Stutsman: Business from Dr. Craig Mosher, Director of Mental Health/Developmental Disabilities Department regarding changes in the ARC Block Grant funding. Good morning.
Director of Mental Health/Developmental Disabilities Dr. Craig Mosher: Good morning. Heck of a time to talk about putting Social Security money in the stock market, huh? Oops. So, OK, the ARC as you know has been receiving a block grant for a number of years from the County to provide a range of services to people with developmental and disabilities and mental retardation. Jeff Lauer was planning to be here this morning, but his daughter fell ill early this morning and he's home with her. But, we've been looking at that budget and as I think I've mentioned to some of you what we've found in studying their budget is that they're basically accumulating a substantial surplus because the County is really giving them more money than they need to cover their expenses. The reason for it is really that a couple of years ago they kind of reorganized the way they did the billing for day care and asked parents to pay a larger share of what the actual costs of that day care was for children with special needs. Because up until then, parents had been paying almost nothing towards that, had been contributing almost nothing even if they could afford to do so. So they did a lot better job of asking parents to pay part of the cost of that special needs day care. As a result, they kind of began to accumulate a budget surplus and the block grant was never adjusted to reflect that. So in looking at that, Jeff and I have agreed that they can basically forgo the last $80,000 that the County would give them this year. That will according to Jeff's projections allow them to wind up for the County fiscal year at the end of June with about $11,000 operating surplus and they have a fund balance of about $449,000 now, so they're in good shape.
Stutsman: Boy, I guess.
Mosher: They're not hurting. Some of that, about $300,000 of that is in what they call a real estate fund that...
Stutsman: OK.
Mosher: ..was, remember we've talked about that in the past as well, but some of that was left over from the sale of their building to the system several years ago and the Nelson Center changed hands and stuff. So in any case, I think they can easily afford this and Jeff is agreeable that this makes sense. I don't think we need to take any formal action.
Stutsman: OK, but just...
Mosher: I've talked with Lynette and it's a little complicated, because it has to come out of different pieces. But there is a block grant payment of $48,069 that normally Lynette would make the first week in April. She's holding that at this point. Then there is a CSA allocation remaining to be paid from the Community Services appropriation of $29,825. Those total to Lynette said $77,894. So that's close to the $80,000. I guess what I'd like to do maybe is simply have you authorize us to withhold up to $80,000 and if we can easily get the other couple thousand out of just not paying for some things that we normally would pay for we'll do it. If not, we can just limit it to that $77,894. Lynette thought you probably ought to actually do a motion since there was a motion authorizing her to make those block grant payments. There probably ought to be a motion authorizing us to withhold that $80,000 from the ARC in the last quarter of our fiscal year.
Lacina: Do we want to draw attention to it or do we just want in the next appropriation which we do quarterly, we've already done it for this year and you're talking this fiscal year aren't you?
Mosher: It's this fiscal year.
Lacina: Yes, OK, that took care of that. You're probably correct, we need to do a motion.
Stutsman: And that money then will go back into the MR/DD.
Mosher: Right...
Stutsman: So it will...
Mosher: It will stay in Department 46 and it will actually go to cover the, we're running over on the waiver line on the HCBS waiver expense as you know so it will go to cover that service which is the same population group and so forth so it seems appropriate.
Stutsman: We were required to explain to people that that money can't just go into the general fund.
Mosher: That's right.
Stutsman: This is a fixed budget and so it has to stay within that mental health budget.
Mosher: Right, you can't take it and spend it in another area of the County Government. It has to stay within that Department 46. There is surely a need for it in this time.
Stutsman: Uh-huh.
Mosher: Like this is going to go on... Money that we need to make things work this year, so...
Stutsman: Right.
Mosher: But I think it's one of the advantages of having somebody more in position to pay attention to these things so that we're able to spot some things like this that have come up. So I don't know.
Stutsman: Probably put this on for next Thursday for formal action.
Mosher: OK, to do a formal motion. OK. But if you could just authorize us to withhold up to $80,000, then I think that will...
Peters: We'll get it on Thursday.
Mosher: OK, great.
Stutsman: Thanks Craig for checking that out then. OK, business from Craig regarding social worker position and discussion.
Mosher: Right, got one other. These are our caseloads for social workers and case managers.
Bolkcom: Thanks.
Mosher: The top group, Kelly, Barbara, Cindy, Craig, Jan, Paul, and Tarin are what we call case managers who are the Medicaid funded Title XIX funded case managers. As you recall, they have lower caseloads because they operate under a separate set of regulations that are much more stringent and demanding, involving a great deal more paper work. So we're trying to keep those caseloads around 35. We had talked last summer about anticipating needing to add another case manager about this time in the spring of this year. Actually things are working out, I think we're not going to need to do that now. The caseloads are, they're looking high here, but we have a person returning from leave and so it's going to balance out OK and I think we don't need to add another case manager now like we had thought we might. We do, however, have a problem with the social worker group which is Dave, Mike, Mimi, and Susan. Their caseloads as you can see are much higher, but as I said, they have less paperwork and so we try and keep those in the sort of low to mid 50's. As you can see, we're really pushing that already, plus we have approximately 50 new people coming into the system from Chatham Oaks, who have not had social work or case management up to this point, because they've been under the block grant and the social workers out there have done that. But now with the switching to fee for service, they're going to have to have a worker in our office in order to manage those cases. There are also, we're anticipating another 20 or so between the ARC and the Mental Health Center and the PALS Program that we haven't provided social work and case management to in the past, but we'll have to now because we're switching to a fee for service arrangement where we're actually going to be allocating hours of service and needing to track that and authorize that funding on an individual basis instead of just the block grant basis that we did before. So this is really a... it's a result of switching from the block grants to the fee for service arrangement, because now we need to authorize the funding for services on a case by case individual basis instead of just giving a block grant to an agency and letting them handle it. So we're going to have to add another social worker, this person is in the budget so it's really I guess an information item but I wanted to come back to you and be sure that it's OK with you to make this move at this time. It is budgeted to start July 1 and we'd like to be able to start planning for that and advertise for it so on and so forth. I just wanted to stop back and get your OK to go ahead and fill that position.
Lacina: The case worker that's presently, case workers that are presently dealing with the individuals at Chatham Oaks, will we deduct that amount of money from Chatham Oaks? Because they are being provided case management right now.
Mosher: Right.
