Health Services Department FY Budget Challenges February 16 th, 2010

Revenue Outlook Department Expenses Budget Challenges Summary Outline

Revenue Outlook Department Expenses Budget Challenges Summary Outline

General Fund 99% Grants 1% $ 45.1 Million Revenue Outlook

Health Services Divisions –Corrections Health Services –PCAN/Orange County Medical Clinic –Mosquito Control –Medical Examiner –Emergency Medical Services

Revenue Outlook Department Expenses Budget Challenges Summary Outline

Mandated PCAN Other Department Expenses 43% 44% 13%

Mandated Department Expenses 43% Medicaid (15M) HCRA (500K) Medical Examiner (2.7M)

PCAN Department Expenses 44% PCAN (14.2M) OCMC (4.5M) Pharmacy (1M)

Other Department Expenses 13% Mosquito Control (1.7M) EMS Office (1.4M) HSD Office (700K) Public Health Unit (1.8M)

Revenue Outlook Department Expenses Budget Challenges Summary Outline

$ 44.6 Million Budget Challenges 7% Reduction = $ 3.1 Million

$ 44.6 Million $19M Mandated $19.7M PCAN Budget Challenges $ 25.6 Million 3.1M = 12% $ 5.9 Million 3.1M = 53%

Budget Challenges Primary Care Access Network Medicaid

Budget Challenges Medicaid

Budget Challenges Inpatient hospitalization in excess of 10 days, but not in excess of 45 days Nursing home care in excess of $170 per month May not exceed $55 per month per person

Economy Need for Services Budget Challenges

Budget Amendment of $ 6M

Monthly Medicaid Expense in Millions Budget Challenges $ 1.4 M

AHCA proposal: Increase Medicaid nursing home cost to counties Budget Challenges $ 3 Million

Budget Challenges Medicaid Refugee Medical Assistance Children & pregnant women Adults or couples without children

LegislationEconomy $ 20 Million Medicaid Budget Challenges

Primary Care Access Network

37% Increase PCAN Patients in Thousands Budget Challenges

Primary Care Secondary Care $ 6M Budget Challenges

Uninsured Other 62% 11% 27% PCAN Primary Care Budget Challenges

Uninsured 62% County Dollars support the uninsured 16% of total PCAN primary care funding PCAN Primary Care Budget Challenges

Closing of Alafaya clinic Eliminate almost 10,000 appointment slots Close some pharmacies Eliminate physician/ARNP positions Community Health Centers, Inc. 7% Budget reduction = Budget Challenges

PCAN Clinic Sites

Secondary Care –“Expanded exclusion list” implemented in July 2008 due to projected budget shortfall –Fewer patients receiving specialist referrals, diagnostic tests, specialty procedures PCAN Secondary Care (6M) Budget Challenges

Mosquito Control

Mosquito Control Budget –1% reduction = 5.5% reduction in Pesticides Budget Challenges

First outbreak of Dengue in Florida in 50 years Disease can range from mild to life threatening Budget Challenges

Revenue Outlook Department Expenses Budget Challenges Summary Outline

Summary 43% of HSD budget covers mandated expenses Mandated expenses likely to increase 7% reduction to overall budget equals 53% if Mandated and PCAN removed Mosquito Control budget reductions not recommended

Summary Reducing HSD budget by 7% will require significant reductions in PCAN: –Closure of one or more clinic sites –Loss of approximately 10,000 appointment slots –Limiting coverage to fewer conditions –Reducing provider reimbursement –Enrollment cap