Amy Drapcho, Northwoods’ fiscal advocate, helps human services agencies of all sizes navigate the complexities of budgeting, planning, and all things finance. Amy recently attended the Human Services Finance Officers (HSFO) Conference in Nashville and brought back a ton of insight on hot topics and opportunities impacting agencies today. Here’s a recap of her favorite sessions and resources.
I am a people person. So, when I attended the annual HSFO Conference, I was excited. My professional background is fiscal; but my passion is connecting with others and forming new bonds. The sessions I attended were engaging and insightful and the people I met were inspiring and energizing. I am sharing some of the highlights of the conference and hope they resonate with you too.
HSFO brings together both public and private industry leaders to provide insights into the latest trends and developments in the world of human services finance and policy. Here are my three biggest takeaways:
- The Unwinding is affecting millions of individuals rolling off Medicaid, Children’s Health Insurance Program (CHIP), and other eligibility programs. Now is the time for federal, state, and local agencies to come together to make sure clients continue to receive the support they need.
- Workforce shortages in the public sector are at crisis levels, presenting funding, management, and ethical challenges for child welfare and other sectors of human services. High vacancy and turnover rates impact everything from lack of residential placement facilities for children and direct care workers providing home-based services for adults, to diminished grants management capacity and training and administration concerns.
- Recent legal updates and the outlook from Washington include some shifting priorities which will impact funding streams. Newer areas of focus include maternal and infant health, early childhood programs, and the recently updated Older Americans Act. Changes to TANF minimum monthly benefits and SNAP work requirement age limits are also being rolled out.
THE RIPPLE EFFECTS OF PUBLIC SECTOR WORKFORCE SHORTAGES
Boz Bostrom, Accounting & Finance Professor, College of Saint Benedict and Saint John's University, opened the conference with a session on business ethics that highlighted two key points related to staffing shortages:
- Ethical dilemmas often arise from higher workloads, including the temptation to rush or take shortcuts, and work quality suffers as a result.
- Culture in the workplace is critically important and a major reason people stay in their jobs, thereby preventing staffing shortages in the first place.
This theme was echoed in an open discussion on child welfare, where staffing shortages dominated the conversation. Representatives from Oklahoma, Ohio, Louisiana, Nevada, Mississippi, Wisconsin, Arizona, Kentucky, and Georgia shared different approaches to recruitment and retention, such as:
- Requesting funding from state legislature for increased pay and longevity bonuses
- Offering more hybrid or remote positions
- Working with local colleges on internship/hiring programs
- Revamping Random Moment Time Studies to increase claiming and revenue to put towards salaries
- Using billboards for recruitment and participating in job fairs
These sessions resonated with me because we’ve been spending a lot of time at Northwoods discussing how to solve the problems of staffing shortages and higher workloads, especially in child welfare. This is a major problem that is prevalent across the country and causing significant ripple effects. From a fiscal, client safety, and even from an ethical point of view, maintaining reasonable workloads is critically important.
LEADERSHIP LESSONS ON CULTURE AND CHANGE
Darin Gordon, former director of TennCare (Tennessee's Medicaid program), shared several powerful quotes during his keynote speech on becoming transformation agents. Here are a few of my favorites:
“We all have the same amount of time, what we choose to do with this time is how we differentiate ourselves.”
This quote cuts right to the heart of why people get involved in social services and government work, and their desire to improve systems and make a positive difference in the lives of the individuals and families who are served by their respective agencies. It also underscores a key issue that many human services practitioners are familiar with: it often feels like there’s just not enough time in the day to get work done! You have to be willing to try new strategies, tools, and practices to maximize your time spent on work that matters.
“Don't shy away from new stuff, lean into it. It's not always a passing fad that can be ignored. Someone needs to be willing to try new, innovative ideas. Someone needs to step up and take risks. If we are not willing to do that, then we might as well just hand our innovation card to someone else.”
This sentiment makes me want to stand up and cheer! All human progress relies on new ideas, and the willingness to try them. In the context of government and working from within a bureaucracy, this idea is even more important because it goes against the grain of maintaining the status quo, staying in our comfort zone, and sticking to what we already know or have proven.
“When Medicaid sneezes, the rest of us get a cold.”