Lacina: Just not through here. So now we're going to pick up another employee which will do the same function that we had a Chatham Oaks. Somewhere there has to be an adjustment on the other side.
Mosher: Actually the amount of money that we've budgeted for for consumers who are out at Chatham Oaks for next year is about $300,000 less than the block grant that we're paying them this year. So we're saving much more than the social worker salary, because we're not going to be, I mean essentially, what it means is that we're not going to be paying for people that are state cases, that are out of County and that have private pay. have the ability to pay for the care. They have a number of people who are either partially or fully private pay out there. We won't have to pay for those under fee for service. That difference is about $300,000 out of the $1.3 million that they got on the block grant this year. So, we're going to save approximately that much in next years budget.
Lacina: Have we checked their cost on the fee for service basis to make sure that we're not seeing an incorporated case worker in that though so we're paying twice? Say they come up with a figure of 127, just pull the number out of the air, and a portion of that is for the case workers which I'm going to assume they're not going to lay off at Chatham Oaks.
Mosher: No, they have two social workers on staff and they'll stay. Right.
Lacina: So, are we saying that we are reducing that? Explain it to me this way, we're going to pick up an employee that is now going to do the work of their two case workers out there. But we're also going to be paying for their case workers through the fee for service that they're going to be charging us.
Mosher: Well it won't be the same work, I mean the social workers out there will need to continue to provide services to the consumers that are there. There will be some overlap, but the social worker in our office that needs then to authorize those cases well be doing the, sort of helping with case management, helping with treatment planning, and authorizing the services and monitoring the services. Something we haven't done in the past, because they were under a block grant. So to some extent, it's kind of a new thing that we're doing to be able to monitor and authorize those services.
Lacina: Why don't we delegate that responsibility to the existing case workers out there that we would then supervise, because they already have the files and are already doing the work.
Mosher: Well, because it's County dollars that we're monitoring and we ought to have County employees monitoring the County dollars. I don't think we'd ask a private agency to authorize and monitor the County funds.
Stutsman: And...
Mosher: They're not a County Department any longer, it's a private agency and we wouldn't ask the Mental Health Center to authorize it's own money out of Johnson County funds. We would do that ourselves with County employees.
Lacina: It just seems to me that we're going to be paying twice, they are going to continue to use those individuals out there and then we're going to put in another layer, because the financial side of it is different than the actual case management of the individuals. The financial side of it, you can still say to the case workers out there, show me the most efficient and best plan for these individuals without duplicating a true case worker.
Mosher: Right, and we don't have to really sort of duplicate the work they do, but remember that the individuals who are there may not be there forever and they need to have a social worker in our office to manage their case. If they move into the community, they'd have a whole different mix of services and so forth. They would need a worker from our office to help manage that, so not everybody is there for long term placement and so forth.
Stutsman: Also, this Court case worker would be managing other services that they would be getting, aside from Chatham Oaks.
Mosher: That's right.
Stutsman: If they're working with Goodwill or...
Mosher: Mental Health Center, whatever...
Stutsman: Uh-huh.
Lacina: Well why wouldn't the case workers at Chatham Oaks be doing that now?
Stutsman: But they're...
Lacina: Because they do move them through Goodwill and other places for services.
Stutsman: They are Chatham Oaks social worker and so that's the limit of their responsibility, just for that person while they're at Chatham Oaks. They don't go out into the community and see that they're provided other services.
Mosher: Right.
Lacina: So they're not working with, for example, one individual that worked for the Dill Burger before it closed, they're not doing that work.
Mosher: The social workers out there, they may have a hand in that, but it's not their responsibility necessarily to set that all up. Under the... It's certainly not their responsibility to authorize County funding for those other services, we have to do that. So our staff need to be sort of in charge of those dollars. We really can't authorize a Chatham Oaks social worker to spend the County money.
Lacina: No, I'm not disagreeing with you on that.
Mosher: Yes.
Lacina: You need to authorize the dollars. I don't know that you need to set up a duplicate case management team to oversee the work that's already being done, especially since we don't anticipate those jobs disappearing.
Mosher: Well...
Lacina: Where's the savings?
Mosher: OK, I don't think it's duplicating, because the case management that the social workers at Chatham Oaks do has to do with what people do out there, whereas we're talking about a person's sort of total program, which as Sally pointed out, may involve other agencies besides Chatham Oaks so it really isn't a duplication and they really haven't been doing this kind of sort of comprehensive planning for an individual out there, because it's not their responsibility. They're running a residential facility.
Jordahl: Craig, let me ask if there are two questions here. There's the question of how the social worker duties are divided up and whether there's a duplication of social workers duties. Then in your earlier comments, you said that there's some $300,000 difference in what we can expect to pay to Chatham Oaks. That's more than a social worker's salary so that comes from there being some people that would no longer be paid for out of the money we give to Chatham Oaks.
Mosher: Right.
Jordahl: Right, and so...
Mosher: It would be funded from other sources.
Jordahl: So in some... So the County's social case worker would be some way involved in deciding who is funded and from what source.
Mosher: Right, for example, everyone who's going to be out there after July will have a social worker or case manger in our office. Part of the job of that person is to be sure that that family doesn't have resources that can help pay for it. If that family does have resources and cannot pay for it, then they'll be a partly private pay individual and it will cost the County less. But we need our people sort of riding herd on that to be sure that those things are done because it's County dollars that are being spent on it.
Jordahl: So it's not a question so much as authorizing County dollars as trying to save County dollars and not spend them in the first place.
Mosher: That's right.
Jordahl: If it's not necessary to do so.
Mosher: Because we're the funder of last resort, we want to be sure that any other possible funding source is tapped before the County pays for the service. I really don't think it's a duplication in terms of the service, because the... We're sort of looking at the whole program for an individual whereas the Chatham Oaks social worker is focused on their activities out there. They help them get into other activities and so forth, but their focus is on providing residential treatment, just like if they were at Hillcrest, a Hillcrest social worker or counselor in Hillcrest residence wouldn't sort of plan the total program for an individual, that's the responsibility of our case manager and social worker to do that.
Jordahl: I see this as almost analogous to the County's contribution in matching funds for a grant, but not perfectly analogous, but that we spend money to hire a social worker and that social worker then in monitoring the expenses and finding other alternate funding sources can bring in money to pay for these individuals, some of which would go to the Chatham Oaks social workers for the services they are providing in-house. But it would be from alternate sources, not from the County's funds. So, by spending some $30,000 or whatever it is on a social worker, we can realize a savings in the neighborhood you're estimating I take this of....
