COMPOSITION OF THE DC FY2000 HUMAN SERVICES BUDGET
The DC Human Services budget is divided between some 20 agencies and administrations, all with specific functions dealing with the needs of the underprivileged residents of our nation's capital. A total of $1840 million is projected for FY00, growing to $2110 million in FY03. 55% of the FY00 funds are provided by the federal government, which also supports almost half of the 5860 full-time government employees. Many other personnel, including hospital workers, are carried under contracts with private concerns.
There are two major and quite separate functions carried out by DHS. Somewhat surprisingly, the predominance of these dollars and personnel are devoted to health functions, while only one- quarter go to taking care of the other needs of the poor. This is shown on the table below:
DIVISION BETWEEN HEALTH AND HUMAN SERVICES
Six different agencies (or funds) in addition to the Department of Health deal with health issues, and three of them are in receivership, as indicated on the table below. NARPAC's daily headlines provide a running record of the continuing problems prevalent in these areas:
MAJOR SUBDIVISIONS WITHIN HEALTH SERVICES
* = In Receivership
Child and Family Services deals primarily with about 3200 children in foster care, many of whom appear to have been exploited by private contractors. The Commission on Mental Health Services--also in receivership--treats some 9,000 disturbed residents, ranging from adult inpatients at St. Elizabeth's tragically outdated, oversized hospital, to community clinical programs. It involves well over 2200 government workers. The Corrections Medical Receiver provides health services at the Central Detention Facility--known generally as the DC Jail.
The DC Office of Aging provides care, food, counseling, and legal services to some 35,000 senior needy, both dependent and independent, using 26 FTE's and $19.2M. Their capital budget includes $9M for two new Senior Wellness Centers. It provides, amongst many other things, half a million home-delivered meals, and almost half a million one-way local transportation trips per year.
The Disability Compensation Fund addresses the needs of some 1200 current and former DC employees who have sustained on-the-job injuries, and is administered by the Department of Employment Services. Well over 3000 new injuries are reported every year--within a workforce of some 32,000 people--for an injury rate approaching 10%, which seems very high.
The Public Benefits Corporation was established to finance the uncompensated needs for health care and service delivery of DC residents. Beneath this seemingly simple budget line item lies a tale of three DC hospitals (DC General, SE Community, and Howard U) and many clinics trying very inefficiently to provide basic health services to DC's unusually large population of uninsured residents, many of them young. SE Community hospital, East of the Anacostia, is deeply in debt and kept open only by heroic financial measures. Although the new mayor proposed to start funding insurance premiums and stop funding inefficient hospitals, the condition of these facilities is such that they cannot survive on Medicare/Medicaid reimbursement rates. The Council severely curtailed the mayor's proposal before forwarding the budget to the Congress. This promises to become a larger issue in the near future, as a specially appointed commission looks into the future of DC's public hospitals.
Hospital problems are further exacerbated by the influence of the seven new Medicaid HMOs. Between 1996 and 1998, those HMOs cut hospital use from 670 hospital-days/1000 recipients to 334, and the DC Hospital Association insists that Medicaid has underestimated the extent of those cuts, according to newspaper accounts in June, 1999.
But the costs of these operations is small compared to the expenditures by the Department of Health itself:
AGENCIES WITHIN DEPARTMENT OF HEALTH
The Department of Health budget has nine separate line items: two of which comprise the management of the department itself, Management Support (offices of the director, administrator, and general counsel) and half the DHS Chief Financial Office. The department has two major functions: to administer the Medicaid program for about 125,000 low income individuals, and to provide for the public health of all DC residents.
The Medical Assistance Administration will spend almost half of all DHS funds--some $838 million in Medicaid funding, of which about $251 million will be raised through local taxes. If approved by Congress, it will also begin to insure a few of DC's 89,000 uninsured poor: 2400 childless adults and 500 kids in need. Medicaid funds are spent in three distinct categories: about $210M for some 8800 aged; $360M for over 26,000 disabled; and another $210M for over 90,000 TANF recipients. For the first time, the DC Council made a token cut in the IMA budget request, claiming it had failed in prior years to spend all it received.
Public Health functions include the registry of about 15,000 newborn; providing for several thousand at risk or living with HIV/AIDS through the Agency for HIV and AIDS; and providing services for prevention and control of air pollution, abatement of asbestos and lead hazards, regulating hazardous waste, and providing inspections of food (some 16,000 food establishments), drugs and medical devices, through the Environmental Health Administration.
The State Health Affairs Office includes five separate program offices:
These are clearly not "normal" municipal functions.
DC's Public Health Service provides nutritional services to low income residents, operates three medical clinics, and oversees the School Health program. It's Y2000 goals include decreasing the low-weight birth rate of DC kids and the high infant mortality rate, and ensuring accessibility to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) for some 30,000 recipients, the Commodity Supplemental Food Program (CSFP) for over 15,000 beneficiaries, and the Farmer's Market Nutrition Program. DC's infant mortality rate of 22.8/1000, resulting from a rate of 25.7 for black mothers, is one of the worst in the nation for blacks as well as others.
