dhss legacy memo - jack markell · dhss legacy memo 1 ... , which began in 2008. ... the blueprint...

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TheLegacyoftheDepartmentofHealthandSocialServicesDuringtheMarkellAdministration

WhenpeoplelookathowthepoliciesandprogramsoftheDepartmentofHealthandSocialServices(DHSS)haveimprovedthelivesofDelawareansduringtheMarkellAdministrationtheywillfindacommontheme–wemeetcommunitieswheretheyare.Andwhenwemeetindividualsandorganizations,wetypicallyhavethesamegoal:tosupportthemortheirclientsinlivingengagedlivesinthecommunityamongtheirpeers.ThatDHSSlegacyalsowillinclude:

• Fewerinstitution-basedservicesandmorecommunity-basedservicesforseniors,peoplewithdisabilities,andindividualswithbehavioralhealthchallenges,assuringthatpeoplegetaccesstotherightlevelofcare.

• Amentalhealthcaresystemthathasachievedcriticalreforms,whilebettersupportingpeoplewithseriousandpersistentmentalillnessastheyliveintheirownhomesinthecommunity.

• Momentumforongoingchangeinthewayhealthcareisdeliveredandpaidforinourstate,tyingpaymentstoanincreaseinpositiveoutcomes.

• Anurgentandgrowingresponsetotheaddictionepidemic,whichcontinuestotaketoomanylivesandimpacttoomanyfamilies.

• Enhancedopportunitiesforpeoplewithdisabilitiestolive,work,andparticipateasactivemembersofthecommunity.

• Supportformoreindividualsandfamiliestomoveoutofpovertybyempoweringthemtoimprovetheirownfinancialsecurity.

• Astrongsafetynetfortensofthousandsofindividualsandfamilieswhocontinuetofaceeconomicchallenges.

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Community-BasedServices

In2009,Delaware’slong-termcareexpendituresweretiltedtoofartowardfacility-basedcareovercommunity-basedcare.Today,thoseexpendituresareshiftingawayfromfacilitiesandtowardthecommunity,whereconsumerswanttobeserved.

WHATCHANGED

• InFiscalYear2009,spendingatDHSS’threelong-term-carefacilitiestotaled$64million.ByFY2016,spendingwasdown33%to$42.8million,acceleratedbythedecisiontocloseEmilyP.BissellHospitalinSeptember2015becauseofongoingbuildingmaintenanceproblemsandadecliningcensusoverall.Thatongoingshiftisalsomorecost-effective:ForeverypersonDHSSservesinafacility,wecanservethreeinthecommunity.

• SinceFebruary2011,DHSS’CareTransitionsTeamhasdiverted86%ofindividuals(631individualsasofSeptember2016)tothecommunitywhohadbeenreferredtoDHSS’threelong-termcarefacilities.Withthecostcuttoone-thirdoftheaverageannualnursinghomecostof$100,000perperson,theshiftsaves$41.6milliononanannualizedbasis.• SinceFY2009,thetotalcensusatEmilyBissellHospital,GovernorBaconHealthCenterandtheDelawareHospitalfortheChronicallyIllhasbeenreducedby45%from

354residentstotoday’scensusof194,betterleveragingthestate’sresourcesandfacilities,andsatisfyingthedesiresofDelawareanstoremainengagedmembersofthecommunity.

• InSeptember2015,citingthedesiresofresidentstoremainwheretheyhadbeentemporarilyrelocatedafterawaterboilerfailureinFebruary2015andadecliningcensus,SecretaryLandgrafmadethedecisiontocloseEmilyBissellpermanently.Adecisiononrepurposingthebuildingswillbemadeinconcertwithstakeholders.

• Medicaid-eligibleDelawareansreceivinghomeandcommunity-basedservicesincreasedfrom1,688inJanuary2009to3,619inJuly2016,a114%increase.AsofSeptember2016,another195DelawareansarereceivingservicesattheLIFECenterontheRiverfrontthroughProgramforAll-InclusiveCarefortheElderly(PACE),whichbeganin2013.And263individualshavetransitionedfromfacility-basedcaretocommunitysettingsthroughtheMoneyFollowsthePersonprogram,whichbeganin2008.

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WHATWASDONE

• LaunchedDelawareAging&DisabilityResourceCenter(www.DelawareADRC.com)inSeptember2011.

1,688 36%

3,057 64%

January2009

Community

Facility

3,619 56%

2,881 44%

July2016

CommunityFacility

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Jan2000 Jan2009 Jul2016Community 980 1,688 3,619

Facility 2,857 3,057 2,881

Eligibles

IndividualsReceivingMedicaidLong-TermServicesandSupports

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• MovedMedicaidlong-termcarepopulationfromfee-for-servicetomanagedcareinApril2012,increasingthemenuofservicesforindividualsoverthepreviousfee-for-servicemodel.

• UsedhousingvouchersthroughtheDelawareStateHousingAuthority’sStateRentalAssistanceProgram(SRAP)tosupportthetransitionof705individualsfromDHSS’facilitiestothecommunity,asofJuly2016.

