1. 1 FY 14 County Executive’s Recommended Budget Department of Health and Human Services Community Budget Presentation Wednesday, March 20, 2013

2. 2 County Executive’s Policy Priorities  A Responsible and Accountable County Government  Affordable Housing in an Inclusive Community  An effective and efficient transportation network  Children Prepared to Live and Learn  Healthy and Sustainable Communities  Safe Streets and Secure Neighborhoods  A strong and vital economy  Ensuring Vital Living for All of Our Residents

3. 3 Tax Supported Changes for Outside Agencies Schools = $55.8 million (2.8% increase) College = $9.2 million (4.2% increase) Park and Planning = $4 million (3.7 % decrease)

4. 4 FY14 CE Recommended HHS Budget Overview  FY14 County General Fund Recommended Expenditures = $185,612,194 (2.1% increase from the FY13 Approved budget of $181,733,135)  FY14 Recommended budget from all revenue sources = $253,791,455 and a total of 1,547.26 work years (0.6% increase from FY13 level of $252,303,162  State budget still pending and uncertainty continues relative to Federal Sequestration - funding levels to Montgomery County currently unknown.

5. 5 DHHS Strategic Areas of Focus  Strengthening infrastructure through Technology Modernization and a focus on efficiencies  Improving our No Wrong Door approach to service delivery by continuing our work on service integration, equity, improved access for all vulnerable populations and improving the quality of our service delivery  Continue to expand Healthcare Access to the vulnerable and maximize our efforts through healthcare reform  Continue our efforts to strengthen our partnership with our non-profit sector  Strategically plan for and delivering services using data

6. Context for CE Decisions Mr. Leggett had the following key criteria in developing the budget: 1. No additional positions 2. Growth to be capped at around 4% 3. Much needed compensation for employees 4. Where possible no reduction to programs and services 6

7. HHS budget facts:  Original MARC for HHS $180,138,009. The CE Recommended budget $185,612,199 an increase of $5.5 million. There are no reductions to General Fund programming.  Of the $5.5 million, $2.25 million is to support employee wage and benefit adjustments.  DD Waiver – Currently showing in the budget as a reduction but as of now negotiations with State are still underway. 7

8. 8 FY 14 Budget Overview  Budget increased to $253,791,455 (almost $1.5 million more than FY13 funding levels). Total $253,791,455 Federal & State Grant Funds 34,991,579 14% State HB669 Grant Funds 33,187,682 13% County General Funds 185,612,194 73%

9. 9 FY14 DHHS Budget by Service Area

10. 10 Complexity of Need Manna Food Center Food Distribution 2008 - 2012 In 2012, MANNA served 184,215 individuals. While the number of households remained constant, households came more often for food there was a significant increase in the smart sacks programs for children.

11. 11 Housing Costs Source: U.S. Census Bureau, American Community Survey 2000, 2005, 2008, 2011

13. 13 Self-Sufficiency Standard Montgomery County 2012 Adult + infant + Monthly Costs Adultinfantpreschoolerschoolageteenagerschoolageteenager2 Adults Housing $1,479$1,677 $1,479 Child Care $0$1,049$1,174$608$0$1,656$1,049$0 Food $256$382$389$457$486$576$604$506 Transportation $181 $362 Health Care $155$393 $405$424$417$436$443 Miscellaneous $207$368$381$333$277$451$395$279 Taxes $727$1,245$1,322$1,070$844$1,557$1,240$793 Earned Income Tax Credit (-) $0 Child Care Tax Credit (-) $0-$50 $0-$100-$50$0 Child Tax Credit (-) $0-$83 -$167 $0 Self-Sufficiency Wage (per adult) Hourly $17.07$29.33$30.59$26.12$21.62$35.50$30.48$10.97 Monthly $3,005$5,161$5,384$4,597$3,806$6,249$5,365$3,862 Annual $36,060$61,936$64,606$55,161$45,666$74,983$64,378$46,340

14. 14 Growth in Clients Served by PMHS (Public Mental Health System) Note: The cumulative increase between FY07 and FY12 as of June 30, 2012 is 56% for total number of PMHS clients in the county.

