1. HEALTH AND FAMILY SERVICES DEPARTMENT FY 2008-09 Budget Worksession July 22, 2008

2. Organization Chart Proposed FY 08-09 Budget Budget Overview Significant Future Issues Summary of Unfunded Needs PRESENTATION OUTLINE

3. Organization Chart Proposed FY 08-09 Budget Budget Overview Significant Future Issues Summary of Unfunded Needs PRESENTATION OUTLINE

4. ORGANIZATION CHART Department Director Larry Jones Deputy Director Ella J. Gilmore Community Action Karl Anderson Cooperative Extension Glinder Stephens Head Start Cathleen Armstead Mosquito Control Tom Breaud History Center Sara Van Arsdel ADA Coordinator Samme Ripley Deputy Director Pete Clarke Citizens Commission Tyra Witsell Medical Examiner Jan Garavaglia MD Corrections Medical Donna Loyko Youth & Family Services Syd McCallister Medical Clinic/PCAN Margaret Brennan Fiscal Yolanda Brown Office on Aging Mimi Reggentin EMS Medical Director George Ralls MD Human Resources Marya Labrador Mental Health & Homelessness Donna Wyche

5. Organization Chart Proposed FY 08-09 Budget Budget Overview Significant Future Issues Summary of Unfunded Needs PRESENTATION OUTLINE

6. PROPOSED FY 08-09 BUDGET Current FY 08$ Change Proposed FY 09 Total Budget$136.9M($18.4M)$118.5M General Fund Budget$85.4M($3.2M) $82.2M Staffing828(14)814

7. PROPOSED FY 08-09 BUDGET (General Fund) Current FY 08$ Change Proposed FY 09 Personal Services$24.8M($0.4M)$24.4M Operating Budget$60.6M($2.8M)$57.8M Budget Change-3.7% Staffing433(15)418

8. Current FY 08$ Change Proposed FY 09 Capital Improvement Projects $18.5M($18.4M)$0.1M Budget Change-99.5% PROPOSED FY 08-09 BUDGET

9. Organization Chart Proposed FY 08-09 Budget Budget Overview Significant Future Issues Summary of Unfunded Needs PRESENTATION OUTLINE

10. Mandated Costs Mandated Costs are $22.1M 27% of General Fund Budget BUDGET OVERVIEW

11. Mandated Costs Child Protection Exams-$176,000 Exams for suspected child abuse Medicaid Match-$9.3M inpatient and nursing home costs Health Care Responsibility Act- $225,000 Payment to out of county hospitals for emergency care of Orange County indigents Burial Program- $204,000 indigent burials BUDGET OVERVIEW

12. Mandated Costs Medical Examiner - $3.62M Required by Florida Statutes Chapter 406 Increasing workload Osceola County share 18% BUDGET OVERVIEW

13. Mandated Costs DJJ Cost Shift- $8.6M Counties are charged a per- diem rate for each pre- disposition day a juvenile is in secure detention County has no control over rates or expenditures BUDGET OVERVIEW

14. 20042009

15. BUDGET OVERVIEW 20042009

16. BUDGET OVERVIEW

17. General Fund and Grants Total $115.9M BUDGET OVERVIEW

19. 10.4% - Neighborhood Centers for Families -After School Zone -Contract Oversight $12.1M

20. Citizens Commission for Children Established in 1989 as an alternative to Juvenile Welfare Board 10-member board Mission was to fund and monitor services for children, youth and families BUDGET OVERVIEW

21. Citizens Commission for Children Funds 13 Neighborhood Centers for Families Funds 26 middle schools for the After School Zone Manages the Citizens Review Panel BUDGET OVERVIEW

22. Citizens Commission for Children After School Zone Started in 1999 to respond to increase in juvenile crime and violence Funded by Orange County Managed through contracts with YMCA and Boys and Girls Club County Funding since inception - $28.6 M BUDGET OVERVIEW

24. Citizens Commission for Children After School Zone Effect of School Board Time Change Doubles program hours Maintaining current model requires an additional $1.6M (2 additional hours) No prior discussions with the County BUDGET OVERVIEW

25. Citizens Commission for Children After School Zone (contd) Options for cost reductions: Cap enrollment Reduce transportation services Eliminate field trips End the program at 5:30pm instead of 6:00pm Reduce two weeks for the Summer Zone Discussions ongoing with OCPS

26. BUDGET OVERVIEW -GOV -Shelter -Crisis/FRP -Veterans -DJJ -Ryan White $32.7M 32.1%

27. Youth and Family Services A Safety Net for Children and Families Crisis and Long Term Family Assistance Residential Services Counseling and Case Management Home Based Services Ryan White Veterans Services BUDGET OVERVIEW

