Sen. Kathy Hogan (D-Fargo) discusses the merger of the Health Department with the Department of Human Services, as well as Human Service Zones, the bonding bill and other topics.
Watch the full conversation https://youtu.be/Iz1LjiQp0zU">on our YouTube channel.
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[Full Transcript]
Dave Thompson: This is "Legislative Review" on Prairie Public. I'm Dave Thompson, thanks for joining us. We're on our radio service, and we're also on our digital platforms. Our guest today, Senator Kathy Hogan from Fargo. She's a Democrat, and also is a human service professional. Senator, thank you for being here today.
Senator Kathy Hogan: Thank you for having me.
Dave: Well, the big question, because the governor has now signed the bill to merge the Department of Human Services with the Health Department, but it's not going to occur right away. There's going to be some time, correct? Can you explain what the bill now does?
Sen. Hogan: Well, essentially it begins the merger process. The Department of Health is much smaller than the Department of Human Services, and the goal is to make it, hopefully, more efficient by doing things that might relate to some aspect of the Department of Human Services over the next two to probably four, or six years. And the actual merger of the departments happens in September of 2022, but the budgets will remain freestanding through the next biennium, and with the new chief health officer that we've just hired, and has been here this weekend, I think that the idea is that the two departments will work with their leadership teams to work the details out. Undoubtedly, there'll be an interim committee monitoring all of the kinds of emerging issues. So it's a planned vision, but the actual operationalization of the whole process will probably take at least two years.
Dave: When the bill came out, there was some talk about hiring some consultants to help. Will that help too?
Sen. Hogan: I think it will help, and we know that we think we will have some resources with COVID money perhaps to really facilitate outside planners, which will actually be able to put the pieces together in a new way.
Dave: Now, are you, I guess the bill is now in its almost final form for the human services budget, correct?
Sen. Hogan: It's getting there. They hope this afternoon.
Dave: Okay, so that'll be one of the final bills probably acted on.
Sen. Hogan: Always-
Dave: A huge budget.
Sen. Hogan: Huge, and when you think that they're merging, not only was there major changes in the Department of Health, but there were a lot of other major changes regarding the role of the Department of Human Services in this budget. And so, lots of moving parts.
Dave: Oh, yes, well, a lot of it is federal fund too, so it's a big agency, and there's a lot of state money in it, but there's a lot of federal money in it too.
Sen. Hogan: Mmm-hmm, and really primarily federal money, particularly on the Medicaid side, and because of COVID, we've really had some enhanced FMAP money, which has created some excess reserves, and we have to be careful not to expand services, because it will be here in two years, or four years. But at the same time, we could perhaps use it to be more efficient.
Dave: Remind us what FMAP stands for. Do you remember the acronym?
Sen. Hogan: Yeah, the Federal Medical Assistance Match Program. It's the match program. And so, traditionally we had been running at about 50%. For every dollar we spent on Medicaid, we got 50 cents federal, but I think we're up to 65 right now. And so, that generates a fair amount of money.
Dave: Now, one thing that's happened over the past several years, or at least a few years, is the idea of setting up Human Service Zones.
Sen. Hogan: Mmm-hmm.
Dave: So that, that was one thing, and there was also the takeover of a lot of, and I'm using takeover kind of as a broad thing, of human service expenses, so that the state is spending more of the money, and it's a little bit of a break on property taxes in North Dakota, but that's still an evolving situation with these zones, correct?
Sen. Hogan: You know, the zones, which used to be the County Social Services, County Social Services were essentially the poor relief at the beginning of statehood. There wasn't a Department of Human Services until the 1930s. It just didn't exist. There was a Department of Health, but not a Department of Human Services until the 1930s. So this change in the human, in the local service, human service delivery system was really massive, and we spent about six years planning it, and we operationalized it. The zones were established in January of 2020, right before COVID hit, and we've been implementing numerous program and administrative changes over the last year, and because of COVID, many things got postponed, or delayed. And so, that project is huge. One of the bills we did this session was a comprehensive, we looked at some of the administrative challenges that we'd faced in the first year. It was 2086, and we did a whole number of tweakings of things that we had had not considered, like indirect costs, like the cost of the janitor in the zone, who pays for that, and what's the reimbursement, and there's a lot of indirect costs kinds of issues, but the role of the state's attorney, there were, it was a very complex bill, and we spent probably six weeks at the beginning of session working on that.
