Street roots., August 02, 2013, Page 7, Image 7

7
street roots
Aug. 2, 2013
rinn Kelley-Siel
We can ‘change
people’s lives'
As Oregon recovers from the recession, the state's new director o f
H um an Services looks at meeting the needs o f a growing demand
BY A M A N D A WALDROUPE
away from barely being able to serve and
meet people’s most basic needs to really
hen Erinn Kelley-Siel became
being able to concentrate on the kinds of
interim director of Oregon’s
services that change people’s lives. There
Department of Human Services in
are some programs where the goal isn’t for
February 2011 and permanent director people
two to need our help, but to get the right
months later, she didn’t have a lot of time to
amount of help at the right time. Most of
get used to her new job.
the focus (during the recession) was on how
The recession caused caseloads for many
do we help the family stabilize today, to
of DHS’ programs — including food stamps,
keep their housing or pay their bills. That’s
child welfare services, foster care and the
an important conversation. Now we want to
Temporary Assistance to Needy Families
be able to pivot and ask, where do you see
(TANF) program — to skyrocket: since
yourself in 12 months? Having that
January 2008, the number of Oregonians
conversation with clients is one, frankly, that
receiving food stamps increased by nearly
we haven’t been able to have because we’ve
been trying to triage. I think for almost
70 percent, and the number of people on
every population we serve, we’re starting to
the TANF program grew by 80 percent.
turn a corner.
At the same time, the agency’s budget
has been cut for the last 10 years and has
A.W.: Over the last few years, there have
not had the funding to provide services to
been proposals from Governor John Kitzhaber
every person needing them. Kelley-Siel
and the Legislature to drastically reduce
compares DHS’ work during the recession
fu n d in g for the TANF (Temporary Assistance
to a MASH unit doing triage.
to Needy Families) program, including
The combination of steep cuts and
shortening the lifetime lim it that someone can
increased service demands motivated
Kelley-Siel to put the agency’s programs and be on TAN F to 18 months, despite the fact that
the program has proven to be very successful.
services, and how they’re administered,
What is it about the TAN F program that it’s
through the wringer. She eliminated the
constantly on the chopping block?
agency’s divisions and its directors, and
began breaking down some of the agency’s
E.K.S.: One is the case management
E.K.S.: That’s a good question. It’s
bureaucratic red-tape to save money and
piece, and showing significant improvement
something I stay up at night and think
provide services more efficiently, earning
in terms of outcomes. Another is having
about. One of the areas in our budget that is
her a reputation as a change-agent.
performance-based contracts with JOBS
still in serious need is the TANF program.
This year, Kelley-Siel and the agency she
contractors and holding our service
It’s not easy to garner public support for
oversees is getting a reprieve. The
providers more accountable. I think the
public assistance programs. Legislators
Legislature did not cut the DHS budget for
economy turning around and us having
know that. In Oregon, our income eligibility
the first time in 10 years, instead increasing
some success under
threshold
is
really
it by 5.9 percent to $9.1 billion dollars. It
our belt in terms of
low. There were a lot
will allow the agency to hire 183 child
getting people to work
of families who
welfare workers and other caseworkers. It
will help a lot.
needed
the
help,
and
also gives the agency flexibility, Kelley-Siel
Another is making
I th in k theses a lo t of
I
would
regularly
get
says, to focus on increasing employment for
TANF part of a larger
emotion around public
some clients and focusing on long-term well­ communications from
conversation the
legislators, (who
assistance
p
r
o
f
rams
rig
h
t
being and self sufficiency.
governor is having
heard) from
now® (But) the federal
about the workforce
constituents. People
A m anda W aldroupe: When you became
system as a whole and
were frustrated about lavestment 1» the S H F
director o f DHS, the agency was faced with
workforce
program
hasxrt
gone
up
the people who did
caseloads quickly increasing because of the
development.
qualify and who didn’t. since 1966, and the cost to
recession and a budget with steep cuts. One of
Instead of turning
serTC people certainly Is ift
the big focuses o f your tenure is streamlining
A.W.: In January,
that into advocacy to
the agency's services and cutting bureaucracy.
