COUNTY OF SAN MATEO

Inter-Departmental Correspondence

County Manager’s Office

DATE:

June 1, 2006

BOARD MEETING DATE:

June 6, 2006

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

John Maltbie, County Manager

SUBJECT:

County Manager’s Report #10

A.

Resolution in support of AB 2495 (Bass), Kin-GAP

RECOMMENDATION:

Adopt a resolution in support of AB 2495 (Bass), Kin-GAP.

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 2495 (Bass) would expand Kin-GAP (Kinship Guardian Assistance Payment Program) benefits to include specialized care increment payments and clothing allowances equivalent to those entitled under the foster care program. The bill would also require county human service departments to provide information regarding the independent living service program to eligible youth nearing 16 years of age and his/her kinship guardian.

Created in 1998, the Kin-GAP program is intended to provide financial assistance for eligible children placed with relative caregivers. These youth are placed with relative caregivers by juvenile court and are at risk of dependency or delinquency. The intent of the Kin-GAP program is to give relatives the option of assuming custody of a youth relative—which is typically considered a preferred placement—and, in turn, reducing demand traditional foster care. In addition, Kin-GAP enables the youth to benefit from foster care payment rates, which are higher than those under the CalWORKs program.

Under current law, Kin-GAP participants do not receive the same specialized care increment payments and annual clothing allowances provided to foster youth. Specialized care increment (SCI) payments are provided to meet the additional health and/or behavioral problems some children have. This payment is in addition to the basic foster care rate. As the name implies, clothing allowances are intended to meet the clothing needs of foster youth.

DISCUSSION:

AB 2495 is intended to provide greater parity between foster care and Kin-GAP payments by providing Kin-GAP youth SCI and clothing allowance payments provided to foster youth. According to advocates, these benefits are important to foster families—the absence of these benefits for Kin-GAP youth can deter relatives who might otherwise participate in Kin-GAP.

San Mateo County has approximately 12 children with Kin-GAP families. While it is unclear how many relative families would elect to participate in Kin-GAP as a result of AB 2495, staff report that in the past year a large number of relative families have been willing but unable to provide care for a relative youth due to the prohibitive cost of providing such care.

While it is commonly accepted that relatives (as well as foster parents) do not care for needy youth for financial reasons, the financial burden of caring for a child can prevent some willing families from providing such care. In San Mateo County, SCI payments vary from $188 for Basic Above Average Care to $525 for Maximum Above Average Care. Clothing allowances in San Mateo County range from $312 starting at birth to $465 for 19 year olds. While these additional payments are small, they can make a difference.

The financial stress on Kin-GAP and foster families is especially acute in San Mateo County where the Fair Market Rent for a two-bedroom apartment is $1,536 among the highest in the nation. Should eligible relative caregivers refuse to provide care, this could result in more children being placed in group homes, foster homes or congregate care.

San Mateo County Foster Parent Association, Legal Advocates for Permanent Parenting and HSA staff recommend support for AB 2495. AB 2495 is currently in the Assembly Appropriations Committee.

FISCAL IMPACT:

Unknown.

B.

Resolution in opposition to AB 2554 (Ridley-Thomas), Emergency medical technician certificates and discipline, with a recommended amendment that the state Emergency Medical Services Agency be designated as the agency solely responsible for the licensing and discipline of Emergency Medical Technicians

RECOMMENDATION:

Adopt a resolution in opposition to AB 2554 (Ridley-Thomas), Emergency medical technician certificates and discipline, with a recommended amendment that the state Emergency Medical Services Agency be designated as the agency solely responsible for the licensing and discipline of Emergency Medical Technicians.

VISION ALIGNMENT:

Commitment: Responsive, effective and collaborative government

Goal(s): Goal 22—County and local governments effectively communicate, collaborate and develop strategic approaches to issues affecting the entire County.

BACKGROUND:

AB 2554 (Ridley-Thomas) would prohibit a medical director of the local Emergency Medical Services agency (LEMSA) from suspending or revoking any Emergency Medical Technician (EMT)-I certificate issued by a public safety agency or placing on probation the certificate holder until local policies and procedures are established.

Under current law, EMTs are certified by LEMSAs, state public safety agencies and limited local public safety agencies. Statewide there are 61 EMT-I certifying agencies (31 LEMSAs and 30 public safety agencies). However, only LEMSA medical directors are empowered to deny, suspend or revoke EMT certificates or to place on probation the EMT. They are not required to consider the actions and recommendation of the EMT’s employer.

