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Commonwealth of Massachusetts

The Governor's Budget Recommendation

Executive Office of Family Services


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Executive Office of Family Services

Department of Public Health Services

Department of Disability Services

Department of Transitional Assistance

Department of Children's Services

Department of Juvenile Justice

Executive Office of Family Services

The new Executive Office of Family Services will oversee health, social, disability and juvenile justice programs for residents of the Commonwealth. Its goal will be to defeat dependency and promote the dignity of those seeking assistance. Family Services will seek to protect children, provide transitional assistance to the truly needy, promote public health, and help those with developmental and physical disabilities.

In Fiscal Year 1997, the Executive Office of Family Services will pursue the following objectives: The Executive Office of Family Services will be positioned to pursue these objectives through the consolidation of the existing 16 Health and Human Services agencies into five new departments: the Department of Public Health Services, the Department of Disability Services, the Department of Transitional Assistance, the Department of Children's Services, and the Department of Juvenile Justice. Agency consolidation will streamline administrative functions, save both agency and vendor resources by reducing the number of service contracts, and allow for greater purchasing power and volume discounts. Consolidation will also foster improved use of information technology to help reduce duplication of services and ensure that program resources are allocated effectively.

Through reconfiguring central, regional, and field offices, with the ultimate goal of providing a single access point for the consumer, the new Family Services secretariat will be better designed to serve those Massachusetts residents and families seeking assistance, many of whom have multiple needs and who are not effectively served under the current system. Currently, the various agencies within the Executive Office of Health and Human Services provide services across the Commonwealth based on different service delivery regions. The new Family Services secretariat will seek to develop service regions with congruent boundaries featuring an integrated network of multi-service field offices equipped to best expedite client intake and referral to services.

Recognizing that many individuals require long-term inpatient care, the Secretariat will maintain a system of facility-based services for the mentally ill, mentally retarded and other chronic care populations; however, because current funding mechanisms appropriate taxpayer dollars to state facilities and not directly to consumer and consumer family needs, there are often many individuals residing in state facilities who both do not want and do not need to be institutionalized. Across the Secretariat, facility-specific accounts will be consolidated with community-based accounts to change the focus from tying dollars to buildings to connecting them with consumer needs. This flexibility will encourage the Secretariat to continue developing alternatives to inpatient care but, importantly, will preserve those facilities capable of delivering high quality, cost-effective care.

The Office of the Secretary will consolidate several functions currently provided at other agencies: The Executive Office will develop and direct statewide policies on child care programs and services. The Office will manage the $52 million federal Child Care Assistance Block Grant which will fund training programs for child care providers; information and referral services for families; and family preservation, employment services, income eligible and special needs child care. These federal funds will be allocated to the Department of Transitional Assistance and the Department of Children's Services. During Fiscal Year 1997, the Executive Office will develop a comprehensive, unified eligibility and intake system for all day care programs.

Finally, the Office of the Secretary will oversee the Commonwealth's soldiers' homes in Chelsea and Holyoke which offer an array of medical and residential services to veterans.

During Fiscal Year 1997, services provided by the Executive Office of Family Services will be performed by 23,012 full-time equivalent staff (FTEs), representing a reduction of 808 FTEs from Fiscal Year 1996 levels.

Budget Recommendations

Fiscal Year 1997 funding recommendations for agencies within the Family Services secretariat include nearly $14 million for improving salaries for the lowest paid, contracted, direct care workers that provide human services to the Departments of Public Health Services, Disability Services, Juvenile Justice, Children's Services, and Transitional Assistance.

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Department of Public Health Services

The new Department of Public Health Services will promote and assure conditions that improve and protect the health of Massachusetts residents. The Department will focus on coordinating health care and promoting community-based heath care activities; fostering continuous improvements in the health status of individuals and communities; supporting programs that prevent and treat disease and disability; intervening to reduce public health threats; and assisting families and individuals in obtaining high quality, appropriate health services. The Department will provide health services to those at highest risk and in greatest need, including those with serious psychiatric illnesses, in a manner which stresses integration of disease prevention, treatment and rehabilitation, and encourages the highest level of functioning and self-sufficiency.

The Department's services will benefit financially needy individuals and families with little or no health insurance; seriously and persistently mentally ill adults and seriously emotionally disturbed children; troubled, at-risk children and adolescents; pregnant women and infants; groups at risk of infectious diseases (including AIDS/HIV), intravenous drug use, homelessness, sexual and domestic violence; and more broadly, state employees and retirees through the purchase of group health insurance; and the general public through health education and safety services.

