#1Rhode Island Department of Human Services Presentation for Senate Special Legislative Commission To Review And Make Recommendations Regarding The Efficient And Effective Administration Of Health And Human Services Programs In The State Of Rhode Island. EOHHS Commission Hearing: February 2, 2022 RHODE ISLAND DEPARTMENT HUMAN I SERVICES#2Mission and Vision DHS works hand-in-hand with community partners and resources throughout our great State to deliver critical benefits, supports and services to more than 300,000 families, adults, children, older adults, individuals with disabilities and veterans every year. Vision As an agency committed to access and achievement, the vision for the Rhode Island Department of Human Services (DHS) is that all Rhode Islanders have the opportunity to thrive at home, work and in the community. Mission DHS's programs and services are all designed to help families become strong, productive, healthy and independent; to help adults achieve their maximum potential; to ensure that children are safe, healthy, ready to learn, and able to reach their maximum potential; to honor, employ, and care for our state's veterans; and to assist elderly and persons with disabilities to enhance their quality of life, and to sustain their independence. 2 RHODE ISLAND#3RHODE ISL ISLAND PARTMENT OF I SHU Guiding Principles A 唱 Right Service, Right Place Effective triage is fundamental to serving customers as quickly as possible. Champion "The Easy Way" Customers should be rewarded for being proactive, coming prepared, and using preferred channels. Prevention > Correction Breaking the cycle of churn requires greater effort up front to avoid unnecessary closures. Clear Message, Warm Voice In every communication or interaction, customers should feel welcome, respected, and understood. Keep Customers in the Loop Make extraordinary efforts to let customers know the status of their case at any given time. HUMA Inspire Confidence Highlight when things go well in order to rebuild trust with employees and customers and build a culture of excellence. Decide with Data Use data to inform decisions and track progress toward department, program, and service level goals. Commitment to Diversity, Equity & Inclusion Excellence Acknowledge that systemic barriers exist and work together to eliminate them, promote change, show accountability, and embrace differences. Support the Whole Family Use a holistic, coordinated approach to ensure families have opportunities to achieve their goals and thrive. | 3 RHODE ISLAND#4DHS Overview DHS delivers critical benefits, supports and services to more than 300,000 families, adults, children, older adults, individuals with disabilities and veterans every year. We are part of the solution to end poverty, food insecurity, and we make a lasting, positive impact on the State's health and future. • Number of Staff: 1047 • Composition: Budget: $742.3M (SFY 22 Enacted) • Four sub-divisions: Office of Child Support Services (OCSS); Office of Rehabilitative Services (ORS); Office of Healthy Aging (OHA); and Office of Veterans Affairs (VETS) Central Management: Office of Constituent Affairs; Legal, Financial Management, Personnel, IT Systems & Support, Office of Performance Analytics and Continuous Improvement; Communications; Legislative Affairs; Policy, Training and Office of Child Care & Licensing Field Operations: Nine office locations (7 customer facing; 4 administrative/back offices) RHODE 4 ISLAND#5Overview of DHS Programs RHODE ISLAND#6DHS Benefit Programs Offered DHS's benefit programs and services, collectively serve more than 300,000 Rhode Island families, adults, children, older Rhode Islanders, individuals with disabilities, and veterans each year. Each have their own eligibility requirements. Child Care General Public Assistance Medicaid Programs Energy Assistance SSI State Supplemental Payment (SSP) RI Works Long Term Services Supports (LTSS) Refugee Cash Assistance (RCA) SNAP | 9 | RHODE ISLAND#7DHS Cash Programs The Rhode Island Works and General Public Assistance (GPA-Bridge) monthly cash payments and case management provides support to very low-income families and adults. RI Works Rhode Island's implementation of the federal Temporary Assistance to Needy Families (TANF) provides cash assistance and social services supports to put low-income Rhode Island families with children on a path to job security. RI Works eligibility: Because it is a federal block grant program, most eligibility rules are determined by state statute. Eligible applicants have: *Very low-income (~50% federal poverty level (FPL)) *Minor aged children Very low resources ($1,000) * a 48-month lifetime time limit RI Works 2021 Highlights * Monthly benefit amounts increased in 2021 for the first time in 30+ years (household of 3 benefit $554 - $721 monthly) * Annual $100 clothing allowance given for all children, not just school aged. RHODE 7 ISLAND#8DHS Cash Programs The programs described below provide monthly cash payments and case management supports to very low-income families and adults. DHS also administers Refugee Cash Assistance and the State Supplemental Payment (SSP). GPA - Bridge This state program provides a cash assistance loan to very low-income adults without children who are unable to work and pending a decision on a federal SSI application. GPA-Bridge eligibility This program is entirely state funded. Most eligibility criteria are set in statute with some regulatory flexibility. Requirements include: Individual income limit $327/month *Medicaid eligible *Disabled, unable to work • Signed agreement for