[Editor's Note: This is part 3 and the final article of a multi-article series about the Grant County Commission work session on Oct. 25, 2022.]

By Mary Alice Murphy

The final discussion at the Grant County Commission work session on Oct. 25, 2022 addressed the potential of the county funding a Health and Human Services Department, as requested by District 3 Commissioner Alicia Edwards.

"I asked in September for an ordinance to create and fund a county Health and Human Services Department," Edwards said. "I'm sharing information I gathered in response to questions. I've been calling it the Health and Human Services Department, but Jamie in Dona Ana County says not to call it that, because it makes it look like it is too closely connected to the state department with that name. I don't know what we'll call it, but it won't be the HHS. Dona Ana is one example of a county with a similar department and Rio Arriba County is a better comparison for us. They had the highest heroin addiction rate in the nation. They created a health and human services department, which currently has 25 people doing a lot of interesting things. It is a direct services department, but I don't think we should do direct services. But their department can be a model for us. We can augment what we do using the services of partners. We allocated ARPA (American Rescue Plan Act) funding to Incite to help us create a network to determine our priorities. We will hear from them in November on the funding process."

She said the county can use its Indigent Fund, ARPA funding and the opioid settlement funding to begin to build the department. "We currently have $700,000 unencumbered funds in the Indigent Fund."

District 5 Commissioner Harry Browne asked how much of those funds is annually received.

Financial Officer Linda Vasquez said in the last fiscal year, the county received about $800,000 into the fund. "We also use about $400,000 of that to put into the state Safety Net Care Pool."

Edwards said: "And we get about 50 percent of the Safety Net Care Pool funding back."

Vasquez said about an 1/8 percent increment is also allocated to the General Fund to pay for the Detention Center indigent care.

Edwards said what the county is getting from that isn't enough to pay for the contracts to provide medical services at the Detention Center. "We can't use the indigent fund because of co-mingling the money."

Vasquez confirmed that and said it would have to be accounted for in a different fund.

Edwards said about 8 percent of the funding, about $65,000 would have to be put toward administrative services.

County Manager Charlene Webb said it would require different rates for different portions of the department. "It's 8 percent of the total $800,000."

Edwards said $300,000 is already allocated - $100,000 to Incite and $200,000 to the actual staffing, with $148,000 left of the $200,000.
"I talked to Ben (Young, county attorney of Mynatt, Martinez and Springer PC) and he is confident that will be most of the opioid settlement for reduction of opioid use. I was advocating for creating a department. I estimate about $75,000 for the department director, with 48 percent additional for benefits and PERA. That's $36,000, with $31,000 for an administrative assistant. So, $156,880 for salary costs and $17,120 for travel and supplies. That's an annual $174,000 in expenses for two staff people. I'm thinking we have enough for two years, with the $148,000 left in ARPA and the 8 percent. We need to come up with $200,000 for a two-year start. I'm thinking two years with the ARPA and the indigent fund to get it started. Rio Arriba County has a GRT increment, the indigent fund and seven-10 large grants a year for 25 people. That will be part of what Incite will report. She was clear that there is a lot of funding out that that is available around substance abuse and mental health. She thinks a department head and an administrative assistant will be critical."

Browne asked the population of Rio Arriba and Webb said it was about 38,000. Browne then asked why such a county department should not provide direct services.

"I think in the next 1-3 years, it will take all we have to get it started," Edwards said. "Maybe later, we can do direct services. I personally think we need to get it off the ground and get it going. Rio Arriba has a managed pathways program, which is outcome-based, similar to what HMS (Hidalgo Medical Services) is doing, and what is being talked about, too, at the hospital. We can consider services or do we want to grow HMS and Gila Regional Medical Center? When Cassandra Hartley was working here, she got value out of already existing services."

District 1 Commissioner and Chair Chris Ponce said the county's job is supporting, HMS, Tu Casa and the hospital. "I don't want to repeat or duplicate what these organizations and the Grant County Community Health Council are doing. We have so many different programs doing the same things, and we get nowhere. We need to know what every organization and facility does."

Edwards said the county had a job description for the department direction position and Hartley had input into the description. "I want to mention that the program is similar to what we're doing now. Rio Arriba has a health council as a partner on community issues. The Rio Arriba County health council serves as an advisory group to the Commission. Another thing Rio Arriba has is senior services and adult day care. They have a six-member Americorps group. They can serve as a model for what we can do."