Mosher: Right...
Jordahl: ...$300,000. So we may be spending 30 but we're gaining 270, sounds like a pretty good deal.
Mosher: Uh-huh.
Lacina: Take a look at the breakdown of the $300,000 savings. In the past when we've given the block grant to Chatham Oaks, it has been so that they... Well let me put it this way, they have invested a lot of the money we have given them into block grants into the maintenance of that building so they've put on the patio, the sun room, when the hot water system went out, they repaired it rather than having the County do it. So when you say case management is saving $300,000, there may be a $300,000 difference, but go back into the budget and you'll find that not all of that was for the clients. We invested money in there so that they could do other things. But...
Bolkcom: I thought we paid for the hot water, I thought we paid for the boiler out of our money.
Lacina: I don't think for all of it.
Stutsman: I think we have...
Lacina: For the hot water (inaudible)...
Stutsman: Used a lot of that block grant funding for...
Bolkcom: Sure, yes.
Stutsman: Physical...
Lacina: Maintenance of the building that we'll now pick up (inaudible).
Bolkcom: I guess I'd like to say I share some of Steve's concern about this. As we look at taking money, service money, we're going to take money away from services to do staff. I guess, unfortunately, I think this is part of the managed care environment that we've moved into with Senate File 69 that whether those 50 people that are coming into the system, moving off block grant, whether they're from Chatham Oaks or somewhere else, we're taking them from block grant to fee for service and we have to monitor that. One of the areas that we haven't talked about that I would assume there might be savings in down the road is that through monitoring and through the kind of follow-up that we're going to get through this position we may move people to, we may find a person or two or more that could go to a less costly environment in the community to be living and so while there may appear to be not a lot of short term savings here, I think in the long run through managing our dollars and the services these consumers get, there might be savings in the future.
Mosher: I really think that's important, because that's exactly the point of a managed care system. You do try to manage that more carefully, you try to monitor more exactly what people need so they don't sort of get authorized for more than what they need. If they need more than what they're getting then they get it, so that they stay out of the hospital and so forth. I think that's very true. I think that we'll be able to more efficiently allocate those dollars, instead of just giving a lump sum to an agency and say you spend it and take care of those people, we're going to authorize it on a case by case basis. So we'll be able to more carefully tailor those services and those expenses to what folks really need. It takes staff to do that and so I think you need to staff to be able to do that monitoring, but I do think it's an efficiency in the long run to do it that way. I think we've seen... I think we'll see some efficiencies with the Mental Health Center. We've given them a block grant for all this time. We're now going to be sort of authorizing services to those individuals on a case by case basis. We may well see some efficiencies there as well. But it does take staff time to do that, but I think it's a good investment because I think that overall it makes the system more efficient, it's a tighter use of County dollars.
Lacina: Well and I'm not disagreeing with what you're saying, but Senate File 69 was to have a better tracking and make these efficiencies and we keep saying in the long run, and we hope, and in the future. But since Senate File 69, we've spent $125,000 that we had to take away from clients that we had to invest in management to establish the CPC and the support mechanism. Then we picked up another case worker, and now we're going to pick up another case worker. At some point, as the saying goes, I want to... Show me the money. Where's the savings? I can't keep saying to the taxpayers that are coming to me looking at County budgets, saying well, someday.
Mosher: OK, but it's not someday, it's this morning. I've just told you that there's a $300,000 difference between what we're allocating to Chatham Oaks for this year and for next year.
Lacina: And I'm saying go back and look at that $300,000, Craig, because while you're saying it's CPC, I'm saying that $300,000 was not necessarily being used for services for clients. It went into building repair, and other things as well. Yes there is a $300,000 difference, but what I'm saying is just manage this very carefully because at some point, we're going to need back from you a report saying Senate File 69 really worked and here's the amount of money we saved and here are the clients and here's the results or else we need to go back to the legislature and say, your mandate has failed miserably, here's a million bucks we've pumped into this management thing that hasn't worked.
Mosher: Well, OK, it's $300,000 a year that they've been getting that's helped to cover these out of County and State cases and not all of that's gone into, I mean we could work out the numbers on that and certainly we can do that in terms to what's gone for physical improvements to the building. Some of that is required of them in their contract, it's not like they sort of did that, it's all spelled out in the contract with them what they do and what they don't. Also, they've accumulated a substantial surplus as you know. It's more than the $300,000 that we're talking about that they've got in the bank at this point that they haven't spent on services that they received from the County over the last five years. So, I think that it really does sort of pay off to monitor those funds. I do think it's a savings and a lot of it is services dollars, because of those people that are now going to be paid for by out of County and State and private pay sources.
Lacina: But there will also be individuals that won't meet the criteria that we have not established. The traditional poor farm took care of County residents that fell under that need for a lot of different purposes. Under this legislation and budget 46 and those things, we have a very narrow description. It really doesn't, an indigent without family would not qualify for those funds. But yet, we will still need to pay for those people. So there will be certain individuals that fall outside of these parameters that you'll have to say, no it can't come from this pool of money and by law you're correct, but we're going to have to say of this $300,000, yes they repaired the elevator system and they took out some hazards out there for some buildings and stuff, which we should have done out of a different, probably maintenance item, but there's also going to be some people that we're going to have to take care of that don't meet that criteria. So don't make this so narrow that we're just taking care of one group and we ignored these others that may have needs as well.
Bolkcom: Yes, I don't think we are. I think...
Stutsman: Yes, I think there's other places in the budget. To me what this amounts to is just much more accountability. We will know how much we're paying for services for each individual. We will know how much we're paying for physical improvements to the building, which I agree are needed and are part of the contract. But we shouldn't lump the two of them together, saying this is our Mental Health budget, which includes physical improvements to that building. I want to know what we are paying for services to people. I think that's going to be the advantage of this managed care.
Mosher: Right.
Stutsman: That we can come up with some numbers and manage them and reassess them on a regular basis. Are we really getting what we want for our dollars and is this the best plan? This is just a start in putting that in place.
