HomeMy WebLinkAboutbocc.packet.05272014.Board Social ServicesAGENDA ITEM SUMMARY
SPECIAL MEETING DATE: May 27, 2014
AGENDA ITEM TITLE: Special Meeting of the Board of Social Services -
Update with the Department of Human Services
STAFF RESPONSIBLE: Nan Sundeen, Mitzi Ledingham, Kim DuBois,
Kathleen Lyons, Marty Ames
ISSUE STATEMENT: The Board of County Commissioners (BOCC), serving as the
Board of Social Services (BOSS), will review the Department of Human Services’ (DHS) 1st
Quarter January-March, 2014, budget expenditure report; 1st Quarter Client Payrolls and
Economic Services program numbers; a special profile on Child Support Enforcement with
Garfield County and programmatic updates from Economic Services, Senior Services, and
Adult and Family Services.
BACKGROUND:
Colorado is a state supervised, county administered human services system. This means
that the state Department of Human Services is responsible for all activities provided by
local and district human service departments, as well as all allocations and expenditures
related to those services. The state relies on the County Board of County Commissioners
serving as the Board of Social Services (C.R.S. 26-1-116) to oversee local Social
Services (“Human Services”) activities to address public assistance and welfare duties,
responsibilities, and activities of the county human services department.
In Pitkin County, human services functions are performed by several different entities.
The Pitkin County Adult and Family Services (AFS) department directly provides adult
and child protection services for Pitkin and the El Jebel/Basalt area of Eagle County.
Eagle County Health and Human Services “Economic Services” provides all public
assistance services to Pitkin residents. In addition, Garfield County Human Services
provides other mandated services to Pitkin residents including Child Support
Enforcement, Long Term Care eligibility determination and Child Care Licensing.
As a reminder, Attachment A provides information regarding monthly gross income
eligibility for the public assistance programs listed above.
2014 BUDGET
The DHS budget is divided into four core areas: Administration, Child Care, Child
Welfare and Colorado Works. Below is a 2014 January - March Budget to Actual matrix
of expenditures and revenues. These numbers include the Child Support Enforcement
program that is provided by Garfield County.
1
HUMAN SERVICES BUDGET VS. ACTUALS ( January - March 2014 )
YTD % Used
Program Budget Actuals Variance
(@ 25%
of yr)
State & Fed. Revenue
741,631
177,523
(564,108) 24%
Admin Expenditures
896,295
186,617
709,678 21%
Surplus/(Deficit)
(154,664)
(9,094)
145,570
State & Fed. Revenue
65,978
10,668
(55,310) 16%
Child Care Expenditures
108,682
11,394
97,288 10%
Surplus/(Deficit)
(42,704)
(726)
41,978
State & Fed. Revenue
575,872
132,788
(443,084) 23%
Child Welfare Expenditures
546,984
163,102
383,882 30%
Surplus/(Deficit)
28,888
(30,314)
(59,202)
Federal Revenue
51,941
11,064
(40,877) 21%
TANF/CO Works Expenditures
67,773
6,602
61,171 10%
Surplus/(Deficit)
(15,832)
4,462
20,294
Child Suport Federal Revenue
12,705
7,129
(5,576) 56%
Enforcement Expenditures
28,250
7,027
21,223 25%
Surplus/(Deficit)
(15,545)
102
15,647
State & Fed. Revenue
1,448,127
339,173
(1,108,954) 23%
Total Programs Expenditures
1,647,984
374,742
1,273,242 23%
Surplus/(Deficit)
(199,857)
(35,570)
164,287
Off-Setting Property & MV Taxes
174,431
71,181
(103,250) 41%
County Revenues Transfers
30,000
30,000
-
Total Fund Surplus/(Deficit)
4,574
65,611
61,037
2
ECONOMIC SERVICES
Client Payrolls
Monthly “payrolls” refer to direct client Electronic Benefit Transfers. Below please find
the three year 1st quarter payroll comparison.
