Commonwealth of Virginia

1. Commonwealth of Virginia Health and Human Resources (HHR) Briefing January 28, 2015 Confidential: The contents of this document are internal pre-decisional records of Commonwealth of Virginia and individuals receiving and reviewing this document must not provide this information to any other person without written permission.

2. Virginia Health and Human Resources Goals The Virginia Health and Human Resources Secretariat is focused on six strategic goals. VirginiaHealth and Human Resources Secretariat Elimination of Intergenerational Poverty Healthy and Productive Virginians • Reduce intergenerational poverty by providing access to nutrition, health care and other support services • Promote health system reform, improve population health and increase access to mental health services Prepare for an Aging and Diverse Population Enable Thriving Children and Families • Provide Virginia’s children and families the resources to learn, grow and live safe, healthy lives • Be ready to offer the services needed in order for adults to remain in their homes and communities Support and Value Veterans and Volunteers • Community Integration of Individuals with Disabilities • Welcome those who have served and volunteered for our country by enabling comprehensive health, behavioral and family support • Provide the right service in the right setting at the right cost Promoting Pathways to the 21st Century Economy for All Virginians While Maximizing the Value of Commonwealth Resources • Financial Stewardship • Information Technology Management • Performance Management • Systems of Care • Customer- Centric • Data Analytics • Cultural Competence • Trauma Informed • Motivational Interviewing

3. Health and Human Resources Secretariat The Secretariat serves as a convener and coordinator across 12 Health and Human Resources agencies and a number of boards, and foundations and works closely with other organizations across Virginia’s government. Virginia Health and Human Resources Secretariat • Children’s Cabinet | Department of Veterans Services Intra-agency Executive Strategy Committee | Coordinating Council on Homelessness Department for Aging and Rehabilitative Services (DARS) Department of Behavioral Health and Developmental Services (DBHDS) Department of Medical Assistance Services (DMAS) Office of Comprehensive Services (OCS) Virginia Board for People with Disabilities (VBPD) Virginia Department for the Blind and Visually Impaired (VDBVI) Virginia Department for the Deaf and Hard of Hearing (VDDHH) Virginia Department of Health (VDH) Virginia Department of Health Professions (VDHP) Virginia Department of Social Services (VDSS) Virginia Foundation for Healthy Youth (VFHY) Assistance Technology Loan Fund Authority (ATLFA ) Virginia Public Safety and Homeland Security Secretariat Virginia Secretariat of Veterans and Defense Affairs Virginia Secretariat of Commerce and Trade Virginia Secretariat of Technology Virginia Secretariat of Education

4. HHR Agency Alignment with Goals Each of the 12 agencies and a number of boards, and foundations creates work plans, which include key objectives, strategies, and measures that align with the overall goals set by the Secretariat and the Office of the Governor. Virginia Health and Human Resources Secretariat Detailed measures and performance indicators to assess performance against objectives Community Integration of Individuals with Disabilities Prepare for an Aging and Diverse Population Healthy and Productive Virginians Enable Thriving Children and Families Support and Value Veterans and Volunteers Elimination of Intergenerational Poverty Measures and Results Specific objectives, strategies, and initiatives to achieve goals Objective Strategies Agency specific goals and objectives aligned to overall goals set by the Secretariat and the Office of the Governor Agency Goals Guides all agency programs, operations and services Mission Statement DARS DBHDS DMAS OCS VBPD VDBVI VDDHH VDH VDHP VDSS VFHY ATLFA

