Travis County Commissioners Court
November 1, 2005
Items 3 and 4
Let's go back and get number three. It is to receive update and take appropriate action on assistance in response to hurricane rita. I did go to the meeting that secretary jackson had on h.u.d. Saturday morning, and what he said is that fema is committed to covering housing and utilities, but expects local governmental entities to help with the rest. The -- a real important item really is food, but on top of that, medical services, employment real important, and what clear, they have six or seven evacuees there. What is clear is that a lot of them really do not quite understand how to access local services. And you almost have to be a sort of government civics expert to understand what the federal government would provide and with the city and the county, so I did pick up one more client for y'all, but what's clear is I think we need to do a better job of connecting the dots, making sure they understand who to contact locally for some of the services they can provide. The other thing is if you had a mortgage in new orleans -- and virtually all mortgage cases have insurance, well, the federal assistance is very, very limited, so you may have lost all you had in the flood, but the feds will exam your insurance company to pick that up. So if you had insurance, and especially good insurance, you're probably in pretty good shape housing wise, but you still need some of the other services. The other thing is the folks that I had a chat with would like to stay here if they can make it work. They had lost just efg that they had back home, and even stuff like vital statistics, records for the school district, they don't even have those. And they're running into obstacles almost everywhere because most governments kind of like us, they have process requirements, paper requirements, and it's difficult to access services if you don't meet those. And that's clear is that we have to do a better job of enabling them to contact the right local people to assist.
>> good morning, judge, Commissioners, sherri fleming, executive manager for health and human services. And I agree absolutely, judge, and one of the reasons I came to the mic this morng was -- this morning was you probably are starting to see in the media that many of the state services are starting to expire, so folks who may have been able to easily access things like food stamps and other services will start to see those services start to decline and people start asking those eligibility questions that may be difficult for them to respond to. We've been anticipating that. I think the community is doing yeoman's job in terms of staying connected so we can be connected with the evacuees in our community. In terms of your staff, we're trying to take advantage of every opportunity where evacuees are gathered, so last week sheriff hamilton was here to inform you about a thanksgiving project that the sheriff's department is working on. We hope to partner with them and make sure that we are there on that day to answer questions, provide information. We also realize that many of the evacuees are challenged because they may not have telephones, they may not have cable so they're not hearing my voice this morning, but we do now that our partners in the faith hp based community will probably be the first line of defense for these folks. So we still encourage them to make sure that they have access to everything that they're entitled to through red cross and fema, but then also to access 211 to connect into local services. But our basic plan is to make sure that we show up wherever evacuees may be gathered so that we can answer questions on site, but then also continue to provide information on how to get into the networks of services that we have in the community.
>> grab that other one there. See if that does the trick.
>> okay. Is that --
>> much better.
>> we've got a short in that other one.
>> okay. So the community I think is meeting somewhere on some subject related with evacuees at least weekly. I know that the city of Austin is continuing to try to provide case management services for those who are most challenge understand our community. I know that the foundation communities project has social workers who have been knocking on doors and making sure that people have referrals to the agencies that they need. So our community is responding in the way that we know that we can, and that is to continue to connect with folks wherever we need to.
>> so if you have a variety of needs, you need a better job, you need some sort of food supplement, mental health, and a couple of people that I chatted with, when they told me what they had experienced during the flood, it really was amazing that they were able to stand there and just relate it to me in a way that I could understand it. But say you need a variety of services, can you go to one place or if you've got five issues, do you have to go to five places?
>> if you have a variety of needs, 211 can help you in terms of providing a list of resources. Also, the county community centers we have social workers available. And depending on the extent of those needs, our social workers do provide some clinical services, but then can connect you into our clinical services depending on what that level of need is. I can't say there is one place where you would get mental health services as well as the basic needs kind of services, but I believe that we can ensure that you get the appropriate referrals so that you don't go place to place getting no answer, no, you're in the wrong place, that sort of thing. So I think we can do a really good job of connecting you with appropriate services so that you are not having to make all those individual phone calls yourself.