In Fiscal Year 1997, the Department of Public Health Services will pursue the following objectives: The Department of Public Health Services, through its three divisions: Public Health; Purchased Medical and Support Services; and Health Policy, Research and Planning, will combine the expertise of the current Departments of Mental Health (DMH), Public Health (DPH), Medical Assistance (DMA), Medical Security, and the Rate Setting Commission to provide an integrated and cost-effective public health services system. Under the current multi-agency structure, the Commonwealth is prohibited from pursuing many innovative strategies in health care purchasing and program design.

As one agency, the Department will be better able to allocate resources in preventive, acute, and continuing care services, and minimize cost shifting that occurs under the current multi-agency system. For example, having separate agencies responsible for mental health services for preventive care (DPH), acute care (DMA), and continuing care (DMH) creates perverse incentives in which agencies benefit by shifting expenses onto each other even though it may not maximally benefit the consumer or be cost-effective for the taxpayer. By consolidating resources and accountability, money saved through purchasing efficiencies in acute and emergency mental health services, an initiative begun this year, can be reinvested in the continuum of mental health services, thus reducing long-term costs.

The Department will also benefit from an integrated network of Family Services field offices with consistent regional boundaries. With services centralized in one area office and a single eligibility process, access and appropriate referral to health care services will be streamlined and improved.

The Division of Public Health will provide innovative care services for persons now being served by several different state agencies, made possible by the integration of prevention and treatment programs within a single agency. As a cornerstone of the new Department of Public Health Services, the Division will provide individuals who currently receive medical services, through programs such as Medicaid, with the necessary assistance to reduce the incidence and severity of health problems, thus lowering the overall cost to the Commonwealth. By creating links between existing prevention, education, and treatment programs such as AIDS/HIV, Substance Abuse, Early Intervention, and Teenage Pregnancy Prevention, the Division will offer a comprehensive continuum of care that will address a variety of individual client needs. Community-based approaches to identify appropriate strategies for preventing disease, promoting early diagnosis and treatment, and improving access to care for the underserved, will allow the Division to build upon the current Department of Public Health's strengths of improving and protecting the public health.

The Division of Purchased Medical and Support Services will provide both acute and continuing health care services including comprehensive mental health care. With consolidated funding and accountability relationships, the Division will purchase health care and support services more effectively through greater purchasing power. For example, the Division will save the Commonwealth money by purchasing health care benefits for both state employees and other program recipients jointly. In addition, client services will improve through performance-based contracting and better coordination of services in co-located field offices.

By pooling funding for facilities and community services, the Division will be able to purchase long-term care services for mental health and chronic care populations more effectively. Currently, the Commonwealth pays for services in state facilities at great cost to the taxpayer. For example, the average daily cost for a chronic care client at a public health facility is roughly twice as much as the cost of serving the same client in a more appropriate community-based setting. Through its ability to purchase the most site-appropriate and cost-effective services, the Division will help to assure a proper mix of high quality inpatient care units and appropriate community placements at the lowest cost to the taxpayer.

The Division of Health Policy, Research and Planning will enable the Commonwealth to keep up with our changing health care environment through improved collection and evaluation of health care data; better monitoring of market trends in health care delivery systems; investigation of alternative financing systems; and development of health outcomes research. In addition, by integrating the agency management information systems of the current DMH, DPH and DMA, more effective program management and planning will be possible.

During Fiscal Year 1997, services provided by the Department of Public Health Services will be performed by 7,649 full-time equivalent staff (FTEs). During Fiscal Year 1996, these services are provided by 7,865 FTEs in the Division of Medical Assistance, Department of Mental Health, Department of Public Health, Department of Medical Security, the Rate Setting Commission, medical assistance eligibility workers at the Massachusetts Commission for the Blind, and the administrative staff who purchase employee health benefits at the Group Insurance Commission.

Budget Recommendations

The amount recommended for the Department of Public Health Services will provide funding for expanded services including: In addition, nearly $3 million is included to enhance the salaries of the lowest paid direct care workers in the mental health system.

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Department of Disability Services

The mission of the Department of Disability Services will be to afford individuals with disabilities the opportunity to maximize their quality of life and achieve economic self- sufficiency in the community of their choice.

