Testimony of Verna Eggleston AdministratorCommissioner Human

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					       Testimony of Verna Eggleston Administrator/Commissioner Human Resources
                                     Administration
                        before the Committee on General Welfare
                                          on
  The FY 2004 PRELIMINARY BUDGET & FY 2003 PRELIMINARY MAYOR’S MANAGEMENT
                                       REPORT

Good morning. My name is Verna Eggleston and I am the Commissioner of the Human Resources Administration, and the
Administrator of the local Social Services District of New York City. I would like to thank the Chair, Councilmember deBlasio, and
the other members of the City Council General Welfare Committee for giving me the opportunity to testify on our priorities and
budget.


When I spoke to you last year, I discussed the work ahead for HRA and the people it serves.

Presented to you was the reauthorization for Temporary Assistance for Needy Families (TANF). In May, the Mayor announced the
City’s plan for TANF reauthorization and for the next phase of welfare reform. To date, Congress hasn't yet completed
reauthorization. While we continue to work with our Washington Office to advocate for our proposals, we're nevertheless moving
forward with those parts of TANF II that are within our authority. Let me describe for you some of the most important initiatives that
are currently underway.

During 2002, alone, we assisted clients in securing nearly 130,000 jobs. We were able to achieve this despite the weak economy.
Further, the dedicated staff at HRA has been able to achieve this even though over half of those who receive cash assistance, as
of December 2002, were temporarily or permanently unable to work.


We attribute our success to performing individualized assessments and plans, our close working relationship with vendors, our
wide range of education/training programs, and our utilization of the concurrent model of work and other activities, including
education and job search.

We have placed a great deal of focus over the past year on assisting those who have not been able to make the transition to the
workplace so easily. HRA is committed to meeting every client where they are, not just those who are ready and able to go to
work. As we move forward, we must do this with a clear understanding of the needs of our participants.


It is clear that for those individuals remaining on today’s cash assistance rolls, an increasing number face substantial challenges in
their move to self-sufficiency, and require specific models that will help get them there. To address their needs, HRA is developing
an improved process whereby those clients who are able to work will be assessed and held accountable to the mandate of work.
Those with significant health concerns that affect their employability will be assessed, connected with proper health treatment, and
monitored to ensure that they comply with their individualized wellness plan, which can result if followed in a greater level of self-
sufficiency.
This initiative will also help achieve fiscal efficiencies in our Medicaid program. Currently, we are spending large sums on clients
who cycle through our systems, using health care without improving their condition and lacking a primary care provider who can
assist them in securing the care they genuinely need. Under our proposal, we will better assess clients for disability benefits, and if
they are entitled, assist them in obtaining such benefits. For others, we will ensure that they use medical care appropriately to
address their wellness needs and return to the road of employability.


We have started our training and technical assistance to staff who work with individuals with disabilities at the Union Square Job
Center. The training includes interviewing skills, time management, caseload management, administering assessment interviews,
and handling substance abuse issues. In addition, the trainer and unit supervisors conduct joint weekly case reviews, which are
an opportunity for staff to discuss clinical issues with their colleagues and present issues that may need additional attention and
oversight.


Retention


As the Mayor stated last May in his speech on welfare reform, because of our continued success with job placements, one of our
primary goals for our welfare program must be retention -- helping the people who have moved into the workforce stay there. We
do this by providing services that result in our newly employed clients’ maintaining independence.


Let me provide a few examples of the retention initiatives we have implemented since last year.

We know that medical insurance is a primary concern for our clients. Consistent with Mayor Bloomberg’s campaign promise in
2001, we amended our procedures to ensure that those leaving welfare for employment did not have their Medicaid automatically
terminated. In 2002, we extended that policy to cover additional groups.


For those who have already made the transition to Medicaid-only, our mail renewal pilot program has simplified the requirements
for continuing health insurance coverage. The elimination of the face to face re-certification interview, four months ahead of the
schedule mandated by the State’s Health Care Reform Act (HCRA) 2002 amendments, demonstrates our commitment to reduce
obstacles to job retention while focusing necessary support for family wellness care and self-sufficiency.

We introduced the Medicaid Plan of Self-Support, a health insurance benefit for single adult safety-net recipients who are
mandated into treatment for a substance abuse disorder and who have obtained employment. The Medicaid Plan of Self-Support
continues Medicaid coverage for one year after the cash assistance case is closed because of employment earnings. The
Medicaid Plan of Self-Support requires continued participation in, and compliance with treatment. The implementation of the
Medicaid Plan of Self-Support to all substance abuse treatment programs was completed in February 2003.

