COUNTY OF SAN MATEO

Inter-Departmental Correspondence

County Manager’s Office

DATE:

April 12, 2006

BOARD MEETING DATE:

April 18, 2006

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

John Maltbie, County Manager

SUBJECT:

County Manager’s Report #7

A.

Resolution in support of AB 2193 (Bass), Child welfare

RECOMMENDATION:

Adopt a resolution in support of AB 2193 (Bass), Child welfare.

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all.

Goal(s): Goal 6—Children grow up healthy in safe and supportive homes and neighborhoods.

BACKGROUND:

AB 2193 (Bass) would establish caseload standards for the child welfare system and phase-in the standards over a five-year period from Fiscal Year 2006-07 though Fiscal Year 2010-2011.

Under current law, the Child Welfare Services (CWS) Program is regulated by the state but administered by counties. It is funded through a combination of federal, state and county governments. CWS is intended to provide services to abused and neglected children and their families.

AB 2193 follows the recommendations generated from SB 2030 (Costa, 1998), which required an evaluation of the adequacy of the current CWS budgeting methodology in California. The resulting study, colloquially called the SB 2030 report, concluded that caseloads are over twice what they should be to meet minimum CWS standards. The study included a survey of all 58 California counties and over 13,000 CWS case-carrying staff. With this data, researchers developed new caseload standards that reflect the growing list of duties and challenges social workers must satisfy.

In an effort to improve CWS, the Child Welfare System Improvement and Accountability Act was established (AB 636 (Steinberg, 2001)) to require counties to conduct self-assessments of their child welfare services, establish performance-based goals and measure progress. In addition, the 2002 Federal Child and Family Services Review of California called for a Performance Improvement Plan (PIP) for the state. While these efforts followed the completion of the SB 2030 report, they likely will have the effect of “raising the bar” and, in turn, increasing the workload of social workers.

DISCUSSION:

AB 2193 is intended to improve services for children who are abused and neglected by reducing the extraordinarily high workloads of child welfare social workers. The current methodology used to determine the appropriate level of funding was established over 20 years ago. Since then, the challenges of serving children and families have increased with drug use, family violence and general family dysfunction. In addition, the 20 years of incremental increases in regulations, duties and complexity associated with CWS have not been recognized. The aggregate of these small workload increases represents significantly more work.

As a result, current funding represents high caseloads that can jeopardize the health and safety of children. This can become a cyclical problem as overburdened social workers leave the profession leading to high turnover rates, recruitment of less experienced staff and a general reduction in the average experience level of social workers.

Based on a revised methodology in determining workloads, the SB 2030 report established both minimum and optimal workload standards.

CWS Basic Program Area

(Cases per social worker per month)

Current Workload Standard

Measured Workload Time

Composite Minimum Recommended Standard Time

Composite Optimum Recommended Standard Time

Screening/Hotline/Intake

322.50

148.58

116.10

68.70

Emergency Response

15.80

16.15

13.03

9.88

Family Maintenance

34.97

29.24

14.18

10.15

Family Reunification

27.00

23.36

15.58

11.94

Permanent Placement

54.00

48.99

23.69

16.42

While AB 2193 focuses on workload standards, the bill also requires counties, as a condition of receiving the increased funding, to establish through a community process a plan to meet the outcome-based requirements of the federal review and AB 636. In addition, the bill requires the allocation of county matching funds, and regular performance reviews.

FISCAL IMPACT:

Unknown. Recognizing the potential harm to children due to excessive workloads, the Human Services Agency currently supplements the minimum county match for state and federal funds by an additional $2-3 million per year. While a cost-analysis of the AB 2193 increased county-match requirement has not been completed, staff anticipates that the County’s current use of county-only funds would likely satisfy any increased local match requirement. Of even greater significance, AB 2193 would allow the County to use current county-only funds as leverage for additional state and federal funds.

B.

Resolution in support of SB 458 (Speier), Basic healthcare counties

RECOMMENDATION:

Adopt a resolution in support of SB 458 (Speier), Basic healthcare counties.

