DHS director Gillespie tackling foster care crisis, awaiting state flexibility for Medicaid

Arkansas Department of Human Services director Cindy Gillespie says she has legislators’ attention for changes to impact the serious foster care crisis in Arkansas, and she’s hoping the new federal administration will allow the state greater flexibility in serving the health care needs of Arkansans.

Gillespie, appearing on this week’s edition of Talk Business & Politics, contends that the huge spike in foster care cases and maltreated children in Arkansas is not contingent on one overriding factor.

“I don’t think anyone can tell you there’s any one single thing that’s at the root of what’s going on. Whenever you have issues like this in society, it’s going to be multi-factor. There’s not one silver bullet that fixes everything,” she said.

Since earlier this year, Gillespie and DHS staff have met three times a week in a foster care “war room” trying to get a deeper understanding of the issue and weighing potential solutions to address the crisis. Gov. Asa Hutchinson’s budget for next session includes money to hire 228 DCFS staff members over three years, including 102 employees this year. Those include 60 caseworkers.

While adding more caseworkers will help, Gillespie said other efforts can stem the problem.

“We have not had a focus on the biological families [previously]. We’ve focused on the children, which is the priority, but you also have to focus on the family – the home that the child is in. See if you can work with that family. Is there a way in some way to keep that child in the home, yet safe? How do you get the services to the family? How do you focus on ensuring there is a plan to get the family as healthy as possible and return the child as quickly as possible?” Gillespie said.

She added that better access to behavioral health services and substance abuse treatment – for both parents and children – was a critical part of the solution. If the 2017 General Assembly increases resources to alleviate foster care cases, Gillespie says that measuring success will be looked at through a larger lens than just a reduced number of cases.

“We also want to measure the number of children who come back into care, how long they stay in care, do we have them in the right placements,” she noted. “When we do have to take a child, for example, we are prioritizing putting the child with a relative, where we can do that safely. .. we have a whole series of measurements that we’re going to be judging ourselves by.”

PRIVATE OPTION, ARKANSAS WORKS
Arkansas’ Medicaid expansion program – the Private Option – is about to rebrand itself as Arkansas Works. With that change, several policy changes pushed by Gov. Hutchinson will take effect, assuming the federal government signs off on waivers.

With the new Trump administration, the governor, Gillespie, and legislators sense that a new attitude toward health care policy is likely to evolve.

Gillespie said the biggest policy change could involve shifting more power to the states.

“We have been facing for several years now, piece by piece, control shifting from here to Washington, D.C., and we think we’re going to see flexibility returning to the states,” she said.

That could come in the form of block grants or capped allotments, said Gillespie. It could also signal flexibility in program requirements, such as limiting Medicaid expansion (Arkansas Works) to those earning just 100% of the federal poverty level instead of 138% under current law.

While flexibility is desired for more local control, does that constitute good public policy to have different standards in different states?

“I personally believe those decisions belong in the states,” Gillespie said. “As somebody who worked in Massachusetts, and now works here, I can tell you that’s a completely different economy in Boston than it is in Little Rock. And what you do for Massachusetts is not the same as what you should do for health care in the Delta.”

Watch Gillespie’s full interview in the video below, including her thoughts on potential Health and Human Services Secretary-nominee Rep. Tom Price, R-Georgia.