• 27 non-SRS Individuals from: Osawatomie State Hospital, KSU Family Center, Three Rivers, Flint Hills R&R, Clay County Child Care, Heartland Works, Kansas Legal Services, KDHR - Job Services, Manhattan Housing Authority, KCSL, Infant-Toddler Services, Salvation Army, Riley County Manhattan Health Dept, Riley County Attorney Office, Crisis Center, Manhattan Housing Authority, Homecare/Hospice, KGD, Pawnee Mental Health Services, United Way.
• Junction City Daily Union, KMAN radio

Questions and Comments:

• Why are terminally ill no longer able to access hospice services on PD waiver but not on FE?
• If someone has medicaid and medicare, could they access hospice through medicare while continuing to carry pd waiver?
• From Childcare Resource and Referral - What does the 3 million dollar cut in Child Care grants refer to? Does this mean that the R&R's will eventually receive less money? Response: It does mean that KACCRRA as a whole will receive less money. KACCRRA will then choose how to budget the reduction in SRS dollars. Since KACCRRA also receives funds from other sources, we cannot say what the exact impact will be on the local R & R's. KACCRRA will not be the only entity affected by these reductions Many other early childhood grantees will be either held at level funding or decreased. Partners such as Early HeadStart, KCCTO, Smoky Hills Public Broadcasting, KCSL, and our own grant program to child care centers will also either be reduced or held level.
• One time funding for mental health was mentioned. Is this new money or was it funded before from a different program?
• There is rumor that there could be cash flow problems as early as November?
• From staff at OSH - State hospitals reductions are causing problems for mental health centers, Mental Health Centers will have to identify services that patients would have gone to Mental Health Centers for; Crisis house is being closed due to Pawnee's budget - has been steady revenue loss.
• What will happen to population that goes to crisis house? they are not appropriate for crisis center or emergency shelter. Housing Authority has two halfway houses, concerned closing will put more individuals who need more monitoring in their houses. Is crisis house closure due to state budget cuts? Not directly but yes, indirectly. If there could have been increases in other areas Pawnee Mental Health could have continued to fund the house.
• Everyone here should extend invitations for volunteers from religious based, etc organizations to help provide services they could help with.

Manhattan (July 10, 2002):

• 18 Community Partners representing: American Red Cross, Osawatomie State Hospital, Pawnee Mental Health Services, Kansas Legal Services, Three Rivers Independent Living, Manhattan Housing Authority, Crisis Center, Riley County/Manhattan Health Department, Community Health Council, Manhattan Emergency Shelter, Infant-Toddler Services, EDS Medicaid Liaison, Mental Health Liaison, 2 Media Reporters: Manhattan Mercury, Manhattan Broadcasting

What further impacts do you see as a result of the program changes we learned about today?

• Longer stays at the emergency shelter may mean they will have to turn people away.
• Clients may need greater access to other resources.
• More stress in families can lead to greater number of abuse situations.
• State hospitals cuts can create pressure to discharge early before the patient is ready. Early discharge of patients that could result in further burdens to local community agencies ( if there are, in fact, local resources to attend to problems of mental illness).
• What will be used for this level of care (state hospital) when needed?
• Short term vs long term impacts - Decisions made now may lead to more costly treatment than if the less expensive services were funded.
• Cuts decrease agency energy and resources for collaboration.

If we need to reduce further, where should we go? (And a corollary, what should we preserve?)

• Children come first - Don't cut childcare - people need it to go to work.
• Fund State Hospitals sufficiently to meet needs.

What do we want the next legislature to do within current resources?

• Consideration of what is a living wage that truly results in successfully and permanently getting off assistance.
• Consider short term vs long term impacts - more costly treatments can be avoided in the long term if less expensive services are funded now.
• Look at Legislative Pay.
• Consider possible reduction of quality of local resources when provided with fewer staff.
• Funding tied to outcomes - balance with long term outcomes.
• Legislative decisions don't always reflect broad understanding of the ripple effect.
• Cuts to SRS affect more than just SRS; increases stress on local agencies too.

Given these (and possibly more) cuts, what do we as a community need to do differently?

•Multi-agency staffings on common clients.
•Less duplication- although choices are still important with increased collaboration.
•Early screening for domestic violence.
•Info sharing system for common clients (Housing Management Information System).
•Better discharge planning out of state hospitals; give adequate time for locals to prepare for medication needs and connection to appropriate resources, etc.
•Could religious organizations provide services affected by Hospice cuts.
•Include religious groups in delivery of social services.
• Local agency front desk staff need to be thoroughly trained to be able to provide answers.