QUARTERLY PROGRAM PAYROLLS
PROGRAM
YTD 1st
QUARTER
2012
YTD 1st
QUARTER
2013
YTD 1st
QUARTER
2014
Aid to the Needy & Disabled AND $ 2,000 $ 3,264 $ 721
Child Care CC 28,641 18,040 6,899
Old Age Pension OAP 21,971 24,717 24,219
Low-income Energy Assistance
Program LEAP 16,284 11,465 16,252
Colorado Works Works 3,112 2,313 1,709
Food Assistance FS 121,024 115,000 92,350
TOTAL $193,031 $174,799 $142,151
Average Benefit per Household per Month (Public Assistance)
1st Quarter 2012 through 2014
Program #HHs served
(duplicated)
Total YTD new
applications
Total YTD
discontinued ** Total YTD benefits Average benefit
per hh/mo
12 13 14 12 13 14 12 13 14 12 13 14 12 13 14
Adult Financial 167 154 63 8 15 5 7 7 14 23,970 27,981 24,935 144 182 396
LEAP* 54 46 36 28 30 15 16,284 11,465 16,252 302 249 451
Food Stamps 471 482 434 47 61 46 17 12 16 121,024 115,000 92,350 257 239 213
Medicaid 565 552 1438 29 30 284 43 39 139 250,339 313,879 582,760 443 569 405
CCAP*** 32 23 10 0 1 4 2 2 5 28,641 18,040 6,899 895 784 690
TANF/COWorks 6 3 1 4 6 3 0 1 0 3,112 2,313 1,709 519 771 1,709
TOTALS 1295 1260 1982 116 143 357 69 61 174 443,370 488,678 724,906 342 388 366
*HHs not duplicated
** CCAP Total YTD new Application was incorrect in prior reports. This has been corrected
COLORADO CHILD CARE ASSISTANCE PROGRAM (CCCAP) Update
The Child Care Assistance Program is currently serving six Pitkin County households
with one application pending. Through March 2014, Pitkin County has expended 34%
of its SFY2014 Child Care allocation. For SFY2015, it is anticipated that Pitkin’s CCAP
allocation will be reduced by approximately 5% or $4,000 based on the new allocation
methodology adopted at the state level.
3
Pitkin County recently kicked off its Child Care Assistance awareness campaign by
launching the new website, Pitkin County’s Smart Start (www.pitkinsmartstart.com).
This website provides information and links to all of the resources parents need to
navigate the community’s system of financial assistance to help low-income working
families with child care expenses.
CCAP Program Analysis
SFY12SFY13
Comparison
SFY 2012 to
SFY 2013 SFY 2014
Comparison
SFY 2013 to
SFY 2014
July 9,9789,17091.89%1,13812.42%
Aug 15,28712,12979.34%1,66013.68%
Sept 13,8947,96357.31%94111.82%
Oct 6,8354,28862.74%86620.18%
Nov 8,7345,99568.64%1,63027.19%
Dec 8,4314,87157.77%97720.05%
Jan 6,4366,863106.63%1,55122.60%
Feb 10,0105,62456.19%4,11073.08%
Mar 12,1955,55345.53%5,09891.81%
Apr 9,1645,19456.68%1,99738.45%
May 10,1095,91358.50%1,997 33.77%
June 10,7693,19929.70%1,997 62.43%
Totals121,843 76,761 64.24%23,96231.22%
Total projected SFY 2014 payrolls 23,962
Projected operating expenses (based on YTD SFY2014)10,141
Total projected SFY 2014 payrolls and expenses 34,103
Less Total SFY 2014 CCAP allocation 82,473
TOTAL Projected Unspent CCAP Allocation 48,371
SFY 2014 Payroll Recap-Pitkin
4
State Fiscal Year 2013
<130%<150%<185%<225%<130%<150%<185%<225%
FKFKFKFK FKFKFKFK
July 7 10 003311 July 46110000
Aug 7 10 002200 Aug 34120000
Sept 68002200 Sept 23120000
Oct 58002200 Oct 35121200
Nov 58002200 Nov 23121200
Dec 58002200 Dec 24122300
Jan 69002200 Jan 24004700
Feb 58111100 Feb 24003400
March 58001100 March
April 58001111 April
May 58001111 May
June 35000000 June
Totals6498 11 1919 33 Totals2033 6 111118 00
% of Total 74%81%1%1%22%16%3%2%% of Total 54%53%16%18%30%29%0%0%
Avg/Mo 58002200 Avg/Mo 34111200
Single and Two-Parent Low Income Families
Target Populations (must be served regardless of cap)TOTALS:62kids
Households under 130% FPG 37 families
Teen Parents (currently 0 teen parent households)1.7 avg kids/fam
CCAP Number of Families & Children by Income Level- Pitkin
State Fiscal Year 2014
(currently 2)
COLORADO INFANT AND TODDLER QUALITY AND AVAILABILITY GRANT
PROGRAM (HB13-1291)
As you are aware, Pitkin County Health and Human Services, in partnership with the
Rural Resort Region Early Childhood Council, Lake County Human Services and Eagle
County Health and Human Services was awarded $451,673 (the second largest award in
the state) with Pitkin County’s portion being $56,603 through 6/30/14.
The purpose of the grant program is to improve quality in infant and toddler care, provide
tiered reimbursement to high-quality early childhood programs, to increase the number of
low-income infants and toddlers served through high quality programs, and to promote
voluntary parental involvement. These funds are currently being used to pay for four
child care slots in recognized high-quality child care programs, to support the Child Care
Assistance awareness campaign (Pitkin Smart Start) discussed above and to assist five
Child Care providers with playground enhancement for infant and toddlers.
The Office of Early Childhood within Colorado Department of Human Services decided
to forego a new application process for grant funding available for SFY2015. Rather,
current grant recipients provided updated work plans and budgets. Pitkin County’s plan
and budget have been approved and a contract amendment is in process. The
approximately $50K funding approved for the next state fiscal year will again support
payment for two child care slots in recognized high-quality child care programs and to
support the Child Care Assistance awareness campaign.
