[Music] Uh, good morning everyone. I'd like to call this meeting of the Cook County Public Health and Human Services Board to order on this Tuesday, May 20th at 8:31 a.m. First, no.
8:31 p.m. No, no, it's A.M. Close. Welcome to Tuesday morning, everyone. I was paying attention. Sun comes up in the east and sets in the west. The first uh item I'd like to uh hit
here is to welcome our new staff, Mr. Bob Nelson. Uh joining the team on the children's mental health case manager and um got to read your your um HR blurb in in in the email, but if you want to take a minute to introduce yourself and
talk about your experiences and sounds like we're really lucky to have you. Yeah. No, I'm excited to be here. Um, my family's had a long history in Cook County. So, my dad, uh, first job, teaching job and coaching job was Cook County High School back in 1949. So,
wow. We've been here a long time. Um, my parents ran, uh, back then it was called Jaco's Clearwater Lodge. So, my youth, uh, I was always up here all summer and always loved being up here and always been a goal to live up here. And um most
of my work career was uh working with homeless youth and street kids in Minneapolis. Uh had a drop in center and some transitional housing units. Um and then a place called St. Joseph's Home for Children which was more of a shelter for kids. Um and then lastly, I've been
at Scott County as ran a 16 bed non-secure facility which housed criminal justice youth and social service youth. So, my career's always been with youth. I love Hopefully they they don't make me look young, but they they keep me young. Um, so I'm real
excited to be here. So, thank you. That's uh quite a resume. Welcome back, I guess we should say. Huh. But thank you for joining the team and thanks for being here this morning. Thank you. Um, anyone have any questions for Bob? Mr. Chair. Oh, please. Yeah. Thank you.
So given the experience and also given the the history in Cook County here, um first I'd say uh welcome and uh the question would be what have you seen that has changed most in Cook County
since you were a kid? And the other question is what have you seen that has changed in youth in your years of service from when you began? I think well when I was a kid the only
TV we got was from Canada. We got two channels. So the media part has really changed now with even the internet like at our I live up on the Hungry Jack Road. Um so having internet and that access has really been a big change.
Um a lot of it which I like doesn't feel like there's been a big change. um Grammar still looks like Grammar, you know, when I was a kid and I like that part of it. But um with kids, I I think again it's social media. It's it's
phones, it's um the addictedness to that and just having a parent manage that aspect in a kid's life and you know, a consequence that I take the phone and that can be a major major situation. And there's I've seen kids that gone into
the commit suicide because parents take their their phones away because it's such a you know connection to them. And um so I I think that part has made a big change in youth. Um a lot of it is the
same. I think sometimes how we work with kids gets different terminology but when it goes back um the some of the core basics are there but over time I think with anything when you work um with people's is you you learn what actually
works and what what doesn't work. So I think things we did in the 80s looking back it's like why did we even think that was a good approach you know and if you work with kids if you can base it on building relationships and
base it on building trust um most of the kids that I work with that's one thing is why are you as an adult in my life why are you and so how do you make those that connectedness so that's that's the part that stays the the same is kids want to connect kids want that
relationship ationship. They want a voice and it's um my role as part of that is trying to be that support and and making that connection and I think it's an honor to work with especially adolescence to have an opportunity to
make them think a little bit and make them um start looking at choices and and that's how you can kind of work on that. I don't want to work with you. Well, what do you want to be? Well, I want to be this. Well, you know, let's start here. You got to go to school to do that. So, how are we going to make that
happen? Versus, you know, you need to go to school, you have to do this. It's it's building that relationship. And that's a fun part um that I enjoy in this work. So, thank you. Thanks, Bob. Any any other questions?
All right. Well, again, thank you. Uh have a great day and and we'll be seeing you seeing you throughout the building. No doubt. Well, thank you. Appreciate it. Now my boss has to make me work upstairs. Yeah. Yeah. Yeah. Thanks guys.
All right, that moves us on to uh our consent agenda and um that includes our meeting agenda. Uh the minutes, financial report, abstract and bills, uh approval of a hire, uh approval of
resignation. Are there any items uh anyone would like to pull from the consent agenda or is there any change to the meeting agenda? Thank you, Mr. Chair. I'd like to pull items E and F.
Okay. We'll move those down to uh director's report. Um if that's okay. Um maybe we'll just do that. We'll put those right away. Um seems appropriate for staff updates.
Um, any other changes for consent or agenda as a whole? I move approval of consent agenda. Thank you, Commissioner Gamble. We have a motion. Is there support? Support. Thank you, Commissioner Sullivan. Motion and support. Any further discussion? Hearing or seeing none, all
those in favor? I I opposed. Motion passes unanimously. Thank you. That moves us down to our staff report this morning. And we have Plman here, our fiscal uh supervisor to give us all the nitty-gritty. Good morning.
Good morning. My name is Plman Deitro and I'm fiscal supervisor for Cook County Public Health and Human Services. I'm here to present the financials for year 2024. The full year end financial report is attached to today's agenda and
available online. This presentation will explain the graphs and charts from the report. and provide more context to the numbers. I will pause for questions after each site. The revenue received was 3% more
than the budget. Some of our financial I'm I'm sorry. Some of our federal and state aid is based on the amount of personnel expenses that we report including wages, training and travel supplies, software licenses or program materials. Since we had increased
personnel expenses and software license in particular, our reported personnel costs were higher resulting high federal reimbursement. overall expenditures of 14% more than a than a
budget. That was largely due to increased personnel cost again software license in particular adult mental health placement costs and increased out of home placement cost. We had budgeted to use
566,645 of fund balance. We have an excess of expenditures paid over revenues received of 518,635 or less than what we budgeted to use from the fund balance. Any questions so
far? This um um graph represents the PHS funding by source. Federal and state grants and aid made up to 42% of our revenue in year 2024. Fees and recoveries including reimbursement from health insurance
plans and license fees made up another 8%. Small amount of revenue came from nongovernmental grants and donations less than 3%. and the remaining 48% of the revenue came from county tax. Now I want to take your attention to the second graph there
to the right. What this shows is what portion of the revenue for PHS was county tax and what was other. And you'll see that in years 23 and 24, all other sources of revenue
exceeded the county tax. And that is a direct result of our staff seeking comparative grants and increasing revenue from billing insurance companies for services we provide to clients and
um and for uh work that our social services staff does. Any questions? Okay. PHHS expenses uh by department. All of our all of the PHS expenses fall into one of the three
departments. Social services, public health, including public health, community grants and child care program and economic assistance. You may remember that we had discussion last year whether we should separate the child care program from the public
health and I did that. So when you're looking at your monthly financial report for year 2025, the child care program is a separate department in our financials. But in the year 2024, they were still together. So these are the percentages by
department. Economic assistance 20%, public health 24, social services 56%. Any questions? And this is the the public health and human services organization chart as the end of
2024. On paper, it looks like a lot of staff. However, there is a very little overlap or redundancy in services. In addition, many of these staff wear multiple hats in their public service roles. As I go through each department in the
report, you'll hear more about the work each team pro uh provides. Social services is comprised of three teams. adult and home and community based services team has one supervisor and five social
workers each with a different case management and care coordination and specialization providing adult protection waiver case management long-term services and supports intellectual and developmental disability services and mean choices
assessments and one social services case who supports this team. The team also has several independent contractors who provide inhome support services to aging population. The second team within the social
services department is the children and family services team with one supervisor and three social workers providing child welfare and child protection services, family assessment response and parent support outreach services and one child care
licenser. The social services K case aid also provides support to this team this team as well. The third team within the social services department is the behavioral health team. Um Bob and John are part of
that team that were part of this meeting earlier. one supervisor and six social workers providing substance use disorder services, children's and adult mental health case management, mobile crisis response
services. The social services CA case aid also provides support to this team contracted provider provider for this unit is the wilderness outpatient for comprehensive assessment outpatient treatment and impatient substance use
disorder referrals. It seems like I missed to skip one slide here. I'm going to give you a quick overview of the behavioral health team and then I'm going to switch to the next which is the public health team. Public health team with one
supervisor and four public health educators to meet all six areas of Minnesota public health responsibility within the local public health act. The office support case 8 provides additional support to this team. This team provided regional collaboration,
grant writing, contracts management, emergency preparedness. And during the pandemic, the public health team played a major role in vaccine planning and implementation, case investigation and contact tracing and liaison to the