repayment when SSI is approved GPA-Bridge 2021 Highlights * Resource test increased from $400 to $3000 in alignment with SSI | 8 RHODE ISLAND#9DHS Nutrition Assistance DHS works in partnership with other state agencies to coordinate responses to food insecurity through federal nutrition programs, coordinating access and promotion of SNAP, WIC (RIDOH), School Meals and Summer Meals (RIDE), Congregate Meals (OHA), Senior Farmers Market Vouchers (DEM). Supplemental Nutrition Assistance Program (SNAP) This federally funded, state administered program is often call the nation's first line of defense against hunger. SNAP provides a monthly food benefit to low-income individuals, families, seniors, and people with disabilities. SNAP eligibility: This federally regulated program allows limited state flexibilities. RI does pursue waiver opportunities when available. In addition to residency and citizenship/immigration requirements, eligibility is primarily based on a household's gross monthly income: 185% or 200% FPL (if older adult or disabled) - income threshold as compared to their household composition (household members who purchase and prepare food together) SNAP 2021 Highlights *Expanded SNAP access to some college students through public health emergency (PHE) flexibilities *Increased community partnerships for outreach and application support | 9 RHODE ISLAND#10DHS Child Care Assistance This work support for low-income parents helps defray the cost of quality child care allowing parents to fully participate in the economy. RI DHS also oversees the child care licensing unit for the State. Child Care Assistance Program (CCAP) CCAP offers subsidies to help low-income parents pay for high quality early childhood education and childcare to support their ability to work or participate in certain education and training programs. In addition to being available to low-income workers, it is also a work support to RI Works families and to young parents completing high school or a GED through the Teen Family Development program. CCAP eligibility There are federal requirements for program access and family affordability, but most CCAP eligibility rules are set in state statute. Eligibility requires: *An entry income limit of 180% FPL * Parents must work at least 20 hours a week or participate in training program * Child must be under age 13 unless with special need * Cooperation with the Office of Child Support and Services CCAP 2021 Highlights * Pilot program authorized for college students to access CCAP * Family co-pays capped at 7% of income * ARPA funds allowed co-pays to be waived for families during some of the PHE RHODE 10 ISLAND#11DHS Health Coverage Eligibility An example of interagency collaboration with EOHHS, DHS determines the eligibility for Medicaid while OHHS administers the program and establishes its policies. Modified Adjusted Gross Income (MAGI) Medicaid Medical coverage available to low-income children, parents, caregivers, and adults. Those eligible for Medicaid have their choice of enrolling in a managed care plans. MAGI Medicaid eligibility Eligibility is based on income though income levels vary based on the age and relationship of applicant. "Complex" Medicaid A variety of Medicaid programs based on a “level of care” needed by the applicant. These include Elderly and Disabled (EAD), Katie Beckett, Long Term Services and Supports (LTSS), Sherlock, Chafee Kids programs. "Complex" eligibility Each of these programs have their own eligibility requirements that require a determination of need based on their level of need as well as income, resource, citizenship criteria. RHODE 11 ISLAND#12DHS Cash Assistance Programs Low-income families have been struggling for years, and COVID has exacerbated those struggles. DHS has responded to customer needs, but we recognize our customers require more resources to help bring them out of poverty - and DHS needs greater resources to provide appropriate access to Rhode Island's most vulnerable families. • The current RIW statute restricts a family's ability to stabilize economically due to a low asset limit and small earned income disregard. We have an opportunity with the Governor's budget to increase the resource limit from $1,000 to $5,000 and increase the earned income disregard from $170 to $300. These changes can improve access for our customers, make things easier for DHS staff, and improve overall efficiency of the Department. . RIW customers often face many challenges that require face-to-face assistance that was unavailable throughout COVID. DHS has just opened its offices and our reopening plan aims to address the challenges that we know our customers have been facing: limited access, long wait times and delayed application processing. The reopened offices will improve access to RI Works and their case management services. | 12 RHODE ISLAND#13DHS Operations Overview RHODE ISLAND#14Key Operational Facts The RI Department of Human Services (DHS) customer facing regional offices are resuming in-person service. DHS hours of operation is 8:30 a.m. to 4 p.m. Monday through Friday, except holidays. DHS staff are available at each regional office to provide a range of services for all programs. RHODE 14 ISLAND#15. Key Operational Facts In addition to the services available at reopened regional sites, customers will continue to have access to: . • The Call Center (1-855-697-4347) Hours: 8:30 AM - 3:00 PM The Customer Portal (healthyrhode.ri.gov) The HealthyRhode mobile app and text messaging Community partners and vendors listed in the Customer Resource Guide available at