El Dorado (June 10, 2002):

• 8 stakeholders in attendance included representatives from Butler County Health Dept; USD 385; ElDorado RCIL (Independent Living Center); Flinthills Services Inc. (CDDO) and the Juvenile Justice Services Administration.

Questions and Comments:

• Osawatomie staff indicated in order to meet budget shortfalls the possibility of closing additional units did exist.
• Does this mean that the consumers being discharged from the hospital will have to go on the Waiver waiting list just like everybody else"? Response: Waiting list and waiver would only apply to folks served by the DD system, not folks with SPMI.
• A school nurse asked what SRS plans to do in regards to the School Violence Prevention Program. Response: The school violence projects will experience some cuts as funding has been decreased from $500,000 to $228,000 for FY 03. The Dept. of Ed. Will notify the grantees that will be discontinued. SRS will then take over managing the remaining projects. The current plan is to continue FY 03 with the remaining grantees as they are now. But, during FY 03, we will spend time reviewing projects, site visiting, looking at outcomes and other evaluative information related to the projects, and then make a decision about whether they continue or we do an RFP process to continue or begin new projects.
• A participant pointed out that Representatives Peggy Palmer and Bill Mason were not running for re-election.

El Dorado (June 24, 2002):

• Stakeholders attending included representatives from Audrey B. Magana & Associates (a CSE contractor); Governors Mental Health Services Planning Council; Butler County Department on Aging; RCIL (Independent Living Center); Butler County Health Department; Mid Cap Inc. (Community Action Program); Susan B. Allen Hospital; The Counseling Center (Mental Health Center); Butler County Silver Haired Legislature; and USD 385. In addition to SRS Program Chiefs and Supervisors there were two representatives from Osawatomie State Hospital and our BCBS Medicaid Liaison.

Identify the most significant (3-5) impacts and implications related to policy changes made by the 2002 Legislature in order to meet FY 03 budget reductions, in your community(s). List specific examples.

Policy Changes: Reduce attendant care wages on PD waiver. Terminally ill patients served through the PD waiver could no longer access hospice services. Increase co-pay for pharmaceuticals. No funding added to reduce waiting lists.

• Independent Living Center had to reduce numbers of staff as well as reduce the salaries of remaining staff.
• More people will go into nursing homes which will increase costs.
• One participant stated that Hospice dropped a person due to high cost of meds.
• Will result in people not taking their medications.
• All community resources will experience an increase in numbers of people needing help at a time when all organizations and agencies are experiencing a shortage of funds.
• May increase the numbers of people who use emergency rooms which will increase costs.
• Could see an increase in wages of employed adults, without medical insurance, being garnished to pay for emergency room bills.
• Waiting lists will grow across the board for people with disabilities as well as the elderly.
• Could result in breaking up homes as spouses and care givers burn out.
• People on waiting lists have spend downs often times resulting in deciding to eat or take their medication. (When a person is on the PD waiver they have a medical card that covers medication.)

Should the 2003 Legislature change any of the policy decisions that were made?

• Support MiCASA - make HCBS an entitlement program so that more federal dollars can be drawn down.
• Reconsider forcing people to choose between Hospice & waiver services. Allow agencies to jointly develop a plan to avoid duplication.
• Legislators need to fully understand how the decisions they make will impact on other program services.
• Revisit time limited General Assistance. This program is all state general funds. The thinking behind this comment was that General Assistance was designed to be interim and if the consumer is awarded SSI or SSDI the state is reimbursed. Consequently this change does not produce large cost savings.
• Rethink the waiver program. By not adding more dollars, people will need to enter nursing homes for care which will dramatically increase costs.

For consideration of the 2003 Legislature, what are the lowest and highest priorities for continued services? What service gaps exist?

• Emphasize the importance of obtaining state match dollars by clearly identifying how the loss of federal funds will impact specific programs and services. Allow use of community funds to draw down state/federal dollars.
• Emphasis on funding programs that are preventative in nature as this will result in cost avoidance in the future.
• Keep HealthWave at 200% poverty level.
• Review all Medicaid programs. Kansas provides a lot of optional services.
• Fully fund information technology as it enhances internal & external communication. This allows SRS to be more efficient in the community resulting in more effective partnerships. Also better state coordination of IT systems would result in cross agency platforms at one level which would increase efficiency.

Identify what steps the community needs to take to prepare for the immediate budget crisis and what steps can be taken to deal with the policy changes likely to be taken by the 2003 legislature.

