Garden City (June 10, 2002):

• 33 people in Garden City and hooked by phone to Liberal, Dodge City, Pratt and Ulysses. One in Dodge, one in Liberal and no one at the two other sites. Entities represented: YMCA Day Care, AAA, Arrowhead West and SDSI, Chamber of Commerce, United Way, City of Garden City, Regional Prevention Center, USD 457, CIL for SWKS, DHR, Area Mental Health Center, SFA, KSU Extension, LINK, Russell Child Development Center, Garden City Community College, KDHE.
• Garden City Telegram.
• The video was such a hit that two individuals asked if they could check it out and show it to their agency's staff so they all understood the situation as well. Copies checked out to them.
• Telegram reporter present at the Public meeting. Story in the next day's paper.

Questions and Comments:

• Even given our preference is that people be able to live in the community there are some situations where placement on the PD waiver (in the community) increases the cost to the agency over care in a nursing facility. Are we going to go back to requiring it to cost less for an individual to be on the waiver rather than in a facility? This would save money.
• Please explain child support project.
• Regarding the reduced child care grants: how will that affect our area? Why the savings in this area different for SGF and AF ?
• Were there any line item vetoes on the SRS budget
• Statement from Dept of Aging rep - FE wait list is 120 now - projected to be 1000 by end of FY‘03
• What would happen if the state would go over budget and it doesn't have the money to do what is planned?
• Regarding consensus case loads: why was there an increase? How is this done?
• Are the reductions / savings figures estimated or somehow known?
• Is July the "cure" month.
• Please explain the reason why the savings on SGF is greater than the all funds savings. (An answer was given that most understood. However a few in the room require a broader explanation). Response: Let's use an example of when this occurred, requiring family financial participation in family preservation and waivers. This would reduce SGF used for family preservation and home and community based services and replace it with fees collected from families. The SGF that would be saved is $1.7 million and replaced with $1.7 million in fees. The all funds reduction would total $0 (-1.7 SGF + 1.7 fees = 0 all funds) and the SGF reduction would total $1.7 million.
• Regarding family participation; does a family's (true or stated) inability to pay the participation rate exclude them from the program? (Answered but audience member wanted to know for sure from the Secretary.)
• We understand there will be training on the family participation fee. Who will collect it? When/where will that training be held?
• Will the family participation fee be like the PD waiver family fee?
• Can transportation be billed outside the waiver rather than in the waiver? We believe we should be allowed to be bill outside the waiver and believe the number of those affected would be low.
• We believe that in the GC area 10 (rather than the stated 4) will be affected by the requirement for choice between hospice and PD waiver services.
• Regarding the requirement to choose between PD waiver and hospice services: The service available / provided by Hospice is different from those available under the waiver. As an example, hospice provides skilled nursing and pain management and doesn't provide attendant care. So the consumer could be forced to choose between having someone bathe and feed them and receiving pain management services.
• Regarding the $1.3 from state hospital budget: affects not noted is the affect on the customers, the area, and the community. Customer could end up staying in local hospitals or in local jails. Additional stresses will be placed on local MH services and on the program/service relationships with the community if person in need of state hospital admission is not served there. Response: The affects were not noted because a final decision by SRS has not been made on how this reduction will be implemented.
• Regarding Parsons unit closings: funding should come with the individuals if they are exiting the hospital. Further no slots are awaiting them and no other funding is available to facilitate this process. Response: The only way to create savings in the closing of a unit in Parsons was to use community funding. Community funding was added to reduce waiting lists by the legislature for fiscal year 2002 and was not projected to be spent in that fiscal year. This is the funding that was used to support individuals as they move out of Parsons.
• Regarding the reduced rate on PD waiver services but not on FE waiver services: why is there a difference. The feeling is that the decision was made based on a desire for a savings in one not on the other (perception is that we have a preference for one service over the other).
• Regarding the requirement/ability at 65 to choose between the PD and FE waiver: will funding be there if the switch is made or would one end up switching from a program to a waiting list?
• If the budget is unfundable will the governor do another "allotment". Does he have it prepared and waiting? Is there a chart of how that allotment will impact this area? Response: According to Duane Goossen in the video, the 2002 Legislature passed a revenue package that will be implemented in July 2002. The current thinking is to see where current revenue projections are, review increased revenue, then compare the results to the original projections. Only if a shortfall is still projected would any allotment be prepared by the Governor.
• Regarding the Chaffee funds (Independent Living Funds): IL is now built into the contract. How does the new bill impact the availability of this money? The bill is a good idea but it shouldn't be allowed to negatively impact the existing programs. Response: The tuition waiver bill should not effect the level of services received by children served under the foster care and adoption contracts.

