MINUTES OF THE
JOINT Subcommittee on
Human Resources/K12
of the
Assembly Committee on Ways and Means
AND THE
Senate Committee on Finance
Seventy-second Session
May 6, 2003
The Joint Subcommittee on Human Resources/K12 of the Assembly Committee on Ways and Means and the Senate Committee on Finance was called to order by Chairman Sheila Leslie at 8:15 a.m., on Tuesday, May 6, 2003, in Room 3137 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.
Assembly COMMITTEE MEMBERS PRESENT:
Ms. Sheila Leslie, Chairman
Mrs. Dawn Gibbons
Ms. Chris Giunchigliani
Mr. David Goldwater
Mr. Lynn Hettrick
Senate COMMITTEE MEMBERS PRESENT:
Senator William J. Raggio
Senator Raymond D. Rawson
Senator Dean A. Rhoads
Senator Barbara K. Cegavske
Senator Bernice Mathews
STAFF MEMBERS PRESENT:
Gary Ghiggeri, Senate Fiscal Analyst
Steven J. Abba, Principal Deputy Fiscal Analyst
Larry L. Peri, Senior Program Analyst
Julie Brand, Program Analyst
Michael J. Chapman, Program Analyst
Julie Walker, Committee Secretary
OTHERS PRESENT:
Carla Watson, Administrative Services Officer, Aging Services Division, Department of Human Resources
Carol Aiello-Sala, Administrator, Aging Services Division, Department of Human Resources
Carlos Brandenburg, Ph.D., Administrator, Division of Mental Health and Developmental Services, Department of Human Resources
Michael J. Willden, Director, Department of Human Resources
Charles Duarte, Administrator, Division of Health Care Financing and Policy, Department of Human Resources
Nancy K. Ford, Administrator, Welfare Division, Department of Human Resources
Assemblywoman Leslie:
The meeting is called to order at 8:15 a.m.
HR, Aging Older Americans Act - Budget Page AGING-5 (Volume 2)
Budget Account 101-3151
Julie Brand, program analyst, Fiscal Analysis Division, Legislative Counsel Bureau:
This budget includes general administration of the division. The General Fund supports the division administration, provides the state match requirement for federal funds, and supplements older volunteer programs and rural senior services. There are three closing issues. The first is the funding for Health Insurance Portability and Accountability Act (1996) (HIPAA) privacy officer; the second is the reduction in federal grant award for Title III; and the third is the expansion of the ombudsman program by five positions.
The first issue for discussion is funding for the HIPAA privacy officer. Please note the decision to fund this position for Aging Services is in conjunction with similar requests by other human resources agencies and has been discussed several times in subcommittee hearings. You may wish to consider withholding funding of this position for aging services with a final decision based upon closure of the human resources director’s office and health care financing and policy budget accounts. Page 44 of Closing List #6 (Exhibit C. Original is on file in the Research Library.) is an in-depth discussion of this issue.
The second item to discuss is the reduction in the federal grant award for Title III entitlements. The Governor is recommending funding for an increase in the federal authority for federal grants anticipated to be received during the biennium. This would include a $66,000 General Fund increase for the match component in fiscal year (FY) 2004 and $76,000 in FY 2005. The Executive Budget recommends a 3 percent increase in the awards for Title III, with a corresponding increase noted for the State match requirement. However, on March 14 the division received notice from the federal government that the aforementioned entitlements for federal fiscal year 2003 would be reduced by 2 percent compared to the amounts granted in federal fiscal year (FFY) 2002. Based on the updated information provided by the government, the division is still recommending no reduction in state match be made in this decision unit, primarily due to the annual federal reallotment of funds occurring in August. If additional Title III awards are available to the State of Nevada, the General Fund match remaining would be allocated to this additional entitlement.
Option 2 b., Exhibit C, p.2, is recommended by staff. The 2003-2005 biennium would be funded at the (FFY) 2003 level increased each year by the division’s 3 percent estimate. This would reduce the General Fund obligation by $5000 in FY 2004 and another $5,200 in FY 2005. Option 2 c., p.2, eliminates funding of this decision unit. If the decision unit is eliminated and an additional General Fund match is required, the division could come to the Interim Finance Committee (IFC) for consideration of funding.
The third issue I will discuss is the expansion of the ombudsman program by five positions. The Governor recommends Medicaid Title XIX funds to expand this program. The positions would include two compliance investigators, two intake workers, and one administrative assistant. If funding is approved, the average caseload would continue to be 50 cases per month, but the carryover of 60 cases would be reduced to a carryover of 40 cases per month. Courtesy visits to nursing homes would increase from 50 percent to 100 percent. The ombudsman program is able to access Medicaid funds because 52.58 percent of services are provided to Medicaid recipients who reside in nursing facilities and other long-term care facilities. If this decision unit is approved, staff recommends reducing State General Funds by $43,401 in FY 2004 and $14,179 in FY 2005, which represents the amount of additional federal Title XIX funds the division can leverage.
E-500 Accessible, Flexible, Cost-efficient Government – Page HR, Aging-10
Enhancement unit E-500 reinstates the funding for the Senior Ride Program. The Taxicab Authority has advised the Division for Aging Services that funding for this program is contingent upon passage of S.B. 288.
SENATE BILL 288: Increases fees for compensable trips of taxicabs and driver’s permit to operate taxicab. (BDR 58-1251)
For the other technical adjustments discussed on page 3, Exhibit C, staff recommends an adjustment of $85,737 each year of the biennium to include funding for the statewide cost allocation from Title III administration. If the division receives additional entitlements as noted in closing issue number 2, the additional Title III funds will be available for administration expenditures. If approval is granted, staff has included the adjustment in the closing document.
Senator Raggio:
Why is option b being considered when notice has been received that the entitlement is going to be reduced by 2 percent? Option b would increase it by 3 percent, but there is notice that funds are going to be reduced by 2 percent. Would option c be a better choice if the funding is certain?
Ms. Brand:
The division has historically been able to access Title III entitlements based on reallotments that occur in August. By maintaining the General Fund apportionment within this decision unit those additional allotments, which have always been available, could be immediately accessed. However, option c, which would allow consideration of funding by IFC, is an option as well, based on the timing of availability of the allotments to the division.
Senator Rawson:
Option c works as well, if there is a concern about it.
Senator Raggio:
That was my point. To be consistent, we should go with option c.
Assemblywoman Leslie:
I have no problem unless a delay would cause the loss of additional federal funds.
Carla Watson, Administrative Services Officer, Aging Services Division, Department of Human Resources:
It is a timing issue. We receive notification from the Administration on Aging in the month of August. We have to respond by August 30; awards are allotted at that time, and we have until September 30 to obligate. Unless IFC meets in the near future, we would miss out on that.
Senator Raggio:
The IFC usually meets in September. Did you say notice is given in August and you must respond by the end of August?
Ms. Watson:
That is correct.
Senator Raggio:
Why do you have to respond by August?
Ms. Watson:
They send a letter asking each division to respond whether excess funds are available for allotment to other states. However, if there is a need for additional funds and the General Fund match was already in the budget, the additional funds could be requested at that time.
Senator Raggio:
Would $61,000 in 2004 and $76,000 in 2005, be the difference? If so, I will not raise an objection.
SENATOR RAWSON MOVED TO CLOSE BUDGET ACCOUNT 101-3151 WITH STAFF RECOMMENDATIONS OF WITHHOLDING THE FUNDING FOR THE HIPAA PRIVACY OFFICER POSITION, REDUCTION IN THE FEDERAL GRANT AWARD (OPTION NUMBER 2., B.), AND THE EXPANSION OF THE OMBUDSMAN PROGRAM BY FIVE POSITIONS, AS WELL AS TECHNICAL ADJUSTMENTS.
ASSEMBLYWOMAN GIBBONS SECONDED THE MOTION.
THE MOTION PASSED UNANIMOUSLY.
*****
Senator Rawson:
The reduction was $43,401 in 2004 and $14,179 in 2005.
Senator Raggio:
What is the status of S.B. 288? The motion would be contingent upon passage of that bill.
Carol Aiello-Sala, Administrator, Aging Services Division, Department of Human Resources:
The bill has passed on the Senate side and it seems to be well received on the Assembly side; however, it has not been voted upon.