5. HHR Groups, Issues and Service Areas Health and Human Resources agencies and a number of boards, and foundations provide a broad range of services addressing multiple issues, impacting the lives of all Virginians. Emergency Medical Services Disease Control and Prevention Sign Language Interpreter Environmental Health Services SERVICES Communications Access Vital Records Developmental Services Licensing and Regulation Public Health Prevention and Early Intervention Child Welfare Independent Living Environment Monitoring & Emergency Response Community Inclusion Prevention Employment Day Support ISSUES Education Access Crisis Intervention Protective Services Crisis Stabilization Substance Abuse Homelessness And Affordable Housing Long Term Care Services Emergency Services Pre-Screening Other Disabilities Youth Nutrition Substance Use Disorder Services Long Term Employment Support Services Tobacco Abuse Inpatient Psychiatric SERVING ALL VIRGINIANS Publicly Funded Healthcare Intellectual and Developmental Disabilities Protection Intermediate Care Facility Child Care Economic Independence Early Learning Development Training Programs Emergency Preparedness Adoption Volunteerism Transition Services PhysicalActivity Employment Foster Care Refugee Resettlement Energy Assistance Prisoner Reentry Child Support Behavioral Health Safety and Permanency Nutritional Support Senior Citizens Family Planning Individuals with Disabilities Food and Water Safety Family Violence Workforce Development Access to Medical Services Financial Assistance Vocational Rehabilitation Community Outreach Assistive Technology Case Management Interpreter Services Families Individuals Communities Children Veterans

6. Health and Human Resources Service Delivery Services are delivered through collaboration with key partners in the Commonwealth. Virginia State Universities (incl. Medical Schools) Other Virginia Departments Child Care Providers Assistors and Navigators Non-profit Partners (incl. Foundations) 5 Virginia Disability Service Agencies 21 Child Support District Offices 39 Community Service Boards/Health Authority Contracted Virginia Relay Providers Sexual Violent Predator Behavioral Rehabilitation Center 9 VDSS Licensing Offices 5 Behavioral Health Training Centers 120 Local Departments of Social Services 29 Community Action Agencies 5 VDSS Area Training Centers 9 State Hospitals LEGEND Local 16 Centers for Independent Living 13 Licensing Boards State Private Medicaid Providers 25 Area Agencies on Aging FAMIS Providers 35 Health Districts 6 Managed Care Organizations 119 Local Health Departments VDBVI Virginia Industries for the Blind

7. Program and Services Map VA Health and HumanResources Secretariat SSA DOL AOA NIH DARS DBHDS DHP DMAS VDSS OCS VBPD VDBVI VDDHH VDH VFHY • Vocational Rehabilitation • Disability Determination • Community Rehabilitation for Disabled • Aging Services • Adult Protective Services • Developmental Disability Services • Mental Health Services • Substance Abuse Treatment Services • Behavioral Health Emergency Response Services • Provider Licensing • Licensing and Health Profession Regulation • Prescription Monitoring Program (PMP) • Health Practitioners Data Center • Medical Assistance • Family Access to Medical Insurance Security (FAMIS) • Medicaid Analytics and Reform • Supplemental Nutrition Assistance Program • Temporary Assistance to Needy Families • Child Care • Energy and Cooling Assistance • Eligibility Determination • Foster Care and Adoption Services • Child Support Enforcement • Child and Adult Protective Services • Licensure • Community Policy and Management Teams (CPMT) • Family Assessment and Planning Teams (FAPT) • At-Risk Youth and Families • Policy Setting • Grants for Innovation • Leadership and Advocacy Training Programs • Vocational Rehabilitation • Randolph-Sheppard Vending Program (RSVP) • Virginia Industries for the Blind • General Library Services and Education Services • Technology Assistance Program (TAP) • Virginia Relay • Outreach and Community Services • Interpreter Services • Family Health Services • Emergency Preparedness and Response • Environmental Health Services • Licensure and Certification • Epidemiology • Virginia Certificate of Public Need (COPN) • Minority Health and Equity • Drinking Water • Youth Programs • Youth Tobacco Use Prevention • Youth Obesity Prevention ACL ACF FNS CDC SAMHSA EPA CMS What We Do, How Effectively We Do It, and How Much Does It Cost?