Garden City (July 15, 2002):

• 23 community members representing: Russell Child Development Center, Iroquois Mental Health Center, KCSL HeadStart, Area Mental Health, Kansas Department of Human Resources, Garden City Community College, SDSI, and the City of Garden City.

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(ies). List specific examples.

• Require family financial participation.
• State Hospitals are a vital part of the continuum of care.
• Reduce pharmacy reimbursement.
• Increase shrinkage at the state hospital.
• Poorest paying the cost of balancing the shortfall.
• Some waiver families are able to afford to pay and this is a good change.
• Client fear of change–the unknown upsetting to those who depend on the services of the agency.
• State Hospital–hire freeze and already understaffed–reduced care–inability to provide care.
• Child care–impacts families and employers.
• MH rates–negatively effect care provided.
• Discontinue KLS project–leads to question–is there duplication of efforts in other places in the overall system not SRS?
• Case Management service–is billing accurate/duplicate/multiple Cm needed for families? Is this a place to look for saving that hurt no one?
Questions, re: CM overuse, system set up to push possible over billing?
• Waiver–family co-pay may limit application/acceptance of services.
• State Hospital–pressure may cause "dumping"–community services may be deleted by cost–community service needs - if more are served with the same dollars the quality of service to all diminishes.
• Pharmacy reimbursement reductions and increased co-pay for pharmaceuticals will have a terrible impact on elderly and mentally ill–they must have their medications, and most have no means for increased expenses.

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

• CMHC provides services in NFMH. If not, NFMH needs to be required to provide quality mental health services they are paid to provide.
• Totally opposed to western Kansas mental health reform grants to the eastern part of state The state maintain the same quality of services to Kansans regardless of where they reside even if regionally it costs more per Kansan to maintain that level.
• Family participation raise 250 of poverty level.
• State employee, raise, and longevity Did not come from an SRS employee but another agency employee in attendance.
• Tech dependent children–can we pay parent to provide the care or can we use lower level license to reduce the cost? Some have a nurse sit and watch child sleep in the home.
• Co-pay for Medicaid dependent families–children pay the price.
• Encourage physician use of Medicaid–policy discourages (rates to doctors).
• Wait list for MR/DD services needs to be funded.
• Waiver fee–cost of collection may be higher than fees collected
• GA limit–24 months–SSI and SSDI process exceeds this amount of time: 1st request–usually denied, 2nd request–sometimes another appeal necessary, 3rd request–if verified, then usually granted. Lengthy process because many people involved–doctors, attorneys, etc.–can take between two to three years. Diagnosis may be difficult to prove due to remissions/recurrence cycles of some diseases/disorders.

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

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.

• Examine cost of privatization.
• Increase use of volunteers.
• Increase local schools involvement with the mentally ill.
• Somebody to help with grant writing for the SPMI (Severe Persistent Mentally Ill). Joint relationship with county, city, schools, mental health centers, SRS etc.
• ID (seek out) duplication of services and work as a community to re-purpose any excess funds to gaps
• Community service provider meetings (team meetings) to focus/streamline services to identified children/families.
• Local control–ID policy/rules/regulations so that communities can better serve themselves.
• Community block grants for community needs.
• Central resource and referral point of contact
• Local office as point of contact rather than Central Office (for service providers like CDDo's, CMHC, etc) The local office understands the needs and how to flex and assist instead of one-size fits all.
• Project model (like current team project with CMHC, SRS, JJA, Extension, Prevention Center, etc) This is what will work. Support communities so they can build their own capacity.
• This group as a resource for developing community responses.
• Close smaller offices to save money–people will come to where the service is–service delivery will not suffer.

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