The1st meeting of the Subcommittee on Families and Children of the Interim Joint Committee on Health and Welfare was held on Monday, July 25, 2005, at<MeetTime> 10:00 AM, in Room 129 of the Capitol Annex. Representative Tom Burch, Chair, called the meeting to order, and the secretary called the roll.
Members:Senator Katie Stine, Co-Chair; Representative Tom Burch, Co-Chair; Senators Charlie Borders, Tom Buford, Denise Harper Angel, Alice Kerr, Richard "Dick" Roeding, and Johnny Ray Turner; Representatives Bob DeWeese, Darryl T Owens, Ruth Ann Palumbo, and Addia Wuchner.
Guest Legislator: Rep. Graham.
Guests: Brenda Dennis, Lexington, Kentucky; Jean Miller, Susan Vessels, Becky Lewis and Kathy King, 4-C; Elizabeth Caywood, Carla Combs and Ruth Hebner, Department for Community Based Services; Karen Hamilton and William Smithwick, Kentucky Baptist Homes for Children; CarollAnn Busher and June Widman, EKCCC; Paula Bendl Smith, Kentucky's Children's Alliance; Gerry Roll and Carolyn May, Hazard Perry County Community Ministries; Amy Hood, Connie Jo Smith, Jill Norris, and Sherri Meyer WKU CCR&R; Heidi Schissler, Protection & Advocacy; Doris Elrod, Jennifer Beck Walker and Beth Carrico, Purchase Area Development District; Connie Willoughby, California DayCare; Debbie Walton, Department for Public Health; Bonnie Thorson Young, Seven Counties Services; Bart Baldwin, Kentucky Children's Alliance; and Anne McArthur, A-C.
LRC Staff: DeeAnn Mansfield, Murray Wood, and Cindy Smith.
The first item on the agenda was an update on First Steps by Dr. Steve Davis, Deputy Commissioner, Department for Public Health, Cabinet for Health and Family Services. Dr. Davis said First Steps serves children with developmental delays from birth to age 3. In March FY 04 by administrative order, the First Steps program was transferred from the Commission for Children with Special Health Care Needs to the Department for Public Health. Workgroups began the redesign process based on the three following principles: (1) children will receive necessary services; (2) families will receive necessary supports; and (3) the program will stay within the budget. In June FY 04 statewide provider training began and in July FY 05 new regulations were established and the new redesigned program began. Next, he reviewed the results for FY 05. He said children and families are receiving necessary services. There is a safety net in place for children to assure needs are met. The workgroup continues to develop long term recommendations and the FY 05 expenditures are below budget. He noted that the number of children served in FY 04 was 11,511 and the number served in FY 05 was 11,052. He said the total budget for FY 05 was $36.3 million. He said the next steps are to have a focused effort on finding children in need; continue training on evidence based practices; have additional administrative efficiency; have a focused effort on utilizing private insurance; develop pilot sites for innovative service delivery; and have a focused effort on child and program evaluation.
Senator Borders asked about why $36 million was needed if they only spent $31.4. Dr. Davis said there was several million that wasn't drawn down from Medicaid because the expenditures weren't there. The budget estimate was the best they could get. Services were delivered to all enrolled children.
Representative Owens asked if all the children were being served. Dr. Davis said all the children referred into the program are being served. He said there are more children in the state that need to come into the program. Representative Owens asked if anything is being done to identify those children. Dr. Davis said point of entry sites are out there to identify those in need of services.
Senator Buford asked if state employee's children are eligible for the program. Dr. Davis said they are. Senator Buford asked if there is any billing to insurance companies. Dr. Davis said there has been, but with minimal success.
Representative Burch noted that First Steps is the last payor, not the first. He also cautioned the committee that children without special needs are using up the lifetime value, but most kids will not use up that benefit.
Senator Roeding asked if there is opposition to add this to the waiver request. Dr. Davis said he will make a note of that and he will find out how the program officers will respond to that.
The next item on the agenda was an agency overview, by Tom Emberton, Commissioner, Department for Community Based Services, Cabinet for Health and Family Services. Commissioner Emberton noted that improvements are being made with the qualifications of staff. He said the three projects currently being worked on are (1) modernization project; (2) House Bill 298 implementation; and (3) the Council on Accreditation.
Jason Moseley, Director of the Division of Policy Development was present to speak about the implementation of House Bill 298. He said that House Bill 298 established the Elder Abuse Committee, which met several times and has developed four subcommittees. Currently there are draft regulations in form now and they hope to have that regulation filed as an emergency regulation on September 15, 2005.
Senator Roeding asked how the emergency regulation was drafted. Mr. Moseley said the Committee members looked at the regulation and share their ideas and concerns. They then took recommendations back to work the regulation through the process. They also submitted their comments to the staff of the Administrative Regulations Review Subcommittee.
Commissioner Emberton said they are moving toward the modernization of the Department for Community Based Services in order to streamline the system based on data and technology. They are working on federal agency approval and are optimistic.
Next, Ruth Hebner, Child Care Researcher said that assessment is the cornerstone of service delivery and needs to be developed. They are engaged in new ways of doing the assessment across the life of the case. They will process key elements not seen in other places. They developed a risk assessment and structured scales that rate actual issues in the life of the case. It is being tested in two regions in Northern Kentucky as well as in clinical usefulness and will be finished in September or October.