SAVINGS

• Startingin2011,thediversionof631individuals,asofSeptember2016,tothecommunitywhohadbeenreferredtoDHSS’threelong-termcarefacilitiessaves$41.6milliononanannualizedbasis.

• TheclosingofEmilyB.BissellHospitalinSeptember2015isestimatedtosave$2.83millionayear,withoutlayoffs,byreducingstaffing,facilityupkeepandovertimeneedsatDHSS’otherfacilities.

WHATITMEANSTODELAWAREANS

JohnTaloneofClaymontisamongthehundredsofDelawareanswhohavebeendischargedordivertedfromDHSS’threenursingfacilitiestoliveinthecommunitywithwrap-aroundsupportsandservices.JohnlikeshisownItaliancooking,andafterspendingfour-and-halfyearsintheDelawareHospitalfortheChronicallyIllinSmyrna,henowcancookandeatthosemealsonhisscheduleathisClaymontapartment.

BYTHENUMBERS

• 1,042:TotalcensusofDHSS’fivefacilitiesin2000.

• 662:TotalcensusofDHSS’fivefacilitiesin2009,down36%from2000.

• 358:TotalcensusofDHSS’nowfourfacilitiesin2016,down46%from2009.

DivertingpeoplefromDHSS’long-termcarefacilitiestothecommunity,withnecessarysupports,givesDelawareanswhattheywantandsaves$41.6milliononanannualizedbasis.

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THEYSAIDIT

“Weareallonestepawayfromhomelessness.Weareallvulnerable.”~CharlesJohnson,SRAPrecipientandfounderofHomelessPeopleAreRealPeople,Too(H.A.R.P.)

MentalHealthSystemReform

FromdayoneoftheMarkellAdministration,DHSShasworkedtoimproveconditionsattheDelawarePsychiatricCenter(DPC)andreformhowmentalhealthservicesareprovidedinthecommunity.ApivotalbenchmarkinthatcommitmentcameinJuly2011whentheStateofDelawareenteredintoafive-yearSettlementAgreementwiththeU.S.DepartmentofJustice,whichresolvedathree-yearinvestigationofDPC.Moreimportantly,thatagreementbecametheblueprintforhowDelawarewouldprovidementalhealthservicesinthecommunitytothemorethan10,000peopletodayestimatedtobelivingwithseriousandpersistentillness.

InSeptember2016,CourtMonitorRobertBernsteinissuedhis10threporttotheU.S.DistrictCourt,writing,“TheMonitor’sfindingthattheStateisinSubstantialCompliancewiththeAgreementisbasednotonlyontheextensivedatapresentedhere,butalsoupontheself-reportsofindividualsservedbyDelaware’spublicmentalhealthsystem.”ThenextstepwouldbefortheU.S.DepartmentofJusticetorecommendtotheCourtthattheStatehasmetitsgoalsandreleasetheStatefromthetermsoftheagreement.SecretaryLandgrafagreesthatthesystemisnotperfectandneedsongoingimprovementsandconstantvigilance,butsheispleasedwiththeconclusionoftheCourtMonitor,“TheState’sservicesforpeoplewithSPMIarenotflawless,butthereisincreasingunityandmomentumregardingthegoalofenabling

40%

57%

3% DelawarePsychiatricCenter

CommunityServices

CommunityMentalHealthInpatient

DSAMHFY10EXPENDITURES

28%

70%

2% DelawarePsychiatricCenter

CommunityServices

CommunityMentalHealthInpatient

DSAMHFY16EXPENDITURES

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theseindividualstomovefromthesocialmarginsandtoliveasordinaryDelawareansasfullmembersoftheircommunities.”

WHATCHANGED

• In2008,only3,700peoplewerebeingservedinthecommunity,andtoomanypeoplewithseriousandpersistentillnesswereinstitutionalized,homeless,forgotten,ortheirfamiliesweredoingthebesttheycouldtopatchtogethersupportforthem.By2015,morethan8,000Delawareans–anincreaseofmorethan116%–werereceivinganoutpatientservice.

• Asmentalhealthsystemreformswereinstitutedandtheshifttocommunity-based

servicestookhold,DPCshiftedtobecomingtheacute-carepsychiatrichospitalitalwaysshouldhavebeen,licensedfor200beds.Individualswhohavebeendischargedafteryearsor,insomecases,decadesatDPCarereceivingintensivetreatmentinthecommunitywithaccesstohousing,employment,clinicalservices,medicationsandotherservices.