5
MEDICAID EXPANSION
On May 13, 2013, Governor John Hickenlooper signed into law the health insurance
alignment and Medicaid expansion, as authorized by the health reform law. The
expansion of Medicaid will allow more than 160,000 Coloradans to gain access to
Medicaid.
As shown above the Medicaid caseload has increased by 189% since 9/30/13 from 196
cases to 567 cases as of 3/31/14. The number of individuals enrolled in Medicaid has
increased by 55% (541 individuals) between September 30, 2013 and March 31, 2014.
Surprisingly, there has not been a large increase in CHP+ newly enrolled individuals
since 9/30/13 – there are only 11 additional individuals covered under CHP+ as of
3/31/14 as compared to 9/30/13.
WEST MOUNTAIN REGION HEALTH ASSISTANCE NETWORK
The West Mountain Region Health Assistance Network, a partnership among Pitkin County
Health & Human Services, Community Health Services, Inc., Garfield County Human
Services and Public Health Departments, Mountain Family Health Centers and Eagle County
Health & Human Services is funded through a grant from Connect for Health Colorado from
July 1, 2013 through December 31, 2014.
During the third quarter of the grant, activities were focused on enrollment of individuals for
medical assistance programs including Medicaid, CHP+ and private insurance through
Connect for Health Colorado.
Between October 1, 2013 and March 31, 2014, the Health Assistance Network (HAN)
conducted almost 1,200 in-person appointments, handled more than 2,800 inquiries and
conducted almost 80 educational presentations across the three county region reaching more
than 2,200 individuals. During the end of March, HAN held three walk-in enrollment events
with one of those being held in Aspen. With great collaboration among many Pitkin County
staff, Health Coverage Guides, Connect for Health representatives, Certified Insurance
Brokers and Medicaid staff, 67 individuals were served during that event. More than 90% of
surveyed participants reported the services they received during the event helpful with 83%
reporting they were able to get all of their issues resolved.
For the period October 1 through April 11, 2014 in our three county region, 4,193 individuals
enrolled in insurance through Connect for Health Colorado with 1,571 of those individuals
residing in Pitkin County.
Connect for Health Colorado provided a “continued open enrollment period” for those
customers awaiting Medicaid determinations as of March 31, 2014. Those customers have
until May 31 to receive their Medicaid determination and, if not eligible for Medicaid, to
complete enrollment in commercial health insurance through our Marketplace. Our public
assistance team members are pulling reports weekly to identify those households that have
been denied Medicaid during the prior week and are making phone contacts to help them
connect with the Health Coverage Guides.
6
Beyond the continued open enrollment period, Health Coverage Guides and other HAN staff
will be providing in-person assistance for life change events, evaluating the past open
enrollment period for best practices, participating in state training for program updates and
re-certification, doing outreach and enrollment for life change events, and preparing for the
next open enrollment period.
The federal government has again changed the dates of the second open enrollment period.
The new dates are November 15, 2014 through February 15, 2015. Connect for Health
Colorado will be issuing contract amendments for grantees to extend those contracts until
March 31, 2015 and establish additional funding amounts for the extension. Connect for
Health Colorado also intends to release a grant announcement in late summer for Health
Assistance Network Site funding for activities that will occur after March 31, 2015.
COLORADO WORKFORCE CENTER COLLABORATION
The Economic Security Subcommittee of the West Mountain Region HHS Network has
been working toward strengthening the relationship of our three county Human Service
departments (Pitkin, Eagle & Garfield) with the local Colorado Workforce Centers
(Glenwood Springs, Rifle and Edwards) to improve services and assure our mutual
customers were being connected with available resources. On April 29th, 20 staff from
each of the three county human services teams and from each of the workforce centers
conducted a joint training to share information about our respective programs, eligibility
criteria and how to connect customers to the services. Based on the initial feedback, the
training was a success with several ideas for partnering and outreach being identified.
We will be developing an action plan to move those ideas forward.
CHILD SUPPORT SERVICES
The Colorado State Child Support Program was formed in 1975. Colorado is a state
supervised, county administered state. Authority resides with Title IV-D of the Social
Security Act and provides federal financing to states that have developed effective state
plans for the establishment of paternity, and the establishment and enforcement of child
support/medical support. Garfield County currently provides services to Pitkin and Rio
Blanco Counties who all reside within the Ninth Judicial District.
The program was originally created to be a debt recovery program of public assistance
money (Colorado Works/TANF). The program has been expanded to allow the public to
apply for child support services for a small fee. Mandatory referrals also include children
who are in foster care. It is optional for the counties in Colorado to require child care
assistance cases. Garfield and Rio Blanco Counties are mandatory referrals.
The state maintains monthly statistics for the amount of child support paid on all cases
that we are working. A percent of the collections on TANF cases are retained by the
county to reimburse their contribution to the TANF grant. In addition, the federal
government pays incentives for TANF and Non-TANF collections made by the child
support unit. Not only does the federal government pay incentives as indicated, federal
money is also used to reimburse a portion of the actual expenses of operating the child
support program.