Salina (June 11, 2002):

• 20 non-SRS individuals from: Home Health/Hospice of DK county, OCCK, KCSL, Minneapolis Housing Authority, Cloud County Community Resource Center, KDHR - Salina Job Service, Central Kansas MHC, SACC, Central Kansas Foundation, DCCCA, SAUW, Independent Connection/OCCK
• Salina Journal

Questions and Comments:

• Do you anticipate the state pending medicaid payments?
• On HCBS waivers where there would be financial participation, would provider agency still be required to provide service and absorb the shortfall created when the consumer doesn't pay?
• These are severe cuts, are there any plans to reinstate money down the line, or plans to make any adjustments to help people?
• Non-profit home health agency must still break even.
• From a non-profit out of cloud county - We get referrals from SRS for welfare to work program, clients come in asking for help but all our money comes from donations; if we can't provide help client goes back to SRS, this creates vicious cycle of clients coming back for help. She sees the answer as helping people become self sufficient.
• Housing authority bases fees on net income, credit given for what client makes at work.
• Since Minneapolis SRS office only open on Friday, need some resources to teach people ways to help themselves and staff need to serve people differently.
• Organizations are willing to help if someone can give guidelines on what to do, Volunteers can only do so much; need more coordination between SRS and helping agencies.
• Question - Why is SRS paying rent for building only open one day a week (Minneapolis), housing authority could probably rent space to SRS.
• Problems that non-profits face - Provide services based on capacity to serve, requests were already exceeding capacity October 2001. Issues they face are maximum budget increases of 3%, vacancies that can't be filled, shrinking service level shrinks capacity to serve, this creates domino effect; able to serve fewer but in long run becomes more expensive because of other programs the consumers are forced to access end up costing more.
• Need to focus not just on agencies but on people we serve.
• Some decisions made on short term this year may be traumatic in long term, the need will accelerate because of things not done today.
• How will SRS start billing families for services received - is there a fee schedule for family pres?
• Some rules that have to be followed make things more expensive. Many of these are federal rules.
• Volunteers and non-profits are already stretched.
• Need to look at the return on investment - are we framing requests to legislature in right way? Have we shown what is generated back into state when person becomes self-sufficient? Should be doing a cost opportunity analysis so they know what issues will have to be addressed in future if something is not funded now.

Salina (July 10, 2002):

• Community Partners representing: NAMI/NCK, Regional Prevention Center- NC KS, Minneapolis Housing Authority, Independent Connection, Central KS Mental Health Center, DCCCA, YMCA Child Care Resource and Referral, Salina Area United Way, Bethphage, SACC, KDHS, EDS Medicaid Liaison

What further impacts do you see as a result of the program changes we learned about today?

• Will Working Healthy increase Medicaid costs/caseloads significantly?
• SRS offices only open 1,2, or 3 days/week makes difficult to link clients of other resources to SRS.
• Reduction of SRS staff places stresses on remaining staff and local agencies.
• Decrease in Programs vs Staff - must be balanced.
• Services for working poor: utilities, food assistance, rent assistance - increased demands vs decreased TAF caseloads - cycle is created.
• Ineligibility due to "just above" threshold - esp for waivers and healthcare.
• Shortage of available healthcare for people on medical assistance - particularly w/dental.

If we need to reduce further, where should we go? (And a corollary, what should we preserve?)

• Don't cut Prescription Programs - People without prescription coverage use other available income to buy medications, thereby making them eligible for medicaid
• Preserve Smart Start - look at evidence that it works.
• Priorities: Services that lead to self-sufficiency and services that keep people (elderly, disabled) in home.

What do we want the next legislature to do within current resources?

• Federal Prescription Program.
• Need to use and look at outcomes when funding programs.
• Should we mandate education to teach clients how best to use limited resources.
• Should we mandate certain services be tied to benefits?
• Focus on educating legislators Re: early childhood development, brain development video.
• Living wage and childcare.
• Data on true costs of Quality Childcare - Workforce 2020 could be used for educating legislators.
• Disincentives to self sufficiency - counting total household income, especially when extended family lives with the family. We should be supporting these efforts in families.
• Do we have incentives for having more children?

Given these (and possibly more) cuts, what do we as a community need to do differently?

•Local Agencies need to incorporate evaluation components to demonstrate effectiveness.
•Promote early childhood development (0-5) Prevention and whole family as well.
•Can Vo-Techs provide any dental care thru dental assistant program.

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