EMTs are skilled medical workers who respond on site to medical emergencies. EMTs assess injuries and illnesses, administer first aid and emergency basic life support following the policies and protocols of the LEMSA’s medical director. EMTs provide these treatments during transport to hospitals as needed. Many firefighters and police officers have EMT certificates as part of their job duties.

DISCUSSION:

According to sponsors, AB 2554 is intended to allow EMT-certifying public safety agencies to be the exclusive agency responsible for discipline of certificate holders. AB 2554 would preclude LEMSAs current disciplinary role until local policies are established. Sponsors argue there is a disconnect in current law since it prevents EMT-certifying public safety agencies the ability to discipline (based on the certificate) the very individuals they certified. As an EMT-certifying public safety agency, they believe they should also have the authority to suspend or revoke the certificate and place on probation the certificate holder.

In contrast, the Emergency Medical Services Administrator’s Association of California (EMSAAC) argues that allowing public safety agencies to investigate and discipline their own personnel fragments the EMT disciplinary process and can allow a “conflict of interest.” EMT-certifying public safety agency disciplinary action will preempt any ability of the LEMSA to discipline—regardless of whether the LEMSA believes such discipline is adequate.

Sponsors also argue this will prevent dual punishments for the same actions. However, the Assembly Health Committee analysis notes that other license/certificate holders are subject to discipline by both the licensing agency as well as employer. For example, a dentist can discipline an employee dental hygienists at the same time the licensing agency can suspend or revoke the license based on the same action.

Under current law, paramedics (similar to EMTs but with more advanced training) are licensed by the state and that license-related discipline is held by the state licensing authority.

As noted above there is conflict among the EMT certifying agencies about discipline authority. Various certifying agencies, each with inherent authority to certify EMTs, can question the appropriateness of not having discipline authority. This conflict seems to highlight the fundamental dysfunction of having disparate certifying authority spread among several different agencies.

A statewide licensing and discipline model can address these conflicts by consolidating the various certifying authorities into one agency (EMSA) that can then provide statewide standards, records and accountability. This is particularly valuable for having easily accessible records of EMTs that move from one LEMSA to another. However, state authority need not foreclose on LEMSA or public safety agency participation in licensing and training. Through contractual arrangements LEMSAs and public safety agencies could continue to provide such services.

While it can be argued that state certification can prevent local flexibility in the certification process, it should be noted that EMSA currently provides minimum statewide standards and that certificates issued by LEMSAs must be recognized by other jurisdictions and the certificate holder changes jobs in differing areas.

The Governor’s 2006-07 Budget proposes a different solution by created a $1.5 million General Fund loan authority and 7.4 additional positions in EMSA to consolidate, at the state level, the licensing and investigation of EMTs. This will also create statewide standards for certification and investigation. EMSA currently has a task force developing legislative language to address the conflict between differing local certifying agencies and their authority to maintain the integrity of their certificates. The San Mateo County EMS Administrator and EMS Medical Director serve on this task force.

In San Mateo County, the local emergency medical services agency and various county public safety agencies have a strong working relationship that facilitates effective collaboration and avoids such conflicts locally.

FISCAL IMPACT:

None.

C.

Resolution in support of AB 2649 (Bass), Kinship support services

RECOMMENDATION:

Adopt a resolution in support of AB 2649 (Bass), Kinship support services.

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 2649 (Bass) would eliminate the requirement that counties participating in the Kinship Support Services Program (KSSP) have at least 40 percent of their dependent children in relative care. This condition of 40 percent relative care placements is a major barrier to many counties access to KSSP funding.

Created in parallel with the Kin-GAP program, KSSP provides funding to counties to create or expand local kinship support that offers community-based services to relative caregivers and their youth. Eligibility for KSSP funding includes a number of conditions such as demonstrated capacity for collaboration, viable plans for ongoing financial support of the services, use of relative caregivers as employees of the program, and that at least 40 percent of a county’s dependent youth be in relative care placements.

San Mateo County’s current KSSP contract with Edgewood provides case management, parenting, and support services to all relative care takers. Approximately 15 percent of the families served are active to child welfare services with another 40 percent receiving TANF payments. The current Kinship support program provides approximately six months case management with unlimited follow up services as necessary.

