HEALTH AND HUMAN SERVICES BOARD
Wednesday, July 16, 2008
HHS Building Auditorium
5:00 p.m.
MEMBERS PRESENT: Sharon Hampson, Jill Billings, James Glasser, Tammy Gamroth, Margaret Wood, Bill Brockmiller, David Trapp
MEMBERS EXCUSED: Loren Kannenberg
MEMBERS ABSENT: Robert Erickson
STAFF & GUESTS: Jerry Huber, Doug Mormann, Dean Ruppert, Bill Adams, Jane Klekamp, Al Graewin, Gary Ingvalson, Linda Lee, Ron Berg, Kathleen Lund, Dave Geske, Renee Weston, Mary Ellen Prinsen, Lorie Mueller, Connie Eide, Laura Gambino
CALL TO ORDER
Meal served at 5:00 p.m. and the meeting was called to order at 5:30 p.m.
BUDGET OVERVIEW AND TWO-YEAR PLAN FOR THE COUNTY
Gary Ingvalson presented on La Crosse County’s 2009 Budget Preliminary Projections, Solutions and Direction. Challenges in 2009 include 2% levy limit, health insurance increases, wage settlement pattern, low investment interest rates, limited to no growth in sales tax revenue, slowing tax base growth, capital improvement needs for Highway and Lakeview, and several misc. increased cost items. Opportunities in 2009 include favorable bond rates, debt payoff/refinancing can be shifted to operating levy authority, health insurance fund in better position than estimated, strong financial position, Mississippi Valley Health Services collaboration saving levy costs, acceleration of debt payoff due to later Law Enforcement Center (LEC) debt issue, relocation of old landfill waste reducing liability.
Initial budget recommendations for 2009 include program and budget cuts (no new positions without outside revenue), split new LEC bond issue and change timing of payments, use 2008 budgeted LEC debt payment to payoff Hwy shop 3 years early, delay Highway capital improvement increase in 2010 spending to evaluate priorities and fund Highway capital at $2 million/year, use balance of old landfill for Highway capital, refinance 1998 LEC debt same term, lower health insurance % using health insurance fund and contingency, fees and charges, targeted use of reserves if necessary.
Two year preliminary plan reviewed. It was noted that this plan was prepared in June, so things may change. County Board imposed a debt freeze at .52 debt levy mill rate, which is the past eight years’ average. Percentage of levy comparison in 2008 at 3.78%, in 2009 estimated will be 5.45%, and in 2010 estimated will be 5.31%. The past nine years we have averaged 7.9% increases.
Departments and Administration are working on preparing budgets in July and August. Budget recommendations will be presented to committees in September.
HEALTH DEPARTMENT BUDGET DISCUSSION/OPTIONS
Doug Mormann presented including a review of the Department’s long-range plan, mission, vision, 2008 goals and objectives by division. Budget funding sources total around $5 million, 40% of this from local tax levy. Fund comparison of outside funding sources vs. fund expenditures for 2007 was discussed. Key policy considerations for 2009 and beyond include business continuity planning, home health mission change, national accreditation of Health Department, public health preparedness and reductions, and six identified current policy initiatives (alcohol prevention, dental care, obesity prevention, homeless wellness and healthcare, integrations of services, tobacco prevention).
Discussion on home health mission change that is necessary due to possibility of Care Management Organization (CMO)/Managed Care Organization (MCO) contracting for home health care services elsewhere for a lesser price. Health Department is looking to expand home health care to children and the mentally ill through the Human Services Department to make up for this loss. Regarding public health preparedness, a decision will have to be made when the federal funds run out to either begin spending county money to maintain the level of preparedness we have reached, or reduce spending and reduce the current level of preparedness we have obtained. Overview of COMPASS 3 needs assessment results showing six categories including 20 total items the public thinks we should be working on. Doug feels we need to do more in the areas identified under “conserve and protect our natural resources”.
HUMAN SERVICES BUDGET DISCUSSION/OPTIONS
Jerry Huber presented on major factors impacting the HS budget including federal/state budgets and statutes, demand for services, rising staff costs (health insurance), and current system of funding that relies on local property taxes. Some strategies being used by the Department for effective budgeting include forecasting and looking for multiple year trends, working proactively with the state/feds/legislature, involving stakeholders in budget process, thinking long-term, and taking calculated risks (ie creating Crisis Assessment Center to save on current inpatient treatment spending). Eighty-five percent (85%) of HS budget is dependent on state/federal funding.
For the 2009 budget, HS will hold their costs down to 2008 levels anticipating no increases in revenue or tax levy, no new positions unless authorized by County Administrator (CA), and no use of fund reserve other than for IT development until policy direction is received from CA. Jerry outlined the various budget issues for all sections of HS:
Admin: Possibility of S&F costs not being held harmless in CA budget; transition issues with the Managed Care Organization (MCO).
Care Management Organization: Transition issues with regional counties, county transition from indirect payments, MCO relationship with Mississippi Valley Health Services (MVHS), transition of home care from Health Dept, joint purchasing transportation with county, creation of Memorandums of Understanding (MOUs) with HS for services.
Economic Support: Continuation of Wisconsin Works, caseload issues with BadgerCare, addressing issues of child poverty.
Aging & Disability Resource Center: Transitional issues with regionalization and being the fiscal host, no benchmarks to base projections with new transition, uncertainty in staffing estimates.
Justice Sanctions: Continued funding of Drug and OWI courts apart from grants, women’s alternative projections without 1st year baseline, controlled expenses with use of monitoring equipment/drug kits.
Clinical: Corporate guardian costs, Process Improvement Team recommendations, concept of Crisis Assessment Center, limited budget to cover need, funding of Watts Reviews, availability of psychiatry, development of gender/cultural specific services, status of revenue to MVHS sum sufficient or sum certain.
Family & Children’s: Use of 62% of total HS levy request, programs mandated by government, $259,103 deficit at end of 2008. Stabilizing this section’s budget will be done by redesigning programs and services and reducing expenditures by reducing services and prioritizing/cutting non-mandated prevention programs.
Budget recommendations for HS and Health Departments will be presented to the HHS Board in September for input. David Trapp suggested “creatively” educating the public on the unmet needs in the area to increase awareness of the needy who are not receiving services due to budget limitations. Huber advised levy freezes trickle down from federal government to Madison to counties.
Studies have shown that communities with large tax bases are thriving and expanding.
ADJOURNMENT
The meeting was adjourned at 7:20 p.m.
Disclaimer: The above minutes may be approved, amended or corrected at the next committee meeting.
Renee Weston, Recorder