Travis County Commssioners Court
April 22, 2003
The Closed Caption log for this Commissioners Court agenda item is provided by Travis County Internet Services. Since this file is derived from the Closed Captions created during live cablecasts, there are occasional spelling and grammatical errors. This Closed Caption log is not an official record the Commissioners Court Meeting and cannot be relied on for official purposes. For official records please contact the County Clerk at (512) 854-4722.
Item 19
We are ready for item 19, consider the f.y. 2003 budget for health and human services, increasing demands in health care and basic needs and take appropriate action. And you turn the rest of this over to you.
>> thank you very much. You all are going to make me leave every Tuesday.
>> that was somebody else's observation.
>> good morning. Given the time restraint, what I would like to do is probably cover the first part of the item and have you take action on that. As before, I want to present this issue in two parts. One is the -- the first part is basically focusing on proposed programmatic directions and changes in policies that we believe will be beneficial for clients and the county overall. The second part, of course, has to do with the chances we're facing in our current budget year. If you turn to page 1, I'm just going to do a real quick review of the programmatic directions and policies that we're proposing that you approve today. [indiscernible] we're saying we want to continue to focus on indigent claims and maintain the level of access that we have. The new thing that we want to introduce is to integrate mental health services into a primary care clinics in order to be more realistic in serving the people who access medical care within our clinic system. And basically I'm asking the primary care administrators to pro possession adding a -- propose adding a social worker within their current budget. On public health, basically we're not changing anything. We just want to continue to ensure that those services exist. On the mental health, I mentioned the integration of mental health services and indigent care, but also we want to look at reallocating a portion of the county's existing resources to support crisis stabilization and a sobering station. What I will do here is sit down with the city of Austin, hmmr, and see what extent we can use current resources to address current issues concerning crisis stabilization. Shifting moneys, we know we would create gaps, so the places we want to make sure we minimize those gaps. That's why it needs to be collaborative. In the basic needs area, we've talked about this a lot not only because of the fiscal challenges but because the demand for these services have in fact increased in the last two years is he very significantly. But we also recognize that there is a need for us to build in a level of accountability of people who access services, emergency assistance services so therefore we're proposing several changes in this area. We want to continue to provide crisis stabilization services because we believe those services are essential. We want to link the emergency assistance services and workforce development efforts, and we have -- that process is actually underway. Workforce has access demographics of our clients and they want to propose a link between our system and theirs. Therefore what we would be doing there is trying to ensure a level of self-sufficiency or efforts towards self-sufficiency towards those people who access emergency services within our operations. We want to continue our efforts to streamline our service delivery process. Which is basically a service improvement, a process, a business process improvement. We want to refine our eligibility criteria. This is where some of the major changes are coming in. We want to expand opportunities for clients to access these services across the community. Geographic distribution is the focus of that. Essentially what we want to do is to see whether or not there are other entities that are willing to essentially enter into an agreement to actually make our services available through their staff or through their locations. For instance, I started talking with david lourie about having the city sights operate emergency assistance to create a one-stop shopping -- excuse me, a one-stop service center from that perspective. Currently there are individuals that go to the city site to access food and clothing. We're saying why not just make emergency assistance available to them. Of course, if we did this, they -- whether it's the city or another subcontractor would have to operate under our current guidelines. We want to reduce the internal infrastructure within our emergency assistance program to ensure that there is an appropriate staff to service delivery operation. And this is the next proposal on page 2 is where it gets more involved. After initial receipt of assistance, any subsequent county-funded assistance will be dependent on demonstrate I have workforce activity for employment. And this will not apply to elderly and disabled. What we're basically saying is that anyone that comes in and receives emergency assistance will have to demonstrate some efforts to workforce development or training before they [indiscernible] within our centers. This is for people who are not elderly or disabled. We also want to cap the services at $700. We are propose to go redefine elderly from 55 to 60. Basically to make it consistent with other eligibility criteria and grant funds -- and grant-funded programs. The next thing we're actually doing, but we want to put it in policy, we want to ensure that the grant funds are utilized before we seek to tap general fund resources for emergency assistance. And as I said before, we do that, but we want to really put that practice into policy. And judge, you asked us for flow of how we would do that, and that is in the handout that we have. I've talked to you about the next fund, which is exclude shelters, halfway houses, preand post-treatments funded by Travis County. That means if you have a contract for us for a shelter, halfway house or for treatment in a residential treatment facility, we're not going to serve those individuals from those treatment facilities with utility and rent assistance because the thought here is that you will be double dipping if we're serving individuals and we have a contract with you. On some occasions we will, of course, lend some assistance in the area of food.