HR, Rural Clinics – Budget Page MHDS-25 (Volume 2)
Budget Account 101-3648
Michael J. Chapman, Program Analyst, Fiscal Analysis Division, Legislative Counsel Bureau:
I will review the budget beginning on page 4 of Exhibit C. The Rural Clinics Program provides community-based mental health services to persons of all age groups with serious and persistent mental illnesses and mild to moderate mental health problems. The division operates 16 clinics in the 15 rural counties and northern Clark County.
The three closing items to be discussed are (1) base budget amendment; (2) caseload increases; and (3) waiting lists.
In the first closing item, a duplication error was made prior to submitting the budget in annualizing salaries for clinical positions. There were corresponding adjustments to Medicaid, out-patient revenues, and private insurance revenues. The agency received an allocation from the contingency fund from the IFC. When the allocation was eliminated in base, the revenues were duplicated for positions in these there revenue sources. The budget office submitted a budget amendment to eliminate the duplicate revenues. The General Fund was thereby increased by $193,500 each year.
There have been concerns regarding revenue deficiencies in this account. For several years a supplemental appropriation has also been provided for FY 2003 of $740,598. Based upon the ongoing revenue problems in this account, staff recommends that the subcommittee issue a Letter of Intent directing the agency to review its methodology of developing budgetary revenue estimates based upon clinical positions during the 2003-2005 interim.
M-200 Demographics/Caseload Changes – Page MHDS-27
Under the second item, caseload increases, maintenance unit M-200, the Governor recommends total funding of $804,500 in the first year of the biennium and $1.46 million in the second year. This would support additional staff of 18.29 FTE positions of which 12.5 full-time equivalency (FTE) would be clinical positions. The ongoing vacancies of clinical positions have been of concern in this account, most apparent in the Ely, Elko, and Pahrump areas. In the last Legislature 11.5 FTE clinical positions were approved, and 2 of those positions are currently vacant. M-200 in this budget includes a .25 FTE to make the .75 FTE clinical social worker for Lake Tahoe a full-time position and more attractive for recruitment. There are currently 8.75 FTE positions vacant; of those, 2 are still frozen, 5.75 are in the process of recruitment, and 1 was recently filled.
E-356 Service at Level Closest to People – page MHDS-28
Under item 3, E-356 addresses current waiting lists. I have provided a table on page 6 that identifies the waiting list for medication clinics, case management, and residential supports. The subcommittee should note there is a column for outpatient wait list, but the Governor did not include funding to address that wait-list increase due to concern over clinical vacancies over the last 2 years. E-356 requests 1.27 additional FTE positions. In considering E-356 with M-200, staff did not make a recommendation due to the ongoing difficulties the agency has experienced in filling the clinical positions. The determination will have to be made whether to approve these positions as recommended by the Governor, or seek some other level of staffing.
E-358 Service at Level Closest to People – Page MHDS-29
E-710 Replacement Equipment – Page MHDS-31
M-300 Fringe Benefits Changes – Page MHDS-20
Under “other closing items,” page 7, the Governor recommended $126,526 each year in General Fund appropriations to support increased hourly service and travel rates for psychiatric contract services throughout rural Nevada. In reviewing E-358, it appeared there was overfunding for this decision unit, and a recommended reduction of $12,053 in the first year of the biennium and $11,656 in the second year was made. Under item 3, decision unit E-710, 22 computers, 22 printers, and other associated hardware and software were included. It became apparent that this was duplicated equipment in the information and technology projects budget account. Staff recommends eliminating the duplicated equipment. Staff also recommends technical adjustments to include vacancy savings in M-300 for increased fringe benefit costs and in module E-356 for recommended new positions.
Senator Rawson:
I believe the discussion should focus on the caseload increases and the positions. I am troubled by the unfilled positions. Two of them have been frozen, but a recommendation for 18.25 FTE new positions when there are 8.75 FTE that are unfilled makes affirmation difficult.
Assemblywoman Leslie:
This is troubling to me as well. The need is there in the rural clinics, and there has been discussion of reclassification of social worker positions to mental health counselors to help recruitment. Relocation funding to pay for interviewing might also be helpful.
Carlos Brandenburg, Ph.D., Administator, Division of Mental Health and Developmental Services, Human Resources Department:
We currently have eight vacant clinical positions, and four of those have been vacant for 2 months. Two more have been vacant for 6 to 8 months. The longest vacancies have been 13 to 15 months. The one with the longest vacancy is the .75 clinical social worker. It is difficult to recruit a social worker in rural Nevada, much less a three-quarter-time social worker. That is why we ask for the .25 position. Under Director Willden’s leadership, allowing us to move from hiring social workers to hiring mental health counselors, who are licensed marriage and family therapists, would provide greater flexibility.
Assemblywoman Leslie:
Will recruitment be more difficult for any particular rural community?
Dr. Brandenburg:
Historically, Elko and Ely have been the most difficult; however, we are being creative in our hiring, and I believe we will fill those positions.
Assemblywoman Leslie:
If we move ahead, I will recommend a Letter of Intent asking you to scrutinize your methodology and revenue estimates.
Senator Rawson:
On E-356, the wait list, $180,000 and $196,000 will be allocated for how many positions?
Assemblywoman Leslie:
The total is 19.56 FTE.
Senator Rawson:
If we went with 16 positions and gave the flexibility to fill them, either clinical or administrative, would that be acceptable?
Dr. Brandenburg:
That is going to be difficult because we have cut back on our support staff. In this budget, we did not ask for any new sites and had to concentrate on the infrastructure. I would beg of you not to take away the infrastructure that we desperately need in the rural areas.
Assemblyman Hettrick:
I share the same concerns. I appreciate the decision not to expand into Laughlin or Lake Tahoe. Is there anything else that could be cut to save General Fund money?
Dr. Brandenburg:
I understand your position, but this is basically survival for us in the rural areas.
Assemblywoman Leslie:
My concern is that we have not filled those positions in the past. The rural suicide rate is tremendous. It is very difficult to operate without a mental health professional in the rural areas, and I am willing to give it a chance.
Dr. Brandenburg:
The 24-hour suicide hotline that has been expanded State-wide has brought in a tremendous amount of referrals, especially to the rural areas.
Senator Rawson:
What are your overall vacancy savings?
Mr. Chapman:
The vacancy savings in the Governor’s budget is approximately $500,000 each year for 116 positions. Then the additional 19 positions would be added.
Senator Rawson:
Is that ten positions for which we are budgeting that will not be filled?
Mr. Chapman:
That would be closer to 8.5 to 9. Clinical positions, salary, and fringe costs approximate $60,000 per year.
Senator Rawson:
Realistically, that has been part of the budget, because normally we would not be able to fill all of those positions, or there have been freezes, and it has been planned.
Assemblywoman Leslie:
That is the reason the rural communities are left with no mental health people. I think we need to do what we can to get people in those areas, but I understand your point. The issue is not that there is not a need in rural Nevada, it is how many positions should be approved and how many can be realistically filled, given the recruitment and retention problems.
Senator Rawson:
Over the biennium there has been an increase in the budgeted vacancy savings and it is $1 million overall. With that kind of vacancy savings built in, I can go with the approval of the positions.
SENATOR RAWSON MADE A MOTION TO CLOSE BUDGET ACCOUNT 101-3648 ACCORDING TO STAFF RECOMMENDATIONS INCLUDING CORRECTION OF ERRORS, CASELOAD INCREASES AND WAITING LIST, TECHNICAL ADJUSTMENTS, AND LETTER OF INTENT CONCERNING HE REVENUE ESTIMATES.
SENATOR MATHEWS SECONDED THE MOTION.
THE MOTION PASSED. (ASSEMBLYWOMAN GIUNCHIGLIANI WAS ABSENT FOR THE VOTE.)
*****
DHR Administration –Budget Page HR ADMIN-1 (Volume 2)
Budget Account 101-3150
Larry L. Peri, Senior Program Analyst, Fiscal Analysis Division, Legislative Counsel Bureau:
This budget is discussed beginning on page 14, Exhibit C. I have three closing issues to present today. The first is MAXIMUS revenue; the second, a new auditor III position recommended in coordination with the creation of an audit function; and third is the transfer in of 3.51 FTE existing positions and the creation of a fiscal unit.
The MAXIMUS revenue has been a topic of discussion this session. The current recommended budget has been reviewed by the department who has presented revised estimates of MAXIMUS revenue of $1,675,000 projected in FY 2004, and $1,725,000 projected in FY 2005. That information is detailed in a memorandum we received from the department shown on page 18. It also includes a revised list of potential expenditures for MAXIMUS revenue. Because staff is proposing adjustments to Title XX in the Grants Management Unit (GMU), the subcommittee may wish to withhold decisions regarding MAXIMUS funding until those issues are discussed because the two are intertwined. Also, any recommendations for MAXIMUS expenditures would need to be reflected as expenditures in the director’s office budget.