28. Youth and Family Services Crisis and Long Term Family Assistance (Welfare Revolving Fund) Crisis Assistance Program - Short term assistance providing one time rental/mortgage payment, utilities to prevent homelessness Family Resource Program - Case Management and temporary financial support for long term self-sufficiency BUDGET OVERVIEW

30. Youth and Family Services Welfare Revolving Fund FY 06-07 45,000 calls 80% eligible based on prescreening 5% assisted (2,622 families) Call volume up 20% in FY 07-08 Costs per client increasing Funding history $2M FY 96-97 $1M FY 08-09 BUDGET OVERVIEW

31. Youth and Family Services Residential Services GOV Youth Shelter Family Preservation Family Counseling Delinquency Supervision BUDGET OVERVIEW

32. Youth and Family Services Current issues Children requiring more complex and cost intensive services State funds for child welfare continues to be reduced limiting options for children Working to match County resources with community needs Seeking appropriate grant increases Continuing strong public/private partnerships BUDGET OVERVIEW

33. - PCAN -Pharmacy -Specialty Care -Medicaid Match -Internal Medicine -Volunteers -Case Management $28.5M 24.6%

34. BUDGET OVERVIEW

35. Program Growth BUDGET OVERVIEW

36. Primary Care Hypertension Diabetes Asthma Heart Disease Acute Care Secondary Care Cancer Cardiology Orthopedics Diabetes Gastroenterology Primary Care Access Network BUDGET OVERVIEW Top 5 Diagnosis

37. Primary Care Access Network (PCAN) Number of uninsured continue to grow Partners are financially pressured due to reduced Medicaid reimbursement rates Funding has remained static for many years May be able to use IGT if cap room exists BUDGET OVERVIEW

38. More uninsured More health care plans being rolled back Cost of services increasing PCAN funding flat until last years $1M dollar reduction PCAN at a critical juncture Patients facing health care decisions vs. living expenses BUDGET OVERVIEW Primary Access Care Network (PCAN)

39. Impact on PCAN services Cap patient enrollment Limit specialty services Consolidate clinics/services Limit dollar value of services Curtail diagnostics/labs BUDGET OVERVIEW Primary Care Access Network (PCAN)

40. BUDGET OVERVIEW -Class Rooms -Transportation -Social Services -Nutrition Services -Special Needs $14.6M 12.6%

41. Comprehensive services provided for 1,536 children Educational Curriculum Transportation Health Services Special Needs Services (10% required) BUDGET OVERVIEW Head Start

42. BUDGET OVERVIEW HEAD START CENTERS

43. Maintains High Quality Services Earned and maintains National Accreditation Increase Recruitment of Volunteers Head Start Center BUDGET OVERVIEW

44. Challenges Federal Reauthorization Act Priority on homeless children Enhanced teacher credentials Increased transportation, food and other operational costs Children served have more severe needs Head Start BUDGET OVERVIEW

45. Responses to Challenges Re-assignment and Cross Training of Staff Increase Internal Monitoring Reduction of Transportation Routes Continue to Maximize Efficiencies BUDGET OVERVIEW Head Start

46. Organization Chart Proposed FY 08-09 Budget Budget Overview Significant Future Issues Summary of Unfunded Needs PRESENTATION OUTLINE

47. SIGNIFICANT FUTURE ISSUES Economy continues to weaken Increasing stress on individuals and families –Financial –Emotional –Physical Demands on social services will continue to increase

48. SIGNIFICANT FUTURE ISSUES PCAN Housing Assistance Citizens Commission for Children Central Receiving Center – Phase 2 Welfare Revolving Fund $518,327 $688,624 $317,220 $206,000 $1,211,450 $2,941,621 FY 07-08 - Funding for Homeless

49. SIGNIFICANT FUTURE ISSUES Strategies for Addressing Increased Service Demands Review contract compliance Prioritize Services Consolidate Services Consider privatization Seek More Funding!

50. Organization Chart Proposed FY 08-09 Budget Budget Overview Significant Future Issues Summary of Unfunded Needs PRESENTATION OUTLINE

51. After School Zone - $1.6M To totally fund additional two hours a day Will bring back to the BCC in August or September Several options are available SUMMARY OF UNFUNDED NEEDS

52. Crisis Assistance - $1.2M Increasing demand in worsening economic conditions Currently meeting 5% of need In place, well functioning system to help residents avoid homelessness SUMMARY OF UNFUNDED NEEDS

53. PCAN - $2.8M Community based system of care for our increasing number of uninsured Clinic partners are feeling financial strain Funding needs may cause enrollment caps and/or reductions in specialty/diagnostic care SUMMARY OF UNFUNDED NEEDS

54. After School Zone $1.6M Crisis Assistance $1.2M PCAN $2.8M SUMMARY OF UNFUNDED NEEDS Total $5.6M

55. HEALTH AND FAMILY SERVICES DEPARTMENT FY 2008-09 Budget Worksession July 22, 2008