Darin shared this quote from former Tennessee Health Commissioner John Dreyzehner because it’s a fair representation of the relative magnitude and impact of Medicaid on all government funding and programs. This concept is especially important in the context of the unwinding (more on that later!).
FUNDING RESOURCES WORTH BOOKMARKING
Throughout the week, presenters shared various websites, resources, tools, and information banks, a few of which I wanted to share here:
- Federal Funds Information for States (FFIS): helps states manage their federal funds by analyzing the impact of federal actions on states—be it sequestration, budget enactment, new legislative proposals, or potential government shutdowns. This site also includes a section specific to human services issues.
- The Cost Allocation Methodologies (CAM) Toolkit: provides a simple, consistent, and objective cost allocation methodology for assisting states in determining equitable distributions of software development costs, expediting the federal approval process, and other topics.
- U.S. Digital Services Playbook: provides guidance for governments to implement information technology projects that work well and are completed on time and within budget.
- Medicaid.gov's Resources for States: this resource bank has a page dedicated to state policy and program topics, including tools, data, and other resources to support states in the maintenance and implementation of programs like Medicaid and CHIP.
- State Compliance with Regulatory Requirements for Medicaid Enterprise System (MES) Modules and Solutions: Center For Medicaid & CHIP Services Bulletin that outlines the reapproval process for state systems with operational costs claimed at the 75% federal match rate.
Lastly, although they’re not related to finance, I wanted to share two short video clips on leadership styles presented during the conference: one from author and management expert Ken Blanchard and one from former PepsiCo CEO Indra Nooyi.
I believe leadership is both an art and a science. The most successful leaders develop and follow their own personal style, mixing in creativity, sincerity, and the essential ingredient of credibility. These two examples poignantly convey the impact a great leader can have on people. When a leader is willing to reach out and provide feedback to employees personally, that leader is investing in the health of their entire organization.
As they say, a picture’s worth 1,000 words! Throughout the 16 presentations I attended, there were a few visuals that really hit home. Here are some of my favorites:
Navigating the Complexities of Government Programs and Funding
Overview of 80+ government benefits and services available for low-income individuals shared during HSFO Conference 2023
Shared by Darin Gordon in his keynote speech, this graphic reflects the complexities of navigating government programs. Most public servants are focused on one set of programs, one office, or one agency. But trying to comprehend ALL government programs is truly mind-boggling.
Through the lens of the individual or family in need of services, sometimes in moments of crisis, it can be overwhelming trying to figure out where to start. In addition, this image highlights why government needs to continue working on the “No Wrong Door” concept, so that people can access services from multiple entry points without being turned away.
Impact of the Unwinding on Individuals and Agencies
Image representing the impact of the Medicaid unwinding shared by NAMD during HSFO Conference 2023
In the National Association of Medicaid Directors' presentation on planning for the end of the Public Health Emergency, presenters shared this analogy that crystalizes how during the PHE, the drain was plugged and no one "trickled off "benefits. Yet with the Unwinding that has begun, experts project that anywhere from 5-18 million individuals are now rolling off Medicaid nationally.
Concerned that many people will not realize the need or know how to re-enroll for critical benefits, states are working hard and creatively on public awareness campaigns. Tara LeBlanc, HSFO president and Medicaid director for Louisiana Department of Health, name a few, such as airing tv spots, billboard signs, printed messages on the back of dollar store receipts, and advocates sitting in local pharmacies to help people navigate through these unprecedented times.
With this “all hands on deck” effort to spread the word about re-enrollment, CMS put out this Call to Action for every state and federal agency that works with beneficiaries to help them maintain coverage. Ongoing resources for states can be found at Medicaid.gov, including fact sheets, guidance, planning tools and templates specific to the unwinding and returning to regular operations.
The Critical Role of Mentors in Finance
Profiles of mentors shared by Accounting & Finance Professor Boz Bostrom during HSFO Conference 2023
Coming full circle, my favorite slide in Boz’s Business Ethics presentation centered on singing praises for his mentors and sharing the positive impact of each relationship on his career. He encouraged everyone in the room to find mentors and to recognize the value they provide.