schools and businesses as well as the coordination of many community volunteers with uh shift to infectious disease control and prevention post pandemic. Using contracts with Sat Mountain Clinic and Nord Health, Cook County provides
several additional public health programs such as home care sliding fee program, child and teen checkup, family home visiting visiting and wick women, infant infants and children. As a reminder, the ship program, the
statewide health improvement plan, is fully administered by K County Public Health and Human Services, where it was contracted to South Mountain Clinic in the past. Any questions so far? Seems like I'm missing a slide here, but
I'm going to go quickly over the economic assistance team here with um one supervisor and for eligibility specialists who provide eligibility determination and rehabilitation reviews for many state and federal support programs such as cash and food
assistance, housing pro housing support, several healthcare programs, child care assistance, and process applications for emergency assistance and county funded burial support. Two case aid provide direct support to this area as well. As a
reminder, the child support services in Cook County provided through a contract with Carlton County. the administration. Um, since it was administrative administrative professional day on April the 23rd, I'd like to acknowledge that our
administrative staff for important work that gets stopped behind the scenes every day. This includes our director providing agency management and leadership and local, regional and state collaboration. One executive administrative assistant, one support
case aid uh with shared responsibilities between the admin team and the economic assistance team. The admin team members support our citizens advisory councils, order supplies for our office and programs and
maintain the PHS social media and outreach. The administrative team also includes the fiscal services with one supervisor, one fiscal officer and accounting technician. We develop the budget, pay the bills, receive revenue,
operate the social security rep program, provide complex grant management and reporting and provide regular financial update to this board. Kudos to my team for the work they do. You're here. Okay, we're going to get into some
numbers next here. Um, the cost and the cost that benefit the entire agency are split between the three departments. So, that's the administrative allocations here. This includes admin wages, postage and copy costs, office supplies and phones,
training and travel for admin staff, travel and pdium for advisory board members, fees to the state of Minnesota for the merit system and state IT support as well as funds transferred to the county general fund for courthouse
office rent, county MIS cost and labor liability insurance and the annual audit. As I go over the details for each department, you will notice a line item in each budget for administrative allocations. As these admin costs are
split proportionally between the economic assistance, social services and public health departments based on FTE. Okay, any questions? Starting with the economic assistance department, the 2024 actual
expenditures were at 100% of the budget while the revenues were within 95% of the budget. The biggest variance can be seen the personnel cost with the caseworks electronic data management software licensing and implementation
cost resulting in 12% actual expenditures over budget and the corresponding increase in federal administrative revenue. And the next um item that is probably worth noting is the client
programs where we saw a lower than budget reimbursement cost reimburseable cost and as a result decrease in a state and federal revenue. The expenditures exceeded the revenues by 48,358.
[Music] This uh provides an overview of the cost versus reimbursement for several for three of the key programs here. There was a decrease in the client program cost in year 2024 with only 59% of the budget utilized and thus a corresponding
decrease in reimbursement. The the revenue comes from the state reimburseable assistance we provide to clients. The county provides assistance for cost effective health insurance and Medicare Part B insurance premiums to
eligible recipients. And we received 100% reimbursement in return from state and federal um services. Provider transportation allows community volunteer drivers to assist eligible elder elderly clients with medical
rights. PHS direct bills and receives reimbursement from managed care organizations with reimbursement rate varying depending on the loaded and unloaded mile. Healthcare access provides assistance to eligible residents to
reimburse them for using their own transportation and medical lodging. the burst amount was at 138% of the cost exceeding 100% due to timing and issuing payment and receiving
revenue. Uh as a reminder, we can continue to pay costs for the previous year until the end of February of the following year and receive revenue till the end of March of the following year.
So sometimes due to this timing um we do um end up receiving revenue past the period which applied to the previous year or vice versa which affects our numbers. So that's why we have
uh more wonder how you can do that to expand that idea. Yeah, Commissioner Gamble. Yeah. Yeah. appreciate the port you you keep and you give us plenty of opportunity to ask questions. I'm just waiting for the presentation to end to be able to ask
the question, but based upon your comment, can you tell us on tracking these and it's an important thing to know because we often hear that from Brady, our auditor treasurer, that funding that comes in that's predicated on previous year, whatever else. If if
we're tracking these things consistently based upon that schedule, then we can use analytics to determine, you know, what's what. So, um, when you're looking at numbers or the department's looking at numbers, are you looking at them in
that context so that you can separate out monies that have been earned prior year, prior to the posting that goes, you know, in in the financials. If that's cleared, if I understand your question, you're asking whether when we
prepare our monthly financial reports, whether that is factored into the monthly financial report. The answer is yes. We report for each month only what applies to that year's expenses and
continue to move in January, February, and March. I actually have to move all the expenses towards the previous year and all the revenues which of course reduces the expenses in revenues for the current year. So when you receive the monthly financial report in January,
February and March that is strictly what applies to the current year and not what applies to the previous year. Okay. And so you're postating then the those earnings in previous months, correct?
Yeah. All right. Thank you, Frank. Did you have a question? I did. Just just so I understand consistently. Um, obviously the third category there, the reimbursements were higher than the expenditures, and you explained why. Does that also follow through for the first two? In other words, the
reimbursements that came in and it's kind of hard to read from here, but uh the reimbursements that came in uh thank you uh for cost effective insuranceances that also would include funds left over from the previous year.
So, I'll take it one line at a time. cost effective insurance we receive 100% reimbursement from the state and federal in in a proportion 50/50%. Okay. So there is a slight difference
there only because again of timing. Okay. Now with provider transportation we do not receive 100% reimbursement and it depends on which managed care organization or um we submit the billing for. Some pay at 100% for the loaded
mile, nothing for unloaded mile, some pay different variation. So we never expect that our provider transportation will be at 100%. We know that that's going to be somewhere between 80 and 90%. And again another complicating
factor is the timing. Okay. Thank you. With healthcare access again that's 100% reimbured similarly to the cost effective insurance. And again, the only thing the only reason you see a difference there is because of timing.
Okay. Any questions? Please. No. Mr. Go ahead, Commissioner Star. Thank you. Um, I was curious about the uh food support which rose significantly. How is food support you uh supported by the county? What
does that include? That's on a different slide. Can we bring that question when we get to that slide? Oh, okay. I'm further ahead then. Yeah. Yes. I think a couple slides ahead. Okay. Commissioner Gamble. Yeah. Thank you, Mr. Chair. And so on on your
comments, as long as we understand that applied revenues received are in the graphs that we're showing and we're consistent in doing that, then that information is something we can understand. And so the point is is that
it takes a narrative to explain because if we were not showing it consistently like that, we would have a we'd be asking the question, why are we seeing it this way? And then when we have the narrative, it helps us understand that. So when we look at it, you know, in the
future, every time we're looking at this, we're we're looking at it in the context of what the narrative has informed for us. And I I would just say and maybe this has happened. I I don't know, but the information that is provided here is is excellent
information and I appreciate all the work that goes into that. Our lived experience provides this information to help us to make informed decisions. And if we can understand it and put it in the right context the outward things
that affect us uh we we can see from our lived experience how that's going to play out. And it would be good in a committee of the whole if we rolled up our sleeves and had a discussion to dig
deeper to understand this which I'm sure you know from the administrative role the budget process is something where we're taking the statistics and the analytics are apply applied in projecting what we with all the things
that are affecting us we project what we're looking at moving forward. So having this information and the detail in which it's presented is hugely beneficial. Uh is your role to gather
the information or to use your mind to make recommendations? Well, I don't know. Um I think I see my role mostly as an um making sure that we account for every order properly and making
recommendations to our director. Beyond that um can I make recommendations? Sure. I don't know what um to what scale and what um where that stops but I take um
my team I should say we take pride in the work we do and we make sure that the financials every month are 100% accurate. We don't submit them to the board until we have finalized every dollar it's been accounted for. Yeah. Um
and I'm I offer my assistance if it's needed. um to participate as needed in meetings and um provide any additional information if it's requested. Yeah. Thank you. I don't know if that um answers a question about Yeah. And Mr.