• Medicaid liaison will provide a list of services identifying what Medicaid and Hospice should provide.
• Attend the Kansas Children's Campaign meeting July 8 in Wichita to learn where candidates stand on children's issues.
• Keep in mind that all agencies and community organizations are experiencing funding shortages.
• The Butler County Community Action Program has developed numerous cross sectional community task forces and coalitions that deal with family issues. They invite community members to attend.
• Butler County also has an existing Community Service Advisory Board that deals with elderly adult issues. Membership consists of numerous state and local agencies.
• The groups mentioned in the previous 2 bullets try to attend each others meetings.
• Agencies need to communicate to the public about what they are doing in church bulletins, e-mails, newspaper calendar of events and newsletters.
• Invite County Commissioners, Mayors and Legislators to participate.
• Explore the possibility of using foundation grants, United Way dollars etc. to leverage more federal dollars.
• Community agencies should explore the possibility of establishing endowments using capital outlay funds. This would result in having money in reserve to use when it is needed.
• Promote community volunteerism to assist agencies in meeting needs of people.
• The Independent Living Center has initiated a "Peer Specialist" program. This results in consumers assisting each other.
• Recommendation that the community consider replicating a program similar to a program in Ames, Iowa, through the Ministerial Alliance entitled "Circle of Support".
• Agencies need to remember this is an election year. Inform legislators about what we need and what we are doing.
• Send legislators results of these meetings.

Emporia:

• 11 stakeholders in attendance included representatives from Emporia Child Care; KVOE Radio station; Domestic Violence Organization (SOS); East Central Kansas Mental Health Center; Hetlinger (CDDO); and one consumer's mother. In addition to SRS program Chiefs and supervisors, Beth Gates, our Medicaid liaison and Ron Alexander from the Office of Prevention were also in attendance.
• Overall, there were very few questions and comments. At the end of the meeting several stakeholders came up to say they thought it was a very informative meeting.

Questions and Comments:

• One of the attendees wanted reassurance the drug formulary would pay for mental health drugs.
• How much money a family would need to contribute towards family preservation.
• Suggestion on reducing expenditures, "Eliminate salary bonuses all together. I don't, nor does anyone else in my agency receive a bonus".
• "Why are individuals traveling out of State? Consider reducing this amount or eliminating this."
Emporia (June 25, 2002):
• Stakeholders included representatives from Hetlinger Developmental Services (CDDO); Citizens Advisory Council; Independent Consumers; Consumer representative of CAC, NAMI of KS, SILK and KCDC Statewide Boards; CDDA; Prarie View of Marion County; a parent; Court Services; Director of Mental Health Center; Director Domestic Violence Organization, SOS; Friends in Faith Organization.

Identify the most significant (3-5) impacts and implications related to policy changes made by the 2002 Legislature in order to meet FY 03 budget reductions, in your community(s). List specific examples.

Policy Changes: Time limited General Assistance and Medikan. $1.3 million unfunded expenditures at State Hospitals. Increase in co-pay amount for pharmaceuticals. Drug formulary.

Impact and Implications:

• On occasion it takes longer for a person to qualify for SSI and SSDI because of back logs in the system. If people are not going to have General Assistance available to them while waiting for a decision, community resources could be drained, especially in rural communities.
• Emporia and surrounding communities may need to develop new resources such as structured housing programs, and soup kitchens.
• If State Institutions are forced to discharge patients too early it could result in increased crisis situations in the community.
• Concern was expressed that local communities will not have the resources available to meet demands. Examples given were housing, mental health, respite care and night support.
• Consumers may not be able to pay for their medications and as a result will stop taking them.
• "Best Practice" standard should be maintained when implementing the drug formulary.

Should the 2003 Legislature change any of the policy decisions that were made?

• A recommendation was made to have the Legislature support initiatives that create resources for families who provide in home care. (Detailed written testimony is attached to this document regarding this item).
• Restore previously cut tax levels to what is realistically needed.
• Require that Mental Health Centers have Consumer Board members (testimony attached).
• Consider making Respite Care a Medicaid service.

For consideration of the 2003 Legislature, what are the lowest and highest priorities for continued services? What service gaps exist?

• Emphasize the importance of obtaining state match dollars by clearly identifying how the loss of federal funds will impact specific programs and services locally. Allow use of community funds to draw down state/federal dollars. This will help communities to maximize local resources.
• Support initiatives that will help keep people with disabilities in their community.
• Make the expansion of electronic communications a priority among state agencies and community partners.

Identify what steps the community needs to take to prepare for the immediate budget crisis and what steps can be taken to deal with the policy changes likely to be taken by the 2003 legislature.

• Invite Legislators to visit Nursing Homes and family homes to become aware of the issues facing people with disabilities first hand. This type of activity would result in them becoming more informed.
• Encourage state policy makers to evaluate our current DD system and research other state systems that have proven to be successful in working with individuals with severely developmentally disabled children, youth and adults. We also as a community, need to support the development of computerized training modules designed to teach individuals how to work effectively with this population.
• Include consumers in Statewide strategic planning activities.
• Work together to create a better understanding of mental illness through education at different levels within the community including: Mental Health consumers themselves. Mental Health Center staff on strength assessments. Community (local organizations). Local law enforcement.
• "Educating" is the responsibility of all state agencies (not just the Department of Education).
• Consumers are the best educators.
• Community and State organizations need to collaborate to prevent duplication of services.
• Local organizations need to do a better job communicating and publicizing their activities to the community at large.
• Emporia is experiencing a shortage of bilingual trained staff in all organizations. A community plan on how to address this shortage needs to be developed.

