Board of Supervisors Early Budget Work Session FY2017... · Profile of Medicaid Coverage Expansion enrollees include 52% young adults (19-39), 34% adults (40-59) and 14% seniors (60+)

Board of Supervisors Early Budget Work Session

ALAMEDA COUNTYHEALTH CARE SERVICES AGENCY

April 10, 2017Rebecca Gebhart, HCSA Interim Director

VISION

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Health Equity through the goals of Healthy People, Healthy Places, Healthy Policies and Healthy Systems

Provide fully integrated health care services through a

comprehensive network of public and private partnerships

that ensures optimal health and well-being and respects

the diversity of all residents3

MISSION

ALAMEDA COUNTY HEALTH CARE SERVICES AGENCYOffice of the Director Finance & Administration Medical Director

Human Resources Fund Development Policy Evaluation

Center for Healthy Schools and Communities

Finance & Administration

Behavioral Health Care Services

Day Treatment

Referral Services

Support Services

24 Hour Services

Outpatient Services

Public Health

Community Health Services

Communicable Disease Control

& Prevention

Family Health Services

Administrative Services

Public Health Nursing

Administration

Environmental Health Services

Outreach

Ancillaries

Emergency Medical Services

Office of AIDS

Environmental Health

Office of the Director Health Officer

Administration andIndigent Health

Administration

Vector Control Services

Special Projects

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Indigent Health Services/HealthPAC

Alignment with County Strategic Initiatives

Countywide Strategic InitiativeHCSA Departments Providing

Initiative-Related Services

Environment & Sustainability Environmental Health Sustainability and green initiatives in all departments

Safe & Livable Communities Administration and Indigent Health Behavioral Health Care Services Environmental Health Public Health

Healthy & Thriving Populations Administration and Indigent Health Behavioral Health Care Services Environmental Health Public Health

Housing Administration and Indigent Health Behavioral Health Public Health

Transportation Public Health

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Mandated and Discretionary Services

Department Mandated Services Discretionary Services

ADMINISTRATION AND INDIGENT HEALTH

Indigent Health, Medical Services to Youth in Custody, Emergency Medical Services

School Health Services, Children’s Policy, Court Appointed Special Advocates, Youth Centers, Children’s Dental, Health Insurance Enrollment, MAA/TCM, Health Care for Low Income Uninsured, Health Care for the Homeless, Alameda County Care Connect

BEHAVIORAL HEALTH CARE SERVICES

Alcohol and Other Drug Services, Mental Health Services, Medi-Cal Consolidation

Housing Support for Homeless, Vocational Training, Self-Help and Empowerment, Crisis Support for the Uninsured

ENVIRONMENTAL HEALTH

Food/Water/Recreational Safety, Hazardous Materials/Waste Management, Vector Control, Land Use/Septic, Solid/Medical Waste, Body Arts, Epidemiological Investigations, Complaints

Green Business/Community Environmental Health Services,Healthy Nail Salons, Pharmaceutical Safe Take Back, Food Facilities Grading System

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Department Mandated Services Discretionary Services

PUBLIC HEALTH

Health Officer, Public Health Statistics, Health Education, Communicable Disease Control & Prevention, Maternal & Child Health, Public Health Laboratory, Nutrition, Chronic Disease Prevention & Control, Public Health Nursing, and Services directed at social factors affecting health

Development Disabilities Planning & Advisory

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Mandated and Discretionary Services

HCSA Operating Values

Data DrivenUse data for decision making and performance measurement

Effective Contracting Efficient contracting business processes

Measuring Impact Results-Based Accountability implementation is an agency priority

Aggressive Resource Leveraging

Seek opportunities to leverage and maximize State, Federal and other funds

Quality Quality assurance, quality improvement and focus on best practices

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FY 17-18 Budget Summary* ($ in millions)

FY 16-17Budget

FY 17-18MOE

Change from FY 16-17 Amount %

Appropriation $728.38 $775.66* $47.28 6.49%

Revenue $594.18 $626.52 $32.34 5.44%

Net County Costs $134.20 $149.14 $14.94 11.13%

FTE-Mgmt 515.39 544.56 29.17 5.66%

FTE-Non-Mgmt 995.94 1,010.94 15.00 1.51%

Total FTE 1,511.33 1,555.50 44.17 2.92%

*Includes Vector Control ($6.38M) & EMS Special District ($21.83M) = $31.46M, IGT = $24.85M and Measure A (non-AHS) = $31.50M

