Provider Contracts Dominate Final County Council HHSA Committee Meetings

The November 16, 2017, meeting of the Cuyahoga County Health, Human Services and Aging Committee featured a list of contracts that were before the committee, as the county authorized and re-authorized contracts to begin in 2018.

The testimony opened with Director Bernadette Kerrigan of First Year Cleveland and Matt Carroll, Chief Economic Opportunity and Growth officer, who discussed infant mortality.  First Year Cleveland is seeking an extension of its contract to April, 2019, which includes $1.5 million from the county. Chairwoman Conwell opened the discussion stating that there are several components to the First Year Cleveland project, and highlighted the role of the faith-based community.  Director Kerrigan explained the role of the faith-based community and how it can help communicate messages about safe sleep. This message focuses on the ABCD concept: “Alone, on the Back, in a Crib, Don’t Smoke. She said that, in an internal First Year Cleveland analysis done last year, each of the 21 families that experienced preventable infant loss were aware of the ABCDs but did not follow them. The contract was approved unanimously and moved to the full council.

The second contract for discussion was for $726,955 to Emerald Development Economic Network (EDEN) for the Rapid Rehousing program.  Ruth Gillett, administrator of the Office of Homeless Services, asked for approval of the contract, which is meant to help fund rapid, short-term rent subsidies for homeless youth and single adults. In addition to subsidies for rent costs, recipients also have access to case management, which can help them find more permanent housing.

Councilwoman Baker asked about the definition of “short-term,” noting that before the short-term subsidy begins, some people are coming from a shelter, which is also intended to be short-term. Administrator Gillett replied that to be eligible for this program, families must be homeless. However, best practices have shown that 70 percent of families receiving rapid rehousing are able to find permanent housing after four months of assistance. If after four months the county does not feel as if the recipient is making positive progress on assuming payment of their rent, the county will use “progressive engagement” to see if an extension can be found using alternative funding sources.

Councilwoman Conwell shared that the committee has heard concerns about the quality of the rapid rehousing. Elaine Gimmel, chief operating officer of EDEN, explained that if a complaint is received by a tenant, then an inspector is sent to the property to look at the issue. If the issue is an imminent threat to safety, the landlord gets 24 hours to address the issue. For other issues, landlords are given 30 days.  If the problem is not solved within 30 days, the tenant is given permission to move. The contract was unanimously passed under second reading suspension.

The next series of contracts were through the Cuyahoga County Department of Job and Family Services (JFS). Assistant Director of Health and Human Services Dave Merriman and Bob Math, contract coordinator for the county, testified on behalf of all of the contracts considered.

The first contract in the series was for $1.3 million to Maximus Human Services, a program that provides citizens with employment in order to meet their work requirements for the Work Experience Program (WEP), an element of both the cash and food assistance programs. Director Merriman testified that WEP participants do not get paid directly from the employer, but can use the experience as a credit towards their work requirement for benefits. This is a contract extension for one year. Mr. Math explained that this program is for individuals who are not ready to fully enter the workforce, but can use this program to develop soft skills. Once they have been in the program for 30-60 days and have developed skills, they are assigned to a job placement program where they can look for unsubsidized employment. There are 1,000 job positions across 400 different work sites for WEP participants, including government and nonprofit organizations. Case managers assisted close to 1,500 participants in 2016. However, when asked by Chairwoman Conwell how many participants have left the program and successfully entered into the job workforce, county officials said that Maximus is not required to track outcomes after they leave the program and county officials did not have that information available due to an outdated county tracking system.

Councilwoman Baker sought to understand the funding breakdown of the $1.3 million funding. Most of the money is Temporary Assistance for Needy Families (TANF), though some money is from Supplemental Nutrition Assistance Program (SNAP). The program receives about 150 referrals a month. The contract was approved by the committee, and under second reading suspension, will not be heard by the full council.

The next contract in the series is with United Way for nearly $1.1 million for emergency food purchases to fight area hunger. The contract is a one-year extension through the end of 2018. The contract is a joint collaboration between the United Way of Greater Cleveland, Cleveland Foodbank, and the Hunger Network. United Way presented on the services that they offer at a previous HHSA meeting. According to Mr. Math, the money is used to distribute food at 38 different sites across the county. Chairwoman Conwell said the network distributed 6.4 million pounds of food for 2016 and 4.3 million in the first three quarters of 2017 at the distribution sites, reaching 70,000-80,000 people per quarter. This was moved to the full council under second reading suspension.

The final contract in the series is with Catholic Charities, another program where Cuyahoga County provides case management to participants in the work assistance program. This program provides individuals enrolled in the cash and food assistance programs with a specific case worker who can help identify and address barriers (substance abuse, mental health, domestic violence, for example) to more sustainable employment. Additionally, case workers may be able to assist individuals to apply for disability assistance benefits and help them through the process, if appropriate.