DISCUSSION:

By eliminating the 40% relative care placement requirement, AB 2649 is intended to expand access to KSSP services to families beyond those in counties with qualifying percentages of relative care. In San Mateo County, many youth placements are in relative care. As a result, San Mateo County is eligible to participate in KSSP. We are one of 11 counties currently receiving funding for this program. Our allocation is approximately $100,000 per year. This allocation provides only $1 of every $4 spent.

San Mateo County offers kinship support services including counseling, peer mentoring, tutoring, homework assistance, recreation and respite services that have been provided to over 700 relative and Non-Related Extended Family Member (NREFM) caregivers and children. The Governor’s proposed budget for 2006-07 does include some expanded KSSP funds, however, these funds are primarily for counties that are not receiving any allocation. We believe it is critical that other counties have access to KSSP services.

The intent of the 40 percent requirement—to encourage more relative placements—is commendable. Relative placements are generally considered less traumatic on youth due to the greater familiarity of relatives. However conditioning KSSP funds on the percentage of relative placements fails to recognize the need for KSSP services in counties that do not meet the placement percentage requirement. Indeed, the absence of adequate supports for relative caregivers can itself be a deterrent to prospective relative caregivers (which can further degrade a county’s relative care placement percentage).

The Governor’s Proposed Budget would increase KSSP funding from $1.5 million to $5 million. HSA staff recommends support for AB 2649.

FISCAL IMPACT:

Unknown. Potentially positive.

D.

Resolution in support of AB 2881 (Mullin), State preschool programs

RECOMMENDATION:

Adopt a resolution in support of AB 2881 (Mullin), State preschool programs.

VISION ALIGNMENT:

Commitment: Provide equal access to educational opportunity

Goal(s): Goal 3—All children ages 0-5 years have access to childcare/early learning opportunities that contribute to their entering kindergarten ready to succeed.

BACKGROUND:

AB 2881 (Mullin) would reorganize existing preschool programs into the Part-Day Preschool Program (State Preschool) and the Full-Day Preschool Program (General Child Care pre-kindergarten centers, federal Child Care and Development fund pre-kindergarten centers, and Full Day State Preschool).

While State Preschool is currently codified, the full-day model is not codified despite being funded since the Budget Act of 1997-98 effectively created full-day child care by allowing state preschool programs the opportunity to extend their part-day services to full-day. Since then, full-day programs have operated on a contractual basis separately from part-day services. In codifying full-day services, AB 2881 would require consolidation of full-day contracts starting in Fiscal Year 2006-07.

AB 2881 expressly specifies that it will not impose requirements in addition to those currently required by contract.

AB 2881 follows a nearly identical bill, AB 927 (Mullin, 2004), which was vetoed by the Governor, who stated in his veto message that this bill simply codifies current practice found in contractual agreements, and, as a result, is not necessary. AB 2881 would require more than AB 827—notably requiring the Superintendent of Public Instruction to review unallocated funds and make recommendations by March 2007 on how best to ensure that the funds are spent on a timely basis.

DISCUSSION:

While AB 2881 simply would codify existing practice, according to the San Mateo County Child Care Partnership Council AB 2881 would also consolidate the various full-day programs into a single contract type and in doing so would simplify Department of Education reporting by decreasing the amount of paperwork, accounting and audit costs while maintaining current services.

Codification is also expected to ensure more uniform practices and accountability for services that are currently “regulated” on a contract-by-contract basis through the state.

This bill has been referred by Supervisor Church. The San Mateo County Child Care Partnership Council has taken a Support and Amend position. They seek an amendment that would expand full-day preschool to ensure that such services include children from 0-5 years of age. Their initial conversations with the sponsors indicate an agreement can be reached. AB 2881 is an urgency bill, requiring 2/3rds vote.

FISCAL IMPACT:

None.

E.

Resolution in support of SB 638 (Torlakson), Before and after school programs

RECOMMENDATION:

Adopt a resolution in support of SB 638 (Torlakson), Before and after school programs.

VISION ALIGNMENT:

Commitment: Provide equal access to educational opportunity.

Goal(s): Goal 4—All children ages 0-5 years have access to childcare/early learning opportunities that contribute to their entering kindergarten ready to succeed.

BACKGROUND:

SB 638 would make changes to the 21^st Century High School After School Safety and Enrichment for Teens (ASSETS) program, the 21^st Century Community Learning Centers 21^st CCLC) program and the After School Education and Safety (ASES) program created through Proposition 49.