The Department will pursue its mission by: The Department will serve approximately 113,000 individuals with disabilities, including those who are deaf and hard of hearing, physically disabled, developmentally disabled, legally blind, and those with traumatic brain injuries.

In Fiscal Year 1997, the Department of Disability Services will pursue the following objectives: The newly integrated Department will foster a more coordinated, cost-effective, and efficient service delivery system. The current system of discrete departments hinders efficiency by requiring some clients to interact with three or more existing agencies to receive services. The Department of Disability Services will share coordinated administrative services thereby reducing duplication of effort and resulting in more administrative efficiencies, ultimately yielding more resources for direct services for individuals with disabilities. The realignment of administrative resources will be enhanced by a quality assurance function that ensures clients are receiving the services and supports they need to achieve greater independence.

The Department of Disability Services represents a consolidation of the Massachusetts Commission for the Blind, Rehabilitation Commission, and Commission for the Deaf and Hard of Hearing, as well as the Department of Mental Retardation and the Administering Agency for Developmental Disabilities. This new Department will deliver services through four component programs: residential supports, vocational supports, family and individual supports, program management and administration; and two bureaus: the Bureau of the Blind, and the Bureau of the Deaf and Hard of Hearing.

The agencies that will comprise the Department of Disability Services employ 8,517 full-time equivalent staff members (FTEs) in Fiscal Year 1996. By the end of Fiscal Year 1997, increased efficiencies will result in fewer than 8,265 FTEs providing the same services and administrative support.

Budget Recommendations

The Fiscal Year 1997 funding recommended for the Department of Disability Services is $793.9 million. Included in this recommendation is an increase of over $4 million for Turning 22 clients, and an additional $4 million to reduce the number of individuals who are currently unserved or underserved, with particular emphasis on consumers and potential consumers whose caregivers are elderly and may no longer be able to provide adequate care. Also included in this recommendation is over $6 million to provide salary increases for the lowest paid direct care workers in the purchase of service system, and $186,448 to pay for salary increases for special education providers. An additional $200,000 for interpreters for the deaf and hard of hearing is also included.

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Department of Transitional Assistance

The mission of the Department of Transitional Assistance (DTA) will be to provide low-income individuals and families with transitional services that promote responsibility and self-sufficiency. These services will include income assistance, child care services, and emergency shelter assistance.

The common focus of all DTA programs will be to provide short-term assistance to individuals currently unemployed and longer-term assistance to individuals who cannot work due to age, disability, or other factors. The Department will administer three cash assistance programs for 277,000 low-income individuals and families: Transitional Aid to Families with Dependent Children (TAFDC); Emergency Aid to the Elderly, Disabled, and Children (EAEDC); and the state supplement to the Supplemental Security Income (SSI) program. The Department will also administer the federal Food Stamps program for 127,000 low-income individuals and families.

In Fiscal Year 1997, the Department will focus on the following objectives: In Fiscal Year 1995, the Weld/Cellucci Administration implemented the Commonwealth's welfare reform initiative. The core objectives of the initiative are to require able-bodied TAFDC recipients to find employment and to provide support services, including day care and health coverage, that enable recipients to retain employment.

The success of the new TAFDC program is contingent upon the efficient provision of subsidized child care to allow recipients to maintain employment. Subsidized child care also assists low-income working families to avoid the need for TAFDC or other income assistance programs. In Fiscal Year 1997, the Administration will expand the average number of TAFDC child care slots by 33% to 34,500, and will increase the number of income-eligible voucher slots by 27% to 4,700.

To ensure that the provision of day care is properly integrated with TAFDC, the Department will become the state agency responsible for administering all subsidized contract and voucher day care programs to low-income families. To enhance the integrity and coordination of the various programs, the Department will work with the Executive Office of Family Services to develop a unified eligibility and intake system for all subsidized child care programs.

The success of welfare reform is also contingent upon the Department's ability to quickly provide TAFDC recipients with effective job entry skills. During Fiscal Year 1997, the Administration will continue to change both the focus and the method of delivering employment and training services. The fundamental goal of the Employment Services Program will be to increase the labor force participation of TAFDC recipients by placing more emphasis on immediate job readiness services and less emphasis on long-term job training. As recommended in the Governor's Reorganization Plan, statewide employment and training services will be centralized into regional career centers, which will be coordinated by the Office of Education and Training. DTA will determine the eligibility of TAFDC recipients for employment and training services. The career centers will refer eligible recipients to programs that provide them the most appropriate services.

