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|
 |
Department of Social and Health Services
|
| GF-STATE
| ALL FUNDS
| FTEs
|
| Governor's 1997-99 proposal
| $5,154.6 million
| $11,278.2 million
| 17,820.9
|
| Net change from 1995-97
| $602.4 million
| $1,336.3 million
| 973.6
|
| Percent change from 1995-97
| 13.2%
| 13.6%
| 5.8%
|
M
ANY OF THE PROGRAMS administered by the Department of Social and
Health Services (DSHS) are facing significant changes as the federal
government moves to redefine its role in relation to state and
local governments - particularly in the area of social services.
The new federal welfare law (P.L. 104-193) eliminates several
major income-assistance programs that have been in existence since
the New Deal of the 1930s and replaces them with a capped block
grant to the states that puts new restrictions on who can qualify
for aid. While providing some flexibility in how states administer
those funds, the new law imposes a number of new costs and reduces
federal funding for public assistance programs in Washington by
an estimated $379 million in the 1997-99 Biennium.
Changes in federal funding account for $102.3 million (20.8 percent)
of the $490.8 million General Fund-State (GF-S) net increase in
the base ("maintenance level") budget for DSHS in the
1997-99 Biennium. Program areas affected by these changes include
income assistance, children's services, juvenile rehabilitation,
child support, and drug and alcohol treatment services. The cost
to the state of responding to P.L. 104-193 is actually higher
than $102.3 million, but additional costs are offset by a $90.4
million increase in the Federal Medical Assistance Percentage
(FMAP), which is established by a federal formula unaffected by
the new welfare law.
New policy initiatives recommended by the Governor will increase
state funding for children's services, child care, juvenile rehabilitation,
and efforts to address the problem of domestic violence. He is
also proposing additional state support for food banks, commodity
purchases, and food assistance for legal immigrants to help mitigate
the effects of federal cutbacks in nutritional programs for low-income
people.
Supplemental Security Income
Under the new welfare law, the federal government will realize
significant cost savings through reductions in the Supplemental
Security Income (SSI) program, which provides income assistance
to low-income people who are elderly, blind, or otherwise disabled.
An average SSI client currently receives $470 per month from
the federal government, supplemented by $25.32 from the state.
P.L. 104-193 will deny SSI eligibility to approximately 11,000
legal immigrants in Washington State, along with 987 non-immigrant
children with severe behavioral problems or medical conditions
that do not meet the new criteria established in the law.
- Legal Immigrants - $91.6 million GF-S, 62.8 FTES: Beginning
in April 1997, approximately 11,000 will lose eligibility
for federal SSI benefits as their cases are reviewed in light
of the new welfare law. Under current state law, these elderly,
blind, and disabled people will become eligible for the state-funded
General Assistance-Unemployable (GA-U) program, which provides
income assistance grants averaging $339 per month. The Governor's
budget fully funds those cases and provides additional staff to
handle the increased GA-U workload and increased medical exams.
- Temporary Aid for Needy Families - $3.8 million GF-S, $3.8
million GF-F, 5.1 FTEs: Approximately 610 non-immigrant
children who will lose SSI benefits under the new federal criteria
live in families that are eligible for Temporary Aid for Needy
Families (TANF), the new block grant program that is replacing
Aid to Families with Dependent Children (AFDC).
- Foster Children - $3.1 million GF-S, $1.1 million GF-F,
10 FTES: Changes in SSI eligibility are expected to result
in the loss of state SSI recoveries for approximately 224 children
in foster care each year. The Governor's budget proposal restores
these losses to the state and provides additional staff to conduct
SSI redeterminations and hearings for the remaining children in
foster care. Without this effort, many more children would lose
SSI eligibility.
- Long-Term Care Impact - $1.1 million GF-S: Legal immigrants
who live in community based residential long term care facilities
are required to participate in their cost of care. With the loss
of SSI eligibility, the GA-U grant will not cover their full cost
of care. These funds restore their patient contribution levels.
