DDRB Targeted Case Management Peg Capo, MBA Executive Director Robyn Peyton Case Management Director

DDRB Mission: The DDRB is a leader, ensuring that individuals with developmental disabilities living in St. Charles County have quality opportunities and choices to be fully included in society. DDRB Vision: People have what they need to live the lives they choose.

History Political subdivision of St. Charles County established in 1977 Hired dedicated staff to support Board in 1993 Separate funding and provision of services Funding Approach “Last Dollar In” >> Partnership Not supplant other public funding sources

Regional Office Caseloads Skyrocketed DDRB lapsed funds increased The Environment County growth 81% population increase (1990 – 2015) 245% DDRB tax revenue increase (1990 – 2015) Regional Office Caseloads Skyrocketed DDRB lapsed funds increased By 2005, 16 counties provided targeted case management

Leadership: DDRB Finance Committee The Decision (2005) Leadership: DDRB Finance Committee Use of St. Charles County tax funds Do not supplant state’s responsibility Start-up/One-Time Funding expected Partnership Experienced County Boards DMH Division of DD, St. Louis Regional Office Stakeholders Agreement with DMH/DD Keep SLRO staff in St. Charles County Keep level of funding in St. Charles County Manage Medicaid-eligibility (Serve Adults 18+)

The Timeline September 2005 – Board approval January 2006 – Robyn Peyton hired as Case Management Director April 2006 – Hired Case Management Supervisor, 4 case managers and Administrative Assistant May 2006 Case Management Program Opens May 2006 First TCM Billing

Current Status Currently serving 1200 customers Current staffing includes 36 case managers (3 of which are mentors), 3 supervisors, assistant director of case management and director of case management. Target staffing ratio is 1:35 Average growth per year was 150 customers Staff were added as needed for growth

Lessons Learned - Program Caseload size Choice Continuity of staff Commitment to no waitlist Communication Flexibility

Lessons Learned - Financial Risk is related to Medicaid Eligibility Contract requires Case Management be provided to everyone, regardless of Medicaid-eligibility Non-Medicaid Case Management Uncompensated Break even at current $103/hr Medicaid rate requires 70 – 75% Medicaid eligibility Things Change! Current Medicaid Rate ($103/hr) under review Conflict Free Case Management affecting much of the state

Questions