Overland Park (June 17, 2002):

• 27 participants from: CLO's, Intensive Family Counseling, the Mental Health Center, Catholic Charities, the Housing Authority, Jo Co Public Health, Developmental Supports, El Centro, Riverside Resources, CASA, Faith Village, The Farm, Human Services & Aging, Temporary Lodging for Children, KVC Behavioral Healthcare, and one consumer.

Questions and Comments:

• As a taxpayer– we'll have to raise taxes.
• Family fees not yet known on HCBS children & unable to expect payment!
• Loss of SRS staff (2000 or so positions) and now no rate increases to community providers!
• Salaries of state workers continue to increase with no rates increasing for community providers.
• Highly concerned about DD's reliance on IGTF and how to replace these funds in FY04.
• Concerned that cuts in funding will not be acceptable reasons to cut services–very concerned that SRS will require the community to continue serving the same #'s with less revenue/funding.
• Who will be the collection agent for Family Financial Participation?
• Will clients with increasing co-pays be harassed (pharmacy co-pay, waivers?) Will they choose to quit? What will then be impact on community? Decreased incomes? Increase in FC? Increased hospitalization?
• No funding to build programs such as truancy–currently no help available for this.
• Billing for services–concerned that if a family is just at 200% of poverty level that it will be difficult to collect. You will have to pay someone to monitor this. Clinically, it makes sense to have them share costs but hard to "draw blood from a turnip."
• Certain persons would have to rely on other community agencies for assistance–many of these agencies are already stretched to the limits.
• Do SRS employees receive bonuses? Based on what? Other agencies are barely able to provide raises to direct care workers.
• Formulary changes could negatively impact SP/MI patients when they leave the state hospital. Will they be forced to use older (but cheaper) medications with lesser efficacy but significantly more serious and lasting side effect profiles?
• Lowering the census at OSH–concerned that this is going to leave a hole in the safely net.
• It is particularly dangerous to reduce funding of preventative programs such as family pres.
• Reduction of attendant care wages is a big concern. It is already very difficult to find qualified capable people to fill the need for these positions.
• $ for attendant care –this is often what helps support the vulnerable population in a community setting and what helps monitor safety for individuals & community members.
• Where do the elderly turn when faced with high prescriptions potential nursing home care etc?
• Change in transportation for PD and FE clients–no good, inexpensive transportation system available in Jo Co for frail people to use–no other funds available–volunteers often can't handle someone in a wheelchair and if clients can't get to doctor appointments then health care costs increase.
• Concerned about people from state hospitals needing community services but with waiver waiting lists these people aren't going to be successful in the community.
• Difficulties attaining physician pre-authorization for Rx drugs and getting them in time to stay within state regulations for DD (problems with implementation in MO).
• How are community based services going to serve consumers from state hospitals if there are no new funds?
• Freezing of funds for persons on the PD and DD waiting lists is happening and these individuals could be put in state institutions.
• There is no quick fix–all agencies forced to downsize, reorganize–leaves very few resources to draw on.
• Don't/ Can't expect community agencies, non-profits, who are already doing a lot with not so much–to do more with less.
• Elect legislators who are not afraid to take a leadership role in problem solving.
• Plan for service cuts–i.e. pharmacy–will they continue to participate?
• How will providers continue shift from state to community providers without better planning?
• Perhaps a re-examination of eligibility is in order.
• SRS needs to educate families about impacts and not allow service providers to take the fall exclusively.
• Focus more on the prevention programs.
• Educate legislators better.
• Develop "appeals" process and exception processes.
• Get info to providers BEFORE info goes to clients.
• Due to these cuts; Jo Co social service and surrounding agencies need to collaborate even more to share services, resources and knowledge.
• Continue to downsize state institutions–it is simply much more inexpensive to provide
services in smaller community agencies.
• Perhaps changing how Health & Environment works with regard to surveys.
• The State Hospital provides services at a more efficient and cost effective rate. CMHC's are allowed to first admit to private hospitals. Frequently medicare or insurance benefits are then run through before the person is admitted to the State Hospitals.
• Why can't the State re-write Mental Health Reform to encourage admissions to the State Hospital that are reimbursable or a least penalize the CMHC's for any admission. The goal would be to increase revenues to the State Facilities (with reimbursement) rather than to private hospitals (who receive reimbursement first). This can help the funding situation.
• Need more federal grant money and maybe need to increase taxes.
• All organizations need to work together to help our clients. The meetings SRS has been providing have been excellent!
• Increase funds for MR/DD so that we can serve consumers who are being cut from state hospitals.

Overland Park (July 11, 2002):

• There were 29 participants for the second stakeholder meeting in Overland Park. Participants were from: Catholic Community Services in Leavenworth, Catholic Charities in Olathe, The Salvation Army, Johnson County Developmental Supports, The United Methodist Church, members of the local SRS Advisory Council, The Coalition for Independence, Lifeskills Management Center, The Johnson Co Health Dept., YMCA, Olathe Parents as Teachers, Head Start of Shawnee Mission, OSH and Rainbow, DCCCA, Riverside Resources, Inc., The Olathe Housing Authority, KU Medical Center–Children with Special Health Care Needs, KVC Behavioral Healthcare, KC Area Parents as Teachers, and two interested citizens.
• Overland Park divided the group into four groups, each responding to the questions.