Dave: Well, it's a complex matter, because human services touches a lot of areas. So I can understand that, you know, you roll it out, there's going to be some tweaks here, some tweaks there.
Sen. Hogan: Right, and then simultaneously to that, there were some pretty major program changes. For example, we changed our entire child abuse neglect law this session too, which normally would have gotten some press, or some awareness, but people didn't even notice it, because there was so many balls in the air, and this comprehensive revision of the child abuse neglect law is also going in collaboration with the revisions of the juvenile justice system. So all of child welfare systems, not just the zone part, but the whole infrastructure and delivery systems, all the definitions are changing over the next two years too.
Dave: Yeah, there's been a lot of talk about the juvenile justice thing. There was a lot of talk during the interim about that. From your perspective, where is it going? Are we going to see some changes, maybe some more emphasis on recovery, that type of thing?
Sen. Hogan: I think the model is excellent. I mean, I think it decriminalizes a lot of behavior, youth behavior, things that we would call what's delinquent, what's unruly. We are now calling the kids that are unruly and having behavioral problems as children in need of service. And I think it's a good model from a recovery, and a support, and a child protection manner. I think that the concern I had throughout the bill was are there adequate services for the children in need? And I think with COVID what I have heard from both school social workers and from juvenile court is there are a lot of kids who are acting up now, and that the adequacy of our response at the local level might not be enough, and we didn't really have enough time to analyze that, and figure out do we have the services that these children need.
Dave: So again, probably something for the upcoming interim to take a look at that in depth.
Sen. Hogan: It will be, it will be.
Dave: It's amazing how a lot of these things, you may think they're separate, but equal programs, but really they do cross over a lot of things, because there's been a lot of discussion, and we've talked about it for years about, you know, community-based services, and how we've got to move toward more community-based services. Now, you've got juvenile justice in there. There's a lot of moving parts.
Sen. Hogan: A lot of moving parts, and simultaneously, I think our resource capacity at the local level is shrinking, for example, the loss of LSS. LSS provided a lot of intensive in-home services, and parenting supports, and counseling supports, and that's just off the table. Now, some of those programs have been picked up in some regions, but right now there's no, there's really limited support services for families in need.
Dave: Who's going to pick that up, do you think? Is this going to be another thing like Lutheran Social Services, or maybe some kind of volunteer work, or maybe a combination with some state help?
Sen. Hogan: Well, I think in some ways we have funding available, but I don't know we have providers organized enough to do it. And so, it might not be a funding issue at all. It's just are there counselors out there? Are there social workers out there? There probably aren't. And so, it's a capacity issue as much as it is a funding issue. And so, that's my concern, because one of the things in the juvenile justice system is we've changed our definition of when, and how a child can go into a group home, and we've kind of eliminated foster group homes. So now, there's not a service to provide, but there's a child with a need, and somebody at the local level is gonna have to make some really tough decisions.
Dave: So you think that's gonna come from the local level this way?
Sen. Hogan: Well, it always happens at the local level. The children need, when I was the Director of Social Service, occasionally I took a child home, because that's what you did. You had a child who had a need, and so, and there wasn't a resource available. And so, it always starts at the local level, and the policy kind of hopefully moves from the bottom level up instead of from the top level down, because the needs are seen by juvenile court, schools. School social workers have become critical.
Dave: You know, your comment about with COVID things have changed, kids were not able to attend school for a while. They had to be on Zoom, or some kind of platform to have learning. They were not able to be as socially interactive as they probably should be, especially in, you know, children and young adults. So that all kind of factors into it.
