MEALSONWHEELS:MORETHANAMEAL
Creatiing an innovative and responsive system to deliver critical nutrition and social interaction
to vulnerable, isolated adultsintheJeffersonManagedCareServiceArea.
ABSTRACTMeals on Wheels America and Meals on Wheels Texas recognize a need to assure more eligible recipients are identified and served through a robust business plan and innovative practices. The following report details an analysis by home delivered meals (aka Meals on Wheels) providers, with the assistance of a consultant, in the Jefferson Managed Care Service Area, to consider how they may collaborate to accomplish these goals.
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ThisreportisfundedbyagrantfromMealsonWheelsAmericatoMealsonWheelsTexas.ThereportispartofanalysisandpreparationforthedevelopmentofapilotprojectintworegionsofTexasdesignatedforservicesfromManagedCareOrganizations(MCOs):theBexarManagedCareServiceArea,centeredaroundBexarCounty,Texas,andtheJeffersonManagedCareServiceArea,nearJeffersonCounty,Texas.
ThisreportisthepropertyofMealsonWheelsTexasandNutritionandServicesforSeniors,theleadagencyfortheprojectintheJeffersonManagedCareServiceArea.Thereportshouldnotbeshared
withoutthepermissionof:
ElaineShellenbergerExecutiveDirector
NutritionandServicesforSeniors4590Concord
BeaumontTX,77703Phone:409-892-4455Fax:409-892-0443
ThisreportwaspreparedbyMarthaSpinks,Ph.D.,consultingwithMealsonWheelsTexas.Dr.Spinkscanbecontactedat:
419StonewoodSanAntonio,TX78216
210.499.5175/[email protected]
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TableofContents
SUMMARYOFTHEMEETINGHELDJANUARY22,2016:....................................................................4
POINTSOFDISCUSSION....................................................................................................................4
INVITEES...........................................................................................................................................5
PILOTPROJECT.................................................................................................................................7
THEBUSINESSPLAN.........................................................................................................................7A. Goal...................................................................................................................................................7B. ManagementPlan..............................................................................................................................7C. OperatingPlan...................................................................................................................................8D. MarketingPlan..................................................................................................................................8E. FundingPlan......................................................................................................................................9F. ReturnonInvestment/SocialReturnonInvestment...........................................................................9
EnvironmentalConsiderationsforExpandingtheClientBaseintheJeffersonManagedCareServiceArea...............................................................................................................................................10
SWOTAnalysis...............................................................................................................................13STRENGTHS...............................................................................................................................................13WEAKNESSES............................................................................................................................................13OPPORTUNITIES........................................................................................................................................14THREATS...................................................................................................................................................14
FOLLOWUP....................................................................................................................................15FORMALIZEANAGREEMENT.....................................................................................................................15TODOLISTPREPARATORYTOTHENEXTMEETING....................................................................................16
APPENDICES...................................................................................................................................17APPENDIXA.Invitation/AgendaEmailedtoJeffersonManagedCareServiceAreaProviders...................18APPENDIXB.BexarandJeffersonManagedCareServicesAreas,byCountiesandPlaces..........................19APPENDIXC.KronkoskyFoundationResearchBrief:MealsonWheels....................................................21APPENDIXD.ProposedFlowChart,OperationandManagementoftheJeffersonManagedCareServiceArea..........................................................................................................................................................26APPENDIXE.ProposedCommunityCoalitionCharter................................................................................27APPENDIXF.DraftAgreementbetweenFiduciaryAgentandCoalitionMembers.....................................30APPENDIXG.OrganizationalCapacitySelfAssessment&CollaborativeSolutionsTool.............................32APPENDIXH.DualEligibleMedicaidEnrollment,byCounty......................................................................42APPENDIXI.Medicare-MedicaidRecipients,byCounty............................................................................43APPENDIXJ.Age,DisabilityandPovertyIndexbyCounty.........................................................................44APPENDIXK.Area2014CensusPopulationCharacteristicsforAge60+,byCounty,withComparisontoStateofTexas............................................................................................................................................50APPENDIXL.SelectedEconomicCharacteristics_14_5YR_DPO3.xls..........................................................51
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SUMMARYOFTHEMEETINGHELDJANUARY22,2016:FOCUSGROUP
FacilitatedbyMealsonWheelsTexas(Facilitator:MarthaSpinks,Ph.D.,MSW,Consultant)
forRegionalHomeDeliveredMealsProviders
ConcerningaPilotProjecttoImproveCoverageinUnservedorUnderservedAreas
HostedbyHollyAnderson,Director,AreaAgencyonAgingDeepEastTexasCouncilofGovernments(DETCOG),Jasper,Texas
POINTSOFDISCUSSION
• IdentifychallengestoMealsonWheelsprograms• Identifyopportunitiespresentedbythechallenges/currentenvironment• Makeaformalcommitmenttocollaboration• Developabusinessplan
GOALFORTHEPILOTPROJECT(Broadlydefinedbytheattendeesattheendofthemeetingandsubjecttoeditsoramendmentsbycollaboratingagencies):Throughacollaborativeeffortamongregionalhomedeliveredmealsproviders,developacooperativebusinessplanthatclosesthegapsinareasnotcurrentlyserved,orareunderserved,byindividualprograms.PROPOSEDNEXTSTEPS:
1. Facilitatorwillusecontentfromthefocusgroupmeetingtodraftacharteragreementandbusinessplanoutlineforthegrouptoreviewandmakecomment.
2. Followinggroupinputbyemail,groupwilldeterminewhethertohaveatelephoneconferenceand/ormeetingtofinalizedraftbusinessplanandcharter.
3. Collaboratingagencieswillsignacharter,designateaFiduciaryAgent,andapproveabusinessplanbyMarch2016.
4. Withformalizationoftherelationshipamongcollaborativemembers,theJeffersonManagedCareServiceAreawilloperationalizetocontractwithoneormoreManagedCareOrganizations(MCO)toprovideMealsonWheels/HomeDeliveredMealstoeligibleadultsinthedesignatedregion.(SeeAppendixBforamapofthepilotregions.)
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*NotincludedinemailinvitationforJanuary22,2016meeting.Theyshouldbeaddedtolistofinvitees.
INVITEES
Name MailingAddress
City/Town ZipCode
EmailAddress Phone Attending
MeetingVirgilAllen P.O.Box415 Coldspring 77331 [email protected] 936.653.4175 Y
BarbaraHayes 602E.ChurchStreet,Ste
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Livingston 77351 [email protected] 936.327.6830 N
FrankIvory 340FHwy75North
Huntsville 77320 [email protected] 936.295.6151 N
BobbieBrodnax 109WestWaterSt
Jasper 75951 [email protected] 438.27280 Y
MaxineMorris P.O.Box1095
Cleveland 77328-1095
[email protected] 281.592.1174 Y
LindaHughes 103North5thSt.
Orange 77631 [email protected] 409.886.2186 Y
SandyVaughn Newton 75966 [email protected] 409.379.8083 Y
VickiSmith POBox3607 Victoria 77904 [email protected] 361.578.2989 NY-EttaMcBride POBox683 Anahuac 77514 [email protected] 409.267.3559 N
ElaineShellenberger
4590Concord
Beaumont 77703 [email protected] 409.892.4455 Y
HollyAnderson 210PremierDr.
Jasper 75951 [email protected] 409.384.5704 Y
BarbaraWilson P.O.Box1095
Cleveland 77328 [email protected] 936.509.6350 Y
TammyBlank 621Harris
Nacogdoches 75964
936.509.6350
Y
RayfieldJefferson
P.O.Box415 Coldspring 77331 [email protected] 936.653.4175 Y
*MitchMcMillon
409N.Fletcher
Jasper
75951
[email protected] 409.384.3701 Y
BobbieStott 210PremierDr.
Jasper 75951 [email protected] 409.384.5704ext5303
Y
DonnaSprouse 210PremierDr.
Jasper 75951 [email protected] 409.384.5704 Y
*KasieKroll 340-FHwy75North
Huntsville 77321 [email protected] 936.291.2868 N
*CharlesLee POBox1008 Groveton 75845
[email protected] 936.642.1541 N
*KatieJones POBox1008 Groveton 75845
[email protected] 936.642.1541 N
*DeaconGlendaHardin
2041TrinityAve.
Liberty 77575 [email protected] 936.336.3762 N
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ATTENDEESSIGNINGCOMMITMENTTOCOLLABORATEwithMealsOnWheelsTexasandOtherLocalHomeDeliveredMealsProviderstoDevelopaBusinessPlan:
Agency Representative Phone EmailEastTexasSupportServices,Inc. BobbieBroadnax 409.382.7280 [email protected]
SanAugustineCounty BridgetteBrown,forJudgeSaymeJohnson
936.201.3951 [email protected]
SeniorCitizensofSanJacintoCounty RayfieldJefferson 936.653.4175 [email protected] TammyBlank 936.569.6350 [email protected] LindaHughes 409.886.2186 [email protected],Beaumont,TX
ElaineShellenberger 409.892.4455
Note:Thisisanonbindingcommitmentbasedontheinitialmeetingofthegroupofpotentialcollaborators.OtherswhodidnotsignordidnotattendthemeetingonJanuary22,2016,haveanopportunitytocommittotheprojectbysigningtheproposedcharter.
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PILOTPROJECT1. Thefirsthourofthemeetingwasapresentationfromthefacilitatoraboutthepilotprojectledby
MealsonWheelsAssociationofTexas,fundedbyMealsonWheelsofAmerica.MealsonWheelsAmericaandMealsonWheelsTexasrecognizeaneedtoexpandservicestoassuremoreeligiblerecipientsareidentifiedandserved.ThechallengesofreachingmoreeligiblerecipientswillrequirecollaborationamongproviderstodevelopabusinessplanthatallowsthevarioushomedeliveredmealsprogramstoidentifyA. theirrespectivestrengthsB. waysinwhichtheprogramscanaligntheirstrengthsandhelpeachotherto—
i. createefficienciesthatresultinmoreclientsbeingservedii. sustainindividualHDMprogramsiii. sustainthetraditionalmodelofalocalHDMprogramthatdelivers“morethana
meal”byengaginginfrequentface-to-facecontactwithclientsiv. collaboratetodevelopinnovativesolutionsthataddressthebarriersdescribedin
itemsi-iiiabove2. Attendeesweregivensummarystatisticsfromanonlinesurveythatwascompletedbythemin
NovemberandDecember.Theresultswereusedtoleadadiscussionaboutthecharacteristicsandcapacityoftheprogramscollectively.