chair and I don't want to take too much time here but I but this is again this is excellent information and uh I just my wife and I just came from a commencement uh for a granddaughter uh
Notre Dame and she happens to be in in analytics and then I have a grandson is also in analytics and then my granddaughter's boyfriend is anal in analytics and uh the discussions and the presentations that were done in this
ceremony. I was so impressed with the depth at which information is gathered and then we analyze it to understand what it tells us. So information is only beneficial to the extent that it informs us and so um I again this is excellent
and and dividing it into more precise like we've done with the the child you know area that's helpful because otherwise it it takes so much narrative to explain everything but when we can see it as you know what we're providing
by way of services this helps us to be able to respond when we see the changes that we're encountering right now, you know, relative to the financial. So that's why I think to dig deeper as to well, what does this mean and and how do
the impacts that we see that change both in services provided in the revenue that funds those and it used in in my experience in my previous term if we were not keeping up on those things that were reimburseable, we're we're missing an opportunity for funding. And when we can
demonstrate that we're doing that and that we're getting that, those are all good stewardship. And I think really understanding that helps us to make decisions to support the team and the department in what it does because it's
well informed. So thank you for helping us turn data into information. Yeah. Yeah. Uh moving on on to uh the funding sources for uh economic assistance team. Federal and state funding made up to 53%
of the revenue received by economic assistance department. This includes federal administrative aid which supports some of the payroll cost of the staff providing the eligibility services for state and federal programs as well as reimbursement for county paid client
assistance. Fees and recoveries made up 3% of the revenue. The county is required to perform collections on behalf of the state and in return the state allows us to keep a talking portion and the reminder of the funding came from county
tax. You will see that under economic assistance is probably one of the highest federal reimbursement rate the highest federal reimbursement rate between all the departments. Okay, any questions? Okay, so here is the graph which shows
the economic assistance new applications in year 2024. We have a total of 231 new applications for assistance in year 2024. This is higher than the prior 5year annual average of 223
applications. Two categories saw an increase, food support and health care, while the other two saw a decrease, emergency assistance and cash assistance. The largest increase last year came from people
applying for food support assistance. Mr. Stler, you had a question about this one. Yes. How do you do that? How do you support them? What does that consist of? on the programmatic side. Um while I
understand some of how it all works, um probably this question should be um addressed to our economic assistance supervisor. But basically is um when people apply and um they approved to
receive food support, they issued u EBT cards which they can use to purchase food in the store. in in a short explanation. That's a SNAP program. Yep. Food support and SNAP are used interchangeably.
That's so is this an indication that there really is a growing need out there now for through 24 and we're into almost half of 25? Well, there are no numbers to year 2025 here. But if you look at the average
between 20 2019 and 2023 of 121 new new applications a year, 2024 had 136 the biggest increase. So yeah, I mean up to through this data, was there anything more you wanted
to add? I think it's worth noting here as well that these are new applications, not active cases. So, this may demonstrate an increased need, but it may not demonstrate an increased uh level of benefits going out to members of our community member. Um, that
doesn't um mean that that's not reflective of the workload of our staff. They're still having to process those applications, interview the household, gather the data, determine if they're eligible for those benefits or not, and if at what level. Um, but this may
show. And again, we we'd have to talk to Doug Mara. She gives a presentation every fall in November to get a more detailed analysis of what she and the team are seeing here. But what this could reflect is more people needing financial support for food. We're seeing that nationally and across the state
with increased demands on food shelves. Uh but these households may or may not be eligible for or receiving those benefits. So, we're getting the applications that's still workload that may not be reflected in the benefits received by members of our community.
Commissioner White, um Alison, so so if someone um qualifies for food stamps, is that based on the size of the household? Is it a set number? Is it a sliding scale type situation? It's based
on a excuse me, on a range of factors. their household size, how many people are a part of that household unit that are purchasing and preparing food together, uh the citizenship status of the household members, uh their utility expenses and housing expenses, their
earned income or unearned income, all of those are factored into the the budget in terms of the benefits that they are issued. Yes. So you said there's citizenship. So if we have someone who does is not a
US citizen but is working here in Cook County or I I don't know they would come in they would not be eligible for food stamps. I don't know that I have the depth of knowledge on policy anymore retained to speak to the cedition food
stamps. I just couldn't I mean I guess I like you come in for food stamps if you're just I don't know it's another area that I hadn't ever thought about. It's it's a factor. We don't have the depth to know how the factor plays in
but it is you know fed federal dollar. So we're just following whatever Yeah. Okay. Um whatever system they have in place and you know comply with that. So when Excuse me. So when um a family or a
person comes in for food stamps, they fill out a form and is it just their income or is it their assets also? Like if they own a lot of property, you know, like somebody they bought land cheap 30 years
ago and it's worth a lot of money now, but they still work um for $15 an hour and that's what they have. So, is it assets and income? You're really testing me on my policy knowledge here, Commissioner. I don't believe there's an
asset test for the SNAP program. So, a person can own their home, they can own vehicles. It's really looking at their income, whether it's earned or unearned. It could be social security income, unemployment insurance income, their housing expenses, okay? And the state defined limits for each of those. I just
got I just got curious right now. So, it's a good thing. And you don't have to come in to apply. You can apply online as well. Commissioner G. Yeah. Thank you, Mr. Chair. The So, the statistic we're looking at is a statistic that says the increase or decrease in number of
applicants, but it doesn't and unless I mess something in the in future slides here, of those applicants that apply, we're finding an increasing number are qualifying. So in other words, what's the result of the applications as to
acceptance? And that that would be a question to the issue of whatever matrix are used to determine whether or not a person qualifies in section 8 housing which is a HUD subsidized that an individual comes in and they're assessed based upon the matrix that that HUD sets
up which is you know what your income and your income is your annual income that comes if you have a significant number of vestments but you're not taking out retirement or dividends from those investments. ments they're not calculated into your annual income
because you're not receiving that income to expense. But you do have assets which can be a house investments and everything else and they are at a a less uh uh amount as far as their consideration in whether you can apply
or not. So, we'll see applicants that'll come in that HUD will set that threshold and in Cook County because HUD makes a determination as to where they think rent should be. It's really not reflective of where rent should be in
Cook County given our realities. But you might come in with the HUD threshold on what you make, but then because HUD sets the rent rate, that makes a lot of people not qualify because that rent rate is set down. So whatever the program is, we have a number of people
that apply, you know, when they come in and uh but it it's based upon a set of criteria. It's whether that criteria is well formed or not. But to the question of number of applicants and actually number of people that receive benefit
and if I may commissioner, the motivation for including the applications as I understand is to demonstrate the workload. Right? This is a presentation on our year in financials. Our personnel expenses are the highest proportion of our expenses as a department. So showing that the volume of applications is reflective of
the work that our staff is doing, not necessarily the level of need in our community. That data will come through in our November report from Doug Mara. If anyone's interested in a midyear snapshot of where we're at in terms of eligible population, I'd be happy to work with her to pull that data
together. Appreciate that. Thank you. Okay. Thank you, Plum. Again, as a reminder, the child support services have been contracted to Carlton County since uh 2013. Um that includes case intake and
assessment, establishing paternity, locating absent parents, establishing and enforcing orders for child support or spousal support, collecting on current orders. In year 2024, uh there
were n 96 open cases in Cook County. Please question when you look at that in the context of Cook County, you look at in the context of the state and you look at in the context of the country and then in the context of the world because of a decreasing population that we don't have
as many kids as we have. It's like is has the need lessened or it's just that the number of children in our population demographic have decreased which is affecting those numbers. I don't have enough information to
provide an answer to that question but could we could certainly get that information and in a in a lot of cases when we're looking at statistics that we have to look at in the context beyond you know what we're what what do those numbers tell us and it might be a reflection
more of the demographic change than it is that the need does no longer exists. Need could actually be going up with the number of people that need the service going down. Commissioner, just looking at the numbers over four years, a drop of a
third in the numbers, that wouldn't be reflective of children aging out of the children category. You know, you wouldn't lose a third of your children over four years, even if there were zero replacement at the bottom. Uh, and there are obviously uh children being born in
Cook County and moving into Cook County. So, that might be part of it and would be good to know. Yeah. Um uh a quick comment. Um sitting on the school board, we look at the number of kids um all the time in the community and it's been pretty stable for a while,
