HEALTH CARE SERVICES AGENCY Alex Briscoe, Agency Director BOS - PowerPoint PPT Presentation

ALAMEDA COUNTY HEALTH CARE SERVICES AGENCY Alex Briscoe, Agency Director BOS Budget Hearing  June 23, 2014 

HCSA MISSION STATEMENT The Mission of the HCSA is to 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. 2

Alameda County Health Care Services Agency Office of the Director Finance & Administration, Fund Development, Human Resources Medical Director, Policy, Compliance, Evaluation HCSA Behavioral Public Health Environmental Administration/ Health Care Health Services Indigent Health Services Indigent Health Care Office of the Director Administration Administration Services/ Health Officer HealthPAC Environmental Health Communicable Outpatient Services 24 Hour Administrative School Health Disease Control Services Services Services Services & Prevention Vector Control Cross-Departmental/ Referral Support Family Health Services Community Services Services Cross-Jurisdictional Services Health Services Health Services U.C. Cooperative Day Public Health Ancillaries Emergency Extension Treatment Nursing Medical Services Outreach Office of AIDS 3

HCSA FY 14/15 VBB Summary* (in millions) Final Change from Approved VBB FY 12/13 Budget FY 13/14 FY 14/15 Amount % Appropriation $682.91 $642.30 ($40.61) (5.95%) Revenue $571.95 $523.70 ($48.25) (8.44%) County General Fund $110.96 $118.60 $7.64 6.88% Use of one-time savings $15.00 $14.00 ($1.00) (6.67%) (recycled County General Fund) Continued County General Fund $95.96 $104.60 $8.64 9.00% Support FTE-Mgmt 460.42 478.83 18.41 4.00% FTE-Non Mgmt 975.88 982.83 6.95 0.71% Total FTE+ 1,436.30 1,461.67 25.36 1.77% * Includes Measure A appropriation & offsetting revenue = $28.68M 4 + Does not include TAP and Contracted personnel of approximately 3,553 FTE

HCSA FY 14/15 VBB HCSA closed the $23.7 million reduction target in the following manner:  Use of FMR = $14 million  Increase in revenue = $6.3 million  Reduction in appropriation of contracts, contract right sizing, and reductions in services and supplies = $1.1 million  Institution for Mental Diseases reductions= $1.1 million  One-time use of FY14/15 Measure A revenue to cover Primary Care indigent health CBO contracts = $.5 million  Reduction in AHS (ACMC) indigent contract = $.5 million  Elimination of 2 FTEs = $.2 million 5

HCSA FY 14/15 VBB By Department $ 642.30M* Agency Admin./ Indigent Health $95.68M 14.90% Public Health $127.13M 19.79% Behavioral Health Care Services Environmental $392.40M Health 61.09% $27.09M 4.22% *Includes Measure A appropriation = $28.68M 6

HCSA FY 14/15 Alameda Health System Contracts FY 13/14 Final FY 14/15 Change from FY 13/14 Alcohol & Drugs $851,856 $881,117 $29,261 Community Health $11,075 $160,000 $148,925 Emergency Medical $5,671,383 $5,661,383 ($10,000) HIV/AIDS Services $389,083 $610,000 $220,917 Indigent Health $88,674,988 $34,040,728 ($54,634,260) Mental Health $35,101,573 $35,955,605 $854,032 Public Health Nursing $10,000 $25,500 $15,500 TOTAL $130,709,958 $77,334,333 ($53,375,625) 7

HCSA FY 14/15 VBB Summary of Revenue by Department $523.70M Revenue = 81.5% of Budget Agency Admin./ Indigent Health Public Health $38.95M $100.46M 7.44% 19.18% Behavioral Environmental Health Care Health Services $24.56M $359.73M 4.69% 68.69% Revenue covers   91.7% of BHCS Budget 40.7% of Admin/Indigent Budget   79.0% of PH Budget 90.7% of EH Budget 8

HCSA FY 14/15 VBB Total Budget = $642.30M General Fund = $118.60M Generated Revenue = $523.70M County General Fund $118.60M 18.46% Revenue Generated by HCSA Departments $523.70M 81.54% 9

HCSA FY 14/15 VBB Summary of County General Fund by Dept $118.60M CGF = 18.5% of Budget Behavioral Health Care Services $32.67M Agency Admin./ 27.54% Indigent Health $56.74M Environmental 47.84% Health $2.53M 2.13% Public Health $26.66M 22.48% General Fund covers   8.32% of BHCS Budget 59.30% of Admin/Indigent Budget   20.98% of PH Budget 9.33% of EH Budget 10

Behavioral Health Care FY 14/15 VBB Summary* (in millions) Final Change from Approved VBB FY 13/14 Budget FY 13/14 FY 14/15 Amount % Appropriation $385.46 $392.40 $6.94 1.80% Revenue $351.01 $359.73 $8.72 2.48% County General Fund $34.45 $32.67 ($1.78) (5.19%) Use of FMR $4.42 $4.13 ($.29) (6.67%) Continued County General Fund $30.03 $28.54 ($1.49) (4.97%) Support FTE-Mgmt 189.33 190.92 1.58 0.84% FTE-Non Mgmt 387.27 384.67 (2.60) (0.67%) Total FTE+ 576.6 575.59 (1.02) (0.18%) * Includes Measure A appropriation & offsetting revenue = $7.52M + Does not include CBO, ACMC, TAP and other contracted FTEs 11