3. Thefacilitatordiscussedtheoutlineofabusinessplan:
A. GoalB. OperatingPlanC. ManagementPlanD. FundingPlanE. ReturnonInvestment/SocialReturnonInvestment
THEBUSINESSPLAN4. Attendeesbegandiscussionsonthebusinessplanasfollows:
A. Goal“Throughacollaborativeeffortamongregionalhomedeliveredmealsproviders,developacooperativebusinessplanthatclosesthegapsinareasnotcurrentlyserved,orthatareunderserved,byindividualprograms.”B. ManagementPlan
1) Designateallpartiestotheagreementasacoalitionandadvisorycommitteetothecoalition
2) Designatealeaderforthegroup,who,ataminimum,willa. Beapointofcontactformembersofthecoalitionb. Beapointofcontactforbusinesspartnersorpotentialbusinesspartners
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c. Organize,atminimum,routinequarterlymeetingsd. Callothermeetingsasneedede. Beonthealertforfundingopportunitiesf. Organizeworkgroupsoridentifyspecialistswithinthegroupwhocanwrite
grants,negotiatecontracts,etc.3) Formalizeanagreementtocollaborateandimplementabusinessplanandregional
operatingnetwork(SeeAppendixEfordraftcharter.)4) Reviewtypescollaborativearrangements,including,butnotlimitedto:
a. Considerorganizingavoluntarycoalition,andthecriteriaformembership.b. Considertheefficacyoforganizingasa501(c)(3)c. PerDETCOGAAAstaff,considerapproachingtheregionalcoalitionofArea
AgenciesonAgingtodiscussexpandingthemembershipofthatexistingorganizationtohomedeliveredmealsproviders.(PersuggestionfromDETCOGAAAstaff.)
5) DesignateaFiduciaryAgentforthecollaborative.(SeeAppendixFfordraftofFiduciaryAgentagreement.)
C. OperatingPlan
1) SeeAppendixDforschematicofproposedoperatingprocedure2) Identifyalliesofthehomedeliveredmealsprograms3) Shareinformation4) Sharegoodideas5) Standardizecoreprogramstothedegreepossible,withtheunderstandingthat
agenciesvarytosomedegreeintheirresourcesaswellastheiradditiveprogramsandwillcontinuetodoso
6) CreateaformalagreementamongareahomedeliveredmealsproviderstoactasacollaborativetocontractwithMCOsandaddressothermutualinterests
7) Createamorecoordinatedandreliableinformationandreferralsystemforclientsandproviders
8) Joinand/orworkwiththeregionalcoalitionofAreaAgenciesonAging9) Developpartnershipsamonghomedeliveredmealsproviderstoassisteachothertofill
respectivegaps
D. MarketingPlan1) Usethecurrentthreatfromnewcompetitorsasanopportunitytorevivemarketing
materialsanddevelopaconsistentstrategythatindividualHDMproviderscanshare,e.g.,
a. WriteabusinesscaseforthesuperiorityoflocalHDMprogramsthatallHDMprovidersuseinprintmaterials,presentations,contactswithofficials,communityleaders,DADS,etc.
b. Designamarketingstrategyforcoreservicesofferedbyallprovidersthatresultsini. Abrochure,postersandotherprintmaterialssharedbyallproviders
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ii. Ascriptedpresentationthatallmemberscanuseincontactswithofficials,themedia,andpotentialbusinesspartners
c. Notdiscussed,butfacilitatorrecommends:i. Astandardizedstyleinlogos,colors,print,signageetc.(Considerusing
thenewMealsonWheelsAmericalogoandcolors.)ii. Apresskitthatrepresentsthecoalitionasanextensivenetworkacross
theregioniii. Contactswithmediaoutletsusingthepresskit,askingforregional
coverageofthecoalitioniv. AdedicatedwebsitetopromoteallregionalHDMprograms(See
exampleatwww.callarideforseniors.org)tosupportersaswellasconsumers.
v. Sampleletterstouseincontactswithofficials,businesses,volunteers,etc.
vi. Amapforwho,bypositionortitle,tocontactineachlocalcommunityvii. Schedulemeetingswithallcountyandstateofficials,community
leaders,communityvolunteersandbusinessestotellthemaboutHDMandtheroleitplaysinthehealthofthecommunityandcontainmentofhealthcrisesandhealthcosts,aswellasthepotentialthreattotraditionalHDM.
E. FundingPlan1) Attendeesaretentativelywillingtodiscussthepossibilityofconsolidating
administrativeactivities,whichmayincludeappointingaFiduciaryAgentfromwithintheagenciesthataremembersofthecollaborative.
2) AttendeesdiscussedthepossiblebenefitofcollaborationwouldbetheabilitytocontractwithMCOsandandotherstogenerateadditionalrevenue
F. ReturnonInvestment/SocialReturnonInvestment
1) ReturnonInvestment(ROI)a. Efficienciesofscaleresultingfromconsolidatingadministrationand
managementofseveralHDMprovidersforcontracting,billing,reporting,etc.b. Efficienciesfromrealigningserviceareasandreferringclientsbetween
providerswithintheserviceareatoallowmoreflexibilitybasedoncapacityandgeographicreachofcollaboratingHDMprograms
c. Savingstoindividuals,insurancecompaniesandlocalhealthcaresystemsthroughearlyidentificationofclienthealthrisksthati. Preventsrecidivism/readmissionofrecentlydischargedindividuals,for
whichhealthcaresystemsnowarepenalizedundertheAffordableCareAct
ii. Preventsordelaysclientmorbidityandmortality,promptinghealthcaretreatmentatanearlierornon-emergencyandlessexpensivestage
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d. Leveragesrelationshipsinthecommunitytoprovideadditionalsocialservicesupportorinterventionthatpreventsmorbidityandmortality
e. IncreaseinunitratesthroughcollaborativeeffortsoflocalHDMprovidersandlocalofficialstoleveragepoliticalinfluenceatthestatelevel
f. IncreaseinfundingsourcesthroughagreementswithManagedCareOrganizations,healthcaresystemsandothers
g. PotentialforMedicaidreimbursementsforotherprogramservices,e.g.,caretransitions,adultdaycare,transportationtomedicalappointments
2) SocialReturnonInvestment(SROI)a. Strengthensthesocialsafetynetforconsumersbykeepingalocalprogramin
placethati. Providessocialinteractiontoisolatedclientsalmostdaily,whichhas
beendocumentedtoimprovementalhealthii. Insuresfrequentface-to-faceobservationandcomparisonofclient
statusovertimeiii. Notifiesfamilycaregivers,healthcareproviders,adultprotective
servicesorothersofconcernsiv. Hasdetailedknowledgeofthewholeperson,e.g.,secondaryhealthor
socialproblems,relationships,isolation,orchangeinstatusthatmaypromptorpreventdecompensationandmaybeunknowntofamilycaregivers,healthcareprovidersorpublicsafetyofficials
v. Canleveragerelationshipsinthecommunitytoprovideadditionalformalandinformalresourcesorinterventionwithat-riskclientswhoareunservedorunderservedbysocialservicesorhealthcaresystems
b. MakesHDMacomponentofbroaderpublichealthconsciousnessofthelocalcommunity,ratherthanisolatingitasacommercialenterprise
c. Educateslocalagencies,officials,businessesandindividualsaboutHDMandthevalueandimpactsaccruingtothecommunityfromlocalHDMproviders,comparedtocommercialproviders
EnvironmentalConsiderationsforExpandingtheClientBaseintheJeffersonManagedCareServiceArea
1. Forthepurposesofthisreport,thetermHomeDeliveredMeals(HDM)referstoallprogramsthat
delivermealstoadultsintheirhomes.HDMisthetermusedbythemajorfunderofmostoftheseprograms,thefederalOlderAmericansAct.MealsonWheelsoftenisusedinterchangeablywithHDM,butforthepurposesofthisreport,MOWisusedtorefertoMealsonWheelsTexas(MOWT),anassociationofHDMprovidersfromacrosstheStateofTexas,ortoorganizationsthataremembersofMOWT.MOWTistherecipientofagrantfromMealsonWheelsAmericaforthepurposeofdevelopingcoalitionsamongHDMproviders—notjustMOWTmembers.
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2. AttendeesatthefocusgroupinthislargelyruralareaparticipatedinaSWOTanalysis,whichprovidesimportantinsightsintotheenvironmentinwhichtheyhaveoperatedfordecades.TheSWOTanalysisisprovidedbelow.
3. ThemajorityofdirectorsofHDMprogramsinthisareahaveatleast10yearsofexperience,andmanyhave20ormoreyearsofexperiencemanagingandsustainingtheircurrentprograms.
4. ThesedirectorshavesignificantexperiencefundraisingandhabituallyovermatchtheOAAgrant,asdomostoftheHDMprogramsthroughoutTexas.AbriefpreparedbytheKronkoskyFoundationatAppendixCdescribestheMOWprogramintheBexarManagedCareServiceArea,yetisinstructiveaboutMOWprogramsmoregenerally,andisfittingasageneraldescriptionoftheJeffersonManagedCareServiceArea.
5. SeeAppendixBforamapoftheareasthatwillbethesitesofthepilotprojects.WhileSanAntonioandBeaumontaresizablemunicipalities,formuchoftheJeffersonandBexarManagedCareServiceAreas,themapshowslargegeographicalexpanseswithfewmajorhighwaysandalimitednumberoftownsorvillages,suggestingthedistancesthatHDMprovidersmayberequiredtodrivetoreachmanyruralclients.Geographyisakeychallengetoexpandingthenumberofclientsserved.
6. TheHDMprogramswereestablishednearly40yearsagowhenthefederalOlderAmericansAct(OAA)addedfundingfornutritionservicesforpeople60andolder.OAAfundingisawardedtostates,andinTexasthosefundsarepassedtoAreaAgenciesonAgingin28designatedregionsthatmanagemostofthefederalandstatefundingforpeople60andolder.Inadditiontonutritionalfunding,theOAAalsoprovidescasemanagement,informationandreferral,benefitscounseling,incomesupport,familycaregiversupport,andotherrelatedsocialservicesprograms.
