The Cuyahoga County Council convened over several weeks to discuss the 2020-2021 biennial budget. The hearings took place over three days and featured testimony and presentations from county health and human services leaders. In this review, we will cover some of the presentations, as well as the questions that followed from county council. The committee of the whole is chaired by Councilman Dale Miller, who also serves as the finance committee chair. On October 15, the committee heard from the director of the Department of Health and Human Services, as well as the heads of the Divisions of Child and Family Services, Senior and Adult Services, Job and Family Services and the Office of Child Support. On October 17, the committee heard from the Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board of Cuyahoga County, the Office of Homeless Services, Family and Children First Council, the Office of Re-Entry and the Department of Law. On October 29, the committee heard from the MetroHealth System. Each agency leader was given five minutes to present his or her testimony, followed by questions and answers by council members.
In this review, we will cover some of the presentations, as well as the questions that followed from county council.
Unique to this year, each day before testimonies began, Miller provided opening remarks that set the tone for the day’s discussions. He encouraged each director to fold three questions into their presentations:
- Is the staffing level the same? Could you use additional staff? Could you work with less staff?
- What additional funding request did you make? Which were approved? Which were denied?
- HHS levy increase, what are the three top areas you would provide additional resources to?
The Department of Health and Human Services – Walter Parfejewiec
To begin the testimony portion of the meeting, the committee heard from Walter Parfejewiec, Director of the Cuyahoga County Department of Health and Human Services. He stated the overall agency budget is $364 million and there are 2,300 workers on staff. Revenue is made up of federal, state and county levy funding, which this year includes $14.7 million in additional funding from the state that will primarily be used for child protection service, kinship care and child welfare. The department will fill approximately 40 vacancies in the Division of Child and Family Services. The agency wants additional staff to reduce wait times at the call center. The agency would also like to see increased funding for foster care services, as more than 2,900 children are now in county custody.
The agency would also like to see increased funding for foster care services, as more than 2,900 children are now in county custody.
Council Vice President Pernel Jones asked if there any budget items that were not approved. Parfejewiec said that several items submitted to the Executive were not approved in the final recommended budget. Among the items requested but not funded for the Department of Health and Human Services in the county executive’s recommended budget, included money for early childhood, expansion of the OPTIONS program (funded through the Department of Senior and Adult Services (DSAS), geriatric nursing, senior transportation, tuition reimbursement and employee parking for Child and Family Services and Job and Family Services staff who work in downtown Cleveland. The list of those items can be found on pages 121 and 122 of the budget book.
Councilman Jack Schron noted that the JFS call center wait times have decreased from 27 minutes earlier this year, to under 16 minutes in October 2019, a decrease of 11 minutes (40 percent) in a few months.
Councilman Mike Gallagher zeroed in on the items that did not get funding and noted that many of the requested funding items were related to seniors. He wondered aloud if there are other ways that the county could encourage seniors to age in their homes, such as a property tax deduction that could benefit seniors in the county. Gallagher asked if Parfejewiec would agree to undertake such a discussion, and Parfejewiec responded “yes.”
Councilwoman Yvonne Conwell, who chairs the Health, Human Services and Aging Committee, wanted to clarify that the budget line item that says “Senior Transportation” was for “Senior Transportation Connection.” Parfejewiec said “yes.”
County Council President Dan Brady also joined the call for increased funding for seniors, saying that the county’s funding pace is not keeping up with the aging of the county’s population. He expressed concerns that there were not enough dollars allocated for senior transportation in the county.
Councilwoman Nan Baker also added that the additional OPTIONS financial request for $800,000 was an “important piece we all need to revisit.”
Miller asked if anything needed to be done to help with “upstream” services rather than responding to “downstream” issues. Parfejewiec noted that the county needs to spend more paying families through kinship care, to try and keep families together, rather than to spend more paying for foster children’s board and care.
Division of Children and Family Services – Cynthia Weiskittel
Administrator Cynthia Weiskittel reported that there are 2,900 children in county custody, the highest number in more than a decade. Additionally, the attrition rate for social workers is of concern. According to the State of Ohio, by 2020, there could be more than 20,000 children in custody of the state. The Division of Children and Family Services has 35 vacancies in “front line workers.” Weiskittel said if she was given additional funding, she could invest more in kinship care. She said of the 2,900 children in county custody, more than 1,000 children are with relatives. The only support that relatives get is about $115 per month per child, but the amount per child goes down with additional children. She said that she would also look into increasing support for children who have aged out of the foster care system. She also would like to address the racial disparities in foster care. Weiskittel said that the county is about 30 percent African-American, yet Black children make up between 65 and 70 percent of foster children in county custody.