In Fiscal Year 1997, as recommended in the Governor's Reorganization Plan, the Department will take steps to improve the integrity of the SSI state supplement program, which is funded by the state but federally administered under contract with the Social Security Administration (SSA). To ensure that only truly disabled individuals are eligible for continued benefits, DTA will collaborate with the Department of Disability Services and SSA to conduct approximately 50,000 disability redeterminations. A similar medical screening and redetermination process, established when the Administration replaced the General Relief program with EAEDC, has resulted in a 55% decline in the EAEDC caseload since Fiscal Year 1992.

The Department will also develop plans, for Fiscal Year 1998, to assume administrative responsibility for the SSI supplement program. A state-administered program will provide the Commonwealth with more flexibility in establishing eligibility standards and monitoring participation in treatment and rehabilitation programs. Furthermore, it will permit the integration of the supplement program with EAEDC, and allow DTA to develop disability standards that are uniform across all assistance programs.

In Fiscal Year 1997, the Department will assume responsibility for several programs that were previously administered by other agencies. DTA will administer all subsidized day care programs, except for Family Preservation Day Care. Previously, the responsibility for these programs was shared between DTA, the Department of Social Services and the Executive Office of Health and Human Services. DTA will also administer the Early Childhood Education and Care program, which was previously managed by the Department of Education. State SSI supplement benefits to the blind will be provided by DTA, rather than the Massachusetts Commission for the Blind. Finally, the Department will assume responsibility for the New Chardon Street Home (a shelter for homeless women and children), which is currently administered by the Department of Social Services.

The Department will also yield responsibility for several programs to other agencies in Fiscal Year 1997. The Department will no longer administer the Employment Services Program, EAEDC health services, or structured housing for teen parents. These services will be provided by the Board of Education and Training, the Department of Public Health Services, and the Executive Office of Family Services, respectively.

In Fiscal Year 1997, the Department of Transitional Assistance will employ 2,550 full-time equivalent staff members (FTEs), which is 96 fewer FTEs than in Fiscal Year 1996.

Budget Recommendations

The Fiscal Year 1997 budget recommendation for DTA anticipates significant federal changes to cash assistance and child care programs. Block grants will replace the current methodology of funding TAFDC programs, in which the State receives 50% federal reimbursement for most spending. The Temporary Assistance to Needy Families Block Grant will provide the Commonwealth with approximately $432 million to fund TAFDC program and administrative expenses, Emergency Assistance, and Employment Services Program. The Child Care Assistance Block Grant will provide approximately $52 million to fund child care programs for TAFDC and income-eligible families.

For Fiscal Year 1997, the Administration recommends $241 million in subsidized day care funding, including $188 million from state appropriations and $53 million in federal block grant funding. This represents a 24% increase from Fiscal Year 1996. The Administration also recommends $513 million in funding for TAFDC, including $98 million from state appropriations and $415 million from federal block grant funding. This represents a 12% decrease from Fiscal Year 1996.

The Fiscal Year 1997 budget recommendation includes $1 million in item 4930-0000 to expand the finger-imaging pilot project to cover all TAFDC recipients. Item 4930-0020 includes about $12 million in new funding to provide EAEDC cash assistance to legal immigrants, who are expected to lose eligibility for SSI as the result of federal eligibility changes.

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Department of Children's Services

The mission of the new Department of Children's Services will be to protect children from abuse and neglect. The Department will provide services to abused and neglected children; provide prevention services to support and strengthen families; and ensure that each child has a safe, nurturing, and permanent home.

The Department will serve approximately 22,000 families. Programs provided by the Department will include crisis intervention, counseling, and family skills training, which help create an environment that will allow children to remain safely in their homes. For children whose families are unable to care for them, the Department will seek alternative permanent homes through adoption, guardianship, or independent living.

In Fiscal Year 1997, the Department of Children's Services will pursue the following objectives: An important initiative of the Weld/Cellucci Administration has been the promotion of adoption as the means to find permanent homes for nearly 4,000 children in foster care and group care who cannot return to their home of origin. The Department of Children's Services will continue the Administration's efforts to expedite adoptions. Since the beginning of Fiscal Year 1992, over 3,500 children have been placed in permanent homes. The implementation of legislation (Chapter 303), signed into law by Governor Weld in 1992, and the success of performance-based adoption contracts, have resulted in earlier development of permanency plans and more expeditious movement of cases through the Probate and Family Court system. The Fiscal Year 1997 budget recommendation includes an additional $570,000 for judicial resources within the Probate and Family Court system, to further streamline and expedite the adoption process. In Fiscal Year 1996, the Department will finalize approximately 1,000 adoptions.