To increase job retention, upon contract renewal, we have restructured the milestones in our job placement contracts. These
contracts allow vendors to earn a portion of their total fee based on securing the person a job, with the additional portions paid
based on the person remaining in the job for 90 and 180 days. While our focus was initially on placement, we have shifted our
resources to place more emphasis on retention. The payment structure reflects this emphasis. The total fee the vendors can earn
is the same, but more of it is available to them only if their clients meet the retention milestones. This change, regularly reinforced
through face-to-face vendor discussions, has resulted in their focusing more of their efforts on retention. We also continue
monitoring each of our own Job Center’s performance with respect to retention and hold targeted discussions about the results in
each center so that we can plan for improved retention results. In 2002, the average retention rate was 79 percent for the three
months and 69 percent for six months.


Transitional Child Care is available to anyone with a child under 13 who is working and whose income is at or below 200 percent
of the poverty level, whose public assistance case has closed, and who was receiving public assistance at least 3 of the 6 months
before the case closed. Co-payments range from $1 to
$66 per week for a family size of 4.


We are currently piloting a system in which, if the family is getting child care before their case closes and we have information
about income, we automatically approve Transitional Child Care. If we are not able to do this, child care is continued for 60 days
while we obtain the necessary income and family size information. Transitional child care continues for a total time period of 12
months after the case has closed. After that time, the family may continue to receive child care assistance from the Administration
for Children's Services as long as they are eligible.


The Automated Child Care Information System, known as ACCIS, also works to promote retention by continuing eligibility for child
care from the first work assignment and orientation until after the person becomes self-sufficient. ACCIS also supports our
retention efforts by making it easier for us to provide the 60-day carryover of child care eligibility after the person's case closes
and the automatic transfer to ACS, as both HRA and ACS share the system.


Prevention

In addition to retention, we have broadened our mission to encompass our second primary goal, prevention -- prevention from
requiring welfare, and/or other social services. Mayor Michael R. Bloomberg, emphasized, “Preventing people from going on
welfare and helping those who have made the transition from welfare to work stay employed are the goals of the next phase of
welfare reform.”


We know that health care is a primary need and is often left unmet in certain employment sectors. I believe we have achieved
great success in separating health insurance from cash public assistance – and increasing the overall number of health insurance
recipients – even as dependence on cash benefits has declined. By mid 2003, the period of coverage will be expanded to allow
continuation of services and coverage and to afford consumers the opportunity to continue Medicaid-only coverage through mail
renewal. We also have plans this year to further streamline the application process.


Family Health Plus is a public health insurance program designed for adults ages 19 through 64 whose income and/or assets are
above the Medicaid levels, but within 150 percent of the Federal Poverty Level. Family Health Plus and Medicaid help low-income
workers who do not receive coverage from their jobs remain in the workforce and contribute to preventing people from depending
on welfare.


Part of our prevention strategy is implementation of the Family Health Plus program in New York City, while simultaneously
completing the transition of Disaster Relief Medicaid recipients to ongoing coverage. Through these efforts, as of March 2003,
106,710 people have enrolled in Family Health Plus. Overall health insurance enrollment has climbed to 2 million for the first time
in history, due in part to the consistent efforts of HRA. HRA is providing health insurance support to many of the working poor in
New York City.


Our policies are designed to further both our retention and prevention strategies.

We also recognize that ensuring adequate food for families is the most important issue for all families, not only those transitioning
from public assistance. Sufficient food also assists families to remain self-sufficient, and does not create an untenable situation in
which families choose welfare because they believe it to be their only option due to food shortage.


Consequently, HRA works with outside organizations to provide food stamp outreach services and supplemental food. Hundreds
of workers at community-based organizations are trained and regularly refer individuals to food stamp offices. Additionally, we do
outreach through a variety of organizations to let individuals know about what assistance may be available. Last month, in
conjunction with Public Advocate Betsy Gotbaum and the New York State Office of Temporary and Disability Assistance (OTDA),
we announced a major initiative with The United Way on food stamp outreach and education. Several community-based
organizations will work on this effort.