More specifically, SB 638 would, among other things, provide for ASES a three-year direct grant process (rather than reimbursements), simply require the State Department of Education (SDE) to notify eligible schools of the funding available under ASSETS, 21^st CCLC and ASES, and allows for better coordination of funds between programs.

The author is in discussions with the Administration about performance measures. In addition to academic measures, the bill may more fully consider non-academic measures such as behavioral changes and safety issues.

DISCUSSION:

According to the sponsors, the 2002 release of ASES (i.e. Proposition 49) funds have been under spent by $30 million due to poor program design hastily crafted to meet the implementation deadlines. Since the program’s funding will be “triggered” by California’s financial largess, this problem will be exacerbated in the 2006-07 fiscal year. Current after school funding of $121 million could quadruple to $550 million at full implementation in out years.

Sponsors assert that SB 638 will streamline and better coordinate California’s after school programs and enable them to better and more effectively access the increased funding from ASES.

Supervisor Jacobs Gibson referred this bill at the request of the Bay Area Partnership for Children and Youth, co-sponsors of SB 638.

FISCAL IMPACT:

Unknown.

F.

Resolution in support of SB 1195 (Alquist), Child care regional market rates

RECOMMENDATION:

Adopt a resolution in support of SB 1195 (Alquist), Child care regional market rates.

VISION ALIGNMENT:

Commitment: Provide equal access to educational opportunity

Goal(s): Goal 3—All children ages 0-5 years have access to childcare/early learning opportunities that contribute to their entering kindergarten ready to succeed.

BACKGROUND:

SB 1195 would require the State Department of Education (SDE) to adjust the income eligibility limit for child care and development services according to changes in the Consumer Price Index (CPI) during those years for which the State Median Income (SMI) is not recalculated. SB 1195 would also require SDE to adjust child care provider reimbursement rates according to changes in the Consumer Price Index during those years for which a new Regional Market Rate Survey (RMRS) is not produced.

Under current law, subsidized child care is available only to families with incomes less than 75 percent of SMI. While enrollment is prioritized based on income (the lower a family’s income the higher their priority), once enrolled income limits can force families to chose between increases in family income (i.e. raises) or losing the child care subsidy. This is especially true in high-cost areas like San Mateo County, where the gap between the income limit to receive subsidized child care and the income needed to provide unsubsidized child care is so great.

DISCUSSION:

By ensuring that income eligibility and reimbursement rates are increased annually (either by the CPI or State Median Income and Regional Market Rate Survey respectively), SB 1195 benefits families with incomes at or near the income eligibility limit. Since the income eligibility rates are based on SMI, high-cost areas like San Mateo County are disadvantaged due to the gap between statewide eligibility for subsidized child care and the local income needed to be self sufficient in the County.

As noted above, SB 1195 would require child care reimbursement rates to be adjusted by CPI when a new RMRS is not produced. The Senate Appropriations Committee analysis notes that during the past ten years CPI has grown faster than RMRS. In addition, RMRSs currently are conducted every two years—thus, this bill would effectively result in a CPI increase of rates every other year.

This bill has been referred to the Legislative Committee by Supervisor Church. The San Mateo County Child Care Partnership Council has taken a support position for SB 1195. The Council analysis notes that SB 1195 “provides an interesting way to skirt the Department of Finance’s unwillingness to adjust the 5-year-old, official state median income.”

FISCAL IMPACT:

None.

G.

Resolution in support of SB 1288 (Cedillo), Medi-Cal drug and alcohol treatment for minors

RECOMMENDATION:

Adopt a resolution in support of SB 1288 (Cedillo), Medi-Cal drug and alcohol treatment for minors.

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all

Goal(s): Goal 8—Help vulnerable people, including youth, achieve a better quality of life.

BACKGROUND:

SB 1288 (Cedillo) would expand Drug Medi-Cal services for youth (12-20 years of age). Specified in the Youth Treatment Guidelines (which provide best practices, treatment models and intervention), services would include residential treatment, outreach, screening, assessment, counseling and other services.

While the bill directs the Department of Health Services (DHS) to try to obtain a Medicaid state plan amendment from the federal Centers for Medicare and Medicaid Services (CMS), it requires these services to be covered under Medi-Cal regardless of whether DHS is able to secure federal financial participation. The bill also expressly states that county welfare departments shall not be responsible for the costs of residential care.