WHATWASDONE

232

204 200

162146 136

113 112 110

0

50

100

150

200

250

FY2008 FY2009 FY2010 FY2011 FY2012 FY2013 FY2014 FY2015 FY2016

Num

bero

fClients

DecliningCensusatDPC

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• CreatedAssertiveCommunityTreatment(ACT)teams–consistingof10membersplusapsychiatrist–whoprovide24/7servicesinthecommunityinsteadofinanofficesetting,plusIntensiveCaseManagement(ICM)andCommunityReintegrationSupportProject(CRISP)teamsdirectedanindividualswithlevelsofneedbeyondwhatisavailablethroughACT.AsofFiscalYear2016,DHSShas15ACTteams,twoICMteamsandtwoCRISPteams,allofwhommustrespondtoclientswhoareincrisisregardlessofthetimeofday,therebyincreasingthechanceofde-escalationandreducingunnecessaryhospitalizations.

• Reducedby25%thenumberofinpatientbeddaysfrom55,785inFY11to41,515inFY16.

• OpenedRecoveryResponseCenter(RRC)inSussexCountytosupportpeopleexperiencingabehavioralhealthcrisis.FromitsopeninginSeptember2012throughJune2015,DHSS’MobileCrisisandRRCinEllendalehaveworkedtogethertodivert74%ofclientsfromhospitalization.Asimilarcrisiswalk-incenteropenedinAugust2016inNewarktoserveNewCastleCounty.

• AsofFiscalYear2016,funded812housingunits–abovethetargetof650setintheSettlementAgreement–forindividualswithseriousandpersistentmentalillnesssotheycanleadstablelivesinthecommunity.

• DevelopedcrisisapartmentsinNewCastleCountyandKentandSussexcountiesthatprovide24/7supervisioninastableenvironmentforuptosevendayssotheclientcanworkthroughacrisiswiththesupportoftheACTteam.InFiscalYear2016,21bedsareavailablestatewide,exceedingthetargetoftheSettlementAgreement.

• ExpandedMobileCrisisServicesstatewideto24/7,withateammemberrequiredtorespondanywhereinthestateinlessthananhour.InFiscalYear2016,theaverageface-to-faceresponsetimewas40minutes,exceedingtheone-hourtargetoftheSettlementAgreement.

• UpdatedDelaware’scivilmentalhealthlawsforthefirsttimein50years.• WonapprovalinJanuary2015toimplementPROMISE(PromotingOptimalMental

HealthforIndividualsthroughSupportsandEmpowerment).Anestimated3,000Delawareanswithbehavioralhealthneedsandfunctionallimitationswillbeeligiblefor

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thisManagedCareOrganizationbenefitpackage,betterleveragingMedicaiddollarsandincreasingemploymentopportunities.

• Createdthepositionofpeersupportspecialist,someonewithasharedlifeexperience,tosupportindividualsinrecoveryastheynavigatethehealthcaresystemandliveinthecommunity.

• SupportedlegislationsignedbytheGovernorinSeptember2016toestablishtheBehavioralandMentalHealthCommission,includingtheAdultMentalHealthPeerReviewSubcommitteetomonitorthetreatmentservicesprovidestoadultswithSPMI.

WHATITMEANSTODELAWAREANS

WilliamandSteve,bothofwhomhaveaseriousmentalillness,shareanapartmentandareservedbyaSussexCountyACTteam.Williamhasahistoryofinvolvementwiththecriminaljusticesystem.Steve,whohasbeeninthecriminaljusticesystem,too,hasaco-occurringaddictiontoalcoholandhasbeenhomeless.Likeotherroommates,WilliamandStevesharetheshoppingandcooking.ACTteammembersvisittwotothreetimesaweektosupportthem.Today,inrecovery,theyarelivingordinarylivesinthecommunity.

BYTHENUMBERS

• 12,826:Delawareansidentifiedasmembersofthetargetpopulationofindividualswithseriousandpersistentmentalillness,asofDecember2016.

• 28,262:MobileCrisiscallsstatewideinFY16.Withskillsinde-escalationandknowledgeofservices,MobileCrisisTeammembersaremakingadifferenceinourcommunities.

• 45peers:Certifiedwiththestateboard,asofSeptember2016.99peoplehavecompletedPeerSupport101,and122havecompletedcertificationtraining.Inhis10thReporttotheU.S.DistrictCourt,CourtMonitorRobertBernsteinwrote,“Inshort,PeerSupportservicesandthelargerpeermovementinDelawarehavebecomeavibrantcomponentoftheservicesystemforpeoplewithSPMI.”

• DHSS’24/7MobileCrisisServicesinNewCastleCounty:1-800-652-2929.InKentandSussexcounties:1-800-345-6785.

THEYSAIDIT

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“…fromtheGovernor’sOfficeondown,thereisacommitmenttoservepeoplewith[seriousandpersistentmentalillness],aswellasotherdisabilities,inwaysthatpromotetheirfullparticipationincommunitylife.”~CourtMonitorRobertBernstein

UrgentResponsetoAddictionEpidemic

ThenumberofDelawareansimpactedbyaddictionhasbeenrisingfortwodecades,mirroringtherapidlyrisingincreaseinprescriptionsforopioidpainmedications.Thousandsofpeoplearefacingaddiction,impactingtheirfamilies,thetreatmentandcriminaljusticesystems,andcostinghundredsofpeopletheirlivesfromoverdoses.