15. 15 Public Assistance Needs  Caseloads continue to increase since FY07 and, as of December 31, 2012, are at the following levels:  Temporary Cash Assistance (TCA): 995 (43.4% increase),  Food Supplement Program (FS): 30,137 (166% increase), and  Medicaid (MA): 49,425 (68.7% increase). The Food Supplement Program caseload has more than doubled since FY07.  Total applications for these programs increased dramatically from FY07 through FY12: TCA by 72%; FS by 117%; and MA by 58%.  Applications for the first 6 months of FY13 continue to remain high.

16. 16 Health Needs  27,814 County residents received primary care and related services under the Montgomery Cares program in FY12, a 32% increase over FY09. However, expansion in the number of patients served has grown only modestly since FY10, due to budget constraints. As a result of expanded funding, Montgomery Cares capacity has grown by 16% in FY13, to 32,250 patients.  The number of patient encounters supported by Montgomery Cares has expanded by 36% since FY09, to 77,162 visits in FY12. As with patient numbers, the number of visits has grown modestly over the past several years. However, FY13 promises a comparable increase in the number of patient encounters, with funds available for 85,625 visits.

17. 17 Senior Initiative  Provide Heavy Chore Services to serve seniors with hoarding behaviors to prevent evictions or condemnation or to correct health and safety conditions. Services include heavy commercial cleaning and pest fumigation.  Protect and advocate for more the more than 7,700 County residents in 183 assisted living facilities and 34 nursing homes by maintaining a regular presence in and access to services for residents.  Provide in-home support services to help vulnerable seniors remain safe and cared for in the community and to prevent premature and/or inappropriate institutionalization.  Offer short-term respite services to caregivers who provide ongoing care to frail elders and provide relief from the demands of care-giving.

18. 18 Aging and Disability Summary Program AreaFY14 BudgetFY14 WYs Community Support Network for People with Disabilities $ 12,049,82623.00 Assessment and Continuing Case Mgmt Svcs 7,039,57458.55 Assisted Living Services 1,899,0987.07 Home Care Services 4,360,99315.50 Home and Community Based Waiver Services 2,002,22413.00 Aging and Disability Resource Unit 824,7659.00 Ombudsman Services 654,4065.50 Respite Care 927,9860.00 Senior Community Services 2,368,6575.93 Senior Nutrition Program 2,532,3213.00 Service Area Administration 459,6523.00 Total$ 35,119,493143.55

19. 19 Aging & Disabilities Services HIGHLIGHTS  Increase annualization of FY13 Broker Positions in Older Adults Waiver and Money Follows the Person Program Option Counseling Grant ($393,476)  Eliminate Medicaid Waiver Administration and Case Management (-$224,403)  Senior Initiative Enhancements: Add funds for contractual position to develop a countywide Mobility Management System ($60,000) Enhance Home Delivered Meals ($82,000) Enhance Escorted Transportation Pilot Project ($55,000) Reduce cost by transferring select Senior Program Transportation routes to the Recreation Department’s Senior Transportation Program with the Jewish Council for Aging (-$142,500)  Increase funding for Senior Care/Gateway Grant ($359,754)  Add four core previously grant-funded staff positions to support various developmental disability services.  Increase funding for Title III Older Americans Act Grant services ($158,945)

20. 20 Behavioral Health & Crisis Services Budget by Program Areas Program AreaFY14 BudgetFY14 WYs Behavioral Health Planning and Management $7,748,02115.50 Access to Behavioral Health Services 3,213,38131.50 Treatment Services Administration 5,588,9864.00 Forensic Services-Adult 2,062,01818.00 Outpatient Behavioral Health Services- Adult 3,127,12522.00 Outpatient Behavioral Health Services- Child 5,442,50328.25 Trauma Services 4,629,00829.55 24-Hour Crisis Center 3,991,85735.90 Mental Health Svcs: Seniors & Persons with Disabilities 688,9262.00 Specialty Behavioral Health Services 2,139,44219.50 Service Area Administration 585,6613.50 Total$39,216,928209.70

21. 21 Behavioral Health and Crisis Services HIGHLIGHTS  Enhance Maryland Strategic Prevention Framework-MSPF Funds to implement assessment and planning process that would culminate in the development of a comprehensive MSPF Strategic Plan in the community. ($33,475)  Add Homeless ID Grant-fund the purchase of state identification cards and/or birth certificates for individuals who are homeless and have a mental illness or a co- occurring substance use disorder. Hire a case manager who can apply homeless individuals for social security and other benefits with the proper documentation. ($72,345)  Additional grant funding for Alcohol and Drug Abuse Administration Treatment services. ($599,300)

