self-sufficiency. >> chair farrell: mr. rohr, i want to make clear, and thank you, we've spoke in my office before this hearing. you know, in the context, so people understand the context of budget cuts and so forth, and reduction for the mayor's budget reductions, i think the bottom line is you're able to achieve those cuts but also the overall budget increase for your budget is basically coming from the state and feds almost on a dollar-for-dollar basis so we're in a fortunate situation with your agency. >> that's right. i'll talk about some of that expansion in a couple of slides. one piece i forgot to point out which is significant is the increase in medi-cal that you see from 24 -- a little under 25 million to over 31 million. our role in medi-cal delivery is to enroll families and individuals who are eligible. we process their applications. we do outreach to get them in.

we provide ongoing case management to make sure they remain eligible and continue to receive medi-cal benefits. the increase is because of the affordable care act which as you know will be implemented january of 2014. the affordable care act will provide for the first time medi-cal coverage for single indigent adults who are age 19 to 64, as well as some expansion for our families. we anticipate a medi-cal case growth of about 30,000 single adults. put that into context right now our medi-cal case load is 47,000 right now. we're looking at an increase of about two-thirds. and with that, obviously with 30,000 new applicants and recipients, we're going to need the staff to process those applications. we're doing a lot around technology to be able to add a significant number of clients without a commensurate increase in staff. we're not increasing our staff by two-thirds. but the increased staff will

allow -- we think will enable us to process those applications in a timely manner and get folks onto medi-cal. a big piece of our budget, as i said earlier, is aid payments or entitlements. i point this out again to say that this is an area that we don't have a whole lot of control over. in fact, you know, we want to maximize enrollment in our programs for folks who are entitled to benefits. some of our programs are goals to get them off, whether it's public assistance or welfare we want to get them to self-sufficiency so they're not relying on a low level of cash assistance. on supportive services the more focuses who can avail themselves of in-home care we want to do that. it's more cost effective than institutional care and more humane and a much better strategy for folks moving forward. similarly cal fresh, which is the new name of our food stamp

program, we want to get -- it's not represented in here because we don't pay for the aid but we want to get as many people onto food assistance as possible. not only does the food purchasing power go back into the community but it helps food stability and nutrition for our folks who are in need. foster care is going down. it continues to decline. we were at about 2500 kids in foster care, as recent hi as six years ago we're down now to about 1,000. it's great news to keep kids safe with their birth parents and not strangers in foster care or other counties with relatives or foster parents. sort of the policy and program changes, and i want to touch on the most -- maybe that should have been first because all of these are what drives the numbers that i just presented to you. as i mentioned mid-cal and the affordable care act one of the most significant shifts in new

initiatives for our agency in many years, it provides an opportunity to enroll tens of thousands of people into medi-cal, which of course saves the city money in terms of providing healthcare, because we're getting reimbursed from the feds and the state. it provides an opportunity to get folks onto other benefit programs, to which they might be eligible. the affordable care act talks about what they call horizonal integration. what that is, once they're on medi-cal, medicaid nationally, medi-cal in california, we want to see what other programs, benefit programs they're eligible for. the one with the biggest overlap is cal fresh which used to be called the food stamp program. some of the technology and business processes i taked about to allow us to absorb 30,000 applicants without a commensurate increase in staff we will be training our workers. so when a client comes in he or

she or the family will be able to not only got their medi-cal eligibility done but also their cal fresh or food stamps eligibility. >> chair farrell: has that been done before in the department? >> we do a little at the the front end on the screening but in terms of the complete process being one worker, no. >> supervisor avalos: i'm looking forward to that being not a novel thing. >> in fact, -- >> supervisor avalos: you're doing that. >> yeah. it's actually just the beginning. we have embarked on a process that we're calling a no wrong door approach to benefits, which ultimately -- and this is really driven by the affordable care act because that used to be the barrier. we had single adults out there not eligible for our programs but under the affordable care act they will be. ultimately 2015 or so, we think an individual will be able to walk in our door and see one worker, or even do this on line. and be certified eligible to all

the programs to which he or she is eligible and the same goes true for families. there are efficiencies which are great for the city in terms of savings. also, of course great for the client, to have one visit to our agency rather than three different applications in three different buildings and three different workers. the consequence though of course of this affordable care act and horizonal integration is increase in the cal fresh workload which we will see. we're proposing increases in staff to manage that. again not commensurate with the growth but additional staff to allow -- to handle that growth funded by the state and feds as well. i mentioned governor brown's refocus on employment for our calworks program, and our share of his increase as proposed in january is about $3 million. that flows right into jobs now which is our local subsidized employment program. the governor was very impressed with the state -- not only our