7
Every state is required to conduct an Annual State Self-Assessment to ensure that they
are in compliance with federal mandates. Every action that we take has a timeframe
assigned and is randomly audited by the counties and state. There are four major
performance goals that counties are monitored on every month. Incentives are paid to the
counties in proportion to the performance they reach and have to be reinvested to
administer the program. The four performance measures are:
• Paternity establishment percentage of 80%
• Caseloads with orders 80%
• Percent of current support paid 64.3%
• Arrears cases with a payment 71.4%
STATISTICS AS OF 12/31/13
GARFIELD PITKIN RIO BLANCO
Caseload size 1,808 102 208
Collections thru year $4,756,828.99 $341,701.95 $631,886.97
Caseload with orders 92.3% 95.3% 92.3%
Current support paid 63.1% 53.1% 66.3%
Arrears paid on case 72.3% 74.7% 69.3%
Paternities established 20 0 4
Orders established 105 5 12
APA orders established 47 2 6
UIFSA's filed 112 3 18
Income withholding filed 993 76 120
Medical withholding filed 237 15 50
Direct income withholding 84 8 19
Modifications filed 145 9 8
Judments filed 132 7 9
Liens filed 1 0 0
Financial liens filed 129 28 14
DOC liens filed 4 0 0
Contempts filed 4 0 0
C-STAT is a recent development and they are also monitoring the counties and state in an
effort to improve the program goals. Tools have developed to help identify cases for
specific case actions in an effort to improve case processing (CSE Tools). Our computer
8
system is also under a major re-design and has been migrated to a new platform. ACSES
is currently undergoing modernization and is being rolled out to the counties in small
increments, which allows for programming to be correct.
SENIOR SERVICES
Senior Services receives federal Title 3 and state Older Coloradoans funding on an
annual basis to supplement local funding in three programs:
Nutrition C1 and C2 (Congregate and Home Delivered Meals)
Information/Assistance/Education
Care Navigation
Whenever this funding is applied to a program, compliance with regulations and
reporting is mandated for the entire program.
2014 actual January February March Quarterly total
C1 (Congregate
Meals)
581 586 652 1819 Congregate Meals and Blizzard Boxes
served to grant-eligible recipients
C2 (Home
Delivered
Meals)
192 177 198 567 Home Delivered Meals to grant-eligible
recipients
Meals Total 773 763 850 2386
I & A 2289 2327 2265 6881 Units of Information and Assistance,
including general information, referrals
for services, newsletter distribution
CM clients
served
15 12 13 Number of unduplicated individuals
served each month
CM hours 44.5 35.5 27 107 Number of care management service
hours
2013
Comparison
January February March Quarterly
total
C1 (Congregate
Meals)
594 500 603 1697 Meals served to grant-eligible seniors.
Includes Congregate Meals and Blizzard
Boxes
C2 (Home
Delivered
Meals)
200 187 220 607 Home Delivered Meals to grant-eligible
seniors and care givers
Meals total 794 687 823 2304
I & A 2434 2160 2311 6905 Units of Information and Assistance,
including general information, referrals
for services, newsletter distribution
CM clients
served
18 27 28 Number of unduplicated individuals
served each month
CM hours 10 38 46 94 Number of care management service
hours
Nutrition
9
This service area continues to reflect a steady but manageable 3.6% increase when
compared to the same quarter last year.
Care Navigation
In April of 2014, Mindsprings Health decided to terminate the contract that Senior
Services and Adult and Family Services (AFS) had with them to provide Care Navigation
Services (this contract was in place for almost 3 years). The contract ended as of April
30 , 2014. Prior to that, Mindsprings Health, AFS and Senior Services had several
discussions about how those services could be provided in a more seamless, user friendly
fashion. During the month of April, Senior Services and AFS determined that this would
be a good opportunity to bring these services “in- house” under our Adult and Family
Services Department. This shift made sense because it allowed our division to provide a
“continuum of care” for Seniors including those needing limited support via Care
Navigation and those needing a higher level of support via Adult Protection Services. It
also made sense as we have developed an improved process to review every referral (for
Care Navigation and Adult Protective Services) to determine the next best steps. . As of
May 1, senior care navigation services are being provided by Adult and Family Services
case worker, Joe Ramsey. This model has been used successfully in Eagle County, and
we predict this will further ensure continuity in serving at-risk older adults experiencing
difficulty living independently
Strategic Planning for Aging Well Community
Highlights of progress since December include:
• 15 Goal areas, approved by Steering Committee
• Objectives written and approved for each Goal
• Community members are being recruited to write Action Steps for each Objective
• June 24 is the public “Senior Summit” kickoff event for Aging Well
• Project Management Team is planning content and publicity (Pat Bingham) for
Senior Summit
The dual purpose of the “Senior Summit” event is to present a summary of the results and
to generate interest and participation in fulfilling the Aging Well goals.