WHATCHANGED

In2010,Delawarerankedfifthintheper-capitarateofopioidpainrelieversales,andthestatehadtheninth-highestdrugoverdosedeathrateinthenation.By2010,thenumberofoverdosedeathsinDelawarehadsurpassedcaraccidentsastheleadingcauseofdeathbyinjury.

By2012,thethousandsofindividualsandfamiliesimpactedbytheaddictionepidemicwerestrugglingtogetthetreatmentservicestheirlovedonesneeded,andDHSSwasstrugglingtomeetthedemandfortreatmentandrecoveryservices.

ForDelaware,itwasanall-hands-on-deckmoment.Aswithanypublichealthcrisis,weareworkingonthreefronts–topreventdrugabuseandtoeducateaboutthedisease;toexpandtreatmentandrecoveryservices;andtocontrolthecrisisfromacriminaljusticestandpointbyworkingtounderstandhowitoriginated.

WHATWASDONE

• In2012,theDepartmentofStateestablishedthePrescriptionDrugMonitoringProgramwiththerequirementof24-hourpharmacyreporting.

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• InFebruary2012,Gov.MarkellestablishedthePrescriptionDrugActionCommitteeofstakeholdersfromacrossthespectrum,chargingthecommitteewithdevelopingaplantocombattheabuseandmisuseassociatedwithprescriptionpainkillers.

• InMarch2012,theDivisionofMedicaidrequiredprescribingproviderstogetpreauthorizationforlong-actionopioidmedicationsforMedicaidpatientsandplacedannuallimitsforshort-actingopioidmedications.Thenewrequirementaffectedanestimated3,500Medicaidclients.

• InJuly2013,Gov.Markellsignedthe911/GoodSamaritanLaw,whichencouragespeopletocall911toreportanoverdosewithoutriskingarrestforlow-leveldrugcrimes.

• InJune2014,asDHSSbegantoaddressbothcapacityandredesignissues,theGeneralAssemblyadded$1millioninnewresourcestoDHSS’budgetforincreasedtreatmentservicesthroughtheDivisionofSubstanceAbuseandMentalHealthandincreasedpreventionservicesthroughtheDivisionofPublicHealth.

• InJuneandAugustof2014,Gov.Markellsignedtwobills–oneexpandingtheuseoftheoverdose-reversingdrugnaloxoneinthecommunityandoneallowingittobeusedbylawenforcementagencies.Today,sixpolicedepartmentsarecarryingthemedication,andalldepartmentshaveusedittosavepeople’slives.

• InOctober2014,DHSSlaunchedwww.HelpIsHereDE.com,aone-stopwebsiteforinformationaboutprevention,treatmentandrecoveryservices.

• InhisStateoftheStateinJanuary2015,Gov.Markellpledgedtomakeasubstantialinvestmentinservicesforthosestrugglingwithaddiction.InFebruary,hisrecommendedbudgetincluded$4.45millioninnewresourcesforwithdrawalmanagement,residentialandoutpatienttreatment,andrecoverylivingservices.• WiththeadditionalresourcesintheFY16budget,DHSSincreasedwithdrawalmanagementservices,residentialtreatmentandyoungadultopiateresidentialbeds,outpatienttreatmentslots,and

soberlivingbedsacrossthestate,whilereformingourtreatmentsystemtoebbandflowwithanindividual’sneeds,embracingtheAmericanSocietyofAddictionMedicinemodel.Whenindividualsinactiveusearereadyfortreatment,DHSSmusthavethecapacitytosupportthematthattime.

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• InApril2015,aspartofourpreventioninitiatives,DHSSlaunchedanunderageandbingedrinkingpreventioncampaignaimedatteens,theirparentsandotherinfluencers,andcollege-agebingedrinkers.

• TheGeneralAssemblypassedaresolutioninApril2015permittingschoolnursesinhighschoolstocarryandadministernaloxone.DHSSandtheDivisionofPublicHealthhavesecurednaloxonetosupplytheschools.

• InAugust2015,theWhiteHouseOfficeofDrugControlPolicyannouncedfiveHigh-IntensityDrugTraffickingAreas(includingPhiladelphia/Camden,whichincludesNewCastleCounty)wouldformanunprecedented15-stateHeroinResponseStrategy.Delawarenowhasapublichealthanalyst(atDHSS)andapublicsafetyanalyst(atDIAC)analyzingdata,spottingtrendsandinformingresponses.

• DelawarewasoneoffourstatesselectedinAugust2016toparticipateinaNationalGovernorsAssociation(NGA)LearningLabondatasharingrelatedtoaddiction.Delawarewillsharetreatment,lawenforcement,EMSandMedicalExaminerdata.

WHATITMEANSTODELAWAREANS

TimMillertookapathtoomanyyoungadultsaretakingtoday.Inmiddleschool,hetriedalcohol.Thenhetookhisgrandfather’sprescriptionpainkillersfromthemedicinecabinet,sayingtheymadehimfeellesssociallyawkward.Yearsafterhighschool,havingbecomeaddictedtoheroin,hewassenttoHowardYoungprisononaburglarycharge.Today,heislivinginlong-termrecovery.

