Joint Committee Committee on Joint Health and Human Services (01/29/2009)

Final
STAFF SUMMARY OF MEETING

COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES

Date:	01/29/2009	ATTENDANCE

Time:	01:31 PM to 04:13 PM	Acree	X
		Carroll M.	X
Place:	LSB A	Gagliardi	X
		Gerou	*
This Meeting was called to order by		Green	E
	Representative Riesberg	Kefalas	X
		Kerr J.	X
This Report was prepared by		Lundberg	X
	Kelly Stapleton	McGihon	E
		Mitchell	A
		Morse	X
		Newell	X
		Nickell	X
		Primavera	X
		Schultheis	*
		Swalm	X
		Tochtrop	*
		Riesberg	X
		Boyd	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
Department Human Services Department of Health Care Policy Financing Colorado Community Health Network		- - -

01:33 PM -- Briefing by the Department Human Services

Karen Beye, Executive Director, Department of Human Services, introduced herself to the committee. Ms. Beye pointed out some organizational changes in the department. Ms. Beye provided a department overview and resource guide to the committee (Attachment A).

(Attachment A can be viewed at Archives)

01:41 PM

Ms. Beye spoke about the Child Welfare Action Committee recommendations. She stated that several of the recommendations from the Child Welfare Action Committee have been implemented including training for employees. She mentioned that the action review committee is looking into how to transition children that are too old for foster care, and how to foster a lifetime connection between foster parent and child. She spoke to Senate Bill 08-177, the Colorado Works Omnibus bill, which addresses how counties may use their Temporary Assistance to Needy Families (TANF) reserves. She also stated that Senate Bill 08-177 allowed the department to increase the basic cash assistance amount to recipients by 30 percent, or about $462/month. She noted that this is the first increase to the basic cash assistance in several decades. She stated that counties where TANF reserve funds are not being used, are going to a Strategic Use Fund, which can be used by the counties for innovative ideas.

01:53 PM

Ms. Beye spoke to the American Recovery Plan, the federal stimulus proposal. She stated that the stimulus package may increase funding for Supplemental Nutrition Assistance Program. She stated the Colorado has seen a 20 percent increase in utilization of food stamps and that approximately 126,000 individuals are on food stamps as of December 2008. She stated that TANF contingency plan, which allows the state to apply for more federal funding if the state meets specific requirements. These requirements are triggered by an increase in requests for food stamps and unemployment benefits. She stated that Colorado would meet these triggers. Ms. Beye stated that part of the stimulus package may include a Child Care Block Grant. She stated that the funds cannot be used to supplant current funds, but that the package would include funds for an increase of Medicaid reimbursement rates.

02:04 PM

Senator Mitchell asked Executive Director Beye if there was any discussion in the Child Welfare Action Committee with regard to best practices or use of specifics models. Ms. Beye responded that the action committee has reviewed other models and best practices.

02:06 PM

Various deputy directors from the department presented to the committee.

02:06 PM -- Vicki Manley, Office Director, State and Veterans Nursing Home, stated that the office has implement 'culture' into the various nursing homes. She stated that by implementing culture into these homes helps the residents deal with boredom and loneliness. She mentioned that a big concern for the division is the Trinidad State Nursing Home which has lost approximately $1 million over the past two years. She stated that revenues from the four state-operated nursing homes are pooled into what is known as the Enterprise Fund 505. She stated that the division is asking for the Trinidad State Nursing Home be removed from the Enterprise Fund 505 as to protect the other nursing homes and the Enterprise Fund 505. She stated the division has two possible solutions for the Trinidad State Nursing Home which are listed in the departmental overview and resource guide (Attachment A).

02:09 PM -- Susan Hunt, Interim Director, Office of Adult, Disability, and Rehabilitation Services, stated that the definition of a developmental disability was reviewed by the department this summer. She stated it was a collaborative effort by the department and various stakeholders. She stated that one of the recommendations was to not change the definition that is currently in statute, but to address the differing opinions through the department rules. Ms. Beye stated that the department discussed the request for budget cuts. She stated that the department either can do across the board cuts and do many things less well or look at specific programs to cut. She stated that there were several programs that will be rolled back or scaled down within the Division of Developmental Disabilities. A handout was provided to the committee detailing the proposed cuts by department (Attachment B).

02:29 PM -- Pauline Burton, Director, Office of Self-Sufficiency, introduced herself to the committee. She spoke to Senate Bill 08-177 and its successes. She stated that last year's bill that allowed the department to intercept gambling winnings to pay back child support has been successful for the Child Support Enforcement division.

02:37 PM -- George Kennedy, Director, Division of Child Welfare, introduced himself to the committee. Ms. Beye spoke to the budget reduction to the Division of Children, Family, and Youth. She stated that the mental health counseling of siblings that was passed last year will not be funded this year.

02:49 PM

Jocelyn Gay, Deputy Executive Director, Behavioral Health and Housing, stated that two acute care units within the Institute of Ft. Logan and the Institute of Pueblo will be closed due to budget cuts. She provided information on the closure of the psychiatric child care unit closure as well. She stated that there are other individuals in the community that can provide these services and supports more effectively than the department. She clarified that the Pueblo Psychiatric Hospital is not what is being closed.