8. Virginians Served Across Health and Human Resources Programs The illustration below provides counts of individuals served by program and agency annually. NOTE: Population counts between different programs may overlap and are not mutually exclusive. 1LIHEAP numbers represent households and not recipients. SOURCES: All SFY 2013 unless noted: Locality Profile, LASER Report, ADAPT (unique client counts), APECS (number of families served), Virginia Medicaid at a Glance, VDSS Annual Statistical Report, DARS APS division Report, DARS Virginia State Rehabilitation Council Annual Report, VDSS Measures (Cost Effective Rate), OCS Strategic Plan (2012-14), DBDHS 2014 Annual Report, CARS, DSA Expenditure Reports

9. Program Overlaps – Sample From Other State The illustration below provides overlap populations between different programs in a state with a matured integrated eligibility system P9 40K P1, P9 29K P1, P2, P9 21K P11 38K P1, P11 29K P1 Only 375K P1, P2 69K P1, P2, P7 18K P1, P7 86K P1, P4 48K P1, P2, P6 99K P1, P2, P6, P7 110K P7 Only 300K P1, P6, P4 36K P6, P1, P7 351K P3, P6, P1 69K SAMPLE P1, P8 18K P3, P6, P1, P8 23K P8 Only 74K P6, P1, P8, P7 40K P1, P6, P8 42K P6, P7 132K P3, P6, P1, P7 56K P6, P1 338K P7, P10 20K P3, P6, P7 56K P6 Only 154K P3, P6, P1, P8, P7 15K P10 Only 129K P7, P10, P6 14K NOTE: Venn diagram sizes may be exaggerated at certain places to show overlap

10. Program Overlaps – Virginians Served The illustration below provides population overlaps of individuals served by Medicaid, SNAP, and TANF in Virginia. Most TANF recipients also receive Medicaid and SNAP benefits Half of Medicaid recipients also receive SNAP benefits Half of SNAP recipients also receive Medicaid benefits SNAP Only 448K Medicaid Only 429K Medicaid & SNAP 687K Medicaid, SNAP & TANF 123K NOTE: Venn diagram sizes have been exaggerated at certain places to show overlap SOURCE: SFY 2014 VDSS Clients Served Annually Medicaid & TANF 5K SNAP & TANF 15K TANF Only 1K

11. Per Capita Annual Spending on Health and Human Resources Programs The illustration below provides annual spending per individual served by program and agency. NOTE: Per recipient spending has been calculated by dividing the total annual expenditures by the annual recipients served for each program. 1LIHEAP numbers represent households and not recipients. SOURCES: All SFY 2013 unless noted:Locality Profile, LASER Report, ADAPT (unique client counts), APECS (number of families served), Virginia Medicaid at a Glance, VDSS Annual Statistical Report, DARS APS division Report, DARS Virginia State Rehabilitation Council Annual Report, VDSS Measures (Cost Effective Rate), OCS Strategic Plan (2012-14), DBDHS 2014 Annual Report, CARS, DSA Expenditure Reports

12. Program Overlaps – Spending The illustration below provides spending overlaps of individuals served by Medicaid, SNAP, and TANF in Virginia. Majority of the state and federal HHR spending focuses on individuals receiving both Medicaid and SNAP benefits followed by individuals receiving Medicaid only Spending on individuals receiving TANF is accompanied by Medicaid and SNAP spending as well Medicaid Only $2,630 M Medicaid & SNAP $5,096 M SNAP Only $572 M NOTE: Costs for each program have been derived by using population overlap data from SFY 2014 and program spending from SFY 2013 SOURCES: SFY 2014 VDSS Clients Served Annually , SFY 2013 VDSS Annual Statistical Reports Medicaid, SNAP & TANF $997M SNAP & TANF $30 M Medicaid & TANF $36 M TANF Only $0.88 M

13. Agency Funding By Source HHR agencies have individual budgets which are all funded by a combination of federal, state, local government and other funds. Total Budget* (in millions) • HHR Agency Budget Breakdown • Total HHR Budget Breakdown