BYTHENUMBERS

• 10,000:NumberofDelawareadultswhosoughtpublictreatmentin2015,withaboutone-thirdindicatingheroinastheirprimarydrugatthetimeofadmission.

• 228:Thenumberofpeoplewhodiedfromsuspectedoverdoseofanysubstancein2015–that’smorethanoneson,daughter,mother,father,sisterorbrothereveryotherday.Theyoungestpersontodiefromanoverdosewas15;theoldestwas87.Theaveragepersontodiewasa42-year-oldwhitemalefromsuburbanNewCastleCounty.

• 2,380:NumberofpeoplewhohavebeenadministerednaloxonebyEMSandpoliceofficersfrom2014throughMay2016.

• 1,576:Numberofpeopleinthecommunitywhohavebeentrainedtousenaloxone,asofFebruary2016.SecretaryLandgrafisamongthosewhohavebeentrainedtoadministernaloxone.

• 14:Numberofpolicestationswith24/7DrugTake-Backcollectioncontainerstoencouragethedisposalofunwanted,unnecessaryorexpiredmedications.

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• 15:Beginningin2015-2016schoolyear,numberofhoursofdrugandalcoholeducationrequiredbeforegraduationforeverypublichighschoolstudent.

THEYSAIDIT

"IneverwantedanythingmorethanhowbadIwantedtobecleanandsoberinthatmoment,”saidTimMiller,whounderwentdetoxinprisonandnowhasfouryearsinrecovery.

EnhancedOpportunitiesforPeoplewithDisabilities

WiththeAmericanswithDisabilitiesActcelebratingits25thanniversaryin2015,thecivilrightsfortheoneinfiveAmericanswithadisabilityareevenmoreentrenched.Whileinclusiongrowswitheachsuccessivegeneration,thereisstillmuchmoreworktodointermsofhealthequity,housingoptions,transportation,education,financialself-sufficiencyandespeciallyemployment.

WHATCHANGED

• UnderGovernorMarkell’sleadershipandinpartnershipwiththebusinesscommunity,Delawarereportedan8.6percentincreaseinactiveemploymentfrom2011to2013amongthe187,000peoplewithdisabilities.TheGovernoralsohasmadethehiringofpeoplewithdisabilitiesapriorityforstategovernment,usinghiringpracticesandprogramstoincreaseemploymentlevels.

• AsChairoftheNationalGovernorsAssociationfrom2012to2013,GovernorMarkellmadeadvancingemploymentopportunitiesforpeoplewithdisabilitieshisyearlonginitiative.Withhisbusinessbackground,heknowsthatcompanies’bottomlinesshouldbeaboutembracingaperson’sability,nottheirdisability.TheGovernorlaidouthowtoadvanceemploymentopportunitiesinhisblueprinttohisfellowgovernors,“ABetterBottomLine:EmployingPeoplewithDisabilities.”

• AstheformerdirectorofTheArcofDelawareandNAMIDelaware,SecretaryLandgrafhasspentmorethan30yearssupportingindividualswith

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disabilities.SheservedasakeyadvisertotheGovernorduringhisNGAinitiative,andwasappointedinJanuary2015totheU.S.DepartmentofLabor’sU.S.AdvisoryCommitteeonIncreasingCompetitiveIntegratedEmploymentforIndividualswithDisabilities.

• AsSecretary,sheisdedicatedtoincreasingopportunitiesforallpeoplewithdisabilities.Opportunitybeginswithajob,aplacetolive,goodhealth,supportsandservices,andfinancialwell-being.

WHATWASDONE

• InJuly2012,theGovernorsignedtheEmploymentFirstAct,requiringstateagenciestoconsider,astheirfirstoption,competitiveemploymentforindividualswithdisabilities.

• Toincreasehiringofqualifiedindividualswithdisabilities,theStateusessuchtoolsasSelectivePlacement,TemptoPerm,casualseasonalhires,andinternshipsandcareer

exploration.• In2013,aworkgroupwastaskedwithadvancinghiringopportunitiesforpeoplewithdisabilitiesinstategovernment.• Aspartofthatwork,thegroupcommissionedtheUniversityofDelawaretoconductanonlinesurveyofstateemployeestobetterunderstanddisabilityawareness.Morethan5,000stateemployeesresponded,

identifyingtwokeyareasforimprovement:HRtrainingrelatedtodisabilityawarenessandrefinementofstatehiringpracticesinordertorecruitqualifiedapplicantswithdisabilities.

• InOctober2014,theOfficeofManagementandBudgetlaunched“FocusonAbility,”disabilityawarenesstrainingforallemployees,withaseparatemoduleforhiringmanagers.

• WorkingwiththeGovernor,SecretaryLandgrafhelpedtofacilitatearelationshipwithSpecialisterne,aglobalorganizationdedicatedtotrainingandpromotingthehiringofindividualsontheautismspectrum,andCAI,aglobalITcompanywithofficesinDelaware.