02:54 PM

Director Beye provided a wrap-up to the committee.

02:55 PM -- Briefing from the Department of Health Care Policy Financing

Joan Henneberry, Executive Director, Department of Health Care Policy and Financing (HCPF) introduced herself to the committee. Ms. Henneberry briefly discussed the programs that the department administers which include Medicaid, the Children's Health Plan Plus (CHP+), Colorado Indigent Care, the Old Age Pension State Medical Program, Comprehensive Primary and Preventative Care Grant Program, Primary Care Fund, and the Home- and Community Based Services waiver programs. Ms. Henneberry referred to a power point handout of her presentation (Attachment C). She stated that Colorado has a fairly lean and conservative Medicaid program. She provided this explanation because the department does not have a lot of wriggle room to make cuts. She pointed out mandatory services versus optional services that the state Medicaid program offers. She noted that in 2008, there was a 10 percent caseload increase in Medicaid. She highlighted that there is a funding formula that is reviewed every three years.

03:06 PM

Ms. Henneberry stated that approximately 60 percent of the departments expenditures goes to acute care, and approximately 68 percent of the premium expenditures are from the elderly and disabled. She noted that on slide 13 it illustrates that a majority of the spending occurs for the elderly and disabled. She spoke to the primary goals of the department which are to:

enroll more children in the public insurance program;
improve health outcomes. Ms. Henneberry stated it is not the departments function to just pay claims, but to also increase the overall health of the population; and
develop strategies for reforming the long-term care system in Colorado.

03:11 PM

Ms. Henneberry also highlighted the department's initiatives which include:

eligibility modernization; and
to improve the Colorado Benefit Management System (CBMS).

03:13 PM

Dr. Sandeep Wadhwa, Chief Medical Officer, spoke to the establishment of a medical home for children enrolled in Medicaid. He stated that the Mental Health parity bill from 2008 was implemented. He stated the department is working towards making it easier for families to enroll in public program. He discussed the department's vision for reform which includes increasing stakeholder collaboration, enhancing the enrollment structure, appropriately defining benefits, care coordination, evaluating health outcomes, and creating a supportive payment system.

03:24 PM

Dr. Wadhwa spoke to the Center for Improving Value in Health Care (CIVHC)- Executive Order. He stated its a multi-stakerholder interdisciplinary group which will identify and pursue strategies to improve quality and contain costs in health care.

03:28 PM

Representative McGihon asked about the provider rate cut for Medicaid clients. John Bartholomew, Director, Budget Division, HCPF spoke to the cuts to the providers. Representative McGihon expressed her concern that access to health care is going to be significantly reduced as providers will be unwilling to take Medicaid clients. There was some discussion regarding the cuts to the providers.

03:39 PM

Representative Gagliardi asked about the department about the modernization eligibility, specifically the $5 million appropriated for FY 2008-09, and how that relates to Representative Acree's bill, House Bill 09-1020. Jennifer Evans, Administrative and Operations Office, DHCPF, responded by explaining that the department was not implementing a new system. She explained that the money from FY 2008-09 was awarded to a different vendor than from the one who worked on the implementation of the CBMS program. She stated that Deloitte will be the new operator of CBMS. On April 15, 2009, Ms. Evans stated that the department will be able to begin to add on other programs to CBMS and move forward with the modernization eligibility initiative.

03:53 PM

Committee members asked several questions of the department regarding the upcoming budget cuts.

03:56 PM -- Colorado Community Health Network

Annette Kowal, Chief Executive Officer, Colorado Community Health Network (CCHN), spoke to the committee regarding about the background of the community health network. She stated that community health centers in Colorado serve a larger portion of low-income individuals due to the state's lean Medicaid program. Ms. Kowal stated that CCHN provided a road map for the state to provide access to care through a primary medical home. She spoke to the initiative which is called "Access for All Colorado." Ms. Kowal provided some financial statistics on how much it will cost to provide a primary care home to all uninsured kids in Colorado.

04:08 PM

Ms. Kowal spoke to the proposed 10 percent budget cut or approximately $6.0 million cut to providers. She said that they would have to reduce their services immediately and serve about 12,000 less individuals.

04:09 PM

Pete Leibig, Chief Executive Officer, Clinica Family Services, Chair of the CCHN board, spoke to the proposed budget cut. Mr. Leibig explained that the community health center's budget is about $24 million. He stated that with the proposed Medicaid reimbursement rate cuts, he will need to cut his budget another $939,000. He stated that the community health center functions as an enrollment center for Medicaid and CHP+. Because of that, he stated that his billing department, which is approximately 15 percent of the budget, has to absorb the costs to process the necessary paperwork for Medicaid and CHP+ enrollees. He stated that it makes it very difficult to continue to take new Medicaid clients with the reduction of the reimbursement.

The Access for All Colorado Plan roadmap was provided to the committee (Attachment D).

04:13 PM

The committee adjourned.