maybe even a little bit on the rise. So it's kind of almost counterintuitive here, but yeah, it's not there's not a drop off of children in that period of time. There is over a period of maybe a couple of decades. So these the numbers have gone down quite a bit in the
schools over the last 30 years, but in the recent past um they're pretty stable, which then comes to the question of okay, so it's great that there's been a one-third decline over four years. But my skepticism says why? Is that
because we're not finding them? They're not coming up or is it because there's an actual drop in need? Well, I mean our staff does a lot of preventative work, too. And that has a direct effect on what's happening in the community. Okay. We have um children and family services
working. Um we have the behavioral health team. We have the social services team. So so so a child may not get to the point where you have to open a case and Okay. Great. And is it Dan from Carlton County? Yeah. He was just here
presenting and I just can't remember but it was a similar trend in the region. Maybe not quite as extreme. I can't recall but um I just don't remember what his explanation was. He he didn't have this is why but it was ideas please. Yeah. If
I recall it was a combination of factors. Child support um cases opening is often driven by a non-custodial parent applying for benefits through the state. So, if a non-custodial parent
applies for medical assistance, that opens up a charging case for child support where the state is going to collect income from that non-custodial parent. Sorry, if the custodial parent applies, I got mixed that up. custodial parent applies for benefits for their
child and the non-custodial parent has income, they go to court, grossly oversimplifying this to charge the non-custodial parent to reduce the amount that the state is paying for that child's care, whether it's medical assistance, cash assistance. So, this
could be economic factors in a community that are driving this decrease. It could be uh the drop in numbers of families eligible for medical assistance following the co 19 related waiverss
that were in place for many many years that kept people eligible for health insurance without having to go through a regular renewal or reapplication process. Um, but yes, I believe that Dan reported that what we're seeing in terms of this
steady decrease is consistent with statewide trends. Food for thought. Thank you, P. Social services department. Um the second of the three major departments in um public health and human services for all three units of social
services cost were 10% over budget and the revenue received was 6% less than the anticipated. $200,000 of fund balance was budgeted. $426,984 of fund balance was
used. Um the reasons here I'm going to um point out several vacancies remained unfilled at year end and into 2024. This led to a reduction in personnel cost and associated federal
and state aid. The biggest variance were seen in children and family services including out of home placement expenditures exceeding the budget with 221% of the budget amount due to the number of children in out of
home placement remain in a high level. 15 children were in our home placement in 2024 whereas only eight in 2022 and 14 in 2023. Mental health services
expenditures exceeded the budget with 199% of the budget amount. This was large due to the mental health placement in state operated mental health facilities for a client care care with over
$251,067 expended. But in year 2024, there were children's mental health placements as well for a total of $28,849. On the revenue side, some of the state and federal locations are based on
expense data or client counts from previous years. We received more revenue for foster care aid than budgeted in 2024 in correspondence with the increased expenditures. We increased um um substance use
disorder services revenue with still room for improvement. But the new electron electronic health record will assist us in achieving this goal by providing better recordeping of services and streamline billing workflow and a lower reimbursement
revenue and other programming areas areas corresponds to a lower [Music] expenditures. Any questions? Yeah. Um, usually when we see a large increase in
expenditures, there's often a often an offsetting increase in revenue, such as line two, okay, where you had 221% increase in the in the expenditures, but you also had almost a doubling of revenue. It looks like just the opposite
is happening with mental health services where you have a doubling in expenditures but yet only received a third of the reimbursement. What happened there? So the mental health services the
biggest um item here was uh contributing to this um was the placements in mental health facilities the regional treatment centers. We receive zero dollars reimbursement from state and federal
funds for these placements. Ah so it's a type of services that were provided. Yep. There is a lot of noise in our in most or if not all counties in in U Minnesota
because this expenses drive um expenditures um high for um many of the other counties and one placement even for one person can in a
small county like us can lead to 300 Um, you know, I'm not saying that the mental health services is it that because we had one person in placement, but only one person can drive the cost because those expenditures are so high in some cases up to $2,000
um a day like that significant cost per day. Um, so yes, unfortunately we get zero reimbursement for those
Commissioner Campbell. Thank you. Um, in some cases when you're looking at funding potential for various services provided, if there's no federal or state dollars allocated under that particular
service, uh, in in the hospital's case, because of the care center and um, looking at services that they provide in in the hospital generally, they're trying to look under the basis under
which funding is available. They're trying to see if some services provided could be charged under a different category in order to enlist some of those refundable dollars, so to speak. Um so uh usually when that happens if if
somebody finds a means of being able to generate revenues in an area where we they're not allocated but we put it under a different category which is allowable then it can be that the agency
will change to exclude that so that you can't get it back door so to speak. Anyway, my point is is that the hospital trying to be creative is looking at ways maybe where we have we don't have the funding that maybe we could put in a
different category in order to get the funding doing it ethically but doing it under the provision that's in place. And so I'm just wondering there if there's anything that we're allowed to do when we're analyzing and understanding could we do something in order to be able to
generate revenues where those funding sources traditionally haven't been available. So in the cases of these adult mental health placements at state operated facilities, these are often courtordered placements for individuals with some of the most complex mental health, chemical health, public safety
needs. And there isn't a lot of flexibility for us on a department level to really influence that from a revenue standpoint. Okay. Yeah. And as long as it it's a provision and it it's an ethical response to a need, I think that
resourcefulness is something that we need to be mindful of. So appreciate that. Thank you. Any other questions? Funding sources for social services department federal and state aid made up
to 32% and of the funding for social services revenue. Fees and recovery funded another 13%. This is from building health insurance companies for client waivered services, care coordination and targeted case management. A small portion came from
non-governmental grants. Um, one example is the arrowhead behavioral health initiative and the remainder from county [Music] tax social services. Some statist statistics here
about hours. Um the number of staff hours in children and family services continue the downward trend due to vacancies in this unit. Um we've had a lot of turnover in the children and family services and
that's reflected in the hours on this graph here. The number of children in our home placement saw an increase in 2023 and another increase in 2024. Um this includes children in
foster homes, group homes, mental health, residential treatment or correctional facilities. The number of children in our home placement is at the highest level in the last five years 15. It's
a not a direct inverse relationship, but um looking at our staff hours versus the auto placements, it's makes sense. Social services and employment and training. PHS cont contracts with
Arowhead Employment Opportunity Agency or AEOA to provide employment and training services for recipients and MIP or DWP benefits. The AIP is the Minnesota Family Investment Program and EWP is a diversionary work program. In
the last couple of years, the number of clients who were required to participate in these services was reduced due to state waiverss remaining in place since the pandemic. I asked when I was preparing this presentation, I asked economic assistant
supervisor Dara whether I could not quite remember when the waiverss ended but the waiverss were partially in place in year 2024 as well even though I don't and the asterics right next to 2024 it u it was
a period of time where the waiverss were still in place any questions yeah can I clarify again mfi mf IP Minnesota family what investment program. Investment program. Okay. So, um I'm familiar with anecdotally I'm familiar with a case
where um we don't have someone who handles that in Cook County. Is that correct? Has to it's administered out of some other place. Correct. AOA does. Yep. AOA does that. Okay. And that that was funds
were not available relatively early in the year. Am I am I wrong there? I'm not I'm not submitting that program is still funded. MFIP is still funded and applica they're taking applications. Yes, this is a a state and federally funded program
administered by our staff. The the issuance of cash benefits is administered by our staff. the provision of employment and training services, which is a requirement for families to be in compliance with program rules to continue to receive that benefit. That's
provided by Aeoa through a purchase of service contract agreement. And I think we have a local employment services counselor unless that changed. Okay. Um this might be housing case management is provided regionally or perhaps energy assistance is also provided by AEOA that
has you know limited availability based on the time of year. So the MFIP is um provides funds certainly training and and and support in job and career
development. And then that's the DWP aspect of it and the MFIP. It provides direct financial aid to allow again it's an investment program. The idea being that it's not a cash grant to buy food. It's investing
money so that the wage earner or wage earners uh can in get a job uh improve get training to get a better paying job that kind of thing. Yep. Correct. So the DWP program is a shorter more intensive
program. Okay. Um, oftentimes a family applies for the diversionary work program and then if they aren't exiting benefits at the point that they complete that program, they would go on to MIP, the Minnesota Family Investment Program or sometimes a family qualifies
for family stabilization services or has barriers to employment. Maybe it's a disability um or other factor in the household. Both programs are timelmited. you can only receive I think it's five years of benefits or 60 months.