14. Top Priorities The Virginia Health and Human Resources Secretariat is focused on key initiatives aligned to our goals. Community Integration of Individuals with Disabilities Continue reform efforts to provide a flexible and individualized system of support focused on active participation and inclusion of individuals with disabilities while meeting the requirements of the Department of Justice Settlement Agreement. Prepare for an Aging and Diverse Population • Be ready to offer the services needed in order for adults to remain in their homes and communities. Elimination of Intergenerational Poverty • Reduce intergenerational poverty by providing access to nutrition, health care and other support services. Healthy and Productive Virginians • Promote health system reform, improve population health and increase access to mental health services Support the efforts of the Governor’s Children’s Cabinet which is solely dedicated to the education, health, safety, and welfare of Virginia’s children and youth. Support the development and implementation of a policy agenda that will help better serve Virginia’s children and will also foster collaboration between state and local agencies. Enable Thriving Children and Families Support and Value Veterans and Volunteers • Welcome those who have served and volunteered for our country by enabling comprehensive health, behavioral and family support

15. Top Priorities The Virginia Health and Human Resources Secretariat is focused on key initiatives aligned to our goals. Develop and implement a comprehensive policy agenda related to the education, health, safety, and well-being of youth throughout the Commonwealth. Children’s Cabinet Create and implement systems that promote child safety, establish enduring family relationships and provide lifelong commitment, continuity of care, a sense of belonging, and legal and social status. Foster Care Permanency Work across agencies and secretariats to demonstrate program results and create data-informed, evidence-based interventions and solutions. Data Analytics & Performance Coordinate with Governor’s task force on Prescription Drug and Heroin Abuse to address a growing and dangerous epidemic of prescription opioid and heroin abuse in the Commonwealth. Prescription Drug and Heroin Abuse Department of Veterans Services Interagency Executive Strategy Council Collaborate with other partners to support Virginia’s veterans. Coordinating Council on Homelessness Maximize the effectiveness services and resources for individuals and families who are experiencing homelessness or at risk of homelessness. DBHDS Commissioner Ferguson initiated a transformation process that includes a comprehensive review of the state behavioral health and developmental services system. Transformation Teams

16. Challenges & Path Forward

17. Key Challenges in Health and Human Services Delivery The systems of care are constantly evolving due to some key challenges in Virginia. Population demographic changes including aging and ethnicity Managing funding instability and inflexibility Developing and retaining a skilled health and human services workforce Keeping pace with technological and political shifts Key Challenges Balancing the requirement for specialization with need for integration Addressing the role of social determinants of health Coordinating with complex federal, state and private structures and requirements

18. ‘Customer-Centric Coordinated Care’ Model Virginia is shifting from a ‘program-focused’ model to a more ‘Customer-Centric Coordinated Care’ model. Traditional Program-Focused Model ‘Customer-Centric Coordinated Care’ Model Services driven by individual, family, or community needs Agency Services are offered based on what agency determines the individual, family, or community is eligible to receive Agency Agency • Agencies recognize and consider the full range of services provided by other agencies, partners and organizations • Agency focus is on the services delivered by the agency or their partners Agency Agency Agency Service Delivery Partner Service Delivery Partner • Services are considered more broadly factoring in role of social determinants • Services are focused on one issue or problem Agency Agency