7. TheOAArequiresproviderstoputupmatchingfunds,whichtheHDMprogramssolicitfromthestate,othergovernmentagencies,andcharitableandcivicorganizations,addingasmuchasmuchas40%-60%tothetotalprogramfunding.HDMtypicallyhavesubstantialvolunteersupport,therecruitmentandmanagementofwhichaddsfurtherin-kindcontributionsfromtheproviders.(SeeAppendixCformoredetailontheimpactofthenonprofitproviders.)
8. ConversationswithmembersofMealsonWheelsTexasindicatedthatMOWprovidershavedifficultyestimatinghowmanyeligibleparticipantsresideintheirareasandwhatpercentageofeligibleclientsarenotserved.Forthisreason,AppendicesHthroughLhavebeenincludedfortheconvenienceofHDMprovidersintheJeffersonManagedCareServiceAreasotheycanextrapolatethenumberofeligibleclientswhoare60andolder,andalsoconsiderthenumbersandcategoriesofnewclientsthatmightbeofferedtothembycontractswithaManagedCareOrganizations,whichprovidecommunity-basedservicestoMedicaid-eligibleadultsunderitsStar+PluscontractwiththeStateofTexas.
9. ContractingwithManagedCareOrganizationsorotherscouldexpandHDMs’traditionalclientbasefrompeople60andovertoanyone18andolderwhomeetsqualificationsforcommunity-basedservices.
10. Star+PlusisaMedicaidManagedCareprogramoftheTexasHealthandHumanServicesCommission(HHSC)foradultswhoarenotreceivingMedicare.Theterm"ManagedCare"meanstheStateofTexashiresmanagedcareorganizations(MCOs)tomanagerecipients’healthcare,includingcommunity-basedservices,suchasHDM,thatpreventadmissionorreadmissiontohospitalsandlongtermcarefacilities.ThoseeligibleforStar+Plusinclude:
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• IndividualswhodoNOThaveMedicarecoverageAND• IndividualswithIntellectualorDevelopmentalDisabilities(IDD),whoreceiveservicesinan
intermediatecarefacility,• IndividualswithanIntellectualDisabilityorRelatedConditions(ICD-IID),• OrIndividualswithoneormoreofthefollowingIDDWaivers:
o CommunityLivingAssistanceandSupportService(CLASS)o DeafBlindandMultipleDisabilities(DBMD)o HomeandCommunity-basedServices(HCS)o TexasHomeLiving(TxHmL)1
11. ThepilotprojectandthedatainthisreportwerepromptedbyrecentchangestothewaytheOlderAmericansActnutritionprogramhasoperatedforthepast40years.TheStateofTexashasbeenapproachedbycommercialprovidersclaimingthattheycanreachisolatedseniorsandmeetthegoaloftheStatetoassureHDMareprovidedtoallseniorsinTexas,regardlessoflocation.WhileHDMprovidershaveprovidedexceptionalservice,reachingallisolatedseniorsinthevast,openareasofTexashasalwaysbeenachallengefornonprofitHDM,duetolimitationsininfrastructureandfunding.
12. ThecommercialprovidershavecontactedstatelegislatorsandTexas’DepartmentofAgingandDisabilityServices(DADS)fortheirsupportinchangingtheTexasAdministrativeCode(TAC)toallowthemtocompetewithnonprofitHDMproviders.
13. Todate,thecommercialprovidershavemadeinroadsintwoareas:1)someAreaAgenciesonAginghavecontractedwithcommercialproviderstodelivermealstoseniorsforemergenciesand/orroutineneeds,and2)ManagedCareOrganizations,chargedbytheStateofTexasStar+Plusprogramtoprovidecommunity-basedservicestoMedicaidrecipients,havecontractedwithbothcommercialandnonprofitHDMproviderstoprovidenutritionservicestotheirclients.
14. TheMealsonWheelsAssociationofAmericahasidentifiedcommercialprovidersasathreattothetraditionalMealsonWheelsprovidersnationally.Asaresult,MOWAawardedMOWTa$10,000granttodeveloptwopilotprojectsinTexasbetweenNovember2015andAugust2016totestwhetherHDMproviderscancollaboratetocreateandoperationalizeabusinessplanthatwillmakethembetterabletomaximizetheirreachtoisolatedseniors,servingmoreseniorsinmorediverseways,tomeetthegoaloftheStatetoserveeveryeligiblesenior,wherevertheymaybe.
1 - For more detail see http://www.starplustx.com/#sthash.0bWe5nz0.dpuf For MCOs assigned to each county and contact information for those MCOs, see http://www.starplustx.com/Counties.) For more information on community-based services funded by Texas Department of Aging and Disability Services, go to http://www.dads.state.tx.us/providers/.)
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SWOTAnalysisSTRENGTHS
1. ThemajorityofHDMarepreparedfreshdaily,withoutadditives/preservatives2. HDMhasfirsthandknowledgeofclientsindetail,e.g.,daytodaycomparisonofphysicaland
cognitivefunction,preferences,supportsystems,families,socialhistory,levelofisolation,idiosyncrasiesthatcouldputthematrisk
3. HDMstaffhavetrustedface-to-facerelationshipswithclientswhomaynotrespondtopeopletheydon’tknow
4. HDMintegratesmanyotherserviceswithmealdelivery,e.g.,SeniorCompanions,AdultDayCare,SeniorCenters,CongregateMeals,SpecialEvents
5. HDMstaffrecognizebarrierstonutrition,particularlyforchilledorfrozenmeals,suchasa. Lackofelectricityb. Lackofrefrigerationc. Lackofcooking/heatingdevicesd. Lackofphysicalorcognitiveabilitytoreceive,store,orpreparemeals
6. HDMsupportsthemissionofAreaAgenciesonAgingbydailyobservingclientsmostatrisk7. HDMhasthecapacitytoprovideclienttrackingtoMCOs8. RecognitionofMOWand/orlocalHDMprovideragenciesasatrustedbrand9. HDMstaffandvolunteerspossess
a. Firsthandknowledgeoftheenvironmentandpeopleb. Decadesofexperiencebystaffc. Personalconnectionsatthelocallevelwith
i. Clientsii. Familycaregiversiii. Communitymembersiv. Governmentofficialsv. Businessesvi. Civicorganizationsvii. Religiousorganizationsviii. Educationalinstitutions
10. VolunteersoffsetexpensesoftraditionalHDMprograms11. HDMprogramsraisefundstomatchandsometimesexceedgovernmentnutritionfunding12. HDMprogramsreceivefinancialcontributionsfromlocalgovernmentsandagenciesto
supplementgovernmentnutritionfundingWEAKNESSES
1. Limitedfunding2. Lackofstaff3. Lackofvolunteers4. Lackoftime5. Relianceondeclininggovernmentfunding
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6. Overtaxedlocaldonors,especiallyinsmallercommunities,whichhavefewercharitableorcivicorganizationsorphilanthropists
7. ManagingthetransitiongapfromoldestoldagingoutofHDMordyingwhiletotryingtoengageBoomers.(ThismayresultinashorttermdipindemandservicesthatwillincreaseasBoomersbecomeolder.)
8. Needtoimprovemarketing9. Lackofmediaexposureinruralareas10. Needtoidentifyallpeoplewhoneedhelp11. HDMstaffagingout,i.e.,staffstaywithHDMprogramformanyyears,oftentillretirement;
limitedfundspreventhiringnewstaffforoverlapandtraining;substantialinstitutionalknowledgeislost
12. DADSpoliciesprevent(ormakedifficult)collaboration/clientsharing/gapcoverage.Example:individualassignedtooneserviceareathatcannotreachfarenoughtoassistcouldbeassistedbyHDMinanotherarea,butassignmentandfundingrulespreventassistance
13. SPURS/HarmonysystemisproblematicforbothHDMprovidersandAAAsOPPORTUNITIES
1. Requestsfromcommercialproviderstoprovideahigherrateformealdeliveryhasopenedadiscussionatstatelevelthatwasnotencouragedinthepast
2. RequestsfromcommercialproviderstochangeTexasAdministrativeCode(TAC)toallowthemmoreflexibilitymayproducemoreflexibilityfortraditionalHDMprograms
3. Thepilotprojectcanbeusedtomountawellintegrated,welldefinedmarketingcampaignthathelpsprovidersengagestakeholders,includingMCOs,consumers,otherhelpingagencies,officials,andbusinesses
THREATS1. RequestsfromcommercialproviderstochangeTexasAdministrativeCode(TAC)toallowthem
moreflexibilitycouldgivethemadvantagesincompetingwithHDMprograms2. Commercialcompetitorswithsubstantialfinancial,marketingandpoliticalresourcescould
poseathreattocontinuingtraditionalHDMprograms3. Thelongtermeffectofcompetitionfromcommercialproviderscouldbethat1)HDM
programscouldnotsustainthecompetition,and2)withthedemiseofHDMprogramscommercialproviderswouldraiserateswiththeeventualresultthat3)fewerclientswouldbeservedthanarecurrentlyserved,because4)theprogrambecomesmoreexpensive
4. Withdrop-shipservicesandmoreflexiblefunding,commercialproviderscanprovidemealssevendaysaweek
5. CommunicationgapswithManagedCareOrganizationsa. DelayedresponsefromMCOstoHDMs’inquiriesaboutclients,includingnotificationof
continuationinthehealthplanb. Delayedreimbursementofprovidersforservicesc. Non-reimbursementwhenservicesareprovidedafterclientdropshealthplanwithout
provider’sknowledge
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6. LackofknowledgebyMCOsreHDMs7. MCOstafflackknowledge/experiencedealingwithclientpopulation,connectingclientsto
resources,includingHDM8. Declineincharitablefunding9. Lackofempathyforagingpopulationsamongfunders10. Logistics
a. Ruralisolation—deliveryoftraditionalHDMtoonepersonatagreatdistancefromothersisnotcosteffective
b. ExtendedserviceareasbeyondabilityofHDMstafforvolunteerstodeliverc. Poorcountryroads—wearandtearonvehicles,poorsignage,addtocomplexityof
deliveryd. Poor9/11networkinruralareasinhibitscommunicatione. Poorinformationandreferralinruralareasf. Clientsmayhavelimitedcapacityforselfcare,e.g.,
i. followingstaffinstructionsii. recognizingwhomtheycantrustiii. havingutilityservice
g. Clientsatriskforhealthcrises,selfneglect,exploitation
FOLLOWUPItemsthatneedtobeaddressedinordertoformacollaboration,signacharter,andcreateandimplementthebusinessplan.FORMALIZEANAGREEMENT
