COMMONWEALTH OF PENNSYLVANIA HOUSE OF REPRESENTATIVES APPROPRIATIONS COMMITTEE HEARING STATE CAPITOL HARRISBURG, PA MAIN BUILDING ROOM 140 WEDNESDAY, MARCH 4, 2020 10:07 A.M. BUDGET HEARING FOR THE DEPARTMENT OF HUMAN SERVICES BEFORE: HONORABLE STAN SAYLOR, MAJORITY CHAIRMAN HONORABLE ROSEMARY BROWN HONORABLE LYNDA SCHLEGEL-CULVER HONORABLE SHERYL DELOZIER HONORABLE GEORGE DUNBAR HONORABLE JONATHAN FRITZ HONORABLE MATT GABLER HONORABLE KEITH GREINER HONORABLE SETH GROVE HONORABLE MARCIA HAHN HONORABLE DOYLE HEFFLEY HONORABLE LEE JAMES HONORABLE JOHN LAWRENCE HONORABLE JASON ORTITAY HONORABLE CLINT OWLETT HONORABLE GREG ROTHMAN HONORABLE JAMES STRUZZI HONORABLE JESSE TOPPER HONORABLE JEFF WHEELAND HONORABLE RYAN WARNER HONORABLE MARTINA WHITE HONORABLE MATT BRADFORD, MINORITY CHAIRMAN HONORABLE DONNA BULLOCK HONORABLE CAROLYN COMITTA HONORABLE AUSTIN DAVIS HONORABLE MARIA DONATUCCI HONORABLE EDWARD GAINEY HONORABLE ELIZABETH FIEDLER HONORABLE MARTY FLYNN HONORABLE PATTY KIM 2 1 BEFORE: (cont.) HONORABLE STEPHEN KINSEY 2 HONORABLE STEPHEN McCARTER HONORABLE BENJAMIN SANCHEZ 3 HONORABLE PETER SCHWEYER 4 ALSO IN ATTENDANCE: HONORABLE ROB KAUFFMAN 5 HONORABLE FRANK RYAN HONORABLE CRIS DUSH 6 HONORABLE BARRY JOZWIAK HONORABLE CHRIS SAINATO 7 HONORABLE TOM CALTAGIRONE HONORABLE ED NEILSON 8 HONORABLE GERALD MULLERY 9 COMMITTEE STAFF PRESENT: DAVID DONLEY, MAJORITY EXECUTIVE DIRECTOR 10 RITCHIE LaFAVER, MAJORITY DEPUTY EXECUTIVE DIRECTOR ANN BALOGA, MINORITY EXECUTIVE DIRECTOR 11 TARA TREES, MINORITY CHIEF COUNSEL 12 13 14 15 16 17 18 19 20 21 22 23 24 * * * * * Pennsylvania House of Representatives 25 Commonwealth of Pennsylvania 3 1 I N D E X 2 TESTIFIERS 3 * * * 4 NAME PAGE 5 TERESA D. MILLER SECRETARY, DEPARTMENT OF HUMAN SERVICES........5 6 DENNIS BOOKWALTER 7 FISCAL MANAGEMENT DIRECTOR, DEPARTMENT OF HUMAN SERVICES................................17 8 MARA PEREZ 9 ASSISTANT FISCAL MANAGEMENT DIRECTOR, DEPARTMENT OF HUMAN SERVICES..................86 10 JONATHAN RUBIN 11 DEPUTY SECRETARY, OFFICE OF CHILD, YOUTH, AND FAMILIES, DEPARTMENT OF HUMAN SERVICES........20 12 KEVIN HANCOCK 13 DEPUTY SECRETARY, OFFICE OF LONG-TERM LIVING, DEPARTMENT OF HUMAN SERVICES..................30 14 15 16 17 SUBMITTED WRITTEN TESTIMONY 18 * * * 19 (See submitted written testimony and handouts online.) 20 21 22 23 24 * * * * * * Summer A. Miller, Court Reporter 25 [email protected] 4 1 P R O C E E D I N G S 2 * * * 3 MAJORITY CHAIRMAN SAYLOR: All right, Madam 4 Secretary, if you would rise, and anybody who may at some 5 point today need to testify, if any of those would rise, as 6 well, that's in the audience. 7 Raise your right hand. 8 9 TERESA D. MILLER, DENNIS BOOKWALTER, MARA 10 PEREZ, JONATHAN RUBIN, KEVIN HANCOCK, called as witnesses, 11 being duly sworn, testified as follows: 12 13 MAJORITY CHAIRMAN SAYLOR: Thank you. 14 With that, we'll move on to our first 15 questioner of the day. It is Representative Grove. 16 REPRESENTATIVE GROVE: Thank you, Mr. 17 Chairman. 18 Good morning, how are you? 19 SECRETARY MILLER: Good morning. Good. 20 REPRESENTATIVE GROVE: Good. 21 So as we unpack the budget this week, one of 22 the things we are very worried about is the size and scope of 23 your budget. Year over year cost increases about a billion, 24 we're looking at supplementals reflected of close to half a 25 billion dollars, and then carried forward supplementals 5 1 heading into about 300 million, totally about a $2 billion 2 increase, which is not sustainable for taxpayers moving 3 forward. 4 On top of that, the Governor signed into law 5 an administrative code that provided a provision to include 6 that any kind of supplementals, we must be notified and given 7 details about. We haven't received that, and the language 8 is, quote, "A written statement detailing the amounts 9 requested and the need for the additional appropriation." 10 So this morning, I just wanted to start with 11 going through those supplementals, the cost increase, and 12 one, why they're there, and two, what are we doing to try to 13 curb those costs. 14 So, one, the early intervention line item 15 enacted in the 2019 General Appropriations Act 16 $161.4 million. Your department is now requesting a 17 supplemental appropriations of $16 million more, or nearly 10 18 percent, for the total appropriation of $177.4 million. Why 19 and what are we doing to curb those costs? 20 SECRETARY MILLER: Yeah. So good morning. 21 Thank you for that question. 22 Our increase in costs with early intervention 23 are directly attributed to the number of people that we're 24 serving. 