E-900 Transfer-in Auditor II From BA 3261 – Page HR ADMIN-4
Item 2, the new auditor III position, is recommended to supervise and assist an existing auditor II position that would be transferred in to this account as discussed in E-900. If this position is approved, there are a number of technical adjustments recommended by staff detailed in the bold type on page 15, of closing project item number 2. This decision unit is proposed to be funded by a transfer of funding into this budget from the GMU.
The third closing issue to be discussed is the transfer in of 3.51 FTE existing positions and the subsequent creation of a fiscal unit. E-900 was just mentioned. That is the transfer in of an auditor II position from the Healthy Nevada Fund Administration budget. If the subcommittee chooses to approve this transfer, staff recommends no adjustments.
E-901 Transfer-in Fiscal Unit to BA 3150 From BA 3278 – Page HR ADMIN-5
Enhancement 901 is the transfer in of an existing administrative services officer I from the Family-to-Family Connection budget. It is similarly proposed to be funded by a transfer in of funds from the proposed new GMU. If the transfer is approved, staff recommends a reduction in the amount of in-state travel.
E-902 Transfer-in Fiscal Unit to BA 3150 From BA 3276
Decision unit E-902 appears at the top of page 16. It recommends the transfer in of 1.51 FTE existing positions from the State and Community Collaborations budget to the proposed fiscal unit. That includes an administrative services officer III position and also an existing .51 FTE accounting assistant II. Those positions would also be funded with a transfer in of funds from the proposed GMU. We have a number of suggestions for your consideration, primarily because those two positions are existing and are discussed in the first paragraph of page 16 in bold print.
Another issue to be discussed is the Health Insurance Portability and Accountability Act (HIPAA). In earlier meetings, the department withdrew a request for three of eight new FTE positions, two in the Division of Child and Family Services (DCFS) and one in the Welfare Division. The remaining five positions have been reviewed, and staff does not feel a full-time position is warranted for Aging Services. Its deletion is recommended. The department feels they could reach their objectives with four full-time positions. We recommend a position be retained in DCFS, a new one be approved for Health, a new one approved for the Division of Health Care Financing and Policy, and a new position for the Division of Mental Health and Developmental Services.
The subcommittee should also note that the current FY 2003 budget for the director’s office contains $495,855 in MAXIMUS funds that were set aside for a contractor to assess HIPAA requirements and design an implementation plan. In an earlier subcommittee hearing, the department indicated that it had terminated its agreement with the contractor and that litigation could be involved with the settlement. At this time, it appears that a settlement is near and that the department is prepared to revert approximately $250,000 out of the original $498,000 to the General Fund at the close of FY 2003. On page 17, the budget recommends the creation of the GMU which, in addition to the individuals within the director’s office and the proposed fiscal and audit units, is going to move an additional 4.51 FTEs into the department’s existing location in the Kincaid Building. Through discussions they have asked for the subcommittee’s consideration of two modular furniture units that would allow them to maximize existing space and assist in accommodating the new staff that would transfer in. There are several technical adjustments in this budget, which appear in the second paragraph, numbers 1 and 2, page 17 of the closing packet.
Assemblywoman Leslie:
I would like to hold the MAXIMUS discussion until we discuss the Grants Management Unit. We will go back then and deal with MAXIMUS. We will talk about the other issues in this budget.
SENATOR RAWSON MADE A MOTION TO CLOSE BUDGET ACCOUNT 101-3150 WITH STAFF RECOMMENDATIONS, WITH THE FOUR HIPAA COMPLIANCE POSITIONS, AND ADDING THE GENERAL FUND SUPPORT OF $5200 FOR THE FURNITURE UNITS AND THE OTHER TECHNICAL ADJUSTMENTS.
ASSEMBLYWOMAN GIBBONS SECONDED THE MOTION.
THE MOTION PASSED. (ASSEMBLYWOMAN GIUNCHIGLIANI WAS ABSENT FOR THE VOTE.)
*****
HR, Purchase of Social Services – Budget Page HR ADMIN-31 (Volume 2)
Budget Account 101-3237
E-909 Transfer-out to GMU BA 3195 – Page HR ADMIN-34
Mr. Peri:
This is one of six programs recommended to be eliminated and transferred into the GMU. Unit E-909 makes that recommendation to transfer 2.01 FTE existing positions and all associated costs and grant expenditures to the proposed new GMU. The base budget in this account reflects the reduction of Temporary Assistance for Needy Families (TANF) revenue. There are several closing issues that have to do with Title XX and possible adjustments to those. However, since this budget is recommended for elimination those adjustments are presented in the GMU. We would suggest the subcommittee consider closing this budget as recommended by the Governor.
SENATOR RAWSON MADE A MOTION TO CLOSE BUDGET ACCOUNT 101-3237 AS RECOMMENDED BY THE GOVERNOR.
ASSEMBLYWOMAN GIBBONS SECONDED THE MOTION.
THE MOTION PASSED. (ASSEMBLYWOMAN GIUNCHIGLIANI WAS ABSENT FOR THE VOTE.)
*****
HR, Family to Family Connection – Budget Page HR ADMIN-43 (Volume 2)
Budget Account 101-3278
Mr. Peri:
This budget is also one of the six recommended to go into the GMU. That is the closing issue. It transfers 1.50 FTE existing positions and all costs and grant expenditures to the GMU. This program is also recommended to be consolidated into the existing Family Resource Centers program. No adjustments are recommended. If later adjustments are necessary, the adjustments could be considered in the GMU. Staff recommends that the subcommittee consider closing this as recommended by the Governor.
ASSEMBLYWOMAN GIBBONS MADE A MOTION TO CLOSE BUDGET ACCOUNT 101-3278 AS RECOMMENDED BY THE GOVERNOR, TO BE TAKEN UP AGAIN IN THE GRANTS MANAGEMENT UNIT.
SENATOR RAWSON SECONDED THE MOTION.
THE MOTION CARRIED. (ASSEMBLYMAN HETTRICK VOTED NO. ASSEMBLYWOMAN GIUNCHIGLIANI WAS ABSENT FOR THE VOTE.)
*****
HR Family Resource Centers – Budget Page HR ADMIN-49 (Volume 2)
Budget Account 101-3294
E-907 Transfer-out to GMU BA 3195 – Page HR ADMIN-52
Mr. Peri:
The closing issue in this budget account is in decision unit E-907. It similarly recommends the elimination of the account and the transfer of the existing positions to the GMU. One change in the GMU is the currently supported local governing boards. They oversee the allocation of funding and program implementation within Family Resource Centers. Those two local governing boards, currently one in the north and one in the south, are recommended for elimination, and the funding for them would be reduced to travel costs for board meetings. They would become more advisory in nature. Staff recommends no adjustments and suggests that the subcommittee consider closing it as recommended by the Governor.
SENATOR RAWSON MADE A MOTION TO ELIMINATE BUDGET ACCOUNT 101-3294 AS RECOMMENDED BY THE GOVERNOR. IT WILL BE TAKEN UP AGAIN IN THE GRANTS MANAGEMENT UNIT.
ASSEMBLYWOMAN GIBBONS SECONDED THE MOTION.
THE MOTION PASSED. (ASSEMBLYWOMAN GIUNCHIGLIANI WAS ABSENT FOR THE VOTE.)
*****
HR, Grants Management Unit – Budget Page HR ADMIN-54 (Volume 2)
Budget Account 101-3195
Mr. Peri:
The Grants Management Unit is on page 27 of Exhibit C. This is the new account proposed for the coming biennium totaling approximately $31 million in each year of the biennium. Of that amount, approximately $2.8 million is General Fund and $28.2 million is federal and other funds. It proposes to consolidate six programs. We have discussed several, and several were closed in earlier subcommittee actions. It would recommend a total of 9.02 existing positions being transferred in, and 1 new position is recommended, a social welfare program chief II. We have identified four closing issues for your consideration.
First is the creation of the new account; second, Title XX purchase of social services, which requires some adjustments and the MAXIMUS revenue that ties into it; third is an issue of increasing Children’s Trust Fund Grants; and fourth, a budget recommendation regarding the consolidation of Title XX Grants and the Tobacco Grants.
