1 Department of Human Services Budget Request FY2013 Agency Budget Briefing February 22, 2012 Pat Quinn, Governor Michelle R. B. Saddler, Secretary

2 DHS Agency Budget for FY2013 General Revenue Fund – Dollars in billions FY10 Actual Expenditures = $3.997B FY11 Actual Expenditures = $3.894B FY12 Estimated Spending = $3.387B FY13 Appropriation Request = $3.385B

3 DHS FY2013 Budget Request Highlights The FY13 proposed budget represents a modest $2.0M GRF decrease from FY12 Agency estimated expenditures. As highlighted in the Governors budget message, DHS will be continuing to rebalance the long term care system for individuals with developmental disabilities and individuals with mental illness. As previously announced, DHS plans to close the Jacksonville Developmental Center and the Tinley Park MHC in FY13.

4 DHS FY2013 Budget Request Highlights Continued In addition, to the facility closures already announced, DHS plans to begin closure of Singer Mental Health Center and Murray Developmental Center in FY13. With these institutional setting closures, the Governors proposed budget includes $20.8M investment in the community for individuals transitioning from state operated DD facilities and $14.6M for community based mental health services in the areas impacted by MH facility closures.

5 DHS FY2013 Budget Request Highlights Continued In addition to the community investment for individuals transitioning from state operated centers, the budget request also includes $38.9M for implementation of the Ligas Consent Decree and over $37.0M for the costs associated with the Williams Consent Decree ($21.0M in GRF and $16.0M from the DHS Community Services Fund). The funding request for the Temporary Assistance for Needy Families includes a $114.9M increase due to caseload growth in FY12 and projected for FY13.

6 DHS FY2013 Budget Request Highlights Continued Unfortunately, there are many valuable programs that are being reduced in the Governors proposed budget. The Home Services Program budget reflects significant changes in eligibility and service costs maximums. The Child Care budget also includes policy changes concerning eligibility and quality investment in order to reduce expenditures. The TANF benefits will be limited to three years instead of the current five years.

7 DHS FY2013 Budget Request Highlights Continued General revenue funding for community youth services is being reduced. Addiction Prevention, general revenue funds, is eliminated in the Governors FY13 proposed budget.

8 DHS FY2013 Alcoholism and Substance Abuse Budget Request Highlights DASA will implement utilization management and quality review measures for Medicaid services to assure the most efficient and clinically effective use of scarce resources. Estimated savings from utilization management is $5.0M in FY13.

9 Alcoholism and Substance Abuse General Revenue Fund – Dollars in millions FY10 Actual Expenditures = $146.8M FY11 Actual Expenditures = $133.2M FY12 Estimated Spending = $130.1M FY13 Appropriation Request = $125.0

10 DHS FY2013 Developmental Disabilities Budget Request Highlights The FY13 budget request represents two significant actions in the States efforts to transition services for individuals with developmental disabilities from Long Term Care Facilities to Person Centered, Community Integrated Services: 1) the closure of SODCs, and 2) the implementation of the Ligas Consent Decree. The costs of operating SODCs will be reduced by $20.8M by the completed closure of Jacksonville Developmental Center, and the initiation of the closure of Murray Developmental Center in FY13.

11 DHS FY2013 Developmental Disabilities Budget Request Highlights Continued As part of these closures, the proposed budget includes $20.8M to support the transition of an additional 350 individuals out of state-operated centers to community-based settings. The proposed budget includes $38.9M to fund activities required under the Ligas Consent Decree. This includes funds for 200 individuals to move from private ICFs/DD to community-based settings and 700 individuals on the waiting list to receive services. DCFS transitions to DD community services are annualized and funding to support 90 additional transitions is reflected in the Governors introduced budget..

12 DHS FY2013 Developmental Disabilities Budget Request Highlights Continued In order to meet budgetary restrictions, Non-Medicaid program funding will be reduced by $18.2M. The community funding for DD services will see a continuation of payment cycles for long term care and community residential and day services. $50.0M of funding for DD community services will be funded from the Healthcare Provider Relief Fund..

13 Developmental Disabilities General Revenue Fund – Dollars in billions FY10 Actual Expenditures = $1.331B FY11 Actual Expenditures = $1.089B FY12 Estimated Spending = $1.109B FY13 Appropriation Request = $1.299B; *$1.349B including $50.0M from the Healthcare Provider Relief Fund

14 DHS FY2013 Family & Community Services Budget Request Highlights At the recommendation of the Human Services Commission the Divisions of Human Capital Development and Community Health and Prevention were merged into the Division of Family and Community Services. FY 2013 will be the first full year of operation for the Division. The division emphasizes a structure that provides services along a continuum of care from birth to death and represents a comprehensive approach to meeting the basic needs of DHS customers: access to food, nutrition education, prenatal care, housing assistance, quality child care, youth services, income assistance and other supportive services.