25 So over the past few years, participation in 6 1 that program has increased substantially. From 2015-16 2 through 2019-20, participation in early intervention has 3 increased by nearly 11,000 participants. We're seeing 4 increased referrals from a number of sources, local community 5 agencies, and increased risk factors. When you think about 6 the opioid epidemic, you think about poverty, teen pregnancy, 7 all of these things contribute to us just seeing more people 8 who need services through early intervention. 9 In terms of what we were doing about it, I 10 mean, we certainly recognize that these increased costs play 11 a role in our supplemental and in our growing budget. We've 12 already begun to explore options to encourage more families 13 to enroll their children in the Medical Assistance Early 14 Periodic Screening Diagnostic and Treatment Program to 15 maximize the federal MA funding we might be able to receive 16 to assist here. So we do recognize the increase and are 17 trying to do what we can. We can't mandate that people go 18 onto Medicaid, but we're certainly trying to do what we can 19 to encourage that. 20 REPRESENTATIVE GROVE: Are we seeing issue 21 with the potential of the department not recognizing how many 22 people are coming onto these programs? So is it an internal 23 issue with your agency trying to reflect how many people are 24 coming onto these programs when we're building budget 25 estimates moving forward? Because if we've been seeing an 7 1 increase since 2015 and a trend upwards, that probably should 2 be taken into account now rather than when, you know, the 3 budget is finalized. 4 SECRETARY MILLER: Right. And I think that's 5 one of the reasons that we have the supplemental. I think 6 going forward, we need to make sure that we are taking into 7 account the increases we've seen in the past to reflect that 8 in our growing budget. 9 We do have, as part of our proposal, I think 10 it's two and a half million dollars for administrative 11 expenses to help the counties deal with these increased 12 services that they're providing. So that is part of our 13 budget this year. 14 REPRESENTATIVE GROVE: Okay. 15 Medical Assistance capitation line item was 16 enacted in the 2019 General Appropriations Act at 17 $2.63 billion. You're now requesting a supplemental 18 appropriation of $165.8 million more, or seven percent, total 19 appropriation $2.529 billion. 20 And I would add, since the enactment of Senate 21 Bill 432 should provide some cost savings within that line 22 item, that should save some dollars on the actuarial 23 analysis. But why are we seeing an increase in that, and 24 then what are we doing to try to mitigate those costs moving 25 forward? 8 1 SECRETARY MILLER: So I think the increases 2 we're seeing -- and frankly, when you look at our 3 supplemental, the increases we're seeing are directly related 4 to increases in our physical health, behavioral health, and 5 CHC line items. I know you're talking just about capitation, 6 we're seeing increased people that we're serving and 7 increases in services that we're providing. So I think it's 8 always important to remember with DHS, I mean, the majority 9 of our programs are entitlement programs. So when people are 10 eligible for those services, we have to provide those 11 services. 12 And certainly with CHC, I mean, one of the 13 biggest cost drivers we're seeing with our budget today, and 14 one of the reasons you see such a big supplemental, is just 15 that we have an aging population. We have more and more 16 seniors who need long-term services and supports. That is 17 the biggest driver. And when I think about our budget going 18 forward and concerns I have, that's an issue that's not just 19 an issue for Pennsylvania, it's an issue for the entire 20 country. But we have our parents and our grandparents are 21 outliving their resources, and that really is the biggest 22 driver of our costs. 23 REPRESENTATIVE GROVE: Unfortunately, I'm out 24 of time. 25 Thank you, Mr. Chairman. 9 1 Thank you, Madam Secretary. 2 MAJORITY CHAIRMAN SAYLOR: Members that are 3 here today that are here to observe, but are not members of 4 the Appropriations Committee, we have Representative Gleim 5 here and Representative Nelson, as well. 6 With that, we will move to Representative 7 Schweyer. 8 REPRESENTATIVE SCHWEYER: Thank you, Mr. 9 Chairman. 10 Secretary Miller, how are you today? 11 SECRETARY MILLER: Good. 12 REPRESENTATIVE SCHWEYER: Thank you for 13 joining us this morning. 14 I'd really like to drill down on the issue of 15 childcare. My district is a little different than most 16 districts in the Commonwealth in that my average age is 34 17 years old and less than 10 percent of my residents are, in 18 fact, senior citizens.