Change in HCSA FTE (Full-Time Equivalents) by department: Admin/Indigent Health (29.5); BHCS (10.7); Environmental Health (0); Public Health (4)

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Appropriation By Department

10Includes Measure A and IGT


$453.90M (58.5%)

Administration and Indigent Health

$172.96M (22.3%)

Public Health

$109.81M (14.2%)


$38.99M (5.0%)

$775.66MTOTAL

Revenue By Department

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$409.39M (65.4%)


$108.58M (17.3%)

Public Health

$74.01M (11.8%)


$34.54M (5.5%)

$626.52M(80.8% OF BUDGET)

Revenue, including Measure A and Medical Care Financing, covers: 90.2% of BHCS Budget 62.8% of Admin/Indigent Budget 67.4% of PH Budget 88.6% of EH Budget

County General Fund by Department

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$44.51M (29.8%)


$64.38M (43.2%)

Public Health

$35.80M (24.0%)


$4.45M (3.0%)

Net County Costs (NCC) as percentage of departmental budget: 9.81% of BHCS Budget 37.22% of Admin/Indigent Budget 32.61% of PH Budget 11.42% of EH Budget

$149.14M(19.2% OF BUDGET)

Total Appropriation by Major Object

13Intra-fund Transfers

($28.22M)

DiscretionaryServices & Supplies

$480.62M (59.8%)

$803.88MTOTAL

Non-DiscretionaryServices and Supplies

$24.78M (3.1%)

Other Charges

$86.39M (10.7%)

Fixed Assets & Other Financing Uses

$.14M (<1%)

Salary & Employee Benefits

$211.95M (26.4%)

Sources of Revenue

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Other*

$63.29M (8.2%)

$775.66MTOTAL

Measure A (non AHS)

$31.50M (4.0%)

County General Fund

$149.14M (19.2%)

Federal Aid

$97.31M (12.6%)

Charges for Services

$199.11M (25.7%)

State Aid

$235.31M (30.3%)

*Other revenues include: TMSF Revenues, Measure C, Use of Available Fund Balance, Aid from Local Government, Fines, Forfeits & Penalties, Permits & Franchises

Change in Net County Cost (in millions)

Component NCC Change

S&EB COLAs $7.46M

Community-Based Organization COLAs $6.12M

Alameda Health System COLA $1.79M

Internal Service Funds (ISF) Adjustments $.65M

Increase in County Counsel Charges $.015M

One-Time Revenues Used for FY 16/17 Budget Balancing $1.62M

Revenue & Other Offsets for Higher Costs ($2.71M)

TOTAL $14.94M

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Board of Supervisors Discretionary Health Services $750,000

Behavioral Health Care Services $8,026,443Criminal Justice Screening & In-Custody Services $4,306,000

Cherry Hill Detoxification & Sobering Services $2,143,224

Behavioral Health & AOD Providers $775,848

Mental Health Services at Juvenile Justice Center $360,000

Juvenile Justice Health Services $261,000

Public Health Services for Homeless Residents $100,000

Mental Health Services for Newcomers and Immigrants $80,371

Public Health $5,231,476Public Health Prevention Initiative $2,973,896

Home Visiting Services $1,250,000

Countywide Plan for Seniors (Home-Based Nursing Case Management) $500,000

Alameda County Dental Health $257,580

Health Services for Persons Who Inject Drugs $150,000

Alameda County Asthma Start $100,000 16

Measure A Appropriation & Revenue ($31.5 M)

Administration and Indigent Health $17,492,081Primary Care CBOs $5,370,494

Non-County Hospitals (UCSF Benioff Children’s & St. Rose Hospitals) $3,500,000

Youth and Family Opportunity Initiatives $2,597,818

School Health Centers & School-Based Behavioral Health $2,580,140

Countywide Plan for Seniors (Hospice, Injury Prevention, Meals/Nutrition) $1,000,000

