Department of Health and Human Services AB73 Clark County Working - - PowerPoint PPT Presentation

Department of Health and Human Services

State of Nevada

Steve Sisolak Governor Richard Whitley Director

Helping people. It’s who we are and what we do.

Division of Welfare and Supportive Services

Robert Thompson, Deputy Administrator, Program & Field Services

Tiffany Husband, Homeless to Housing Manager Sheila Lambert, DHHS, GMU, Project Manager | Southern Nevada Coordinator 02/13/2020

AB73 – Clark County Working Group on Homelessness

Agenda Overview

2

• Introduction to DHHS
• DWSS Priorities & Services
• Medicaid Eligibility and

Enrollment

• Targeted Outreach and

Homeless to Housing Unit

• Program, Grant and Funding

Initiatives

• 1915(i) Housing Tenancy

Support and other Initiatives

DHHS is the Largest Department in State Government managed by Director Richard Whitley. The Director’s Office includes the Grant Management Unit, Office of Minority Health, Office

• f Consumer Health Assistance, Office of Health

Information Technology, Tribal Liaison, Office of Food Security, Public Defender’s Office as well as the five major divisions:

• 1. Aging and Disability Services
• 2. Child and Family Services
• 3. Health Care Financing and Policy (State Medicaid)
• 4. Public and Behavioral Health
• 5. Welfare and Supportive Services

Mission ion Stateme tement: The Department of Health and Human Services promotes the health and well- being of Nevadans through the delivery or facilitation of essential services to ensure families are strengthened, public health is protected, and individuals achieve their highest level of self-sufficiency.

Nevada Department of Health and Human Services Overview

DWSS Strategic Priorities

• To make Public Assistance Available to Those Most in

Need through an Efficient and Responsive System while Ensuring Program Integrity and Reducing Fraud in the System.

• To Create Opportunities for Increased Self-Sufficiency

and Independence through the Delivery of Employment and Training Opportunities for Recipients of Public Assistance and through the Establishment of Paternity, Support and Medical Orders and the Collection of Support for the Children we Serve.

• To Enhance Eligibility Determination Processes

through Technology Improvements and Process Reengineering to Improve Worker Efficiency, Client Access and Deliver the Highest Quality of Customer Service to the Clients we Serve

• Seek Collaborative Opportunities for Operations of

DWSS Programs to Enhance Efficiency, Consistency, and Responsiveness to Customers while Providing Services in a Manner Designed to have a Positive Collective Impact on Public Health

4

DWSS Major Activities & Services

5

FIELD SERVICES INCLUDING HOMELESS TO HOUSING EMPLOYMENT AND SUPPORT SERVICES CHILD SUPPORT ENFORCEMENT PROGRAM REVIEW AND EVALUATION ELIGIBILITY AND PAYMENTS PROGRAM OPERATION SUPPORT AND TRAINING CHILD CARE ASSISTANCE INVESTIGATIONS AND RECOVERY

DWSS Actions & Tasks

6

694,269 Unique Individuals participating in at least one (1) of three (3) Programs

DWSS Field Services

• Nevada TANF Recipients 23,536 in FY 2019, and projected

to decrease to 22,992 in 2020, and 22,488 in 2021

• Average monthly client actions are projected to increase

from 141,818 in FY 18 to 142,022 in FY 2020 and 144,007 in FY 2021.

• Process 69,000 applications per month for SNAP, TANF and

Medicaid.

• Process 108,000 Changes monthly to individual clients.
• SNAP Participants 419,832 (October 2019) and is expected

to average 430,045 in 2021.

7

Recipients by Program

8

SNAP Medicaid TANF

Program Recipients Medicaid 658,580 TANF 20,774 SNAP 414,969

35,020 348 276,343 2,609 17,496 362,132 321 Note: October 2019 data are used in the diagram above. 694,269 unique individuals are in at least one of the three

• programs. Medicaid counts include retroactive cases. Nevada Checkup cases are not included.

Nevada Medicaid Service Population

Medicaid population includes those served by Fee-For-Service and Managed Care Organizations.

• Fee-For-Service: Health

Services paid directly by DHHS.

• Managed Care Organization

(MCO): Health services to manage cost, utilization and

• quality. Paid per member, per

month to health care

• rganization.
• ABD: Aged, Blind or Disabled
• CHIP: Children’s Health

Insurance Program

9

Medicaid Applications Processed

10

Medicaid Caseloads by Category

11

Medicaid Processing Timeframes

12

SNAP Projections

13

TANF Projections

14

The Temporary Assistance for Needy Families (TANF) Grant

15

TANF is funded from the Personal Responsibility and Work Opportunity Act of 1996 (PL 104-193) States are required to provide a minimum maintenance of effort (MOE) funding contribution (mandatory minimum of 75% of the allocation spent in 1994). Requires states to engage 50% of all families and 90% of two-parent families with work-eligible individuals in work activities. Nevada did not meet the requirement from FFY12 - FFY17 for all families and has not met the requirement for the two-parent families. Failure to adhere to the federal requirements has resulted in the State repaying those funds to the federal funder.