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• DHSShashiredseveralSpecialisternecontractorstododocumentscanning.OnegraduateofSpecialisterneisnowastateemployeeinthematerialscenterforthe

DivisionfortheVisuallyImpaired.• Bytheendof2015,CAIhascommittedthat3percentofitsworkforcewillbeindividualsontheautismspectrum.• Inlate2015,DHSScreatedavideotopromoteemploymentforindividualswithdisabilitiesthathighlightsthejobsorexpectationsoffiveDelawareans.Thevideowillbeshownanddiscussedwith

individuals,familiesandprospectiveemployers.• In2015,Delaware’sDisabilityMentoringDaywasexpandedfromNewCastleCountyto

allthreecounties.Morethan60studentsparticipatedinjob-shadowingatnearbyworkplaces.

• Tosupportyoungpeoplewithdisabilitiesandtheirfamilies,DHSSearnedapprovalfromtheCentersforMedicareandMedicaidServicesinJanuary2015forPathwaystoEmployment,becomingthefirststatetosupportyoungpeoplewithdisabilitiesastheymakethetransitionfromschooltotheworldofwork.AsofSeptember2016,248youngpeopleage14-25haveenrolledinPathways,with180moreidentifiedaspotentialcandidates.TheMedicaidprogramhelpstoreducethebarrierstoemploymentthoughsuchservicesasassistivetechnology,non-medicaltransportation,careerexploration,personalcareandfinancialcoaching.

• Thefinancialempowermentprogram,$tandByMe,createdin2011inpartnershipwiththeUnitedWayofDelaware,supportspeoplewithdisabilitiesinmanagingtheirfinanceswithfreeone-on-onecoaching.

• MedicaidforWorkersallowspeoplewithdisabilitiestobuyintoMedicaidinordertokeepthesupportstheyneedwhiletheyareemployed.

• InJune2015,Delawarebecamethe19thstatetocreateanAchievingaBetterLifeExperience(ABLEAct)program,followingaDecember2014federallawcreatingtheprogram.ThestateDepartmentofFinanceisdevisingrulesforthetax-freesavingsaccountsfordisability-relatedexpenses.

• BecauseaDelawarepublichealthassessmentfoundanumberofhealthdisparitiesamongpeoplewithdisabilities–includingobesityrates,higherratesofsmoking,andhigherratesofchronicconditionssuchasdiabetes,heartdiseaseanddepression,DHSSisrequiringitsdivisionsandprogramstoincludeaperson’sdisabilitystatuswhen

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demographicinformationiscollected.ThatinformationwillallowDHSStoremovebarrierstocareandincreaseaccess.

• InAugust2016,theGovernorsignedlegislationsupportingthehiringofpeoplewithdisabilitiesbyprovidingtaxcreditstoDelawareemployerswhohirepeoplethroughtheDivisionofVocationalRehabilitation.Thetaxcreditwillbeginin2017.

• Tosupportpeoplewithdisabilities,theGovernorsignedlegislationinSeptember2016providingtheoptionofasupporteddecision-makingagreementforadultswhodonotneedaguardianbutwhoneedassistanceingatheringinformation,makingdecisions,andcommunicatingthosedecisions.

WHATITMEANSTODELAWAREANS

• JessicaHengst,whohasDownsyndrome,foldstowelsandcleansthepoolareaatMainstaySuitesinDoverandhasasecondjobatOldNavyintheDoverMall.Oneday,hermomsaidshewouldlikehertoliveonherown.• AgunincidentinPhiladelphialedtoDwayneAdamslosing

hislefteyeandhavingonlypartialvisioninhisrighteye.Jobspecialistsaskedhimifhewantedtosellnewspapersatastand.Hetoldthemhewantedtobecomeamassagetherapist.Hebuiltonthatinterestinphysicalhealth,andtodayownsBreakingBarriersfitnesscenterinWilmington.

• Establishinganexpectationofalifetimeofworkiscrucialforyoungpeoplewithdisabilities.ForRickandAmyKosmalskiofBear,theexpectationsforKayla,their10-year-olddaughterwithDownsyndrome,arenodifferentthantheyareforLogan,their5-year-oldsonwithoutadisability.TheKosmalskisbelieveKaylaandLoganeachcanbewhatevertheywanttobe.

BYTHENUMBERS

• 36.4%:PercentageofDelawareansage18to64withdisabilitieswhoareemployed.

• 248:Numberofyoungpeopleage14-25enrolledinPathwaystoEmploymenttosupportthemintransitionfromschooltotheworldofwork.

• 5,000:Numberofstateemployeeswhorespondedtoa2013UDsurveyaboutdisabilityawarenessintheworkplace.

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• 12%:Percentageofindividualswithdisabilitiesamongallpeopleservedbythefinancialempowermentprogram$tandByMesince2011.