- Naturalization Efforts - $2.4 million GF-S cost; savings
of $13.7 million GF-S: Many legal immigrants have been living
in the United States for years, but have not applied for U.S.
citizenship because they are not confident of their English
proficiency or lack the knowledge about civics necessary to pass
the test. The Governor's proposal will fund efforts by community-based
organizations to work with this population so that they can achieve
U.S. citizenship. By doing so, many immigrants will be able to
re-establish their eligibility for federally-funded programs.
This naturalization effort will save an estimated $13.7 million
in state GA-U costs and reduce pressure on food assistance programs
as discussed below.
- SSI State Supplemental Payment - Savings of $6.2 million
GF-S: With the many changes in Supplemental Security Income
(SSI) eligibility at the federal level, the caseload for SSI will
decline significantly. This being the case, DSHS will return
to a standard payment level method of calculating the state supplemental
payment beginning on January 1, 1997, resulting in savings for
the state.
Food Stamps
Under P.L. 104-193, the federal government plans to reduce its
expenditures on food stamps by $23 billion over the next six years
- accounting for more than 40 percent of the $54.5 billion in
federal savings assumed under the new welfare law. Federal savings
are achieved by denying food stamps to legal immigrants who have
not received citizenship, reducing the value of food stamps to
other families and individuals, and capping the allowance for
shelter costs. Beginning in January 1997, able-bodied people
ages 18 to 50 with no dependents can only receive food stamps
for three months out of any 36-month period unless they are engaged
in qualifying work activities.
Cutbacks in the federal Food Stamp Program will result in an estimated
loss of $196.4 million in direct support to low-income
families in Washington over the next two years. As a result of
these changes, more than 200,000 low-income families in Washington
will see their federal food stamps allowances reduced or cut off
next year. Of that total, more than 38,000 legal immigrants -
many working minimum-wage jobs to support children and elderly
parents - will lose eligibility for food stamps next year. Below
are the measures Governor Lowry is proposing as
the state's response to these impending reductions in federal support for food purchases.
- State Food Program for Legal Immigrants - $43.6 million
GF-S: The Governor's proposal establishes a state-administered
food program for legal immigrants to mitigate the loss of federal
food stamps. Approximately 38,000 legal immigrants currently
receive a monthly food stamp allotment of $75.00. The Governor's
proposal would provide $50.00 for each person through a voucher
or for federal food stamps purchased by the state. The naturalization
effort described above will allow an estimated 4,340 persons to
gain U.S. citizenship, re-establish eligibility for food stamps,
and reduce pressure on the new state food program.
- Food Banks - $9 million GF-S (in the Department of Community,
Trade and Economic Development budget): Food banks are an
integral link in providing food to needy residents. The Governor's
budget proposal provides funding to allow food banks to buy additional
food to accommodate the increased pressure food banks will face
in the next biennium as a result of federal cutbacks in the food
stamp program.
- Commodities Program - $3.4 million GF-S (in the Department
of General Administration budget): The state has long been
a partner with the federal government in distributing food in
bulk commodities to food banks, soup kitchens, and other outlets.
The Governor's proposal provides additional state funding to
help make up for reductions in federal support for the bulk commodities
program since 1995.
- Work Program for 18 to 50 Year Olds - $5 million GF-S,
$4.2 million GF-F: Under the federal welfare bill, able-bodied
people between the ages of 18 and 50 will be denied food stamps
after three months unless they work or participate in a state-approved
employment program. This work requirement provision can be waived
in counties with unemployment of over 10 percent (19 counties)
and areas where there are insufficient jobs (17 counties). In
the non-exempt counties (King, Thurston, and Spokane) DSHS will
work with private community-based organizations to establish work
participation programs.
- Grant Increase - $15.3 million GF-S, $44.5 million GF-F:
Approximately 96 percent of all current AFDC recipients also
receive food stamps. To help offset scheduled reductions
in federal food stamp benefits, the Governor is proposing a cost-of-living
(COLA) increase for public assistance clients as part of his compensation
package for the 1997-99 Biennium. As noted in the discussion
of the Governor's overall compensation package in Part II of this
document, public assistance clients have not received a COLA since
January 1993. Under the Governor's plan, monthly grants will
increase by 2.5 percent on July 1, 1997 and an additional 2.7
percent on July 1, 1998.
