things, you can't -- you can't undercut us. so this is not the time to be cutting public health. this is the time when public health really needs to be built up. you know, i'm almost to the point now where i feel like there needs to be some sort of bond measure or something so that public health isn't constantly short every time. the bottom line it's not getting enough funding to perform at the level that's required of it. i mean that's the structural problem we have. is that it's not getting enough money to perform at the standard that you need it to perform. so i hope you really take that into consideration. >> chair farrell: thank you very much. next speaker please. >> good afternoon. my name is -- and i'm with 1021, a field representative for city funded nonprofits. and i want to speak in support of the supplemental. i think that since the economic

downturn, we've seen year after year, just incredibly devastating cuts, and i think that this year we're blessed with a better budget, and that we need to share the wealth, and physically with our most vulnerable residents of the city. we can't see the level of cuts that we've seen, year after year. the department is completely -- there's just nowhere else to cut. and we have to take care of our vulnerable people. we do. so i hope that you vote in support of this. thank you. >> chair farrell: thank you very much. next speaker please. >> i'm rebecca, i'm an r.n. public health nurse with the city and county of san francisco. one of the things that gus mentioned was, in the psychiatric unit, and when you start cutting staffing, it becomes a health and safety issue for our workers. and the potential for people to get injured, and assaulted, goes up.

so it's so important to be adequately staffed in public health. and i'm just asking for your support on the supplemental bill. thanks. >> chair farrell: thank you very much. are there any members of the public that wish to speak on item no. 2? okay. seeing none, public comment is closed. colleagues, we have the supplement a before us. we have recommendations that the department of public health as agreed on from our public analyst. could we entertain a motion to accept the recommendations of the budget analyst and amend the appropriation? so moved. we can do that without opposition. can i entertain a motion to move this item forward as amended. we can do that without opposition. thank you very much. mr. clerk, can you please call item 3. >> the clerk: 3. hearing to receive an update on the human services agency's budget for fy2013-2014 and fy2014-2015. >> chair farrell: thank you very much.

colleagues, this is one of the opportunities we have to hear from one of our larger city agencies before the crunch of budget season to give it preview into their budget picture for next year. i also -- i know we have trent -- here, the head of our human services agency. i'd also like to recognize in the chambers with us former supervisor bevan dufty who is here. welcome back, supervisor dufty. i don't know if you or someone else wants to start the presentation. hold on one second. i think you're green lit. >> good afternoon, supervisors. trent rohr, director of the -- agency. nice to see you again. i have a presentation. so what i want to do is give you a pretty high level view of our 730 million dollar budget, talk

a little about some initiatives that will be before you in june, that we hope to have funded in our budget and then talk to you about sort of the big piece of our budget this year, and the changes have a lot to do with what's going on in sacramento. and the good news is the better revenue picture in sacramento is directly benefiting us as an agency and us as a city and of course the clients whom we ser serve. >> chair farrell: i want to recognize chief financial officer who is here as well as ann hinton from the head of our department of aging and adult services. thank you for being here. >> thank you. to start off with our reduction plan which is small when you keep in mind that our budget overall is over $730 million. so our 3% general fund target is about -- under $1.4 million, that we can meet in 13-14 and

14-15 with increased revenue, principally from the state, and then some non-salary underspending, just scoring those savings and that's typically in the contracts area. so there's no service impact or staffing impact for meeting our reduction target. so this shows our budget in the current year, and then the budget year, in 13-14 and breaks down what the human services agency looks like. you know that the human services agency is comprised of two city departments, department of human services and department of aging and adult services. the yellow slice there represents the admin support for both departments. so basically they support -- the department of human services and department of aging under the rubric of the human services agency. you can see roughly the breakdown, almost two-thirds of funding is for department of human services, a quarter for

aging and adult services, and then under 15% for program support which is really another name for administration. so we contract support, i.t., personnel, and the like. so sort of a key thing to keep in mind about the human services agency's budget is we are largely funded by federal and state sources. roughly a third federal, a third state, and a third county general fund. it's not exact. it fluctuates from year to year but that's sort of roughly how it plays out. and then, furthers, a lot of what is funded are entitlements or aid. so it's important to know that because those aren't funds that we have any discretion over. these are entitlements to families, single adults, to our seniors, whether it's getting support for food assistance or cash assistance through welfare

programs, providers under hiss. it's hard to see on the slide but sort of upper right green section, the 16% ever operating general fund, some of that is a required match or maintenance of effort to draw down the federal and state funds. and that's about $45 million. so if you take the $45 million out of the 111, that's about what our discretionary general fund is. so roughly $750 millio0 milliont we consider general discretionary fund. in other words funding that we as an agency, the mayor, and of course the board of supervisors, have discretion over and set your priorities through that funding. the next slide shows where we spend our dollars. and it really breaks down sort of our major program areas. adult services is lumped into one big slice but that

represents a lot of programs, mostly supportive services, which is providing in-home services for seniors and disabled results to allow them to remain in their communities. you see program support, admin, the next largest is family and children services, which is child welfare, childcare, adoption, services to families whose children are at risk, or victims of abuse or neglect. the bulk of the 130 million goes toward services like adoption assistance. the next largest is everything from front end street and emergency services to our emergency shelter system for single adults and families, through the back end which is supportive housing for families and single adults. in the middle between the shelter and permanent housing is transitional housing, services to help stabilize homeless individuals whether it's case management or employment

services, and these service are principally provided through community based organizations, our community partners. as proposed for 13-14, i'll point out a few of the changes. and of course i said it's good news which means increased funding for us and primarily from the state and the feds. large increase in homeless services, you'll see from 88.9 million to 102 million. this represents a bit of a reconciliation for our federal mckinney dollars. the grant cycle and the federal fiscal year don't exactly match. they don't match at all, our local fiscal year. and so every year when we apply for these grant funds they come in at a different time. so we're trying to get a solid and standard way of recognizing that in the local budget and avoid the fluctuations we might see year to year. it doesn't necessarily represent new money but trying to make it a little simpler to make year-to-year comparisons.

some of the -- another big piece is a shift of transitional housing for our youth and/or homeless service area which is not a new program but it's budget mechanics shifting that. we have funding for expansion of housing for families and single adults. some through our federal application process. and then funding for possibly a new emergency shelter in bayview hunters point, 100 bed shelter. in our adult service area, you see about a 6 million increase. that's principally an increase in ihss for an increased case load which is representative in wages and benefits. and i want to point out the black segment in the upper right because it represents a significant increase investment by the state into our calworks or welfare to work program. in january the governor proposed

about 160 million statewide to increase our work focus in our calworks program. which translates to increased funding for our community partners to deliver employment training services as well as increased employment services staff to help our families move from welfare towards self-sufficiency. some of that will also take the form of increasing our subsidized employment program which is shown really tremendous success in moving families into 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 n