Identify the most significant impacts and implications in your community related to policy changes made by the 2002 Legislature in order to meet FY 03 budget reductions.

(Group 1 Priority)

• Healthwave Eligibility.
• PDWaiver–Transportation decreases.
• Drug formulary changes and increase in co-pays.
• Attendant care wages.
• State Hospitals mandate to "serve fewer Kansans"

(Group 2 Priority)

• No funding added to reduce waiting lists.
• Reduction of inpatient hospital services–provides further stress on community services.
• Elimination of transportation for those on PD and FE waivers and non-emergency medical transportation will create barriers in accessing health care.
• Cut in pharmacy reimbursement rates affects pharmacy providing services–increased co-payment a concern.
• Increased immunization and mental health outreach for children was positive.

(Group 3 Priority)

• Reduction in child care grants.
• Limited family preservation (fewer slots).
• Health Wave $ increasing.
• Concern–SRS staff reduction and not filling positions.
• Positive–funded consensus caseload estimates.
• Positive–child care subsidy funding preserved.
• Positive–pharmacy co-pay only $1 increase.
• Positive-- drug formulary.
• Positive–Care management.

(Group 4 Priority)

• Cuts in grants will decrease quality of child care programs and new programs won't be created.
• Not enough dollars spent on preventive services so all agencies are dealing in crisis mode.
• Families referred for family preservation are too close to "past the point of no return".
• Fees for family preservation may have unexpected results–families declining service and a decrease in allocations.
• Cuts to KACCRRA will affect services to families.
• Increase in Healthwave enrollment means more kids will have health insurance.

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

• Yes. Do not reduce eligibility for Healthwave.
• Keep PD scores at current level–will keep persons with disabilities out of institution, thus reducing costs. Same for head injury, frail and elderly etc.
• Allow person with multiple disabilities access to all services.
• If legislature is going to reduce dollars for services; SRS needs to reduce expectations on service providers.
• Should take measures to assure support to community providers to maintain existing level of services provided.
• Status quo—and we're glad!
• want to rescind SB429 $ saved should go into cut programs instead–saw pros and cons.
• Change philosophy of balancing the budget through kids and kids programs.
• Become more child focused and prevention focused!
• Don't tie dollars collected through FP fee participation to the allocation.
• Change language of tuition waiver legislation to enhance success of students and limit $ for the program.

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

(Group 1 Priority)

• Healthwave and primary care for persons without insurance or medicaid including non-documented persons.
• Dental care
• Transportation for PD clients
• Cuts at State Hospitals.
• Identify Service gaps.
• Dual diagnosis
• Sexual Predator Program Enhancement

(Group 2 Priority)

• Access to health care for mental health; MR/DD, Elderly, PD (Waiting lists).
• Pharmacy
• Maintain existing services to avoid greater impacts on citizens.
• Affordable and accessible housing.
• Transportation
• Dental coverage
• Interpretation, translation, communication services
• Home care
• Gaps are identified in Transportation, and interpretation and translation services.

(Group 3 Priority)

• Keep tobacco money focused on children's human services.
• Keep Healthwave eligibility at 200%–don't raise premiums ; fully fund; improve timeliness of processing and find more providers to accept.
• GAP—Prescription coverage for medicaid.
• Don't cut child care subsidies.
• Strengthen children's mental health services.
• Fund TAF increases–preserve consensus caseload estimates for TAF.
• No more reductions in SRS staff.

(Group 4 Priority)

• More money for preventive services.
• Increased revenue.
• Can't let current programs suffer to do a better job of prevention.
• More dollars for early childhood education. More parent education and awareness of the resources that are available.
• Need professionals who speak languages other than English to do direct work with families.
• Vote and educate public.

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.

• Identify gaps in services through community planning sessions.
• Be aware of community trends.
• Rally the community to fill in gaps, to be aware of changes, to be proactive not retroactive.
• Provide low cost liability insurance to groups and volunteers willing to provide various services.
• Encourage more pro bono work by professionals, students, graduate school. Continue to require "community service" as a requirement for graduation.
• Identify and support unpaid natural support systems: neighbors, family, friends, religious organizations.
• Reduce amount of services to clients: looking at eligibility guidelines.
• Address the only most severe crisis.
• Vote, attend community forums, get media attention.
• Furlough instead of terminations of employees; at least can keep their jobs and benefits.
• Learn from other states, models.
• Communication and collaboration by the child serving agencies so we can present a unified front.
• Educate the community on children's issues–have a strategic plan on how to do.
• Get businesses more involved–reassess how to use the tax breaks available.
• Get Board of Directors of local non-profits involved in marketing campaign.
• Be aware of the increased need of working families on the edge.
• Greater community involvement–employer mentoring to demonstrate productive, livable jobs.
• Economic development–need public sector job creation strategies.
• Healthwave stakeholder meeting as soon as possible to work on issues.
• Child Care subsidy stakeholder meeting if SRS waiting list happens.

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