Under current law, youth receive a patchwork of services through Drug Medi-Cal (one of the optional benefits the state has chosen to offer) or, if not covered by Drug Medi-Cal, through the federally mandated early, periodic, screening, diagnosis and treatment (EPSTD) program, which requires states to provide any medically necessary (as determined by a physician) service. There are no other funding sources specifically designated for services to youth. Any additional funding would come from existing state and federal funding sources, which have remained static.

DISCUSSION:

According to SB 1288 supporters, there is an inadequate amount of alcohol and other drug services for youth. The Legislative Analysts Office (LAO) found in a 2004 report that, “while children and youth constitute about 23 percent of the caseload, they received only about 6 percent to 8 percent of the Drug Medi-Cal budget.”

San Mateo County has an estimated 4,500 youth (12-17) that have substance abuse problems warranting treatment. However, the County serves only an estimated 300 youth through the patchwork of funding.

According to the Human Services Agency, 42.2% of San Mateo County students in grades 7, 9, 11, and non-traditional (NT) settings have used alcohol at least once in their lives; 26.3% are current users; and 25.1% of 11th graders have “had enough alcohol to feel it a lot” or “until I get really drunk.” 13.4% of 9th, 11th, and NT students have mixed alcohol with driving. In addition, one in four San Mateo County students, grades 7, 9, 11, and NT, have used marijuana at last once and 13.2% report current use.

By expanding funding for youth-focused drug and alcohol services, SB 1288 is intended to encourage the development of more youth-focused treatment facilities that can then create a continuum of care.

FISCAL IMPACT:

Unknown. Potentially positive.

H.

Resolution in support of SB 1289 (Cedillo), Foster children continuing aid and transitional services

RECOMMENDATION:

Adopt a resolution in support of SB 1289 (Cedillo), Foster children continuing aid and transitional services.

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all.

Goal(s): Goal 8—Help vulnerable people such as youth achieve a better quality of life.

BACKGROUND:

SB 1289 would allow foster youth receiving AFDC-FC aid to continue receiving such aid until 21 years of age if the youth on his or her 18^th birthday either is attending high school, college or vocational/technical training or is employed. SB 1289 would also require counties to phase in monthly one-on-one counseling for foster youth starting at age 14.

Under current law, foster youth receive aid until the age of 18 and can only be continued after age 18 if the youth is attending high school (or an equivalent program) and is expected to complete his/her education before reaching age 19.

Presumably current law supposes that youth emancipating from foster care are able to be independent at age 18 (or 19) with responsibility to care for themselves including finding and maintain housing, employment and, possibly education. Statewide statistics suggest this may not be the case for many emancipated foster youth. According to the author, homelessness and unemployment respectively affect over half of recently emancipated youth.

At this time, the early Independent Living Program (ILP) has prepared six youth upon their entrance to the ninth grade to be on a college bound track. This entails an academic plan, which outlines their course selections for their high school journey and monitoring of their progress by the ILP coordinator. In September 2006, it is anticipated that early ILP will be expanded to include the fourteen-year-old youths being served by the Adolescent Services Unit.

DISCUSSION:

SB 1289 is intended to allow (but not require) emancipating foster youth who are most vulnerable and least able to care for themselves to remain in foster care until the age of 21 while they acquire additional educational skills and/or work experience. The additional skills and experience emancipated foster youth gain from age 18-21 are intended to reduce the occurrence of homelessness, un- and underemployment, and other risks associated with emancipation.

Over the past five years, San Mateo County has expanded the services available to emancipating and emancipated foster youth. Services currently include moving and relocation assistance, continuous housing support, furniture and clothing assistance, emergency aftercare and employment and educational services. Despite these efforts, a recent survey of San Mateo County foster youth found that that 56% of emancipated youths reported experiencing bouts of homelessness for at least brief periods.

It is expected that by increasing services to youth between 18-21 years of age, these youth will have a greater opportunity to become independent and avoid future problems with homelessness and unemployment.

FISCAL IMPACT:

Unknown. The increase in services for 14/15 year olds will affect approximately 35 youth in our current caseload. The addition of one Independent Living Class costs approximately $54,000. Expanding services to 18-21 year olds will impact approximately 20% of the emancipating youth or about 15 youth. This will result in an increase in state, federal, and county costs in the out of home placement budget.