HEALTH AND FAMILY SERVICES DEPARTMENT FY 2008-09 Budget Worksession July 22, 2008.

HEALTH AND FAMILY SERVICES DEPARTMENT

FY 2008-09Budget Worksession

July 22 , 2008

• Organization Chart

• Proposed FY 08-09 Budget

• Budget Overview

• Significant Future Issues

• Summary of Unfunded Needs

PRESENTATION OUTLINE

ORGANIZATION CHART

Department DirectorLarry Jones

Office on AgingMimi Reggentin

EMS Medical DirectorGeorge Ralls MD

Human ResourcesMarya Labrador

Mental Health & HomelessnessDonna Wyche

Deputy DirectorElla J. Gilmore

Deputy DirectorPete Clarke

Community Action Karl Anderson

Cooperative ExtensionGlinder Stephens

Head StartCathleen Armstead

Mosquito ControlTom Breaud

History CenterSara Van Arsdel

Citizens’ CommissionTyra Witsell

Medical ExaminerJan Garavaglia MD

Corrections MedicalDonna Loyko

Youth & Family ServicesSyd McCallister

Medical Clinic/PCANMargaret Brennan

ADA CoordinatorSamme Ripley

FiscalYolanda Brown



• Budget Overview




PROPOSED FY 08-09 BUDGET

CurrentFY 08 $ Change

ProposedFY 09

Total Budget $136.9M ($18.4M) $118.5M

General Fund Budget $85.4M ($3.2M)

$82.2M

Staffing 828 (14) 814

PROPOSED FY 08-09 BUDGET(General Fund)


ProposedFY 09

Personal Services $24.8M ($0.4M) $24.4M

Operating Budget $60.6M ($2.8M) $57.8M

Budget Change -3.7%

Staffing 433 (15) 418


ProposedFY 09

Capital Improvement Projects

$18.5M ($18.4M) $0.1M

Budget Change -99.5%

PROPOSED FY 08-09 BUDGET



• Budget Overview




Mandated Costs Mandated Costs are $22.1M

27% of General Fund Budget

BUDGET OVERVIEW

Mandated Costs

• Child Protection Exams-$176,000 Exams for suspected child abuse

• Medicaid Match-$9.3M inpatient and nursing home costs

• Health Care Responsibility Act- $225,000 Payment to out of county hospitals for emergency care of Orange County indigents

• Burial Program- $204,000 indigent burials

BUDGET OVERVIEW

Mandated Costs

Medical Examiner - $3.62M

•Required by Florida Statutes Chapter 406

• Increasing workload

•Osceola County share 18%

BUDGET OVERVIEW

Mandated Costs

DJJ Cost Shift- $8.6M

•Counties are charged a per-diem rate for each pre-disposition day a juvenile is in secure detention

•County has no control over rates or expenditures

BUDGET OVERVIEW

BUDGET OVERVIEW

Mandated Budget

-

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

2004 20092004 2009

BUDGET OVERVIEW

Budget minus Mandated

40,000,000

47,500,000

55,000,000

62,500,000

70,000,000

2004 20092004 2009

BUDGET OVERVIEW

Budget by Funding Source

Federal Grants $28.7M 25%

State Grants $4.9M 4%

General Fund $82.3M 71%

Federal Grants

State Grants

General Fund

Medical Clinic/PCAN

$28.5 Million

Head Start

$14.6 Million Mental Health and Homeless Issues

$4.3 Million

Youth &Family Services

(includes Ryan White)

$37.2 Million

EMS & Medical Examiner

$5.2 Million

Community Action, Cooperative Extension,

HFS Dept Off ice (includes ADA and

Commission on Aging), Fiscal & Human Resources,

Mosquito Control, Public Health, History Center

$14 Million

Citizens' Commission for Children

$12.1 Million

General Fund and Grants

Total $115.9M

BUDGET OVERVIEW

BUDGET OVERVIEW

Medical Clinic/PCAN

$28.5 Million

Head Start

$14.6 Million Mental Health and Homeless Issues

$4.3 Million

Youth &Family Services

(includes Ryan White)

$37.2 Million

EMS & Medical Examiner

$5.2 Million

Community Action, Cooperative Extension,

HFS Dept Office (includes ADA and

Commission on Aging), Fiscal & Human Resources,

Mosquito Control, Public Health, History Center

$14 Million


$12.1 Million

BUDGET OVERVIEW


10.4%

- Neighborhood

Centers for Families

-After School Zone

-Contract Oversight

$12.1M

Citizens’ Commission for Children

• Established in 1989 as an alternative to Juvenile Welfare Board

• 10-member board

• Mission was to fund and monitor services for children, youth and families

BUDGET OVERVIEW


• Funds 13 Neighborhood Centers for Families

• Funds 26 middle schools for the After School Zone

• Manages the Citizen’s Review Panel

BUDGET OVERVIEW


After School Zone

• Started in 1999 to respond to increase in juvenile crime and violence

• Funded by Orange County

• Managed through contracts with YMCA and Boy’s and Girl’s Club

• County Funding since inception - $28.6 M

BUDGET OVERVIEW

BUDGET OVERVIEW


After School Zone

Effect of School Board Time Change

• Doubles program hours

• Maintaining current model requires an additional $1.6M (2 additional hours)

• No prior discussions with the County

BUDGET OVERVIEW

BUDGET OVERVIEW


After School Zone (cont’d)

Options for cost reductions:

• Cap enrollment

• Reduce transportation services

• Eliminate field trips

• End the program at 5:30pm instead of 6:00pm

• Reduce two weeks for the “Summer Zone”

Discussions ongoing with OCPS

BUDGET OVERVIEW

Youth & Family Services

-GOV

-Shelter

-Crisis/FRP

-Veterans

-DJJ

-Ryan White

$32.7M

32.1%

Youth and Family Services

“A Safety Net for Children and Families”