Representative Palumbo asked if certain companies helped prepare the assessment. Ms. Hebner said that the concept was looked at for three years, and they looked at the research out there, but are using internal people for the assessment.
The last item on the agenda was a discussion on the Child Care Market Survey by Betsy Farley, Director, Division of Child Care, Cabinet for Health and Family Services. Ms. Farley said they surveyed child care providers across the state using NACCRRAware in April. NACCRRAware is a national data base which is used to maintain information for child care and available providers. They illustrated that geographical differences relevant to regions correlate to urban and non-urban status. There are three regions, Eastern, Central and Western. The categories are urban/non urban; infant/toddler, preschool, school-age; full-time/part-time; and licensed, certified or registered. The results show that 76 percent of providers will receive an increase at the 69 percent rate of reimbursement. Twenty four percent are currently at the 69 percent rate of reimbursement. There will be thirteen million in expenditures to facilitate the increase for all categories in all regions. Parental co-payments will be reassessed. In conclusion, she noted that the average increase to the provider is ninety cents per day per child. They are reassessing the model selected to determine urban/non-urban counties. Also, there could be an increase in provider participation.
Senator Stine asked if the ninety cent increase was publicized. Ms. Farley said it was in the state plan, which was sent out to many people, including to Health and Welfare in April.
Representative Burch asked how Kentucky ranks in comparison with other states. Ms. Farley said they are interested the same thing and that other states turned in their plan on June 30.
Senator Buford asked when the reviews will be complete. Ms. Farley said at the end of July, or first part of August. Senator Buford asked when they will be prepared to file the regulation. Ms. Farley said in October or November.
Representative Owen asked for confirmation that the survey determines the money the state will pay and it is done every two years. Ms. Farley said they evaluate on an on-going basis and will adjust rates as necessary.
Next, there was a discussion on the Provision of Child Care Resource and Referral Services. Senator Stine asked for an overview of the current service provided. Paula Bendl Smith, Director of the Kentucky Child Care Network was present, and noted that she was not prepared to testify due to the current protest of the contract with the University of Kentucky, and thought the audience members would like to speak about the CCR&R resources. She said that CCR&R agencies are local, non-profit agencies in Kentucky. There are ten agencies serving 15 Area Development Districts. They represent a diversity of nonprofit agencies. She said the Child Care Network was formed in 1992. There are expected outcomes to meet specific services. They service families and child care providers then line the two together to give families tools to identify quality child care. They help to link CCR&R agencies and promote the STARS Program. She said that 45,000 providers received training in the last 5 years at 9,000 training events. She reported that there are 690,000 kids in Kentucky who have both parents at work and there are 165,000 regulated slots in Type 1 and Type 2 care.
Senator Stine asked for definitions what Type 1 and Type 2 care. Ms. Smith said Type 1 is in-home certified family child care and type 2 is larger family child care home.
Next, members of the audience were able to speak about their experiences, but were cautioned not to speak about the child care contract issue.
First, Doris Elrod spoke about the needs of childcare providers in the Purchase Area. She is also the founding member of Guardian Angel, a full service child care facility. She noted that without the assessment of the PAD staff, she could not be in operation, even if other funds were found.
Next, Connie Willoughby said she is the Executive Director of two United Way agencies in federal housing project. There are children in her facilities that are growing up in poverty. She serves 250 children who need to be provided high quality care in order to be able to stay away from issues that got their families where they are.
Next, Susan Vessels, Executive Director of 4C said that 4C is the oldest CCR&R in Kentucky. They serve families from the KIPDA and Lincoln Trail District. They benefit over 50,000 children. The staff received advanced training. The local CCR&R is ready to implement the programs. She also said the R&R's know of the great desire for assessment and technical support.
Next, Gerry Roll from the Hazard Perry County Community Ministries said there are 300 children in three centers. Seventy five receive assistance. Twenty eight percent of their parent's income is spent on childcare, which means 60% of their total income is spent on childcare and housing, while their total pay is very little, even with a two year degree. Child care workers make $6 an hour, which is terrible. Twenty-five percent of her families can't afford to pay for childcare.
Next, Ann McArthur, a mother of two said she has worked for ten years in daycare. She said there are 50,000 children in the Stars Program in Kentucky. Also, 3800 staff received scholarships. She has witnessed the success of the Kids Now Program and the Stars Program. The quality of care has improved due to those programs. She has also seen learning through a play environment increase. She said that thankfully the cost of childcare has not been an issue for her family and she has seen the benefits that investment can make.
Next, Brenda Dennis spoke about her center in Fayette County. She said there are 144 children at her center. She has changed two centers that needed to be better into top rated centers. She also said that in her opinion the Stars Program will not work and it should not be under Licensing and Regulation, but should be with the Child Care Council.
Next, Jean Miller, an in-home provider spoke. She said she was nationally accredited on July 1, and noted that in-home childcare is more than just a babysitting service. She also praised 4C for their continued support and said they are very much needed.
The meeting was adjourned at 12:17 p.m.