Sen. Hogan: Yeah, everything is unstable right now. And so, as we do these major administrative restructurings, we have to remember that the consumer on the ground who needs help right now, and one of the examples that the juvenile court said, we have kids who are kind of painting graffiti. or doing kind of not really criminal things, but you know, bad behavior that need consequences, and they need somebody to help them understand that that's not acceptable. And so, those kinds of unruly behaviors, and just bad decision-making, and a lot of people are making bad decisions these days, and it's understandable. But we, as a society, have to help both the children and the families understand options and resources.
Dave: Well, I also wanted to bring up a couple other things, House Bill 1416 and 14, I think, 66.
Sen. Hogan: Yeah.
Dave: Now, this has to do with early childhood services being restructured into the Department of Human Services, and this evidence-based four-year-old preschool program, two issues that have been discussed for a long time in the legislative session.
Sen. Hogan: Yeah, and it was really exciting to see the kind of understanding that if we coordinate, we had programs in commerce, we had programs in DPI, we had programs in health, and we have programs in human services, and they're putting them all under one umbrella, and we'll begin to see what options we have with the redesign of those programs. But the exciting one, so first we're gonna make sure childcare is licensed, and trained, and has support services. Simultaneous to that is Child Care Aware, which was really a childcare support structure that helped childcare providers learn, and provided training, and mentoring, and support, that was an LSS program that also moved into the department. So all of a sudden, this early childhood initiative is very large. It's very large, and hopefully with coordination at the state level, we can be more efficient, but we can actually help families when they have a behavior problem, if they have a developmental issue, if they have a health issue by having one place to go. And that's, I think, again, the beginning of what will be a four to six-year project.
Dave: Another four to six-year project to create one-stop shop, so to speak.
Sen. Hogan: One-stop shop, maybe, or at least a vision of who's doing what, and some kind of inventory. And then we're also focused on if we know that if we help children before they start school and they start school well that their lifelong success is better, and so, we're looking at a very innovative, evidence-based practice for four-year-olds, and it will be a community partnership. So we'll need communities to apply to get funds, and instead of funding on a per capita base, we're going to grant fund it. So we're gonna give you, if you have 14 kids at your school, you can get a set amount of money, and you have to do the program then, and it's a very established program. And the success of most of these programs means that you have fidelity to practice. If you don't do it the same with every child, your success usually doesn't happen, and we haven't rolled out an evidence-based comprehensive plan on an early childhood program before. And so, that's very exciting.
Dave: What's your assessment of the need for childcare in North Dakota right now? Because we keep hearing from businesses that there is a need, because of their employees.
Sen. Hogan: There is a desperate need, and one of the things the Department of Human Services did really, really well with the COVID money was they enhanced the grants to childcare centers, particularly for essential workers initially, and then they helped low-income families by reducing the amount of out-of-pocket cost they had for childcare assistance. They often had to pay 20%, or 30%, and with COVID money, we could lower that, so that we could keep low-end workers, low-income workers, working with childcare. Again, the capacity number, it's funny, because I asked this earlier, and we don't have a good sense of what our current capacity is. And that's one of the things, that's one of the pieces of data that we really have to have, and getting childcare licensed, but again, workers are the number one problem for childcare providers. I mean, you can't go to work in a hospital, or in a factory, or any place if you can't get childcare workers, and childcare workers have historically been the lowest paid of all of the service providers, often literally at minimum wage, with no benefits. And so, that's been a huge dilemma, and I think with this early childhood initiative, we'll have that data. I think we'll know what that is.
Dave: So the next step after you get the data is determine what the needs are, and maybe try to help with pay to attract people to do the work?
Sen. Hogan: Yeah, and right now our current reimbursement level for low-income families who are eligible for childcare assistance is so low that they struggle with, if I earn $600 a month, or $1,200 a month, and 1/3 of it goes to childcare, is it worth going to work? And so, those dilemmas for the working poor are absolutely real.
Dave: Do you think that the new amount of COVID relief money coming in through the American Rescue Act is going to help in this regard?
Sen. Hogan: I think one of the areas that it will really help is in childcare. I think everyone in the nation is facing the dilemma we're facing in North Dakota. It's this childcare crisis, and essentially it's because childcare workers have been the lowest paid. They're not as well paid as the CNAs in the nursing homes, or the DD providers. They don't have benefits. And so, childcare in our country is the worst paid profession, profession, or service industry.
