MM Curator summary
NY counties continue to pay increasing Medicaid costs that they cannot directly impact.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
Genesee County is on track to spend more than $9 million on Medicaid this year and New York State is doing very little to help alleviate this local obligation, according to the director of the county’s Department of Social Services.
Presenting his departmental review at Monday’s Genesee County Legislature Human Services Committee meeting, David Rumsey (photo above) said the county has little input over the government-financed health insurance program for eligible people.
Approximately 3,000 county residents are on Medicaid, he said, and that number continues to increase.
“The transition of Medicaid administrative functions from the county to the state remains unchanged. There has been no additional movement by the state to take over the Medicaid administrative functions,” he said.
Rumsey also mentioned the inordinate amount of time spent on determining people’s eligibility in light of the required five-year lookback period for chronic care (nursing home) cases.
“The Medicaid assistance programs have the greatest burden to the county, but for which we have little control,” he added, reporting that projected spending by the county for Medicaid in 2021 is $9,052,134.
In his report, Rumsey touched upon other programs and services offered by DSS as well as its budget status.
2021 BUDGET STATUS
Anticipated 20 percent cuts in state aid did not occur, he said, keeping the DSS budget on track for 2021.
“The pandemic continued to bring uncertainty about the projected funding streams and allocations, and it still does,” he said.
Rumsey said he is monitoring state training school expenses since the number of youths currently in detention will need to be budgeted for in 2023 (two-year billing cycle).
He also reported that required training for new employees hired over the last year was put on hold at the state level.
“The state is currently formulating a plan to move the virtual training back to in-person, but this plan is reliant on the continued safety for the trainees that attend,” he said.
— Temporary Assistance (Public Assistance): This unit provides cash assistance to individuals or families, with benefits provided based on eligibility and on-going case monitoring.
“The overall monthly caseload is trending downward with a decrease in both Family Assistance and Safety Net,” he said. “There has not been a significant increase in homelessness noted yet. The eviction moratorium is extended through January 15, 2022 which may change this trend.”
— Emergency Rental Assistance Program (ERAP): This was rolled out by the Office of Temporary and Disability Assistance to assist renters and landlords, but the start was “slow and not successful,” Rumsey said.
He said most of the funds went to renters, while assistance to landlords lagged behind.
“A lot of landlords had property damaged,” he said. “Now, they are getting a few more rights.”
— Fraud: The DSS Fraud Department has been very busy, Rumsey said, with its two investigators following up on Font End Detection System referrals, Intentional Program Violations, prison matches, and allegations of welfare fraud.
— Child Support: Federal guidelines strive for a minimum collection rate of 80 percent; DSS is at 78.94 percent, well above the state average of 67.20 percent, Rumsey said.
“This unit continues to work to ensure right sized orders are established and appropriate modifications to existing orders is occurring,” he said. “The COVID-19 pandemic caused delays in the operations of this unit as the Child Support Court was temporarily closed.”
Other programs include Home Energy Assistance and Supplemental Nutritional Assistance.
— Family First: In a move that will save the county money, the state is requiring the local DSS offices to reduce the number of residential placements by 12 percent.
“The Family First initiative is also requiring us to have at least 30 percent of our total foster care population in a certified Kinship (relative) foster home, and we are currently meeting both requirements,” Rumsey reported.
He also said that the Family First Prevention Act reforms federal financing to prioritize family-based foster care, preferably with kin, over residential care by limiting federal reimbursement for certain residential placements.
— Foster Care: The DSS foster care unit has certified nine new foster homes this year, with three more pending by the end of the year, Rumsey said. Of the nine, three were “kinship” and six were regular foster care. DSS also was able to certify one new cluster foster home, increasing that number to four.
Rumsey said the county saved money this year through a reduction in voluntary agency therapeutic foster care placements and utilizing certified county foster homes.
— Preventive Services: Mandated preventive services are provided to assist families and children in meeting their needs and keeping the youth out of foster care placements. Rumsey said that through August, DSS has worked with 222 children with only five being placed outside of the home.
— Child Protective Services: Through August, DSS has handled 646 cases of suspected child abuse and maltreatment, he said, with investigations taking place within 60 days as mandated by New York State. For September, there were 32 more CPS cases compared to September 2020.
“Moving forward these cases will be harder to determine because there is the movement from needing just credible evidence to having a preponderance of the evidence, which is a higher standard that must be met,” Rumsey advised.
— Adoptions: DSS assisted in the adoption of four children with expectations that another three will be finalized by the end of the year. Of the 54 youth in foster care, 10 are freed for adoption, he said.
Rumsey said that 115 children are currently receiving adoption subsidy payments.
The current annual adoption subsidy rates are basic $7,800, special $9,358 and exceptional $12,453.
“The other concern is that once a foster family adopts children, they rarely continue as foster parent resources for other children who are placed,” he said. “Permanency for children often results in shortages of foster parents.”
— Adult Services: Currently, DSS has 155 Adult Preventive and Protective Services for Adults cases, with 33 of those personal care cases being monitored.
“DSS continues to partner with the Office for the Aging, the District Attorney, the Sheriff and Lifespan in a coordinated Enhanced Multi-Disciplinary Team to work together to assist our elderly Genesee County residents in combating elder abuse and financial exploitation,” he reported.
— Detention: In 2021, five youths were placed into OCFS State Training Schools, which are very costly to the county, Rumsey said. The current detention rate is $468.17/day.
Photo by Mike Pettinella.