According to the State of Ohio, by 2020, there could be more than 20,000 children in custody of the state.
Conwell sought clarity on what the requirements for relatives would be for those who take children into their care. Weiskittel explained that the county would still do a home inspection, to ensure the child is safe. Weiskittel also explained that while the payment for relatives is $115 for the first child, for an agency that provides Level 1 foster care (which is the lowest amount of supportive care needed) the reimbursement rate is $611 per month. For foster care children who need more support, the reimbursement rate can be as high as $900 per month, sometimes even up to $4,500.
Councilwoman Sunny Simon asked if, because the opioid crisis seems to be slowing down, the agency expected the number of children in foster care to decrease. Weiskittel said that they expect the number to be flat, though she clarified that the high enrollment is not drug specific.
Miller asked for clarification on what she would do if she had more resources. Weiskittel said that she would seek to address systemic poverty, as well as apply research that can address the racial disparities in foster care representation. She said, “if you have an opioid baby, you have a child in the suburbs.” In the suburbs, she explained, hospitals do not test for drugs like they do in Cleveland hospitals. This may contribute to the over representation of Black children in county custody.
“If you have an opioid baby, you have a child in the suburbs.” In the suburbs…hospitals do not test for drugs like they do in Cleveland hospitals.
Weiskittel also said that the county needs to do better in supporting its staff because many of them experience “secondary” trauma on a regular basis. Finally, she noted that 34 percent of children are placed outside of Cuyahoga County and that she really wants to try and do better at increasing the payment for kin.
Division of Senior and Adult Services – Tracey Mason
Next up was Tracey Mason, the administrator for the Department of Senior and Adult Services (DSAS). The agency did see an increase from the last biennial budget from $19.7 million to $20.1 million. DSAS intends to maintain staffing levels and give current staffers a two percent cost of living increase. DSAS fights social isolation of seniors by funding several senior centers, providing approximately $1.8 million to 26 organizations, which serve 2,500 seniors each month. In addition, DSAS supports 1,200 clients in the OPTIONS program, which provides homemaking services, transportation, among other services, and aims to keep seniors at home and out of nursing homes. There is a high demand for the program and there is a waiting list of 75 individuals. DSAS also maintains an Emergency Assistance Fund, to help individuals in crisis. DSAS priorities are food security, housing, transportation, elder abuse and fighting social isolation.
DSAS supports 1,200 clients in the OPTIONS program, which provides homemaking services, transportation, among other services, and aims to keep seniors at home and out of nursing homes.
DSAS would like to request to add four Adult Protective Services (APS) workers and one supervisor. There has been a sharp increase in APS reports. Additionally, DSAS asked for two assessment specialists, requested an increase in OPTIONS funding to serve 1,500 clients and additional funding to expand the Senior Transportation Connection fleet.
Miller noted that although the funding for the division went up, the portion coming from the health and human services levy fund went down. This means that dollars are still coming into the agency, but that it would be coming from other sources, and that the overall percentage of dollars from the health and human services levy would decrease.
Baker noted that she supported the expansion of OPTIONS, as that has been something she has been interested in bringing to her district for a long time. Gallagher sought clarity on just how much money is spent overall per senior in Cuyahoga County compared to other counties. Mason stated that Cuyahoga County spends $55 spent per senior, compared with Franklin County at $159 per senior and $137 per senior in Hamilton County. Gallagher said that “we really need to think about that one.” Simon was quick to note that she would like to see how much other counties spend on health and human services compared to Cuyahoga County.
