Agenda 04-04-2019 Item 2 - Health and Human Service Initiatives and County Impacts

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2 began in January 2019 with progressive corrective actions effective July 2019. A revised MOU (attached) has now been executed and reflects recent negotiations to change how some of the measures will be calculated. If counties have continued failures in performance after corrective action, the Secretary of DHHS may assume control of service delivery. 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. Social Services Reform The Phase I report from the consulting firm has been published. Much of the report focuses on the plan to provide support and supervision for counties through seven state regional offices. Organization of county or regional offices will be addressed in Phase II. Child Welfare Reform The Phase I report from the consulting firm has been published. This report contains a long list of recommendations including implementing a practice model that emphasizes trauma informed, evidence based practice by social workers and strong state supervision. Medicaid Transformation North Carolina recently received approval for its waiver to move forward with integrated, managed care for Medicaid participants. Although Social Services will continue to establish eligibility, participants will also need to be informed about selecting a medical home. Other impacts of managed care will be realized by all Medicaid providers, including county agencies such as health and transportation. Orange County is in one of first regions scheduled to implement managed care with some of the Medicaid clients. During the work session, Social Services will provide additional information about each of these critical changes as well as anticipated impacts from these changes. FINANCIAL IMPACT: Although receiving this information does not have financial impacts, failure to make progress on performance measures could result in additional County costs. Medicaid transformation may impact some County agencies receiving Medicaid reimbursement for services. SOCIAL JUSTICE IMPACT: The following Orange County Social Justice Goals are applicable to this item: • GOAL: FOSTER A COMMUNITY CULTURE THAT REJECTS OPPRESSION AND INEQUITY The fair treatment and meaningful involvement of all people regardless of race or color; religious or philosophical beliefs; sex, gender or sexual orientation; national origin or ethnic background; age; military service; disability; and familial, residential or economic status. • GOAL: ENSURE ECONOMIC SELF-SUFFICIENCY The creation and preservation of infrastructure, policies, programs and funding necessary for residents to provide shelter, food, clothing and medical care for themselves and their dependents.