• 1,008:EstimatednumberofpeoplewithdisabilitiesexpectedtocreateABLEsavingsaccountsinDelawarebyFiscalYear2017.

THEYSAIDIT

“DisabilityMentoringDayisagreatopportunityforkidstolearnaboutdifferentjobs,tobeinvolvedwiththecommunity.”~JaySiegel,a2014DisabilityMentoringDayGraduate

HealthCareReformandInnovation

BeginninginMarch2010whentheAffordableCareActwassignedintolaw,Delawarehasbeenonthesuperhighwayofhealthcarereform.Astheleadstateagency,DHSShasworkedtoimplementitsstate-federalpartnershipHealthInsuranceMarketplace,withcoveragebeginning

Jan.1,2014,andtheexpansionofMedicaid,withcoveragebeginningonthesamedate.DHSShasbeenasignificantpartnerindesigningaplanandapplyingforafederalCenterforMedicareandMedicaidInnovation(CMMI)grantandimplementingtheplantochangethewayhealthcareisdeliveredandpaidforinDelaware.

WHATCHANGED

• In2008,Delaware’sinsuredratewasestimatedat11.2percent,or101,000individuals.ThatraterankedDelaware33rdamongthestates.By2015,thatpercentagewasdownto5.9percent,withanestimated54,000Delawareanswithoutcoverage.Delawarenowhasthe9th-lowestuninsuredrateinthecountry.

• Delaware’shealthcarecostsare25percentabovethenationalaverage,with$8billionspentannuallyonhealthcareand22percentoftheStatebudgetdevotedtohealthcarecosts.

• Thoseexpenditureshavenotresultedinahighrateofpositiveoutcomes.Delaware’srateforsuchdiseasesasdiabetes,obesityandcancerareabovetheU.S.average,andthehealthofmanyDelawareansremainsatorbelowaverageonmanymeasures.

WHATWASDONE

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• Delawareadoptedastate-federalpartnershipforitsHealthInsuranceMarketplace,meaningDelawarewouldretainresponsibilityforplanmanagementandconsumerassistance,whilethefederalgovernmentwouldberesponsibleforinformationtechnologythroughHealthCare.gov.

• Throughthefirstthreeyears,28,256Delawareansenrolledforprivatehealthinsuranceplans,withenrollmentalmostdoublingfromYear1toYear3–oneofthehighestincreasesinthecountry.

• InJuly2013,Gov.MarkellexpandedeligibilityforMedicaidupto138percentoftheFederalPovertyLevelbeginningJan.1,2014.ThroughJanuary2016,9,896Delawareadultswereeligibleforcoveragethroughtheexpansion.

• Beginningin2013,morethan100stakeholders,includingthoserepresentinghospitals,providers,insurers,educationalinstitutions,patients,andgovernment,cametogethertodevelopDelaware’shealthinnovationplan.

• Basedonthatplan,Delawarewasawardedafour-year,$35milliongrantfromtheCentersforMedicareandMedicaidInnovation(CMMI)totransformthestate’shealthcaredeliverysystembyusingatotalinvestmentof$130millionoverfouryears.

• In2015,theDelawareCenterforHealthInnovation,anot-for-profitorganization,wascreatedtocarryouttheinnovationwork.TheDCHIBoardcreatedsixcommittees:Clinical,WorkforceandEducation,Payment,HIT,HealthyNeighborhoods,andPatient/ConsumerAdvisory.Twomulti-payer,value-basedpaymentmodelswillbeofferedstatewide:Pay-4-ValueandTotalCostof

Care.• Delaware’sgoalsby2018aretobecomeoneofthefivehealthieststatesintheU.S.;to

achievetopperformanceforqualityandpatientexperience;andtobringhealthcarespendinggrowthmorecloselyinlinewiththegrowthoftheeconomy.

WHATITMEANSTODELAWAREANS

FelipeHernandez,a26-year-oldmachineoperatorfromWilmington,didnothaveinsurancecoveragelikehiswifeanddaughterdid.RelativestoldhimabouttheHealthInsuranceMarketplaceandheenrolledforcoveragebeginningin2014andre-enrolledfor2015.Hernandez,whopaysamonthlypremiumofabout$73,saidheisnowmorehopefulaboutthefutureforhimandhisfamily.

BYTHENUMBERS

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• 38,152:NumberofDelawareanswhohavegainedaccesstocarethroughtheMarketplaceandMedicaidexpansionasofJanuary2016.

• 82%:PercentageofDelawareanseligiblefortaxsubsidiesontheHealthInsuranceMarketplace,withtheaveragemonthlypremiumaftertaxcreditat$150asofJanuary2016.

• $35million:AmountoffederalgrantDelawarereceivedtochangethewayhealthcareisdeliveredandpaidfor.

THEYSAIDIT

“I’vegonetothedoctorforexams,bloodwork,andmedicationstopreventfutureillness.Myhealthhasimprovedalot.I’mnotgoingtogobrokebecauseIgetsick.”~FelipeHernandez,whoboughtprivatecoverageontheHealthInsuranceMarketplace

FinancialEmpowermentandaStrongSafetyNet

SoonafterbecomingCabinetSecretary,Iaskedmyleadershipwhatthedepartmentwasdoingtofosterself-sufficiency.Theiranswerwas:Weprovidebenefits.