Temporary Aid for Needy Families
Under the new Temporary Aid for Needy Families (TANF) program
created by the new federal law, grant recipients must find work
within two years after first receiving assistance or their benefits
will be terminated. States must ensure that 25 percent of all
welfare recipients are engaged in work in 1997 - a requirement
increasing annually to 50 percent by 2002 - or face financial
penalties. In two-parent families, the minimum participation
rate is 75 percent in 1997, rising to 90 percent in 1999. States
may count vocational training toward meeting these requirements,
but only for one year per client. Job search and readiness training
is limited to four consecutive weeks, or six weeks total.
Since September 1995, Washington has required most recipients
of AFDC cash assistance to participate in education or job-training
programs as a condition of receiving benefits. Since then, AFDC
caseloads have shown a steady decline, and are expected to drop
even further in the future resulting in estimated savings of $16
million GF-S and $14.7 million GF-F in the 1997-99 Biennium.
Under the TANF plan Governor Lowry will submit to the federal
government in January, 1997, Washington State will be allowed
to continue its mandatory education and training program. Using
the state's existing Success Through Employment Program (STEP)
waiver, exemptions from work requirements will be preserved for
single parents with children under three and those caring for
a disabled child.
Using the new flexibility provided under the TANF program, the
Governor's budget proposal realizes some savings and directs additional
state funding to meet new federal requirements and help those
in need.
New Costs
- Mandatory Work-Participation - $8.2 million GF-F, 6.4 FTEs:
To comply with new federal requirements, the state will have
to provide additional funding to meet work-training costs for
an additional 2,433 two-parent families in 1998 and an additional
3,226 two-parent families in 1999. Funds provided include costs
of education and training program, along with necessary child
care.
- Enhanced Work Participation Program - $18.3 million GF-F,
7.6 FTEs: The Governor's proposal uses available federal
revenues to support additional training and education to
prepare those receiving assistance to become self-sufficient and
stay off welfare. These funds will allow 1,000 to 1,500 additional
single-parents to participate in these programs. A portion of
these funds are also used to enhance the level of funding for
each participant in the program.
- Community Services Training - $916,000 GF-F: To ensure
that Washington's job training program continues to be successful,
workers in DSHS local offices need to understand the complexities
of the impending changes in welfare policy. The Governor's budget
includes funding to provide that training.
- Information System Changes - $ 4.1 million GF-S, $7.8 million
GF-F: New requirements imposed by P.L. 104-193 will require
the state to change its computer systems in order to comply with
new eligibility rules and expanded tracking and reporting requirements.
- Homelessness Prevention - $5 million GF-S (in the Department
of Community, Trade and Economic Development budget): Despite
other measures included in the Governor's budget proposal, the
new federal welfare law will put additional individuals and families
at risk of becoming homeless. The Governor's proposal provides
funding to increase homelessness prevention efforts through intervention
services that include small loans or grants to families at risk
of losing their housing, coupled with training, financial planning,
and other services.
Cost-Saving Measures
- Child Support $50 Pass-Through - Savings of $23.4 million
GF-S: Under the new welfare law, the federal government will
no longer share in the cost of providing the first $50 collected
from child support payments to families receiving TANF grants.
Because only one in five families has child support income, the
state will also discontinue its part in this program.
- Grant Savings Resulting from Enhanced Work Program - Savings
of $4.5 million GF-S, $4.9 million GF-F: By providing
additional work opportunities, fewer families will be dependent
on their monthly grant amount for income. Cost savings included
in the Governor's proposal are based on the assumption of a 2
percent increase in "exits" from both the single- and
two-parent portions of the assistance program.