The Preventative Health Services department is responsible for developing health promotion and disease prevention. It will provide information on care for the newborn, immunize about 14,000 kids, and "reduce the risk behavior associated with tobacco use". In addition to the $11.7 million to be spent here, The Addiction Prevention and Recovery Administration will spend $32.4 million to: implement a uniform "gate-keeping" system to assess needs based on severity of addiction; outsource the Detox Center at DC General Hospital; reduce the sale of tobacco to minors; improve access to treatment services; and "improve staff resources and implement systems related to performing the Single State Agency function".
Despite the efforts of some 3900 DC employees, health conditions among DC's very large low income population are likened to those in the "Third World", and many of the agencies have been called dysfunctional, in stark contrast to the exceptional care provided to those in DC's surrounding suburbs. The transition team's report on Human Services suggests.
"Across all human services area, partnerships must be created to elicit and involve the resources of the private and non-profit sector in tackling the City's problems. The district must take full advantage of available federal funds, exploring federal/local partnerships where appropriate. And where models exist--locally, in the region, or in the nation--we must take advantage of their experience as we improve our own initiatives."Human Services
The remaining quarter of DHS funds and manpower are devoted primarily to human services such as income supplements, and again there appear to be more than enough separate agencies, funds and government workers addressing the problems:
MAJOR SUBDIVISIONS WITHIN HUMAN SERVICES
# = Not Included in Totals
Five different agencies/funds are involved in this work. The major ones are the Department of Human Services itself (see below), and the DC Department of Recreation and Parks with its $26 million budget and 539 employees (see next section.
The other three budget lines items are important, but small in terms of budget impact. The Unemployment Compensation Fund of $7.2 million is administered by the Dept of Employment Services, and relates to the over 16,000 recipients among the well over 20,000 unemployed, about evenly split between male and female, three-quarters minority, and about half living East of the Anacostia River. There is also a small Office for Human Rights and Minority Business Development, and an Office for Latino Affairs. DC's Latinos will soon reach 10% of the City's total population.
But over 95% of the Social Services budget is spent by the eleven different funding centers within the Department of Human Services:
AGENCIES WITHIN DEPARTMENT OF HUMAN SERVICES
* = under court orders
The "front office" of this department uses about 10% of available funds, and includes the Office of the Commissioner of Social Services, a large Management Support Staff, and the other half of the DHS Chief Financial Officer's staff.
The Division of Early Childhood Development coordinates efforts to expand and improve child development and early education services for some 6500 kids (est?). Included here are several federally funded grant programs including the ChildCare and Development Fund and the Head Start State Collaboration Project, reaching about 2000 youngsters. The Child Day Care Services Division administers DC's subsidized childcare for some 10,000 younger kids 6-weeks to 12 years primarily in TANF families (see below). A separate DC Early Intervention Program services another 10,000 infants and toddlers at risk of having "developmental delays".
The Income Maintenance Administration administers the Temporary Assistance to Needy Families (TANF) program which provides financial assistance to meet the needs of kids under 18 deprived of adequate parental support; the Program on Work, employment, and Responsibility (POWER) which is similar to TANF but serves families requiring special services due to medical incapacity or mental health problems; the General Public Assistance for Children(GPC) program which provides TANF-level support to kids residing with a unrelated (non-family) caretaker; and the federally-funded Food Stamp Program, administered by DC to well over 120,000 recipients. Funds for these programs come from two other divisions:
The Temporary Assistance for Needy Families Division contains federal and local funds used for cash payments ($72.4M), job training ($42.4M), and other supportive services. There are over 90,000 beneficiaries from the TANF program. The General Public Assistance (GPA) and Supplemental Security Income (SSI) Division contains federal and local funds for some 5000 GPC recipients, and perhaps 35,000 SSI participants. This division also supports about $1M for burial assistance and $2.3M for tenant assistance, i.e. housing subsidies for low-income, elderly, and disabled persons.
The Youth Services Administration uses almost $41 million to provide services to three court-ordered groups: youth detained for trial, youth committed as delinquents, and persons in need of supervision. Such services include drug treatment, counseling, and educational support. Some 4000 juvenile cases are referred to the courts by DC police annually. Many difficulties in this area have been the subject of recent daily headlines, and the YSA has operated since 1986 subject to a court order under the Jerry M. consent degree.
The Mental Retardation and Developmental Disabilities Administration services the sizable DC population of mentally retarded, another agency that has seen more than its share of public scrutiny in the press due to questionable management and contractor fraud. It operates under a 1978 court order, the Pratt Consent Decree.
DC will devote $24 million to Its Family Services
which has five separate responsibilities:
Finally, the Rehabilitation Services Administration will use $20 million to prepare persons with disabilities to enter and maintain gainful employment. There are over 25,000 disabled persons living in DC.
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NARPAC, Inc. has virtually no expertise in these areas, and therefore cannot judge the effectiveness of any of the above listed programs, from Medicaid payments to Homemaker Services. But in a city whose government workforce has been largely patronage-based, whose more highly visible services such as public safety and education have been declared largely dysfunctional, and whose health and welfare statistics are abysmal, it defies any rational logic that these human services functions are being well performed, or that the beneficiaries are being well served. Nothing could speak more strongly for much stronger regional cooperation in the funding and administration of metro area "poverty-sharing" to such a large accumulated population of needy Americans.