>> judge, are we taking questions as we go or wow like for us to just wait?
>> I would like to hear the whole first part. So that I can keep it all together.
>> workforce development we've talked about allotted. Basically a link between emergency assistance and workforce development. Essentially we want to continue the efforts in that area. Systems of care we've talked about that a lot. We're basically talking about wrap-around services. We're going to do a more extensive report to you in the middle of March concerning assistance, but we've been seeing some good outcomes associated with that. Of course that is correct is a partnership between us, the city of Austin, mhmr and juvenile court. We want to continue home visiting services. You are quite familiar with those. Healthy families is probably our best model for that in-house, but there are other community models that we want to continue to support. There's no question about the relevance about the [indiscernible] activities and we want to continue to service for that. We want to continue to serve in community planning and program development in support of the c.a.n., Looking at describing the conditions, but also being a catalyst to create joint efforts toward resolving certain challenges that we have in health and human services. And administrative services, what we seek there is utilize technology to improve our efficiencies. We also want to both in planning and administrative services to incorporate program evaluation, utilizing existing resources. Basically to promote best practices. [one moment, please, for change in captioners]
>> ... A good number of the folks coming in have that issue.
>> yes.
>> I have -- I had no issues related to folks who unfortunately committed their crimes here in Travis County, and have come back to our community as -- as those are folks that we have a -- a responsibility to. And they deserve as much as anybody else to get back on their feet. Where I had questions and concerns is that we have folks that are coming in from other counties, who committed their crimes elsewhere, who have zero ties to Travis County, other than well, that sounds like a cool place to live. Perhaps even a buzz in the inmate community of that's a good place to go get back because there's a -- it's a very giving community. I had some real problems that somebody literally who had no ties to Travis County, no family, no nothing, who came to us from another county could literally establish residency that day. And I -- that troubled me. Hey, I understand the -- in terms of dealing with our folks that have come back to our community, we have an obligation there. But I did not feel for me that there was an obligation to somebody in games county that chose to -- to come to Travis County but somehow we would use our property tax dollars to help that person get back on their feet.
>> can that be taken care of by -- by asking questions about residency and -- and area, you know, period of time that they have been here?
>> actually, if you wanted to -- to restrict individuals that were not from Travis County, you could establish a stronger residency requirement if -- if you strublght me to do that, I can do that.
>> my thought was either six months or one year. Let's say they decided to say it doesn't make any difference, I do want to move to Travis County. That's cool. Let's say six months or a year from now they are having difficulty. At that point it seems to me that they truly are a resident of Travis County and have tried to put down some roots here. But I just had some real issues with somebody literally who had no ties to this community, and it was -- it was a substantial amount of money, I don't think taxpayers here would have issues with us saying, well, that's lovely, you chose our community, but you are not quite eligible for our emergency assistance until you have shown that you are indeed a resident of Travis County. To vote here you have to stay here at least 30 days before you are eligible to vote.
>> the other thing that we might have to check on the special [indiscernible] health care, statutory requirements, residency guidelines that are built into that.
>> think thing was on the rent assistance, granted this was very modest check, 1240 some odd -- 240 some odd dollars, I had a real issue since there was a buzz in the inmate community of hey, come to Travis County. I didn't think that that was an appropriate use of our rent assistance dollars. The other things would be prioritizing. If you have money left over, you can address other groups. Maybe that would be another way to do it. Could we do that --
>> I think the restrictions that we look at primarily are going to be in health care.
>> I mean it can be prioritized.
>> if it's your desire, we could make the residency requirements consistent with the indigent health care acts residency requirement.
>> it's my desire to seek a policy in writing. The proposed policy.
>> okay.
>> are we only talking about rental assistance or are we talking about all assistance.
>> I think all assistance.
>> because at some point I think we need to look at the state standard and federal standard, also.
>> uh-huh. Are we talking about Travis County assistance or assistance that we deliver for other entities like the state and federal government.