>> if you make a phone call to 211, would that person that answers the phone most likely if you started just sort of listing the things that you needed, would the response most likely be, ms. Fleming, you need to come to 211 cesar chavez and we can help you there? I mean, it's lot easier to help somebody when they're standing there versus over the phone when you say you need to go here. Would that be the response they would say, come down here, let's be able to interview you or talk to you so we can tell you what services we can take care of?
>> 211 is strictly a referral service. If you listed a variety of needs, say you needed medical assistance and you need some basic need support, I don't have a job, so I need help with food or help with my rent, they would list for them a menu of services in the zip code where they're located. They will list the overarching services such as county services, city services, those things that are government run, the food stamp programs, those kinds of things, but they'll also get churches who might have food pantries or clothes closets. They would also get an intake number for mhmr. So that worker would be able to for each need identified give them two to three different sources that they would be able to access those services. And yes, they would encowrnl them to contact the city or the county because of the variety of services that we can plug them into. And because we do have social work and case management case available at our locations, so we can make those hard line referrals. We can actually pick up the phone and call mhmr and facilitate that appointment.
>> well, if you need medication, like the gentleman in the state man article yesterday, diabetic that needs medication, and his thing was he didn't have any and he was exercising to, I guess, self-treat. But as a buy debt tick I know that you have to do both. You can't really just do one of them. So is there a place in the community that he can go to get diabetes medication?
>> he would have to go in through the m.a.p. System, and we know that the m.a.p. System is stressed. There is a telephone intake process where people have to call and get an appointment if they live within the city limits. If they live outside the city they're able to come and walk into appointments in rural areas, so that makes it a little bit easier, not a lot, but a little bit easier to be able to access those medical assistance services. If there's an emergency, however, he would be able to go to the emergency room and have a physician --
>> but you have to pay to get the tool that tests your sugar level. And if you're going to buy it, why wouldn't you just buy your medication. But you don't know how serious it is until you test your sugar level. So he may be walking around with a sugar level of 400, which is seriously high, and not know it. It would seem to me to be as able as him being able to call a number and at least get an application filed. The article did not leave the impression that his application was being processed. So he may have to stand in line with others, and when his turn comes get served, but I was not left with the impression that he even had an application filed anywhere.
>> right. But in the case of a person with diabetes, it's a chronic illness, and that person could present at the emergency room at brackenridge and actually be screened from m.a.p. Services and get a m.a.p. Card there. So my suggestion would be forgive me, but my suggestion would be in a case like that where medication is necessary to manage your health, it's the most prudent, I think, to go and have yourself checked out at brackenridge, at the emergency room, where a medical assistance program worker can then make sure -- where the physicians can make sure you're okay, but also you could be screened for the medical assistance program. Now, that's not the solution to accessing those services, but in the case of someone who would need insulin or has a chronic chronic high pressure problem or something that needs immediate treatment, that would be the best recommendation.
>> and brack would have a vested interest literally in trying to make sure that they get associated with some kind of paying program, be it the m.a.p. Program or something else, so it's not one more thing that's uncompensated care. If the person is eligible, there could be no better way for them to get connected in than to unfortunately go through the front door with brack and hopefully that's the last time we have to enter the system and it would be the more appropriate way of going through the clinics after that.
>> so who should he call at 2:00 this afternoon?
>> what should he call to receive --
>> to get whatever help he can get, even if the this thing for him to do is present at the brackenridge emergency room, who needs to tell him that?
>> I would be happy to talk with him and tell him he can call me.
>> my final note on this is it seems to me we have an abundance of chefs from new orleans. I am not sure we have that many chef jobs here. So for those looking, a gentleman yesterday in the paper, a couple of people I chatted with on Saturday, the husbands were chefs, had worked as chefs in new orleans and were kind of here job hunting. It seems on to me if you can't find a chef job, you may need training for another position. So that was federal money provided to assist for that, right? > that's correct. And they want to hear from you yesterday. At our work source location here -- and I don't have that phone number with me.
>> that's who they should contact.