approximately 400,000
the same/"
expand eligibility, it
When you think o f what the agency was like in
Oregonians will
turned into negativity
2011, what kind o f an agency do you see now?
become eligible for
about the people who
Medicaid as a result of
did qualify for it. I
the Affordable Care Act
E rin n K elley-Siel: In the past, we’ve
think there’s a lot of
taking effect. What impact will Medicaid
been an agency that has had a lot of
emotion around public assistance programs
expansion have on people served by DHS?
divisions, departments and programs. We’ve
right now. (But) the federal investment in
been pretty focused on compliance,
the TANF program hasn’t gone up since
E.K.S.: One of our overarching goals is to
administration and regulation. We’re moving
1966, and the cost to serve people certainly
get people on their own feet and help them
even more aggressively (to asking)... what
isn’t the same.
go to work. There is an inextricable link
are we trying to accomplish and what do
When we rebooted the TANF program in
between people’s ability to work and
people need and how, and not letting
2007, we saw almost instantaneous results
people’s ability to get to work. Some of our
process and bureaucracy be barriers to
around client engagement and participation.
clients have no access to health care. We’ve
service. One key to spending more time
Had we been able to continue that, we
got quite a few parents and children in the
with (clients) is having less paperwork and
would have been looked at as one of those
welfare system who don’t qualify for
depending on 30-year-old, disconnected
states in the country doing the right thing.
Medicaid services, that keeps their kid with
technology systems. In the last few years,
The problem was the economy hit (and
health needs from accessing treatment.
because of the recession, we ve been driven
caseloads increased). It was a Cadillac
Medicaid expansion is going to really impact
by crises. This last budget is getting ahead
program. It really met people’s needs, even
that group of people in a positive way. The
of those challenges, using the data we have
though the cost per person was high. That’s
other thing that is going to be really
to anticipate issues ... and encourage more
the debate we have to keep putting on the
interesting is how coordinated care
innovation.
table. The imperative around TANF is
organizations explore social determinants of
stronger now than before. It puts pressure
health [access to transportation, healthy
A.W.: You’ve recently described the 2013-
on us to help people help themselves.
food, housing, etc.] more. Their relationship
2015 budget, which is about 6 percent larger
with DHS is going to keep evolving.
S T A F F W R IT E R
W
than the last biennium ’s, as giving your
agency the ability to “set a new foundation for
how services are delivered. What is that new
foundation?
E.K.S.: Financially, we’re getting to pivot
A.W.: What ways can that perception of
TAN F - and the propensity to cut the
program’s budget — be changed?
A.W.: How do you see that relationship
evolving?
PHOTO
CO URTESY OF DHS
E.K.S.: One of the biggest challenges
with our clients is often some of the durable
medical equipment they need to be more
self-sufficient. In my world, I have the
“screw-for-the-wheelchair” story. There was
a mom taking care of her son who had been
hit by a car riding his bicycle when he was
eight years old, and is now significantly
disabled. She wanted to care for him at
home, as long as she can. One thing that
happened to her is that his wheelchair
broke. She needed a screw. She applied (to
Medicaid) to get the screw replaced. It took
eight weeks for them to respond, and she
didn’t get permission to replace it. That’s
the kind of stuff I’m optimistic will not be
part of the conversation anymore. All the
hoops she had to go through? It’s going to
be a no-brainer.
A.W.: In May, the Secretary o f State’s office
published an audit o f Oregon’s public
assistance programs showing that some DHS
clients receiving food stamp benefits and other
forms of assistance were actually ineligible for
those services, and that the state’s criteria for
determining eligibility is “expansive. ” How is
D H S continuing to respond to the audit?
E.K.S.: There were some suggestions
that the audit made that couldn’t happen.
There were also issues around this issue of
categorical eligibility where tightening up on
the administration of that may be
accomplished with a more stringent review
of those cases. But it would also cost quite a
bit in staffing resources, and require more
administration and more bureaucracy to
accomplish. Ultimately, the question is
whether the Legislature wants to invest its
General Fund resources to create more
capacity to do that kind of work. The audit
raised some pretty big policy questions. The
Legislature implicitly answered with the
DHS budget