1. Welcome Thank you for joining us! Please mute your phones during the presentation to reduce background noise. Please feel free to ask questions at any time during the presentation by using the chat function or by emailing: tkusmierz@fl-counties.com

2. Florida Association of Counties Webinar Series County Health Departments Medicaid Nursing Home Contributions

3. County Health Departments Why do counties care about CHDs? State and County partnership –Partnership established in Florida Statutes (F.S 154.01) and formalized through the county core contract –CHDs are expected to work with local governments to meet request for services and establish programs/positions to meet public health needs –Important safety net provider –First to respond during and after emergencies (Hurricanes, pandemics, etc.)

4. CHDs and Rate Control During the 2009 Legislative Session, SB 1662 repealed CHD’s exemption from rate control Bill was filed in the last two weeks of session –Because SB 1662 was a budget conforming bill it had limited committee assignments CHDs have never had to operate under “rate” like other state agencies

5. What is Rate Control? Rate: Established by Legislature Number of Positions Salary range for each position

6. What is Rate Control (Cont.) Rate is unique to state government –Additional control that places an arbitrary salary cap on positions regardless of the cash or budget Does not consider the pay range of the class Requires that vacant positions revert to the minimum salary for the position grade Rate, budget and salary dollars are not always in alignment –A county could have sufficient cash and budget to hire a doctor, nurse or dentist at the upper salary limits necessary to recruit but not enough rate to allow that to occur

7. CHD Funding CHD positions are not fully state funded. –30% general revenue funding The remainder is provided through –Local governments –Private Foundation Grants –Federal funding and grants

8. Impacts of Rate The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program WIC provides Federal grants to States for –Supplemental foods –Health care referrals –Nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk CHDs have requested 200+ additional positions to meet the increased demand for these services Those requests are waiting for approval from the state

9. 2010 Legislation Reinstates the exemption from Rate Control for CHDs –SB 1572: Senator Nan Rich (Broward/Miami- Dade) –HB 979: Rep. Dwayne Taylor (Volusia)

10. Medicaid Nursing Home Background –In 1972, legislation was passed requiring counties to reimburse the state for Medicaid costs Inpatient hospital costs in excess of 12 days and up to 45 days Nursing home costs capped at $55 per patient per month –In 2001, the Legislature increased the counties’ share for inpatient hospital services adding days 11 and 12

11. Medicaid Nursing Home (Cont) The Agency for Health Care Administration (AHCA) has proposed increasing the County contributions for Medicaid nursing home services –From $55 to $202 –Almost $67 million cost shift to the counties based on the current average monthly caseload of 37,731 patients 2007-2008 Fiscal Year, Counties were billed over $200 million for Medicaid services –$35 million was for Medicaid nursing homes.

12. Should Counties Pay More? Counties are active participates in the provision of health care funding and services through their contributions: –Low Income Pool and other IGTs –Health Care Responsibility Act (HCRA) –County Health Departments –Federally Qualified Health Centers –Local indigent health care programs Given the contributions Counties are currently mandated to make to Medicaid and the other ways in which local governments are assisting both the Medicaid and uninsured populations, we believe counties are shouldering a fair share of the costs for serving this population

13. New Developments State is prohibited from increasing the county share of cost while they are receiving federal stimulus dollars –Prohibition runs through January 2011 The President has recommended extending the enhanced Federal Medical Assistance Percentage (FMAP) through June 2011

14. Questions? Contact: Heather Wildermuth (850) 922-4300 hwildermuth@fl-counties.com

15. Join us for our upcoming webinars February 19 th – Growth Management and Transportation February 26 th – TABOR