FFY 2018 TANF and State Funds by Category

• Assistance Programs: $38,178,000 or 37%
• Child Care: $16,590,000 or 16.1%
• Work Education & Training: $1,489,000 or 1.4%
• Child Welfare: $15,604,000 or 15.1%
• Administration: $8,163,000 or 7.9%
• Emergency Short Term Services: $2,721,000 or 2.6%
• Other Benefits/Services: $20,390,000 or 19.8%

TOTAL: $ 103,135,000 Population Served in Nevada: 9,023 Families; 22,836 Recipients; 17,191 Children and 5,645 Adults

• Resource: https://fas.org/sgp/crs/misc/RL32760.pdf

16

Program Improvements

• TANF met the All Family Work Participation Rate.
• SNAP increased access through outreach, resulting

in the State receiving a $739,060 bonus.

• SNAP accuracy increased by 4.23%; 8.17% above

the national average.

• SNAP Timeliness ranked #6 in nation in application

and processing times, resulting in $786,576 bonus.

• Call Center Phone Tree redesign increased direct

access to case managers, increasing the number of telephonic applications, interviews and case updates by 12,726 per month.

17

Targeted Outreach

❖Targeted Outreach Partnership established in 2015 to connect clients through non-traditional points of entry. ❖DWSS services now include 133 Community Partner Sites with 32 Eligibility Workers. ❖Outreach Workers are equipped to provide EBT cards at time of interview. ❖Service Coordination with the Nevada Department of Corrections Re-Entry; Clark County Detention Center; Veteran’s Administration; The Center; HELP; Courtyard; Shannon West Homeless Youth Center; and Catholic

• Charities. Active partner with the

Nevada Homeless Alliance.

18

Homeless to Housing

Tiffany Husband Homeless to Housing Manager

✓Expand coordinated entry for services. ✓Support collaboration and coordination. ✓Client driven housing and service goals. ✓Data driven programs and services. ✓Streamlining and blending funding to enhance services. ✓Alignment of activities with the United States and Nevada Interagency Council on Homelessness Strategic Plan(s).

Director’s Office | Grant Management Unit Major Programs

20

Family Resource Centers Food Security Grants Funds for a Healthy Nevada Title XX Community Service Block Grant Grief Support Trust Account; Children’s Trust Fund; Victims of Human Trafficking; Problem Gambling

Major State Block Grants

21

• HOME Investment Partnership Program
• Community Service Block Grant and Title XX Block Grant
• Job Training Formula Grants to States
• Social Service Block Grant
• Maternal and Child Health
• Temporary Assistance for Needy Families
• Substance Abuse Prevention & Treatment
• Community Mental Health Services
• Child Care and Development
• Low Income Home Energy Assistance (LIHEAP)

Substance Abuse and Mental Health Service Administration (SAMHSA)

• CABHI: Cooperative Agreements to Benefit Homeless Individuals
• Program eliminated by Congress and merging into other direct

service programs;

• Funding will go directly to non-profit providers; and
• State has passed through all available funds for last cycle.
• Clark County received $125,677 CABHI grant for SSI/SSDI

Outreach, Access, and Recovery (SOAR)

• PATH: Projects for Assistance in Transition from Homelessness

(services for SMI experiencing homelessness).

• Money is directed to Clark County non-profits to provide direct

services to the community.

22

Substance Abuse Prevention and Treatment Agency (SAPTA) Specialty Court Grant

SAPTA awarded a $ 1 million grant to the Clark County Specialty Courts starting in 2017:

• Focused on 175 inmates, with Length-of-State

(LOS) beyond 90-days needing housing. Of those, 61% identified as indigent living with family, 37% identified as homeless, 2% or 9 (nine) individuals as having independent housing.

• Success: The length of time for discharge has

been reduced from 4-6 months to 33-61 days.

• They have served 477 unique individuals.
• Clients receive all types of services from case

management, employment services, Medicaid, as well as coordination for long- term housing, as examples)

• Court estimated a savings of $250,000 for

CCDC (inpatient/transition housing and case coordination in lieu of incarceration)

• SAPTA is continuing to push the majority of all

available dollars to the local communities, for local prioritization. Recognizing the federal assurances must be met.

23

Medicaid Funding Model

24

How is Medicaid funded?

For every $1.00 that is spent for an adult Medicaid eligible service (SFY20), Nevada will receive $.64 cents from the federal government. By expanding Medicaid eligible services through waivers, Nevada could maximize services. This would allow general fund or grants to be leveraged for non- eligible activities or Medicaid uninsurable clients.