- Streamlining Eligibility - Savings of $2.2 million GF-S
and $1.8 million GF-F, reduction of 46.8 FTEs: Under the
new federal welfare law, DSHS will be able to save administrative
costs by eliminating the three-tiered income test, the graduation
requirement, retrospective budgeting of income, and extending
eligibility reviews to 12 months instead of six.
- License Suspension - Net savings of $1.4 million GF-S and
$493,000 in Other Funds: The federal welfare bill requires
that states enact laws that allow for the suspension of driver's,
professional, occupation, and recreational licenses for those
parents with child support arrearages. These statutory changes,
which the Governor has proposed for the past two years, are expected
to increase compliance with court-ordered child support decrees
and reduce state costs for cash assistance.
- Grant Diversion - Savings of $143,000 GF-S, 1 FTE: Many
times families seek public assistance because of a short-term
crisis - lack of rent payment for one month, a broken-down car,
medical bills. This program would provide up to three months
of cash assistance to get a family through its immediate crisis
and avoid resorting to public assistance.
- Family Planning Services - Net savings of $396,000 GF-S,
$7.4 million GF-F (funding in the Department of Health, savings
in DSHS): The Governor's proposal is designed to realize
financial benefits provided in the new federal welfare law to
states that reduce out-of-wedlock births. Successful states will
have the opportunity to access a share of a $20 million federal
bonus. These funds will make family planning services available
to low-income families. As a result of this effort, Washington
State will see savings in labor and delivery expenditures, and
in medical costs for unintended pregnancies.
Child Care
Whether by choice or economic necessity, more than 62 percent
of all mothers with children under six are in the labor force.
If mothers of young children are to enter or remain in jobs,
they need adequate care for their children while they work. Given
the new work requirements under the federal welfare bill, it is
imperative that the state increase its efforts to support child
care for low-income mothers so that they can enter - or remain
in - the workforce. The Governor's budget proposal directs DSHS
to plan for a "seamless" state child care system that
incorporates two different programs - the Employment Child Care
program and the Transitional Child Care program - which serve
similar clients but have different eligibility standards and co-payment
rules. With the merging of these two programs, Washington State
will have a more cohesive approach to providing child care assistance
to low-income working families.
- Market Rates - $14.2 million GF-S, $6.5 million GF-F:
Federal law previously required states to pay rates to child
care vendors up to the 75th percentile of the market rate to ensure
equal access. The new federal welfare law has a comparable requirement
that access to child care be assured. The Governor's proposal
increases child care rates by 4.13 percent in FY 1998 and 10.35
percent in FY 1999 to help low-income families obtain quality
child care.
- Child Care Food Program - $17 million GF-S (funding in
the Office of Superintendent of Public Instruction): The
federal welfare bill reduced funding for the Child Care food program
administered by the Office of the Superintendent of Public Instruction.
Over the next six years, the federal government will reduce reimbursements
for meals served by child care providers, who rely on these payments
to stay in business. The Governor's proposal replaces federal
funding lost in the 1997-99 Biennium.
- Child Care Provider Training - $1.2 million GF-S: Well-trained
staff are essential in assuring that Washington's child care centers
and family day care homes provide high-quality care to young children.
This proposal funds a 15-hour training program for family child
care providers and mandates training for workers in centers.
Funds for vouchers for low-income staff are also included.
- Child Care Development Fund - $672,000 GF-S, $728,000 GF-F:
These funds would provide grants to child care homes and
centers to support the expansion of child care capacity with an
emphasis on off-hour care and in areas where welfare recipients
will be seeking employment.
- Resource and Referral - $240,000 GF-S, $260,000 GF-F:
This proposal expands child care resource and referral efforts
to educate and assist parents in choosing child care. Funding
proposed by the Governor will also allow these agencies to expand
into unserved areas and offer referral services to welfare clients
unable to find child care.
- Fire Safety Inspections - $262,000 GF-S: Ensuring
children's safety in child care centers and group homes is a paramount
concern. Lack of funding has resulted in a lag in the timing
of fire inspections. The Governor's proposal would provide funding
to contract for fire inspections and safety training for licensers
and providers.
