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LEADERSHIP AGENDA

OPERATIONAL SCAN

DEPARTMENT PERFORMANCE

Human Services

Charles Krogmeier, Director

Mission Statement:
The Mission of the Iowa Department of Human Services is to help individuals and families achieve safe, stable, self-sufficient, and healthy lives, thereby contributing to the economic growth of the state. We do this by keeping a customer focus, striving for excellence, sound stewardship of state resources, maximizing the use of federal funding and leveraging opportunities, and by working with our public and private partners to achieve results.

Measures:
Preventing hunger
Children safe from re-abuse
Children's health care access
Child support due that is collected
Dollars saved through the Pharmaceutical Preferred Drug List (Iowa Medicaid) program

•  Performance Plan - How we measure our progress


•  Strategic Plan - How we plan for progress


•  Performance Report - How we report for progress


• Department Home Page - Learn more about this department

Why this is important:
Food assistance prevents hunger and helps families meet their basic nutritional needs and increases the family's nutritional levels. Preventing hunger is one of the building blocks in all of social service. It doesn't solve all of a family's problems, but other problems are more manageable if hunger is not an issue. Many people receiving food assistance are on fixed incomes. Food assistance allows seniors to not have to make the difficult choice between buying food or prescription drugs. In addition, the Food Assistance program stimulates the economy for the benefit of all Iowans. The U.S. Department of Agriculture has estimated that every $5 in food assistance generates $9.20 in local and state economic activity. The Food Assistance Program brought $380,572,498 into Iowa in FY09. In a monthly average of 130,581 households and 284,250 recipients received food assistance through the Food Assistance Program - an increase of 21.4% in dollars and 14.2% in the number of individuals served over last year.

The Commodity Supplemental Food program serves low-income working families and the elderly in Central Iowa. Approximately 3,255 Iowans are served monthly - 95% of whom are elderly. 1.1 million pounds of commodities were distributed to these families in SFY2008.

The Emergency Food Assistance program distributes food to low-income Iowans through eight food banks statewide. Emergency food was distributed to approximately 224,000 individuals per month. 3.6 million pounds of commodities were distributed through this program in SFY2008 and in the first have of SFY2009 5.4 million pounds were distributed.

What we're doing about this:
Recognizing many eligible Iowans are still not receiving Food Assistance, DHS continues to find ways to make this important nutrition benefit available. Of particular concern are senior citizens and working families who may not realize that they could get help. DHS is able to reach out to seniors and the low-income public in several ways through collaboration with the Food Assistance Nutrition Education program. DHS outreach provides information on good nutrition, the benefits of activity, and how Food Assistance can help.

The Food Assistance program is also achieving results by promoting a new multi-program online application, continuing to support Electronic Benefits Transfer (EBT) access at Farmers' Markets, and utilizing a new statewide Customer Service Center for clients to call to report changes. The new online application for Food Assistance, Family Investment Program, Medical Assistance and Child Care Assistance is available at www.Oasis.Iowa.gov.

Why this is important:
This measure is an indicator of the safety of children and the effectiveness of communities, providers and the department working together to ensure children are safe from repeat abuse or neglect. Child neglect is considered "denial of critical care," failure on the part of a person responsible for the care of a child to provide for the adequate food, shelter, clothing or other care necessary for the child's health and welfare when financially able to do so or when offered financial or other reasonable means to do so. In 2007, 79% of child abuse in Iowa was related to denial of critical care.

Additionally, the Department seeks outside multidisciplinary oversight to ensure the child protection system is keeping children in Iowa safe from abuse. The Iowa Child Death Review Team and Citizen Review Panels identify strengths and weaknesses of the child protective service system as a whole. The Death review team reviews all records pertinent to the deaths of children ages 17 and younger, in order to recommend to the legislature public initiatives and changes that will reduce or prevent such deaths in the future. The Citizen Review Panels specifically review current policy, review consistency of practice with current policy, analyze trends and recommend policy based on their reviews.


What we're doing about this:
The Department continues to research and implement best practices in child welfare to improve our results success. The use of Family Team meetings to provide the family with support and focus on the safety of children; standardized risk and safety assessment tools, statewide safety training with providers and department staff; expansion of the service array to include Safety Services and Family, Safety and Permanency Services; regionalized abuse registry and assessment ensure consistency statewide; engaging community partners in the development of community based child welfare services and supports; standardization of data; and integration of a quality assurance review process into everyday practice.

Why this is important:
Access to health care improves health, wellness and quality of life. Healthy children are able to attend school, learn, grow, develop healthy lifestyles, and become productive adults. Iowa provides public health insurance to over 220,000 children (approximately 217,000 in Medicaid and 21,500 in hawk-i). Overall, about 5.4% of Iowa children are uninsured, about half of whom are under 200% of Federal Poverty Level. In FY09, outreach programs and continuous eligibility have led to increased enrollment for children in Medicaid while generating fewer referrals from Medicaid to hawk-i.


What we're doing about this:
The department conducts grassroots outreach and media activities with the Department of Public Health as well as working cooperatively with schools, medical providers, businesses, faith-based and other organizations. A statewide mailing is sent to all school age children across Iowa at the start of the school year. The Department has developed an automated referral system from Medicaid. The hawk-i program makes referrals to Medicaid services.

Why this is important:
Current child support collected in the month due helps families have predictable income to use for the needs of the children. Current support also helps families avoid the need for public assistance. In State Fiscal Year 2009, the Child Support Recovery Unit served 191,446 cases. Those cases represent 675,804 parents and children.


What we're doing about this:
Workers in the Child Support Division locate absent parents, secure income-withholding orders, and, in the case of non-paying obligors, offset tax refunds and apply license sanctions. Iowa has developed joint offices with Nebraska and Illinois to improve payment rates of shared interstate cases. 69.52% of child support due was collected and a total of $346.8 million in child support was collected in 2009.

Why this is important:
The implementation of the Preferred Drug List (PDL) and the receipt of Supplemental Drug Rebates from drug manufacturers have played a critical role in containing the costs of prescription drugs in the Iowa Medicaid program. The PDL was implemented in January 2005 and has saved the state nearly $100 million to date (state dollars), or an average of 21% of the drug budget. Members continue to have rapid access to medically necessary non-preferred drugs through an extremely efficient Prior Authorization system that provides determinations in an average time of less than one hour. Since PDL implementation, supplemental rebates have averaged approximately $5 million (state dollars) annually. The PDL has also increased the federal rebates to the point where the state collects over 40% of everything it spends on drugs back in the form of rebates. The annual state share of these combined rebates is nearly $38 million.


What we're doing about this:
DHS implemented a Preferred Drug List and negotiated for Supplemental Rebates beginning January 2005. The federal Medicare Part D drug program shifted drug costs out of the Iowa Medicaid program for dually eligible Medicaid members to the federal Medicare program, resulting in a reduction of expenditures from 2006 to 2007, as seen on the chart. In 2006, the Department collaborated in the creation of the Sovereign States Drug Consortium that leverages their collective covered lives to negotiate for discounts in drug costs. Since its inception, this group, authorized by the federal government, has allowed the state to obtain better supplemental rebates. There are currently seven states in the group representing 1.2 million eligibles and over $1.3 billion in drug expenditures. Nearly $35 million have been saved in SFY 2009 through the Prescription Drug List and the rebate program.

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