When Erinn Kelley-Siel became interim director of Oregon’s Department of Human Services in February 2011 and permanent director two months later, she didn’t have a lot of time to get used to her new job.
The recession caused caseloads for many of DHS’ programs — including food stamps, child welfare services, foster care and the Temporary Assistance to Needy Families (TANF) program — to skyrocket: since January 2008, the number of Oregonians receiving food stamps increased by nearly 70 percent, and the number of people on the TANF program grew by 80 percent.
At the same time, the agency’s budget has been cut for the last 10 years and has not had the funding to provide services to every person needing them. Kelley-Siel compares DHS’ work during the recession to a MASH unit doing triage.
The combination of steep cuts and increased service demands motivated Kelley-Siel to put the agency’s programs and services, and how they’re administered, through the wringer. She eliminated the agency’s divisions and its directors, and began breaking down some of the agency’s bureaucratic red-tape to save money and provide services more efficiently, earning her a reputation as a change-agent.
This year, Kelley-Siel and the agency she oversees is getting a reprieve. The Legislature did not cut the DHS budget for the first time in 10 years, instead increasing it by 5.9 percent to $9.1 billion dollars. It will allow the agency to hire 183 child welfare workers and other caseworkers. It also gives the agency flexibility, Kelley-Siel says, to focus on increasing employment for some clients and focusing on long-term well-being and self sufficiency.
Amanda Waldroupe: When you became director of DHS, the agency was faced with caseloads quickly increasing because of the recession and a budget with steep cuts. One of the big focuses of your tenure is streamlining the agency’s services and cutting bureaucracy. When you think of what the agency was like in 2011, what kind of an agency do you see now?
Erinn Kelley-Siel: In the past, we’ve been an agency that has had a lot of divisions, departments and programs. We’ve been pretty focused on compliance, administration and regulation. We’re moving even more aggressively (to asking) ... what are we trying to accomplish and what do people need and how, and not letting process and bureaucracy be barriers to service. One key to spending more time with (clients) is having less paperwork and depending on 30-year-old, disconnected technology systems. In the last few years, because of the recession, we’ve been driven by crises. This last budget is getting ahead of those challenges, using the data we have to anticipate issues … and encourage more innovation.
A.W.: You’ve recently described the 2013-2015 budget, which is about 6 percent larger 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 away from barely being able to serve and meet people’s most basic needs to really being able to concentrate on the kinds of services that change people’s lives. There are some programs where the goal isn’t for people to need our help, but to get the right amount of help at the right time. Most of the focus (during the recession) was on how do we help the family stabilize today, to keep their housing or pay their bills. That’s an important conversation. Now we want to be able to pivot and ask, where do you see yourself in 12 months? Having that conversation with clients is one, frankly, that we haven’t been able to have because we’ve been trying to triage. I think for almost every population we serve, we’re starting to turn a corner.
A.W.: Over the last few years, there have been proposals from Governor John Kitzhaber and the Legislature to drastically reduce funding for the TANF (Temporary Assistance to Needy Families) program, including shortening the lifetime limit that someone can be on TANF to 18 months, despite the fact that the program has proven to be very successful. What is it about the TANF program that it’s constantly on the chopping block?
E.K.S.: That’s a good question. It’s something I stay up at night and think about. One of the areas in our budget that is still in serious need is the TANF program. It’s not easy to garner public support for public assistance programs. Legislators know that. In Oregon, our income eligibility threshold is really low. There were a lot of families who needed the help, and I would regularly get communications from legislators, (who heard) from constituents. People were frustrated about the people who did qualify and who didn’t. Instead of turning that into advocacy to expand eligibility, it turned into negativity about the people who did qualify for it. I think there’s a lot of emotion around public assistance programs right now. (But) the federal investment in the TANF program hasn’t gone up since 1966, and the cost to serve people certainly isn’t the same.
When we rebooted the TANF program in 2007, we saw almost instantaneous results around client engagement and participation. Had we been able to continue that, we would have been looked at as one of those states in the country doing the right thing. The problem was the economy hit (and caseloads increased). It was a Cadillac program. It really met people’s needs, even though the cost per person was high. That’s the debate we have to keep putting on the table. The imperative around TANF is stronger now than before. It puts pressure on us to help people help themselves.
A.W.: What ways can that perception of TANF — and the propensity to cut the program’s budget — be changed?
E.K.S.: One is the case management piece, and showing significant improvement in terms of outcomes. Another is having performance-based contracts with JOBS contractors and holding our service providers more accountable. I think the economy turning around and us having some success under our belt in terms of getting people to work will help a lot. Another is making TANF part of a larger conversation the governor is having about the workforce system as a whole and workforce development.
A.W.: In January, approximately 400,000 Oregonians will become eligible for Medicaid as a result of the Affordable Care Act taking effect. What impact will Medicaid expansion have on people served by DHS?
E.K.S.: One of our overarching goals is to get people on their own feet and help them go to work. There is an inextricable link between people’s ability to work and people’s ability to get to work. Some of our clients have no access to health care. We’ve got quite a few parents and children in the welfare system who don’t qualify for Medicaid services, that keeps their kid with health needs from accessing treatment. Medicaid expansion is going to really impact that group of people in a positive way. The other thing that is going to be really interesting is how coordinated care organizations explore social determinants of health [access to transportation, healthy food, housing, etc.] more. Their relationship with DHS is going to keep evolving.
A.W.: How do you see that relationship evolving?
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 of State’s office published an audit of 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 DHS 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