Children's Services Enhancements
Since taking office, Governor Lowry has made children's health
and safety one of his top priorities. The supplemental budget
approved by the 1996 Legislature included a total of $10.8 million
($7.5 million GF-S) for improvements recommended by the Governor,
adding 109 social workers; increasing the number of licensers
for child care, foster, and group homes; and providing $1.1 million
to conduct a Management Improvement Project (MIP) at the Children
and Family Services Division of DSHS, now known as the Children's
Administration.
Besides supporting the $30 million carry-forward cost of those
initiatives, the Governor's 1997-99 budget proposal includes $74.5
million ($58.7 million GF-S) to support additional improvements
in children's services. It also replaces 73 percent of the $8.9
million cutback in federal funding for the Social Services Block
Grant, which is used primarily to support Children's Protective
Services (CPS) and other children's programs. In addition, the
Governor's proposal increases funding for the Family Policy Council
and the Community Public Health and Safety Networks, which have
all developed plans on how their communities will respond to reduce
child abuse and neglect, teen pregnancy, substance abuse, teen
violence, teen suicide, domestic violence, out-of-home placement,
and school dropouts.
- Worker Caseloads - $11.4 million GF-S, 133.8 FTEs:
The 1996 supplemental budget provided funding to reduce the
average workload from 36 cases per worker to 32 cases by July 1997. That
ratio is still, however, far higher than the nationally recommended
standard of 1 to 15. The Governor's 1997-99 budget recommends
adding 113 social workers to continue the 32-cases-per-worker
ratio and adds 83 more social workers to bring caseloads down
to 1 to 29. This level of staffing achieves "Standard 1"
of the department's workload study.
- Training, Quality Assurance, and Supervision - $6.9 million
GF-S, 32.7 FTEs: The need for improved oversight and training
remains an issue for both caseworkers and those who contract with
the state to provide child care, foster care, and other services.
The Governor recommends reducing the span of control so that
supervisors have no more than eight social workers reporting to
them. His budget proposal also supports 64 hours of advanced
social worker training for caseworkers, and includes funding for
the "Passport" program. This program would provide
a concise record of a foster child's current medical, dental,
behavioral, psychological and education status along with a record
of vaccinations, allergies, medications and upcoming appointments.
This will provide the continuity for social workers to more adequately
address the health needs of children in the state's care.
- Substance Abuse and Special Needs - $16.3 million GF-S,
22.1 FTEs: Recent data show that more than half of all children
placed in out-of-home care come from families with substance-abuse
problems. The Governor is recommending additional funding to
hire chemical-dependency specialists to work directly with families
and provide assistance to field staff. Funds are also provided
for additional chemical dependency treatment, providing services
to all currently unserved sexually aggressive youth and increasing
the capacity of tribal governments to provide basic services to
Indian children and their families. Funding is also recommended
to provide early intervention specialists in selected school districts
to deal with children who suffer from emotional difficulties,
abuse, neglect and other problems.
- Prevention Strategies - $7 million GF-S: Besides strengthening
the state's response to child abuse and neglect, the Governor's
proposal also provides additional support so that communities
can implement proven strategies to prevent these problems. Funding
is provided for the Community Public Health and Safety Networks
to develop two programs: the first is a pilot program for selected
networks to sponsor home health nurse visits in all homes with
newborn children. The second program would be unrestricted funding
for the 53 community networks to focus on services for families
who are at risk of CPS involvement. These programs will augment
efforts by the networks to implement plans designed to address
the problems of young people in their communities.
- Foster Care and Adoption Services - $9.5 million GF-S:
A strong, foster care system is essential in the continuum of
services for children and families. In order to increase the
number and quality of homes, the Governor's budget proposal increases
base funding for family foster homes and private child-placement
agencies. In addition, funding is provided for specialized independent
living situations for adolescents, and for additional home studies
to allow more children to be placed in permanent adoptive homes.
- Child Fatality Review Process - $1.7 million GF-S, 6.3
FTEs: The State of Washington currently reviews child fatalities
only when the child has had DSHS involvement in the past year.