county but other county's ability to deliver subsidized employment programs under president obama's stimulus act and outcomes for families with regards to that program. he talks a lot about investing in counties and our systems to subsidize employment. we're particularly well positioned because we have our existing jobs now program and it represents an expansion of that which of course is great news. family and children's services and realignment this is under realignment phase two which was part of the governor's revenue initiative that passed, what realignment basically does is takes funding for child welfare out of the state general fund and dedicates a tax revenue stream to it. in this case its sales tax, vehicle license fee. because those revenue streams are growing and because our share, being filed chair systems across the state, it's fixed in

constitutional language as revenue grows so does our funding. we're anticipating growth of 3 million for childcare in this coming year. it could be much higher than that. what this means is increased funding for our children in foster care, our families who are at risk of being in foster care, things like transitional housing for aging out foster youth, whatever package of services and staffing we need to help our families who are most in crisis in the city. in housing and homeless, hop la is the housing opportunities for persons with aids program. this is a program that we began administering a few weeks ago. this was formerly administered by the housing authority. it's procured through the mayor's office of housing. and we competed to be the administrator of hop la and were selected as the administrator of the program. it's a federally funded program, provides housing subsidies in form of section eight or voucher

to homeless individuals with aids or hiv. it fits nicely into our stream of supportive housing for homeless individuals with our housing first program, local program, and now hop la. so it allows us to sort of, on the operational level, have a homeless individual come in through us or your cvos and we can slot that person into the appropriate housing opportunity when they're available. so with that the next two are under our aging adult services program so i'll give anne hinton director of dos opportunity to talk about those two. >> good afternoon, supervisors. i actually thought i would take a minute and draw your attention back to page 5 and the slide that trent was referencing, the adult services department at 1.73.6 million. and just to say that we're divided into four divisions, trent mentioned ihss program which serves about 20,000

san franciscans but we also then, a second part of our department is the protective services, which is adult protective services, the public guardian, pa, and so on. we also are -- house the older americans act programs under the agency on aging and veterans services. so that's a third division. the fourth is long-term care services and support and that primarily relates to transitional care, the community living fund and division and community integration programs. so then taking you back to slide seven and those last two items, so try to connect the dots a little here. the ihss memo of effort, this is part of governor brown's coordinated care initiative, which is part of an opportunity that the state had under the affordable care act to begin to move people -- older adults and younger adults with disabilities into managed care. part of that will not happen for a number of years.

but the good thing for us is that the maintenance of effort that has been drawn up between the states and the county is actually going to have a financial benefit to san francisco. and so we're -- so the positions that we are proposing are revenue-backed by those revenues that are coming to us that are part of this maintenance of effort agreement. the last item on this slide is the broadbent technology opportunity. i think most of you are aware of the technology centers that are available in your different districts for older adults and younger adults with disabilities. we have placed over 200 computers in centers. there's been something like 40,000 hours of training done. almost 21,000 folks who have been trained. and so the initiative that we have -- in this year's budget really is to keep these last three years of work that we've done in the various communities alive and moving it forward. we have older adults and younger

adults with disabilities now accessing medical records, being able to talk with grandchildren and people around the country and around the world. and it's certainly has shut down that myth when you're older you can't learn new things. we're very proud of this work and think that this initiative is well worth the support. thank you. >> chair farrell: thank you very much. >> supervisors, the rest of the presentation you have, i'm happy to go through it but it's pretty detailed. so supervisor farrell and i, in talking yesterday, felt that you can take a look and if you have questions obviously, speak with me. or if the committee would like, i can certainly go through them. >> chair farrell: thanks. supervisor wiener. >> supervisor wiener: thank you. thanks for the presentation. just a question. you went over this i think briefly before. but the 102.3 million in homeless services, can you break

down what goes into that. because when you always hear different numbers about how much we're spending on homelessness, 100 million, 200 million. i know there are a lot of -- it interconnects with a lot of different services so i know it's probably pretty challenging. of course once we house a homeless person they're not homeless anymore depending on what kind of housing it is. so i'm curious to know. >> thanks for it the question, supervisor. here it is. so broadly speaking, what the 102 million, as proposed funds is our emergency shelter system for single adults which is about 10 million -- i'm going to ballpark it because i don't have the details in front of me -- our family shelter system is, our family shelter waiting list, transitional housing for families, and then a huge portfolio of supporting housing for single adults which is now about 3200 units.

that's the bulk of it. when i say funding supportive housing, what does that mean. it means subsidizing the tenants rent, it means paying fr property management, it means paying the least cost to the owner but that's the form of the subsidy to the client and paying for services on site. ta's in the that's in the form of case managers, mental health support, substance abuse support. it gets expensive. but it's as expensive or more expensive to have that same person be on the street, utilizing emergency rooms, crisis clinics, ems calls, police, studies have shown that. we've talked, supervisor, about sort of where we're at now with our approach to homelessness. you know, we were very i think successful over the last many years at implementing what we call housing first, which was based on a lot of research and studies that show that anyone can be housed.