• Crisis and Long Term Family Assistance

• Residential Services

• Counseling and Case Management

• Home Based Services

• Ryan White

• Veterans Services

BUDGET OVERVIEW


Crisis and Long Term Family Assistance (Welfare Revolving Fund)

• Crisis Assistance Program -Short term assistance providing one time rental/mortgage payment, utilities to prevent homelessness

• Family Resource Program -Case Management and temporary financial support for long term self-sufficiency

BUDGET OVERVIEW

BUDGET OVERVIEWBUDGET OVERVIEW


Welfare Revolving Fund

FY 06-07• 45,000 calls• 80% eligible based on

prescreening• 5% assisted (2,622 families)• Call volume up 20% in FY 07-08

Costs per client increasing Funding history

• $2M FY 96-97• $1M FY 08-09

BUDGET OVERVIEWBUDGET OVERVIEW


Residential Services

• GOV• Youth Shelter• Family Preservation• Family Counseling• Delinquency Supervision

BUDGET OVERVIEW

Youth and Family Services Current issues

• Children requiring more complex and cost intensive services

• State funds for child welfare continues to be reduced limiting options for children

• Working to match County resources with community needs

• Seeking appropriate grant increases

• Continuing strong public/private partnerships

BUDGET OVERVIEW

BUDGET OVERVIEW

Medical Clinic/ PCAN

-PCAN

-Pharmacy

-Specialty Care

-Medicaid Match

-Internal Medicine

-Volunteers

-Case Management

$28.5M

24.6%

Primary Care Access Primary Care Access NetworkNetwork

Primary Care Access Primary Care Access NetworkNetwork

BUDGET OVERVIEW

PCAN Growth 2000-2007

5,00017,610

27,611 32,35946,246

65,29979,000

100,000

020,00040,00060,00080,000

100,000120,000

Fiscal Year

Un

du

plic

ate

d P

ati

en

ts

En

rolle

d

Program Growth

BUDGET OVERVIEW

Primary Care• Hypertension• Diabetes• Asthma• Heart Disease• Acute Care

Secondary Care• Cancer• Cardiology• Orthopedics• Diabetes• Gastroenterology

Primary Care Access Network

BUDGET OVERVIEW

Top 5 Diagnosis

Primary Care Access Network (PCAN)

• Number of uninsured continue to grow

• Partners are financially pressured due to reduced Medicaid reimbursement rates

• Funding has remained static for many years

• May be able to use IGT if cap room exists

BUDGET OVERVIEW

• More uninsured

• More health care plans being rolled back

• Cost of services increasing

• PCAN funding flat until last year’s $1M dollar reduction

• PCAN at a critical juncture

• Patients facing health care decisions vs. living expenses

BUDGET OVERVIEW

Primary Access Care Network (PCAN)

Impact on PCAN services

• Cap patient enrollment

• Limit specialty services

• Consolidate clinics/services

• Limit dollar value of services

• Curtail diagnostics/labs

BUDGET OVERVIEW

Primary Care Access Network (PCAN)

BUDGET OVERVIEW

Head Start

-Class Rooms

-Transportation

-Social Services

-Nutrition Services

-Special Needs

$14.6M

12.6%

Comprehensive services provided for 1,536 children

• Educational Curriculum

• Transportation

• Health Services

• Special Needs Services (10% required)

BUDGET OVERVIEW

Head Start

BUDGET OVERVIEW

HEAD START CENTERS

• Maintains High Quality Services

• Earned and maintains National Accreditation

• Increase Recruitment of Volunteers

Head Start Center

BUDGET OVERVIEW

Challenges

Federal Reauthorization Act

• Priority on homeless children

• Enhanced teacher credentials

• Increased transportation, food and other operational costs

• Children served have more severe needs

Head Start

BUDGET OVERVIEW

Responses to Challenges

• Re-assignment and Cross Training of Staff

• Increase Internal Monitoring

• Reduction of Transportation Routes

• Continue to Maximize Efficiencies

BUDGET OVERVIEW

Head Start



• Budget Overview




SIGNIFICANT FUTURE ISSUES

• Economy continues to weaken

• Increasing stress on individuals and families

– Financial– Emotional– Physical

• Demands on social services will continue to increase


• PCAN • Housing Assistance

• Citizens’ Commission for Children • Central Receiving Center – Phase 2• Welfare Revolving Fund

$518,327

$688,624

$317,220

$206,000

$1,211,450$2,941,621

FY 07-08 - Funding for Homeless


Strategies for Addressing Increased Service Demands

• Review contract compliance• Prioritize Services• Consolidate Services• Consider privatization• Seek More Funding!



• Budget Overview




After School Zone - $1.6M

• To totally fund additional two hours a day

• Will bring back to the BCC in August or September

• Several options are available

SUMMARY OF UNFUNDED NEEDS

Crisis Assistance - $1.2M

• Increasing demand in worsening economic conditions

• Currently meeting 5% of need

• In place, well functioning system to help residents avoid homelessness


PCAN - $2.8M

• Community based system of care for our increasing number of uninsured

• Clinic partners are feeling financial strain

• Funding needs may cause enrollment caps and/or reductions in specialty/diagnostic care


• After School Zone $1.6M

• Crisis Assistance $1.2M

• PCAN $2.8M


Total $5.6M

HEALTH AND FAMILY SERVICES DEPARTMENT

FY 2008-09Budget Worksession

July 22, 2008

HEALTH AND FAMILY SERVICES DEPARTMENT FY 2008-09 Budget Worksession July 22, 2008.

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Transcript of HEALTH AND FAMILY SERVICES DEPARTMENT FY 2008-09 Budget Worksession July 22, 2008.