There is a need to extend this review to all child fatalities.
Information gathered will be used to assess all current programs
and strategies.
- System Change - $2.9 million GF-S, 19 FTES: Preliminary
findings by the Management Improvement Project (MIP) indicate
that additional resources are needed to accelerate redesign of
CAMIS, the primary computer system for children's services. The
Governor's proposal also responds to the need for a review of
the work flow of social workers and lead workers, so that they
can adjust work priorities.
Juvenile Justice
There are approximately 1,400 young people in state juvenile rehabilitation
institutions and group homes administered by DSHS. This population
is forecast to grow to 1,500 by the year 2000. The characteristics
of the juvenile rehabilitation population indicate a need for
treatment and rehabilitative services to address specific problems
that place these youths at greater risk for delinquency and reoffense.
Approximately 82 percent of juvenile offenders are chemically
dependent, while 46 percent need mental health treatment. Through
his Juvenile Justice Initiative, the Governor is proposing a $16.2
million GF-S package of sentencing changes and program enhancements
that responds to these issues in a comprehensive fashion.
- Juvenile Offender Sentencing Revisions - $7.5 million GF-S,
40.8 FTEs: As part of his Juvenile Justice Initiative, the
Governor will introduce legislation that deals with a broad array
of juvenile issues, including key recommendations of the Sentencing
Guidelines Commission. Major provisions of the Governor's proposal
would simplify the juvenile sentencing system; increase penalties
for serious sex offenses and crimes involving a firearm; allow
alternative sentencing for chemically dependent youth; and expand
parole conditions to include participation in substance abuse
and mental health treatment. It would also require parents to
attend their children's hearings and create a youthful offender
option for judges to impose a dual juvenile/adult sentence.
- Juvenile Parole Aftercare and Supervision - $5.2 million
GF-S, $330,000 Local, 30.5 FTEs: With additional support
provided in the Governor's budget proposal, DSHS will develop
an intensive parole supervision program for the top 25 percent
of highest risk juvenile offenders.
- Increase Mental Health Services - $576,000 GF-S: Funding
is provided to make contracted psychiatric and psychological services
available at all institutions and state group homes.
- Employment Programs for Youthful Offenders - $2.9 million
GF-S: The Governor's proposal will allow DSHS to develop
a Juvenile Industries Model for pre-vocational, pre-apprentice,
vocational, community service, along with employment programs
for youthful offenders. This program will be developed in conjunction
with the Corrections Clearing House and the Employment Security
Department.
- TeamChild - $100,000 GF-S (funding is in the Department
of Community, Trade and Economic Development budget): This
program is designed to provide a full continuum of social services
for young people in the court system, including advocacy and case
management. Juvenile Courts, in collaboration with the public
defender community, will provide services to at-risk youth to
maximize the effectiveness of other social service providers.
Domestic Violence
Governor Lowry's budget recommendations for the 1997-99 Biennium
continue his commitment to eradicating domestic violence. Combining
$1.3 million GF-S with $3.9 million in federal funds, his proposal
builds on the strengths of existing programs, maximizes the use
of new federal grants for domestic violence programs, and provides
additional support for prevention strategies, intervention, and
support services.
- Washington State as an Employer - $244,000 (Personnel Services
Revolving Fund): The Department of Personnel (DOP) will
be directed to provide assistance to victims and perpetrators
of domestic violence through the Employee Assistance program.
DOP will also assist state agencies in providing domestic violence
training and make a sample policy available to all agencies and
institutions of higher education.
- Strengthening the Statewide Network of Domestic Violence
Programs - $1.4 million (GF-F): Washington State currently
provides $7 million from state and federal sources for a statewide
network of domestic violence programs to provide necessary services
to victims. Currently, seven counties do not have their own program,
and many programs are unable to operate their shelters on a 24-hour
basis. These additional federal resources can address these shortfalls
and fund new programs in parts of the state where none currently
exist.