Ourmissionasadepartmentistofosterself-sufficiency,andwhilebenefitscansupplementinacrisisastheydidforsomanyfamiliesduringtheGreatRecession,theywillneverprovidefinancialsustainabilityorsecurity.

Delaware’shouseholdfinancialdemographicsspeaktotheneedforthisfocus.AccordingtotheU.S.Census,ofthe335,707householdsinDelawarein2013,42%hadincomesbelow$50,000,and29%hadincomesbelow$35,000.Manyofthesehouseholdshavetraditionallystruggledwithmonthlyexpensesthatexceedincome.Theyhavenosavingsorsafetynet,supplementtheirincomewithcredit,havelowcreditscoresandhighdebt,areexploitedbythe“fringe”financialsector,andlackaccesstomaintainfinancialservices.

WiththesupportofGovernorMarkell,welaunched$tandByMe,Delaware’sfinancialempowermentpartnershipwiththeUnitedWayofDelaware,in2011.$tandByMe,whichisheadquarteredinDHSS,hasasitscoreservicefreepersonalfinancialcoaching.Thecoachneverdictates,butratheraskseachcustomertoidentifytheirownchallengesandgoals,andcomewithacustomer-drivenactionplan.

WHATHASCHANGED

• ThroughJune2016,$tandByMehadservedalmost60,000Delawareansthroughfinancialcoaching,workshops,collegefinancialaidapplications,andfreetax

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preparation.Ofthose11,000haveparticipatedinpersonalfinancialcoachingtoimprovetheirfinancialwell-being.

• Collectively,$tandByMecoachingcustomershavereducedtheirdebtby$4.5million,increasedtheirsavingsby$2million,raisedtheircreditscorebyanaverageof52points,established5,056budgetsandestablished14,000personalfinancialgoals.Highschoolparentsandtheirstudentshavefilledout3,700collegefinancialaidapplicationsand7,409attendedfinancialaidworkshops.

• Inadditiontoitsemployer-andschool-basedprograms,$tandByMehasspecialprogramsforDelawareans50andolder,Hispanics,childcarefamiliesandemployees,aspiringhomeowners,veterans,peoplewithdisabilities,andstudentsincommunitycollegeandworkforcedevelopmentprograms.Becauseofthenumberoflow-incomeemployeesinDHSS,SecretaryLandgrafadded$tandByMecoachingasanemployeebenefit.

WHATWASDONE

• Tobuildsecurityforthefutureof$tandByMebeyondtheMarkellAdministration,legislationwasintroducedandpassedin2015tocodifytheOfficeofFinancialEmpowermentwithinDHSS.

• InMarch2015,DHSSwasoneof10statestoearnacompetitivefederalgrantforDelawareWONDER(WorkOpportunityNetworkstoDevelopEmploymentReadiness),aninnovativeprogramthatworkswithlocalpartnerstoprovidejobtrainingandintensivecasemanagementtoDelawareanswhoreceivefoodbenefitsandhavelimited

jobskillsorworkexperience.Throughthe$18.8milliongrant,about20percentofthe147,000Delawareanswhoreceivefoodbenefitswillbeeligibleforjobtraininginfourareas:constructiontrade,culinaryarts,manufacturingandbroadjob-placement.TheprogrambeganinFebruary2016andhas750peopleenrolledasofSeptember2016–halfparticipatinginthenewemploymenttracksandhalfinacontrolgroup.• TheeconomicimpactoftheGreat

Recessionaffectedtensofthousandsofindividualsandfamilieswhowereaccustomedtohelpingothers,notbeingtheoneswhoneededsupport.Today,whilethegrowthofenrollmenthasslowed,thenumbersremainhigh:222,000DelawareansareenrolledinMedicaidasofFiscalYear2017;147,000arereceivingfoodbenefits.UntilthefinancialchallengesthataffectsomanyDelawareansend–especiallythoseonthelowerendoftheincomescale–DHSSwillcontinuetoprovideastrongsafetynet.

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WHATITMEANSTODELAWAREANS

Threeyearsago,WaldemarColon,whoworksatDoverDownsHotel&Casino,andhiswifewantedtobuyahouse,buttheircreditscoresweren’thighenoughtogetamortgage.Waldemar,a$tandByMeclient,workedwithhisfinancialcoachand,together,theydevelopedastrategyforhimtoraisehiscreditscore.Withfinancialempowermentprovidedthrough$tandByMe,theColonsboughttheirhouse.

THEYSAIDIT

“Thisiswhywedowhatwedo.Itgivespeoplethefoundationandstabilitytotryandpursueabetterlife.”~GovernorJackMarkellattheJuly2015billsigningtocodifytheOfficeofFinancialEmpowermentwithinDHSS