1. Health Services Department FY 2012-13 Budget Worksession July 16, 2012

2. Organization Chart Proposed FY 2012-13 Budget Accomplishments Budget Challenges Summary Presentation Outline

3. Organization Chart Proposed FY 2012-13 Budget Accomplishments Budget Challenges Summary Presentation Outline

4. Organization Chart Office of the Medical Director, EMS Medical Clinic/PCAN Margaret Brennan Medical Clinic/PCAN Margaret Brennan Mosquito Control Tom Breaud, Ph.D. Mosquito Control Tom Breaud, Ph.D. Corrections Medical Robert Buck, D.O. Corrections Medical Robert Buck, D.O. Medical Examiner Jan Garavaglia, M.D. Medical Examiner Jan Garavaglia, M.D. George Ralls M.D. Carol Burkett Office for Drug Free Community Carol Burkett Office for Drug Free Community

5. Organization Chart Proposed FY 2012-13 Budget Accomplishments Budget Challenges Summary Presentation Outline

6. Proposed FY 2012-13 Budget Current FY 2012$ Change Proposed FY 2013 Personal Services$8.9M($0.2M)$8.7M Operating Budget40.5M10.0M50.5M Budget Change20.1% Staffing134(4)130

7. Organization Chart Proposed FY 2012-13 Budget Accomplishments Budget Challenges Summary Presentation Outline

8. Accomplishments Access to Care: –Provided care for 106,838 uninsured Orange County residents –Over 132,000 patients visits Opened a Primary Care Clinic in Bithlo Grants Awarded to PCAN: –$100K from CHIC –$100K from BCBS of Florida Foundation –$786K from Health Facilities Authority Volunteers provided $8.8M in uncompensated care to the uninsured PCAN/OCMC

9. Conducted complaint investigations within 2 days 98% of the time Completed spray missions for adult mosquitoes within 5 days 100% of the time –Missions completed the same day assigned 99% of the time 51,000 acres sprayed by air Accomplishments Mosquito Control

10. Medical Examiner –Implemented Electronic Death Record System (EDRS) with a smooth transition –Managed several very high profile cases EMS –Continued success in minimizing hospital offload delays –Implementation of Orange County AED Registry Accomplishments

11. Organization Chart Proposed FY 2012-13 Budget Accomplishments Budget Challenges Summary Presentation Outline

12. Medicaid Budget Challenges Certification of Previously Denied Bills New Billing Process Medicaid Expansion (Affordable Care Act)

13. Medicaid Budget Challenges Previously Denied Bills –August 1 st – AHCA certifies outstanding claims –September 1 st – Last day to contest AHCA’s certification –October 1 st – DOR starts to withhold the backlog amount from revenue sharing

14. Medicaid Budget Challenges Previously Denied Bills –August 1 st – AHCA certifies outstanding claims –September 1 st – Last day to contest AHCA’s certification –We will be sending a check to AHCA for 1/3 of the certified amount in FY 2013 Estimated amount $7.0M

15. Medicaid Budget Challenges New Billing Process –May 1 st – New process takes effect –60 days to review the billings and make a refund request –30 days after bill received revenue sharing withheld

16. Medicaid Budget Challenges New Billing Process –May 1 st – New process takes effect –60 days to review the billings and make a refund request –We will be sending a check to AHCA every month

17. Medicaid Budget Challenges Back Billings New Billings FY 2013 Budget $7.0M $23.0M $30.0M

18. Orange County Medicaid Enrollees (in thousands) Apr08Apr09Apr10 Budget Challenges Feb11Apr12

19. Pictures 20122013201420152016201720182019 Medicaid Expansion Accountable Care Organizations Insurance Reform s Individual Mandate Permanent Health Insurance Exchange Budget Challenges Affordable Care Act

20. Medicaid Billings Orange County Budget Challenges

21. Primary CareSecondary Care PCAN Funding Budget Challenges

22. Too early to tell how active the season will be Aerial spraying in FY 2012 exceeded budget –1 st time in over 15 years Emergency control measures are costly Budget Challenges Mosquito Control

23. Organization Chart Proposed FY 2012-13 Budget Accomplishments Budget Challenges Summary Presentation Outline

24. Health Services Department proposed budget $59.4M –20.1% Increase in Operating Budget (Medicaid) Budget Challenges –Medicaid –PCAN funding –Active Mosquito season possible Pictures Summary

25. FY 2012-13 Budget Worksession July 16, 2012 Health Services Department

26. Comparing Estimates on the Impact of Medicaid Expansions in Florida SourceAHCA EstimateGeorgetown Estimate Cost of expanded Medicaid enrollment Assumes unrealistic 100% enrollment rate Assumes optimistic 75% enrollment rate Cost of raising primary care payment rates Assumes state costs after 2014 Same assumption Savings from reduced need for safety net NoneAssumes at least 25% to 50% reduction in associated costs Savings from transfer of medically needy to exchanges NoneAssumes at least 25% to 50% reduction in associated costs

27. Estimated Costs and Savings: An Alternative to AHCA Numbers Costs (billions) Expanded Enrollment Primary Care Payments Offsetting Savings Total Cost Or Savings Savings (billions)

28. AHCA estimate: –$6 billion in increased costs Georgetown study estimate: –$1 billion in increased costs to possibly $3 billion in savings Estimated Costs and Savings: An Alternative to AHCA Numbers