The decision units in the four closing issues are matched to the budgets that we have reviewed. Those budgets transfer out positions and costs into this account, and the listed decision units accommodate the transfer in. The first consideration for the subcommittee is whether or not to approve the new budget account. The latest Title XX grant award for FY 2003 has been received, and this budget requires an adjustment. The budget currently recommends Title XX revenue authority of $12,407,310 in FY 2004 and $12,819,060 in FY 2005. We were asked by the subcommittee to provide a moderate estimate, and we have chosen one after working with the department. They identified four options shown on page 20, Exhibit C. Option 1 is a conservative estimate, ranging down to option 4 which is a liberal estimate. We have chosen option 3 and have discussed that with the department who concurs with our decision. Option 3 seeks to take advantage of the actual FFY 2003 grant and the proposed FFY 2004 estimate. That is the President’s recommendation, and Congress approved the President’s estimate for federal FY 2003.
If you compare the Governor’s recommended budget to option 3, the new figures yield an increase in the first year of additional Title XX funds of $274,440, and in the second year the estimate we have chosen would be slightly less than what is currently in the budget. Therefore, a decrease of $77,060 would be required. The additional amount in the first year of $274,440, in addition to a projected balance forward from FY 2003 to FY 2004 of $102,061, would make available $376,501 of additional Title XX revenue in the first year of the biennium.
The subcommittee has several alternatives for the additional Title XX funds. First, the subcommittee could direct $77,060 of that money toward the second year of the biennium to eliminate the shortfall. Plus it could increase Title XX in a State agency that receives these funds and reduce General Fund support. One suggestion we have is the Elder Protective Services Homemaker Program in Aging Services. If you did that and reduced the shortfall of $77,060 in the second year, you could apply $299,441 to another State agency, in this case, Elder Protective Services Homemaker, and, commensurately, that would reduce the General Fund in that account by the same amount. The department has suggested additional Title XX funding could also be used to reduce MAXIMUS support in the GMU. That is why we have waited until now to make suggestions on how you might want to expend MAXIMUS funds. Regardless of the decision made, the shortfall of $77,060 in Title XX must still be accommodated in the second year.
The final issue is, we are also required to review the transfers out of this account and compare them to the transfers in to all the State agencies that receive Title XX. That has been done, and there is an imbalance that currently exists in the Division of Child and Family Services (DCFS). That shows $1,154,223 in each year of the biennium that is budgeted in DCFS in excess of what would be available. The division has submitted an amendment to the Fiscal Analysis Division proposing to correct the imbalance. We will have a recommendation for you to consider in the DCFS closings.
Assemblywoman Leslie:
Does that mean there was a mistake made in the total that we are going to have to deal with when we close DCFS, because it was counted twice?
Mr. Peri:
That is accurate. The transfers out of the Title XX funds are $1.1 million less than what is shown to be collected in DCFS. We technically have a shortfall in DCFS that the submitted amendment proposes to eliminate. The amounts that go out of the Title XX budget are accurate. It is the receiving end that shows too much. We would have to reduce it on the DCFS end.
The third issue, the Children’s Trust Fund, is another account proposed to be transferred in to the GMU, and the Committee for the Protection of Children (CPC) has endorsed a proposed increase to the grants currently budgeted at $890,000 for child abuse and neglect prevention activities in each year of the biennium. The CPC would like to see that increased to $1.05 million each year. It is not in the budget and would require adjustments. When we closed the Children’s Trust Fund budget, the administrative allowance was exceeded. The budget was closed as recommended, and our suggestion was to wait until we got to this budget to correct it. Therefore, the $160,000 addition proposed in each year of the biennium for grants would be made up of a proposed transfer out of the operating expenditures, consisting of $15,492 in the first year and $18,155 in the second year. This would then bring their administrative cap into the proper balance. We would recommend that the remaining portion be transferred from the reserve category to the grants category, and that would result in the availability of $1.05 million in each year of the biennium.
Item number 4, with the approval of the GMU, the budget before you has consolidated 12 Title XX expenditure categories into one category and has consolidated the 2 tobacco grants into one expenditure category. Staff requests that they all be shown individually. We think that would allow them to be viewed more easily, versus a rolled-up version.
Technical adjustments are covered on page 29 of Exhibit C. Two adjustment are recommended, consisting of a reduction of $353 in FY 2004 for publishing an RFP and an elimination of $8000 over the biennium for the purchasing assessment, apply to Family Resource Centers, E-907 and would reduce General Fund. For Title XX, E-909, it is recommended that the amount for the statewide cost-allocation assessment be moved into the correct category. The amount is $5204 each year and should be moved from category 89, Attorney General Cost Allocation, to category 88, Statewide Cost Allocation. Further, there is a correction of revenue distribution between the Family resources center and Family-to-Family programs and Title XX Non-State Agencies, hat would result in a reduction of General Funds. General Fund support would be reduced by $4884 in FY 2004 and by $4893 in FY 2005 and expenditures would be reduced by the same amounts in the Non-State Agencies grant expenditure amount. E-476 recommends a transfer of $283,513 in FY 2003-2004 and $299,494 in FY 2004-2005 to the Human Resources Director’s Office to create a new fiscal support group to provide fiscal services to the GMU. Staff requests permission to adjust this transfer out based upon any changes in expenditures made in the Director’s Office (B/A 101-3150). One final adjustment left off the closing sheets is in E-906. The non-State owned building rent is overstated in this budget by $5062 in the first year and $5285 in the second year. We would recommend corresponding reductions in General Fund support.
You may consider these suggestions or go back to the MAXIMUS discussion in the director’s office.
Assemblywoman Leslie:
We will stay with this and go back to MAXIMUS later.
Senator Rawson:
This is about as complicated as it gets. As we make our decisions we should deal with the $77,000 shortfall in the second year. I like the suggestion of using some of those funds in aging services because it recovers General Fund.
Assemblywoman Leslie:
Are you talking about using the extra Title XX money first by eliminating the $77,060 shortfall and then using the remainder to offset General Fund costs in Elder Protective Services Homemaker Programs in Aging services?
Senator Rawson:
Yes.
Assemblywoman Leslie:
I would agree.
Mr. Peri:
Senator Rawson, are you suggesting the subcommittee consider the staff recommendation to utilize the additional Title XX money to alleviate that shortfall in the second year and direct the remaining part to another State agency, reducing General Fund at the same amount?
Senator Rawson:
I believe so, but I do not know what effect that has on the list on page 19.
Mr. Peri:
That would be another discussion. The two are connected. The list on page 19 proposed to take the additional Title XX money and work it into the GMU. We are suggesting that not be done, and instead directing it to other State agencies. Page 19 is something we want to discuss for the items listed that could be funded with MAXIMUS money.
Assemblywoman Leslie:
Would we be using the Title XX money instead of the MAXIMUS money to fund the GMU so it would free up more MAXIMUS funds for other uses?
Mr. Peri:
We are suggesting that the additional Title XX money be used as staff has recommended, and as Senator Rawson has indicated, and not be put into the GMU to reduce MAXIMUS funds. Apparently, there is $406,000 recommended in the GMU, and that is primarily to pay Title XX’s share of the administrative expenses that fund the creation and infrastructure of the GMU. Those MAXIMUS funds are already in there, and we are suggesting they remain. The department suggested, as an alternative, that we could lessen MAXIMUS funds by this additional Title XX.
Assemblywoman Leslie:
We are saying “no” to that.
Mr. Peri:
Another suggestion is to do what Senator Rawson has discussed. That would save General Fund money and leave the MAXIMUS as recommended in the current budget.
Assemblywoman Leslie:
Is that your intent, Senator Rawson?
Senator Rawson:
Yes.
Assemblywoman Gibbons:
Could you state that again, please, so I can understand it?
Assemblywoman Leslie:
We are going back to item number 2 on page 28. There is an additional $376,501 in Title XX. We suggest using $77,060 to eliminate the shortfall we expect in FY 2005, and using the remainder of $299,441 to put in the Elder Protective Services budget that has already been approved. By so doing, we would reduce the amount of General Fund and it would be available for another use. We would leave the MAXIMUS funds in the GMU as it is budgeted. We will return to MAXIMUS later in this discussion today. Is that accurate, Mr. Peri?
Mr. Peri:
That is correct.
Senator Rawson:
Are there any decisions other than following staff recommendations for the remainder?
