By James Goodman
Democrat and Chronicle

(May 6, 2002) — On a typical day at Rochester General Hospital, two or three patients are ready to be moved to nursing homes but are waiting for the necessary paperwork.

Their transfer, hospital officials say, is being delayed because the Monroe County Department of Social Services takes longer to process patients' Medicaid applications.

That's not the only sign county workers are being spread thin. County officials recently brainstormed with Family Court judges about how to address problems related to vacancies in 10 of the county's 81 child protective positions.

"Things are bad and are going to get worse," said Family Court Judge Anthony Sciolino.

This is the situation County Executive Jack Doyle is facing as he gives his eighth State of the County address this evening.

Like many other counties in New York, Monroe is trying to avoid red ink amid depleted reserve funds and rising costs. Other counties are raising taxes to increase their revenue; Doyle said that's not an option here.

"It's a destructive form of taxation. It adversely affects every segment of society -- businesses, homeowners and the elderly," he said.

Instead, Doyle is relying on cost-saving measures, including possible layoffs.

Doyle announced a hiring freeze in February that had started in fall of last year. As of early April, the county had 377 vacancies out of 4,879 full-time jobs; 78 other vacant jobs were recently abolished.

Services are being squeezed, even more because some public assistance caseloads, such as Medicaid, continue to grow.

County employees recently received a questionnaire asking them if they've served in the military or were volunteer firefighters. Although county officials say a similar form has been used before and they are now just updating records, the information sought helps determine seniority.

"My people took this as preparation for layoffs," said John Vasko, president of the Monroe County Federation of Social Workers.

Fiscal woes

The county's expenses have outpaced revenue for the past several years, eating up funds held in reserve. In 1997, reserves were as high as $56.5 million, but they dwindled to $22.4 million by the end of 2000. At the end of last year, according to a recent estimate by Moody's Investors Services, the reserves stood somewhere between $9.8 million on the plus side and $9.9 million in the red.

The county's chief financial officer, Gerald Mecca, has since narrowed that estimate to between plus $3 million and negative $3 million. County officials have declined to speculate on the exact figure, although they expected to do more short-term borrowing to meet expenses.

The last time the county was in a crisis situation was in 1992. Republican County Executive Robert King took office that January, inheriting a $42 million budget gap. He raised the county's portion of the sales tax from 3 percent to 4 percent -- making the sales tax 8 percent when the state's share is included. And he laid off almost 300 employees. Eighty of those jobs were restored after he won legislative approval of the first half-cent of the sales tax boost.

Doyle does not expect any increase in the sales tax or change in its distribution formula when it comes up for renewal next year.

A survey by the New York Association of Counties found that almost three-quarters of counties increased their revenue last year by raising property taxes. By closing the door on this option, Doyle already has put himself in a bind.

Earlier this year, the county announced that the state's subsidies for day care were about $6 million below county projections. Rather than make up the difference in county money, Doyle proposed tightening eligibility requirements.

The state eventually agreed to provide additional funds for this year. But tighter eligibility requirements are in effect for new applicants and will apply to 1,300 children in January.

Tashia Bramhan, a 30-year-old working mother from Rochester, has felt the effect of the new rules. Last year, Bramhan qualified for a weekly subsidy of more than $200 to put her two children in day care over the summer. But when she recently applied for a similar subsidy this year, she received a rejection letter because her income exceeded the new maximum.

"Now I am at a loss about what to do with my kids," Bramhan said.

Gaps to fill

Richard Schauseil, director of the Department of Social Services, said that the county plans to plug gaps by shifting caseworkers performing other tasks to high-need areas.

Schauseil will have plenty of gaps to fill, even though he has 31 more employees than a year ago. The demands on the county work force are greater.

Medicaid cases continue to grow -- with the average monthly caseloads expected to increase by 1,000 to 37,000 this year. And the number of "safety net" assistance cases, which includes those who have used up their welfare benefits, is projected to increase to about 4,500 a month -- or 800 a month more than last year.

The health and social services departments account for almost 62 percent of the county budget. That has prompted the county to hire a local firm, Altreya Consulting, for $285,000 to look for cost-saving measures.

But finding savings may be difficult because most of the funding for social services goes to recipients in the form of benefits. Niagara County hired the Center for Governmental Research to look for cost-savings in its social services department. So far the county has realized only about $200,000 in savings, according to Niagara's social services commissioner, Anthony Restaino.

The savings largely resulted from moving employees whose salaries were partly paid by the county to slots that are fully reimbursed by state and federal funding.

At the Health Department, Doyle has already done belt-tightening. Molly McNulty, an assistant professor in the department of community and preventive medicine at the University of Rochester Medical School, found that funding in 2002 dropped in three of five early childhood prevention health programs that get county money.

Funding to help families suffering the loss of an infant decreased by $48,820, or 23 percent. The budget for medical services to children dropped by $39,331, or 51 percent. And funding to help families of disabled children get medical care was reduced by $23,900, or 33 percent.

Concerns

The concern -- expressed both by union officials and advocates for recipients -- is that services are being compromised in the name of cost efficiency.

"The (hiring) freeze is a huge problem," said Bryan Hetherington, chief counsel for the Public Interest Law Office of Rochester.

By the end of last year, said Hetherington, statistics provided by the state show that the average time for processing various forms of public assistance was on the rise. For example, the average time to process Medicaid applications was 49 days in December compared with 42 days in September.

Hospital administrators also tell of a slowdown. Over the past six months, the time it takes for Rochester General patients to get an appointment with county Medicaid eligibility examiners has roughly doubled -- often taking more than two weeks, said Mary Jane Stone, manager of social work services for ViaHealth, the parent organization for Rochester General.

Such delays can contribute to a backup of patients in hospitals -- a problem that becomes worrisome when emergency rooms are overcrowded. These delays also keep patients from getting rehabilitative services at nursing homes.

Schauseil said he hopes to have caseworkers assigned to public assistance help out on Medicaid. "We understand that there are limited resources," he said.