Mosher: Yes, I want to just be clear that the only people that sort of don't fit in the MH/DD category, sort of indigent folks we really don't have any more. There are three positions that you know that you've authorized for folks with brain injury out there that you're paying for out of Department 45. That's the only people that we're not covering. I don't think we have anyone, I know we don't have anyone there now who sort of doesn't have a disability and is simply there because they're indigent. That just isn't...
Lacina: So 100%, everybody out there is covered under this account right now.
Mosher: Everyone out there either is MH/MR/DD or they're traumatic brain injury.
Lacina: OK.
Mosher: Now, I can't speak for all of the sort of out of County. It's possible there's somebody from another county there.
Lacina: Or the University Hospitals. It may be County residents getting psych help, or would they fall under that too? They fall under ours....
Stutsman: Yes.
Mosher: If they're getting help at the psych unit at the University, they would meet our criteria for MH/DD.
Lacina: OK.
Mosher: So, yes.
Stutsman: And there's other sources of funding for indigent/poor. Medicaid funding and things. So, and they're certainly able to access those fundings. So...
Jordahl: So, I want to pin this down, is there a dollar per dollar equivalent in the $300,000 that we would be saving in this coming year that in your request with the replacement dollars coming from other sources from family or from the State or from other Counties. Is that dollar per dollar equivalent there, so that Steve's concerns about the level of funding being not covering maintenance expenses is allayed, or is it not. Would the State be replacing or other sources be replacing somewhat less than $300,000?
Mosher: I think that's going to work out for them. I think they're funded from those other sources to cover those individuals. They haven't been collecting any State case money until just the last month, we got them on the State case program. So that's a whole new funding source they haven't had before. People from other counties and so forth, they certainly can collect for those counties for this care because those counties will pay for this level of care. I don't know of any counties that don't have residential care in their plans. The other counties will certainly reimburse them for people they have there, so... I think they're going to be OK.
Bolkcom: The other thing that's been pointed out this morning. Not only is it a $300,000 savings, but the ARC savings of approximately 80,000 dollars in the currently year.
Mosher: Uh-huh.
Bolkcom: I assume that's potentially going to be an ongoing amount of money as well. The home managed care environment in Senate File 69, the impetus about that was that the State Legislature did not feel that Counties were managing these dollars well, a significant part of their budget. You can't begin to manage dollars well, unless you have people that can do it. We've gone down a path so far to put a couple more people on to manage those dollars. We've talked about $380,000 in better spent money, that's going to be spent for other services for all the new people that need services in this County. There's a cost involved in doing that. Hopefully there's going to be, not only a more efficient use of our dollars, but hopefully the consumers that we're serving are going to get better services and more appropriate services. So there's a quality of care issue here as well to have us manage those dollars well and manage those services well.
Mosher: Also, I can tell you that we're meeting with Youth Homes about the PALS Program and we'll have some savings from that as well, because we've learned some things about the way that's been working out that we need to fix and I'll share that with you when we get the numbers worked out and so forth. There will be some more savings from that. I think it really is working and I think we are more efficiently using the County dollars as a result of having this additional staff to ride herd on things.
Lacina: There will definitely be a big advantage from the accounting standpoint of knowing where the dollars go versus what we had in the past.
Mosher: Right.
Lacina: I totally agree with that. Good.
Mosher: OK.
Lacina: I think you're right, that there are savings, it's just that we have to watch this and as we recognize savings, we say we've saved $300,000, we have to be able to say and it is showing up in the budget in the general fund and the reduction of expenditures, to be able to show the taxpayers exactly, and the legislators, where this is working.
Jordahl: Yes, so this is, when we went through the budget process you're saying that the request for Chatham Oaks was $300,000 less than this year.
Mosher: We budgeted approximately $300,000 less on the line that we used to pay for residential care facilities over 26 beds than we did in this current year's budget. That's what I meant by it.
Lacina: But if the demand is up, then we have to pay, it's a mandate we have to pay that. So, until we actually look at actuals, we're kind of anticipating a usership, which I'm sure you're using the best numbers you can to project that.
Mosher: That's right, and that's still our estimate. We're anticipating about 50 people from Johnson County out there on a regular basis next year.
Jordahl: With regard to where that $300,000 shows up in the budget, it shows up in your ability to allow some growth, or some growing room, or whatever in other areas of the Department 46 budget.
Mosher: Right.
Jordahl: Because this money didn't have to go to the residential care facilities over 26 beds.
Mosher: Right. As we've said, for example, the waiver line for a HCBS waiver services for persons who are usually with MR/DD in residential care and community based services, has gone up dramatically because of the switch to those service and so that's where the... It's that kind of moving around in the budget that we're now able to do, because of the savings that we're effecting and not having to cut services yet. Some of the Counties are cutting back on services as you know. We're able to squeeze it out, because we can move those dollars around.
Jordahl: Essentially pulling in dollars from other sources. It's not grant money, but it's money from elsewhere.
Mosher: Well it's allowing other people to pay for things they should be paying for...
Jordahl: Yes.
Mosher: Instead of us paying for it, yes.
Lacina: So originally in your request, you wanted a 7 1/2% increase and then we were waiting for the State to come down that number with a number which we believed would be 2.89 increase in your total budget. Do we have that firmly pinned down now? Because at the last MH/MR meeting, you said you were still waiting for, we took action based on 2.89.
Mosher: Yes.
Lacina: You said you were still waiting for some other information. What component was that?
Mosher: Well, the State had to tell us what the 2.89 would be for Johnson County in actual dollars, because there was a formula based on population and last years net County expenditure number. So each County got a slightly different, it didn't get exactly 2.89, we got 3.09...
Jordahl: 3.09, something like that.
Mosher: Or something like that. Instead of 2.89%, because our population is slightly higher than the average or something, so the actual number was a little different than that and Lynette is processing all that.
Lacina: So it's a 3% increase in your budget plus these savings we should be able to offer substantially more services to the public.
Mosher: Well, we should be...
Stutsman: We'll have a lot more people coming in too.
Mosher: We should be able to cover the increases that we're seeing. We're seeing about an 11% increase in new people coming into the system.
Lacina: And County individuals that are...
Mosher: Johnson County legal settlement people. That's an expense and we need to try to cover what, I mean we're not taking people that we ought not to be paying for, we're being real careful about, the Mental Health Center is now checking legal settlement on every individual coming in the door. They weren't doing that before. This is new, I'm sure we paid for a lot of people from other counties through the Mental Health Center over the years. But now they've begun checking legal settlement as of last July. So we're going to see some changes in how things operate.