Mr. Peri:
Closing item number 1, the desire for approval of the Grants Management, budget account would be the first decision; you have made a suggestion for the Title XX money, as depicted in item number 2, if you want to include it as part of the staff’s recommendations; item number 3 is to increase the Children’s Trust Fund Grants; item number 4 is to ‘unconsolidate’ the way the grant categories for Title XX and the Tobacco Grants are currently displayed; last are the technical adjustments.
Assemblyman Hettrick:
On page 29, number 3, Increase Children’s Trust Fund Grants, what is the impact of pulling the money out of the reserve?
Mr. Peri:
That will eventually bring it down to approximately $250,000 annually. They have consistently carried a large balance forward in reserve. The CPC feels if they maintain $250,000 annually, that will be satisfactory.
Assemblyman Hettrick:
The way we are doing this, it would become base?
Mr. Peri:
It would be their desire to keep a $250,000 reserve and keep a commensurate level of $1million in grants in each year into the future.
Senator Rawson:
There is a specific funding source for this, so it never becomes General Fund base.
Assemblywoman Leslie:
I am still troubled by an item on page 29, the $2.3 million that has been overstated in Title XX revenue. There have been so many mistakes. It will have to improve so the staff will not have to deal with all of these errors. There have been a lot of errors on this account.
SENATOR RAWSON MADE A MOTION TO CLOSE BUDGET ACCOUNT 101-3195, APPROVING THE GRANTS MANAGEMENT UNIT WITH THE INCLUSION OF THE BUDGETS FOR PURCHASE OF SOCIAL SERVICES, FAMILY TO FAMILY CONNECTION, FAMILY RESOURCE CENTERS, COMMUNITY SERVICES BLOCK GRANTS, CHILDREN’S TRUST ACCOUNT, ALL OF WHICH WERE PREVIOUSLY ELIMINATED, AND THE TOBACCO GRANTS FROM THE HEALTHY NEVADA FUND ADMINISTRATION BUDGET.
ASSEMBLYMAN HETTRICK SECONDED THE MOTION.
THE MOTION PASSED. (ASSEMBLYWOMAN GIUNCHIGLIANI WAS ABSENT FOR THE VOTE.)
*****
Assemblywoman Leslie:
We will return to our discussion of MAXIMUS.
Mr. Peri:
The amount of MAXIMUS revenue that has been reprojected is displayed on page 18. If you look at the middle of the page 20, there is a table that explains the amount of MAXIMUS expenditures. That illustration is what the Executive Budget recommends, a total of $406,268 over the biennium. We agree with that, and the action you have taken would keep it intact. That is the only MAXIMUS money earmarked for expenditure out of the two respective amounts that have been reprojected consisting of $1.6 million and $1.7 million. The director’s office has provided a revised listing of items that could be considered for MAXIMUS funding in the coming biennium. Those are shown near the bottom half of page 19. Item number 1, a proposal suggested by the department, which was not approved, would have reduced the MAXIMUS money in the budget, so the figure of $347,827 really is the $406,268 kept intact as recommended by the Governor. Everything below it, from item 2 on, are possible uses of MAXIMUS. There are five more items that theoretically could be considered, as well as the balance that could be left in reserve.
Senator Rawson:
I like the idea of a reserve. There are some worthwhile considerations on this list. Suicide prevention is necessary. I would also like the committee to consider an elder court project. I wonder if the Olmstead Act compliance contractor would not fit our purposes.
Assemblywoman Leslie:
Are you suggesting numbers 2, 3, and 4, plus another? Would that be $75,000 for an elder court study?
Senator Rawson:
Yes, that is correct.
Senator Raggio:
I need some clarification on the items to be funded. The funding limit is not clear. I thought there was only $406,000 in the budget. Are we suggesting that we enhance that amount?
Assemblywoman Leslie:
The revised revenue is the $1.675 million in 2004 and $1.725 million in 2005. We have already used $406,000 out of that.
Senator Raggio:
There is potential funding available for at least items 2, 3, and 4 from MAXIMUS.
Assemblywoman Leslie:
Senator Rawson is suggesting funding items 2, 3, and 4, plus the elder court study, with the rest going into the reserve.
Senator Raggio:
One reason I am asking is because we have been holding S.B. 49, the suicide prevention bill, which was referred back to Senate Finance based on the likelihood of MAXIMUS funding.
SENATE BILL 49: Creates Statewide Program for Suicide Prevention within Department of Human Resources. (BDR 40-288)
Assemblywoman Leslie:
I would support the funding, the S.B. 49 recommendations, and all the items Senator Rawson mentioned.
Michael J. Willden, Director, Department of Human Resources:
During the strategic planning process, the Office of Community-Based Services contracted with Tony Records to consult with us on Olmstead Act issues and the disability plans. We want to continue to contract for his consultation expertise to ensure that we stay in compliance with the Olmstead Act provisions.
Mr. Peri:
We began with estimated revenue of $1.675 million in the first year of the biennium. The budget includes $406,268 as an expenditure in the GMU. Senator Rawson suggested that the funding of the Kids Count Study Support should be considered, plus similar funding for an elder count study costing another $150,000. Director Willden has clarified the Olmstead Act compliance contractor, for a cost of $75,000, and the suicide prevention program in S.B. 49, would be $142,910 in the first year. Similarly, we would have $172,160 in the second year for the suicide prevention, $75,000 for the Olmstead Act, $75,000 for the Kids Count Study Support, and another $75,000 for the elder count. In the first year there would be $900,822 left in reserve. Theoretically, if it materializes and the residual is not obligated, it reverts.
Assemblywoman Leslie:
We do not have that money in hand, is that correct, Mr. Willden?
Mr. Willden:
That is correct. We feel fairly confident about the estimates.
Assemblywoman Leslie:
The elder count proposal is in a bill, S.B. 81.
SENATE BILL 81: Makes appropriation to Aging Services Division of Department of Human Resources for development of statistics to determine priorities for funding programs for senior citizens and for publication of results in brochure entitled Nevada Elder Count.
(BDR S-930)
Assemblyman Hettrick:
If we are going to hold this money and use it for the suicide prevention, I would like to consider funding the suicide bill, A.B. 340, I sponsored because we have one of the best suicide programs in the State of Nevada. It is being run in Douglas County and they are asking for a one-time operation to get grant money to fund that into the future. If we are going to use some MAXIMUS money for that and reserve it, I would like to fund that as well.
ASSEMBLY BILL 340: Makes appropriation to Douglas County for support of programs that are designed to prevent suicide. (BDR S-778)
Assemblywoman Leslie:
How much is that?
Mr. Hettrick:
It is $108,000.
Assemblywoman Leslie:
Please confirm the amount. I am in favor of that. Mr. Hettrick’s bill for suicide prevention would be a one-time, $108,000 appropriation through the MAXIMUS money to be added to the items proposed by Senator Rawson. The rest of the MAXIMUS money we would put into reserve.
Senator Raggio:
I think we need to understand that this is one-time funding and does not get built into a base even if is across the biennium.
SENATOR RAWSON MOVED TO CLOSE BUDGET ACCOUNT 101-3150 AND FUND THE FOLLOWING ITEMS UNDER MAXIMUS REVENUES: ITEM NUMBER 1, THE S.B. 40 SUICIDE PREVENTION PROGRAM; ITEM NUMBER 2, OLMSTEAD COMPLIANCE CONTRACTOR; ITEM NUMBER 3, KIDS COUNT STUDY SUPPORT; ITEM NUMBER 4, AN ELDER COUNT STUDY; ITEM NUMBER 5, THE A.B. 340 SUICIDE PREVENTION PROGRAM IN DOUGLAS COUNTY AT A COST OF $108,000; AND TO PLACE THE REST OF THE MAXIMUS FUNDING INTO RESERVES.
ASSEMBLYWOMAN GIBBONS SECONDED THE MOTION.
THE MOTION PASSED (ASSEMBLYWOMAN GIUNCHIGLIANI WAS ABSENT FOR THE VOTE.)
*****
HR, State and Community Collaborations – Budget Page HR ADMIN-65 (Volume 2) Budget Account 101-3276
Mr. Peri:
The discussion on this budget appears on page 30 of Exhibit C . There are two closing issues identified. One is the reorganization of the budget and the transfer of staff and programs as proposed in the budget. The second one is alignment of revenue proposed to transfer out of this account to the Special Children’s Clinic Budget. On page 31, the budget recommends under decision unit E-902 the transfer of an existing administrative services officer III and a 0.51 FTE accounting assistant II out of this budget to the director’s office budget for the proposed fiscal unit. You have already approved that. Decision unit E‑930 would transfer 1.51 existing FTE positions related to the Head Start‑State Collaboration Federal Grant and associated costs to the Welfare Division. The remaining 11.01 FTE and costs in this entire account are then recommended to transfer to the Division of Health.
