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

ALAMEDA COUNTY HEALTH CARE SERVICES AGENCY FY 2017-2018 Board of Supervisors Budget Hearings June 26, 2017 Rebecca Gebhart, HCSA Interim Director

VISION Health Equity through the goals of Healthy People , Healthy Places , Healthy Policies and Healthy Systems 2

MISSION 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 3

Health Care Services Agency FY 17-18 Budget Summary* ($ in millions) FY 16-17 FY 17-18 Change from FY 16-17 Final Budget VBB 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: 4 Admin/Indigent Health (29.5); BHCS (10.7); Environmental Health (0); Public Health (2.7)

O FFICE OF THE A GENCY D IRECTOR MISSION 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 5

Office of the Agency Director FY 17-18 Budget Summary* ($ in millions) FY 16-17 FY 17-18 Change from FY 16-17 Final Budget VBB 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) 6

MISSION Maximize the recovery, resilience and wellness of all eligible Alameda County residents who are developing or experiencing serious mental health, alcohol or drug concerns 7

Behavioral Health Care Services FY 17-18 Budget Summary* ($ in millions) FY 16-17 FY 17-18 Change from FY 16-17 Final Budget VBB 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) 8

MISSION Work in partnership with the community to ensure the optimal health and well being of all people for both present and future generations 9

Public Health FY 17-18 Budget Summary* ($ in millions) FY 16-17 FY 17-18 Change from FY 16-17 Final Budget VBB 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) 10

Environmental Health Photo courtesy of Aroon Karuna MISSION To protect the health, safety and well-being of the public through the promotion of environmental quality 11

Environmental Health FY 17-18 Budget Summary* ($ in millions) FY 16-17 FY 17-18 Change from FY 16-17 Final Budget VBB 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 0% FTE-Non-Mgmt 152.57 152.57 0 0% Total FTE 188.57 188.57 0 0% *Includes Vector Control Special District ($6.38M) 12

Measure A Appropriation & Revenue ($31.5 M) 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 13

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 14

Measure A One-Time Allocations Approved in FY 16-17 $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 15 $9,440,306

HCSA FY 17-18 VBB REDUCTION STRATEGIES NCC Reduction Strategy 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 $2.29M California Children’s Services Program Tobacco Master Settlement Revenue $1.0M Elimination of Vacant Funded Positions $.26M Increased Environmental Health revenue $.15M TOTAL $19.3M 16

 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 17

2017-2018 CHALLENGES & PRIORITIES  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 18

ALAMEDA COUNTY Health Care Services Agency HEALTH CARE SERVICES AGENCY FY 16/17 Budget Presentation Thank You and Questions 19

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 20

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 21

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 22