Budget Hearings June 26, 2017 Rebecca Gebhart, HCSA Interim - - PowerPoint PPT Presentation

FY 2017-2018 Board of Supervisors Budget Hearings

ALAMEDA COUNTY HEALTH CARE SERVICES AGENCY

June 26, 2017 Rebecca 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 residents

MISSION

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Health Care Services Agency FY 17-18 Budget Summary* ($ in millions)

FY 16-17

Final Budget

FY 17-18 VBB Change from FY 16-17 Amount %

Appropriation $728.38 $766.80* $38.42 5.27% Revenue $594.18 $629.96 $35.78 6.02% Net County Costs $134.20 $136.84 $2.64 1.97% FTE-Mgmt 515.39 543.56 28.17 5.47% FTE-Non-Mgmt 995.94 1,010.59 14.65 1.47% Total FTE 1,511.33 1,554.15 42.82 2.83%

*Includes Vector Control ($6.38M) & EMS Special District ($21.83M) = $28.21M, IGT ($24.85M) and Non-AHS Measure A ($31.50M) Change in HCSA FTE (Full-Time Equivalents) by department: Admin/Indigent Health (29.5); BHCS (10.7); Environmental Health (0); Public Health (2.7)

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To achieve health equity by respecting the collective knowledge of our diverse communities, developing high quality, integrated and responsive health safety net systems and initiatives and catalyzing partnerships for the well-being of our residents

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MISSION

OFFICE OF THE

AGENCY DIRECTOR

Office of the Agency Director FY 17-18 Budget Summary* ($ in millions)

FY 16-17 Final Budget FY 17-18 VBB Change from FY 16-17 Amount %

Appropriation $151.73 $168.82* $17.09 11.26% Revenue $90.98 $109.03 $18.05 19.84% Net County Costs $60.75 $59.79 ($.96) (1.58%) FTE-Mgmt 78.15 95.65 17.50 22.39% FTE-Non-Mgmt 71.39 83.40 12.01 16.82% Total FTE 149.54 179.05 29.51 19.73%

*Includes Measure A for Office of the Agency Director ($17.49M) and Board of Supervisors ($750K); Medical Care Financing ($24.86M); and EMS Special District ($21.83M)

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Maximize the recovery, resilience and wellness of all eligible Alameda County residents who are developing or experiencing serious mental health, alcohol or drug concerns

MISSION

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Behavioral Health Care Services FY 17-18 Budget Summary* ($ in millions)

FY 16-17 Final Budget FY 17-18 VBB Change from FY 16-17 Amount %

Appropriation $431.59 $449.88* $18.29 4.24% Revenue $394.52 $411.66 $17.14 4.34% Net County Costs $37.07 $38.22 $1.15 3.10% FTE-Mgmt 202.16 208.32 6.16 3.05% FTE-Non-Mgmt 386.56 391.06 4.5 1.16% Total FTE 588.72 599.38 10.66 1.81%

*Includes Measure A appropriation and offsetting revenue ($8.03M)

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Work in partnership with the community to ensure the

• ptimal health and well being of all people for both present

and future generations

MISSION

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

FY 16-17 Final Budget FY 17-18 VBB Change from FY 16-17 Amount %

Appropriation $106.99 $109.11* $2.12 1.98% Revenue $74.28 $74.55 $.27 .36% Net County Costs $32.71 $34.56 $1.85 5.66% FTE-Mgmt 199.08 203.59 4.51 2.27% FTE-Non-Mgmt 385.42 383.56

• 1.86

.48% Total FTE 584.50 587.15 2.65 .45%

*Includes Measure A appropriation and offsetting revenue ($5.23M)

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To protect the health, safety and well-being of the public through the promotion of environmental quality

MISSION

Environmental Health

Photo courtesy of Aroon Karuna

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

FY 16-17 Final Budget FY 17-18 VBB Change from FY 16-17 Amount %

Appropriation $38.07 $38.99* $.92 2.42% Revenue $34.40 $34.71 $.31 .90% Net County Costs $3.67 $4.28 $.61 16.62% FTE-Mgmt 36.00 36.00 0% FTE-Non-Mgmt 152.57 152.57 0% Total FTE 188.57 188.57 0%

*Includes Vector Control Special District ($6.38M)

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Board of Supervisors Discretionary Health Services $750,000 Behavioral Health Care Services $8,026,443

Criminal 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 $5,231,476

Public 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

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Measure A Appropriation & Revenue ($31.5 M)

Office of the Agency Director $17,492,081

Primary 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)

$3,600,000 Home Visiting Services $3,000,000 EMS 5150 Transport Services $1,000,000 La Clínica de La Raza, Inc. (Dental Clinic Expansion Project) $400,000 The Unity Council (Latino Boys and Men Program) $246,048 Community Paramedicine Pilot Program $229,337 Healthy Homes Department (Fixing to Stay & Group Living Facilities) $188,386 Connecting Kids to Coverage Initiative $150,000 HIV Education Prevention Project of Alameda County $100,000 Food as Medicine Initiative $100,000 LifeLong Medical Care (Heart 2 Heart) $100,000 Nutrition Services in West Oakland $100,000 Roots Consulting $71,535 Youth UpRising $50,000 Eden Youth and Family Center $50,000 Getting the Most Out of Life (GMOL) $35,000 Native American Health Center $20,000 Southern Alameda County Comite for Raza Mental Health

$9,440,306

Measure A One-Time Allocations Approved in FY 16-17

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HCSA FY 17-18 VBB REDUCTION STRATEGIES

Reduction Strategy NCC Savings

Use of Fiscal Management Rewards $7.0M Decreases in Appropriation for Contracted Services $4.59M Reduction in Alameda Health System contract $4.0M Increased revenues for Substance Use Disorder Quality Assurance/Utility Review, Medi-Cal services for Inmates, and California Children’s Services Program $2.29M Tobacco Master Settlement Revenue $1.0M Elimination of Vacant Funded Positions $.26M Increased Environmental Health revenue $.15M

TOTAL $19.3M

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• 1991 Mental Health Realignment Growth is

shifted as part of In-Home Supportive Services (IHSS) solution

• Community Health Center use of contract

pharmacy

• Proposition 56 funding for Medi-Cal

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• Potential repeal of Affordable Care Act and changes to Medicaid
• Implementation of 2020 Medicaid Waiver pilots
• 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 and deplete reserves

• 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 Agency FY 16/17 Budget Presentation

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ALAMEDA COUNTY HEALTH CARE SERVICES AGENCY

Thank You and Questions

Human Impact on Safety Net Providers

• Safety Net providers

destabilized across county

• $300M revenue lost from

ACA for providers

• 480 jobs lost from the

community clinics alone

• Physicians
• Clinicians
• Nurses
• Medical assistants
• Social Workers
• Substance Abuse Counselors
• Administrative Staff

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Human Impact on Individuals & Families

• 160,000 insured residents could

lose coverage

• Forgo coverage due to higher

costs

• Longer wait times
• Not access early and timely

preventive care

• Pay more for less coverage
• Use more expensive, urgent care

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Human Impact on Communities

• Local economy destabilized
• $600M loss in gross domestic

product in Alameda County

• 6,000 job losses in Alameda

County

• Local tax revenue losses
• Losses to healthcare industries

and other industries that provide services to or benefit from healthcare spending

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