Um and the the cash grant in the case of DWP is vendor paid towards rent or utilities. Uh MIP again there's a little more flexibility in terms of how that cash grant is issued depending on the household circumstances and includes a
food benefit and a cash benefit. Thank you. Yeah. Shifting to social services, substance use disorder services, the cl number of clients served, public health and human services contracts with the wilderness outpatient treatment program to provide
comprehensive assessments and outpatient group or individual treatment services while our staff provide the coordination with facilities for impatient treatment or and financing. In 2024, 52 comprehensive assessments were
conducted. Um and an inpatient treatment coordination was provided to 32 clients. 12 clients participated in outpatient treatment services. Funding sources for the counteracted um services for substance
use disorder. Um the program is funded mostly by county tax. uh 40 14% came from liquor license fees which is one half of the liquor license
fees collected by the county and 7% of the private of from private paying clients or insurance fees. Can you make a comment on this slide? We invested in a new electronic medical record as you might remember in
late 2024. As a result of that, we're expecting this proportion of county tax to be much much lower next year as we have a more functional health record system for billing and documenting. Mr. Sure. Um just for clarification, if
if the percentage is staff time which is charged to the county tax and we've got a software system that makes us more efficient. It's basically the time in in wage that's reflected
than in this. In other words, the cost for staff because we're seeing how much staff time is invested in this. If we can find methodology that reduces staff time, it's going to reduce that number because the impact of staff time on
being funded through county tax. Is that that's what you're saying? That's accurate in theory, but in in the representation of this graph, this as I understand, plum, and correct me if I'm wrong here, this is fully purchased services through our uh licensed drug and alcohol assessor. the the purchase
of service contract that we have with Greg Barry Wilderness Outpatient Treatment Program. That's the funding to pay for Greg's contract. Yes, there are staff time associated with the operation of the outpatient treatment program. Melissa has a significant role in that
in meeting with residents, determining their funding source. Um, Plman and his team with billing for services. So, there are indirect public health and human services staffing costs that I don't believe are reflected in this graph. This is fully the revenue for the assessment and treatment
component of the program. Correct. The detail of this can be found on page 13 of the financial report and the majority of the um expenses come from the contract services with wilderness outpatient.
um a portion we pay to um the behavioral health fund for our county share for um having the county participating in a behavioral health fund for the state of Minnesota and the administrative cost
that is where part of the the personnel expense. Um if you remember at the beginning of the presentation I talked about administration cost and what it included some personnel expenses travel and so forth and so that is um the third
largest um expense in the ICD program. So not so there is some personnel expense but it mainly is the contracted services. Thank you. Okay. mental health um services staff hours
were up in 2024. And the next slide is going to show the mental health clients and work group. While the number has fluctuated in the last four years, 2024 saw a significant increase in both adult mental health and
children's mental health work groups to the highest count in the last 5 years. The number of adult clients receiving intellectual and developmental disability services had progressively increased in years 2020 through 2022,
decreased in 2023 and increased again in 2024 to again the highest levels in the last 5 years. While the number of children receiving these services has been consistent. This includes clients receiving care services or community access for
disability inclusion, home and community based services to children and adults which require the level of care provided in a nursing facility. This helps a person living as independently as possible in a community rather than in a facility.
Social services adult services staff hours. Again, this team has been experiencing turnover since 2022, resulting in less reported staff hours in 2022, slight increase in 2023, and
another decrease in 2024. Social services, home and community based services, number of individuals receiving services. Adult services supports our aging community members who need additional help to remain in the community. The inh home support program coordinates local independent
contractors to provide homemaking, chore and transportation services so that people can remain in their own homes as long as they would like can. Some of the costs for providing these services and reimburseable through the recipient's waiverss. We have seen a steady growth
in the number of people seeking these services. However, due to lack of service providers in the county, there is waiting list for the people that receive service. I know that our inhome support coordinator is working hard to recruit
and onboard new providers and we anticipate that number of um people receiving services will increase in or has already increased in the year 2025. So we'll um halfway almost halfway through the
year here. I feel confident that next year we'll be looking at a higher number um than what we have in 2024. And these services include things like housekeeping, cooking, not medical care. Yeah, these are primarily um home
making, chore, and transportation services. Thank you. question. Keep moving. Public health. Public health again including the childcare program costs were 46% more than budgeted and the revenue
received was 41% more than budget. While report was budgeted to use $366,645 of fund balance all under the child care program only $43,293 were
needed. One FTE was added in year 2024. The contracted services cost came in 3% over the budget with 7% more in revenue. The child care program expenses was were right on budget with the wage subsidy
program actually significantly under budget with $142,394 less than budget while we received over $184,000 in grand revenue related to the child care program that was not budget and that came from deed department of
employment and education. uh with $153, $110, Minnesota Department of Education with $6,000, and the Northland Foundation with $25,000. Any questions, the funding sources for
public health, 52% of the funding for public health came from federal and state grants, mostly from state, the larger of the two. 2% of from non-governmental grants and donations
and the remaining from county tax. Earlier in the presentation um when I was going through the staff charter for public health I said that they work in within the six areas of public health and this is how the hours um were reported by
staff for year 2024. 33% assuring an adequate local public health infrastructure. 4% protecting against environmental health hazards. 1% assuring health services. 12% preparing
and responding to emergencies. 1% preventing the spread of comm communicable diseases. 49% promoting healthy communities and healthy behaviors. The public health community grants are awarded to community agencies through a
competitive annual grant making process. $150,000 were awarded in year 2024. Uh as a reminder, a subcommittee of the public health advisory committee makes funding recommendations each year which is presented to the human
services board. grants are made in line with the goals set forth in the community health improvement plan. Um these represent areas of essential community services that would go unfilled without support through this grant making
fund. This is the list of the 2024 recipients of the public funds. I just like you to call attention to the to the largest recipient, the Cook County Council on Aging. Uh I sit on that subcommittee on that grant subcommittee and this is something that
I would like to bring up. We may not have time today due to time constraints, but this is I would just like you to keep that picture in your mind for future discussions. Yeah, we're going to be meeting with the um hub or the cocon council on aging
board um at a future committee the whole or um and just to discuss the state of affairs there and and the funding um situations. So, and they provide essential services. I mean, absolutely. I mean, but be aware of the
scale, right? Oh, yeah. Yeah. And it's less than they were asking for too. Oh, yeah. Yeah. Yeah. Mr. Gamble, I think community the whole is the best venue for that discussion is we can be more in depth in that discussion too. So, yeah,
it'd be good. Yeah. Yeah. That's that. Oh, almost. No, no, we got a little bit to go here. That's the end of nine. Oh, yeah. Overall, three departments that made up the public health and human services saw an increase in actual expenditures and a slight increase in
revenue. This resulted in $518,635 use of fund balance while $566,645 of budgeted or we used $48,010 less than what we budgeted the actual unrestricted fund
balance as of December 31st of 2024 among amounts to 3,35,844. I want take attention to that number. That's an important number. That is what we have in the checking account to operate for the years going
forward. And why that number is important is because um we have some requirements to maintain a healthy amount of fund balance. Um um because our first tax
distribution is done in May and we need to have f um healthy fund balance to allow us to operate in the first several months of the year while we are waiting to receive our tax distribution.
So um what that percentage comes is we should be able to operate for the first 5 months or that is 42% of u the
year. So 42% is the requirement minimum amount of fund balance we need to have um in um that is percentage from our budget for the
following year. That is why the $3.3 million um amount is very important. Commissioner Gamble has a question. Yeah, thank you. Yeah, I just who sets that that requirement? In other words, uh is it it it's not an internal
assessment that we just say we think. In other words, the industry itself or government agency is just saying this is it. I mean, when we look at the the county fund balance overall, it just giving the directive as to where it should be. This the office of the state.
Okay. Yep. for our public health and human services that requirement is 42%. Uh my understanding for the highway department that's 60 and for the general fund is 75. Okay. Thank you.