1. ReviewthisreportofthemeetingonJanuary22,20162. Submitquestionsandcommentstothefacilitatorand/orElaineShellenberger,Executive
DirectorofNutritionforSeniorsandMore,whoseagencyreceivedthegrantforthisproject3. HDMprovidersintheJeffersonHealthServiceAreawhowishtoproceedwitharegional
collaborationshoulda. Reviewthedraftcharter(AppendixE),providecomments,recommendmodifications,
andadvisethefacilitatoriftheprovideriswillingtosignthecharterb. ReviewthedraftFiduciaryAgentAgreement(AppendixF),providecomments,
recommendmodifications,andadvisethefacilitatoriftheprovideriswillingtosignthecharter
c. IndicateavailabilityforparticipationonanAdvisoryCommitteethatwillcommunicatefrequentlytoimplementtheoperationalplan
d. Bepreparedtoattendafollowupmeetingtofinalizedetailsofthecollaborationandsignthecharter
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TODOLISTPREPARATORYTOTHENEXTMEETING1. ElaineShellenbergerwillforwardinformationtoattendeesaboutacquiringaMedicaid
numberforbilling.2. IndividualorganizationsshouldcompletetheOrganizationalAssessment(SeeAppendixG)and
submittothefacilitatoralongwiththefollowinginformation:a. Identifywhateachcollaboratorcancontributetothecollaborationb. Identifywhateachcollaboratorneedsfromothercollaboratorsc. Identifyareaswherecollaboratorsmayneedtocreateanewsystemorprocessto
makethebusinessplanwork3. ProviderswithanMCOcontractemailacopyofthecontracttothefacilitator,alongwith
contactinformationforMCOstaffpersonresponsibleforsettingupormanagingthecontract.4. Eachattendeesubmitoneormorestories,nottoexceed250words,thatillustratetheimpact
oftheHDMprogram5. EachattendeesubmitanyinformationaboutoperationsofMom’sMealsorothercommercial
providers,intheirareathatcanbedocumented,e.g.,a. AclientrequestingMom’sMealsinplaceoftraditionalHDMb. AclientbeingreassignedbyanMCOfromHDMtoMom’sMealsc. AnAreaAgencyonAgingthatisusingdropshipproviders
17
APPENDICES
APPENDIXA.Invitation/AgendaEmailedtoJeffersonManagedCareServiceAreaProviders........................18
APPENDIXB.BexarandJeffersonManagedCareServicesAreas,byCountiesandPlaces..............................19
APPENDIXC.KronkoskyFoundationResearchBrief:MealsonWheels.........................................................21
APPENDIXD.ProposedFlowChart,OperationandManagementoftheJeffersonManagedCareServiceArea
..........................................................................................................................................................................26
APPENDIXE.ProposedCommunityCoalitionCharter......................................................................................27
APPENDIXF.DraftAgreementbetweenFiduciaryAgentandCoalitionMembers..........................................30
APPENDIXG.OrganizationalCapacitySelfAssessment&CollaborativeSolutionsTool.................................32
APPENDIXH.DualEligibleMedicaidEnrollment,byCounty............................................................................42
APPENDIXI.Medicare-MedicaidRecipients,byCounty..................................................................................43
APPENDIXJ.Age,DisabilityandPovertyIndexbyCounty...............................................................................44
APPENDIXK.Area2014CensusPopulationCharacteristicsforAge60+,byCounty,withComparisontoState
ofTexas.............................................................................................................................................................50
APPENDIXL.SelectedEconomicCharacteristics_14_5YR_DPO3.xls...............................................................51
18
APPENDIXA.Invitation/AgendaEmailedtoJeffersonManagedCareServiceAreaProviders
MeetingAgendaFriday,January22,2016
10a.m.-2p.m.MealsonWheelsAssociationofTexas(MOWAT)
&HomeDeliveredMealsProvidersoftheDeepEastTexasArea
LOCATION:DeepEastTexasAreaAgencyonAging
210PremierDriveJasper,Texas75951
ExecutiveDirectorsofareaHomeDeliveredMeals(HDM)ProgramsareinvitedtoattendameetingwithrepresentativesofMealsonWheelsAssociationofTexas(MOWAT)onFriday,January22,2016,from10a.m.to2p.m.Lunchwillbeprovidedbythemeetinghost,DeepEastTexasAreaAgencyonAging.ThepurposeofthismeetingistodiscussbuildingacollaborationamongHDMproviderstoexpandandimproveHDMservices,withaspecialfocusonreachingunservedorunderservedareas.AllHDMproviders—notjustmembersofMOWAT,andnotjustrecipientsofstateorfederalfunding—arestronglyencouragedtoattend.WeareawarethatthereareHDMprogramsthataredoingimportantworkwithouttheseconnections,andwewouldliketoknowaboutyouandhowyoumightbepartofthisproject.SeveralHDMprovidersthatwerepreviouslyidentifiedreceivedsurveysfromMOWATinNovemberandDecemberaskingabouttheircapacity,theirconcerns,andtheirinterestincollaboratingtostrengthentheirorganizationsandexpandservices.Ifyouwanttoknowmoreaboutthesurvey,gotohttps://www.surveymonkey.com/r/attachmentDETCOGtoviewand/orcompletethesurvey.Thegoalsofthemeetingare:
1.DiscussMOWAT’spilotprojecttoassistHDMprogramsinDeepEastTexastocreateandtestanewcollaborativebusinessmodel.2.SharewhathasbeenlearnedfromtheMOWATsurveyabouttheStrengths/Weaknesses/Opportunities/ThreatsrelatedtotheareaHomeDeliveredMealsprograms.3.WiththeinputofHDMprovidersinattendance,fillininformationthatthesurveymaynothavecaptured.4.WiththeinputofHDMprovidersinattendance,outlineaplanabouthowHDMproviderscancollaboratetocreatearobustprogramthatexpandsmealservicestomoreconsumersandopensnewopportunitiestoprovidersthatwillstrengthentheiroperations.5.Draftatentativeagreementtocollaborateandpilotthedevelopmentandimplementationofanewbusinessplan.IfyouhavequestionsabouttheMOWATpilotproject,pleasefeelfreetocontactMarthaSpinks,Ph.D.,MSW,[email protected].
HollyAnderson,CIRS-ADirector,AreaAgencyonAgingDirector,211/AreaInformationCenter210PremierDriveJasper,Texas75951409-384-7614,409-384-5704,ext5258(office)409-384-6177(fax)
19
APPENDIXB.BexarandJeffersonManagedCareServicesAreas,byCountiesandPlaces
Note:SanAugustineandTrinityCountiesarenotnormallypartoftheJeffersonManagedCareServiceArea,buthavebeenaddedforthepurposesofthepilotprojectduetointerestfromthosecounties.UvaldeisnotnormallypartoftheBexarManagedCareServiceArea,butisbeingconsideredforadditiontothepilotproject.
20
Withthedesignationofplacesandmajorhighwaysineachcounty,thismapillustratestherelativeisolationofareasinTexas.SeebelowfortheCensusBureaudefinitionof“Places,”whicharerepresentedonthismap.GeographicTermsandConcepts-PlaceIncorporatedPlacesarethosereportedtotheCensusBureauaslegallyinexistenceasofJanuary1,2010,asreportedinthelatestBoundaryandAnnexationSurvey(BAS),underthelawsoftheirrespectivestates.Anincorporatedplaceisestablishedtoprovidegovernmentalfunctionsforaconcentrationofpeopleasopposedtoaminorcivildivision,whichgenerallyiscreatedtoprovideservicesoradministeranareawithoutregard,necessarily,topopulation.Placesalwaysarewithinasinglestateorequivalententity,butmayextendacrosscountyandcountysubdivisionboundaries.Anincorporatedplaceusuallyisacity,town,village,orborough,butcanhaveotherlegaldescriptions.
CensusDesignatedPlaces(CDPs)arethestatisticalcounterpartsofincorporatedplaces,andaredelineatedtoprovidedataforsettledconcentrationsofpopulationthatareidentifiablebynamebutarenotlegallyincorporatedunderthelawsofthestateinwhichtheyarelocated.Theboundariesusuallyaredefinedincooperationwithlocalortribalofficialsandgenerallyupdatedpriortoeachdecennialcensus.Theseboundaries,whichusuallycoincidewithvisiblefeaturesortheboundaryofanadjacentincorporatedplaceoranotherlegalentityboundary,havenolegalstatus,nordotheseplaceshaveofficialselectedtoservetraditionalmunicipalfunctions.CDPboundariesmaychangefromonedecennialcensustothenextwithchangesinthesettlementpattern;aCDPwiththesamenameasinanearliercensusdoesnotnecessarilyhavethesameboundary.CDPsmustbecontainedwithinasinglestateandmaynotextendintoanincorporatedplace.TherearenopopulationsizerequirementsforCDPs.(Retrievedfromhttps://www.census.gov/geo/reference/gtc/gtc_place.html,February22,2016)
27
APPENDIXE.ProposedCommunityCoalitionCharterArticleI–NameThenameofthisCoalition(“Coalition”)shallbe<insertname>.ArticleII–Mission&VisionThemissionofthe<coalitionname>is:Throughacollaborativeeffortamongregionalhomedeliveredmealsproviders,developacooperativebusinessplanthatclosesthegapsinareasnotcurrentlyserved,orthosethatareunderservedbyindividualprograms.Thecoalitionwillstrivetoincreasethenumberofeligibleadultsreceivingservicesby10%inthenext12months.ArticleIII–Purpose1. Tobuildandsustainacommunitycoalitionwithafocusonthedeliveryofnutritionservicesand
associatedsupporttovulnerableadults2. Toprovidemutualsupporttocoalitionmemberstoassuretheirprogramsaresustainableandresponsive
totheneedsofeligibleadultsintheirrespectivecommunities3. Todevelopandoperationalizeabusinessplanthanidentifiesopportunitiesforexpansion,improvement
andinnovationofnutritionprograms4. Tocollaborateandencourageeffortsoforganizationswithasharedpurposeofimprovingcare5. ToadvancecommunityengagementthatfurthersthemissionandvisionoftheCoalition.