>> they should contact work siewrs, be sure to identify user self as a hukt evacuee. You -- hurricane katrina evacuee. If you go to the Texas works website, you you can get connected, you can also put your information in so you can be connected with other positions that are posted, but you will be connected with the work source center. The main center is on airport boulevard, right across from ohio land mall in -- highland mall in the old solo serve building for the locals here, but that would be the place they really need to hear from you because we really want to be able to expend those federal funds.
>> but is work source sort of doing outreach and is work source being reachable? The folks I chatted with, half of them have a telephone, the others don't. Computers and the ability to access a website, they're just not doing that. But if -- I guess the question is if the phone call goes into work source, will there be like a work source case worker type returning the phone call?
>> yes. And also goodwill temporary worker, case worker, because goodwill is also managing those placements for those federal dollars as well. So they could expect to get a call back or get communicated with in however they indicate is the best way to contact them.
>> okay. You're left with the impression that the problem is sort of working itself through. And then when you show up with four or five -- where four or five evacuees are, you hear their questions and you understand they're not accessing services here and they're really sort of basically surviving. And when you've got families with children it's even more of a situation because you have to spend money for different things that maybe the feds don't take into account. Sow get food and clothing, but there are other things that children need that you try to provide. And this mental health and health services thing is really a big issue. And if you've got children who are going without health services, it can be critical.
>> I think you're correct and I think it's important to note that some of the challenges that we currently face with those folks in our community who are struggling will be some of the same challenges that playing these individuals un-- that plaig these individuals unfortunately. And transportation is a big issue, jobs, replaced, making a liveable wage.
>> judge, did you or sherri either one can answer this, but did mr. Jackson deliver any sort of a message to this community where we thought that something was going to be taken care of from the feds that we find out now is something that we thought -- because I know when everybody started coming to town, I think everybody just shot, do you know what, just rack up your bills, just keep a list of all the things that we're going to be reimbursed for. Do we think that that now is something different than what we thought we were going to be able to do?
>> I don't think staff has given up on that yet. I do think that -- and pete is going to back me up here, but I do think we have gotten some news that we have not been pleased with and that that is that some of our staff costs are not reimbursible. What is considering about that -- what is interesting about that is I think we in an effort to provide care for these individuals in our community, we also tried to care for our staff by not allowing them to work overtime and long hours. I think we bent over backwards to make sure we had shifts of people to trade out. Well, it turns out that the only costs that they were interested in seeing were overtime costs. And we worked really hard not to incur any overtime costs. So that's a lesson learned for us. But in this case what we've heard so far, but it's my understanding that we are still negotiating with fema, but that they have responded so far negatively to our staff costs.
>> have we gotten a penny out of fema for the costs incurred by Travis County? Because it is extraordinarily disheart ening to read -- I read the houston chronicle every morning online, that hairkt, -- harris county, city of houston have gotten fema costs related to personnel, not housing fees. Have we gotten a dime out of fema?
>> no, ma'am. We have not submitted those costs yet. We had our meetings for katrina -- they had their meetings early on.
>> extraordinary costs.
>> we had our meetings of -- our initial meeting for request for public assistance. We have 60 days to get all of our bills in order. What we had planned on doing is working through the auditor's office and the rest was to go back and verify those hours, have our own internal auditors look at them also and then we will sit down with fema within the next couple of weeks and go through those costs. Our primary costs was for staff, personnel costs. One of the rules under fema for request for public assistance is that straight time is not covered. Overtime is covered. Now, how ironic it is if sherri sent a counselor or someone down to work, and she hired someone to backfill that position, that backfill pay would be eligible for reimbursement, but her staff that she sent down, took away from that job and sent to somewhere else, that time is not eligible unless it runs into overtime. So there was some misinformation floating out there that all costs and all times will be paid back, but that's what we'll go back and be verifying on that.
>> was that in writing or did we just assume that that was going to be the case? Because when it all happened, before we knew it people were at our door steps. We could be subject to, do you know what, you should have been a little clearer on what we were going to do. I can see where this thing could get real ugly. I mean, here are the expenses. I can also see where the federal government looks at you and says, if you handled this within your work load or within your regular hours, we're going to have an issue with that. Now, the more disturbing thing to me is if we have a problem with this, I mean, not that I?m looking to point fingers, but you just can't assume. I mean, too often we assume that something is going to be the case, and fed-wise this is really going to present a problem not just for Travis County, but for an awful lot of people, especially in the state of Texas if there is fine printing with this fema reimbursement program.
