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Health & Fitness

Committee Evaluates Departments' Performances

The 2014 legislative session came to a close last month, but the Appropriations – Health, Mental Health and Social Services committee will continue overseeing departments’ spending to determine whether or not they are delivering measurable, positive outcomes for Missourians.

Our June 9 hearing opened with a period of public testimony. These hearings are excellent opportunities for individuals and organizations to share their concerns about state programs.

The public testimony centered on the dental services that the legislature reinstated for adult Medicaid recipients in the 2015 budget. Poor oral health is linked to a variety of serious health conditions, and when individuals lack preventative care they often seek relief in the emergency department, which is both expensive and ineffective. Offering adults access to basic oral healthcare will improve wellness while saving the state money by averting ER visits.

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It appears likely that Governor Nixon will withhold funds from the budget passed by the General Assembly. These dental benefits, however, are too essential to scale back. I encouraged everyone at the hearing to convey to the Governor that he needs to protect funding for dental coverage since this program will produce a significant return on the state’s investment. In fact, a portion of the budget for adult dental care came from the savings that this reform will generate

Recent audits have demonstrated a pattern of inefficiency in the Department of Social Services (DSS), and the committee has been continually concerned by the department’s lack of performance measures to indicate how successfully its programs operate.

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Temporary Assistance for Needy Families (TANF) and the Child Care Development Fund, which subsidizes child care, are the two largest federal block grants administered by DSS. Both have been plagued by poor performance and a lack of compliance with federal regulations.

Many TANF recipients are supposed to take part in work activities in order to receive benefits. DSS failed to meet the federal government’s work participation standards in 2011, so our state could face an $8.5 million penalty. DSS fell short of these standards in 2008 and 2009, and department officials told the committee that our state can expect another penalty when the 2012 data is assessed.

From 2008 to 2012 Missouri’s food stamp error rate was higher than the national average, reaching 7.18% in 2012. During oversight hearings last summer, my interim committee expected DSS to define the steps it would take to rectify this pattern of inaccuracy. Thankfully, the Family Support Division (FSD) in DSS has managed to improve the error rate to the point that Missouri may be eligible for a high performance bonus. Expecting transparency and accountability from departments encourages improvement, and the appropriations committee will follow up on this issue to ensure that Missouri’s food stamp program remains on track.

During the hearing, it became clear that departments often renew federal grants and waivers without any real input from the General Assembly. In the future, legislators need to be made aware of programs that are set to expire so we can have a frank discussion about their value before deciding whether or not our state should continue to participate. Missourians do not want their money blindly thrown after initiatives simply because the federal government makes them available.

Departmental oversight must be a year-round process to promote transparency and gain real insights into how well departments are operating. My appropriations committee will have monthly meetings to continue delving into departments’ performances and spending. Our hearings will begin with an opportunity for public testimony, and if you are interested in speaking, please email me at sue.allen@house.mo.gov.

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