1. Health Services Department FY 2010-11 Budget Challenges February 16 th, 2010

2. Revenue Outlook Department Expenses Budget Challenges Summary Outline

3. Revenue Outlook Department Expenses Budget Challenges Summary Outline

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

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

6. Revenue Outlook Department Expenses Budget Challenges Summary Outline

7. Mandated PCAN Other Department Expenses 43% 44% 13%

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

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

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

11. Revenue Outlook Department Expenses Budget Challenges Summary Outline

12. $ 44.6 Million Budget Challenges 7% Reduction = $ 3.1 Million

13. $ 44.6 Million $19M Mandated $19.7M PCAN Budget Challenges $ 25.6 Million 3.1M = 12% $ 5.9 Million 3.1M = 53%

14. Budget Challenges Primary Care Access Network Medicaid

15. Budget Challenges Medicaid

16. 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

17. Economy Need for Services Budget Challenges

19. Budget Amendment of $ 6M

20. Monthly Medicaid Expense in Millions Budget Challenges $ 1.4 M

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

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

23. LegislationEconomy $ 20 Million Medicaid Budget Challenges

24. Primary Care Access Network

25. 37% Increase PCAN Patients in Thousands Budget Challenges

26. Primary Care Secondary Care $ 6M Budget Challenges

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

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

29. 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

30. PCAN Clinic Sites

31. 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

32. Mosquito Control

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

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

36. Revenue Outlook Department Expenses Budget Challenges Summary Outline

37. 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

38. 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