dhs.ri.gov in English, Spanish and Portuguese. These resources offer different tools to the customer, including application assistance, application submission, checking benefits, uploading documents, seeing notices, conducting interviews, getting general and case-specific information. RHODE 15 ISLAND#16Current DHS Regional Offices Location Woonsocket (219 Pond Street) Pawtucket (249 Roosevelt St) Office Type Customer Facing - All DHS Programs Customer Facing - All DHS Programs Warwick (195 Buttonwoods Ave) Customer Facing - All DHS Programs South County Regional (4808 Tower Hill Road, Wakefield) Customer Facing - All DHS Programs Newport Regional (31 John Clarke Rd, Middletown) Customer Facing - All DHS Programs Reopening Date January 4, 2022 (RIW Recertifications) January 18, 2022 (All Programs) November 1, 2022 (RIW Recertifications) January 18, 2022 (All Programs) November 1, 2021 (RIW Recertifications) January 18, 2022 (All Programs) November 1, 2021 (RIW Recertifications) January 18, 2022 (All Programs) November 1, 2021 (RIW Recertifications) January 18, 2022 (All Programs) Providence, 1 Reservoir Ave. Customer Facing - All DHS Programs Facilities readiness date to be confirmed by DCAMM Providence, 40 Fountain Street Customer Facing - All DHS Programs January 4, 2022 (RIW Recertifications) January 18, 2022 (All programs, limited service) RHODE 16 ISLAND#17DHS Challenges and Opportunities RHODE ISLAND#18Workforce . . DHS is experiencing workforce challenges like many other industries. We recognize that our staff are experiencing the impact of the pandemic which effects our overall staffing levels. To help our workforce cope with the impact of the pandemic, we have provided and will continue to offer Covid-19 workshops facilitated by our employee assistance program. In addition, DHS facilitates a weekly Health and Safety Committee with labor leadership to address questions. and concerns. DHS recognizes that vacancies also has impacted our staffing levels. We have processed the documentation for the customer facing hiring. They are making their way through the system and will be posted. We are working on positions across all regional offices to ensure all Rhode Islanders have access to the benefits and services they need. EOHHS has helped us remove any barriers to filling these positions. DHS Call Center wait times are longer than acceptable, some factors impacting wait times are: Recertifications waivers ended - we have worked with our federal partners and received a short extension Shifting staff from teleworking to returning to the office • The need to increase staffing levels - working to fill positions • DHS recognizes that our labor partners are critical to raising the concerns of our workforce and is committed to collaborating to find solutions. | RHODE 18 ISLAND#19Customer Relations . • Customers have different communication needs and preferences, and DHS has a plan for communication improvements, increasing self service and enhancing communication between workers and clients - which can greatly reduce the burden of wait times on the phones. We also have a plan for upgrading the phone systems for the call center, including improving self-service options and having better call return services. We are working with our Congressional Delegation, specifically Senator Whitehouse's office, to potentially make some waiver changes permanent. We continue to collaborate with EOHHS, federal and community partners to improve customer access and choice. • We are working to streamline the DHS application, specifically for our older adults. . Expansion of mobile app is on the horizon. RHODE 19 ISLAND#20UHIP/RIBridges Update RHODE ISLAND#21RI Bridges (UHIP) Project Summary The Executive Office of Health & Human Services (EOHHS), the Department of Human Services (DHS) and HealthSource RI (HSRI), are charged with promoting health, nurturing quality of life and supporting our most vulnerable residents by preserving and improving access to quality health coverage and care as well as ensuring efficient, effective, and timely delivery of human services. The State's work on the RI Bridges system, also known as UHIP, serves approximately one third of the State and is the case management system that supports these efforts. Some of the key programs supported by RI Bridges include Medicaid, SNAP, CCAP, R.I. Works (RIW), LTSS, and General Public Assistance ("GPA") Program. Project Timeline Scope Phase 1 - Implementation of State Phase Health Exchange Phase 2 - Addition of Human Services Programs Phase 2 - Stabilization of Integrated System End Date Status Budget Snapshot* October 2013 COMPLETED September 2016 COMPLETED 2020 COMPLETED Overall Health* Schedule Budget Phase 3 - Ongoing M&O and DDI (new dev.) for Certain Programs TBD* IN-PROGRESS Fiscal Year FY2021 Approximate Project Budget $83m Key Updates* • • FY2022 $83m Completed transition into new M&O contract (RFP & vendor selection completed in 2021) including implementation of new performance measures and executive reporting Implemented multiple system releases including enhancements and ongoing maintenance & operations changes; one notable enhancement enabled text message notifications for RIBridges customers FY2023 $78m Risk/Issues/Decisions Needed FY2024 TBD *Note: The RI Bridges program is managed by an executive committee (DHS director (chair), HSRI director, Medicaid director, IT Chief of Apps) and details on budget, status, risks/issues are provided via monthly executive reporting to the DOA director and EOHHS secretary. 21 RHODE ISLAND#22Questions and Discussion RHODE ISLAND