19. Individual/ Family/ Community ‘Customer-Centric Coordinated Care’ Model The HHR ‘Customer-Centric Coordinated Care’ model recognizes that a wide range of organizations are involved in addressing our Commonwealth’s toughest challenges. ACL ACL ACL ACL ACF ACF ACF ACF ACF ACF AOA AOA ASPR-HHS ASPR-HHS ASPR-HHS CMS CMS CMS CMS CMS CDC CDC CDC DHS DHS DOD DOD DOE DOE DOE DOE DOJ DOJ DOJ DOL DOL DOL DOL DOL DOT DOT DCHD APA DCR DCR EPA EPA DEQ DGIF DGS DGS DGS DHCD DHCD DHCD FDA FDA FDA DJJ DHRM DJJ DJJ DJJ DJJ DMA Behavioral Health Training Centers Behavioral Health Training Centers Behavioral Health Training Centers Behavioral Health Training Centers Behavioral Health Training Centers Behavioral Health Training Centers Behavioral Health Training Centers DOC FEMA FEMA FEMA DJJ DOE DOC DOC DMV DMV Child Care Providers Child Care Providers Child Care Providers DOLI FNS FNS FNS Multiple DOE DOE DOE DOE DOE DOE DOE DOA Child Support District Offices Child Support District Offices • Federal Agencies • Federal Agencies DPOR DOC Community Action Agencies Community Action Agencies Community Action Agencies DRPT HUD HUD HUD DPOR DPB DPB Fair Housing Community Service Boards Community Service Boards Community Service Boards Community Service Boards Community Service Boards Community Service Boards Community Service Boards Community Service Boards Community Service Boards Community Service Boards Community Service Boards Community Service Boards DRPT DVS DOJJ Services DOJJ Services DOJJ Services DOJJ Services GMU IRS IRS IRS Fair Housing Health Authority Health Authority Health Authority Health Authority Health Authority • Stakeholders • Stakeholders LVA Health Districts Health Districts Health Districts Health Districts Health Districts OAG OAG GMU • Non-HHR State Agencies • Non-HHR State Agencies OAG NIH NIH NIH NIH Licensing Boards Licensing Boards Licensing Boards Licensing Boards Licensing Boards Licensing Boards Advocacy Groups Advocacy Groups Advocacy Groups Advocacy Groups Advocacy Groups Advocacy Groups Advocacy Groups Advocacy Groups Advocacy Groups Advocacy Groups Advocacy Groups Advocacy Groups OSIG OSIG LVA State Police Local Departments of Social Services Local Departments of Social Services Local Departments of Social Services Local Departments of Social Services Local Departments of Social Services Local Departments of Social Services Local Departments of Social Services Local Departments of Social Services Local Departments of Social Services Local Departments of Social Services Local Departments of Social Services State Police OES NNSA NNSA VCCS VDBVI / VRCBVI Local Health Departments Local Health Departments Local Health Departments Local Health Departments Local Health Departments Local Health Departments Local Health Departments Local Health Departments Local Health Departments Local Health Departments • Service Delivery Partners • Service Delivery Partners SCHEV VCCS VDACS VCE VDHP NRC NRC Managed Care Organizations Managed Care Organizations Managed Care Organizations Managed Care Organizations Managed Care Organizations Managed Care Organizations Managed Care Organizations VDACS TAX VCE DBHDS VDDHH DMAS DARS VBPD VDSS VFHY OCS VDH State HHR Agencies OSG OSG Industry Associations Industry Associations Industry Associations Industry Associations Industry Associations Industry Associations Industry Associations Industry Associations Industry Associations VDEM Providers Providers Providers Providers Providers Providers Providers Providers Providers Providers Providers Providers VDEM VDOT Medical Societies Medical Societies Medical Societies Medical Societies Medical Societies Medical Societies Medical Societies VDOT SVP Behavioral Rehabilitation Center SVP Behavioral Rehabilitation Center SVP Behavioral Rehabilitation Center SVP Behavioral Rehabilitation Center SVP Behavioral Rehabilitation Center SAMHSA SAMHSA SAMHSA SAMHSA SAMHSA SAMHSA VEC VEC VEC State Hospitals State Hospitals State Hospitals State Hospitals State Hospitals State Hospitals State Hospitals State Hospitals VHDA VHDA VEC SSA SSA SSA SSA SSA SSA SSA SSA VDSS Licensing Offices VDSS Licensing Offices VDSS Licensing Offices VDSS Licensing Offices VDSS Licensing Offices VIMS VITA Virginia Disability Service Agencies Virginia Disability Service Agencies Virginia Disability Service Agencies Virginia Disability Service Agencies Virginia Disability Service Agencies Virginia Disability Service Agencies Virginia Disability Service Agencies Virginia Disability Service Agencies Virginia Disability Service Agencies Virginia Disability Service Agencies USDA USDA USDA USDA VMRC VSBD Non-profit Organizations Non-profit Organizations Non-profit Organizations Non-profit Organizations Non-profit Organizations Non-profit Organizations Non-profit Organizations Non-profit Organizations Non-profit Organizations Non-profit Organizations Non-profit Organizations Non-profit Organizations VSBD VBDVI Virginia Industries for the Blind VBDVI Virginia Industries for the Blind VBDVI Virginia Industries for the Blind VBDVI Virginia Industries for the Blind VBDVI Virginia Industries for the Blind VBDVI Virginia Industries for the Blind USDA-RD USDA-RD VSP Policy Think Tanks Policy Think Tanks Policy Think Tanks Policy Think Tanks Policy Think Tanks Policy Think Tanks DARS DBHDS DMAS OCS VBPD Schools Schools Schools Schools Schools Schools Schools Schools Schools Schools Schools Schools VDBVI VDDHH Universities Universities Universities Universities Universities Universities Universities Universities Universities Universities Universities Universities VDH VDHP VDSS VFHY