As a result of these and other efforts, the number of people receiving food stamps has increased. While there is more to do, our
efforts to date have been successful. Between January 2002 and February of this year, the non-public assistance food stamp rolls
increased by nearly 20%, from 358,630 to 426,737. In February of this year alone the rolls increased by nearly 12,000 people.
Today this caseload is at its highest point in 20 years.

To further assist our clients, we will begin using a shortened food stamp only application at pilot sites in each borough in April. If
the pilot is successful, we plan to implement the shortened form throughout all Food Stamp Offices in May and June.


Assisting people to access Food Stamps is only one part of our efforts to provide food assistance to New Yorkers. In addition,
HRA’s Office of Food Programs and Policy Coordination seeks to improve the nutritional status of low-income New Yorkers by
providing education about Food Stamp eligibility and general nutrition and administering the distribution of non-perishable food
commodities to 620 active emergency food programs (soup kitchens and food pantries). In 2002, HRA distributed 14.6 million
pounds of food that fed 11.1 million meals.

The City’s TANF reauthorization proposal and our current and future programs build on our success to date by addressing barriers
to employment for those currently on the caseload, and support the client to be a participant in the process. We believe that in
order to increase the self-sufficiency of current or potential public assistance clients, we must make the client the primary catalyst
in his or her future.


Funding the Vision


Now I like to discuss how we are finding ways to fund our vision, despite reduced federal and state funding.


The current City and State fiscal problems have posed a challenge to implementing or expanding services. We have been asked
and have met the savings target reductions of $30 million this year and almost $53 million for CFY 04. We have reached these
savings targets because we have started or will be implementing measures that will generate these savings. This is due to the
continued aggressive efforts on the part of our staff to identify ways to reduce costs or increase revenues. Therefore, to date, we
have been successful in avoiding service cuts. I’d like to share with you some examples of the ways by which we are meeting our
savings targets, without reducing services.

HRA, together with the Department of Homeless Services (DHS), has recently begun using a new client tracking system for
determining the public assistance eligibility of homeless families in City shelters. Oftentimes a public assistance family entering a
shelter fails to report for recertification or fails to report its change in address. This often results in a case closing. If the shelter
resident does not have an open public assistance case, the City assumes the cost of providing a shelter with 100 percent city tax
levy funds. By re-establishing public assistance eligibility, the shelter portion of their grant can be used retroactively to help pay for
the cost of shelter. This enables us to claim state and federal reimbursement for approximately 25 percent of the 8,800 homeless
families in DHS shelters who were formerly funded through City tax levy money. DHS and HRA share the savings credit for this
initiative.

We have submitted claims for enhanced Medicaid revenue for skilled medical personnel. Since 75 percent reimbursement is
available for the costs of medical professionals performing clinical duties, HRA worked to redesign the claiming process for a
contract which provides eligibility determination for homecare services.


HRA has also submitted $17 million in Medicaid claims for hospital in-patient costs. Although federal regulations permit Medicaid
reimbursement for these costs, New York State only recently began to submit claims for State Fiscal Year 2001-2002. To date
$12 million in claims have been recognized, and are expected to be paid.


We continue to find ways to improve our services and reduce our costs.


We will begin to recoup increased federal reimbursement for client carfare. A federal limit of $25 per month on food stamp
employment and training reimbursement for carfare payments for job search or training activities was recently eliminated. The
increased reimbursement will reduce the City and State costs in the $33 million transportation budget.


HRA determined that Serostim, a high-cost prescription drug, was being heavily used in the illegal market and worked with the
State to put the drug on its prior authorization list. Subsequently, New York City Medicaid Serostim prescriptions have plummeted
from about costing $5 million per month to $1.5 million, producing savings in the Medicaid budget. We will implement a new State
pre-approval process for Serostim which will generate savings in the City’s share of Medicaid expenditures for pharmaceuticals by
ensuring proper utilization.


Conclusion
I’d like to conclude by saying that we are committed to pursuing the strategies of prevention and retention, in a flexible manner
which recognizes that every person we serve has individual needs. As we look toward the coming year, we must continue to
expand our programs to engage all our clients in the process of self-sufficiency, regardless of fiscal constraints. We acknowledge
that the success of welfare reform cannot be measured solely by reduction in caseloads, but also by the ability of people to
become and remain self-sufficient. We are committed to assisting our clients achieve self-sufficiency.

I welcome any questions you may have on the implementation of our vision.

                                                                                                                     CITY HALL
                                                                                                                 MARCH 13, 2003

				
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