22. 22 Positive Youth Development  Crossroads Youth Opportunity Center and UpCounty Youth Opportunity Center provide a wide array of support services for high-risk youth and youth who seek to exit gang life, juvenile delinquency, and criminal activity, along with the prevention of violence.  Maryland Multicultural Youth Center provides case management, GED preparation, job readiness development, and after school programs to high risk youth.  Asian American Leadership, Empowerment and Development for Youth and Family Program provides after school enrichment programs and mentoring to students at four middle schools and two high schools.  Identity After School Program provides after school programming to serve at risk Latino youth.

23. 23 Children, Youth, & Family Services Budget by Program Areas Program AreaFY14 BudgetFY14 WYs Child Welfare Services$ 22,077,721209.40 Linkages to Learning 4,950,0755.00 Positive Youth Development 4,003,4289.50 Early Childhood Services 2,912,83812.00 Infants and Toddlers 3,401,85713.03 Child Care Subsidies 3,838,18416.50 Income Supports 16,655,431156.10 Child and Adolescent School and Community Based Services 2,854,9424.00 Service Area Administration 391,8514.50 Total$ 61,086,327430.03

24. 24 Children, Youth and Family Services HIGHLIGHTS  Add Linkages to Learning site at Georgian Forest Elementary School ($170,640)  Add funding to provide Positive Youth Development programming at Gaithersburg and Watkins Mill High Schools through the new wellness centers ($1,085,740)  Enhance Maryland State Clig—MA funds are used primarily for contractual services to support the program ($500,439)  Add The Extended Individualized Family Service Plan—this is a new grant funding awarded to Montgomery County non-competitively based on the large number of three year olds served as compared to the number of three year olds served in other jurisdictions ($510,226)

25. 25 Public Health Budget by Program Areas Program AreaFY14 BudgetFY14 WYs Health Care for the Uninsured$ 12,862,4636.00 Communicable Disease and Epidemiology 2,008,01018.30 Community Health Services 11,607,762127.80 Dental Services 2,268,11315.75 Environmental Health Regulatory Services 3,150,33330.00 Health Care and Group Residential Facilities 1,522,67312.50 Cancer and Tobacco Prevention 1,140,1943.00 STD/HIV Prevention and Treatment Program 7,306,14342.65 School Health Services 23,191,546256.33 Tuberculosis Services 1,656,57016.20 Women’s Health Services 2,804,99019.65 Public Health Emergency Preparedness & Response 1,172,71010.30 Service Area Administration 1,708,40612.50 Total$ 72,399,913570.98

26. 26 Public Health HIGHLIGHTS  Add funding to staff and operate two new School Based Health Centers at Viers Mill and Weller road Elementary Schools ($489,440)  Add funding to staff and operate two new High School Wellness Centers at Gaithersburg and Watkins Mill High Schools ($509,440)  Eliminate Kaiser Community Benefit Grant (-$95,000)

27. 27 Special Needs Housing Budget by Program Areas Program AreaFY14 BudgetFY14 WYs Rental & Energy Assistance Program $ 5,068,17513.00 Shelter Services 6,426,8253.00 Permanent Supportive Housing Services 2,316,9079.90 Housing Stabilization Services 5,339,47134.50 Service Area Administration 273,9702.00 Total$ 19,425,34862.50

28. 28 Special Needs Housing HIGHLIGHTS Increase to recordation tax allocated for HHS programming for rental assistance and permanent housing services ($1,350,000).

29. 29 HHS Technology Modernization Effort  HHS Technology Modernization efforts continue  HHS has completed our high level requirements definition and have moved into the detailed definition phase  We are continuing to stay aligned with the DHMH and DHR development of Health Insurance Exchange  MCDHHS with our partners in Montgomery CARES is also looking at Electronic Health Record Implementation  The project is currently level funded and the work is on schedule and on time

30. 30 Support to Community Organizations The FY14 CE Recommended Community Grants Non-Departmental Account for all grants is up to nearly $4.5 million and it includes full or partial funding for 143 requests of which 89 belong to HHS  There are 19 Community Services Grant awards totaling $94,004.  There are 70 Community Grant Awards totaling $2,537,049.

31. 31 Questions?