ArticleIV–ParticipationSectionI–CollaborationParticipationinthe<coalitionname>isopentoorganizationsandindividualsinterestedinfosteringthevisionbyactivelyengagingintheplanningandworkoftheCoalition.Chartermembersshouldjoininacommitmentto:• Sharebestpracticesandknowledge• Mentorpartnersandproviders• Requestandprovideassistancewhereneeded• Sharedataandsupportanalyses• Promoteimplementationofevidence-basedinterventions
Participantcategoriesmayinclude:• Providersofhomedeliveredmeals• Providersofothernutritionalservicestovulnerableadults(e.g.,congregatemeals,foodbanks,
governmentcommoditiesprograms,etc.)• ManagedCareOrganizations
28
• HealthcareProvidersacrossthecontinuumofcare• ProviderAssociations• ConsumerAdvocacyOrganizations• GovernmentOrganizations(DepartmentofAgriculture,MunicipalOfficials,HealthDepartment,Area
AgencyonAging,etc.)• QualityImprovementOrganizations• EducationalandFundingOrganizations• Consumers
The<coalitionname>,hasreceiveda$10,000grantfromMealsonWheelsAmericatoconductapilotprojectdemonstratingtheabilityof<coalitionname>tocreatearegionalcollaborationthataccomplishesthepurposesdescribedherein.SectionII–CoalitionParticipantResponsibilitiesMeetingAttendance.CoalitionMembersagreetoattendinpersonorbyteleconferenceaminimumof70%ofscheduledmeetingseachyearwithnotmorethantwo(2)consecutiveunexcusedabsences.Committees.CoalitionMembersagreetoactivelyparticipateincommitteework,andareexpectedtovolunteertheirservicesforCoalitionprojects.ArticleV–CommitteesSection1.TheactivitiesoftheCoalitionwilltakeplacewithinitscommitteesandallActiveParticipantsareexpectedtoselectthecommitteeorcommitteesonwhichtheywishtoserveduringanygivenyear.Section2.ThestandingcommitteesoftheCoalitionare:
1. ManagementAdvisoryCommittee2. MarketingCommittee3. EducationandCommunicationCommittee4. TechnicalSupport
OtherTaskForcesmaybeformedonanadhocbasisasneeded.Section3.CommitteesarechairedbyActiveParticipants,chosenbytheCoalition.Section4.Thetermofserviceforthecommitteechairsshallbeoneyear.Section5.Nomembershallholdmorethanonecommitteechairmanshipatatime.ArticleVI–MeetingsSection1.AnnualMeetingThereshallbeanAnnualMeetingoftheCoalition,atwhichtimetheCoalitionwillreviewmembership,committeereports,developannualgoals,andconductotherbusinessasappropriate.
29
Section2.RegularMeetingsMeetingsoftheCoalitionshallbeheldatleastquarterly.Meetingsmaytakeplaceinpersonorremotely.ArticleVII–ProceduralPoliciesSection1.ConflictsNoonemayprofitfinanciallyfrommembershipintheCoalitionbysalesorsolicitationatmeetingsorworkshops.ParticipantswilldiscloseanyactualorpotentialconflictsofinteresttotheActiveMembers.Section2.DecisionMakingInthespiritofthe<coalitionname>vision,allCoalitionbusinessshallbeconductedbasedonthephilosophyofmutualrespect.Simplemajorityruleswillapply.CoalitionParticipantsareentitledtoonevotepermember.Section3.VotingVotingonthebusinessoftheCoalitionmaybeconductedbythoseinattendanceatthemeetingeitherinpersonorbyteleconference.Proxyvotingviaemailispermissible.CharterMembers.Signaturesbelowconfirmtheintentofthesigneetoparticipateinthe<coalitionname>inaccordancewiththeconditionsofthischarteragreement.SIGNATURE ORGANIZATION DATE
30
APPENDIXF.DraftAgreementbetweenFiduciaryAgentandCoalitionMembers
AgreementtoActasFiduciaryAgentonBehalfofaPrincipalof<nameofcoalition>
Thisdocumentisanagreementbetween________________________________(“FiduciaryAgent(FA)”)and_____________________________(“Principal”),amemberof<nameofcoalition>.TheFiduciaryAgentwillberesponsibleforthesolicitationandmanagementoffundingawardedtoPrincipalthroughthe<nameofcoalition>.TheFiduciaryAgentisrequiredtoactforthebenefitofthePrincipal,withthedutiesofgoodfaith,trust,confidence,reasonablecareanddiligence,loyalty,disclosure,accounting,andcandor.A. ThisdutyobligatestheFAtoactinthebestinterestofthePrincipal.Specificdutiesinclude:
1. AdministeringtheprojectasdirectedbytheManagementAdvisoryCommitteeof<nameofcoalition>andrespectivefunders,includingorganizationsawardinggrantsorcontractsto<nameofcoalition>.
2. Actingasthepointofcontactonbehalfof<nameofcoalition>forapplication,management,reportingandadministrationofcontractsandgrantsintendedtobenefitmembersofthecoalition.
3. Establishingandmaintainingaccountingsystemsandfinancialrecordstoaccuratelyaccountforinvoicing,reporting,andreimbursementfromorganizationscontractingwith<nameofcoalition>.
4. Monitoringthemanagementandoperationsoftheprojectarereviewedassessinginformationgatheredfromprogramandfinancialreports,routinecommitteemeetings,sitevisits,teleconferences,andothermeans.
5. Ensuringthatprojectobjectivesaremetandfundsarespentandaccountedforproperly.6. AssuringtheFAmanagementsystemsaresufficienttomeetprojectobjectives,complywithaward
termsandconditions,andaccountforfunds.
B. ThedutiesofthePrincipalinclude:1. FollowingthefinancialmanagementrequirementsimposedbytheFA,whomustcomplywiththe
requirementsthatcontractingorganizationsimposeontheFA.2. ProperaccountingandfinancialrecordkeepingandtimelyreportingtotheFAofbothperformanceand
financialdataandanyotherinformationpertinenttothemanagementoftheprojectandreimbursementforservicesrendered.
3. Accountingofreceiptsandexpenditures,cashmanagement,maintenanceofadequatefinancialrecords,andrefundingexpendituresdisallowedbyfundingorganizations.
C. SharedFAandPrincipalResponsibilities:
1. FAandPrincipalwillensurethattherequirements,limitations,andregulationspertinenttocontractsandgrantsareapplied.
2. Attentionshouldbedirectedtothemaintenanceofcurrentfinancialdata.3. ReviewingFinancialOperations
a. FAshouldbefamiliarwithPrincipal’sfinancialoperations,records,systems,andprocedures.b. PrincipalshouldbefamiliarwithFA’sfinancialoperations,records,systems,andprocedures.
31
4. RecordingFinancialActivitiesa. FAinvoicesandreceiptsshouldbesupportedbyreportformsdulyfiledbytheFA.Allfinancial
recordsmustvalidateinvoicesandreceiptsrelatedtotherespectivecontract(s).b. PrincipalexpendituresshouldbeevidencedbyreportformsdulyfiledbythePrincipal.All
financialrecordsmustvalidateexpendituresrelatedtotherespectivecontract(s).5. AuditRequirements-FAmustmeet,andmustensurethatPrincipalhasmet,thenecessaryaudit
requirements.6. ReportingIrregularities-FAandPrincipalshallpromptlynotifythecontractingorganizationofany
illegalactsorirregularitiesandofproposedandactualactions,ifany.Illegalactsandirregularitiesincludeconflictsofinterest,falsificationofrecordsorreports,andmisappropriationoffundsorotherassets.
7. DebarredandSuspendedOrganizations-FAandPrincipalmustnotcontractatanyleveltoanypartythatisdebarredorsuspendedfromparticipationinFederalassistanceprograms.
8. TheFAandPrincipalmusthavesufficientinsurance,bondorothercoveragetoprotecttheFA,thePrincipal,the<nameofcoalition>andcontractingorganizations.
7. MonitoringProjectPerformancea. TheFAandPrincipalhavefullresponsibilityfortheconductoftheprojectoractivitysupported
andfortheresultsachieved.b. TheFAandPrincipalmustmonitortheperformanceoftheprojectandcommunicateregularly
toassureadherencetoperformancegoals,timeschedulesorotherrequirementsasappropriatetotheprojectorthetermsoftheagreement.
8. ContractingOrganizationResponsibilities:a. TheContractingOrganizationroleisthatofapartner,wheretheContractingOrganization
reimbursesthe<nameofcoalition>tocarryouttheprojectactivities.b. Acontractingorganizationshouldlimitinvolvementbetweenitself,theFA,andPrincipalinthe
performanceofaprojecttotheminimumnecessarytoachieveprogramobjectivesandtoensureconformancewithrequirementsofthecontract.
c. TheFAistheprimarypointofcontactwiththeContractingOrganization,representingtheinterestsofPrincipalasindividualsandasacollaborativewhole,the<nameofcoalition>.
d. TheFAisresponsibleforsharingcommunicationsfromtheContractingAgencywiththePrincipal,anddeterminingwiththePrincipalwhatisinthebestinterestofthePrincipalandthe<nameofcoalition>.
ThesignaturesbelowconstituteanagreementbetweentheFiduciaryAgentandthePrincipaltotheenterintotherelationshipdefinedabove.Thisagreementcanbecancelledbyeitherpartywithtwoweeksnoticeinwriting.FiduciaryAgent Organization Date___________________________________________________________________________________________Principal Organization Date
32
APPENDIXG.OrganizationalCapacitySelfAssessment&CollaborativeSolutionsToolUsethisasaself-assessmenttooltodetermineyourorganization’sorganizationalcapacityandtoconsiderhowyouragencymaycontributetoorbenefitfromthecollaborativeeffortsofotherMealsonWheelsorHomeDeliveredMealsproviders.Circleeachelementthatmostcloselydescribesyourorganization.Thisinformationwillguideconversationsamongcollaboratorsonhowtostructurethecollaborationtofillgapsinservicestoclients,andhoworganizationsmightcollaboratetoaddressareasforimprovement.Pleasecompleteandreturntotheconsultantbyemailorpostalmail.
CapacityElements LEVELONE LEVELTWO LEVELTHREE LEVELFOUR
Notehereifyoucanassistorwouldliketohave
assistancefroma
collaboratorto
strengthenyour
agency’scapacitywithanelement.