Mr. Merriman explained how the Comprehensive Case Management Employment Program (CCMEP) is for cash assistance recipients 14-24. Mr. Merriman explained that Maximus and Catholic Charities work in very close proximity to each other, often with the same clients, and are able to connect clients to the OhioMeansJobs center, which is located in the same building.

Chairwoman Conwell asked about county oversight on these programs. Mr. Math shared that with all contracts, there is a robust evaluation system in place.  Each one of the contract awardees must submit a monthly report, quarterly report, and year-end report.

Having no more questions, the contract extension was passed under second reading suspension to the full council.

The next contract is for the Centers for Families and Children (C4FC).  C4FC has been a longtime provider of job search, job readiness, and job placement programs, and in cooperation with El Barrio has now added a job skills center. This is an on-boarding service. When a person requests cash assistance, he/she goes through a classroom experience that defines what work is required for participation. There are rules and laws in place that are meant to protect the worker, and it is important that they understand what rules are in place.  If a person doesn’t complete the training, they don’t receive cash assistance. The individuals who participate in these cash assistance programs often end up working at facilities that can lead to subsidized employment opportunities at places such as  CVS, Starbucks, and local hospitals. The pharmacy that is owned and operated by C4FC is one facility where workers have the opportunity to learn skills that prepare them for work in other retail pharmacy locations.

Bob Math added that the contract is also outcome-based, with payments made to C4FC depending on the number of people who keep their jobs for one month and retain their job for one quarter.

Councilmembers were interested in knowing how these contracts are scored. Mr. Math informed the committee that five different organizations bid for this contract. Each response is reviewed by a proposal review team, comprised of four reviewers. After reviewing the responses, the team grades each response and ranks them.

Councilwoman Baker wanted to explore the barriers to job placement. She asked about the biggest barrier.  Mr. Merriman shared that there are multiple factors at play, but education plays a big part, including the process of getting a GED. He also said that there are three different high-school equivalent certifications in addition to the GED, and that they are offered at several sites across the county, including Tri-C, Polaris, Seeds of Literacy, and Parma Adult Basic Education and Literacy (ABEL).

The contract extension was passed on second reading suspension, and passed unanimously to the full council.

The final contract was for a company called Verge, Inc. for $700,000, also for workforce readiness.  This was one of the top responses to the RFP, which was also issued for C4FC.  The contract was approved by second reading suspension and forwarded to council unanimously.

December 6, 2017

The December 6, 2017, meeting of the Cuyahoga County Health, Human Services and Aging (HHSA) Committee sought to approve three contracts from different county agencies that needed approval before the end of 2017.

Bob Math, contract coordinator for the county, testified on a contract extension until December, 2018, worth nearly $2.5 million, with the County Prosecutor’s office to provide legal counsel to the Department of Children and Family Services (DCFS).  The office handles court filings, as well as represents county staff on every case that is filed.  Currently, attorneys are tasked with about 130 cases, which is leading to increased burnout and high turnover.  Additionally, the number of kids in foster care is increasing, due in large part to the opioid epidemic.  The contract amount increase will allow for the hiring of two additional attorneys to better distribute the workload.  The contract was passed to the full council for third reading.*

The second item on the agenda was a large master contract award for $43 million to 35 providers which provide out-of-home foster care and residential care for children under the custody of DCFS. There are currently 2,000 children in DCFS custody, and 56 percent are in out-of-home foster care, according to Mr. Math.  Sixty-eight (68) percent of children are located in Cuyahoga County, 29 percent are in Ohio but outside of Cuyahoga County, and a small percentage (3 percent) are out of state due to extenuating circumstances based on the needs of the children.

*Note: The contract was accidentally forwarded to the full council under second reading suspension due to an administrative error (was supposed to be for third reading), however there were no objections from HHSA Committee members, and the contract was approved under second reading suspension by the full council.

  • Adelphoi Village, Inc.
  • Applewood Centers, Inc.
  • Artis’s Tender Love & Care, Inc.
  • The Bair Foundation v. Beech Brook
  • Bellefaire Jewish Children’s Bureau
  • BHC Belmont Pines Hospital, Inc.
  • BHC Fox Run Hospital, Inc.
  • Caring for Kids, Inc.
  • Carrington Youth Academy LLC
  • Catholic Charities Corporation
  • Christian Children’s Home of Ohio, Inc.
  • The Cleveland Christian Home Incorporated
  • Cornell Abraxas Group, Inc.
  • Detroit Behavioral Institute, Inc.
  • The Glen Mills Schools
  • House of New Hope
  • In Focus of Cleveland, Inc.
  • Keystone Richland Center LLC
  • Lutheran Homes Society, Inc.
  • Lutheran Metropolitan Ministry
  • National Youth Advocate Program, Inc.
  • New Beginnings Residential Treatment Center, LLC
  • New Directions, Inc.
  • OhioGuidestone
  • Ohio Mentor, Inc.
  • Pathway Caring for Children
  • Pressley Ridge
  • Quality Care Residential Homes, Inc.
  • Reach Counseling Services
  • Rite of Passage, Inc.
  • Specialized Alternatives for Families and Youth of Ohio, Inc.
  • Tri‐State Youth Authority, Inc.
  • The Twelve of Ohio, Inc.
  • The Village Network

