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, realizes the additional $27 million in revenue that comes back from the state. so you can see the table, we outlay $107 million for our services, 27 million to the state as our maintenance of effort payments, we continue to draw the share so it's a wash.

it's general assembly cost accounting. this is an overview on what will supplemental is. i'm sure we will discuss when mr. resolution gives his report, but i do want to leave you with this. the way that county human service agencies work and are funded, everything we do, we are a political subdivision of the state, we are required in state code, every county has to have a human services agency, the state is who decides how much funding we get. they look at case loads, they look at new cal works mandates and they decide how much we should be funded. in this case they decided we need

8 million more in cal worbs, they decided we need 7 million more to manage our cal fresh case loads and the like, and they are providing that money to counties. if we don't use the money essentially what we are telling the state is we don't need your money, it's okay, thank you, but -- i understand mr. rose and his team are doing their analytics and they are doing their rigorous work, they are not looking at whether it's county drars or state dollars or federal dollars, it's all taxpayer dollars and their analysis are sound. but i want to leave you with that, it's a message to the state that we don't need the money to support our most vulnerable is difficult when we are back lobbying saying we need this, we need this, and the governor can say, well, you didn't spend the money we already allocated to you. i will leave you with that as a thread of discussion looking forward to the budget analyst. >> thanks. any other

questions right now? >> you said thread or threat? >> thread, with a d >> just joking. >> okay, if nothing else at this point, i know we will come back. mr. rose, can we go to your report, please? >> yes, mr. chairman, members of the committee, first of all let me state that san francisco residents, supervisors, as you know pay federal, state and local dollars. they are all taxpayers' dollars so, yes, mr. rourke is correct that we look at these reports to determine whether or not the funds are justified. it doesn't make any difference if it's local, state or federal, it's still taxpayer dollars being paid by san francisco residents. in fact, under that theory, we shouldn't look at the airport or the port. those are not general fund dollars. i just want to emphasize that. and so the fact that the state allocated the money and said this is what you need, maybe

the state needs a budget analyst. i don't know. >> we can recommend you, mr. rose, if you want to go to sacramento. >> thank you, supervisor. now getting to the details of our report on page 5, the bottom of page 5, as shown in table 4, the proposed ordinance would appropriate 31.5 million and that's as mr. rourke indicated for new state and cal revenues ascribed to 5 different hsa programs to pay for different expenditures including contractors, client services, training and marketing and that's shown as i say in table 4 on page 6. on page 8 of our report, we note that table 6 details the 68 total positions being added by program for a total of 16.85

fte's for fiscal year 13-14. and on page 9 we note that the salary and benefit costs for the proposed fte's in 13-14 would be funded by hsa existing salary savings in the hsa 13-14 budget. as a matter of fact, the department has a total of surplus funds of 10.8 million. so mr. chairman and members of the committee, you might want to criticize, you might criticize the budget analyst for why we did not make further recommended reductions for this fiscal year. we always attempt to be conservative, anything we recommend we are very very conservative and are quite certain that what we have recommended will be far less than what the department could

absorb and in this case they've got millions of dollars worth of unexpended savings in salary savings. by the way, that's been consistent, i might add, for the past several years in this department. >> when you ask the department why there is such a big increase, what is their response? >> in terms of the salary savings? >> salary savings. >> basically, it's a problem throughout the city. it's with the human resources department it's difficult, there is turnover, when you have 27,000 employees in an operation, it is very difficult and there is attrition on an on-going basis, it is difficult to fill all the positions at any given time. >> mr. rose, hold on one second. mr. rourke, is there something specific just on that point? >> with an fte number of about 2,000 in our agency our natural

rate of attrition is about 100, 110 positions, people resigning, it takes months to fill them, you go to a list, if there's not a list you go to an exam, so there is always this vacancy churn but it's important to note that's not the same 110, 150 positions, right? it's different vacancies over time. you take a snapshot, you say there's 150 vacancies. if you take a snapshot two months later, there may still be 150 vacancies but they're different vacancies. >> what is different now these past 3 or 4 years compared to the years before that we didn't have any salary savings. >> we are now at a vacancy level of, i believe, 170. two years ago we were well over 220, 230, and that was a function of the recession years and trying to contain costs.

we intentionally kept positions rather than laying people off, we intentionally kept positions vacant to give us flexibility when times are good we leave the position in the budget and then we can fill it when we have funding available. we've slowly been catching up. even with aggressive hiring, we still have resignations, we still have retirements, so now we are slowly catching up. the process of the mayor's office has been much quicker but it does take time to catch up because we were so significantly basically understaffed for many years during the lean years. >> so do you have a timeline, a plan, for catching up? next fiscal year or is it going to be -- there is a general attrition that happens but it seems like we have vacancies that are well above what that is. >> we certainly have vacancies

above the natural rate of attrition. some of that is because we intentionally kept positions vacant to control costs. we are hiring in both groups. we hired a lot of folks for the affordable care act. our training and staff development team is more robust now so we think we will be caught up and sort of achieve our natural rate of attrition i would guess by the end of the summer, maybe the fall. because we are doing such an aggressive work in our internal hr department and in partnership with dhr and the mayor's office to fill funded positions and certainly as i showed in the presentation, the work is there. our case loads are growing across are growing across the agency .