>> well, especially when we're put on cnn and the vice-president comes to visit and all sorts of people go wow, what an amazingly prepared community, and the answer is yeah, on our tab, not yours. I know that the county judge down in jefferson county is unbelievably disappoint that had they are going to be getting 75% reimbursement on their cleanups, whereas other things are getting 100%. Oh, I?m sorry, you just chose the wrong cleanup. So it is absolutely unfair and once again we're just -- the one that really is going to chap is that we have a backlog that is beginning to develop in our own county jail system where we're having to send inmates out of county because of jail standards rules, and the state of Texas is backing up not only their state jail inmates, but their institutional inmates that are supposed to go to tdcj, and their answer is to back them up in the counties at their expense. This stuff is unbelievably expenses and once again local government is picking up the tab for what is the state's responsibility or the fed's responsibility and they are not being evenhanded with the application of rules, and that chaps. That chaps.
>> well, the secretary did say that -- he said it also and enthusiastically that fema would reimburse local entities for their expenses, but he was not real clear about what expenses would be covered. He's with h.u.d. And fema is another federal entity.
>> I think that we talk some of this up to the frenzy that was going on and I think that there were fema representatives who were present here in our community who were reassuring us without receiving like reassurance from their superiors. So when we start talking up the chain of command, we find that some of our information had not been verified, and pete, would you agree with that?
>> I would, and on normal disaster recovery issues, it is a 75/25 split. That is what we've always worked under. It was like everything, 100% will be reimbursed, 100% will be reimbursed. A lot of people took that to be beyond what fema normally does. That was a first for them to come in and do the 100%. We will --
>> there were state officials saying 100% because I know we got a couple of phone calls where they were saying that, and they claim to be relying on representations by fema officials. So it wasn't like we were kind of guessing at it. They were saying we were kind of relying on it.
>> but back to the original question as far as expenses, we have got that process underway and we will be submitting those personnel and any other expenses that we incurred through that having our second meeting with fema very shortly.
>> do we know for a fact that fema will not reimburse for medical-related expenses? And if not, why can't we put the question to them directly? What about evacuees with medical needs? If the county and city provide medical services, physician attention, medication, will we get reimbursed. And if so, do we get 100%, 75% or what?
>> we have to think about that specific question, judge, because there were certainly arrangements that the city of Austin made at the convention center that we assume they have been or will be reimbursed for. In terms of follow-up care, once these folks are no longer eligible for medicaid services, then the state -- we would have to find that out. And I think there is a limit, fema closes the book on this disaster after a certain number of days, and that has been the other thing that has been somewhat elusive in finding out exactly when that door is going to close.
>> let us find out the answer.
>> yes, sir.
>> because from a selfish perspective torks me it makes more sense for us to pay $100 up front than pay the 500-dollar bill at brackenridge for county residents that have serious medical needs. That's why the clinic approach makes all the sense in the world.
>> yes, sir.
>> anything else on these two items today? I actually called up one of them, but it's the same information, the same thing can be said for three and four.
>> that is correct.
>> any other questions or comments. Leave these two items on.
>> yes, sir, we will be back next week. On this disaster after a certain number of days, and that has been the other thing that has been somewhat elusive in finding out exactly when that door is going to close.
>> let us find out the answer.
>> yes, sir.
>> because from a selfish perspective it works for me it makes more sense for us to pay $100 up front than pay the 500-dollar bill at brackenridge for county residents that have serious medical needs. That's why the clinic approach makes all the sense in the world.
>> yes, sir.
>> anything else on these two items today? I actually called up one of them, but it's the same information, the same thing can be said for three and four.
>> that is correct.
>> any other questions or comments. Leave these two items on.
>> yes, sir, we will be back next week.
>> okay, thank you.
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Last Modified:
Wednesday, November 1, 2005 8:22 AM