Dave: Again, you're talking about a systemic problem. That's going to take some change, and perhaps getting to that, and I hate to use the hackneyed phrase of that's the $64,000 question at this point.
Sen. Hogan: Yeah, yeah, and how the funding will maintain. I understand that some of the federal money will be allowed to be used over the next two, or three, or four years, so we can hopefully stabilize the system.
Dave: Are there any other things that you'd like? Because we got on the COVID money, and the new amount of money, which apparently is gonna be $1.8 billion over two years from what I understand now, and that number's been kind of fluctuating up and down. Are there any particular things that you would like to see that money used for?
Sen. Hogan: I think one of the things that we used with the first COVID money that I think is critical is rent assistance for people, because a lot of people are working at those low-end jobs, and they literally are losing their housing now, because they don't have, and when unemployment was enhanced, that's fine. But rent assistance is a really critical way, and not so much, we need to support homeless shelters, but if we can prevent an eviction, if we can do emergency rental assistance, sometimes for a month, or three months, a lot of people over the last year used every single penny of their reserves. They used their savings. They got two or three months behind in rent, and if we don't help those situations, our homeless problem is just gonna grow. And so, the prevention side is one of the house, and housing assistance is one of the areas that we started. We did really nice work with the homeless on COVID to make sure that when they were sick, they had services. The state did an excellent job on that with local providers. But I think this long-term housing issue will really be a critical issue for stabilizing the working poor, and it's, these are people, most of the homeless in shelters have jobs, like 70% have jobs. So they're working, but they don't have enough money to get an apartment.
Dave: Now, that's a stat that is not well-known-
Sen. Hogan: No.
Dave: That the majority of people who are in homeless shelters actually do have work. They do have jobs, and I've been hearing a lot of evidence that the people who don't want to work, a lot of the people who don't want to work.
Sen. Hogan: Yeah, well, and I think that idea of them not wanting to work is really hard, because if it's a childcare issue, it's really hard to work when you're homeless. You know, it's really hard to get a job. It's hard to apply, because you don't have an address, or a mailbox. All of those kinds of things that those of us who are privileged to have housing, and a little money, that don't worry when we go to the grocery store if we can afford anything, we can't comprehend what it's like to be really deeply poor.
Dave: Let me ask you about something that is kind of tangential, but it is important too, because it came out of the corrections budget, and for a long time, you know, judges were sentencing people to jails because that's where they can get treatment for addiction, things like that. And there's going to be a change it looks like that some people who are in the New England facility, and that's a women's facility, will be moved to Mandan, so they can get some of these treatment things in Mandan. Is this going to be an evolving thing that you see over the next few-
Sen. Hogan: Well, and I think that connections between corrections and human services, as we've seen over the last four years, has really, people begin to understand that they're very connected. And I think Mandan not only has more service available to help women, it's closer to their families. One of the critical things about when a woman is in corrections, she needs to maintain family supports, so that when she is discharged, she has a place to go, and that she knows her children, and she knows that she can do a plan together. One of the more difficult things is women who were sent to New England had such difficulty. They were often really isolated from their families. And-
Dave: That is one, that's one complaint I heard is that, you know, a lot of people are coming from the more populous eastern part of the state-
Sen. Hogan: Sure.
Dave: And they're going out to New England, and they are far from families, and family support is one of the important steps in getting people to recover
Sen. Hogan: Well, and for women, a lot of times, even when they're in correctional facilities, if we can provide parent training, if we can teach them how to read to their children, and how to change their diapers, and how to feed, and how to really teach the children, that's a golden opportunity to change the cycle. And so, those are things we have to really do, and that's a partnership between local providers, human services, corrections, and if all the systems aren't working together, those things don't happen.
Dave: Well, we've been talking a lot about human services, and that's big. There are a lot of issues that human services deals with, but I just have to ask about a couple of other things.
Sen. Hogan: Sure.