Browne noted that Americorps participants have to take a year to three years off from their studies, so "it's hard to create stability."

"I have a sense of urgency around this," Edwards said. "When Sheriff (Frank) Gomez gave his report, he said they had a drug bust that netted 1,900 fentanyl pills. A lot of scary things are happening around fentanyl. Two milligrams of fentanyl, depending on body size and drug use, is fatal. That many pills are enough to cause 95,000 fatalities. That's one-third more than the entire population of the four-county area. Fentanyl is causing problems in the Detention Center, for law enforcement. I want the county to take the lead in combating this."

She said she could think of a ton of measurable things a coordinator could do, including helping roll out the 988 toll-free number for mental health crises. "We need measurable data on mental health crises. To reduce recidivism, there are incredible opportunities to look at people who are clean and sober for a time. Fentanyl is an issue in Grant County. I'm working with Cassandra, and I think there are loads of ways to measure. Cassandra was way down the road to coordinating all the organizations on the 988 response and determining what services are already being done. We have a lot of organization in the community doing services. If someone calls 988, they are identified by the area code. If you have 575, they will send you to a call center in New Mexico, which will help you coordinate services."

She talked about the Open Beds program, which is software that can look at the number and connect someone to an empty bed where they can receive treatment. "There are 77 organizations in Grant County that provide services. That is a huge number to coordinate."

District 4 Commissioner Billy Billings said: "If we have 77 organizations, we as a county don't need to provide direct services."

Ponce said he would like to sit down with all the organizations. "I don't want the county to provide services that are already being done. I don't want to spend public funding on doing things others already are doing."

Edwards said: "We definitely don't want to duplicate services, but we need to coordinate everyone. At no point was there any thought of the county doing direct services."

Ponce said the county manager should supervise the employee with a job description. Edwards said she thinks the job description is already there.

Browne asked if the commissioners agree that coordination is a county service.

"I see a lot of chances for the county to duplicate services," Billings said. "I thought the Grant County Community Health Council did coordination. HMS is doing coordination."

"I think there are cross-purposes of the definition of coordination," Edwards said. "We do have a number of organizations already duplicating services. I think there is not enough communication between organizations. My observation is that we do not have a coordinated response to mental health or substance abuse. We have Stepping Up and the RISE program. Stepping up is a continuum where they can intercept problems. The weakest link is providing a wrap-around to getting all services coordinated, including housing, food and basic needs. We don't have the continuum to make sure no one falls through the cracks. We will provide the structure."

Browne agreed that "none of us wants to duplicate services; none of use wants the organizations to duplicate services. Maybe what we need is more months of learning. There are going to be areas where there aren't services, and I might then be open to providing direct services. I nominate the word wellness to be part of the department title."

Ponce said he would like to see something in front of him to read.

"I've seen a draft of what Incite will provide," Edwards said. "It will be a visual. We have lost over the past number of years, people who have previously successfully coordinated efforts. The state defunded health councils in 2017. One of the underlying issues is the need for stability. The county is stable. We lost people, too, such as Mary Stoecker, Michele Giese. We lost with them who had a lot of care coordination and case management skills. The key is to keep people who need help from falling through the cracks."

Ponce said he thought the discussion should be part of their retreat or a work session.

Billings, District 2 Commissioner Javier "Harvey" Salas, Edwards and Browne had no commissioner reports. Ponce said Incite would present to the commissioner for 2 ½ hours in November. "I would like another work session for this and other issues, for a whole 8-hour day."

Edwards noted the election canvass was set for Nov. 14. "Since we're already here, we could spend the whole day on these topics."

Ponce asked if the sheriff had applied for a grant he had talked about. Webb said she would follow up.

Ponce also reminded people that with Halloween coming up, it would be busy for law enforcement. "I hope people look at the trunk or treats being held to make Halloween as safe as they can."

The commissioners went into executive session.

To read the previous articles, please visit https://www.grantcountybeat.com/news/news-articles/75329-grant-county-commission-work-session-102522-part-1 ; and https://www.grantcountybeat.com/news/news-articles/75344-grant-county-commission-work-session-102522-part-2 .