the notion that someone had to be housing-ready was turned on its head about eight years ago. so we did a really good job of putting housing first forward and getting folks, who have multiple barriers, into that housing. but that's what we focused on is housing first. the success was defined keeping that person in housing. housing retention rates over 90% for a difficult population is laudable. however we're at the next phase where we built up our portfolio but not seeing a lot of turnover. we're not seeing a lot of turnover because our goal is to keep folks in housing. i think it's probably time to look at what our next phase is, and what that looks like to start to generate more positive exits from our housing for folks, whether through employment, through connection with individuals families or friends, through getting on disability assistance where we can raise someone's income. so thinking through what that

might look like in our buildings and we have 30 plus buildings, and what that staffing mix and investment might look like. that's something we're discussing internally now. >> chair farrell: in terms of those 3200 units is there a formal waiting list in terms of knowing what the the backlog of people who want to go into that housing, and but who are -- there's not a unit available. >> unlike the housing authority our buildings don't have a wait list. what we've developed are access points, an access point being the shelter, streets, general hospital, other sort of points of contact with our system. and they get referred into whether it's us for placement at our housing or dpa for dos housing, criteria are used such as acuity levels of individuals, are they very sick, do they really need to be housed, prioritizing in that way. we look at time in shelter.

if they've been in shelter for a long time they would be prioritized. i can tell you the wait out of shelter, of someone who is in the queue, they're in our shelter system consistently the wait has been generally four months to get into housing. our turnover is about 20 to 30 units a month. >> supervisor wiener: the 20 or 30 units a month that become vacant and available, what -- i imagine there are various reasons why they become vacant. can you sort of -- and i'm particularly interested to know, in terms of people successfully moving back, say potentially into the job market or being able to have housing of a different kind of housing, and then open up such spot so someone else can come off from a shelter. >> right. so we've worked a little bit with the controller, two years

ago, maybe a year and a half, on sort of examining kind of those questions, what are the rates of turnover, what are the lengths of stays, what are the reasons for turnover. one of the things we found data at the provider level was not very robust. an hanecdotally of our exits, hf or so may be considered positive and the other half not, meaning evictions for failure to pay rent, for not allowing unit inspections, a range of reasons. we try not to evict but sometimes you need to or the quality of life in the building gets degraded. but other exits are folks do get a job and they move. folks get reunited with their family and leave the city, those kinds of better exits. what we're again sort of through this process of thinking through in a sophisticated way what the next phase looks like those are

questions what needs to answer and what works internally towards doing that and moving towards a pilot, either an existing building or new building, a pilot of what a more transitional model looks like. not transitional housing because that's a forced exit after a certain period of time. but a service mix that with the intent of it being a transitional housing placement, you know, and seeing what that might look like, who might be the candidate to enter that type of program, could it be anybody, would it be folks from homeward bound. those questions we would answer through data and maybe piloting something. >> supervisor wiener: do we have -- and i know there -- this flows into dph at some time. i know not all of the services or contacts with the homeless are through hsa. do we have data on people who are living on the streets, in it terms of what perge percentage

of them are actively trying to get into shelter, other forms of housing. and what percentage report. i know there's a debate about whether there are or aren't enough shelter beds, whether people are on the streets simply because there is no bed for them as opposed to people either choosing to be on the street, or because of mental illness or drug addiction, liking the capacity to really enter into the system. do we have good data on that bakedown? >> you know we really don't but all the things you mentioned are reasons folks are on the street, whether it's inability to access a bed on a given night, whether it's the shelter system as it is now isn't good at accommodating an individual, whether the person doesn't want to have lights out at 10:00, or not be able to use indoors, that sort of thing. whether it's not understanding the shelter system, if they're

new to the city. whether it's mental illness and substance abuse, addiction preventing them to think rationally. all that stuff is mixed in. as part of our homeless count this year we surveyed over 1,000 folks on the street and it was a robust survey so we hope to glean more about things like how long have people been on the street, where they came from, why are they not using shelter, have they used shelter in the past, to answer some of these questions. >> supervisor wiener: you know, i think it's -- and this is the frustration throughout the city because we have this -- you know, for decades now, really significant challenge around homelessness. and we spend -- it's $102 million for the programs u described. when you add dph and everything else in there it's significant higher. so we're spending a lot of money, and, you know, i'm a believer in having a policy in