Dave: How did you feel about the bonding bill as it finally came out?
Sen. Hogan: It was, first, I strongly support bonding, because I think that's historically something that we need to do. And I think the bonding of several critical projects makes sense, instead of doing a large hodgepodge of issues. I think what we'll learn from this is we'll begin with these two large projects, and I think we'll learn that this works, and you know, whether it's a 15-year, or a 30-year bond, I think there's lots of development, and I was really pleased that both chambers and the governor came to consensus on let's get back to bonding, because that's how you and I buy a house. That's how the world works. This is just common sense. And so, I think it's the beginning of a movement.
Dave: The cost of money is cheap right now, of course.
Sen. Hogan: Yeah.
Dave: So the idea is to just use another-
Sen. Hogan: Yup?
Dave: A cliche, strike while the iron's hot, basically.
Sen. Hogan: Mmm-hmm, yeah.
Dave: And also, there have been some other bills that have been very controversial there, the transgender bill, for example. I know that that's still pending somewhere. I would assume that you were not a fan of that bill.
Sen. Hogan: No, I had, I had real concerns. You know, I often said, and I, in my district where I came from I got thousands of emails, we all did, about that bill. But I only got 44 for my district, and 40 of them said vote no on the bill. Four said to vote for it, which I thought was interesting. So I didn't quite see the difference, and maybe that's an urban, rural difference. But 15 years ago, I didn't know transgender people, and over the last 15 years I've had the privilege of walking with several of them, and particularly as families, as children come out, and go through the process of understanding what being transgender is, and making really complex medical, and social, emotional decisions. And I think if we start limiting and judging these very vulnerable individuals, it's so hurtful to the families, and to the individuals. I think that impacts big business wanting to come to town. I think we are going to be seen as a non-welcoming place, and in my community, I don't think that's what we wanna be, and that's what I heard from my constituents. And so, I just didn't see it was necessary. People said it was unfair at sports. Are sports more important than the lives of children? You know, it's like is winning and losing the big issue here? It didn't make any sense to me. And so, it was one of those issues that sometimes we make issues almost to create divides rather than to find solutions.
Dave: Well, in the few minutes we have left, there's another bill that's pending out there, just wanting to get your opinion on it, and that's the idea of changing the retirement, the state retirement plan from defined benefit to defined contribution. Defined contribution would be for new hires effective in 2023. That has not passed yet. It's pending in a conference committee. What are your thoughts about that?
Sen. Hogan: My feeling is that this is such a major change that impacts a lot of people in this state, and that we didn't do the actuarial studies. We haven't done it before, employee benefits. None of the standard procedures for a major policy change like this were followed, and that just makes it unacceptable. And I'm not opposed to looking at it, but then let's look at it using the established standards.
Dave: So instead of death by study, you think that there ought to be a real study to look at this-
Sen. Hogan: And it has to be an independent, external audit that looks at the financial issues, because I think if you take the local governments out, the state employees program is going to be financially just gutted, and then the state has that liability. And so, I don't think we really know what we're doing, and this is not the way to make major decisions.
Dave: Is there anything else that you'd like to see in terms of maybe a bill, or two, or a study, or two that you'd like to see accomplished over the next two years?
Sen. Hogan: Well, I think we have a lot of really good studies. We'd looked at drug pricing. We'd looked a lot about drug regulation, and that's an area that I think every citizen is concerned about, either an employer, or employee, because drug prices continue to go up, and I think that's one that we really need to look at. There's a study on autism. We've had a lot of controversy about autistics, and services to individuals with developmental disabilities. So there's a lot of issues out there.
Dave: I was gonna say, and there's a lot, there will be a lot of time to study it, and there'll be a lot of interesting studies to watch, so-
Sen. Hogan: Yeah.
Dave: Senator, thank you very much for the time this afternoon.
Sen. Hogan: Thank you, good to talk.
Dave: Our Senator Kathy Hogan from Fargo, she's a Democrat. She also was a professional in human services, so she knows a lot about human services. For Prairie Public and "Legislative Review," I'm Dave Thompson.