Winfield (June 4, 2002):

• 12 stakeholders in attendance included representatives from RADAC; Medical Lodge of Ark City; a consumers husband; Head Start; Cowley County Youth Services, Cowley County Mental Health Center; Winfield Police Dept; and USD 470.
• State Senator Greta Goodwin attended this session.
• In addition to SRS program Chiefs and supervisors Beth Gates, Medicaid liaison; Leona Beazly from Osowatomie State hospital and Lois Howard, DD-QE coordinator were also in attendance.

Questions and Comments:

• Amount of money a family would need to contribute towards family preservation.
• Senator Goodwin addressed the audience at the end of the meeting. Her tone reflected she was not very happy with her colleagues on the House side and she urged folks to get out and vote. She also reflected that often times when legislators make budget cuts they are unaware of the trickle down effect. The example she cited was the administrative reduction of the one year moratorium on all office furniture/equipment purchases. She pointed out much of the furniture the State purchases is made by inmates who get paid for their services. When they don't get paid the child support stops and their families will most likely need to sign up for other services offered by SRS and other community entities. The Senator plans to attend and participate in the June 20 follow-up meeting. • Both audiences were appreciative of the thoroughness of the information provided. Hats off to all those that worked on the handout material! It was terrific to have some of the information specific to the EAO Management Area regarding numbers of people affected.

Winfield (June 20, 2002):

• State Senator Greta Goodwin, representatives from Cowley County Health Department; Medical Lodge of Ark City and Medicaid liaison from Blue Cross Blue Shield. In addition to SRS Program Chiefs and supervisors; Leona Beazly from Osawatomie State Hospital and Barbara Lambert, MH-QE Coordinator were also in attendance.

Identify the most significant (3-5) impacts and implications related to policy changes made by the 2002 Legislature in order to meet FY 03 budget reductions, in your community(s). List specific examples.

• Policy Changes: Time Limited GA and Medikan. Reduce Pharmacy Reimbursement. Increase co-pay for Pharmaceuticals
• There will be an increase in adults accessing community resources, such as food banks, churches, Salvation Army, etc. These adults will have multiple needs and many communities do not have organized collaboratives in place to deal with adults in need.
• These adults will not have resources to pay for medication which will result in increased referrals to APS, Mental Health Centers, State Hospitals, and law enforcement.
• Pharmacists are also concerned about their loss of income.

Should the 2003 Legislature change any of the policy decisions that were made?

• Audience members agreed that some cost containment strategies identified in the sections under Pharmacy and Care Management and Improve Management of Home Health Services were good.
• Senator Goodwin felt that it is critical that law makers understand the impact of how one decision will impact other programs and services - example, reduction/restriction in Family Preservation could lead to an increase in Foster Care referrals which cost more money.
• The Senator also suggested that the detailed schedule of legislative policy changes be sent to all legislators.

For consideration of the 2003 Legislature, what are the lowest and highest priorities for continued services? What service gaps exist?

All four were high priority:

• Emphasize the importance of obtaining state match dollars by clearly identifying how the loss of federal funds will impact specific programs and services. Allow use of community funds to draw down state/federal dollars.
• Emphasis on funding programs and services that will prevent expenditures in the future. (The pay now or pay later approach.)
• Emphasis on expanding the use of information technology to increase communication between state agencies, higher education and local communities, by encouraging the sharing of existing technology resources to avoid duplication.
• All issues identified in #1 regarding the implications of eliminating General Assistance.
• One participant suggested the legislature needs to remember that the Kansas population is aging. Consequently, more dollars will need to be targeted for services designed to meet the needs of an aging population.

Identify what steps the community needs to take to prepare for the immediate budget crisis and what steps can be taken to deal with the policy changes likely to be taken by the 2003 legislature.

• Inform our legislative delegation how policy and budget changes will impact local programs and services.
• Educate citizens about available services in their communities.
• Educate each other about what services each of us brings to the table so that we can better partner to address the issues.
• Develop strong partnerships between state agencies. An example would be between SRS and Department of Corrections, by SRS providing parenting classes to inmates to help them become better parents when paroled. This would help keep kids safe in their homes. The current El Dorado pilot between DOC and SRS is a joint initiative designed to teach self sufficiency skills to inmates prior to being paroled.
• Establish community agency coalitions that address adult needs for services.
• Expand video conferencing usage between Mental Health Centers and State Institutes (SI) for things like court appearances, medication checks, and discharge planning. This would result in time and transportation savings to hospital, mental health, Judicial, and law enforcement systems.
• Better usage of State Institutional staff expertise in our communities.
• Expand the use of all electronic communication resources between community and all agencies.

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