>> we don't have control over the requirements for state and federal dollars. Those in fact give you the rules for those.
>> okay.
>> we have to operate within the guidelines that they give us.
>> okay.
>> I think the context is important in the specific wording.
>> uh-huh.
>> okay.
>> so what you want from me is really is a more specific [indiscernible] options for residency requirements.
>> again, my thing was making it very clear that obviously somebody who unfortunately committed their crime here in Travis County and they come back home, of course those are folks that I feel we have an obligation to assist. But it's -- it had to do with the immediate residency that got established by folks who had zero ties to Travis County, I felt that there again are some options that I'm seeking in terms of a residency requirement related to the use of the Travis County property tax dollars. Not related to any grants that have their own rules of how we have to divvy those out.
>> so are you targeting ex-offenders or new residents in general? That's for the member of the court [multiple voices]
>> they are targeting ex-offenders, it seems. I don't know that we have to act on it today, but I think that we need to understand the policy that they are asking us to come up here.
>> what I hear is ex-offenders.
>> what I was hearing [multiple voices] 40 to 50% of those coming in for assistance were ex-offenders. I mean, this -- if we are talking about the low hanging fruit, my sense was that this was a problem and that this was perhaps inappropriately diverting dollars that ought to be going to Travis County residents for folks who really were not residents of Travis County.
>> sounds like ex-offenders.
>> do you want to limit, have one set of residency requirements for ex-ochders and -- ex-offenders and another set for people who are not ex-offenders [multiple voices]
>> I don't know what you can and what you can't do. But I was very much troubled by people that had zero ties to this community paroling themselves here and taking advantage of -- of the good natured -- um ...
>> how do we know whether you are an ex-offender.
>> they have their documents there, judge.
>> [multiple voices]
>> -- process.
>> how do we Travis County staff know.
>> that's usually identified indirectly through the programs that people are --
>> we ask the question on our form?
>> no. We don't do that.
>> when you apply for assistance, do we ask that question?
>> no. We don't do that. All -- in my opinion, I think that -- I'm not answering your question --
>> no, you're not.
>> probably won't. In my opinion --
>> the question on the form, yes or no.
>> no, it's not on the form.
>> how do we know whether you are an ex-offender.
>> usually through the interview process that person will disclose that if they are participating in a shelter, a transitional home, a residential treatment facility. They will -- and just getting a history they will say, you know, I was released from jail this day and i've been out x amount of time or whatever, so it's disclosed. It's not actually a question.
>> okay. We were able to determine for the last 12 months what percent of our rental assistance went to ex-offenders newly arrived in Travis County?
>> I think what we are able to determine is whether or not the voucher is going to a shelter or residential home or a treatment facility that's really geared toward ex-offenders.
>> see, that's a little different.
>> yes.
>> let's quantify the problem when you bring back the draft policy. This is news to me that the percentage would be that high.
>> that's what I was shocked by judge, yeah.
>> basically, what I'm asking you all to do is to approve the programmatic direction and the policies that's we have laid out. Even what what you are just told me is that stephen, this is okay with me, but we want you to come back with more specific options defining residency.
>> other questions, beginning with me.
>> okay.
>> what is -- what's our definition of demonstrated workforce activity?
>> basically, we want a person to -- to be involved. And -- in a training program, or would -- would have been seeking employment, either through workforce or some other agency.
>> let me suggest an enumerated -- [indiscernible] showing how your staff is working with that. Employment I can see. Now, how did we arrive at $700?
>> judge, the rent portion of the assistance can average anywhere -- the average is about $238, but current policy sets the rent allocation based on the number of bedrooms in a particular house. So it can go as high as $550 some dollars, then the utility portion of the county funds averages about $85 per client. What we would be combining would be if they were to receive rent, utilities and then sometimes there might be prescription assistance. So what we will be capping is those dollars that come directly from general fund.
>> people would still have access to [inaudible] funds.
>> so your intention is Travis County cash assistance?
>> yes, sir.
>> well, vouchers, primarily. We don't give --
>> Travis County voucher assistance.
>> yes.
>> we are able to determine the amount I guess.
>> the amount.
>> so -- so there's nothing -- that would not [indiscernible] us from assisting with, say, food, or would it?