Item number 2 is an alignment of revenue proposed to transfer from this account to the Special Children’s Clinic account. The budget recommends a transfer of Part C of the Individuals with Disabilities Education Act (IDEA) funds to the Special Children’s Clinic budget totaling $2,308,666 in FY 2004 and $2,300,660 in FY 2005. The revenue amounts in the Special Children’s Clinic budget to accept those amounts are understated. Based on discussions with the director’s office, staff would recommend increasing Part C IDEA revenue authority in the Special Children’s Clinic budget by the understated amounts, or $716,176 in FY 2004 and $708,187 in FY 2005. Additionally, staff recommends that the subcommittee consider increasing expenditures in the Special Children’s Clinic budget by $318,682 in each year of the 2003-2005 biennium. That would address the remainder of the waiting list. The difference, of $397,494 in the first year and $389,505 in the second year of additional federal Part C IDEA revenue, could be used to reduce the General Fund support in the Special Children’s Clinic budget by those same amounts.
SENATOR RAWSON MOVED TO CLOSE BUDGET ACCOUNT 101-3276 AS THE GOVERNOR RECOMMENDS WITH ADJUSTMENTS RECOMMENDED BY STAFF.
ASSEMBLYWOMAN GIBBONS SECONDED THE MOTION.
THE MOTION CARRIED. (ASSEMBLYWOMAN GIUNCHIGLIANI WAS ABSENT FOR THE VOTE.)
*****
Health Care Financing & Policy – Budget Page HCF&P-1 (Volume 2)
Budget Account 101-3158
Steven J. Abba, Principal Deputy Fiscal Analyst, Fiscal Analysis Division, Legislative Counsel Bureau:
I will be discussing this budget as it appears on page 43 of the exhibit. The first account is the division’s administrative account. There are two issues I will discuss. The first issue is the new management analyst IV position that is recommended for the division to act as a HIPAA privacy officer. There are two existing positions on staff that also work on various activities related to HIPAA. The division has provided an extensive amount of information on what this position would do within the division. Staff recommends the position be approved. If other divisions within the Department of Human Resources need support in terms of HIPAA, this position would be available to provide that support.
The other issue is under “other closing issues.” There are several decision units that propose to transfer approximately 27 positions from the Medicaid and Nevada Check Up budgets into the division’s administrative account. Staff concurs with these transfers that would locate positions within Medicaid and Nevada Check Up program that support the entire division within the administrative account. It would allow the division to cost‑allocate these positions against federal Title XIX and Title XXI funds, as well as the cost containment fees that helped fund this budget. There is a savings of $300,000 per year displayed in decision unit E-909. Staff recommends approval of these transfers. There is one technical adjustment reflected on the interlocal contract with UNLV. The adjustment reflects a reduction in General Fund of approximately $60,000 per year. Another very small item provides for six replacement computers for each fiscal year.
Senator Rawson:
This budget as recommended would allow cost-allocation and save General Fund money.
SENATOR RAWSON MOVED TO CLOSE BUDGET ACCOUNT 101-3158 WITH STAFF RECOMMENDATIONS.
SENATOR MATHEWS SECONDED THE MOTION.
THE MOTION PASSED. (ASSEMBLYWOMAN GIUNCHIGLIANI WAS ABSENT FOR THE VOTE).
*****
HR, HCF&P, Nevada Check-up Program – Budget Page HCF&P-31 (Volume II)
Budget Account 101-3178
E-425 Nevadans with Health Insurance
Mr. Abba:
There are three closing issues in the Nevada Check Up program found on page 47. The first issue is caseload increases. In March, delinquent notices were sent to all families who have children enrolled in a Nevada Check Up program. The delinquent notice informed the families they would have to be current on their premiums. There were 3000 children disenrolled from the program because of nonpayment of premiums by the families. It is anticipated that the majority of those families will reenroll and bring their premiums current. There were 700 children who were disenrolled due to other eligibility issues. That background, plus a review of the caseload projections, provides for an opportunity to reduce caseload projections in FY 2004 and FY 2005. On page 47 is a table that reflects the current caseload projections compared to the Governor’s recommended caseload projections. The reduced caseload projection provides for a General Fund savings if the committee wishes to approve the caseload increases. The General Fund savings would be approximately $590,000 in FY 2004 and $650,000 in FY 2005. If the committee wishes to approve this decision unit, the decision unit for caseload increases would be reduced to $1.3 million in General Fund for FY 2004 and $2.6 Million in FY 2005, based upon the reduction in caseload, instead of the General Fund amount recommended in the Governor’s budget of $1.9 million and $3.3 million.
E-600 Budget Reductions – Page HCF&P-34
The next decision unit for consideration is E-600. This is the budget reduction module. Based upon recent information the division received on the actuarially determined rates for HMOs that provide coverage for children enrolled in this program, there is an opportunity to reduce this decision unit in a greater amount than that displayed in the Executive Budget. The recent actuarial review provided information that premiums could be reduced by $22.52 per member per month in the Check Up program. Implementing the rate reductions would provide for a General Fund savings of approximately $888,000 in FY 2004 and $1.1 million in FY 2005. The other issue in this decision unit is the elimination of the premium differential that has existed for a number of years between Medicaid and Nevada Check Up. Contracts have been issued and are pending signatures with the HMO providers. The other issue in this budget is premiums currently paid by families that have children enrolled in the program. Currently the premiums in the Nevada Check Up budget reflect the premium rates that have been in existence since the program was initiated in 1998. On page 48, there is a table at the top of the page illustrating the current premiums. This is not a per-child premium, this is a household premium, and the average annual premium paid per family is $36.59. The proposal for the subcommittee’s consideration is to increase the premiums by $5 to $20, based on the percent of poverty level.
E-432 Nevadans with Health Insurance
If the premiums were increased to the levels displayed in the table, the additional premium revenue generated would amount to $369,000 in FY 2004 and $543,000 in FY 2005. It would provide a General Fund savings of $285,000 over the biennium.
Under other issues, decision unit E-432 reflects the savings if the elimination of the Children’s Health Assurance Program (CHAP) assets test were approved in the Medicaid budget. This is more appropriately discussed in the Medicaid budget. Staff requests permission to make changes in the Check Up budget depending on the decision in the Medicaid budget regarding the elimination of the CHAP assets test. There is only one technical adjustment based upon the closing of the Blue Cross-Blue Shield settlement account. The closing documents reflect a transfer of funds from that account in the amount of $225,000 and a reduction of General Fund in the Check Up budget in the like amount. The use of settlement revenue provides for a one-time savings of General Fund.
Assemblywoman Gibbons:
It seems that the Governor’s recommendations are more correct than the revised proposal if there will be reenrollment.
Mr. Abba:
The assumptions for the revised caseload add back the 2300 children into the caseload estimates. It is assumed that the families of those 2300 children would make their premiums current and reenroll in the program. The reduction takes into account the 700 children that were disenrolled for other eligibility issues, and re-review of the 2003 caseload projections, which are not coming in at the levels that were projected in the Governor’s budget. These projections were worked out in conjunction with the division, and the division feels comfortable with these projections. They are based upon increases of 1 percent per month for the out years of FY 2004 and FY 2005, and are the same assumptions that were used in building the Governor’s budget.
Assemblywoman Gibbons:
Do we know how the premium increases would affect the number of children that might be no longer involved?
Senator Rawson:
There is only 1 percent of the families that really falls into that category, so I do not expect to see a big negative effect when the premium increases. I can see the concern, but when most of the families are below 75 percent of poverty, that is comparable to other states.
Assemblywoman Leslie:
Actually, 99 percent of the families in Nevada Check Up are below 175 percent, and only 1 percent would be eligible for that upper $20 increase.
Senator Rawson:
It is reasonable for us to proceed? If we see a negative trend, can we adjust that in the future?
Assemblywoman Leslie:
The Division’s staff indicated they are doing a yearly collection of premiums now and that will cut down on nonpayment of premiums. I think the premium increases are minimal and reasonable.