ADULT AND FAMILY SERVICES
Adult and Aging Services (Adult Protection and Care Navigation)
There is a lot of momentum, as mentioned in the Senior Services report, to expand and
streamline services for aging adults in all counties in Colorado. Legislation was passed
that will be in effect beginning July, 2014 will require certain entities to be mandated
reporters when they have protective concerns for adults over age 75. SB13-111, among
other things, makes it mandatory for certain professional groups to report this
mistreatment of at-risk elders to law enforcement beginning on July 1, 2014.
The AFS department will be engaging in several discussions with our local law
enforcement agencies and other partners to educate our community and discuss how we
can work cooperatively to address these situations.
10
The State Adult Protective Services has also engaged in several other initiatives to better
serve at risk adults. Some examples:
1. There is now an identified allocation for each county to provide staff
resources as well as direct support for at-risk adults (SFY 2014 staff
allocation is 10,670 and direct support is $3,010);
2. There is a new web-based documentation system to record our work
with adults (from referral to case closure). Pitkin County will be
hosting a computer based training for Pitkin and Eagle County at the
end of June, 2014.
Typically Pitkin Adult and Family Services caseworkers have been generalists and doing
the work of both Child Welfare and Adult Protection Services. However, we have
decided, based on the need, momentum and new APS initiatives to restructure our team
and have one member of our team be dedicated to Adult and Aging Services (Care
Navigation, funded by external sources and APS, funded by State CDHS.)
Child Welfare
FACET (Family Assessment Community Evaluation Team) was officially launched in
August of 2013 after months of planning. FACET is modeled after a prevention
program in Garfield County and it works to address the needs (on a voluntary basis) of
families who reside in Pitkin/Eagle (Roaring Fork Valley) who are at-risk, but the issues
don’t warrant a child abuse and neglect intervention. We have convened meetings with
18 different families and many community partners including Family Resource Center,
Buddies Program, Youth Zone, DHS, Aspen and Basalt Schools, Response, Mindsprings
Health, Aspen Hope Center, etc. as we all work together to support families and
determine what would be helpful for them. The families walk away from FACET with a
plan, financial resources and a case manager to follow up on linking them to support
agencies.
The FACET group (known in the Roaring Fork Valley as FACET South) had a strategic
planning session in April to begin to plan for next steps for the FACET Program (funded
through a grant from Healthy Community Fund). The group determined that they wanted
to have a dedicated staff person to accept referrals, facilitate meetings and reach out to
the community. Youth Zone is prepared to take on this task after obtaining approval
from their Board of Directors. We are thrilled to have this option for children, youth and
families in our community.
LINK TO STRATEGIC PLAN:
Livable and Sustainable Community
Prosperous Economy
KEY DISCUSSION ITEMS:
1. Review January-March, 2014 program expenditures and 1st quarter client payrolls