>> no, sir. Not bags of food. Currently we do provide food vouchers as well. So because the food vouchers have a dollar value, we would include the food voucher. But if it were bags of food from our individual pantries, no, sir, we wouldn't include that.
>> the only thing -- I have a little problem with the bags of food that we give because there's some doughnuts in there that are given that I don't think they are healthy for anybody, including poor people.
>> this is mrs. Johnson's?
>> I don't know what they are [laughter] but doughnuts are not healthy food. I have a problem with that. Especially if children are going to eat them.
>> I don't want beats --
>> now wait a minute.
>> I mean, you know -- [indiscernible] food is food. I mean, if somebody is hungry, doughnut is not as good as you know something else, but -- [multiple voices]
>> stephen is writing all of this done.
>> I didn't write any of this down.
>> not that steve, that steve.
>> I really object to that.
>> I think we have to leave some individual choice.
>> I know that, but we shouldn't make the choice by giving it to them.
>> dealing with the basic needs of the elderly, are we defining the eligibility as far as from 55 to 60, what was that based on?
>> basically we want it to be -- have our eligibility requirements consistent with our grant requirements and also we are looking at the fact that people that are 55 are still in -- in an employment market.
>> yeah. Unless you are real poor and you've had a real bad health, you know, problem with your health all your life, you are going to be a lot more elderly at 55.
>> but then you would fall into the disabled category. We didn't include --
>> I mean, a healthy elderly can be 80 and look great.
>> if the court decides to accept the particular program modifications, how would the person that would be most impacted, the basic needs of this, and emergency assistance, things of that nature, food, shelter, rental assistance, utility supplements, things of that category, how would they be notified that there will be a change into the direction the court is hearing them once the court decides to approve this particular phase of the presentation?
>> basically, we could do general postings within our community centers, but remember right now people -- people aside from elderly and disabled, are only eligible to be served once a year. So during that intake process, we would communicate the -- the eligibility requirements.
>> okay.
>> an individual in the community now basically would find out whether or not they are eligible for a program through the intake process. Now, we do have general information fliers that are available through community centers and through other agencies. But usually it's that -- a person doesn't go through the eligibility or intake process by just looking at an information sheet. They actually have to sit down with an intake worker or a case worker for that to be determined.
>> have you noticed -- the last question. Have you noticed a significant increase in the person that -- in -- that would be participating and are participating in this program in the downturn of the economy, have the numbers really reflected that? Of course that would be some folks we may not be able to serve. I'm kind of concerned about that phase that we won't be able to serve folks. How will we direct those persons that we will not have the ability to serve if [indiscernible] taking place. How will they get service?
>> well, actually, that's part of the part 2. But -- in general, when people do not qualify for our programs, we will refer them to outside agencies that they may qualify for.
>> okay. Okay. Thank you. That's my final question.
>> what effective date do you have in mind if we approve the new policies? The necessary training time for your people --
>> I would say within about 30 days.
>> okay. So is it our intention for stephen to put together the draft policy, to ensure implementation steps on a couple of items that we mentioned, bring this back next week. At this time we will also discuss the money item, which is item b. [multiple voices]
>> next week, I won't be here next week.
>> you won't be here.
>> two weeks.
>> two weeks.
>> two weeks.
>> judge, let me ask something.
>> yes, sir.
>> judge, first, does it have to be in the form of a motion or just giving direction, and he will come back in two weeks --
>> I think giving direction will be fine.
>> okay.
>> if --
>> all right.
>> you need time to work on those anyway, right.
>> yes. Now what I'm hearing is that the main thing that you have me following up on is the residency piece.
>> looking for options. There may not be any option that we find palatable, but I would certainly like to see it explored to see if there's something logical that makes sense.
>> in addition to options regarding the residency piece, what I will bring you back is the implementation date, what we will do with staff in order to ensure that they are trained. They receive training regarding this item.
>> yes.
>> specifics of the demonstrated workforce activity, if the $700 is cash/voucher, and I guess that I would -- I mean, I assume -- I guess my concern is that whatever we adopt, that we implement the same thing at all of the centers.
>> oh, yes.
>> and that we -- that part of that also, is, I guess, getting out notice to -- to prospective clients.
>> yes.