20. The eHHR (electronic Health and Human Resources) Program The eHHR Program promotes enterprise projects in Virginia enabling integrated, citizen-centered services. Enterprise Data Partners Enterprise Business Services Enterprise Interfaces LASER Rushmore CAS Birth Registry Death Registry Immunization Registry Fiscal Impact Tax Organization Hub Healthcare Translator Workforce Engine Rules Engine EDM Wells Fargo EBT Federal RIDP Mapping Geocoder USPS Address Standardization MEC Person Hub Outcome Measures: DOE, DOC, DJJ, State Police WOTC EDM • Enterprise Service Bus Census DOE, Elections HIE IEVS Individual/Family/Community Data Sharing Learn Fare MMIS Population Health VDH, DHP SAMS APECS COV Provider At-Risk Population DHCD, DOC, DJJ, DBHDS SPIDER CHAMPS • Enterprise Service Bus • Enterprise Service Bus Security Governance PDMS MLO Social Program DSS, OCS Commercial TALON FFM Federal Health Care DMAS Technology SSA IRS Finance FNS DDS • Enterprise Service Bus Enterprise Applications VaCMS CommonHelp Data Warehouse Document Management • BUSINESS SERVICES • INTERFACE Citizen Facing Database Management APPLICATIONS Business Services Performance Services Security Services LEGEND DATA PARTNERS TextData Type ALL TextCurrent TextFuture Business Services Performance Services Security Services

21. Virginia Department of Social Services (VDSS) Mission Help people triumph over poverty, abuse and neglect to shape strong futures for themselves, their families and communities. Goals 2015 Key Priorities • Increase safe and stable living situations for children and families • Increase self-sufficiency of families and individuals through opportunities for education, employment, income and health care • Improve access to nutrition and alleviate hunger among low-income households • Increase access to quality early care and education for children in low-income households • Modernize current eligibility systems to increase operational efficiency • Enhance and implement policies to increase permanency of children and youth in foster care • Improve child support services through rightsizing support and leverage technology for operational efficiency • Create awareness and advocate for increased regulation of child care Programs and Services1 Results & Impact2 Children from foster care transitioned to a permanent living arrangement in Q4 of FY 2014 79% 43% 98% $6.59 83% 77% Child Support Services At-risk children receiving child care subsidies who are in licensed facilities Early Childhood Initiatives Licensure of Child and Adult Care Facilities Child support collected per dollar spent; VA’s child support system is recognized as one of the best in the nation Refugee Services Community & Volunteer Services Foster Care and Adoption Services Social Safety Net Programs (SNAP, TANF) Local Departments of Social Services Abused children not victims of subsequent maltreatment within six months Child and Adult Protective Services Medicaid Eligibility Determination TANF recipients engaged in workforce activities Child Care Workforce Development Income-eligible adults and children participating in SNAP Enterprise Systems Modernization Sources: 1 VDSS Strategic Plan 2014-2016 2 Virginia Performs VDSS Performance Measures (data for Q4, FY 2014); SNAP participation rate (annual FY 2014); SNAP participation rate (annual FY 2014)