Mental and Behavioral Health Expenditures in Clark County

25

FFS Expenditures, CY19 Calendar Year (CY) 2019 * 77.9% of all FFS Medicaid Expenditures * 84.28% of all MCO Medicaid Expenditures TOTAL: $244,376,860 or 79.9% (out of $305,888,487 statewide)

• f all Medicaid Behavioral Health Dollars are spent in Clark County (74% of population)

Provider Type

• Pro. No.

FFS MCO Psychiatric Hospital, Inpatient 13 $ 6,080,506 $ 30,878,952 Behavioral Health, Outpatient 14 $ 95,218,992 $ 43,825,529 Psychologist 26 $ 1,263,321 $ 3,131,813 Targeted Case Management 54 $ 40,925,433 $ 4,339 Residential Treatment Center 63 $ 20,194,700 $ 1,591,407 MH Rehabilitative Treatment 82 $ 1,255,012 $ 6,855 $ 164,937,964 $ 79,438,895 Clark County Total $ 244,376,860

Type of Behavioral Services

• Section 1915(i) of the Social Security

Act allows states to submit a SPA to

• ffer HCBS to individuals whose needs

are substantial but are not severe enough to qualify them for institutional

• r waiver services.
• Does not require cost neutrality.
• Provider qualifications are currently

being developed.

• Public Workshops in early spring.
• June 2020 – estimated timeframe to go

to the Board of Health.

• CMS has a 90-day review period.

26

Medicaid 1915(i) Tenancy State Plan Amendment (SPA) Home and Community Based Services (HCBS)

Medicaid Academy

• DHHS would establish a Medicaid Academy to transition providers from

CABHI and PATH dollars to Medicaid dollars.

• Accountability, consistency, and sustainability.
• Enhance the State’s ability to direct grants to non-Medicaid eligible

activities such as housing programs.

• Expand to introduce new providers to be able to bill for Medicaid services.
• Medicaid academy to support the process of becoming an eligible provider

as well as supporting the required policy and billing infrastructure with technical assistance and support.

• Utilizing grants or state general fund (SGF) dollars, $1.00 in services equal

$1.00 in return. When we use SGF with federal matching of Medicaid services, the match can be 2:1 or greater, depending on FMAP population served.

27

Housing Case Management Services under the 1915(i)

✓ Conducting Biopsychosocial assessment ✓ Development of Individualized Housing Goal ✓ Housing search process preference inventory and assessment Assistance with: ✓ Lease signing, utilities connection, etc. ✓ Managing relationships with property managers, landlords to facilitate access to housing and prevent eviction ✓ Maintaining documents required for housing subsidies, applications and re- certifications, rental leases ✓ Coordinate care related to primary and behavioral health care, emergency and urgent care

Enhancement Activities

▪ CMS Support Act Grant – Expand number of providers eligible to provide mental and behavioral health services. ▪ Develop Medication Assistant Treatment (MAT) chapter to the MSM. ▪ Develop an 1115 Waiver for Institutional of Mental Disease (IMD). ▪ Develop Integrated Care System (Integration of behavioral health services into medical settings, including FQHC’s). ▪ Education tool kits for community on screening, brief intervention and referral to treatment (SBIRT). Disclaimer: Medicaid expansion or enhancement activities require Centers for Medicare and Medicaid Services (CMS) approval. Legislative approval is also required new or expanded programs.

29

Contact Information

30 Robert Thompson Deputy Administrator, Program and Field Services Nevada Department of Health and Human Services Division of Welfare and Supportive Services (702) 671-2074 RThompson@DWWS.nv.gov Tiffany Husband Homeless to Housing Manager Nevada Department of Health and Human Services Division of Welfare and Supportive Services (702) 486-1532 THusband@DWWS.nv.gov Sheila Lambert Project Manager | Southern Nevada Coordinator Nevada Department of Health and Human Services Director’s Office, Grant Management Unit (702) 236-5602 SLambert@DHHS.nv.gov

Questions?

31

Resource Links

32

Department of Health and Human Services (DHHS): http://dhhs.nv.gov/ Division of Welfare and Supportive Services: https://dwss.nv.gov/ Office of Analytics: http://dhhs.nv.gov/Programs/Office_of_Analytics/DHHS_Office_of_Analytics/ Substance Abuse Prevention and Treatment Agency: http://dpbh.nv.gov/Programs/ClinicalSAPTA/Home_- _SAPTA/ Medicaid Service Manual (MSM): http://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Resources/AdminSupport/Manuals/MSM/Medicaid_S ervices_Manual_Complete.pdf TANF: https://www.acf.hhs.gov/sites/default/files/ofa/2019_15months_tanf_totalrecip_07192019_508.pdf SNAP: https://fns-prod.azureedge.net/sites/default/files/resource-files/29SNAPcurrPP-1.pdf