Right. Good question. All questions are good questions. So please um go ahead and ask if you have a question. Okay. So this graph I'm going to take a moment to explain here. The blue bars represent the annual
budgets going back to 2021. The red bar represents 42% of that budget, which is how much PHS must hold in reserves to meet the first five months of expenses. The green bars indicate the
actual amount of public health and human services reserves for each of those budget years. It wasn't that long ago when our fund balance fell below the state required minimum. Um it's not shown on this graph, but there was a time where it was below
42%. However, in years 2021 and 2022, due to uh decrease in plant expenditures uh and increase in third party billing efforts, we had recorded an excess of revenue over cost resulting in the return to the fund balance.
We began using some of that fund balance in um with budgeted of 656,881 in year 2023 and $566,645 in year
2024. And why we did that is because if you look at the green graph in 2023, well, our fund balance was more than our budget. And so we reduced the levy by using up some of our funds, some of our
reserves which reduced the levy request. We did the same in 2024 and 2025 we are reducing um the levy amount by using fund balance. Um and again in 2025 the budget
includes another use of 566,645 in the current year of funds in event and budgeted out of home placements and uh and to fund the child care program subsidy. While PHS still has a healthy
fund balance and against to the bearers require a minimum in reserves. Uh we're looking at we're working on currently on the budget for 2026 and my recommendation for that year will
be to use very little or no use of fun balance. Um there's some sense of uncertainty in the federal government and in the state level too. Um but I think I'm going to save that presentation for when we present our um
budget. um sometime in August I think we're going to do that July 15th at the public health and human services board meeting I believe is what the budget calendar states the challenge we have with with presenting and we can't do that that early in the year is first we don't have
we're only halfway through the year the current year so our financials while we use prediction based on several years prior it's a little bit uncertain uh yeah two is we don't get our locations
for the for the next year some until sometime in July and August from the state. So again we take threeear averages we take um some um so there is a challenge of presenting the board to the board that early in the
year and and I think without going too much into the budget for next year um one other significant expense it's it's related to personnel is open enrollment has not completed until sometime in
November and I don't I don't know how how many people will select health insurance and how many are not going to and that also has an impact to our budget. So in any event we'll be presenting a preliminary budget in July but with some challenges
just a teaser there. That's just I'm just saying what's the reality is commissioner G. Yeah thank you. Um, in the case of fund balance for the county as a whole, um, my question is, um, other than just stewardship of
dollars and having something to fall back on if if we meet challenges, unforeseen challenges, in the case of the fund balance for the county, uh, the benefit in addition to having monies for rainy days is, uh, that it affords us a
better bond rate. Um and uh so I'm wondering what other benefits exist other than having the rainy day funds uh like in some cases requirements when they do analysis on generating money or
grant funds or whatever when they look at your financials if we see tangible benefit because of where our fund balance is. In other words, does fund balance afford us anything beyond having money for rainy day?
Well, that question might be probably for Brady as much as anyone else because um our fund balance the way I see our fund balance is is um a reserve that allows us to operate but we don't invest
our fund balance and um put it in you know um at least public health and humans we don't now on a county Well, there might be some mechanism for um earning some revenue based on um what's in the bank.
But in public health and human services, whatever we see is whatever it is, we don't get percentage of um um interest because um we've invested the money somewhere, right? But the in my point in
in any area where we see benefit and and it can be that in grant applications when they're looking at your fund balance just like in the county when they're looking at when we're looking at bonding when we get a rating based upon we are financially which includes fund
balance then that has benefit to us. So if if you're making an application then for grants and stuff and people looking at said boy this is good then that's affording you additional dollars because of your financial position I see yeah I do understand your question
better now there are some programs that are directly um funded by fund balance the wage subsidy program and the public health grant funds so a healthy uh fund balance means more
um opportunity to spend more money within those programs. Whereas lesser fund um balance amount will probably um put a little bit of pressure or some pressure on the wage subsidy program and on the public health grant funds. Thank
you, Alison. Yeah, just to expand on Plumb's response, to my knowledge, we aren't reporting fund balance as a part of competitive grant applications to the state. I don't think that makes us more competitive. However, the board's decision to invest fund balance in programs like the child care wage
subsidy program is making us significantly more competitive in those big deed grant applications because there's a county match. Is it a requirement the county match? Because many times it is a county match requirement in order to receive the
funds in which case because we have fund balance we can do that. So so indirectly yes. Pardon? So indirectly, yes. Um that the for the wage enhancement, the county match isn't a requirement. Okay. My understanding is that it's making us
more competitive because we're able to complement those county dollars with state funds to increase our impact to the benefit of providers and families. Thank you, Frank. Yeah. and and Allison to just to take that a little bit further and put it in context. I think
over the last two years um on the childcare wage enhancement program, I've probably gotten about $400,000 for the wage enhancement program directly out of the fund balance. And I'd just like to point out looking at the numbers that's not
sustainable, right? So if that wage enhancement program is going to continue, it can't be continued to be funded from the fund balance. and we will be presenting to the committee of the whole in July with a mid-year update on the wage enhancement pilot and plans for 2026 budget and
seeking direction from this board on how to move forward. One more slide on fund balances. This is what it would look like if public health and human services was required to hold 75% in the reserves. Just like the county general
fund, the use of fund balance in 2024 has resulted in the public public health and human services available reserves to be at 65% of the budget but not not at 75. We we intentionally been using F balance
because we've had a good healthy reserve but um we're getting close if not at the point where we cannot sustain to use um a lot or many or maybe even none of fund balance because we're not going to meet
that 42% of requirement if you continue to do so and because um frankly there is a lot of uncertainty on the federal and state level. So, we should um um carefully examine that and
when we prepare our 2026 um year 2026 budget and I know Allison and I are um carefully looking at the numbers and trying to make recommendations to the board. Any [Music]
questions? Again, here's our final um budget and actuals financials for 2024. Any final questions for me? Thank you, Mr. Chair. I appreciate the discussion and and look forward to the committee of the whole. I I think it it
it's really good to be able to dig deeper and I appreciate the time um in the information presented it would be interesting to see on a graph by department the percentage of revenue
that is coming from tax dollars. So if we take we take a period of time you took you know from what was it 2021 or whatever but if you take let's say a a five six 10 year whatever period and then you you go and you look at the
percentage that is coming because we're resourceful and we're getting grant funding. You can look at the percentage that's coming from state, the percentage that coming from federal and the percentage that's coming from our levy. And if you put that on the graph by department, we can see trends. And and
if you see a trend where where the percentage that's coming from tax levy is going up and we see that it's going down in in our grant funding or other areas, it just helps us to understand to the extent that we're resourceful and we can get more monies from grant and it
pushes down that tax levy impact. That's a good thing and that's the kind of stuff we should be publishing to say this is what we're encouraging. So, but I would I would like to see by department the allocation of where our revenue comes from. Can I just clarify
your question, Commissioner? Are you looking for by department within the public health and human services department or PHS within overall county? Okay. No. Yeah. Relative to public health because you divided it into your categories social services, mental, you know, and ch child. take it by
department and take our source of revenue and show us the trend where things are going. And then when we go into this 2026 budget period, whatever the fallout and whatever we see there now, we're going to see the impact of
those areas that are threatened and where are we going to shift that? And as our directive is is we have to look at the level of services and we have to look at where the money's going to come from. But it'd be helpful to see that trend.
So basically that graph only broken down per three departments. Yeah. Okay. Yeah. If that's possible to have I'd like to see that. Yeah. And the other thing that's a component of that is if you take similar counties within public
health human services, how did they reflect percentage of levy contributed to those departments? So break this down and then ask other counties to break it down. Well, I don't
know if I can I have a poll on other counties, but I can certainly prepare the information. We'll give you some we'll give you some pull there, but it'd be helpful to see. I mean, those things you you can celebrate or you learn from. I think it'd be beneficial because we're all in this together kind of thing. It's
just how are we together learning our stewardship. the the more practical might be just the state. Um like I don't know how many counties we're gonna as we're preparing our budget. I don't know how many other counties budgets we can dive into to compare. Well, I mean you
ask the information and and you I mean respectfully it's not a demand, but you you ask the information to the extent that you can get it. I mean for me looking at the wage thing and talking to 87 counties about the wage thing, I got a lot of information. when I put that together, I can graph it out. And so I I
think the task can be overwhelming on top of what we're doing, but we're we're in a situation where I think the more we can form and the more we have contacts, the more we either are firmed in it. I know in doing budget as an executive director, I would show comparables with
regions, with nature and of other organizations, total budget. And it allowed in our in our annual meetings, people to be board members and and people that were interested to be able to compare and they could ask questions, say, "How come we're so much
lower? How come we're so much higher?" Because that context was provided. So I I'm not trying to bel labor but I think it's helpful information to the extent we can get it. Um Rana had a comment and then Commissioner S. I just want to say that you know when you're working with
people and especially children if we're investing services for a young child who then goes on to lead a healthy normal life and doesn't need to be for example in in treatment for a year. That would be expensive. That's a benefit. There's
no way of really quantifying that, but but I think the whole program works for people where public health is helping them to be successful in life, which is not only saves money, but benefits the community.