22. Virginia Department of Social Services (VDSS) Mission Help people triumph over poverty, abuse and neglect to shape strong futures for themselves, their families and communities. Goals 2015 Key Priorities • Increase safe and stable living situations for children and families • Increase self-sufficiency of families and individuals through opportunities for education, employment, income and health care • Improve access to nutrition and alleviate hunger among low-income households • Increase access to quality early care and education for children in low-income households • Modernize current eligibility systems to increase operational efficiency • Enhance and implement policies to increase permanency of children and youth in foster care • Improve child support services through rightsizing support and leverage technology for operational efficiency • Create awareness and advocate for increased regulation of child care Programs and Services1 Results & Impact2 Children from foster care transitioned to a permanent living arrangement in Q4 of FY 2014 79% 43% 98% $6.59 83% 77% Child Support Services At-risk children receiving child care subsidies who are in licensed facilities Early Childhood Initiatives Licensure of Child and Adult Care Facilities Child support collected per dollar spent; VA’s child support system is recognized as one of the best in the nation Refugee Services Community & Volunteer Services Foster Care and Adoption Services Social Safety Net Programs (SNAP, TANF) Local Departments of Social Services Abused children not victims of subsequent maltreatment within six months Child and Adult Protective Services Medicaid Eligibility Determination TANF recipients engaged in workforce activities Child Care Workforce Development Income-eligible adults and children participating in SNAP Enterprise Systems Modernization Sources: 1 VDSS Strategic Plan 2014-2016 2 Virginia Performs VDSS Performance Measures (data for Q4, FY 2014); SNAP participation rate (annual FY 2014); SNAP participation rate (annual FY 2014)

23. Virginia Children’s Cabinet Mission Develop and implement a comprehensive policy agenda related to the education, health, safety, and well-being of youth throughout the Commonwealth. Goals • Eradicate the achievement gap in schools in high poverty communities • Increase access to basic needs including housing, healthcare, and proper nutrition • Improve outcomes for youth transitioning out of Virginia’s juvenile justice, mental health and foster care systems • Increase workforce opportunities for parents and for youth as they transition out of high school • Improve early childhood care and education Cross-Agency Collaboration Cabinet’s Priorities Beyond The Barriers Address issues facing schools in high-poverty communities Raising The Foundation Make child care providers accountable for quality care Access To Basics Ensure access to healthcare, housing, and proper nutrition for children Triumph Over Transitions Assess services for youth transitioning out of juvenile justice, mental health, and foster care systems Working Parents, Building Families Address policies and services that encourage workforce development efforts for parents Sources: VA Governor’s Executive Order Number 21 (2014) VA Health and Human Resources Secretariat Secretary of Education Secretary of Commerce and Trade Secretary of Health and Human Resources Children’s Cabinet Lieutenant Governor Secretary of Public Safety and Homeland Security Virginia’s First Lady

24. Virginia Department for Aging and Rehabilitative Services (DARS) Mission DARS, in collaboration with community partners, provides and advocates for resources and services to improve the employment, quality of life, security, and independence of older Virginians, Virginians with disabilities, and their families. Goals 2015 Key Priorities • Enable 4,000 Virginians with significant disabilities to join the state workforce and become competitive wage earners • Preventthe abuse, neglect, and/or exploitationof adults who are older or incapacitated • Maximizeeach individual’s independence, self-sufficiency and personal choice • Preventinappropriate/premature institutionalizationof adults • Assistwhen necessary withappropriate long-termcareor alternative placement • Continue to offer safe options for long-term care needs • Continue to improve sheltered workshops to ensure payment of competitive wages in integrated settings • Continue efforts to increase coordination across the programs that came together to form DARS • Continue to move forward on Auxiliary Grant-related efforts in regards to housing and behavioral health coordination Programs and Services2 Results & Impact1 Individualized plans for employment created in the Vocational Rehabilitation Program 8K 4,087 97.3% 2.7M Virginians employed because of our programs Services for Older Virginians and Virginians with Disabilities Accuracy for disability decisions of Title II, Title XVI and Title XIX disability claims Employment Services (Employment and Vocational, and Transition Services) Disability Determination Nutritional meals received by over 25K Vintage Virginians in 12 months Community Based Services (Brain Injury, Community Rehabilitation Case Management, Independent Living, and Personal Assistance Services) Aging Services Ombudsman Adult Services Adult Protective Services Sources: 1Virginia Performs DARS Performance Measures (data as of September 30, 2014) 2 Agency Executive Progress Report.