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all

Goal(s): Goal 5—Residents have access to healthcare and preventative care.

BACKGROUND:

SB 458 (Speier) permits county organized health systems (COHS) to offer, in addition to their current services, health coverage paid from private sources. SB 458 would also allow for specified employers to provide preventative health care coverage to their employees. Administering health care service plans would coordinate employer monthly payments for employee coverage with specified health care providers.

Under Section 17000 of the Welfare and Institutions Code, counties are required to provide health care to the medically indigent, those who lack the resources to provide their own healthcare and are ineligible for existing subsidized healthcare services such as Medi-Cal, Healthy Families and Healthy Kids. There have been several efforts to expand health care coverage to the medically indigent. Of note, SB 2 (Burton, 2003) would have mandated certain employers to provide health insurance for their employees. While SB 2 was signed into law, voters rejected SB 2 in a referendum found in Proposition 72 in November 2004.

SB 458 passed from the Senate (39:0). Since of June 2005, SB 458 is in the Assembly Committee for Health.

DISCUSSION:

In light of SB 2 and Proposition 72, SB 458 is an attempt to expand access to affordable health care coverage but without a mandate to purchase. SB 458 provides the flexibility for some COHSs to expand their coverage service to include commercial insurance. In addition, it would enable pilot efforts for prepaid outpatient health care plans.

HPSM is involved in several public insurance programs in addition to Medi-Cal related coverage. These include the state Healthy Families and San Mateo County’s Healthy Kids programs and HealthWorx which provides health insurance for the County’s In Home Support Services (IHSS) workers.

Staff has been unable to determine the potential impacts of SB 458 should the County be able to provide such services. However, providing counties and other communities additional flexibility in creating affordable health care options conforms to San Mateo County’s longstanding position regarding increased local flexibility. Moreover, any steps to expand health care coverage can have the effect of reducing demand on the local safety net and public hospital services.

FISCAL IMPACT:

Unknown.

C.

Resolution approving the 2006 Federal Legislative Priorities

RECOMMENDATION:

Adopt a resolution approving San Mateo County’s 2006 Federal Legislative Priorities

VISION ALIGNMENT:

Commitment: Responsive, effective and collaborative government

Goal(s): Goal 20—Government decisions are based on careful consideration of future impact, rather than temporary relief or immediate gain.

BACKGROUND:

The County’s 2006 Federal Legislative Priorities are intended to serve as a brief outline of issues and programs currently before Congress that are of particular concern and interest to the County of San Mateo. This document, in combination with other positions adopted by the Board of Supervisors, will guide the County’s federal legislative advocacy efforts. The Legislative Committee in coordination with County staff, departments and the County’s advocates developed the 2006 Federal Legislative Priorities.

DISCUSSION:

Similar to the County’s Legislative Program, the County’s Federal Legislative Priorities attempts to cover the breadth and depth of federal legislative issues that may have an impact on San Mateo County, it is not comprehensive, complete or final. Some of the notable issues are:

●

TANF Regulations—The recently enacted Deficit Reduction Act reauthorized the Temporary Assistance for Needy Families (TANF) program, known as CalWORKs in California, and directs the federal Department of Health and Human Services to issue an interim final rule by June 20, 2006 for counties to implement the CalWORKs program.

●

CDBG Funding—Once again the President’s Budget targets the Community Development Block Grant (CDBG) program, along with other federal programs aimed at community and economic development, for significant reductions and elimination. The Administration’s budget proposes to reduce CDBG formula grants from $3.711 billion in FY 2006 to $2.775 billion, a cut of almost $1 billion (25 percent) in FY 2007.

●

SCAAP—The President’s budget proposes the elimination of the State Criminal Alien Assistance Program (SCAAP). $405 million was appropriated in FY 2006, of which California receives about 40 percent. Of the $301 million appropriated in FY 2005, California’s state and local governments received $121 million. The San Mateo County Sheriff’s Office receives about $ 1.2 million annually in SCAAP funding.

FISCAL IMPACT:

Unknown.