So, that's the way I see it. You know, the numbers aren't comparable in certain ways because of that. We know we have a lot of elderly people here. they need certain things, but also, you know, the the goal is to improve
people's lives. That's the what public health is is doing, you know, physically and mentally, whatever. The service and the cost. I respectfully, the service and the cost are two things. Obviously, our whole endeavor is to try to let our services improve people's lives, right? And and so that's there, but there is a
measurable cost that is there. So, I think it needs to be looked at that coming out of the the corrections board meeting uh this last week and the number of testimonials, people 20 years later that bump into people that were their counselors and and seeing where their
life is at. Those are tangible things, but but there is a cost associated with it. And and for us when we look at the county as a whole, it's where do we invest dollars in in roads, in people, you know, in in buildings and it's just
part of stewardship. But I but I agree. Yeah. And and uh it ends up being a blessing when you see the the bread coming back on the water. Mhm. Yeah. Commissioner, I was just going to say to Commissioner Gamble's um request to look at levy kind of through different
counties that at our district meeting in June with AMC that might be a great place to ask for that. Yeah. Or even ahead can speak to it so people could provide it. Right. That's a good idea. I can
certainly prepare information for I intentionally excluded 2020 because that was a little different year. So I'll prepare information for the last four years for the revenues by
department. Yeah. Um and I and I appreciate the narrative that informs relative to why did you pick the years that you pick the years because sometimes we pick the years you know to represent what we want to represent and to the extent that we can understand in
that context with a narrative informing the why that's beneficial. What we're looking is good information that helps us to make good decisions. Yeah. Thank you, Plummet. Any final questions? Thank you. Thank you. Great.
[Music] Look forward to uh our meeting in July. Yeah. In other words, what have you done for us lately? Yeah. We have a preliminary budget prepared. We actually have to submit it to Brady
by uh end of the week here. Yeah. Um it should it's early but um we'll do our best to um get as close as we can to it's going to be. So thank you. Thank you. Thank you so much plumbing.
Um this brings us down to item five. I need to take a short break. I don't know if anyone else does but other Okay. Yeah. And we don't have a whole lot of time here. Yeah, I'm I uh I'm projecting that we may not get through our number seven item, committee reports, but we'll just see where time where time goes
here. Yeah, thank you. It's hugely important and sometimes you don't gather the information and the questions come in. We need to do this. We need to have time to get up and live.
Well, I'm always open to any recommendations of how and I really purpose out. kind of keep it somewhat system same maybe but The playing all these We're all back now. Whenever Are we
still rolling? I just muted it. Okay. Thank you. Are we Are we unmuted now? We're unmuted. Okay. All right. Welcome back everyone. Um just had a short recess in our public health human services board. Uh it's now
10:10 uh May 10th. Um we are on to um item five uh includes our director's report. I think we're going to shuffle things up a little bit. We'll move item D first and then we'll jump to A and
then EF from the consent and then BC to make it really clear for everyone. Does that spell something? Uh nope. I mean, not intentionally. Uh, so item D is the, uh, fiscal reporting letter. Thank you, Commissioner Mills. I'd like
to, uh, take a moment to recognize our fiscal team after that excellent presentation from Plum and Demitra. We also have a recognition from the Department of Human Services for our 2024 calendar year reporting. This was
sent from temporary commissioner Shireen Gandhi of the Minnesota Department of Human Services uh as addressed to Cook County Board of Commissioners Chair Jenny Stoley. The letter reads, "It is my pleasure to commend you and your staff for perfect performance in meeting the
Department of Human Services financial reporting requirements for calendar year 2024. All key quarterly fiscal reports for your programs your county participates in were submitted to our financial operations division on or before the report deadlines in perfect
order. This effort required submission of 32 major reports covering the four calendar quarters of 2024. These reports are the local collaborative time study, MIP consolidated fund, calendar, sorry, client stat statistics, seagar, income
maintenance expense, social services fund, title 4E, brassb-based grant, fiscal report. I know this accomplishment requires planning, an efficient operation, and teamwork within your county human services department. The result is timely revenue for your
county and compliance with federal reporting for us at the state. Please congratulate your management and staff on this superb effort. Plan bravo. Thank you. And team and team. Yeah. Yeah. I just
want to take a minute and acknowledge the work of my team. They work very diligently to um receive revenue and report expenditures and um this is an important work they do and that award
goes to the entire fiscal team. Um and thank you for the recognition. I um asked Allison to put that before a financial presentation on the agenda, but we had to do the financial presentation
first. Yeah. Yeah. Timing is everything. Well, thank you. It's not much better than perfect. So, well done. So, kudos plumman, Andy, and Leah of our fiscal team. Thank you. With that, I'll move into
staff updates, give a summary of where things are at uh staff-wise within our department, and then be available for any questions or comments regarding the two staffing related items that were pulled from the consent agenda. I've included an updated organizational
chart in the agenda materials under item 5A. Since our last meeting, we've welcomed Bob, who you met this morning, as our new children's mental health case manager. We are recruiting for two vacant positions on our children and family services team. We have one
posting that closed yesterday that we're using to fill two vacancies. One of those positions has been vacant since January 10th, 2025, and the other was recently vacated by Marissa Eckle uh following her resignation in
April. On the consent agenda, we have the recognizing the resignation of Sarah Eisenrike as our coordinated crisis response worker. And at this point, we're doing some re-evaluation within our behavioral health team. We haven't immediately posted for that children's
mental health case manager position that was vacated by Rose Downey last month. Uh with Bob coming on board and as we're wrapping up our temporary employment contract with Tammy who is working with us through temporary social work, we're
taking a look at case loads and ensuring that we're well positioned to post and recruit for that second children's mental health case manager position. Within behavioral health, we also have additional budgeted positions that are fully funded under that state department
of human services mobile crisis grant. Again, Sarah's resignation impacts program staffing overall. So, we're taking a pause to look at needs across the program and the department. We're very excited to be welcoming Erica Turnis to the team.
Erica brings a unique combination of public service experience and systems aptitude with her work with the library and schools in Cook County. Erica starts June 9th. Melissa is uh beginning her phased uh resignation with her reduction of hours effective the
first week of June. And Melissa will be continuing to provide halftime onboarding and support through July to support Erica in her onboarding. This point I'd be happy to take any questions regarding staff updates overall and the two items from
the consent agenda. F first, thank you Melissa for for the overlap and timing. really appreciate your work. Sorry to see you go, but um excited for you to move on. Uh Commissioner Gamble, you wanted to pull items E and F from the consent
agenda. Yeah, want to be sensitive to time here, but uh how long uh in the position served how long is served in the position? That was one question I had. and then uh the pay grade at which
the position was at. And then we see in our in the consent agenda what the proposed pay grade is. So that those are my three qu questions. How long Melissa has been in the position what pay grade what is it?
Um I've been here for three years. Okay. On June 21st. So I will have met the three-year mark. Okay. Thank you. And your question is about the pay grade at the executive admin assistant position. That's right. Where where the pay grade was and then moving into
the new hire in the position, how that's changed. So the pay grade uh has been evaluated at a 160 I believe as long as Melissa's been in the position for the last three years. So that's been consistent. It was a part of the DDA review process re reviewed but did not
result in a rescoring of that position. Um, are you asking about the the rate for bringing Erica in and the rationale there? No, just just wanted to know if if if sometimes when you're posting the position, you're looking new, higher, you change the pay grade and and the pay
grade hasn't changed. That answers my question. And then the other question I had relative to item F on the consent agenda was that um you know uh we had uh uh Sarah come before us uh one month
one month previously. And so whatever we know in that regard at some point, it'd be interesting to to know uh when Sarah was introduced and and uh she's leaving after a month. So that that was my question. So Sarah started on March
10th. So she was with us just under two months in that position. Yeah. Okay. So yeah, that's that that those are my questions. Yeah. Okay. Thank you. Um so we have um two items
uh that we need to act on. Uh the hiring and then the resignation acceptance. Mr. Chair, Commissioner Svin. I'd like to make a motion to approve the hire of Erica Turnis and the resignation of Sarah Einri. I support. Okay. We have a motion from Commissioner Sullivan,
support from Commissioner Gamble. Any further discussion? Oh, thank you for the discussion. Y hearing or seeing none. All those in favor? I I opposed. Motion passes unanimously. Thank you. And then that'll move us on to item B.