Behavioral Health Care FY 14/15 VBB By Major Programmatic Spending Category $392.40M * Ancillary Narcotic Day Outreach Programs Treatment Treatment Programs $1.20 Program $34.55M Innovation $8.54M 24 Hour 0.3% $7.42 8.8% $6.07M 2.2% Services 1.9% 1.5% $73.72M 18.8% Referral Services Support $7.94M Services 2.0% $13.86M 3.5% Outpatient Prevention Services Administration Services $183.65M $41.28M $14.17M 46.8% 10.5% 3.6% *Includes $7.52M in Measure A appropriations 12

Behavioral Health FY 14/15 VBB By Population Served $ 392.40M * Transitional Age Youth Children's Services Services $11.34 $143.80 2.9% 36.6% Older Adult Adult Services Services $225.82 $11.43 57.5% 2.9% 13 *Includes $7.52M in Measure A appropriations

Behavioral Health 2011 Realignment (aka Public Safety Realignment) FY13-14 VBB FY14-15 VBB Budget Budget Variance Women & Children’s Residential $687,665 $687,665 0 Treatment Drug Court $1,062,586 $1,062,586 0 Non Drug Medi-Cal Substance Abuse Treatment $281,694 $281,694 0 Drug Medi-Cal $6,013,339 $6,013,339 0 Healthy Families $417,514 $417,514 0 New Katie A $1,677,959 $1,677,959 0 EPSDT Base $37,911,718 $37,911,718 0 Mental Health $5,001,628 $5,001,628 0 Managed Care Total 0 $53,054,103 $53,054,103 The FY14-15 2011 Realignment budget is currently flat; there may be changes during the FY14-15 year which will be budgeted as an adjustment. 14

Public Health FY 14/15 VBB Summary* (in millions) Final Change from Approved VBB FY 13/14 Budget FY 13/14 FY 14/15 Amount % Appropriation $125.82 $127.13 $1.31 1.04% Revenue $99.17 $100.46 $1.29 1.30% County General Fund $26.65 $26.67 $.02 .08% Use of FMR $3.61 $3.37 ($.24) (6.65%) Continued County General Fund $23.04 $23.3 $.26 1.13% Support FTE-Mgmt 209.92 223.92 14.00 6.67% FTE-Non Mgmt 427.22 434.60 7.38 1.73% Total FTE+ 637.13 658.52 21.38 3.36% * Includes Measure A appropriation & offsetting revenue = $4.09M 15 + Does not include TAP and Contracted personnel of approximately 190.61 FTE

Public Health FY 14/15 VBB By Major Programmatic Spending Category $127.13M Administrative Office of Public Health Services Director Emergency Nursing $6.63M $2.61M Medical Services $7.57M 5.2% 2.1% $31.22M 6.0% 24.6% Communicable Disease Control & Prevention $22.61M 17.8% Community Family Health Health Services Services $19.45M $37.04M 15.3% 29.1% 16 *Includes $4.09M in Measure A appropriations

Administration/Indigent Health FY 14/15 VBB Summary* (in millions) Final Change from Approved VBB FY 13/14 Budget FY 13/14 FY 14/15 Amount % Appropriation $146.01 $95.68 ($50.33) (34.47%) Revenue $98.65 $38.94 ($59.71) (60.53%) County General Fund $47.36 $56.74 $9.38 19.81% Use of FMR $6.69 $6.24 ($.45) (6.73%) Continued County General Fund $40.67 $50.50 $9.83 24.17% Support FTE-Mgmt 32.17 34.00 1.83 5.70% FTE-Non Mgmt 35.83 39.00 3.17 8.84% Total FTE+ 68.00 73.00 5.00 7.35% * Includes Measure A appropriation & offsetting revenue = $17.07M. 17 + Does not include TAP and Contracted personnel of approximately 463.93 FTEs.

Administration/Indigent Health FY14/15 VBB By Major Programmatic Spending Category $95,683,653* Leadership, Administration & Finance** $11.09 11.6% Cross- Dept./Cross- Jurisdictional Indigent Services Health $21.87M Services 22.9% $62.72M 65.5% * Includes Measure A appropriation = 17.07M; also includes Human Resources 18 **Human Resources is included in Leadership, Finance & Administration

HCSA 14/15 1991 Realignment 1991 Realignment Funded Indigent Health (81%) and Non-Indigent Health (19%) Non-Indigent Indigent $70 Realignment Funding ($M) $60 $55.6 $52.3 $52.3 $51.7 $49.4 $50 $40.3 $40 $30 $20 $9.7 $10 $0 FY08/09 FY09/10 FY10/11 FY11/12 FY12/13 FY13/14 FY14/15 19

Environmental Health FY 14/15 VBB Summary* (in millions) Final Change from Approved VBB FY 13/14 Budget FY 13/14 FY 14/15 Amount % Appropriation $26.36 $27.09 $.73 2.77% Revenue $23.87 $24.56 $.69 2.89% County General Fund $2.49 $2.53 $.04 1.61% Use of FMR $.28 $.26 ($.02) (7.14%) Continued County General Fund $2.21 $2.27 $.06 2.71% Support FTE-Mgmt 29.00 30 1 3.45% FTE-Non Mgmt 125.56 124.56 (1) (.8%) Total FTE+ 154.56 154.56 0 0% *Includes Vector Control Special District = $5.76M 20