Agenda - 09-04-2018 8-a - Minutes

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 35 The performance agreement section of the law becomes effective July 1, 2018, with an expectation that counties submit a signed MOU to DHHS by June 29, 2018. County directors and state staff have met numerous times to develop the performance measures and the language for the MOU. Although the measures in the MOU are not new, the law contained additional language to allow progressive actions if counties do not meet the goals. These are outlined in Attachment X of the MOU and include program improvements and corrective action plans. If counties have continued failures in performance after corrective action, the Secretary of DHHS may assume control of service delivery. County directors have expressed concerns about signing the MOU's knowing that they cannot meet all the expectations. During the meeting, the DSS Director will provide information about any known actions by other counties related to signing these agreements. These agreements apply to child welfare programs, adult protective services, adult guardianship services, child support and all public assistance programs except Medicaid. Although Medicaid is not included in the agreements, there is separate legislation with additional sanctions for any performance issues with Medicaid eligibility. Orange County Department of Social Services (DSS) has integrated Medicaid with other public assistance programs during the intake process so performance among these programs is interrelated. Although Orange County operates child support through a separate department under the County Manager's supervision, those performance measures are also included in the MOU. Some of the discussion between DHHS and DSS has focused on the specific performance measures and also on the data currently available to counties to track performance. Many of the measures are based on the Child and Family Services Review (CFSR), federal reviews of performance in all states. All states have trouble meeting the goals in these reviews and state performance and issues are available online (https: / /www.acf.hhs.gov /cb /resource /cfsr- round3- findings- 2015- 2016). For example, one of the measures, 41 % of foster children are discharged to permanency within 12 months of entering foster care, will be very difficult to achieve. The latest reviews of 24 states show that no state achieved substantial conformity with this outcome and North Carolina scored 34 %. The difficulty in meeting some of the measures reflects the complexity of the cases in child welfare. A parent with a serious addiction issue is unlikely to immediately receive needed services to treat the addiction and is unlikely to make sufficient progress to safely return to parenting in twelve months. The majority of the families involved in child welfare have mental health and /or substance abuse issues. Often DSS does not control access to services and may have no way to expedite treatment for parents. There may also be difficulties meeting all the child support measures. In times of economic downturns, collections will be lower. For example, data from FY 2016 -17 showed that 66 counties did not meet the collection goal. It is unlikely that Orange County or many other counties will be able to meet all the performance measures in this agreement. In recognition of the many factors involved, DHHS will be defining target goals for individual counties and will be helping to identify system and policy issues outside of local agency control. Hopefully this approach will allow for less emphasis on monitoring and sanctions and more focus on continuous improvement at both the state and county level.