- Children of Victims of Domestic Violence - $1 million GF-S,
$1.8 million (GF-F): Studies have found that children who
witness domestic violence exhibit more aggressive and antisocial
behavior, are more fearful and inhibited, and have lower social
competence. Approximately 14,200 women and children are served
by domestic violence programs each year in Washington State.
However, domestic violence programs do not have the resources
to devote services to these children. The Governor's budget proposal
provides funding for children's advocates to act as case managers
in each of the 40 state-supported domestic violence programs.
- Increase Support for Legal Advocacy Services - $423,000
(GF-F): Legal advocacy is one of the most effective ways
to support a victim's choice to leave a batterer and seek protection
through the criminal justice system. Washington State has been
supporting this activity for the past five years by allocating
funds from Byrne Grant funds received from the federal Department
of Justice. Additional funds will increase support for these
legal advocacy services funded through the Department of Community,
Trade and Economic Development.
- Increase Awareness and Prevention of Domestic Violence
- $200,000 GF-S: The first step in preventing domestic violence
is to increase public awareness through information and training.
The Washington State Coalition Against Domestic Violence has
served as the central community resource in providing training
for domestic violence programs through educational seminars on
domestic violence for the general public. These additional funds
will promote awareness and prevention of domestic violence through
increased efforts of the Coalition Against Domestic Violence.
- Training for the Criminal Justice Community: $50,000 GF-S
and $100,000 (GF-F): Persons working with victims and perpetrators
of domestic violence need to have a better understanding of this
problem. The Governor's proposal makes domestic violence training
mandatory for law enforcement officers, prosecuting attorneys,
and judges. Funding is provided to support this training, and
to expand data collection and analysis on domestic violence by
the Washington Association of Sheriffs and Police Chiefs
Drug and Alcohol Programs
Under H.R. 3136, the 104th Congress prohibits eligibility for
Social Security Disability Insurance (SSDI) and Supplemental Security
Income (SSI) benefits for individuals whose drug addiction and/or
alcoholism is material to the finding of disability. Current
beneficiaries of those programs who have these addictions will
lose their benefits after January 1, 1997.
Up to half of the 4,700 drug- and alcohol-dependent people currently
receiving benefits through SSDI or SSI are expected to apply for
benefits under the General Assistance-Unemployable (GA-U) program
or under the state Alcoholism and Drug Addiction Treatment and
Support Act (ADATSA). The fiscal impact of the resulting increase
in GA-U benefits for these clients is estimated at $29.3 million
GF-S in the 1997-99 Biennium. The Governor's budget proposal
addresses these additional costs, while also expanding treatment
to help these people break their addictions and lead productive
lives.
- ADATSA for SSI/SSDI Clients - $5.63 million GF-S: Of
the 4,700 individuals currently receiving SSI/SSDI benefits due
to an alcoholism or drug addiction disability, it is anticipated
that 510 will seek Alcoholism and Drug Abuse Treatment and Support
Act (ADATSA) services.
- Expand ADATSA Capacity - $3.96 million GF-S: Funds
are provided to expand the treatment capacity of the Alcoholism
and Drug Abuse Treatment and Support Act (ADATSA) program to accommodate
the significant growth in people eligible for the program. The
program does not have sufficient capacity to serve all clients
currently eligible for chemical dependency treatment.
- Fetal Alcohol Syndrome - $1.4 million GF-S: Funds
are provided for an advocacy program to provide coordinated services
to the highest risk mothers who are abusing alcohol.
Medical Assistance
Medical Assistance Administration is continuing its move towards
managed care arrangements rather than fee-for-service. Virtually
all clients in Aid to Families with Dependent Children, the First
Steps program , and children's programs are currently in managed
care arrangements for most of their medical care. Beginning in
February 1997, the state will move to managed care SSI clients
not receiving Medicare. Governor Lowry's Medical Assistance budget
supports these initiatives in the 1997-99 Biennium.