1 StaffingLevels Somepositionswithinandperipheraltoorganization(e.g.,staff,volunteers,board,seniormanagement)areunfilled,inadequatelyfilled,orexperiencehighturnoverand/orpoorattendance
Criticalpositionswithinandperipheraltoorganizationarestaffed,thoughsomeinappropriately;attendanceproblemsarelimited;highturnoverissometimesachallenge
Criticalpositionswithinandperipheraltoorganizationareadequatelyandappropriatelystaffed;attendanceproblemsarerare;turnoverislimited
Allpositionswithinandperipheraltoorganizationareadequatelyandappropriatelystaffed;attendanceproblemsareextremelyrare;turnoverislimited;vacanciesfilledimmediately
2 Skills,Abilities,&CommitmentofVolunteers
Volunteersnotworkinguptotheirpotentialorill-equippedforworkwithorganization;maybeunreliableorhavelowcommitment
Manyvolunteersworkinguptotheirpotential;mostlyreliable,loyal,andcommittedtoorganization’ssuccess
Capablesetofindividualsthatbringrequiredskillstoorganization;culturallycompetent,reliable,loyal,andgenerallycommittedtoorganization’ssuccessandto
Extremelycapablesetofindividualsthatbringcomplementaryskillstoorganization;culturallycompetent,reliable,loyal,highlycommittedto
33
CapacityElements LEVELONE LEVELTWO LEVELTHREE LEVELFOUR
Notehereifyoucanassistorwouldliketohave
assistancefroma
collaboratorto
strengthenyour
agency’scapacitywithanelement.
“makingthingshappen”;workeasilywithmoststaff,butdonotgenerallyplaycoreroleswithoutstaffsupervision
organization’ssuccessandto“makingthingshappen”;oftengobeyondcallofduty;abletoworkeasilywithwiderangeofstaffandplaycoreroleswithoutspecialsupervision
3 Fundraising Generallyweakfundraisingskillsandlackofexpertise(eitherinternallyoraccessibleexternally)
Mainfundraisingneedscoveredbysomecombinationofinternalskillsandexpertise,andaccesstoexternalfundraisingassistance(if/whenneeded)
Fundraisingneedsadequatelycoveredbywell-developedinternalfundraisingskills;occasionalaccesstosomeexternalfundraisingexpertise(if/whenneeded)
Highlydevelopedinternalfundraisingskillsandexpertiseinallfundingsourcetypestocoverallneeds;accesstoexternalfundraisingexpertiseforadditionalextraordinaryneeds
4 BoardInvolvement&ParticipationinFundraising
Mostmembersdonotrecognizefundraisingasoneoftheboard'srolesandresponsibilities;nogoalsorplansforboard-
Membersacceptthattheboardhassomefundraisingresponsibilities,butsomeconcernsexistregardingabilityofboardtobesuccessfulinthisarea;board
Manymembersembracefundraisingasoneoftheboard'scorerolesandresponsibilities,andparticipatewithfundraisingendeavors;
Allmembersembracefundraisingasoneoftheboard'scorerolesandresponsibilities;realisticandappropriateboard
34
CapacityElements LEVELONE LEVELTWO LEVELTHREE LEVELFOUR
Notehereifyoucanassistorwouldliketohave
assistancefroma
collaboratorto
strengthenyour
agency’scapacitywithanelement.
drivenfundraisingactivitiesexist;membersdonotgenerallymakefinancialcontributionstoorganization
fundraisingactivitiesarelimited;somemembersmakeapersonallysignificantannualfinancialcontributiontoorganizationbasedontheirindividualmeans
realisticandappropriateboardfundraisinggoalsandplansexist;fundraisingactivitiesareunderway;mostmembersmakeapersonallysignificantannualfinancialcontributiontoorganizationbasedontheirindividualmeans
fundraisinggoalsandplansinplace;boardactivelyfundraisesandhasachievedmeasurableprogresstowardsgoals;allmembersmakeapersonallysignificantannualfinancialcontributiontoorganizationbasedontheirindividualmeans,andsomecontributemorefrequently
5 RevenueGeneration
Nointernalrevenue-generationactivities;conceptssuchascause-relatedmarketing,fee-for-services,andretailingareneitherexplorednorpursued
Someinternalrevenuegenerationactivities,howeverfinancialnetcontributionismarginal;revenuegenerationactivitiesmaydistractfromprogrammaticworkandoftentieupseniormanagementteam
Someproveninternalrevenuegenerationactivities:theseactivitiesprovidesubstantialadditionalfundsforprogramdelivery,butoccasionallydistractfromprogrammaticworkandrequire
Significantinternalrevenuegeneration;experiencedandskilledinareassuchascause-relatedmarketing,fee-for-services,andretailing;revenue-generatingactivitiessupport,butdon’tdistract
35
CapacityElements LEVELONE LEVELTWO LEVELTHREE LEVELFOUR
Notehereifyoucanassistorwouldliketohave
assistancefroma
collaboratorto
strengthenyour
agency’scapacitywithanelement.
extensiveseniormanagementattention
from,focusoncreatingsocialimpact
6 CommunicationsStrategy
Nocommunicationsplanorarticulatedcommunicationsstrategyinplace;keymessagesnotdefinedorarticulated;stakeholdersnotidentified;informationmessagesaboutorganizationareinconsistent
Nocommunicationsplanorarticulatedcommunicationsstrategyinplace,butkeymessagesdefinedandstakeholdersidentified;communicationstostakeholdersarefairlyinconsistent
Communicationsplanandstrategyinplace;keymessagesdefinedandstakeholdersidentified;communicationstostakeholdersaregenerallyconsistentandcoordinated
Communicationsplanandstrategyinplaceandupdatedonafrequentbasis;stakeholdersandtheirvaluesidentified,andcommunicationstoeachofthosestakeholderscustomized;communicationsalwayscarryaconsistentandpowerfulmessage
36
CapacityElements LEVELONE LEVELTWO LEVELTHREE LEVELFOUR
Notehereifyoucanassistorwouldliketohave
assistancefroma
collaboratorto
strengthenyour
agency’scapacitywithanelement.
7 Communications&Outreach
Nomarketingmaterials,oroutdatedmaterials;strictlyinternally-focusedandlittletonooutreachtostakeholders;anymaterialsthatexistareunprofessionalinpresentation
Loosecollectionofmaterialsusedformarketing;genericdocumentsandnotalwaysupdatedtoreflectcurrentprograms,activities,andoutcomes;materialshaveaminimaldegreeofprofessionalismorconsistentlookandfeel;afewkeymaterialsareprovidedinmultiplelanguagesasneeded
Packetofmarketingmaterialsusedonaconsistentbasis;informationcontainedinthematerialsisuptodateandreflectscurrentprograms,activities,andoutcomes;materialsreasonablyprofessionalinpresentationandalignedwithestablishedstandardsforfont,color,logoplacement,etc.;mostmaterialsareprovidedinmultiplelanguagesasneeded
Packetofmarketingmaterialsusedconsistentlyandeasilyupdatedonaregularbasis;materialsextremelyprofessionalinappearanceandappealtoavarietyofstakeholders;allmaterialsconsistentlyadheretoestablishedstandardsforfont,color,logoplacement,etc.;allmaterialsareprovidedinmultiplelanguagesasneeded
8 Telephone&Fax
Workingstatus,lackofsophistication,orlimitednumberoftelephoneandfaxfacilitiesareanimpedimenttoday-to-day
Adequatebasictelephoneandfaxfacilitiesaccessibletomoststaff;maybemoderatelyreliableoruser-friendly,ormaylackcertainfeaturesthatwouldincrease
Solidbasictelephoneandfaxfacilitiesaccessibletoentirestaff(inofficeandoutinthefield);catertoday-to-daycommunicationneedswith
Sophisticatedandreliabletelephoneandfaxfacilitiesaccessiblebyallstaff(inofficeandoutinthefield),includesaround-the-clock,individual
37
CapacityElements LEVELONE LEVELTWO LEVELTHREE LEVELFOUR
Notehereifyoucanassistorwouldliketohave
assistancefroma
collaboratorto
strengthenyour
agency’scapacitywithanelement.
effectivenessandefficiency
effectivenessandefficiency(e.g.,individualvoice-mail),ormaynotbeeasilyaccessibletosomestaff(e.g.,fieldstaff);mostfrequentusersreceivetrainingonphonesystemfeatures
essentiallynoproblems;includesadditionalfeaturescontributingtoincreasedeffectivenessandefficiency(e.g.,individual,remotelyaccessiblevoice-mail);moststaffreceivetrainingonphonesystemfeatures
voice-mail;supplementedbyadditionalfacilities(e.g.,pagers,cellphones)forselectedstaff;effectiveandessentialinincreasingstaffeffectivenessandefficiency;allstaffreceivetrainingonphonesystemfeatures
9 Computers,Applications,Network,&Email
Limited/nouseofcomputersorothertechnologyinday-to-dayactivityand/orlittleornousagebystaffofexistingITinfrastructure
Adequatelyequippedatcentrallevel;incomplete/limitedinfrastructureatlocationsasidefromcentraloffices;equipmentsharingmaybecommon;satisfactoryuseofITinfrastructurebystaff;periodictrainingprovidedtosomestaffmembers
Solidhardwareandsoftwareinfrastructurethatcontributestoincreasedefficiency;noorlimitedsharingofequipmentisnecessary;regularuseofITinfrastructurebystaff,thoughsomeaccessibilitychallengesforfront-lineprogramdeliverersmayexist;periodictraining
State-of-the-art,fullynetworkedcomputinghardwarewithcomprehensiverangeofup-to-datesoftwareapplications;greatlyenhancesefficiency;allstaffhaveindividualcomputeraccessande-mail;highusagelevelofITinfrastructurebystaff;regulartraining
38
CapacityElements LEVELONE LEVELTWO LEVELTHREE LEVELFOUR
Notehereifyoucanassistorwouldliketohave
assistancefroma
collaboratorto
strengthenyour
agency’scapacitywithanelement.
providedtoallstaffmembers
providedtoallstaffmembers
10
Website Noindividualwebsite
Basicwebsitecontaininggeneralinformation,butlittleinformationoncurrentdevelopments;sitemaintenanceisaburdenandperformedonlyoccasionally
Comprehensivewebsitecontainingbasicinformationonorganizationaswellasup-to-datelatestdevelopments;mostinformationisorganization-specific;easytomaintainandregularlymaintained
Sophisticated,comprehensive,andinteractivewebsite,regularlymaintainedandkeptuptodateonlatestareaandorganizationdevelopments;praisedforitsuser-friendlinessanddepthofinformation;includeslinkstorelatedorganizationsandusefulresourcesontopicaddressedbyorganization
39
CapacityElements LEVELONE LEVELTWO LEVELTHREE LEVELFOUR
Notehereifyoucanassistorwouldliketohave
assistancefroma
collaboratorto
strengthenyour
agency’scapacitywithanelement.