EMS Corps $604,942

EMS Injury Prevention & Senior Injury Prevention Programs $325,112

Health Enrollment for Children $300,000

Health Services for Day Laborers $267,903

Juvenile Justice Health Services $244,963

Direct Medical & Support Services $214,322

Health Services for Unaccompanied Immigrant Youth $164,902

Alameda Boys & Girls Club $107,161

Center for Early Intervention on Deafness $53,581

Center for Elders’ Independence $53,581

City of San Leandro Senior Services $53,581

Fremont Aging & Family Services $53,581

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Measure A Appropriation & Revenue ($31.5 M)

FY 16-17 Human ImpactsImproving Health Safety Net System Alameda County Care Connect to Provide Whole Person Care

HCSA awarded $140 million for the pilot to improve integration of services across multiple sectors and strengthen the countywide system

Aims to help an estimated 20,000 patients move from conditions of crisis and acute care toward increased stability and wellness

Seeks to transition 600 chronically homeless clients into housing and providing more than 1000 clients with tenancy sustaining services

Impact to Clients/Alameda County 29,000 members currently enrolled in HealthPAC

HealthPAC’s Hepatitis C Virus (HCV) Campaign achievements to date:

More than 32,000 HCV tests conducted

932 patients identified with chronic HCV

326 patients completed treatment and nearly all were cured

Application Assistance 3,600 residents received application assistance (Jul. 2016 - Jan. 2017) 18

FY 16-17 Human Impacts Children’s Behavioral Health

Impact to Clients/Alameda County Contract developed with lead administrative psychiatrist for review of

psychotropic medications.

Guidelines and procedure for review of psychotropic medication for foster youth being finalized.

Impacts to Providers and Program Services 2-year contract awarded to Jewish Family and Community Services to

implement and evaluate Early Childhood Consultation.

System Coordination and Collaboration Primary Care and BHCS Integration Conference planned for June 1, 2017

Medi-Cal 101 training presentation to providers by end of FY 16-17

Assess and contract with Short Term Residential Therapeutic Programs (STRTPs) based on future CFS/Probation placements

Assess need for additional mental health services for youth in foster homes including Therapeutic Foster Care

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FY 17-18 Human Impacts Changes to Affordable Care Act

Status of ACA Changes American Health Care Act failed in House of Representatives.

Administrative changes by HHS Secretary Tom Price to regulations and how ACA is administered may impact number of currently insured residents.

Federal Budget proposes cuts to Health and Human Services.

Impact to Patients Approximately 105,000 newly eligible residents enrolled in Medi-Cal and

64,000 residents enrolled through Covered California due to ACA.

Profile of Medicaid Coverage Expansion enrollees include 52% young adults (19-39), 34% adults (40-59) and 14% seniors (60+).

Impacts to Providers and Program Services Local economy and safety-net providers received estimated $300M from

Medi-Cal expansion.

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2016-2017 ACCOMPLISHMENTS Local Agency Management Program (LAMP) approved by Board to submit

to State Water Board for approval

Nutrition Services awarded “Best 3-Year Integrated Work Plan” by California Department of Public Health

Public Health lab added new state-of-the-art laboratory tests for HIV, STDs, measles and enteroviruses

Continued expansion of services for Older Adults, including Public Health Nurses in Adult Protective Services and In-Home Support Services (IHSS)

Stabilized overcrowding issues at John George Psychiatric Hospital in partnership with Alameda Health System

Assisted Outpatient Treatment, Community Conservatorship and IHOT programs begun July 1, 2016

Stabilized mental health care for Asian Pacific Islander community in partnership with Asian Health Services

Awarded $140M Whole Person Care Pilot and $17M Dental Transformation Initiative grants in partnership with safety net providers 21

Potential changes to Affordable Care Act

Implementation of 2020 Medicaid Waiver provisions

Impact of housing crisis on the health of vulnerable populations

Financial viability of 911 Emergency Response System

Rate increases to providers insufficient to cover costs

Ongoing budget gaps and loss of revenue threaten program sustainability

Monitoring of labeling and production of cannabis products

HCSA leadership transitions, succession planning, new leadership mentoring and ongoing team development

2017-2018 CHALLENGES & PRIORITIES

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Health Care Services AgencyFY 16/17 Budget Presentation

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ALAMEDA COUNTYHEALTH CARE SERVICES AGENCY

Questions

Documents

Board of Supervisors Early Budget Work Session FY2017... · Profile of Medicaid Coverage Expansion enrollees include 52% young adults (19-39), 34% adults (40-59) and 14% seniors (60+)