Jordahl: The other thing about the 3%, or 3.09, whatever that number is it reflects one years worth of growth. We had a year where we were completely frozen. As the County has grown, we missed a whole year of dollars.
Mosher: That's right.
Bolkcom: So that 3% roughly has to make up for two years worth of growth.
Mosher: Exactly.
Jordahl: At 11% a year. Pretty good.
Bolkcom: It's tight.
Jordahl: What was last years growth, saying 11% increase in Johnson County legal settlement cases, now what's another years perspective on this. Is this sort of a constant figure? I realize you haven't been in this position all that long.
Mosher: I think it was about 8% last year.
Jordahl: But substantially above nothing.
Mosher: Oh yes, yes. It's been, Sally's used a figure of about 12 to 15% growth over the last 4 or 5 years is what she's seen. I want to confirm that number. It grows each year and we need to, we need to really monitor the budget, so that we can accommodate that. The other piece that's coming is that the rates have been frozen as you know for the residential services by the legislature for about five or six years now. We thought that freeze might lift when we moved away from the POS system into more of a County contracting system.
Bolkcom: POS?
Lacina: Purchase of services.
Bolkcom: I know what it is...I'm sorry...
Mosher: DHS runs a State wide contracting system called POS or purchase of service. It now looks as if DHS may keep the purchase of service system and we may go on using that which means those rates may stay frozen which is sort of a help to the budget in a sense but it's a real problem for some of the provider agencies. Because if you talk to Systems or to the Mental Health Center, or to Hillcrest, or Goodwill, they're having real trouble hiring qualified people because they're competing with the fast food places at this point in salaries. So I don't know what the solution to that's going to be because we don't have extra money.
Stutsman: Just think of trying to limit any business to no inflation factor and no growth for 5 years. That's a lot to ask of these providers.
Mosher: And what do you do with salaries. You can't keep people, if you can't keep pace at least with inflation and stuff.
Stutsman: You can squeeze a budget but there gets to be a point where there's no more room to squeeze.
Mosher: Yes.
Lacina: Well and that's also why we are seriously looking at this case worker position. Because the other thing, if you use that 15% growth factor in 4 1/2 years, you've doubled your demand, compounded. If you have 15% each year, 4 1/2 years, you've just doubled. So we need to take a very careful look at this 11 to 15% growth and say, where are these people coming from, what class of needs are we meeting, or is there something out there generating BI, or what's happening. Hopefully with the database that you've established, we're going to know how many people are coming into the system, what their needs are, if there's a success rate, and pretty soon, we're going to have to start analyzing these numbers because in about 3 years, we're at a crisis.
Jordahl: Yes. How is this compared to, I know you're not necessarily a demographic statistician here, maybe you're looking at your own numbers, but I'm wondering about Johnson County growth in general. I don't believe our population growth is as high as 11, 12% a year.
Mosher: I don't know, do we know what the population figure is for the County?
Stutsman: Yes, we have that information but...
Lacina: Do you want me to grab it?
Stutsman: It's...
Bolkcom: It's...
Stutsman: The growth...
Bolkcom: What are we about 5% last year or something, 5, 6%? We're still growing.
Stutsman: I don't think it's that high.
Lacina: No, I don't think it's that high.
Jordahl: But Steve's question of why do we have 11 or 12% growth in utilization of MHDD services and 5% growth of population is an interesting one.
Mosher: And it's possible that it won't stay that high. You're exactly right, it's very important to get good data on this, because we need to be able to project where that's going. I think it's also important to have the staff to carefully authorize those expenditures on a case by case basis so that we operate as efficiently as we can. Without that staff, if the caseloads get too high, and people can't monitor cases very well, we're not going to be as efficient as we can so I think it's a good investment.
Lacina: One of the important things with monitoring is we may find that yes, there is a 15% and if we look and see why, it may be more out-patient care at the University that flows over then onto our backs. They can make efficiencies bring people in from around the State, and there may actually be some program shedding for housing and other projects, not just your budget, but in general so it's important to look at these numbers very carefully about why they're making these changes.
Jordahl: When you talk about Johnson County legal settlement though a person coming from University Hospitals wouldn't have a Johnson County legal settlement would they?
Mosher: Right, and typically...
Lacina: It depends on if they're in there under State papers or, it depends upon the program they're in, they may be a resident under some other program that may fall back upon us.
Mosher: Well...
Lacina: Veterans would be an example of where a Johnson County veteran might be in the VA hospital and suddenly they make cut backs and we would see them fall back upon the veteran's benefits. So maybe just a statement that we wouldn't be eligible, we know we had two people over at the hospital that were our people that they were taking care of that they tried at least. I don't know if they succeeded in getting them out to Chatham Oaks.
Mosher: Right.
Lacina: Would have been ours.
Mosher: Yes, and it's certainly true that people used to stay at University Hospital in the psychiatric wards longer than they do now and that they're now trying to move people as quickly as possible into either Chatham Oaks or into Hillcrest, or into one of the other programs. So that does, sort of move up the point at which the County picks up that funding. There's a real two way street with the University. In some ways, they bring more people to the County and that may cost us some more money, although most of them as you say are covered by other counties, but it also, Johnson County people go into that hospital instead of going to the MHI at Independence a lot of times and that's a State expense, that's not a County expense, then when they go into the University Hospital, so that's a savings to the County. It's a real two way, it's a balancing act with the University. There's cost factors on both sides there.
Stutsman: That lends to the argument too about careful monitoring of these people and making sure they do have legal settlement here and if they don't, to follow up on who does pay.
Mosher: Right.
Jordahl: One thing I've heard spoken about in terms of increases in utilization of mental health services is that it may be that people who may not have gotten appropriate services in the past are beginning to be appropriately brought into the system. I don't know if this represents sort of a catch up period where people are saying, well OK, there are services that maybe are acceptable that may be more home based and community based. People don't have to be institutionalized so they can be run into something that's more community based and they're more willing then to enter the system, but maybe then this 12, 15% will dissipate after that lag has caught up. It would be interesting to see the numbers, see what kind of services this increase in population represents.
Mosher: Yes, that's a possibility for sure.
Stutsman: But you're talking about people that are just completely new to the system, they have not accessed any services no matter what they are.
Mosher: Right.