15 DHS FY2013 Family & Community Services Budget Request Highlights Continued The proposed budget includes funding in the income assistance lines to allow us to meet the estimated TANF caseload increase of 34.32% and to maintain all other income assistance caseloads. The FY 13 introduced budget includes funding to support rate increases for home child care providers and proposes to serve 171,000 children per month in FY13. A new LINK contract and contractor will start in FY13, resulting in an estimated savings of $9.8M for FY13. Income eligibility under the Emergency Food Assistance Program increased from 130% to 185% of FPL. Potentially 337,000 people will be eligible to access emergency food.

16 DHS FY2013 Family & Community Services Budget Request Highlights Continued Child Care funding for FY13 continues in the federal 347 fund at the FY12 level. The proposed budget supports Child Care program changes that include increased parent co-payments, reducing initial application eligibility to 150% of FPL and implementing upfront registrations for providers before they serve children. Emergency and Transitional Housing is being reduced by 51.7% and Homeless Prevention is maintained at the FY12 level. There will be 24 Family and Community Resource Centers consolidated throughout the state. The Infant Mortality and Intensive Prenatal appropriations were combined to promote use of these limited resources in a more coordinated manner.

17 DHS FY2013 Family & Community Services Budget Request Highlights Continued Support Services funding is increased in the FY13 budget for TANF clients engaged in employment and training activities. State funded portion of the Addiction Prevention services were eliminated in the FY2013 budget – approximately 33,500 school aged youth and adults will lose access to evidence-based substance abuse prevention services. Reductions are also noted in Healthy Families grants, Youth Programs (Teen Reach), Domestic Violence Shelters and Community Services.

18 Family & Community Services General Revenue Fund – Dollars in billions FY10 Actual Expenditures = $1.242B FY11 Actual Expenditures = $1.422B FY12 Estimated Spending = $.876B FY13 Appropriation Request = $.969B

19 DHS FY2013 Mental Health Budget Request Highlights The Governors introduced budget request includes $21.0M general revenue funds for the implementation of the Williams Consent Decree. This will be in addition to funds available in the DHS Community Services fund to support costs associated with the Williams Consent Decree and other rebalancing efforts. This funding will support transitions for an additional 384 individuals. The request includes $14.6M for rebalancing in Region 1S and Region 2 to reinvest in community services in those regions resulting in a community-based service system that is more Recovery –focused and better integrated with other human services supports.

20 DHS FY2013 Mental Health Budget Request Highlights Continued The FY13 budget request reduces GRF by $58.4M for community mental health services. The following programs are at risk for reductions or eliminations: Crisis ResidentialNon-Medicaid FFS Supported ResidentialChildrens MH Special Projects Supervised ResidentialPsychiatric Leadership Crisis ServicesMental Health Rental Subsidies Patient TransportationJuvenile Justice Programs Jail Data Link

21 Mental Health General Revenue Fund – Dollars in millions FY10 Actual Expenditures = $524.4M FY11 Actual Expenditures = $490.1M FY12 Estimated Spending = $498.1M FY13 Appropriation Request = $453.6M

22 DHS FY2013 Rehabilitation Services Budget Request Highlights The Home Services Program budget proposal includes $44.2M to support liability growth and annualization. The proposed budget reflects a $240.0M shift off GRF to a fund to be created to receive Federal Financial Participation generated from the Home Services program. The new fund will be used to support program liability. In addition, $60.4M in policy and programmatic changes will be implemented in order to preserve the integrity of the program and ensure it will be sustainable to those who need it in the foreseeable future.

23 DHS FY2013 Rehabilitation Services Budget Request Highlights The eligibility threshold, as assessed by the Determination of Need (DON), will be increased from 29 to 37. This change will impact approximately 1,500 new applicants, not existing customers. The Service Cost Maximums for customers with DON scores between 29 and 39 will be decreased to be more consistent with the Department on Agings Community Care Program. This may reduce services to up to 14,000 customers. Individuals with a diagnosis of only mental illness or developmental disabilities will not be allowed into the Home Services Program. This change will impact approximately 400 new applicants. With the exception of Respite, services to individuals under the age of 18 will be eliminated. This change will impact up to1,300 customers.

24 DHS FY2013 Rehabilitation Services Budget Request Highlights Individuals in the Brain Injury Waiver, who do not need a specialized service, will be transitioned to the Persons with Disabilities Waiver. This change will impact approximately 3,000 customers. The provider payment process with be tightened by piloting a new time sheet. In addition, payments will no longer be made to providers who do not complete a Medicaid Provider Enrollment Form. The eligibility requirements for Interim services will be limited in order to more narrowly define its use and time limits for service until Medicaid eligibility is determined. The program will continue to defer approximately $12M of program liability into the next fiscal year.

25 Rehabilitation Services General Revenue Fund – Dollars in millions FY10 Actual Expenditures = $598.3M FY11 Actual Expenditures = $605.6M FY12 Estimated Spending = $620.9M FY13 Appropriation Request = $379.6M; *$619.6M including $240.0 from the new HSP Medicaid Trust Fund

26 DHS FY2013 The DHS Budget Briefing Book will not be available in printed form, but the material can be reviewed or downloaded from the DHS Website at May we entertain questions about the Appropriation Request?