City and County of San Francisco MCAH Budgetary Effects of Replacing TCM with FFP MCAH Action, 5/20/2015 MCAH Director Mary Hansell, DrPH, RN, & Chief Fiscal Analyst Joshua Nossiter The goal was to both integrate and expand the reach of our programs while minimizing the burden on local general funds. Where TCM Field Nursing, NFP, and MCAH were three, we made them one.

Added 30 TCM and NFP staff Increased average MCF from 48% to 74%

Local funds more than doubled FFP nearly quadrupled

TCM Revenues vs FFP Revenues Prior years TCM revenues budgeted at 37% of total Field Nursing Unit expenses; current FFP Revenues budgeted at 44% of total expenses 12-13 TCM revenue actuals (last representative year) were 33% of total Field Nursing expenses; YTD MCAH 14-15 FFP actuals are 43% of total MCAH expenses

The Halo Effect on the Budget Larger number of high MCF staff and “program” MCFs along with base MCF lead to: Higher rate of match for non-salary expenses, and indirect expense driven revenue, which contribute to the halo effect 40% increase in rate of budgeted FFP reimbursement of total MCAH expenses in 14-15 over 13-14 (45% to 32%) Estimated savings to county general fund in FY 2015 = more than $500,000 Consider budgeting true costs of rent, indirect, other costs to fully capture program expenses