According to Mr. Math, 30 percent of the contract is federal funding and 70 percent is from the HHS levy.

Councilwoman Conwell asked about the vetting process for foster care sites. Mr. Math explained that DCFS employees visit on a monthly basis.

Councilman Miller was interested in understanding the increased costs for some of the providers in the contract.  Mr. Math testified that some providers had raised their rates. He did not go into any detail about why some providers raised their rates and some did not.

Councilwoman Brown asked about available resources for parents whose children need increased amounts of support while in care. Mr. Math explained that there are six levels of care on the continuum, and those that are at the highest need have additional resources in order to maintain high quality of care. Sometimes, a child needs placement but there are no spaces available in Cuyahoga County, so that child may be sent to a nearby Ohio county that has availability.

The contract was approved under second reading suspension and moved to the full council for consideration.

Another master contract approved was for the Department of Senior Adult Services (DSAS) OPTIONS program, for $2.1 million. Paul Porter from the Department of Health and Human Services, on behalf of DSAS, testified that the contact was for 21 organizations across the county.

Councilwoman Conwell asked how often the organizations were monitored by DSAS, to which Mr. Porter replied that DSAS conducts client surveys every six months to ensure customer satisfaction.

  • A-1 Health Care, Inc.
  • ABC International Services, Inc.
  • Buckeye Homecare Services, Inc.
  • Casleo Corporation
  • Critical Signal Technologies, Inc.
  • Family & Community Services, Inc.
  • First Choice Medical Staffing, Inc.
  • Geocare Inc.
  • Home Care Relief Inc.
  • Priority Home Health Care, Inc.
  • Renaissance Home Health Care
  • Rose Centers for Aging Well, LLC
  • RX Home Healthcare Inc.
  • Senior Transportation Connection
  • Solutions Premier Training Services
  • The Benjamin Rose Institute
  • TOBI Transportation LLC
  • Transport Assistance, Inc.
  • U First Homecare Services, Inc.
  • Visiting Nurse Association Healthcare Partners of Ohio
  • Xcel Healthcare Providers Inc.

Marlene Stabler, executive director of DSAS, testified that DSAS is looking at new providers to serve people on the east and west sides.  The contract was approved under second reading suspension and forwarded to the full council for consideration.

Next was a contract with Lutheran Metropolitan Ministries (LMM) for $533,000. Adult Guardianship services are provided in collaboration with the Probate Court. Kendra Daniel, testifying on behalf of Lutheran Metropolitan Ministries, told the committee that there is currently a waiting list and a shortage of guardians, both locally and nationally.

The contract was approved by the committee under second reading suspension.

The final contract was for Frontline Services for $1.2 million to provide temporary housing services for the Northpoint shelter at East 15th St. and Superior Ave.  Frontline was the only respondent to the RFP. The contract is for temporary shelter for adults and youth, in addition to wraparound services to help secure permanent housing in the future.  In partnership with the City of Cleveland, the shelter is meant to help those who are experiencing a housing crisis. The shelter contains about 160 beds, with 50 of those beds reserved for youth aged 18-24.The average stay at the facility is three to five months.

Councilwoman Conwell asked about security at the shelter, as the committee has heard many reports of security issues at the Norma Herr shelter in the past. Xavier Moore, facility manager at the Northpoint facility, assured the committee that they are not experiencing uncontrollable security situations, including that they have recently hired more staff. Lahman Busbee, intake manager at Northpoint, explained to the committee that there is a consistent effort made by staff to connect those young adults who are in need of emergency housing with a family member or loved one, who may not know that he/she is homeless and in urgent need. Councilman Scott Tuma was interested in knowing why the facility is experiencing an increase in the number of young adults, to which Mr. Busbee said that there has been an increase in the number of young people in the LGBTQ community who are in need because they face more challenges in the community. Additionally, there are young people who have aged out of foster care and are in need of temporary emergency shelter. Currently, all but two beds are filled at the 160 bed facility.

The contract was passed under second reading suspension and the meeting was adjourned.