2. Review CCCAP expenditures and number of families
3. Review special presentation by Joy Davis, Child Support Enforcement manager
from Garfield County.
4. Review and discuss any issues/concerns related to other updates.
11
BUDGETARY IMPACT: None
RECOMMENDED BOCC ACTION:
1. Approve January-March 2014 program expenditures and 1st quarter 2014 client
payrolls.
ATTACHMENTS:
A) 2014 Updated Federal Poverty Guidelines Chart
12
10
0
%
o
f
Po
v
e
r
t
y
13
0
%
o
f
Po
v
e
r
t
y
13
0
%
o
f
Po
v
e
r
t
y
13
3
%
o
f
Po
v
e
r
t
y
14
2
%
o
f
Po
v
e
r
t
y
15
0
%
o
f
Po
v
e
r
t
y
18
5
%
o
f
Po
v
e
r
t
y
18
5
%
o
f
Po
v
e
r
t
y
19
5
%
o
f
Po
v
e
r
t
y
20
0
%
o
f
Po
v
e
r
t
y
20
0
%
o
f
Po
v
e
r
t
y
25
0
%
o
f
Po
v
e
r
t
y
25
0
%
o
f
Po
v
e
r
t
y
26
0
%
o
f
Po
v
e
r
t
y
300% of Poverty350% of Poverty400% of Poverty450% of Poverty
●Me
d
i
c
a
i
d
(A
d
u
l
t
s
,
Pa
r
e
n
t
s
&
Ca
r
e
t
a
k
e
r
Re
l
a
t
i
v
e
s
)
●Me
d
i
c
a
i
d
(c
h
i
l
d
r
e
n
ag
e
s
0
-
18
)
● E
a
g
l
e
&
Pi
t
k
i
n
Pr
e
n
a
t
a
l
● M
e
d
i
c
a
i
d
(p
r
e
g
n
a
n
t
wo
m
e
n
)
● N
u
r
s
e
F
a
m
i
l
y
Pa
r
t
n
e
r
s
h
i
p
● C
o
l
o
r
a
d
o
In
d
i
g
e
n
t
C
a
r
e
(C
I
C
P
)
● M
e
d
i
c
a
i
d
BC
C
P
● C
H
P
+
● Medicaid Buy-In (Children)● Eagle & Pitkin Family Planning● Medicaid Buy-In (Adult)
● E
a
g
l
e
C
h
i
l
d
Ca
r
e
(
i
n
i
t
i
a
l
el
i
g
i
b
i
l
i
t
y
)
●Pi
t
k
i
n
Ch
i
l
d
C
a
r
e
(i
n
i
t
i
a
l
e
l
i
g
i
b
i
l
i
t
y
)
20
1
4
F
P
G
2
0
1
3
F
P
G
2
0
1
4
F
P
G
2
0
1
4
F
P
G
2
0
1
4
F
P
G
2
0
1
3
F
P
G
2
0
1
3
F
P
G
20
1
4
F
P
G
20
1
4
F
P
G
20
1
3
F
P
G
20
1
4
F
P
G
2
0
1
3
F
P
G
2
0
1
4
F
P
G
2
0
1
4
F
P
G
2
0
1
4
F
P
G
2
0
1
4
F
P
G
2
0
1
3
F
P
G
2
0
1
4
F
P
G
3832
1
2
5
3
9
7
3
1
,
2
4
5
1
,
2
6
5
1
,
2
9
4
1
,
3
8
1
1
,
4
3
6
1
,
7
7
2
1,
8
0
0
1,
8
9
7
1,
9
1
6
1,
9
4
5
2,
3
9
4
2,
4
3
1
2,
5
2
9
2
,
9
1
8
3
,
4
0
3
3
,
8
3
2
4
,
3
7
7
2
3
3
1
1
,
3
1
1
1
,
6
8
1
1
,
7
0
5
1
,
7
4
4
1
,
8
6
2
1
,
9
3
9
2
,
3
9
2
2,
4
2
6
2,
5
5
7
2,
5
8
6
2,
6
2
2
3,
2
3
2
3,
2
7
7
3,
4
0
9
3
,
9
3
1
4
,
5
8
7
5
,
1
7
2
5
,
8
9
8
3
4
2
1
1
,
6
4
9
2
,
1
1
6
2
,
1
4
4
2
,
1
9
4
2
,
3
4
2
2
,
4
4
1
3
,
0
1
1
3,
0
5
1
3,
2
1
6
3,
2
5
6
3,
2
9
8
4,
0
6
9
4,
1
2
3
4,
2
8
8
4
,
9
4
8
5
,
7
7
2
6
,
5
1
2
7
,
4
2
1
4
5
1
0
1
,
9
8
8
2
,
5
5
2
2
,
5
8
4
2
,
6
4
4
2
,
8
2
3
2
,
9
4
4
3
,
6
3
1
3,
6
7
7
3,
8
7
6
3,
9
2
6
3,
9
7
5
4,
9
0
7
4,
9
6
9
5,
1
6
8
5
,
9
6
2
6
,
9
5
6
7
,
8
5
2
8
,
9
4
3
5
6
0
5
2
,
3
2
6
2
,
9
8
7
3
,
0
2
4
3
,
0
9
4
3
,
3
0
3
3
,
4
4
6
4
,
2
5
1
4,
3
0
3
4,
5
3
6
4,
5
9
6
4,
6
5
2
5,
7
4
4
5,
8
1
4
6,
0
4
8
6
,
9
7
6
8
,
1
4
0
9
,
1
9
2
1
0
,
4
6
6
6
6
9
7
2
,
6
6
4
3
,
4
2
3
3
,
4
6
4
3
,
5
4
4
3
,
7
8
4
3
,
9
4
9
4
,
8
7
1
4,
9
2
9
5,
1
9
6
5,
2
6
6
5,
3
2
8
6,
5
8
2
6,
6
6
0
6,
9
2
7
7
,
9
9
3
9
,
3
2
4
1
0
,
5
3
2
1
1
,
9
8
8
7
7
7
0
3
,
0
0
3
3
,
8
5
8
3
,
9
0
4
3
,
9
9
4
4
,
2
6
4
4
,
4
5
1
5
,
4
9
0
5,
5
5
5
5,
8
5
5
5,
9
3
6
6,
0
0
5
7,
4
0
9
7,
5
0
6
7,
8
0
7
9
,
0
0
7
1
0
,
5
0
8
1
1
,
8
7
2
1
3
,
5
1
1
8
8
4
4
3
,
3
4
1
4
,
2
9
4
4
,
3
4
4
4
,
4
4
4
4
,
7
4
4
4
,
9
5
4
6
,
1
1
0
6,
1
8
1
6,
5
1
5
6,
6
0
6
6,
6
8
2
8,
2
5
7
8,
3
5
2
8,
6
8
7
1
0
,
0
2
1
1
1
,
6
9
2
1
3
,
2
1
2
1
5
,
0
3
3
+3
3
8
+
4
3
6
+
4
4
0
+
4
5
0
+4
8
0
+
5
0
3
+6
2
0
+6
2
6
+6
6
0
+6
7
0
+6
7
7
+8
4
8
+8
4
6
+8
8
0
+
1
0
1
4
+
1
,
1
8
4
+
1
,
3
4
0
+
1
,
5
2
2
OA
P
M
a
x
i
m
u
m
i
n
d
i
v
i
d
u
a
l
i
n
c
o
m
e
=
$
7
4
8
.