All right. Under five. Yeah. So for agency report, we continue to be busy with a number of different initiatives throughout the county. Our medication lockbox initiative to promote safe storage and disposal of medications and other substances is now live. This pilot
uses county opioid settlement funds and includes distribution sites at our public health and human services department here in the courthouse as well as Grand Portage Health Services, Grand Portage Human Services, and the Sawtooth Mountain Clinic. Our targeted population for that
distribution is older adults, especially those with young children in the home, some multi-generational homes. Earlier this month, staff co-hosted an applied suicide and intervention skills or assist training in Grand Portage with trainers from First Link Crisis Response
Center out of Fargo, Morehead. Uh that work was funded by our substance misuse and suicide prevention grant from the state department of health. The bike rodeo is scheduled for Thursday of this week, the 22nd, at the community center. We are still looking
for volunteers for this fun event. So, if any of you want to contribute to like education, our community, you can reach out to Christina Matson and our public health team or find that media release that went out communitywide
yesterday. Uh we were informed since our April meeting that we were not successful in our application to the state for the super grant. That was the substance use prevention grant. Uh we in applying for the grant were not in the top tier priority for projects but uh
were still eligible and and felt had a competitive request. Uh but unfortunately we're not awarded that grant and are expecting that grants will continue to be increasingly competitive given the state and federal landscape going forward. We are continuing to monitor for new grant opportunities.
The request for proposals is opening next week for the public health fund 2026 grant making cycle. Our subcommittee has been meeting to finalize our outreach materials, application materials, and evaluation tools, and we'll be putting out a media
release uh with information to community nonprofits on how to apply for 2026 funding. As I mentioned in our financial report, we are on the agenda for the July committee of the whole to present on our community child care initiatives, give a
mid-year report on what is, I believe, year three of that pilot uh midyear and uh introducing some uh questions and uh strategies for our 2026 budget cycle. Continuing to monitor program
cuts that are proposed at a state and federal level. I received a memo from the state department of children, Youth, and Families Commissioner regarding proposed changes to the SNAP program that would increase uh the the responsibility for counties
or the state anyways to pay a share of those benefit costs. uh reducing federal reimbursement of state administrative costs, expanding work requirements to older Americans, imposing work requirements on families with
children, restricting state flexibility for work requirements, waiverss, and exemptions, limits to the thrifty food plan, which is the budget under which SNAP benefits are calculated. restricting those household utility deductions which are used to calculate
benefits and restricting SNAP eligibility for legal non-citizens. Doing some outreach in the weeks ahead just to inform community members on what these proposed impacts are and how to engage with lawmakers around uh protecting the SNAP
program in Minnesota. I included in the agenda materials a letter that was uh put out by the state department of human services and sent to stat shack which is the statewide health advisory council that summarizes the
uncertainty around some of the federal dollars uh and the impact on public health as a state and to local public health. given time our time. I'm not going to spend a lot of time going over that memo, but included that for your
information. Um, with regards to the local impact of some of those uh federal termination of grants, we were notified on March 25th that a grant that we had been receiving for CO 19 vaccine implementation was terminated. We have
since uh received a notice from the state that that grant has been reinstated. So, we're working with our our county attorney and our community health board to assess the risk in accepting this grant and what this could mean for our department. Uh other
counties within the CHB are declining to accept that grant. Uh which could result in uh nearly double grant award to Cook County should we accept the grant. So, we had uh approximately $33,000 remaining in our
allocation and there's a potential of nearly $50,000 that other counties within the CHB will not be accepting. So, our intent at this point is to accept the grant and to utilize these funds for a larger project and to
mirror the grant language within our vendor contract to protect any county liability around those funds. So, that's something that we're actively working with uh within our our fiscal team on a programmatic side and with our county attorney. And that's it for department
updates. Happy to take questions on any of those reports. I did not put together a comprehensive legislative update, but would encourage you to review the the emails that have come out in the last couple days from AMC for an update on where we're at in the legislative assession and what that means for health
and human services priorities and programs. Thank you. Any questions for Allison? All right. Well, time is running out here. Um we'll move on to item uh six um which is uh items for board action and
this in is the um uh amendments to the public health human services advisory council um bylaws. Um you want to give an overview of those of those changes? I'd be happy to and I'd invite our chair as well to comment on um the intent and discussion around
these changes. So in the last two public health and human services advisory council meetings, we meet every other month. So our our May and March meeting, we've had extensive conversation around recruitment for that council. Um not
just for members but for officers and um if our bylaws are unnecessarily restrictive in terms of community members and members eligibility to become officers within the council. So over the last two meetings, we've
reviewed the bylaws and have proposed changes. I left changes tracking on within the department or within the document so that it's clear what is being modified. Uh the first modification is within section 4
officers sub section B item two. The bylaws previously stated that the chairperson and vice chairperson shall have served at least one year as a advisory council member before being elected into office. Our proposed change is that advisory council members shall
have served at least one year before being elected as chairperson. So this would remove that one year of service requirement for the vice chair. Uh the council also discussed uh ways to provide more support to incoming members
to better understand their roles and responsibilities on the advisory council and a desire to formalize that in the bylaws. So we have added item seven under section five subsection A. The agency director and council chair shall
provide an orientation to new members to ensure understanding of roles and responsibilities for serving as a council member. These changes were reviewed and approved by motion at our May meeting. Anything, Frank, that you'd
like to add there? Uh, no. just that the reason for looking for these changes now is that although we have a in my opinion a very strong board, it's not a very deep board. Um we have to uh and we are
working on plans to increase the representation of the board through um actively seeking new members in especially looking at geographical diversity. uh age of life
diversity. Um more gray beards than uh uh than little little moms and dads um up there um service
recipients and non-traditional service providers and those seeking representation of membership from those groups is included in our charter. So we're going to be actively doing that. Um may I encourage the board members as
you meet with various um homeowners associations during the summer that season is coming up. Um you might want to mention that that we are looking for this. We will be contacting uh and reaching out for an increased
membership. So that is that's all I wanted to add to that. Thank you. Um just the date at the end says March 17, 2020. So, we just want to make sure that's changed to whatever that May date that or Yeah. So, that was
the last time that the bylaws were reviewed and approved by this board. Please. Yeah. So, I would um I would just note on page one under definitions, uh it it's something I think in making the
change it' be done anyway, but there's an additional E in front of the C for council. Yeah. Red. Mhm. Yeah. In red there. So, it just checking it for correctness and and spelling, but other than other than that one, that's the only thing that I
noted. And then the dates being correct. Uh I had approved the amendment to the uh as proposed for public health and human services advisory council to their uh bylaws. We have a motion from Commissioner Gamble. Is there support? Support. We have motion and support from
Commissioner Sullivan. Any further discussion? I'll recuse myself. as chairman of the council. Um well, there's no benefit. There's no gain. And so, um I'm afraid you're
obligated to vote. Okay. And and just saying in making the motion that I am on that advisory committee. So, I'm familiar with the process we went through to arrive at this document. Thank you. All right. All those in favor? I I
opposed. Motion passes unanimously. Um we ran out of time today, so we have our committee reports left. Um and um I'm afraid we're just going to have to pass over that and move on to adjournment. Um because of
that jump, I'd ask for a motion to adjurnn today. So move. Thank you. We have a motion. Is there support? Support. Thank you. Motion support. Any further discussion? Hearing or seeing none. All those in favor? I opposed. Motion passes unanimous. Seconds left.
So that's great. Thank you. Thank you. Thank you. Yeah. Yeah. Yeah. We'll do that. Some people want to sit out here. Yes.