Stutsman: Any other comments, it's been a good discussion, I think it shows the Board's interest in following this...
Mosher: Yes.
Stutsman: And seeing that those dollars are managed well.
Mosher: Well, I appreciate your staying on top of it and taking the time to talk about it, because it is a complex, it's a big budget and it's a complex one and I appreciate your interest in trying to figure it out.
Lacina: Well I sure, certainly shouldn't imply that Craig isn't doing a good job, it's just we're all really concerned about what's coming down the road and you are too. You're doing a good job.
Jordahl: Yes, and we need to be doing this kind of looking at all kind of Departments as we get the budgets are ever tighter...
Mosher: Yes.
Jordahl: ...under this freeze and the needs keep going up in all departments. Funding doesn't correspondingly do so. We've got to have this kind of conversation and we're planning that kind of thing. Sit down with it and look at these budgets more closely.
Stutsman: Well we appreciate your coming in and keeping us up to date and informed. We know the social worker is in the budget, but it helps to clarify.
Mosher: I guess one other personnel thing I might just mention, as you know there's also another quarter time increment for the data entry individual that's budgeted and we'd like to do that July 1 as well. Just to get her the time she needs to generate that information that you want. I assume since that's in the budget, that's OK too to plan on.
Lacina: Just do a payroll authorization at that time and yes.
Mosher: Yes. So...Those are OK, we can go ahead with those?
Stutsman: Uh-huh.
Lacina: At some point would you come back and talk to us a little bit about the State's MIS System for tracking the computer system.
Mosher: Yes.
Lacina: Because that's going to be interesting to see what they want.
Mosher: Yes, I'll try to, we're getting close, we're still entering new people into the system. We've still got folks in the Mental Health Center, for example, we don't have final information on that, so once we get everybody in, we can start generating some reports and I'll be more than happy to share that with you.
Lacina: Great, thank you.
Jordahl: In that same vein, I'd like to know where this 11% growth is going, is there a bulge in one particular area of service, it would be interesting to see that.
Mosher: Good question, yes.
Stutsman: Yes.
Mosher: OK.
Stutsman: Great.
Bolkcom: Thank you, Craig.
Stutsman: Thanks, Craig. Inquiries and reports from the public, any comments from the public.
REVEREND BOB WELSH: REQUEST TO MONITOR COMMUNITY SERVICE ALLOCATION SPENDING
Bob Welsh: While Craig is still here, I mentioned again, I mentioned that your budget, I do hope during the year you will look at community services allocation formulas and what it's going for and check that out. Maybe some of that is going to be high and you've got that whole philosophical thing that BI belong in 45 or 46, count that, I made that request at the time of your budget hearing. Just in light of the discussion this morning, I'd just remind you of that.
Stutsman: OK, thank you, Bob. Any other comments? Reports? Reports and inquiries from the members of the Board of Supervisors, Joe? Do you have...
Bolkcom: Well we met with the City and the County, we are the County, so we met with ourselves, and the School Board last night. Had a real good exchange. I thought it was real helpful to have the School Board there and they seemed to be pretty satisfied with their coming and being involved. We talked about a variety of issues. Also attended the Planning and Zoning Commission last night to learn more about the Comprehensive Plan update that continues to be worked on and they'll be setting up another meeting sometime next month. Also attended the Decat meeting, a Decategorization meeting dealing with services to children and families in the county on Tuesday. They are in the process of trying to figure out how we're going to continue to provide the services that are provided through the Decat agencies with less money. So it's less money.
Jordahl: Dramatically less money.
Bolkcom: Jonathan was there.
Jordahl: I attended that meeting too, they were talking about where the surplus funds they were able to use for Decat was, I don't know how many years ago they were talking about, it used to be $700,000 a year they had left over and now we're talking about a $75,000 budget this year. So they're talking about dividing up a very small pot of money and beginning to look more at coordinating services of similar types as a coordination effort, as an efficiency effort but without a lot of money to put behind it and looking for alternate sources of funding. Let's see... Last night, the meeting was a lot of fun. The interesting thing about the joint meeting with the City Council and the County and the School District was that of course the Iowa City School District encompasses more than just Iowa City. So, you have the question of how do you make decisions about taxation. For example, the tax increment financing district where the County and the School District will continue to get the taxes that we now get on that ground as agricultural ground. But, the huge boost in value of taxes that are going to be created there with the construction of the mall don't go to the School District, and I think Steve has got some more details he can provide about this in terms of Sheriff's coverage and so forth. The question of how does that apply when you've got Coralville taking that money for infrastructure in the mall area and yet bringing more needs, more population, people to work in those businesses and so forth. That being more population to the schools, yet the schools don't receive that money. So there was some interesting discussion of that. One of the things that came out that I did not know myself at the time was that you can do less than a total TIF. You could do, say put 50% of the increased value into the reconstruction of the area and use some of the increased value to go and defray other costs that are brought upon the whole community, law enforcement I think was significantly mentioned. So it's interesting as we sit down with these joint discussions to begin to talk about how mutual concerns, how the changes will impact the County. It could be addressed in the structures of other people's decision-making. That's why these joint talks are particularly valuable. Speaking of joint talks on Friday morning at 9:30 in this room, we're going to have the first meeting of the What/When Committee for implementation of the Computer Needs Report. This is a public meeting, if anybody's interested, and would like to attend, we're going to sit down with all of the department heads and talk about what we want to do in prioritizing these recommendations and getting started on actually doing something with it. I'm real excited about that.
Stutsman: That's it?
Jordahl: Yes.
Stutsman: OK. Steve?
Lacina: Attorney General, Tom Miller is intervening in a case now, which we don't have any jurisdiction from the Supervisor's standpoint in, except that we will be picking up the bill in Court Services for any work that is a Judge...
Stutsman: Eads?
Lacina: Eads. If he is successful in his attempt to...
Stutsman: Appoint Joe Johnston as the Special Prosecutor?
Lacina: Yes, and that's very well said, I was trying to think how to phrase it. I guess the question I've got, Pat help me. In our budget, since we get to pay the bill for his actions, where is that going to fall, Carol help me. I was looking for Court Services and I can't find the number.
County Attorney Pat White: 28.