it budget discussions based on data. and where it's possible to have that data, so we can make good policy decisions about how we're allocating our resources, and whether we're succeeding, and whether it's a good expenditure, is there a better way to expend it to address the challenge. and it seems like having more thorough data about what we just talked about in terms of why people are on the street versus in a shelter, or in housing, knowing what the breakdown is, and also data about the people who are currently housed, and why they're leaving would be important. because i compoa in working with various segments with our homeless provider network there are some really amazing people in city staff, and in nonprofits, and amazing organizations, who a lot of people who do tremendous work,

but i think in terms of the broad structure it would be really good to have a deeper understanding of that information, that data. >> you know i think we're on the same page, supervisor. one of the things i talk about is i think our system is really effective at solving the homeless problem on the individual level. we know how to do that. we know that supportive housing works. we know that we have great outcomes in supportive housing. we're a national model. but then we go bigger and systematically and you see we still have a couple thousand people on the street, we still have 260 families on the homeless family waiting list for shelter. answering those questions as to why, you know, how can we house or reunite someone with their family through homeward bound, over 14,000 people since 2004, yet you can argue you haven't seen appreciable improvement on the street. i would argue that we have but some argue that we don't.

you know, those are the big questions. you know, influx of people, influx more than outflow, you know, all urban centers, you know, claim to be sort of attracting the hoamsdz. homeland homeless. i think that's right. it's the urban areas. it is about getting smarter, about who is on the street, who's in need and why the system that's effective for so many thousands of people not effective for that person on the street. >> supervisor wiener: do we have estimates for how many people per year are arriving in san francisco and are immediately homeless? >> no, we don't. what we will have, from the survey, and we've done this every two years, is the percent of folks who either came to san francisco homeless, or became homeless while in san francisco. and then the length of time they've been here. so we can glean some information from that. i don't want to ballpark it

because it can be a sensitive sort of issue. anywhere from 25 to 40%, san francisco -- came to san francisco while homeless but that's self-reported and that's a pretty wide band. >> supervisor wiener: i would imagine there were people who were already homeless and came here and remained homeless. there are people came here wanting to make a life here and understimulated and became homeless. >> i think the homeward bound, which reunites folks with their families or someone who can take care of them in other cities, when you look at those numbers, and we're at 8,000 who have been reunited with friends or families since 2004 that suggests a lot of folks came here, you know -- and not unlike others. san francisco is a city of refuge for a lot of folks. poor, not poor, college grads, gay lesbian youth, immigrants.

but we're not a nation state. we're not going to close our borders. we need to be responsible. but that data does suggest that folks are coming here and it's not working out for them which is why we started the program when we did eight years ago. >> supervisor wiener: thank you. >> uh-huh. >> chair farrell: supervisor breed. >> supervisor breed: thank you. i just had a few questions about jobs now program, and wanted to know specifically what is happening to help deal with the transition of employment for jobs now. for example, people may take on the responsibility of someone, and the assistance to pay them through jobs now. but there comes a point where the jobs now support runs out, and then typically sometimes we've had situations where that person is laid off, and then

they're collecting unemployment, or it just -- there's no transition or no link to a maybe long-term job opportunity in maybe another field or something to that effect. just wanted to know a little bit more about how the jobs program is specifically connecting people to long-term job security. >> sure. so the goal of jobs now is to get someone immediately into employment and get income into their pocket. the secondary goal is to get someone who has a fairly -- typically a fairly limited work history or limited educational background, to get that experience. what we have found, and this is data from when we started the program in 2009, and we have a very large sample of over 5,000 placements that very often, in the private sector, once the subsidy ran out, if the employee was successful, the employer

kept that employee on, over half. i'll get you the exact numbers, i don't remember. i think it was in the 60% but let's call it over half were retained. they retained a full time job, not on the city's dime anymore. 88% of employees placed said it added value to the company. you can take any job training or job placement program in the city, whether it's nonprofit run or city run and you will never find a 50% placement rate. it's a very, very high placement rate number for folks with multiple barriers to employment. so it shows this is an effective strategy. we have a very large public sector to jobs now. so this is a public service trainees in rec and park, dpw, hssa and other city departments. the placements tend to be six months, some can last up to a year. we have been working with dhr to

allow those placements to count for mqs for city employment and met minimum qualifications. our staff is working with these clients. they're getting help with their résume, with soft skills, interview skills, things like that, they're connected with us. so we encourage folks to apply for, and get on lists for city employment, and at hssa. we've been able to hire a lot and getting former public assistance recipients working as case worgers in our system. city employment is not the answer to long-term employment. even though we're a very large employer what we do want is for people to get those job skills. you mentioned folks who don't get jobs, and there are certainly a lot, about you what they have after their placement is hopefully a solid reference. they certainly have a solid -- now a recent work history. they a