- Expanded Selective Contracting - Savings of $4.7 million
GF-S, $2.3 million Other Funds: Savings in hospital costs
would be realized from greater discounts through the selective
contracting program, expanding it to include "centers of
excellence" for organ transplants and inclusion of uncompensated
managed care costs in the Disproportionate Share Hospital (DSH)
program. Hospitals that participate in the selective contracting
program would be required to provide greater discounts. Hospitals
that choose not to participate are limited to emergency admissions
for medical assistance clients. Under the "centers of excellence"
approach, fewer hospitals would provide organ transplant services
for medical assistance clients.
- Limit Managed Care Rate Increases - Savings of $15.1 million
GF-S, $20.7 million Other Funds. Savings would be achieved
by keeping managed care rate increases to an overall rate of 2
percent annually.
Aging and Adult Services
Long term care services in Washington State has seen a shift away
from heavy reliance on nursing homes to expansion of less costly
community options. Since the passage of ESHB 1908 in 1995, DSHS
has been aggressively reducing nursing homes placements in favor
of community care. The Medicaid nursing home population, which
stood at 16,292 at the start of the 1995-97 Biennium, is expected
to drop below 15,000 by the beginning of the next biennium. This
decrease in the nursing home census will save the state $33.6
million GF-S and $35.1 million GF-F. This is almost enough to
cover the cost of mandatory nursing home rate increases, projected
to require expenditures of $36.5 million GF-S and $38.2 million
GF-F in the 1997-99 Biennium.
Most of the increase in the Governor's 1997-99 base budget for
Aging and Adult Services is the $149.5 million supporting caseload
growth in community-based care. Contributing to this increase
is a growing population of elderly and disabled people, the expansion
of long term care options, improved access to services, and a
growing client preference for home and community care. In addition,
the Governor's budget provides some additional funding to improve
the quality of care in these residential settings.
- Residential Services Quality and Safety - $2.9 million
GF-S, $1.7 million Other Funds. The Aging and Adult Services
Administration intends to expand training for providers of adult
family homes, increase the frequency of adult family home inspections,
and provide for more frequent case manager visits at long term
care residential facilities. The Division of Developmental Disabilities
has similar proposals for training, certification, and quality
improvement in their residential services, but with special emphasis
on the needs of clients with developmental disabilities.
Other Initiatives
The Governor's budget proposal also includes several initiatives
designed to improve the quality of care for clients served by
DSHS, protect their health and safety, and ensure that providers
have adequate resources to provide these services.
- Targeted Vendor Rate Increase - $49.8 million GF-S, $33.4
million GF-F: Some DSHS vendor groups - including nursing
homes, hospitals, and child care providers - receive mandated
rate increases within the maintenance level budget. However,
other vendors must also meet the increased cost of living. The
Governor's budget proposal provides cost-of-living increases to
selected DSHS vendors of 2.5 percent on July 1, 1997 and 2.7 percent
on July 1, 1998.
- Community Protection Initiative - $3.1 million GF-S, $3.2
million Other Funds. The Division of Developmental Disabilities
will move 40 persons with dangerous behaviors out of adult family
homes and other settings into more secure residential facilities.
These persons have histories of sexual violence, physical assault,
and arson, and are considered to be dangerous to themselves and
the communities where they live. They will be moved into specially
designed Intensive Tenant Support services that will include 24-hour
supervision, employment/day programs, and behavior therapy.
- Criminal History Background Checks - $1.8 million GF-S,
$1.2 million Other Funds. DSHS is proposing legislation to
require background checks on all its employees whose duties require
them to have unsupervised access to children and vulnerable adults.
The bill also requires background checks on contractors, licensees,
and their employees who also have similar access to these people.
The Governor's budget proposal supports these measures to ensure
the safety of all DSHS clientele.
- Mental Health Managed Care Initiative - Savings of $16.5
million GF-S, $8.1 million Other Funds. Community inpatient
hospitalization services are currently on a fee-for-service basis,
while outpatient services have been on Prepaid Health Plans since
early 1996. In FY 1998, inpatient services will be integrated
with outpatient services under a single capitated managed care
system for Medicaid eligible mental health clients. This is intended
to prevent cost shifting and ensure clients receive services appropriate
to their needs.
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