Lacina: OK, because my concern is that if we get... I remember back in the mid 80's we had one murder case that cost us $350,000 and Langenberg and those guys set up the indigent defense study commission. It was the woman that was killed out there close to West Branch. We have to really be careful that people that are not accountable to us, that make these decisions could cost us a lot of money and then all of a sudden, we've got Craig coming back in here and we're trying to figure out how we're going to cut services and do all of this other stuff. So just as a word of warning we've got to watch that closely, because that may be a hit that we're going to have to scramble and make line item adjustments to pay that bill. We won't have a choice in it.
Bolkcom: Because that order, because the Attorney General is involved and it's referred to the Supreme Court for a decision, will that happen before Joe Johnston begins his work, or will that...
White: No way to know.
Bolkcom: I see.
White: The Judge Eads order doesn't speak at all to costs and the extent to which he contemplated that is unknown to me but certainly that was one of the reasons why I wanted his order reviewed by the Supreme Court. I think there are major questions about jurisdiction and separation of powers when a State Judicial Department attempts to enter an order that would impact County budgets without notice and without hearing. There isn't money in the Court Services budget to...
Lacina: (inaudible) need to look...
White: No, we're... I've already told my attorney's that they're going to have to cut down on deposition costs the rest of the year. We're significantly ahead of pro-rata where we ought to be at this time of year as a function of increased caseloads. We're just going to have to find ways to get by without Court Reporters and without written transcripts where they would normally be needed. Even without any additional expense coming from a special prosecutor.
Stutsman: Is this an unlimited expense? Do we pay for him, do we pay for support staff, do we pay for other attorneys?
White: The order is wholly silent on that.
Lacina: My guess...
White: There's nothing in there about rates or support or time...
Lacina: But we could be at risk for whatever. If Mr. Johnson all of a sudden starts putting through claims, I don't think we would have a choice but to pay them, would we Pat?
White: Well that's one of the logistical things that he and I have talked by phone a couple of times and I'm hoping to meet with him, depending on my own schedule, he's been very gracious about being flexible. We're going to start to meet either yet today or tomorrow to begin to discuss some of the logistical things. It's hard to know when the Supreme Court would act or what action they would take.
Stutsman: OK.
REPORT (STUTSMAN): ATTENDED AGRICULTURE BREAKFAST
Lacina: The other thing is Sally and I attended an ag breakfast this morning, but go ahead Sally.
Stutsman: Oh...
Lacina: Give that...
Stutsman: The Chamber has sponsored. Is it monthly, Steve? Ag breakfasts or maybe every other...
Lacina: Actually kind of quarterly though, if they can have a speaker.
Stutsman: OK...
Lacina: They have monthly meetings. But not to the extent that they did this morning.
Stutsman: The breakfast had a speaker this morning, Dr. Kelly Donham who spoke about hog lots and the impact of health impacts associated with that. So it was very interesting. He's certainly a wealth of information. I appreciate his broad-base approach to this, recognizing this is an important viable industry in Iowa and yet recognizing too that it has some consequences too, as far as health and social economic issues and things. So it was a good meeting.
Jordahl: Was any mention made there of the regulation, I intended to attend that this morning and...
Stutsman: No, he didn't address that at all. One of the things that he talked about that I thought was real interesting is that we don't know the long term effect of lagoons, and there just isn't data available yet and plus we don't know the long term effect of people who are spending eight hours every day in hog confinement facilities. We just don't know. I know my husband has spent some time in a hog confinement situation when we raised hogs and just a couple hours and he'd come out of there coughing and carrying on. I don't know what kind of impact. The scientists don't know either. So it will be interesting, when they start putting that data together to see what comes about.
REPORT (JORDAHL): UPDATE REGARDING HOG CONFINEMENT OPERATIONS LAWSUIT IN HUMBOLDT COUNTY
Jordahl: Yes, there are a lot of different concerns. I received a phone call earlier this week from David Vestal, Legal Council of the Iowa State Association of Counties, informing me that Humboldt County had won in it's suit with a hog confinement operator up there. That 3 of their elements of their ordinance which exceeded State code in their stringency, regulating this on the basis of sewage lagoons on the basis of there being some potential for a disaster impact, were upheld by the Court, including a provision that required that the operator put aside a substantial amount of money so as to pay for a potential clean-up. I assume this is going to go on through the Courts and not going to stop there, but it was interesting to see that at least at one level that was upheld.
REPORT (LACINA): ECONOMIC RANKING OF AGRICULTURAL PRODUCTION AND STATUS OF FAMILY FARMS
Lacina: We'll be getting a copy of the Supreme Court ruling kind of going the other direction, it says under the right to farm law, we don't have jurisdiction, to include if it's less than 40 acres. So if someone comes in for production on 4 acres and wants to put up a greenhouse, we couldn't stop it unless they tried to do retail. So this is something we're going to have to watch very carefully and make sure that we know what jurisdiction we do have. The other interesting thing. On the other side of it, David Lyon, who is the Economic Development Director, has been going around the State, giving some presentations and livestock production in Iowa as far as economic benefit to the state now equals grain sales in Iowa and those are the two largest revenue generators. When we think of manufacturing or any other industry, those two are the top generators of revenue plus employment obviously. Farm families and value added. So they are, of course obviously we have land and good working people.
Bolkcom: It makes sense.
Lacina: We generate good crops.
Jordahl: Well I'm not talking against agricultural production. I think the idea of a large hog confinement operation speaks directly to the question of a family farm. So many people are going to be able to actually farm as families, if they are having to compete with things that are basically industries. I think it is a question of the survival of family farms as well.
Lacina: I did ask this morning, what number would be sustainable operation. Iowa State over the year has generated some figures, it used to be 160, would sustain a farm family and then it went up to 640. Now if you're on crop ground, you're up into the 1,500 to 2,000 acres. Solely for grain. I asked what would be a viable number on the hog production side. They said of course it's a variable depending upon the operator and the efficiencies, but if you're looking at a $35,000 income per year, you're probably looking at 3,500 head for an average family farm to be viable.
Jordahl: Oh, my gosh.
Lacina: So the number's are substantially higher and we do have a lot of people that just hope to stay on the farm and they're going to have to diversify and get into that livestock side.
Stutsman: There were a lot of interesting issues brought up.
Lacina: Good discussion.
Stutsman: There, even the discussion about what is a large hog operation, what is the definition? Because there's some farmers that raise, that are family farms that own the land, operate the facility, manage it and everything.
Jordahl: Sure.
Stutsman: And yet raise a lot of hogs. So...
