Making more bricks with less straw: Agency heads share thoughts on operating in hard times

At last week’s Fall Legislative Forum organized by the Oklahoma Institute for Child Advocacy, a panel of state agency directors discussed some of the accomplishments and continuing challenges facing Oklahoma government. Taking part in the panel were leaders from the Department of Mental Health and Substance Abuse Services, Department of Human Services, the Office of Juvenile Affairs, the Health Department, and the Health Care Authority. The panelists discussed several ways we have made progress in Oklahoma despite tough budget times.

Commissioner Terri White, Department of Mental Health and Substance Abuse Services

White said that preventing addiction is the biggest public health problem facing Oklahoma. She expressed concern that the current discussion on allowing sale of strong beer and wine in grocery stores has concentrated on economic development issues without taking into account increased risk of underage access to alcohol.

“The younger someone uses alcohol, the more likely it is they’ll use as adults,” White said.

Over the course of the budget crisis, she said $30 million had been cut from the mental health budget, 90 percent of which goes directly to care providers. On the positive side, she praised new investments of $3 million for a Smart on Crime initiative and $2 milion to Systems of Care, which coordinates services between agencies for children with the highest needs.

“If we don’t make sure the brain health of our children is our highest priority, we’re going to be paying for those problems over and over with more tax dollars than we can afford to come up with,” White said.

Director Howard Hendrick, Department of Human Services

Hendrick said DHS has made progress in recent years in collecting child support. He said Oklahoma is ranked first for paternity testing done to determine who owes child support, and they have tripled support collection over the past few years. Hendrick said for every dollar the state spends on collections, we get a $3 federal match, and that results in another $4 in child support paid.

He said in 2009, Oklahoma for the first time went below the national average for child abuse (though that statistic has been disputed). He said Oklahoma ranks highest in the nation for per capita adoptions of children out of foster care.

However, the agency continues to struggle to meet skyrocketing demand during the recession. Hendrick said 30 percent of Oklahomans are currently on food stamps, and 40 percent have received SNAP food stamp benefits at some time in the last 12 months.

Hendrick said he believes in limited government if the rising tide is lifting all ships, but the “number of ships getting stuck in the harbor is increasing.”

“Work has to pay, and right now work is not paying enough,” he said.

Hendrick said public sector cutbacks also have immediate effects on the private sector, as many private jobs are funded with 100 percent government revenue.

Executive Director Gene Christian, Office of Juvenile Affairs

Juvenile Affairs has been in the news lately due to problems with violence and escapes after youth were transferred out of the state’s only maximum-security juvenile detention center, which shut down in September.

However, Christian argued that a few of the hardest cases should not distract from a bigger picture that is improving. He said OJA worked to promote prevention and community services that reduce the need for high security detention. Five years ago, Juvenile Affairs had 394 secure beds with a 50 person waiting list, while today they use just 150 out 194 secure beds, with no waiting list. That compares to 230 non-secure beds (in facilities without fences or locking doors).

He said they’ve accomplished this shift while dealing with 12 percent budget cuts and a 25 percent staff reduction.

Christian said there has been a 22 percent decrease in overall intake of youth, in part because their community partners have helped prevent crime. However, he said there are still not enough treatment programs for juveniles struggling with substance abuse.

“We should be embarrassed that I have more beds for substance abuse treatment than DMHSAS,” he said. “They have to commit a crime before they can get treatment.”

He said Juvenile Affairs will continue to encourage non-secure facilities when they can but would rather put more resources in reintegration services that help troubled youth find career and education opportunities.

“The better they do, the less I have to do,” he said. “And I’m of the opinion I need to do less.”

Assistant Deputy Commissioner Toni Frioux, State Department of Health

Frioux said the Health Department has not had to totally eliminate any programs due to budget cuts, but they did lose more than 200 full-time employees over the last 3 years. While the Health Department closed more than half of the state’s guidance centers for children with developmental delays, Frioux said the consolidation has made the program less fragmented and now provides better access to a full complement of professionals.

Oklahoma received a $37 million grant award under the health care reform law to fund nurses, social workers, or other professionals meeting with at-risk families in their homes. Oklahoma was one of only three states whose grant proposal was fully funded, with 22 others receiving partial funding. Frioux said the state won the grant because we are “already ahead of the game” with home visitation programs like Children First and Start Right.

On the downside, the most recent State of the States Health Report gave Oklahoma a D for infant mortality rate, F in tobacco use prevention, and a D in obesity prevention.  Oklahoma is predicted to become the most obese state in the nation within the next few years.

The current health improvement plan being pursued by the Department includes allowing municipalities to implement more restrictive tobacco laws; requiring health education in grades 6-8; and banning all electronic devices from use by drivers under the age of 18.

CEO Mike Fogarty, Oklahoma Health Care Authority

OHCA operates SoonerCare, Oklahoma’s Medicaid program. Fogarty said OHCA has made substantial progress in covering Oklahoma children since the agency was created in the mid-90s. In 1997, SoonerCare had 280,000 enrolled, half of which were children. Today there are 700,000 enrolled, of which 2/3rdsare children.

The growth has reduced the percentage of children with no form of health coverage from 25 percent in 1997 to about 12 percent today. He said most of the kids who remain uninsured have parents who make too much to qualify for SoonerCare but still can’t afford access.

Fogarty said growth in early years was due to intentional outreach programs, but more recently the surge is fueled by greater need during the recession.

“Any program that is means-tested is counter-cyclical,” he said.

OHCA is the only major state agency that did not have its budget cut, and in fact received a 12 percent increase in state funding. However, the number of Oklahomans eligible for the program increased closer to 18 percent. Fogarty said he was pleased that Oklahoma has avoided severe cuts to Medicaid that were attempted in other states.

He said that during a budget crisis, it is crucial for child advocates to demonstrate the effectiveness of public programs with quality research.

“There are limits to how many bricks you can make with less straw, and we’re there,” Fogarty said.