0
0
AN
D
M
a
x
i
m
u
m
i
n
d
i
v
i
d
u
a
l
i
n
c
o
m
e
=
$
1
7
5
.
0
0
Ma
x
i
m
u
m
i
n
c
o
m
e
f
o
r
Q
M
B
-
I
n
d
i
v
i
d
u
a
l
=
$
9
9
3
o
r
C
o
u
p
l
e
=
$
1
,
3
3
1
(
1
0
0
%
F
P
L
2
0
1
4
)
Ma
x
i
m
u
m
i
n
c
o
m
e
f
o
r
S
L
M
B
-
I
n
d
i
v
i
d
u
a
l
=
$
1
,
1
8
7
o
r
C
o
u
p
l
e
=
$
1
,
5
9
3
(
1
2
0
%
F
P
L
2
0
1
4
)
Ma
x
i
m
u
m
i
n
c
o
m
e
f
o
r
Q
u
a
l
i
f
y
i
n
g
I
n
d
i
v
i
d
u
a
l
p
r
o
g
r
a
m
-
I
n
d
i
v
i
d
u
a
l
=
$
1
,
3
3
3
o
r
C
o
u
p
l
e
=
$
1
,
7
9
0
(
1
3
5
%
F
P
L
2
0
1
4
)
Ma
x
i
m
u
m
i
n
c
o
m
e
f
o
r
Q
u
a
l
i
f
y
i
n
g
D
i
s
a
b
l
e
d
W
o
r
k
i
n
g
I
n
d
i
v
i
d
u
a
l
p
r
o
g
r
a
m
-
I
n
d
i
v
i
d
u
a
l
=
$
1
,
9
6
5
o
r
C
o
u
p
l
e
=
$
2
,
6
2
2
(
2
0
0
%
F
P
L
2
0
1
4
)
TA
N
F
N
e
e
d
S
t
a
n
d
a
r
d
E
f
f
e
c
t
i
v
e
01
/
0
1
/
0
9
Ma
x
I
n
c
o
m
e
E
f
f
e
c
t
i
v
e
01
/
0
1
/
1
3
f
o
r
A
d
u
l
t
F
i
n
a
n
c
i
a
l
-
A
N
D
FP
G
E
f
f
e
c
t
i
v
e
07
/
0
1
/
1
3
f
o
r
W
I
C
(
W
o
m
e
n
,
I
n
f
a
n
t
s
,
C
h
i
l
d
r
e
n
)
Medical Programs
FP
G
E
f
f
e
c
t
i
v
e
09
/
1
7
/
1
3
f
o
r
C
o
l
o
I
n
d
i
g
e
n
t
C
a
r
e
P
r
o
g
r
a
m
(
C
I
C
P
)
Current Updates
FP
G
E
f
f
e
c
t
i
v
e
1
1
/
0
1
/
1
3
-
0
4
/
3
0
/
2
0
1
4
f
o
r
L
E
A
P
updated 05/08/14 DM
FP
G
E
f
f
e
c
t
i
v
e
1
0
/
0
1
/
1
3
f
o
r
A
d
v
a
n
c
e
d
P
r
e
m
i
u
m
T
a
x
C
r
e
d
i
t
(
H
e
a
l
t
h
A
s
s
i
s
t
a
n
c
e
N
e
t
w
o
r
k
-
M
a
r
k
e
t
p
l
a
c
e
)
FP
G
E
f
f
e
c
t
i
v
e
10
/
0
1
/
1
3
f
o
r
F
o
o
d
A
s
s
i
s
t
a
n
c
e
FP
G
E
f
f
e
c
t
i
v
e
10
/
0
1
/
1
3
f
o
r
F
o
o
d
A
s
s
i
s
t
a
n
c
e
(
H
o
u
s
e
h
o
l
d
s
w
i
t
h
E
l
d
e
r
l
y
o
r
D
i
s
a
b
l
e
d
M
e
m
b
e
r
)
FP
G
E
f
f
e
c
t
i
v
e
11
/
0
1
/
1
3
f
o
r
E
a
g
l
e
C
h
i
l
d
C
a
r
e
(
i
n
i
t
i
a
l
e
l
i
g
i
b
i
l
i
t
y
)
FP
G
E
f
f
e
c
t
i
v
e
11
/
0
1
/
1
3
f
o
r
E
a
g
l
e
&
P
i
t
k
i
n
P
r
e
n
a
t
a
l
Ma
x
I
n
c
o
m
e
E
f
f
e
c
t
i
v
e
01
/
0
1
/
1
4
f
o
r
A
d
u
l
t
F
i
n
a
n
c
i
a
l
-
OA
P
O
n
l
y
FP
G
E
f
f
e
c
t
i
v
e
01
/
0
1
/
1
4
f
o
r
E
a
r
l
y
H
e
a
d
S
t
a
r
t
FP
G
E
f
f
e
c
t
i
v
e
02
/
0
1
/
1
4
f
o
r
B
C
C
P
(
B
r
e
a
s
t
&