11
Databases/ManagementReportingSystems
Nosystemsfortrackingclients,staffvolunteers,programoutcomesandfinancialinformation
Electronicdatabasesandmanagementreportingsystemsexistinonlyfewareas;systemsperformonlybasicfeatures,areawkwardtouse,orareusedonlyoccasionallybystaff
Electronicdatabaseandmanagementreportingsystemsexistinmostareasfortrackingclients,staff,volunteers,programoutcomes,andfinancialinformation;commonlyusedandhelpincreaseinformationsharingandefficiency
Sophisticated,comprehensiveelectronicdatabaseandmanagementreportingsystemsexistfortrackingclients,staff,volunteers,programoutcomes,andfinancialinformation;widelyusedandessentialinincreasinginformationsharingandefficiency
12
Buildings&OfficeSpace
Inadequatephysicalinfrastructure,resultinginlossofeffectivenessandefficiency(e.g.,unfavorablelocationsforclientsandemployees,nopossibilityofconfidentialdiscussions,insufficientworkspaceforindividuals,no
Physicalinfrastructurecanbemadetoworkwellenoughtosuitorganization’smostimportantandimmediateneeds;anumberofimprovementscouldincreaseeffectivenessandefficiency
Fullyadequatephysicalinfrastructureforthecurrentneedsoftheorganization;infrastructuredoesnotimpedeeffectivenessandefficiency;decorpartiallyreflectsculturaltraditionsofconstituents
Physicalinfrastructurewell-tailoredtoorganization’scurrentandanticipatedfutureneeds;well-designedtoenhanceorganization’seffectivenessandefficiency;favorablelocationsforclientsandemployees;plentifulspace
40
CapacityElements LEVELONE LEVELTWO LEVELTHREE LEVELFOUR
Notehereifyoucanassistorwouldliketohave
assistancefroma
collaboratorto
strengthenyour
agency’scapacitywithanelement.
spaceforteamwork)
encouragesteamwork;layoutincreasescriticalinteractionsamongstaff;decorclearlyreflectsandaffirmsculturaltraditionsofconstituents
13
ManagementofLegal&LiabilityMatters
Legalissuesnotanticipated;issuesaddressedindividuallywhentheyarise;propertyinsuranceincludessomeliabilitycoverage
Legalsupportresourcesidentified,readilyavailable,andemployedon"asneeded"basis;majorliabilityexposuresmanagedandinsured(includingpropertyliabilityandworkerscompensation)
Legalsupportregularlyavailableandconsultedinplanning;routinelegalriskmanagementandoccasionalreviewofinsurance
Well-developed,effective,andefficientinternallegalinfrastructureforday-to-daylegalwork;additionalaccesstogeneralandspecializedexternalexpertisetocoverpeaksandextraordinarycases;continuouslegalriskmanagementandregularadjustmentofinsurance
41
CapacityElements LEVELONE LEVELTWO LEVELTHREE LEVELFOUR
Notehereifyoucanassistorwouldliketohave
assistancefroma
collaboratorto
strengthenyour
agency’scapacitywithanelement.
Comments:
Note:ThisassessmentisadaptedfromtheMargueriteCaseyFoundationOrganizationalCapacityAssessmentTool,self-assessmentinstrumentthathelpsnonprofitsidentifycapacitystrengthsandchallengesandestablishcapacitybuildinggoals.Retrievedfromhttp://caseygrants.org/resources/org-capacity-assessment/,February24,2016.
42
APPENDIXH.DualEligibleMedicaidEnrollment,byCounty
FinalCount-MedicaidEnrollmentbyCounty-October2013
Total
Enrollment
TotalEnrollment
inChildren'sMedicaid
TotalChildrenUnderAge19
Enrolledin
Medicaid
Aged
Disa
bled
&Blind
TAN
FAd
ults
TAN
FCh
ildren
FosterC
are
Children
Pregnan
tWom
en
New
borns
Children
Age1-5
Med
icallyNeedy
Chambers 3,216 2,326 2,430 170 470 114 354 30 136 215 733 -
Hardin 6,194 3,939 4,189 459 1,219 265 736 43 312 403 1,089 -Jasper 5,855 3,701 3,983 475 1,223 250 769 38 206 341 1,057 -
Jefferson 40,933 26,501 28,720 2,508 8,698 1,651 4,918 280 1,574 2,259 7,778 1Liberty 11,827 8,195 8,562 617 1,959 586 1,662 148 469 689 2,249 1Newton 2,187 1,279 1,384 190 539 104 294 6 73 91 296 2Orange 11,862 7,588 8,130 558 2,515 690 1,785 128 511 692 2,053 -
Polk 7,415 4,524 4,865 600 1,610 412 1,055 90 269 371 1,161 -San
Augustine 1,642 952 1,008 228 356 58 217 17 48 67 244 -San
Jacinto 4,147 2,692 2,832 250 810 250 653 39 145 209 623 -Trinity 2,263 1,342 1,451 210 524 103 272 22 84 88 354 -Tyler 2,838 1,747 1,856 246 607 115 308 66 123 165 461 -
Walker 6,122 4,195 4,468 345 1,098 227 654 118 256 344 1,259 1DataSource:TexasHealthandHumanServicesCommission.MonthlyMedicaidEligiblesFileExtractandTexasMedicaidHistorical(8-Month)EnrollmentFile.TablePreparedby:ResearchandEvaluationDepartment,StrategicDecisionSupport,TexasHealthandHumanServicesCommission.(Retrievedfrom:http://www.hhsE.state.tx.us/research/MedicaidEnrollment/ME/201212.html)
43
APPENDIXI.Medicare-MedicaidRecipients,byCountyCounty-LevelDualStatusCodes,March2015Medicare-MedicaidEnrolleeStateandCountyEnrollmentSnapshots,UpdatedQuarterly(March2015)
CountyofBeneficiary
Qua
lifiedMed
icare
Bene
ficiarie
s(QMB)-only
QMBplusFull
Med
icaidBe
nefits
Specified
Low
-incomeMed
icare
Bene
ficiarie
s(SLM
B)-only
SLMBplusFull
Med
icaidBe
nefits
Qua
lifying
Individu
als(QI)
OtherDua
lFull
Med
icaidBe
nefit
Qua
lifiedDisabled
an
dWorking
Individu
als(QDW
I)
Total
CHAMBERS 89 161 59 14 35 53 0 411
HARDIN 276 470 206 48 115 182 0 1297
JASPER 295 519 204 37 116 120 0 1291
JEFFERSON 1864 4083 1025 252 481 868 0 8573
LIBERTY 618 917 343 38 191 161 0 2268
NEWTON 128 276 69 20 40 60 0 593
ORANGE 545 851 348 73 171 249 0 2237
POLK 417 697 257 52 147 153 0 1723 SANAUGUSTINE 87 210 40 14 31 38 0 420
SANJACINTO 165 298 98 * 50 43 0 654
TRINITY 140 274 122 19 43 53 0 651
TYLER 174 285 92 21 66 77 0 715
WALKER 268 496 190 20 73 88 0 1135
(Retrievedfromhttps://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Analytics.html,February27,2016.)
44
APPENDIXJ.Age,DisabilityandPovertyIndexbyCounty
ChambersCounty HardinCounty JeffersonCounty JasperCountyJEFFERSON
MANAGEDCARESERVICEAREA
Estimate MarginofError
Estimate MarginofError
Estimate MarginofError
Estimate MarginofError
Total: 36,155 +/-171 54,652 +/-251 34,797 +/-182 236,106 +/-1,256
Under18years: 10,089 +/-145 13,842 +/-93 8,815 +/-121 59,029 +/-273
Withadisability: 571 +/-226 770 +/-253 602 +/-223 2,648 +/-443
Incomeinthepast12-monthsbelowpovertylevel
200 +/-185 214 +/-160238 +/-147 952 +/-219
Incomeinthepast12-monthsatorabovepovertylevel
371 +/-189 556 +/-193364 +/-150 1,696 +/-400
Nodisability: 9,518 +/-279 13,072 +/-260 8,213 +/-253 56,381 +/-492
Incomeinthepast12-monthsbelowpovertylevel
889 +/-401 2,058 +/-4382,063 +/-503 18,231 +/-1,122
Incomeinthepast12-monthsatorabovepovertylevel
8,629 +/-504 11,014 +/-5256,150 +/-560 38,150 +/-1,048
18to64years: 22,461 +/-171 33,166 +/-125 20,089 +/-169 145,535 +/-1,174
Withadisability: 2,838 +/-483 4,786 +/-501 3,695 +/-426 17,820 +/-930
Incomeinthepast12-monthsbelowpovertylevel
622 +/-193 976 +/-201780 +/-194 5,104 +/-504
Incomeinthepast12-monthsatorabovepovertylevel
2,216 +/-449 3,810 +/-4692,915 +/-398 12,716 +/-783
Nodisability: 19,623 +/-498 28,380 +/-489 16,394 +/-454 127,715 +/-1,520
Incomeinthepast12-monthsbelowpovertylevel
1,778 +/-317 2,671 +/-3982,518 +/-615 22,062 +/-1,418
Incomeinthepast12-monthsatorabovepovertylevel
17,845 +/-594 25,709 +/-61113,876 +/-675 105,653 +/-1,623
65yearsandover: 3,605 +/-123 7,644 +/-177 5,893 +/-144 31,542 +/-279
45
ChambersCounty HardinCounty JeffersonCounty JasperCountyJEFFERSON
MANAGEDCARESERVICEAREA
Estimate MarginofError
Estimate MarginofError
Estimate MarginofError
Estimate MarginofError
Withadisability: 1,639 +/-170 3,179 +/-315 3,310 +/-308 14,541 +/-534
Incomeinthepast12-monthsbelowpovertylevel
216 +/-115 328 +/-151493 +/-144 2,223 +/-300
Incomeinthepast12-monthsatorabovepovertylevel
1,423 +/-189 2,851 +/-3132,817 +/-317 12,318 +/-569
Nodisability: 1,966 +/-174 4,465 +/-313 2,583 +/-298 17,001 +/-571
Incomeinthepast12-monthsbelowpovertylevel
242 +/-133 369 +/-146121 +/-60 1,756 +/-317
Incomeinthepast12-monthsatorabovepovertylevel