SENATOR RAWSON MOVED TO CLOSE BUDGET ACCOUNT 101-3178 ACCORDING TO STAFF RECOMMENDATIONS INCLUDING REVISED CASELOAD PROJECTIONS, THE BUDGET REDUCTIONS, APPROVAL OF PREMIUM INCREASES, AND WITH OTHER TECHNICAL ADJUSTMENTS BY STAFF INCLUDING THE CHAP ASSETS TEST.
ASSEMBLYMAN HETTRICK SECONDED THE MOTION.
THE MOTION CARRIED. (ASSEMBLYMAN GOLDWATER, ASSEMBLYWOMAN GIUNCHIGLIANI, AND SENATOR CEGAVSKE WERE ABSENT FOR THE VOTE.)
*****
HR, Welfare Field Services – Budget Page WELFARE-11 (Volume 2)
Budget Account 101-3233
Mr. Abba:
This budget can be found on page 49, and the text begins on page 50 of the Closing List (Exhibit C). The three main closing issues are staffing alternatives, new positions for the Health Insurance for Work Advancement (HIWA) program, and new positions for elimination of the Children’s Health Assurance Program (CHAP) assets test.
M-200 Demographic/Caseload Changes – Page WELFARE-13
M-202 Demographics Caseload Changes – Page WELFARE-13
E-600 Budget Reductions – Page WELFARE-17
Decision units M-200, M-202, and E-600 are taken into consideration in the first closing issue. To address caseload growth, the Executive Budget recommends the continuation of 84.5 positions in M-202, 240 new positions in M-200 and vacancy savings in E-600 in an amount that offsets the salary costs of 29.5 of the 84.5 positions approved by the IFC. There has been a number of concerns expressed regarding the large contingent of positions recommended; therefore, staff has worked with the Welfare Division over the past few weeks to develop a staffing alternative based on several premises for the subcommittee’s consideration.
The first premise is for the committee to approve decision module M-202 and not approve the E-600 module, which has vacancy savings built in, in the amount of 29.5 of those positions. Out of those positions, 26 eligibility workers and 3 supervisors are included. The premise for the staffing alternative is to approve 129.5 of the 240 new positions recommended in M-200. This eliminates 110.5 of the new positions. The staffing alternative provides for 72.5 eligibility workers within that component of 129.5 positions. Staff recommends, as part of the staffing alternative, to accelerate the hiring of the eligibility workers. Those positions, in addition to the 29.5 positions in M-202, would be implemented in phases beginning in July 2003, and September and November, and July 2004, coinciding with the division’s training academies run in Las Vegas and Reno. The remaining positions would be phased in over the course of FY 2004. The other premise is that there will be a need to establish a new district office. The Executive Budget recommends two new district offices phased in over the biennium, and with staffing alternative we are recommending one new office in Las Vegas. The division is currently in negotiations with a landlord for a 36,000 square foot facility, and we are recommending the funding for that facility beginning in November 2003. That facility would house 120 staff.
The staffing alternative, if approved, would save $1.85 million in State funds compared to the staffing proposal recommended in the Executive Budget. The savings for the next biennium 2005-2007, by not approving the 240 positions and only the 129.5 new positions, would be approximately $10.6 million. The table on page 51 provides a comparison of the Governor’s recommended staffing with the staffing alternative, and the differences by fiscal year. If the subcommittee approves the staffing alternative, the staff would request that the Welfare Division report to the IFC in March 2004 regarding the phase in of the positions as well as how the division is handling the caseload, how they have addressed their backlog in applications, and the backlog in redeterminations. At that time the committee could decide whether the Division would need additional resources. If this proposal is approved by the subcommittee, there are some technical issues that need to be addressed in areas of the lease space cost, cost for outfitting the recommended new facility, worker driven costs, equipment, and vacancy savings. Staff would request permission from the subcommittee to work with the division on the appropriate adjustments.
E-425 Nevadans With Health Insurance
The second closing issue is reviewed on page 52. Though the Executive Budget recommends two new eligibility worker positions for the HIWA program, the staff does not recommend approval of the two new worker eligibility worker positions at this time. When you hear the Medicaid budget next week, information will be provided indicating that the program would not be able to be implemented until April 2004 versus October 2003. Additionally, the caseload for that program has been reprojected and will be reduced, and if the staffing alternative is approved we feel it is premature to be adding positions for a program for which we are unclear on caseload.
E-432 Nevadans with Health Insurance – Page WELFARE-16
Closing item number 3 is the E-432, the component of eligibility workers the Welfare Division would need if the CHAP assets test were eliminated. Similar to the Nevada Check Up Program, staff would ask that this issue be addressed when the CHAP assets test is taken up in the Medicaid budget. Staff indicates the 13 new eligibility workers would be needed based upon the caseload projections that would occur if the assets test were eliminated. Other closing adjustments are for the prices for computers and software.
Senator Raggio:
Why would it take staff so long to implement the HIWA program?
Charles Duarte, Administrator, Division of Health Care Financing and Policy, Department of Human Resources:
It is primarily development issues that are preventing an early implementation of the program as well as some of the public notice requirements for this. We have projected an April 2004 date for this new program.
Assemblywoman Leslie:
Is it true that we could not justify staff until October 2004 because of the way caseload comes in?
Mr. Duarte:
Those are Welfare Division staff that Mr. Abba referred to.
Senator Raggio:
The Governor had recommended this program to be implemented this October. Are you now indicating it is not feasible?
Mr. Duarte:
Because of the implementation of our Medicaid management information system and the timing involved with that, we have made a determination that we would have to delay implementation until April 2004.
Senator Raggio:
Is there no way around that?
Mr. Duarte:
We can look at opportunities to address the issue, but that was our first determination.
Senator Raggio:
This was high priority the last time we discussed it, the Governor recommended it, it was highlighted in the State of the State message and in the budget. It is disappointing that now we are told we cannot implement it until April 2004. Is it all because of this system? Can we work around that and get it implemented sooner?
Mr. Duarte:
We can take a look at implementing it sooner and report back to staff.
Assemblywoman Leslie:
Does the State plan have to be amended, Mr. Duarte?
Mr. Duarte:
The options available are straightforward to implement in terms of the State plan, but there is still a hearing process we would have to go through once it is approved.
Assemblywoman Leslie:
Our staff report states that even if it starts in April, staff does not come online until October, so how are we going to start it in April?
Mr. Abba:
In the Medicaid budget, there are four positions devoted to the HIWA Program paid by funding from the Ticket to Work Grant. The division indicates that they will retain two of those positions to administer the HIWA Program, so they currently exist. The staff in the welfare field services budget is strictly eligibility staff. The statement I have in the closing documents that a position could not be justified in October is based upon the caseload as it transitions in from an eligibility perspective to the program, assuming an April start date. The transition of caseload that would support a position beginning in October 2004 is referring to an eligibility worker. From staff’s perspective, we are indicating that, with the upfronting of the eligibility workers and the M-202 and M‑200 modules, we should wait to see what happens with that caseload and with those additional eligibility workers from those two decision units in order to accommodate the caseload from the HIWA Program.
Assemblywoman Leslie:
If we approve the other staffing increases, do you feel comfortable that this could be absorbed, even if we are able to move back the start date?
Nancy K. Ford, Administrator, Welfare Division, Department of Human Resources:
Given the later start date, and if we get the new positions, we could absorb this temporarily. If the caseload grew at a much faster rate than we anticipated, we could also go back to IFC to address the issue.
Assemblywoman Leslie:
The intent of this committee is to get this implemented as soon as possible.
Senator Rawson:
I recommend we close this budget with the staffing alternative plus the ability to handle the technical issues of outfitting and rent space. It would be eliminating the HIWA program positions for now, and the new positions would be eliminated for the CHAPS assets test.
Senator Raggio:
I would second the motion if it included a Letter of Intent to the department to report on a periodic basis, the indication being that we would like to implement that program as soon as possible and have them report their effort back quarterly.
Assemblywoman Leslie:
I think the staffing alternative gets to the issue of trying to process applications in a more timely manner and takes care of the backlog. It is fewer staff than in the Governor’s budget, but the tradeoff is that the Welfare Division gets the staff earlier, and the long-term savings in the next biennium is significant.
Assemblyman Hettrick:
I support all of what has been done here. At this time, however, I cannot support removing the CHAPS assets test. Given the situation and the additional workers, I think the test is reasonable. If we are going to include that, I will have to vote “no” on the motion, even though I agree with the bulk of the motion.