Cuyahoga County spends $55 spent per senior, compared with Franklin County at $159 per senior and $137 per senior in Hamilton County
Cuyahoga Job and Family Services – David Merriman on behalf of Kevin Gowan
Kevin Gowan, administrator of the Cuyahoga County Job and Family Services (JFS) had a family emergency, so David Merriman, deputy administrator for the Department of Health and Human Services delivered testimony on his behalf. Merriman explained that the Division of Job and Family Services has an annual budget of $80 million. The division has a staff of 853 and is responsible for programs related to the Supplemental Nutrition Program (SNAP), the Temporary Assistance for Needy Families (TANF), as well as subsidized child care and Medicaid. Merriman described that if the division were to receive any more money, workers at the Virgil Brown building would get their parking subsidized. Currently, most county workers park for free at county buildings that are outside of the central business district. Covering parking for workers who work downtown would close the disparity that currently exists. The division would also assess the staffing levels of the call center. As has been mentioned, although the average wait time is lower than what it was earlier this year, county leadership would like to get the wait time down to five minutes or less. JFS would like to have an analysis done to find out exactly how many workers would be needed to meet that performance goal.
The Division of Job and Family Services has an annual budget of $80 million.
Conwell opened the questions by asking if JFS currently works with the Office of Homeless Services, in an effort to prevent homelessness, as well as get individuals who are in a shelter, out of a shelter.
Merriman answered that there are workforce program options through JFS for individuals who are homeless. The exact program would be dependent on the age of the individual. For young adults, for example, an option could be the county internship program. Other non-government workforce agency partners, outside of JFS, have programs that can assist those who are in a homeless shelter, as well.
JFS gets about 4,500 calls per day, about 90,000 per month.
Baker also wondered how far along JFS was in filling 40 vacant positions at the JFS call center, which is responsible for handling reauthorizations of the Supplemental Nutrition Assistant Program (SNAP). Merriman explained that 17 individuals were in training and the county is doing continuous outreach to get candidates. There are 350 eligibility specialists, individuals who are working in the call center, and the agency loses about five people per month through attrition, so it is taking time to get to full strength. JFS gets about 4,500 calls per day, about 90,000 per month.
Miller asked why the number of individuals in Cuyahoga County that are enrolled in SNAP in 2019 was lower (200,000) than it was in 2018 (220,000). Merriman explained that there has been a decrease in the number of households that are on SNAP across the state. Officials are not certain about the reason behind the decrease. However, it could also be because of a feature of the state system called “auto-discontinuance.” Whereby if a person enrolled in SNAP hits a certain date, and all of the information is not complete to re-enroll, then that person is automatically shut out of the program. This is something that the county is lobbying the state to pause, so that people are not kicked out of the program entirely, due to long wait times at the call center.
Office of Child Support Services – Tiffany Dobbins‐Brazelton
Director Tiffany Dobbins-Brazelton described the mission of the Office of Child Support Services, explaining the office encourages responsible parenting, promoting self-sufficiency and child well-being by locating parents, establishing paternity, establishing and enforcing support obligations and collecting support for children. The Office of Child Support Services has a budget of approximately $44 million per year, with 319 staff. The office is supported by a mix of federal, state and local HHS levy dollars.
Council did not have many questions. Miller asked about the percentage of individuals who pay on time. According to Dobbins-Brazelton, about 64 percent paid on time. After a final series of clarifications, the meeting was then adjourned.
Alcohol, Drug Addiction and Mental Health Services Board (ADAMHS) – Scott Osiecki
Scott Osiecki, Chief Executive Officer for the ADAMHS board, presented to county council. In his prepared remarks, he mentioned he was grateful to the county executive for his agency not seeing any cuts. The ADAMHS board requested an increase of $5.1 million from county council, in addition to the current $32 million that they receive from the health and human services levy. In his remarks, Osiecki mentioned the Opioid Mitigation Fund settlement dollars and how the ADAMHS board will receive approximately $10 million from those dollars. He is careful to note, however, that those dollars are for one-time use and are specifically earmarked for drug addiction-related services. The $5.1 million request would be used for crisis services and residential housing. Underscoring the need for crisis services support, Osiecki noted Cuyahoga County experienced 211 deaths by suicide in 2018, the highest since 1985. In 2019, there have been 194 deaths by suicide. Also, a part of the $5.1 million ask, would be short-term housing for individuals who have mental illness who would otherwise be homeless. Currently, the program serves 200 people, but the ADAMHS board would like to increase the number of people supported in the program to 400.
The ADAMHS board requested an increase of $5.1 million from county council, in addition to the current $32 million that they receive from the health and human services levy.