25. Governor’s Initiative on Homelessness Mission To develop and oversee a plan to leverage state resources more effectively. Maximize the effectiveness of state services and resources for individuals and families who are experiencing homelessness or at risk of homelessness. Realize efficiencies through enhanced coordination and share resources among state agencies. Goals 2015 Key Priorities End homelessness among veterans by the end of 2015 • End Veteran Homelessness • Continue to promote Rapid Re-Housing • Improve method of tracking the number of Youth Experiencing Homelessness Governing Structure Performance & Impact Committee Solutions Committee Governor’s Advisory Committee on Homelessness Governor’s Coordinating Council on Homelessness Results & Impact1 Ending Veteran Homelessness Committee Decrease in total persons who are homeless from 2010-14 30% 36% 22.6% 25% Interagency Partnership to Prevent & End Youth Homelessness Decrease in Veterans who are homelessfrom 2012-14 Decrease in individuals who are chronically homeless from 2010-14 Strategies Decrease in families who are homeless from 2010-14 Increase permanent supportive housing units Increase flexibility of funding Implement statewide data collection and system coordination Provide access to substance abuse and mental health treatment Improve discharge policies for facilities Sources: 1 Virginia Health and Human Resources Secretariat

26. Healthy Virginia • Expand outreach and reach more people in need • Improve access to health care • Pursue innovativesolutions to health challenges Goals 10 Point Action Plan Providing dental benefits to pregnant women in Medicaid and FAMIS 6 Covering people with serious mental illness through the Governor’s Action Plan (GAP) 1 Accelerating veterans’ access to care 7 Signing up more children for Medicaid and FAMIS 2 Transforming health care delivery through an innovation grant 8 Enrolling more Virginians in Federal Marketplace health insurance plans 3 Improving coordination of care for people with serious mental illnesses 9 Informing Virginians of their health options with an improved website. 4 45K 35K 20K 160K Reducing prescription drug and heroin abuse 10 Allowing eligible state workers to insure their children through FAMIS 5 Performance Targets Uninsured Virginians with severe mental illness to be provided with medical and behavioral healthcare Pregnant women in Medicaid and FAMIS to be provided with comprehensive dental coverage Children to be provided insurance through enrollment in FAMIS Virginians to be provided private insurance through enrollment in the Federal Marketplace Sources: 1 Virginia Health and Human Resources Secretariat Innovation Outreach Access

27. Veteran’s Initiative Work with the U.S. Department of Veterans Affairs (VA) and community providers to accelerate access to quality care for veterans across the Commonwealth of Virginia Goals 2015 Key Priorities Challenges Growing Demand Fastest growing veteran population of any state leading increase in demand for primary care and specialty services Provider Capacity VA faces challenges recruiting and retaining primary care and specialty providers who can meet the care needs of veterans Transportation Limited transportation options and uncoordinated transportation assistance present roadblocks to access Limited Clinic Space Limited clinic spaces and lack of availability in specific geographical locations leading to longer wait times Care Coordination Many veterans seek care from multiple providers and need coordinated care, including exchange of relevant health information Key Strategies Promote Public-Private Partnerships Partner and collaborate with private providers and community resources to meet veterans’ needs • Increase veterans’ access to quality care in a timely manner by promoting partnerships with the VA and other health providers in Virginia • Host regional planning sessions to identify localized needs • Coordinate improved transportation support services Enhance Access to Care Innovate delivery strategies and leverage the Veterans Choice Act to promote more collaboration, improve access andincrease choices Offer Transportation Assistance Provide assistance in areas with limited facilities and coordination in areashaving existing transportationassistance services Sources: 1 Virginia Health and Human Resources Secretariat