>> that would primarily be general notification because we don't know who is actually going to present for services. It's not like m.a.p. Where we have an enrolled membership.
>> okay.
>> Commissioner Daugherty?
>> stephen, are you -- since I'm really new at this part of it, the first two pages that we have gone over, are you wanting us to say, yes, go and get me the directions for these two pages.
>> yes.
>> so in other words I'm going to tell you to go away and say, I'm signing off on $700 the -- I'm telling you that today.
>> well, not today, but when you vote on it, it would be a cap. We can't go above that.
>> I understand that. So in other words I'm really putting myself in a spot because I know that there are a lot more people out there that are needing our services than what we can afford.
>> yes.
>> so I'm real hesitant to say $700 is the number that I want you to have, because I may be telling you that I want you to have $250 because I know that you are going to have a lot more people that's going to need something. Or I'm saying that you are going to have $700 and when the $700, when it runs out for x amount of dollars, whether that's April the 29th or may 16th, then I'm basically telling you, well, then you're closing up shop for four months or whatever. I mean, is that what's telling you $700, if you get that okay from me today, that that's what you are going to do --
>> actually, it's a two-part question. First is the $700 is a cap that we can spend on an individual client. The second part, when we start to -- I guess two weeks from now, when we talk about the fiscal challenges that we are facing, you are going to tell me how much is okay within certain budget lines or how much I have. Whether or not you will even entertain an increase. And that -- at that point I will know how many people I can serve considering that $700 cap and at that time even give you a number of options to ensure that the services last all year or end at a certain date or whatever. Those are just two factors that will control how I manage to -- the county's resources given the direction that you give me.
>> but giving you that direction today doesn't give you the ability to arbitrarily say you know what you told me $700, I have rethought this thing, I can't serve enough people with $700, so I'm going down to something below that. Does that still give you the authority to do that?
>> I couldn't go above it. But the $700 is just a cap. I --
>> you can't go below it?
>> I could.
>> up to 700.
>> up to 700 per client per year or per lifetime?
>> per year. But there a other criteria that we are building in that will prevent an individual from getting sevens unless they have demonstrated some activity toward workforce and we are going to be more specific when we come back about that.
>> could I get one other clarification that might give Commissioner Daugherty also some -- some comfort. Are we talking about just trying to get through fiscal year '03 with whatever kind of policy caps, et cetera, because quite frankly, we don't know what the big number is going to be for health and human services for next year in terms of what challenges there may be. Are we just talking about how are we going to get through '03.
>> given our environment this is what we are proposing as policy changes. During budget discussion and actually before the budget discussions we have to -- to consider legislative changes, which might change the whole environment.
>> so in terms of the -- we always have the ability given whatever financial conditions, whatever things come up from the state, as we take a look at that holistic look at the whole big, county budget, we may change some of these things. This is -- for right now, this is going to get us through '03, it could go into '04 with the same rules and regulations but we are not locked in to that because we are not there yet.
>> no. We won't have to consider a number of factors in going into the '04 budget --
>> stephen what's the amount of average annual assistance per client today?
>> $116. $160.
>> 160.
>> why are we going from 160 to 700? Or is that just the cap --
>> the cap. It's the cap.
>> the average is 160, we're sure of that?
>> yes.
>> the average of 160 is when you take the number of clients served across all general fund programs, judge, and so that's where the 160 comes from. The 700 cap is proposed to either attempt to be responsive to the call that we have from the court to try to be more holistic in our services to clients. Right now we are able to provide assistance for rent, for example, based on a policy schedule of the number of bedrooms. The 700 cap would essentially remove that, that policy requirement about the number of bedrooms and allow us to maybe possibly pay somebody's total rent as opposed to paying a portion of the rent and have them go to another agency to give another portion. So that's essentially what the cap would do for us.
>> you are combining that with actually more stringent restrictions of -- you can't come back unless you have demonstrated some activity that demonstrates self accountability.
>> okay.
>> but even if you gave that to everybody every month, they would meet -- they would need just slightly more than a legislator, just slightly more.
>> so the -- for the record come back in two weeks [indiscernible] possibly look at the money [indiscernible]
>> okay. Anything further on this item today?
>> thank you all.
>> thank you.
Last Modified: Wednesday, April 23, 2003 5:52 PM