377,548 813,770,245 778,521,943
Safety Net Hospitals 5,588,529 8,000,000 8,000,000
FRA and NFFRA 1,296,168,097 1,323,846,451 1,334,275,791
Health Care Access 9,262,406 10,540,915 9,960,562
Children's Health Insurance Program 171,919,507 180,875,309 177,271,420
School District Claiming 19,622,983 54,723,724 54,723,724
MO HealthNet Supplemental Pool 31,659,577 35,698,082 35,698,082
IGT Safety Net Hospitals 168,379,866 199,854,549 199,854,549
IGT Health Care Home 2,575,887 7,600,000 7,600,000
FQHC 10,400,213 15,570,000 14,449,149
Long-term Care UPL 045,895,112 45,895,112
Medicaid Expansion 0 0 1,642,736,262
Blind Pension Medical Benefits 0 25,122,517 29,143,226
TOTAL 6,469,420,301$ 6,964,552,589$ 8,642,588,405$
EXPENSE AND EQUIPMENT
General Revenue Fund 5,754,220 3,929,578 3,929,578
Federal Funds 4,646,260 5,772,103 5,772,103
Other Funds 1,669,597 1,507,625 1,507,625
PROGRAM SPECIFIC DISTRIBUTION
General Revenue Fund 1,120,626,611 1,178,670,955 1,172,109,325
Federal Funds 3,063,702,810 3,387,571,190 5,145,568,252
Other Funds 2,273,020,803 2,387,101,138 2,313,701,522
TOTAL
General Revenue Fund 1,126,380,831 1,182,600,533 1,176,038,903
Federal Funds 3,068,349,070 3,393,343,293 5,151,340,355
Other Funds 2,274,690,400 2,388,608,763 2,315,209,147
Total Full-time Equivalent Employees 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.
11-14
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.