1,724 +/-198 4,096 +/-3142,462 +/-301 15,245 +/-531
JEFFERSONMANAGEDCARESERVICEAREA
LibertyCounty NewtonCounty OrangeCounty PolkCounty
Estimate MarginofError
Estimate MarginofError
Estimate MarginofError
Estimate MarginofError
Total: 70,612 +/-595 13,956 +/-184 81,682 +/-297 41,370 +/-875
Under18years: 19,096 +/-98 3,192 +/-35 20,128 +/-174 9,168 +/-122
Withadisability: 822 +/-231 228 +/-168 1,355 +/-319 753 +/-219
Incomeinthepast12-monthsbelowpovertylevel
226 +/-140 36 +/-35 435 +/-197 247 +/-164
Incomeinthepast12-monthsatorabovepovertylevel
596 +/-182 192 +/-163 920 +/-268 506 +/-160
Nodisability: 18,274 +/-263 2,964 +/-178 18,773 +/-365 8,415 +/-263
Incomeinthepast12-monthsbelowpovertylevel
4,135 +/-651 674 +/-266 3,297 +/-515 2,203 +/-363
Incomeinthepast12-monthsatorabovepovertylevel
14,139 +/-681 2,290 +/-297 15,476 +/-595 6,212 +/-438
46
JEFFERSONMANAGEDCARESERVICEAREA
LibertyCounty NewtonCounty OrangeCounty PolkCounty
Estimate MarginofError
Estimate MarginofError
Estimate MarginofError
Estimate MarginofError
18to64years: 42,567 +/-589 8,335 +/-189 49,958 +/-251 23,630 +/-855
Withadisability: 7,325 +/-600 1,429 +/-268 8,046 +/-701 5,294 +/-461
Incomeinthepast12-monthsbelowpovertylevel
2,150 +/-410 319 +/-138 2,439 +/-429 1,540 +/-356
Incomeinthepast12-monthsatorabovepovertylevel
5,175 +/-503 1,110 +/-224 5,607 +/-536 3,754 +/-391
Nodisability: 35,242 +/-702 6,906 +/-307 41,912 +/-708 18,336 +/-858
Incomeinthepast12-monthsbelowpovertylevel
5,514 +/-821 884 +/-212 4,892 +/-542 2,745 +/-492
Incomeinthepast12-monthsatorabovepovertylevel
29,728 +/-980 6,022 +/-389 37,020 +/-862 15,591 +/-929
65yearsandover: 8,949 +/-193 2,429 +/-55 11,596 +/-167 8,572 +/-175
Withadisability: 4,681 +/-319 1,238 +/-172 5,059 +/-278 4,258 +/-324
Incomeinthepast12-monthsbelowpovertylevel
464 +/-126 98 +/-50 548 +/-147 401 +/-133
Incomeinthepast12-monthsatorabovepovertylevel
4,217 +/-352 1,140 +/-168 4,511 +/-269 3,857 +/-315
Nodisability: 4,268 +/-296 1,191 +/-153 6,537 +/-265 4,314 +/-335
Incomeinthepast12-monthsbelowpovertylevel
445 +/-136 68 +/-49 443 +/-133 312 +/-96
Incomeinthepast12-monthsatorabovepovertylevel
3,823 +/-297 1,123 +/-152 6,094 +/-305 4,002 +/-334
JEFFERSONMANAGEDCARESERVICEAREA
SanAugustineCounty
SanJacintoCounty
TrinityCounty TylerCounty
Estimate MarginofError
Estimate MarginofError
Estimate MarginofError
Estimate MarginofError
Total: 8,554 +/-122 26,659 +/-120 14,330 +/-86 19,040 +/-462
47
JEFFERSONMANAGEDCARESERVICEAREA
SanAugustineCounty
SanJacintoCounty
TrinityCounty TylerCounty
Estimate MarginofError
Estimate MarginofError
Estimate MarginofError
Estimate MarginofError
Under18years: 1,732 +/-74 6,215 +/-36 2,874 +/-122 4,024 +/-148
Withadisability: 89 +/-47 467 +/-177 112 +/-84 400 +/-112
Incomeinthepast12-monthsbelowpovertylevel
32 +/-41 259 +/-142 71 +/-63 197 +/-114
Incomeinthepast12-monthsatorabovepovertylevel
57 +/-46 208 +/-120 41 +/-45 203 +/-75
Nodisability: 1,643 +/-74 5,748 +/-179 2,762 +/-135 3,624 +/-189
Incomeinthepast12-monthsbelowpovertylevel
636 +/-283 1,433 +/-355 659 +/-230 765 +/-208
Incomeinthepast12-monthsatorabovepovertylevel
1,007 +/-271 4,315 +/-398 2,103 +/-267 2,859 +/-289
18to64years: 4,847 +/-98 15,588 +/-137 7,848 +/-183 10,818 +/-421
Withadisability: 1,258 +/-308 2,351 +/-409 1,975 +/-319 2,090 +/-266
Incomeinthepast12-monthsbelowpovertylevel
493 +/-205 841 +/-239 409 +/-159 731 +/-211
Incomeinthepast12-monthsatorabovepovertylevel
765 +/-214 1,510 +/-368 1,566 +/-309 1,359 +/-219
Nodisability: 3,589 +/-318 13,237 +/-399 5,873 +/-380 8,728 +/-441
Incomeinthepast12-monthsbelowpovertylevel
531 +/-201 2,295 +/-489 771 +/-252 862 +/-235
Incomeinthepast12-monthsatorabovepovertylevel
3,058 +/-306 10,942 +/-603 5,102 +/-448 7,866 +/-446
65yearsandover: 1,975 +/-95 4,856 +/-131 3,608 +/-144 4,198 +/-97
Withadisability: 924 +/-164 2,086 +/-223 1,507 +/-194 1,943 +/-241
Incomeinthepast12-monthsbelowpovertylevel
169 +/-69 328 +/-153 198 +/-89 290 +/-94
48
JEFFERSONMANAGEDCARESERVICEAREA
SanAugustineCounty
SanJacintoCounty
TrinityCounty TylerCounty
Estimate MarginofError
Estimate MarginofError
Estimate MarginofError
Estimate MarginofError
Incomeinthepast12-monthsatorabovepovertylevel
755 +/-172 1,758 +/-267 1,309 +/-196 1,653 +/-221
Nodisability: 1,051 +/-159 2,770 +/-255 2,101 +/-210 2,255 +/-245
Incomeinthepast12-monthsbelowpovertylevel
170 +/-83 220 +/-96 191 +/-103 172 +/-76
Incomeinthepast12-monthsatorabovepovertylevel
881 +/-168 2,550 +/-250 1,910 +/-203 2,083 +/-244
JEFFERSONMANAGEDCARESERVICEAREAWalkerCounty
Estimate MarginofError
Total: 47,998 +/-1,577
Under18years: 10,707 +/-151
Withadisability: 458 +/-200
Incomeinthepast12-monthsbelowpovertylevel 223 +/-134
Incomeinthepast12-monthsatorabovepovertylevel 235 +/-145
Nodisability: 10,249 +/-245
Incomeinthepast12-monthsbelowpovertylevel 3,005 +/-550
Incomeinthepast12-monthsatorabovepovertylevel 7,244 +/-631
18to64years: 30,496 +/-1,559
Withadisability: 2,648 +/-392
Incomeinthepast12-monthsbelowpovertylevel 930 +/-246
Incomeinthepast12-monthsatorabovepovertylevel 1,718 +/-331
Nodisability: 27,848 +/-1,533
49
JEFFERSONMANAGEDCARESERVICEAREAWalkerCounty
Estimate MarginofError
Incomeinthepast12-monthsbelowpovertylevel 7,403 +/-719
Incomeinthepast12-monthsatorabovepovertylevel 20,445 +/-1,239
65yearsandover: 6,795 +/-234
Withadisability: 2,001 +/-256
Incomeinthepast12-monthsbelowpovertylevel 164 +/-87
Incomeinthepast12-monthsatorabovepovertylevel 1,837 +/-248
Nodisability: 4,794 +/-279
Incomeinthepast12-monthsbelowpovertylevel 461 +/-186
Incomeinthepast12-monthsatorabovepovertylevel 4,333 +/-290
50
APPENDIXK.Area2014CensusPopulationCharacteristicsforAge60+,byCounty,withComparisontoStateofTexas
ExhibitFollowsonNextPages,K.1-K.25StateofTexas………………………………………………………………………………………………………………………………….K.1HardinCounty………………………………………………………………………………………………………………………….........K.4JasperCounty…………………………………………………………………………………………………………………………..….....K.7JeffersonCounty…………………………………………………………………………………………………………………………....K.10LibertyCounty………………………………………………………………………………………………………………………………...K.13OrangeCounty………………………………………………………………………………………………………………………………..K.16PolkCounty…………………………………………………………………………………………………………………………………….K.19SanJacintoCounty…………………………………………………………………………………………………………………….…...K.22WalkerCounty………………………………………………………………………………………………………………………………..K.25
51
APPENDIXL.SelectedEconomicCharacteristics_14_5YR_DPO3.xlsNote:Duetolimitedpopulationsize,identicalCensusBureaudatafor2014CensusPopulationCharacteristicsAge60+isnotavailableforthefollowingcounties:Chambers,Newton,SanAugustine,Trinity,andTyler.Similar,butnotidentical,dataforthosecountiesareavailableintheseries.Forconsistency,all12countiesplusthestateofTexasareincludedinthefollowingseries.
ExhibitFollowsonNextPages,L.1-L.14StateofTexas…………………………………………………………………………………………………………………………….L.1ChambersCounty……………………………………………………………………………………………………………………….L.2HardinCounty………………………………………………………………………………………………………………..…………..L.3JasperCounty……………………………………………………………………………………….........................................L.4JeffersonCounty……………………………………………………………………………………………………………….………..L.5LibertyCounty………………………………………………………………………………………………………………….…………L.6NewtonCounty……………………………………………………………………………………………………………………..……L.7OrangeCounty……………………………………………………………………………………………………………………….…..L.8PolkCounty………………………………………………………………………………………………………………………………...L.9SanAugustine…………………………………………………………………………………………………………………………...L.10SanJacintoCounty………………………………………………………………………………………………………………….…L.11Trinity……………………………………………………………………………………………………………………………………..…L.12Tyler…………………………………………………………………………………………………………………………………..……..L.13WalkerCounty…………………………………………………………………………………………………………………………..L.14…