In Fiscal Year 1997, the Department of Children's Services will complete implementation of a new system of residential group care. The new system will offer a comprehensive array of services to children and their families through a network of private providers. The primary goal of the new system is to return youth, as quickly as possible, to their families, or to prepare them to live independently in the community. The program will emphasize education programs, and it will offer an improved level of services to younger adolescents with serious behavior problems.

The Department also plans to improve the foster care system by providing more service options to children in foster care. The improved system will have multiple levels of care through regular foster homes; specialized foster homes; and emergency foster homes, where children will receive the level of treatment required to meet their needs.

The Department will be the primary provider of services to families affected by domestic violence. The Weld/Cellucci Administration continues to support shelter and counseling services for victims of domestic violence. The Department will expand services for children, teenagers, and non-English speaking women affected by domestic violence. The Batterer Intervention Program, currently administered by the Department of Public Health, will be transferred to the Department of Children's Services to foster a more coordinated and effective service delivery system.

In Fiscal Year 1997, the Office for Children's licensing function will move to the Department of Children's Services, eliminating the duplication of administrative services. The licensing function will strengthen and support the Department's Quality Assurance efforts. The Department will license and monitor over 14,500 child care providers including family day care programs, group day care programs, school age day care programs, and substitute day care providers serving approximately 170,000 children and their families.

The essential state services being consolidated within the Department of Children's Services are currently provided through the Department of Social Services, the Office for Children, and the Department of Public Health.

Budget Recommendations

The Fiscal Year 1997 funding recommendation includes $3.6 million for caseload growth in adoption and guardianship services; $7.8 million for foster care services; $3.3 million for expansion of services to families affected by domestic violence; $2.5 million for statewide expansion of the Collaborative Assessment Program (CAP) with the Department of Public Health Services, of which $1.9 million is within the Department of Children's Services; $885,629 for salary increases for special education staff; and $589,722 for salary increases for direct care workers in the purchase of services system. Additionally, the New Chardon Street Home for the Homeless (4800-0050), will be transferred from the Department of Social Services to the Department of Transitional Assistance; and the Family Preservation Day Care (4000-0230) program will be transferred from the Executive Office of Health and Human Services to the Department of Children's Services. The Social Services Block Grant, totaling $63.3 million, will be transferred from the Department of Social Services' state appropriations to a federal grant.

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Department of Juvenile Justice

The Department of Juvenile Justice will be responsible for the enhancement of public safety; crime prevention; and rehabilitation of delinquent youth. The Department will be primarily responsible for two categories of youth who appear before the courts: those who have been charged with criminal offenses and are detained on bail or without bail; and those who have been committed by the Juvenile Court to remain in the custody of the Department.

The Department will provide a continuum of services ranging from secure residential programs to non-residential community supervision. Treatment services in residential facilities will provide education; clinical and family services; and vocational training. These services are designed to reduce the risk that youthful offenders pose to the community. Youth who are deemed to be lower risk will live at home where they will be supervised by caseworkers and community monitors.

In Fiscal Year 1997, the Department of Juvenile Justice will pursue the following objectives: In Fiscal Year 1997, the Weld/Cellucci Administration is proposing the transfer of juvenile probation from the Juvenile Court to the Department of Juvenile Justice. The transfer of juvenile probation will enable the Department to expand the continuum of services necessary to carefully monitor youth in the community; ensure the public's safety; and reduce future crime. This intensive supervision will save taxpayers the cost of incarcerating certain offenders, while assuring that probation can be revoked if necessary.

The essential state services consolidated within the Department of Juvenile Justice are currently provided through the Department of Youth Services and the Juvenile Court Division of the Trial Court.

Budget Recommendations

The Fiscal Year 1997 recommendation is $101.69 million. This level of funding includes $5.01 million for expected caseload growth, and $6.17 million for juvenile probation. In account 4950-0012, Juvenile Corrections, $1.52 million of additional funds will cover the expenses related to improving the salaries for direct care workers, and $46,261 of additional funds will cover salary increases for special education staff.

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