Jordahl: Well I think the question that they were raising up in Humboldt, isn't necessarily a question of any particular number of size, defining. Because it wasn't a zoning question. It was a Disaster Services question. I have the law here, I know we should all have a look at that. The question was an impact on the environment and particularly it's done through Disaster Services rather than Zoning. I'm not sure exactly how it's done, waiver or something like that. I'll have to sit down and we can talk about that later.
Lacina: Well and Humboldt has an unusual situation too. We were, went up to Algona and I think it was DeCoster, paid $3,000,000 for a grain elevator up there and we drove in and around it, a lot of security and stuff in it, but they then pumped an additional $11,000,000 into this facility to get it up large enough to handle the livestock that they've got there, plus they've got a rail siting that they ship, buy the cheap corn, make the feed, put it on the rail, and ship it to Missouri and other places for their centers. So we're talking large corporate hog operations. We're not trying to hammer the small 5,000 head producer in Iowa that's a family farm, we're talking 6,000 sows at 20 pigs per year, is what they're cranking out of some of these operations.
Jordahl: Well, yes...
Lacina: It's beyond our scope...
Bolkcom: Industrial.
Lacina: Of what we've got anywhere near here.
Jordahl: Well and one of the big concerns up there that we don't have here to the best of my knowledge I the agricultural drainage wells to get the, it's very swampy up there in Humboldt County. So that's, Dave Vestal did say that was one of the big differences too, it wouldn't necessarily work for us to regulate things in the same way because they do have that question of proximity to drainage wells.
Stutsman: Uh-huh.
Lacina: Kay Chelvig is the Supervisor up there. Sometime when you have the chance to sit down and talk to her, it's their scope. When they started putting in rail systems and just mega systems, it's amazing.
REPORT (STUTSMAN): JOHNSON COUNTY AWARDED HUMAN SERVICES INNOVATION ZONE
Stutsman: I also wanted to announce unofficially or officially, Johnson County was considered and awarded and Innovation Zone from the State. Naomi had mentioned it last night, she saw it in the paper and I thought, oh, I hadn't gotten any official notice. Well guess what, Cheryl hasn't either. So, that's how we're finding out by this article in the paper. So it's going to be interesting when they send a formal letter.
Lacina: Makes a difference.
Stutsman: What this is going to mean is that we are going to be able to gain some waivers on some rules and regulations to help people who are on the FIP program, Family Investment Program. To move through the system faster. I think it's going to be a collaborative effort from various agencies in the community, including Job Services and the Department of Public Health and the Visiting Nurse Association to work together to help get these people independent and off of welfare and be conscious the whole time that the clock is ticking and so the faster we move them through the system, the better it's going to be for everybody. I think that's real exciting. Johnson County was one of 5 in the state that was awarded that.
Bolkcom: Good work.
Lacina: Good job.
Stutsman: So when I get more official documentation, I'll let the Board know.
Welsh: Which paper was that in?
Stutsman: Des Moines Register evidently. Interesting process, they tell the media before they tell the people that are involved in it, but anyway... Anything else? Carol?
Administrative Assistant Carol Peters: I would just like to remind the Board of your continuing Strategic Planning Session. It will be April 7th, 8:00 in the morning at Wetherby's in the board room. Also then you have your joint meeting with Washington County and Muscatine County, 11:30 on the 10th. I'm still collecting agenda items for that meeting.
Stutsman: We also have interviews for the SEATS Director on Friday starting at, is it 10? Or...
Peters: Let me check on that.
Stutsman: OK, I think it's 10, 11, and 1:00. All right, is there anything else that we need to do?
Jordahl: Well, I guess...
Lacina: Take a break and go in Executive Session.
Jordahl: One thing...
Stutsman: Well I need to ask Pat if he's got anything he wants to report on.
REPORT (JORDAHL): FIRST BOARD OF SUPERVISOR'S NIGHT MEETING
Jordahl: A week from today, we do have our first night meeting at 5:30 in the evening on the 10th of April, in the same place. People interested in evening meetings, this is the first opportunity to do that.
Stutsman: Pat, do you have anything that you'd like to report?
White: No.
Stutsman: OK.
White: Actually, I might just share with you one thought that I do have on the developments of the last couple of days. It follows up Steve's comment. As you may have heard, I announced yesterday, or more accurately we included in the petition that was filed with the Supreme Court seeking to set aside Judge Eads order, the fact that if there is going to be a grand jury inquiry, I'm going to ask, and if jurisdiction returns to me, I'm going to ask the Attorney General to handle it. There are a variety of reasons for that decision, but one of them that relates to something, I've had discussions with several of you about is my own schedule and my own workload. I spent 5 to 6 weeks doing almost nothing else back in September and October. I just don't have that time available to do it again.
Stutsman: Oh boy.
White: So the practicalities of this case continuing to disrupt my ability to do the rest of my job was a factor. We'll see what happens.
Welsh: You have our support.
Stutsman: Thank you, Pat. We are going to take a break before we come back for Executive Session regarding the update on the evaluation of County Engineer.
BOARD OF SUPERVISORS: EXECUTIVE SESSION TO EVALUATE COUNTY ENGINEER ED TICE
Motion by Lacina, second by Bolkcom, to enter into Executive Session at 10:23 a.m. for an evaluation of Ed Tice under section 21.5(1.i), Code of Iowa, "to evaluate the professional competency of an individual whose appointment, hiring, performance or discharge is being considered when necessary to prevent needless and irreparable injury to that individual's reputation and that individual requests a closed session." Roll call: aye: Bolkcom, Jordahl, Stutsman, Lacina; absent: Duffy.
Recessed at 10:23 a.m.; reconvened at 10:40 a.m.
Recessed at 11:25 a.m.; reconvened at 12:35 p.m.
Motion by Lacina, second by Bolkcom, to leave Executive Session at 1:10 p.m. Roll call: aye: Bolkcom, Jordahl, Stutsman, Lacina; absent: Duffy.
Adjourned at 1:10 p.m.
Attest: Tom Slockett, Auditor
By:
On the _______ day of _____________________, 1997
By Chris Lambert and Casie Parkins, Recording Secretaries
Minutes of April 1 sent to the Board of Supervisors on April 7, 1997 at 12:30 p.m.
Complete minutes sent to the Board of Supervisors on July 22,1997 at 11:45 a.m.