C
e
r
v
i
c
a
l
C
a
n
c
e
r
)
FP
G
E
f
f
e
c
t
i
v
e
02
/
2
8
/
1
4
f
o
r
N
u
r
s
e
F
a
m
i
l
y
P
a
r
t
n
e
r
s
h
i
p
FP
G
E
f
f
e
c
t
i
v
e
01
/
0
1
/
1
4
f
o
r
E
a
g
l
e
&
P
i
t
k
i
n
F
a
m
i
l
y
P
l
a
n
n
i
n
g
FP
G
E
f
f
e
c
t
i
v
e
03
/
1
4
/
1
4
f
o
r
P
i
t
k
i
n
C
h
i
l
d
C
a
r
e
(
i
n
i
t
i
a
l
e
l
i
g
i
b
i
l
i
t
y
)
FP
G
E
f
f
e
c
t
i
v
e
04
/
0
1
/
1
4
f
o
r
M
e
d
i
c
a
i
d
C
h
i
l
d
r
e
n
(
a
g
e
s
0
-
1
8
)
FP
G
E
f
f
e
c
t
i
v
e
04
/
0
1
/
1
4
f
o
r
M
e
d
i
c
a
i
d
(
p
r
e
g
n
a
n
t
w
o
m
e
n
)
FP
G
E
f
f
e
c
t
i
v
e
04
/
0
1
/
1
4
f
o
r
M
e
d
i
c
a
i
d
(
A
d
u
l
t
s
,
P
a
r
e
n
t
s
&
C
a
r
e
t
a
k
e
r
R
e
l
a
t
i
v
e
s
)
FP
G
E
f
f
e
c
t
i
v
e
0
4
/
0
1
/
1
4
f
o
r
C
H
P
+
FP
G
E
f
f
e
c
t
i
v
e
04
/
0
1
/
1
4
f
o
r
M
S
P
(
A
l
l
P
r
o
g
r
a
m
s
)
FP
G
E
f
f
e
c
t
i
v
e
04
/
0
1
/
1
4
f
o
r
M
e
d
i
c
a
i
d
B
u
y
-
I
n
P
r
o
g
r
a
m
(
A
d
u
l
t
)
FP
G
E
f
f
e
c
t
i
v
e
0
4
/
0
1
/
1
4
f
o
r
M
e
d
i
c
a
i
d
B
u
y
-
I
n
P
r
o
g
r
a
m
(
C
h
i
l
d
r
e
n
)
FP
G
E
f
f
e
c
t
i
v
e
03
/
1
0
/
1
4
f
o
r
C
S
F
P
C
o
m
m
o
d
i
t
y
S
e
n
i
o
r
F
o
o
d
P
r
o
g
r
a
m
FP
G
E
f
f
e
c
t
i
v
e
03
/
2
7
/
1
4
fo
r
C
o
m
m
o
d
i
t
i
e
s
(
T
E
F
A
P
)
FP
G
E
f
f
e
c
t
i
v
e
04
/
0
1
/
1
3
f
o
r
E
a
g
l
e
W
O
R
K
S
D
i
v
e
r
s
i
o
n
EA
G
L
E
/
P
I
T
K
I
N
C
O
U
N
T
Y
H
E
A
L
T
H
&
H
U
M
A
N
S
E
R
V
I
C
E
S
Fe
d
e
r
a
l
P
o
v
e
r
t
y
G
u
i
d
e
l
i
n
e
s
-
M
o
n
t
h
l
y
G
r
o
s
s
I
n
c
o
m
e
Fa
m
i
l
y
Si
z
e
● L
e
v
e
l
of
N
e
e
d
TA
N
F
(o
n
e
ca
r
e
t
a
k
e
r
or
r
e
l
a
t
i
v
e
)
● E
a
r
l
y
He
a
d
S
t
a
r
t
Medical Programs
● L
E
A
P
● Advanced Premium Tax Credit (Health Assistance Network- Marketplace)
● E
a
g
l
e
WO
R
K
S
Di
v
e
r
s
i
o
n
● F
o
o
d
Ass
i
s
t
a
n
c
e
(h
o
u
s
e
h
o
l
d
s
w
i
t
h
el
d
e
r
l
y
o
r
di
s
a
b
l
e
d
me
m
b
e
r
)
● C
o
m
m
o
d
i
t
i
e
s
(T
E
F
A
P
)
● W
I
C
P
r
o
g
r
a
m
(W
o
m
e
n
,
In
f
a
n
t
s
,
Ch
i
l
d
r
e
n
)
Ad
u
l
t
F
i
n
a
n
c
i
a
l
Ba
s
e
d
o
n
Ea
c
h
A
d
d
t
'
l
MS
P
● F
o
o
d
As
s
i
s
t
a
n
c
e
● C
S
F
P
Co
m
m
o
d
i
t
y
Se
n
i
o
r
Fo
o
d
Pr
o
g
r
a
m