Schron asked questions about the long-term sustainability of the drug addiction programming that would be supported by the opioid mitigation funds, and whether or not those programs would need to be funded by health and human service levy dollars once the Opioid Mitigation Funds are spent. Osiecki explained that the opioid settlement dollars would go towards programs such as “peer support” at local hospitals, where people who are admitted for drug use would be able to connect with a person who can get connected to drug treatment and recovery programs. These programs will be measured to determine outcomes and if/how they would be funded, would be determined at that time.
Councilwoman Shontel Brown asked Osiecki to explain how much money Cuyahoga County should expect, given the large amounts of money given to state mental health and addiction services in the most recently passed state biennial budget. Osiecki said that amounts of additional funding from the state is still unclear, as the state has not yet figured out how those dollars would be allocated to various counties across the state of Ohio. Councilman Mike Gallagher followed with a similar question in which he asked how much money would be expected from the state, in a budget where Governor Mike DeWine allocated more dollars for drug treatment as a result of the opioid crisis. Osiecki similarly explained that the state had not yet figured out to spend the money.
Family and Children First Council – Robin Brown
Program Director Robin Martin, from the Family Children First Council, also presented to the committee of the whole. The office has two state-mandated primary areas of focus, service coordination and child well-being. The state covers 89 percent of the service coordination activities of the office, with the HHS levy covering the remaining 11 percent. Child well-being programs are 100 percent funded locally. Those funds support comprehensive sex education, out of school programming, youth internships and Closing The Achievement Gap (CTAG).
Child well-being programs are 100 percent funded locally.
Martin described how Governor Mike DeWine recently announced the Multi-System Youth (MSY) initiative which aims to keep families together, while MSY can still receive services. The Family and Children First Councils (FCFC) across the state are designated to lead efforts at the local level.
Councilman Jones asked Martin to differentiate what age children she serves compared to other county agencies. Martin explained that for service coordination, for children with early intervention such as developmental disabilities, her service coverage goes from birth until age 21. When it comes to early childhood visits and University Pre-K, Invest in Children goes up to when kids finish preschool, and FCFC begins when they enter kindergarten.
Later in her remarks, Martin said that she hopes to hire a new service coordinator, to assist children who may find themselves in crisis, and connect those kids with someone who gets them to a stable environment.
MetroHealth, the Office of Homeless Services, the Office of Early Childhood/Invest in Children, the Law Department and the Office of Re-Entry also testified.
The budget amendments, if enacted, would represent a large increase in health and human services (HHS) on top of what the county executive included in his recommended budget.
UDPATE November 26, 2019:
After less than two weeks of deliberations, based on the testimony by agency directors, Cuyahoga County Council unveiled its list of major budget amendments for the 2020-2021 biennium budget. The budget amendments, if enacted, would represent a large increase in health and human services (HHS) on top of what the county executive included in his recommended budget.
The largest increase was made to the budget of the Department of Senior and Adult Services (DSAS). It saw an increase of $1.9 million in 2020 and $1.8 million in 2021, for a total increase of $3.7 million over the biennium. This represents a 10 percent increase in the department’s overall budget. The DSAS budget increases will go towards senior transportation, geriatric nurses, congregate meals and other senior programs. Funding was also added to the OPTIONS program, which is designed to keep seniors in their homes.
Funding was also added to the OPTIONS program, which is designed to keep seniors in their homes.
The Alcohol Drug Addiction and Mental Health (ADAMHS) board also saw a recommended $1 million increase for 2020. This is the first increase in county funding to the board in several years. The funding would come from the HHS levy. Additionally, the board could see more money if an increase in the health and human services levy passes in 2021. The United Way of Greater Cleveland saw an increase in its emergency food contract for $50,000 per year. The Closing the Achievement Gap program which is a part of the Family and Children First program also saw an increased budget. Finally, the Cuyahoga County Division of Job and Family Services will receive a budget increase to assist with hiring personnel to staff its call center. The amount is yet to be determined. The call center has experienced issues in the past with long wait times due to a number of issues, including understaffing, though the call center’s wait times are showing improvement. The goal is to get wait times under five minutes, according to county officials.
The county amendments will be heard on second reading on November 28, with third reading and final adoption on December 10, 2019.