1. Delaware Health and Social Services Department of Health and Social Services Joint Finance Committee Fiscal Year 2012 Budget Hearing Rita Landgraf Cabinet Secretary February 28, 2011

2. Delaware Health and Social Services OFFICE OF THE SECRETARY State Service Centers Social Services Aging and Adults with Physical Disabilities Substance Abuse and Mental Health Long Term Care Residents Protection Developmental Disabilities Public Health Medical Examiner Child Support Enforcement Medicaid and Medical Assistance Management Services Visually Impaired

3. Delaware Health and Social Services Our Services DHSS provides services that Delawareans consume every day across the life spectrum – Birth to Earth Medicaid; TANF; SNAP; CHIP, LIHEAP, Americorp Subsidized child care and cash assistance; death and forensic testing; marriage and birth records; restaurant inspections; water safety testing; immunizations, monitors and control disease, cancer screening and treatment, provide substance abuse and mental health treatment, child support enforcement Services for: the aging, adults with developmental and physical disabilities, visually impaired, and other vulnerable populations Manages four long term care facilities and the state's only psychiatric hospital, the Delaware Psychiatric Center.

4. Delaware Health and Social Services Our Services Must facilitate and empower individuals and communities to gain healthy outcomes, both in physical wellness and emotional well being; to gain economic self sufficiency, which will eliminate or limit long term reliance on government, and to protect and support those citizens most vulnerable due to advanced age, disabilities, and produce positive outcomes for the individuals we serve

5. Delaware Health and Social Services OUR CURRENT AND PROJECTED ENVIRONMENT CHALLENGES

6. Delaware Health and Social Services Medicaid Eligible's

7. Delaware Health and Social Services

8. DIVISION OF SOCIAL SERVICES Application Activity

9. Delaware Health and Social Services The Solutions: Smarter Budgeting –Core Service identification; triage; and partnerships Efficient Sizing –Through strategic reviews, rightsizing and implementing non-traditional practices to support workforce and advance the Department to better meet the needs of our citizens Smarter Spending –Rewarding performance, not just good intentions. Advancing evidence based practices leading to better outcomes for Delaware’s citizens Smarter Management –Using flexibility, supporting each other across the Department and across the administration. Ensuring resources are expended where needed and avoiding unintended consequences

10. Delaware Health and Social Services Our Prioritization Rationale

11. Delaware Health and Social Services Top Priorities Improving the health of Delawareans and show through statistical analysis - Health Care Reform opportunities Streamline service delivery to meet demand of increasing population - To effectively collaborate within DHSS so that customers receive the maximum possible service as seamlessly as possible Preserving services to our most vulnerable populations Community living for everyone Provide high quality customer service – both in interpersonal interactions and in addressing the concern presented Strive to offer programs that empower or assist clients in self- improvement and to rely less on entitlements

12. Delaware Health and Social Services Top Priorities Consolidate financial services management in all divisions under one umbrella/ DHSS unit Use technology and human resources to maximize efficiency, productivity and service delivery Create employment opportunities, enhance education and promote a more efficient government Maximize federal and state funding to help Delaware residents achieve maximum independence

13. Delaware Health and Social Services DHSS State Budget Overview

14. Delaware Health and Social Services Budget FY11 GF Budget $891,599.4 Net DHSS/OMB Adjustments and New Dollars = $83,634.9 Million FY 12 GRB = $975,234.3 (9.4% Increase over FY11)

15. Delaware Health and Social Services FY 12 Budget Request – (cont’d) Base Reductions ($18,847.1) & (29.0) FTE’s Overtime Casual($4,758.1) Vacant FTE’s (29.0) FTE’s ($1,489.4) Salary Savings ($2,581.7) General Assistance($4,547.5) LTC Savings($1,200.0) Other Reductions($4,271.3) Federal Funds Reallocation$4,980.8 DSAMH $49.0 DSS $4,931.8 Structural Changes ($100.0) & (3.0) FTE’s Weatherization to DNREC (3.0) FTE’s ($100.0) LTC Transition IRM/Fiscal Consolidation Newark Clinic

16. Delaware Health and Social Services GRB Gains to Support Services within Community Funding support for 25 individuals transitioning back to community from DPC DDDS funding to support 140 Special School Graduates and 75 new residential placements Off-setting the loss of federal funds in TANF and Child Care with General funds Transition funding for General Assistance

17. Delaware Health and Social Services Additional Focus Areas Health Care Reform Re-Entry Update

18. Delaware Health and Social Services Health Care Reform A Challenge and an Opportunity Challenge/ Opportunity for Delaware: Maximize benefits for Delaware citizens to support the goals of widespread access to health insurance & health care, supporting people in community-based settings, and promoting healthy lifestyles.

19. Delaware Health and Social Services Grants to Date Health Benefit Exchange Planning Grant - $1 million Premium Review Grant - $1 million Aging and Disability Resource Center - $400,000 Maternal, Infant and Child Visitation Program - $1.280 million Personal Responsibility Education - $250,000 Public Health Infrastructure Grant - #1 - $100,000 Supplemental Funding – Behavioral Risk Factor Survey - $37,860 Strengthen Epidemiology, Lab and health information system capacity - $429,055 Healthy Communities – Tobacco Cessation - $54,554 HIV Surveillance Enhanced Lab Reporting - $51,218

20. Delaware Health and Social Services Grants Continued Health Insurance Consumer Information - $141,930 Medicare Prescription Drug Program - $84,240 Background Checks on Direct Care (LTC) $3,000,000 Primary Workforce Traineeship $156,671 New Access for Fed. Funded Health Ctrs. $1,299,330 Increase Demand for Health Centers $ 937,211 Capital Improvement $2,089,754 HIT for Health Ctrs. $1,231,799 Total $13, 544,505

21. Delaware Health and Social Services Re- Entry Update One area where the State must work smarter has to do with those who are incarcerated. Far too many of them, upon release, re-offend, thus costing the citizens of Delaware more expenses for re-arrest, re- adjudication, re-incarceration. In response to this issue, the Governor charged me with leading an initiative for a smarter approach to working with the incarcerated population. This initiative has been logically labeled as the Prison Re-Entry Initiative.

22. Delaware Health and Social Services