Current Funding Streams – Directly or Indirectly Related to Reporting and Investigating Suspected Abuse of At-Risk Adults clients Existing Funding Sources Adult Protective Services (APS) annual allocation of State General Fund & matching funds by counties (80/20), and approximately $1.96 million in federal funding (SSBG). No federal APS funding exists.

What’s it pay for? Funding supports county adult protective services as they answer phones, record calls, investigate reports within prescribed timeframes, identify community resources to enable at risk individuals to remain selfsufficient, provide legal support and representation and provide on-going case management, when appropriate.

The Gap When mandatory reporting became effective 7/1/14, there was an increase in reports to APS of 41% over the prior fiscal year, with funding provided for only a planned 15% increase in reports. Funding was also tied to a 25:1 caseload ratio for APS workers. The increase in reports has driven the current caseload ratio to: 30:1.

Flexible Funding? No

$1 million for Client Services allocated from the State General Fund

Funds available to counties for one-time expenditures for clients’ needs (including I/DD population), which are unavailable through other government or community benefits/programs and the client is unable to afford to purchase the service/product. Services may include emergency shelter, home repairs or modifications, medical specialist evaluations, assistive technology, etc. Training funds provided to CDHS to train county caseworkers, supervisors and case aides. Funding supports four day training academy and covers the lodging for county staff, facility

If additional investigations are required of county APS, I/DD population will likely require extensive services to address their needs that are not available currently in the community.

No. Dedicated to client services.

Additional funding will be needed to provide specialized training for county APS workers.

No.

Annual APS Caseworker Training funds - $80,000 CDHS

fee and materials. County General Fund – Law Enforcement Workload

Annual budgetary requests by law enforcement to local governments to address state mandates.

Voter approved mill levies for DD services.

Roughly 15 counties have dedicated mill levies to serve the DD community. Funding pays for services dictated by voters. To provide quality assurance including investigation

$25.51 per person enrolled paid by DD system to CCBs (50% general funds and 50% federal match) HCPF – I/DD cash fund – one time use, not ongoing

Waiting list reduction

Unfunded mandate. No state general fund dollars have been appropriated to address the increased workload assumed by law enforcement. Typically DD mill levies equal 1 mill. Current funds are not meeting the need for funding for CCBs to serve in this capacity These funds are not available since they are committed and are one time use funding

Possible New Revenue Sources Revenue Source

Marijuana Taxes

Overall Viability Not likely Likely to to generate generate substantial substantial and and sustainable sustainable revenue revenue X While marijuana taxes may be currently designated for other uses, voter approval to retain the $66M from the past year might free up some general fund. Marijuana taxes could be designated for mandatory reporting in future years.

Revenue Source VOCA Funds

Overall Viability X

Surcharge on birth/death certificates

X

Increase in county fees for various financial and legal documents

X

Create a means test for the senior homestead exemption and use the balance for APS OAP sponsor deeming savings

X X

Federal VOCA funding tripled in the past year and the Federal regs are being changed to encourage states to use a portion of this increase for APS. Statute authorizes the Colorado Department of Public Health and Environment to set birth and death certificate fees that reflect the Office of the State Registrar’s direct and indirect costs. A recent $3 dollar increase on death certificates resulted in roughly $700,000 to be used for a new electronic death certificate registration system. An additional increase is not likely, nor would it generate sufficient funds. The fees associated with many of these documents have not been changed for years. While some may have a nexus to APS, others do not. Means testing the homestead exemption requires a constitutional amendment. In 2010, the General Assembly passed HB 10-1384, which modified the Old Age Pension (OAP) program provisions related to qualified aliens who apply for the state’s OAP cash benefit. The bill delayed eligibility for qualified aliens to receive OAP benefits until they have been in the United States for at least five years. The Bill had two phases, the first was estimated to generate a $13 million savings to the General Fund in the first year of implementation and approximately $14 million in savings in subsequent years. The second phase is expected to save an additional $15 million annually beginning in FY 2013-14. Unused OAP savings flow into the General Fund. All or a portion of these projected savings could be used for mandatory reporting and related infrastructure

Revenue Source

Overall Viability improvements without negatively impacting existing funding for other programs. This legislation has already been passed so there is no identified downside related to this option.

Medicaid targeted case management

X

Medicaid case management services help beneficiaries receive care by identifying needed services, finding providers, and monitoring and evaluating the services delivered. Targeted Case Management (TCM) refers to case management restricted to specific beneficiary groups defined by disease or medical condition, by geographic regions, or other groups identified by a state and approved by the Centers for Medicare and Medicaid Services (CMS). TCM reimbursement is currently used for APS in at least eight (8) states with an average annual reimbursement of approximately $1,000,000 per state. Adults currently receiving TCM in Colorado include Medicaid eligible persons with:  A developmental disability;  A mental illness who are in need of case management services; or  A need for substance abuse treatment. TCM reimbursement could be a viable source of funding for Colorado APS as it is estimated that APS caseworkers assist up to 50% of their clients with applying for and accessing Medicaid services. However, TCM spending has increased rapidly and adding another target population may be challenging as it requires a state plan amendment

Revenue Source

Overall Viability to the Centers for Medicare and Medicaid Services. Coordination with current TCM providers, the CDHS divisions of Developmental Disabilities, and Behavioral Health, could minimize any perception of competition for funding. Workload considerations at the county level include requiring caseworkers to track their time, meet educational eligibility requirements, and county participation in post payment reviews of TCM.

Surcharge on probate cases on wills Long-term care estate recovery

X X

Adding an additional surcharge to the probate of wills could result in $60,000 - $120,000 in revenue, depending on the surcharge amount. Federal regulations may prohibit this option.

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