Assemblywoman Leslie:
As we understand it, these 13 new eligibility workers, with elimination of the CHAPS assets test, would only happen if, when the Medicaid budget closed, we vote on that issue, and we will not do that until next week. You could vote for this motion today knowing that unless we take that action next week, these additional workers would not be approved.
Assemblyman Hettrick:
On that basis, I understand. I will just condition the vote on the fact that I do not support the elimination of the assets test and will vote ‘yes’ on this motion.
SENATOR RAWSON MADE A MOTION TO CLOSE BUDGET 101-3233 WITH THE STAFFING ALTERNATIVE PLUS THE ABILITY TO HANDLE THE TECHNICAL ISSUES OF HOUSING AND THE RENT SPACE. IT WOULD ELIMINATE THE HIWA PROGRAM POSITIONS FOR NOW AND THE NEW POSITIONS WOULD BE ELIMINATED FOR THE CHAPS ASSETS TEST; AND IT WOULD INCLUDE A LETTER OF INTENT TO THE DEPARTMENT TO REPORT ON A QUARTERLY BASIS AND IMPLEMENT THE PROGRAM AS SOON AS POSSIBLE.
SENATOR RAGGIO SECONDED THE MOTION.
THE MOTION CARRIED. (ASSEMBLYWOMAN GIUNCHIGLIANI AND SENATOR CEGAVSKE WERE ABSENT FOR THE VOTE.)
*****
HR, Welfare/TANF – Budget Page WELFARE-20 (Volume 2)
Budget Account 101-3230
Mr. Abba:
I will not repeat the items in the preliminary discussion of the Temporary Assistance for Needy Families (TANF) caseload projections. Since the Welfare Division brought their new caseload projections at the previous work session meeting, the division has come back with two alternative caseload projections based upon concerns expressed by the subcommittee.
These are reflected on page 54 in the table in the middle of the page. They are referred to as Option 1 and Option 2. The table reflects the Governor’s recommended TANF caseload projections, the March projections provided at the update hearing, and the difference between the two caseloads. The welfare Option 1 caseload is in the middle of the table and includes the reflected difference between the Governor’s recommended caseload included in the Executive Budget. The welfare Option 2 reflects the projected caseload and the difference compared to the Governor’s recommended caseload. The division prefers welfare Option 1, providing for caseload of approximately 32,430 recipients per month for 2004 and 35,350 for 2005. Staff concurs with the division’s preference. At the bottom of the page, the two options are listed with their projected costs and cost savings. If Option 1 is approved, the amounts budgeted for TANF cash assistance expenditures would be reduced by $6 million in FY 2004 and $9.5 million in FY 2005. If Option 2 is approved, that would reduce the amounts budgeted for TANF cash expenditures by $8.7 million in FY 2004 and $13.5 in FY 2005.
I will proceed to the Kinship Care Program. The caseload projections that I went over did not include the Kinship Care Program. They were done separately. I would call your attention to a budget reduction measure on page 55 that was implemented in November, which reduced the grant payment for the additional children that might be covered by a family under Kinship Care. When the program was first established, the grant rates were set at a level that each child in the family would receive the same grant level, $534 for a child under age 12, and $616 for a child ages 13 and over. The budget reduction measure maintained that level of grant for the first child and reduced the grant level for the second child to $100. Based upon the caseload projections that were run in conjunction with the division, if the cash grant levels were maintained at their current levels, there would be a General Fund savings of approximately $781,000 in FY 2004 and $1.3 million in FY 2005, based on the reductions. In previous meetings, the committee expressed interest in increasing the cash grant levels back to their pre-November levels. If that option were chosen, there would be an increase in costs, because the second or third child would receive the same grant level as the first child instead of the $100 grant level that is currently received. In order to do that there would be an additional cost over and above what is recommended in the Executive Budget of $601,000 for FY 2004 and $705,000 in FY 2005. The Welfare Division is concerned that, if this option were selected, there might be a “woodwork” effect, causing additional families to enroll their children into the program. At the bottom of page 55, I have taken into account the potential “woodwork” effect if five additional children per month were to enroll in a program based upon the assumption that the higher grants would make it more attractive for families to enroll in the program. If that were the case, based upon those five additional children, there would be an additional cost over and above the $601,000 in 2004 of about $225,000 in FY 2004 and an additional $600,000 in FY 2005. This would be a General Fund cost.
The options for the committee to consider are keeping the program at its current grant levels, resulting in a savings of $781,000 in 2004 and $1.3 million in 2005, or reinstating the benefit to the pre-November levels, which would require additional expenditure of General Funds.
Item number 3 on page 56 describes the overstatement of TANF funds by $6.5 million each year of the biennium, which was included in the Executive Budget in error. The projected balance forward of TANF funds from FY 2003, and some of the savings that would be generated, depending upon which caseload option the committee chooses, will correct the overstatement of TANF funds. Staff requests permission from the committee to make necessary adjustments based upon the caseload option that is selected.
M-593 E & T Participation Rate – Page WELFARE-23
Under other closing items, M-593, there is an adjustment that could be made based upon caseload reductions as well as lower costs paid per participant in New Employees of Nevada (NEON) that would result in a General Fund savings of approximately $1 million in 2004 and $1.9 million in 2005. Staff requests permission to work with the agency on making any necessary adjustments based upon the selected caseload option. The budget reductions that had to be made during the current interim because of the TANF caseload increases are displayed on the bottom of page 56. The information displayed shows the reductions that were made to the counties that received TANF funds and the reductions that were made to the non-profit agencies that received TANF funds. The tables at the bottom of the page illustrate the amount of funding that was provided in FY 2002 compared to the amounts recommended in FY 2004 and FY 2005 and the differences.
Assemblywoman Giunchigliani:
It is my understanding that it would keep the Kinship Care Program as it is, but with the income for the second and third child at the $100 rather than the increase, but that you would add to the “wish list” the additional revenue, if we can find that money.
SENATOR RAWSON MADE A MOTION TO CLOSE BUDGET ACCOUNT 101-3230, BY SELECTING OPTION 1 OF THE TANF CASELOAD PROJECTIONS AND FOLLOW THE CURRENT GRANT LEVELS WITH THE NEW GRANT LEVELS TO A “WISH LIST,” AND WITH TECHNICAL NEW PROJECTIONS ON THE KINSHIP CARE PROGRAM, ADDING THE ADJUSTMENTS FOR THE OVERSTATEMENT OF TANF FUNDS.
SENATOR RAGGIO SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
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HR, Child Support Enforcement Program – Budget Page WELFARE-25 (Volume 2) Budget Account 101-3238
M-200 Demographics/Caseload Changes – Page WELFARE 26
Mr. Abba:
The child support budget on page 58 under M-200 includes nine new positions recommended for the biennium. Staff recommends approval of the nine new positions. There is also a decision unit contingent upon passage of S.B. 186, which provides for a new revenue source called a “wage assignment fee” of $2 assessed to the child support obligors. The $2 would be split evenly between the child support program at the State level and the district attorneys and would help fund their programs in both areas.
SENATE BILL 186: Imposes fee upon obligor of child support who is subject to withholding of income by his employer. (BDR 3-446)
The closing as prepared by staff assumes that S.B. 186 would be passed, and the effective date for the program to start would be October versus July, as currently reflected in the Executive Budget. The division has requested approval to establish a reserve in this account of $750,000 minimum. The budget reflects $1.8 million in the reserve, but there are a number of adjustments that have to be made based on information that became available after the Governor’s budget was completed. The closing adjustments recommended reducing the reserve to approximately $880,000, contingent upon the passage of S.B. 186. Staff would agree with the Welfare Division that the reserve level of $750,000 would be appropriate. Staff would recommend for this biennium that any monies above the $750,000 level be placed in reserve for reversion to the General Fund.
SENATOR RAWSON MOVED TO CLOSE BUDGET 101-3238 ACCORDING TO STAFF RECOMMENDATIONS.
ASSEMBLYWOMAN GIUNCHIGLIANI SECONDED THE MOTION.
THE MOTION CARRIED. (SENATOR RAGGIO WAS ABSENT FOR THE VOTE.)
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Assemblywoman Leslie:
This meeting is adjourned at 10:38 a.m.
RESPECTFULLY SUBMITTED:
Julie Walker,
Committee Secretary
APPROVED BY:
Assemblywoman Sheila Leslie, Chairman
DATE:
Senator Raymond Rawson, Chairman
DATE: