♪ ♪ ♪ ♪ . >> welcome to the san francisco board of supervisors for wednesday, april 23, 2014. my name is mark farrell, i will be chairing this committee. i am joined by supervisor avalos. i want to thank the clerk of the committee miss linda wong as well as members of sfgtv covering this meeting. >> please silence all cell phones and any electronic devices, please be sure copies of any documents be submitted to the clerk. >> thank you, madam clerk, please call item no. 1.

>> item no. 1, ordinance amending ordinance 16013 to reflect the addition of 68 new positions at the human services agency for implementation of additional work associated with increases in state and federal funding. >> thank you. i believe we have clint moor here on this item. >> good morning, supervisors, trepbt row, director of human services agency. we have a powerpoint and i will walk you guys through. in brief, what we are requesting is spending authority for increased state and federal revenue that's largely due to growth in case loads as well as initiatives at the state level either governor's initiatives or initiatives that were in the statute from prior years. the first slide is sort of an

overview. two of the items and the largest item is the in home supportive services as well as the cal are really more technical in nature. i will walk you through nonetheless. the enhancements in services and increases in staff are really reflected in the cal works, cal fresh and children and family services areas. so i will start with cal works. in fiscal year 13-14 the governor and legislature approved a significant increase in funding statewide for the cal works program. i want to give you a little context and history for this. two years ago the governor proposed shortening the time frame that families could be on cal works from 48 months to 24 months. the response from advocates and from county human services agencies was that if the time frame for being on public

assistance is shortened, we need more tools to help our families move from welfare to work. and so the governor and the legislature agreed and in the subsequent year funded what you see before you, the $231 million in new state funding. >> you said from 48 to 24 months? >> correct. >> and that was state law? >> correct. essentially what it does is it limits the type of activities a family can participate in after they are on aid for 24 months so really the message it's sending is you basically have two years now to engage in cal works welfare to work services and move towards self-sufficiency rather than 4, which obviously has a huge impact on our families, many of which aren't ready to move from --. >> was there opposition on that? >> there was. some of it was

a budget context and part of it was his view of reforming the cal works program. the governor's view statewide there weren't enough families participating so the idea coming from his office was to shorten the time frame and create some urgency. >> some pressure on the families. >> right. sdpietz our opposition it did pass but the lemonedout of the lemons was the significantly increased funding before you now. basically what the funding is for, it recognizes many families are not ready to move into the work force. they might be facing issues of homelessness, substance abuse, the whole range of issues many families are dealing from in dealing from public assistance to self-sufficiency. so the funding is for several things. the first is a state-wide standardized assessment that all counties should use for families and this is basically trying to

assess hr employ bltd and their needs and strengths are in designing a welfare to work plan. the second area is what's called reengagement services. this is really targeted to families that have not been participating and provides funding for not only case workers to support families but also services to help folks reengage in their activities. and the third area, which is sort of what i think is the most important, is what's called stablization services. these are basically flexible state dollars that are allocated to our county to provide intensive case management if necessary, to address homelessness, we could use it for rental subsidies, for example, domestic violence counseling, behavioral health needs, it's really a flexible pot of money. it's targeted for families who aren't yet ready to move from welfare to work. the idea would be a 6-month services that would be at least 6 months in duration and that 24 month clock would

not start ticking until after that 6 months of stablization services are provided. >> so, mr. rourke, for the 7.9 allocated to san francisco, do they have the flexibility to spend it as you want or is it mandated within these buckets that you spend it on? >> it's actually fundable across, with the exception of one pot of money, it's fundable across the entire allocation for cal works. we can make the determination to use it for more case workers, child care, so we are doing just that. we've developed what's called a family stablization plan that was submitted to the state department of social services for their approval. the other big area of funding is for subsidized employment. as you know, san francisco has for years had a very robust subsidized employment program called jobs now. some of the additional funding is going to expand that jobs now program

which places parents who are on public assistance into paid work either in the public sector or private sector. the state funds are used to offset the wages that are paid either in the public sector or for private employers. so the second half of the slide is more the detail --. >> i'm sorry, on the jobs now, how have we seen the number of jobs year over year rise and fall? are they pretty stable? what do we see in terms of jobs now, jobs created. >> in terms of the actual subsidized slots or post subsidy? >> will, those are two good things to talk about. >> we have been, and this funding will help, there was also an additional pot of state money two years ago under assembly bill 98 that provided more state dollars for subsidized jobs as well so our slots have been growing. i don't want to guess. i think

our slots now are in the -- i think we have about a thousand placements now in our current jobs now program, roughly. >> that will be great. and if your office can send to me and jeremy in my office staff year for year what we see in terms of jobs and placements. >> be happy to. we do a year end summary report that we have in our agency. i'll forward that to you. so to continue on the cal works august mentation, to comply with these new mandates, we are proposing to add 22, a little over 22 positions as well as services in the community an and additional subsidies for jobs now. what we will achieve by adding these staff, which are social workers and case workers as well as employment specialists, we will get families enrolled in their employment plan within a week. currently given our current

staffing configuration it's typically 3 to 4 weeks to get into a plan. we'll be able it provide the family stablization services that i talked about before including expanding child care for homeless families, additional intensive case management and expanded behavioral health services, among other services. we're going to cease an ssi advocacy program. this is especially important for parents who are disabled and therefore unable to work but who are not yet on federal disability. so what the ssi advocacy program will do is help parents who are disabled, as well as children who are disabled, navigate that process to apply for federal cash benefits which is a much higher cash allotment than is the cal works program. we will be able to add between 70 and 100 private sector subsidized employment slots and then we're going to leepbten public sector trainee slots from 6 months to a year and this is especially important because one of the exit strategies for the public

sector subsidized employment program is actually entrance into city employment. we have been very successful, for example, in the human services agency, folks who have been in the subsector program being hired out of public assistance and into an agency that's helping folks navigate the public assistance system. so it's a great way to get sort of a peer to peer type employment client relationship which we think is really beneficial for our clients. anyway, by extending from 6 months to a year it allows them to meet those minimum qualifications for many city jobs including clerks and eligibility positions and the like. >> so, mr. rourke, what is on average the suction diper employee? >> we have been kind of an iterate process. we've been

adjusting it back and forth, but right now i believe it's $5,000 and it's spread over a number of months. basically what we're trying to do is sort of mitigate the r*ifk to a private employer to taking on someone who they might feel has some barriers to work. we pre-screen them, we train them, we actually help them get that job and we know they're qualified but it allows folks to engage. in the early jobs now program while in the stimulus act we subsidize 100 percent of the wages in the private sector so someone could be employed for up to 18 months and we would reimburse the employer that whole wage. we just don't have the funding level to be able to do that for so long. >> just to be clear, i remember the jobs now, the implementation of it, it was great, but that's all dried up, right? >> right, that dried up the end of september two years ago, three years ago now. okay, so the next program area

that we're seeing expansion and the state again recognizing the growth in case load and has allocated funds to support case workers to deal with the increased case led is the cal fresh program, formerly known as food stamps. we've seen, as you can see with the case load graph, a significant increase largely during the recession years but we still continue to see an uptick but more importantly we're going to see a significant increase as we target individuals who we have enrolled in medical through the affordable care act chl there's one of the requirements of the affordable care act discusses what they call horizontal integration and the requirement that counties or states provide the tublt for recipients of affordable care act of medicaid or medical be offered public benefits to which they may be eligible. notably here it's

cal fresh. so what we intend to do for the tens of thousands of people we have enrolled in medical is target those who are not yet on cal fresh and do we colleen an in reach strategy and get them to avoil themselves of the cal fresh benefits so basically two needs, one is staff to do that in reach and second is staff to manage that on-going case load. as you can see by the graph, the red line below, although fte's have grown, they haven't grown proportionate with the case load yet the state when they do their funding models to county looks at that and funds us accordingly. so we are looking at that state money and know we can hire additional workers to do the in reach, to do the outreach, and manage the case load. i don't have to tell you the benefit to families but it's a huge need for families trying to manage high rents, high cost of living in san francisco and having a

few extra dollars toward food is significant and one of the strategies for the food insecurity task force is to increase cal fresh food stamps enrollment and specifically approximately 36,000 households in san francisco we think are eligible for cal fresh but are not receiving cal fresh. so that's really the target population that we're hoping to hit. >> trent, you and i have talked about how changes in federal law might be impactinginging the federal food stamp program, snap, around the country but here in san francisco or california we're somewhat protected. can you describe how and what the difference is in other places? >> it's a complex change in federal law that i'm not going to walk through the details. but the implications in the change in the farm bill that you note, supervisor, is that the average allotment for a family on food stamps, cal fresh, would be reduced by

about $100 to $120 per year. the reason i said there's no implication for us is because the state of california is working within the context of the federal law to try to mitigate those federal cuts by back filling -- basically using state funds to back fill that loss of federal dollars. although the details haven't been worked out yet, the state has said its intention is to not have households of single adults and families be harmed by that change in the farm bill. it has to do with a deduction related to what's called the low income energy assistance and it's related to the amount of money a family gets to liheap and food stamps. the next program is medical. although the budgets ask for mi

medical, additional medical case workers, it does ask for staff to support what this slide is called, which is service integration and which i'm going it talk about a little bit. there's been an enormous growth in medical because of the affordable care act, over 33,000 applications, most of whom will be eligible once we finish processing the backlog of thousands of applications. >> this is just within san francisco. >> correct. you can see the graph, we've almost doubled our medical case load, we have not 94 are we proposing to double our number of case workers and the reason we don't need to do that is because we've changed dramatically our business processes in determining eligibility of clients for all of our programs. in the old model, every client or customer in a human services agency had a case worker for each of the programs that he or she was involved in. so there was a food stamps eligibility

worker, a medical eligibility worker or a cal works eligibility worker so a family or single adult would go to several offices and meet with several different case workers to deal with either problems with their benefits or to apply for benefits. as funding from the state started eroding over time our case loads for those case workers would increase significantry. you are not doing any case work if you have four or five hundred clients. what we have done, merely mirroring with a lot of counties in california have done, is move to a service center approach. you as a client can go to any office and get assistance from any case worker who may be available to help us. a case worker merely has to go on the computer and look it up to provide

assistance. i talked about horizontal integration a bit ago, someone can come in thinking they are just applying for medical but once we're fully operational in service enter gracious, in that same transaction they can leave our building with medical, cal fresh and cash assistance. that's the idea, that's the goal. we're not fully there yet. in order to make this a good customer experience for our clients, we've developed a lot of technology, a lot of information technology tools to help our clients. we have lobby navigation software, we have work force management software, we have what's called task management assignment tools. it's very, very data intensive but what it attempts to do is sort of balance the workload across our offices based on the needs of the clients. so for example if we see any given week a huge spike in the number of people applying through the phone or through the internet we're able

to quickly redeemploy rr people from front end lobby or if we have a huge increase in lobby like we did with medical we would assign people to the front. so it's constantly looking at the thousands of transactions we're doing daily for the hundreds of clients we're serving daily. in order to do this --. >> please continue. >> in order to do this we are proposing, again funded with state dollars, to hire analytical and systems support team of 11 individuals, program support analysts, business process analysts, then headed by an 0923 manager to really be able to fully realize this service integration vision that we have and it's not yet fully realized but these positions are critical in being able to manage the work force in order to deploy them in order to serve the needs of the client. >> mr. rourke, through the

chair, i wanted to thank you for explaining the staffing needs. i know the budget analyst had raised some questions about justification but this is helping me understand the service structure and the staffing structure and the horizontal integration you are talking about and that i know for cal fresh from the food security task force that you mentioned food security task force needs especially for the cal fresh positions, so this is really helping me understand the staffing needs. and i know when workloads are so overwhelming for your staff that they really need reinforcements, but your restructuring of how you use your money and resources so efficiently is really helpful for me. so thank you for explaining that. >> great. yeah, it is more difficult to explain. for every 200 new clients we need x more case managers, that's just not the world we are operating in any more. so the next slide is our family and children's services area. so the big impetus for our additional staff here is

what's called the katy a lawsuit. in 2008 the state settled this lawsuit and basically what the lawsuit said or the suit was about lack of access to mental health services for kids in foster care or for kids who are potential candidates for foster care. the settlement basically established mental health services as an entitlement for kids in foster care and for children who are candidates for foster care. it seems like a no-brainer, right, if a child has to be removed from his or her birth parents it's a traumatic experience, not just the instance that led to the removal but the removal itself. so the notion that mental health services should be available at the ready almost immediately upon removal is almost a no-brainer and we're pleased that the settlement worked out the way it did but it does increase the workload

for our staff. we've been working hand in hand to implement the katy a requirements. so what we're really seeing is the need for our child welfare workers, all of whom are masters level social workers, so they are clinically trained, over time because of workload demands and because of administrative requirements, our case workers are spending too much time doing what i would call administrative duties and less clinical work with children who are in foster care. because of the mental health needs and mental health mandates it's important our case workers be retrained and refocused on not necessarily providing intensive mental health needs but to be able to look through a mental lens and identify the needs of those children. so we're

looking at providing additional case workers to relieve that administrative burden of our clinical case workers. the 7fte would allow them to free themselves to do more of that clinical work. in addition we want them to do more work in the field, so providing mobile tools such as tablets and cell phones to be able to access the statewide data base mobilely rather than come back to the office again with an eye toward having our child welfare workers, our social workers out in the field with the families and kids they are tasked to serve. the third bullet is compliance monitoring unit that was recently highlighted in a state audit of our agency that was just released a few weeks ago. what the audit noted is that we are lacking in policy oversight and quality assurance of the

work in child welfare, meaning we don't have a robust enough infrastructure to make sure what we are doing is consistent with state law, federal law and regs. the audit didn't find that we were violating laws and regulations, it found we didn't have enough infrastructure to make sure. they did note that we need this. what was interesting is we had noted that we needed this long before the audit occurred so the timing is actually good. the next area is in home supportive services. again, similar to medical, similar to cal fresh, the case load for ihhs has grown significantly over the last 10, 12 years. our fte, our social workers charged with implementing ihhs within the agency, they had grown along with that case load through about july of 07. once the recession hit and we had

to, we were getting cuts from the state as well as cuts locally, that fte dropped and has since leveled off. so the implication of that is that we're not able to keep up, you can see in the first bullet, keep up with the required work in the ihhs program and notably every consumer on ihhs, and we have over 21,000 of them, they have to be reassessed annually for their needs, reassessed to make sure the number of service hours they are authorized to receive is the appropriate number of hours, is it high enough, is it too high, is it too low, and be able to assess is that individual still able to live and thrive in the community and in their home. so you can see with case loads of about 390 we are on time with our assessments in a little less than half of our cases. this isn't putting clients at risk, it's simply not meeting the state mandates around annual reassessments.

client are seen, they are just not seen within a year so they could be seen at 15 or 16 month intervals and that sort of thing. so what we're proposing is adding 8 social workers, 2 social worker techs and an ihhs nurse to be able to catch up with the need for annual assessments. >> can i ask through the chair, mr. rourke, miss hinton is here as well that the projections for the senior prop police station are exploding and i'm just wondering why the numbers of case load are not going up higher given the baby boomers turning into seniors really really rapidly and it just seems like we need to project out as the baby boom generation will fill out in about 10 years. >> right. >> so that we are ready for the huge increase in seniors. >> that's correct, supervisor. san francisco, about 18 percent of our population is 65

and older. statewide average is about 14 percent of the population, so we see here a disproportionate number of seniors. in terms of why it's leveled off, i think there could be a lot of explanations, demographickly or program wise, i think we did a fantastic job increasing our penetration rate over the last 10 years, we're really reaching through community partners, through partnerships with hospitals, through our own internal staff, at reaching folks who need ihhs. i'm still confident we are reaching folks who need these services to remain in their homes but with the additional staff i think you are right, we will be better positioned to hit that next uptick which i think is coming. i want to mention sort of the question may come up, why not go to a service center model or service center model with ihhs, and it's a different type of

program than your typical eligibility program. it's not just getting you on cal fresh benefits or getting you cash assistance. our social workers are doing case work and working with clients and consumers every day. they are building relationships. it's really by its nature a case load design program so it really doesn't lend itself to the more generic services as our other eligibility programs. so the last two slides are really what i've called the tech nical slides. first is our cal end information system, the information system that we use to determine eligibility for our benefits, medical, cal fresh, cal works and cap. because of the significant changes needed to this information system to implement the affordable care act, the state has provided additional funding to do these software changes and upgrades and you can see they are listed out

there but this is basically just spending authority for the almost $2 million from the state to make the changes to our system. and the last slide, although it's a big number, it is really just an accounting ear technical change that reflects the new way that the ihhs program is funded. so the old way, which is reflected in our budget now, is the county expends dollars locally on the program for the staff, our contractor, then we snit a claim to the state and then they reimburse us with federal and state dollars for their share. so there still is a county share of about 27 million but we get reimbursement from the state and the feds. that share in the old world, the cost to the county could fluctuate, go up and down based on growth in the case load or decreases in the case load in the old funding model. in the new funding which is based on

what's called maintenance of effort, the county share does not fluctuate any more. there is an annual 3 percent escalator, but in terms of we see a significant growth in the case load, to your point, supervisor mar, we are not going to see a commensurate increase in county costs. it's fixed at that 27 million number again with a small escalator. but because of the maintenance of effort it changes the way we submit our bills to the state, if you will. we still have the local costs, we have our case workers, we have our consortium and the public authority that total about $107 million. our county share of 27 million is still fixed but we not only need to pay the contractor and our staff but we also have to provide this maintenance of effort payments to the state. so basically what this piece of the legislation does, it gives us the spending authority to provide that $27 million to the state but then it also gives us the revenue,