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