In public sector finance, whether in budgeting, auditing, administrative, or other positions, learning the ropes and understanding all the nuances in state or federal policies and programs can be overwhelming. It helps if you have connections to learn from, discuss resources and best practices, think through grey areas together, and point you in the right direction.
SPOTLIGHT ON SESSIONS HIGHLIGHTING PUBLIC/PRIVATE PARTNERSHIPS
One of the final things I took away from the HSFO Conference is the amount of private sector expertise and assistance readily available to states and counties on a variety of programs and projects. Even for the most experienced finance officers, it can be tricky to navigate APDs, CAPs, FFPs, CCWIS, and the alphabet soup of human services funding requirements, as well as all the intricacies and nuances related to public programs such as Title IV-E, Medicaid, SNAP, TANF, and CHIP. Industry consultants and HSFO Corporate Members shared some key insights on how to leverage resources and maximize funds for programs that impact people in need. A few examples:
- Public Consulting Group presented on a range of topics, from rightsizing your CCWIS roadmap, to cost allocations and the Family First Prevention Services Act. In their presentation on CCWIS Roadmaps, it was clear that PCG staff have decades of experience in working through the intricacies involved at each stage of this process. Their advice on the value of the journey, and the importance of planning, was helpful because it encourages states and counties to be strategic as they embark on major system change. They encouraged counties to learn about the marketplace, invite different vendors to demo their solutions so you can see what’s current and what benefits your needs, and remember that technology is always evolving.
- Presenters from Milliman, along with PCG, discussed proposed changes to Medicaid rules that will ensure access to services. One of the main changes, intended to improve access by addressing workforce shortages, is to raise the compensation threshold to 80% for direct care workers in Home & Community Based Services. This applies to personal care, homemaker, and home health services, and will hopefully increase the availability of services for people with disabilities, aging populations, and others in need of home-based care. To learn more, view their whitepapers on "Home and Community-Based Services Payment Adequacy Considerations Under the CMS Proposed Access Rule" or "State-Directed Payment Considerations for the CMS Medicaid and CHIP Managed Care Access, Finance, and Quality Proposed Rulemaking."
- Berry Dunn and PCG delivered a session about rethinking federal and state grant opportunities, sharing examples of ARPA-funded programs around the country, such as addressing affordable housing & utilities, funding for program evaluation and focus on data, and not-surprisingly, projects funding public sector workforce issues related to the pandemic. Common challenges from a grants management perspective included staff capacity, lack of training, outdated procurement policies, and technology/software infrastructure needed to support the new program, as well as universal administrative issues such as communication, competing priorities, and politics. Being transparent with your funder, hiring outside expertise, and networking with peers and especially with other recipients, are some possible resources when tackling these types of roadblocks.
- Staff from Diversified Services Network (DSN) also gave a comprehensive presentation on grants management, including detailed guidance on the different phases of grant projects, proper accounting procedures, allowability and allocation of costs, expenditure analysis, and other best practices. The most common theme throughout this presentation was that all costs must be documented; records must be kept; nothing can be assumed. Resource tip: The Director of Grants Management, Karen Kinder, is a very spunky presenter and chock full of wisdom. I love that she invited session attendees to reach out for advice and said I should encourage our readers to do the same. You can find Karen on LinkedIn if you want to get in touch—tell her Amy sent you!
JUST FOR FUN: INSIDER NASHVILLE TRAVEL TIP
At the end of the ethics session that kicked off the conference, I learned a cool insider tip for enjoying Nashville’s music scene: Look for venues with a singer/songwriter performing. When you’re in the presence of a singer/songwriter, ask them to play an original song (as they often take requests and play covers). Then ask for the story behind that song, and you will hear something special. Great tip, Boz; thank you!
Getting out to meet colleagues, hear from experts, and broaden my fiscal knowledge was a great opportunity for me. I especially loved meeting people from all over the country, and hearing about pain points and successes they are experiencing in their respective human services agencies. I also had a few funny things happen along the way, but those are stories I’ll save for another day.
If you’d like to swap funny stories, discuss your funding challenges, or learn more about Northwoods, our software Traverse®, or our new Case Aide Services to support caseworkers, I'd love to hear from you. You can connect with me on LinkedIn!