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Kim Gabaldon has had her hands full during her first year as social services manager. Gabaldon updated the Los Alamos County Council on the new Social Services Division’s activities during Tuesday’s work session.
The division was created a year ago in response to a community needs assessment conducted by the Community Services Department in 2010.
The report found that social services were fragmented across multiple departments within the county and recommended creating a new department to be responsible for all oversight and funding of community services in order to provide a more integrated, cohesive system of care.
Gabaldon was hired to head the division in March 2013. Healthcare Program Specialist Nicholle Cordova was hired shortly afterward to provide administrative support for the division.
The county’s Health Care Assistance Program (HCAP), also known as indigent healthcare, has consumed most of Gabaldon’s attention this first year.
Shortly after the Office of Management and Budget transferred supervision of the program to social services, council voted to reduce the scope of services, number of providers and qualifying income limits in order keep the fund solvent. Social Services had to communicate the changes to 370 previous and existing clients.
The reduced scope resulted in a 24 percent decrease in the number of clients. Claims between July 1 and Nov. 30 fell to 44 percent of those for the same period in 2012.
Seventy provider contracts were also cancelled, with another 30 contracts reissued.
Cordova has since certified as a notary public and is working toward certification that would allow her to prequalify people for the Medicaid program. The certification process is currently on hold with the DOH.
Councilors expressed concerns about how those dropped from the rolls were meeting their healthcare needs.
Gabaldon reported that her division has offered support by creating and distributing resource lists for low-cost vision, dental and primary care services, prescription drug assistance programs and mental health crisis support. Those lists are available at the county’s customer care center.
Gabaldon also estimates that 80 percent of those affected qualified for Medicaid under the Affordable Care Act as of Jan. 1.
All HCAP applicants must apply for Medicaid prior to acceptance in the county’s indigent program. The social services office is also receiving more incomplete applications, which Gabaldon attributes to those clients learning they were Medicaid eligible.
Gabaldon has also been in the thick of the fight to prevent DOH from intercepting the county’s entire 1/8 indigent healthcare GRT increment. Prior to coming to Los Alamos, Gabaldon spent five years in DOH’s Behavioral Health Services Division. Due to those ties, she was asked to be part of a team representing the New Mexico Association of Counties’ interests in negotiations with DOH.
Gabaldon noted additional needs identified in the LACHC Health Action Plan, including working with the Community and Economic Development Housing Division to explore affordable housing options for moderate and low-income families, particularly how to provide emergency shelter.
Gabaldon also identified the need for case coordination to assist residents in accessing information, referral sources and support services. She suggested that the division may eventually be able to shift some of its focus from providing indigent care services to case coordination as the Affordable Care Act takes effect and decreases indigent caseloads.
Councilor Rick Reiss was disturbed by the number of projects Gabaldon is involved with.
“My first and foremost concern is the scope and scope creep,” Reiss said. “It seems like there’s no end to what would come under your umbrella.”
“It is a huge scope,” Gabaldon agreed. “We’re talking about prevention efforts across a lifespan. We’re talking about the very young right through the very elderly. It’s not the same set of services for those you are young and those who are trying to stay in their homes longer.”
Kalogeros-Chattan explained why the scope was so broad and the efforts she has made to divide the workload among the community services department.
“One of the main motivations in creating the social services division was to collect the different pieces of social services that were being rendered all over by various county staff,” Kalogeros-Chattan added. “So what we’re trying to do is piece-by-piece collect it.
“The difficulty is that it is so big. There was a time when we thought that Kim would be able to do this all herself, and that didn’t turn out to be true. And that’s no fault of Kim. That’s just the sheer breadth of what it is and the fact that the indigent health has been nothing but a moving target for the entire year.”
Chair Geoff Rodgers also expressed concerns about the division’s responsibilities.
“With a new department without a long history to deal with it’s very easy to say, ‘Well, that sounds like social services. Let’s give it to her,’” Rodgers said.
“We may need some policy guidance to put parameters around this department so it doesn’t just become a dumping ground for everything else that no one knows what to do with.”
Overall, council appeared to be pleased with the divisions progress so far.
“I think it was absolutely the right thing to do to get a fulltime staff person in the county to take leadership of coordinating services,” Councilor Pete Sheehey said.