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Board of Health

Board of Health. Proposed 2011 Public Health Budget October 29, 2010 Dr. David Fleming Director and Health Officer. Overview of today’s Proposed Budget discussion. Background and context: 2009 / 2010 budgets Proposed 2011 budget funded by County GF

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Board of Health

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  1. Board of Health Proposed 2011 Public Health Budget October 29, 2010 Dr. David Fleming Director and Health Officer

  2. Overview of today’s Proposed Budget discussion • Background and context: 2009 / 2010 budgets • Proposed 2011 budget funded by County GF • State budget shortfall impacts on the Public Health budget

  3. Public Health’s funding comes from many different sources Public Health Fund Funding Sources

  4. 2009 Reductions Total reductions 2009 $14.5 million total reduction Examples of reductions • Eliminated street outreach to pregnant women with substance abuse • Reduced number of Immunization clinics • Eliminated HIV/AIDS Hotline and perinatal case management • Eliminated county-funded dental sealants • Reduced services to Children with Special Health Care Needs • Reduced MEO death investigators • Reduced Public Health laboratory testing $14.5M total 139 positions

  5. 2010 Reductions Total reductions 2009-2010 $10.7 million total reductions Examples of reductions • Eliminated childcare nurse visits outside Seattle • Eliminated senior exercise and nutrition • Reduced HIV/AIDS education and outreach • Cut family planning • Closed remaining immunization clinics • Reduced Public Health services at Northshore • Closed the Kent Teen Clinic $25.2M total $10.7M 217 positions 78 positions $14.5M 139 positions 139 Jobs

  6. Proposed 2011 Reductions Total reductions 2009-2011 $7.7 million total reduction Cuts will be felt by all members of the King County community who are touched by the population-based and personal health care services that Public Health provides. $32.9M total $7.7M 344 positions 127 positions $10.7M 78 positions $14.5M 139 positions

  7. In 2011 Public Health was assigned a target GF reduction of 12% totaling $3.4 million Rationale for CountyGeneral Fund dollars • Implement business model changes as part of continuous quality improvement • Fund services where Public Health is the only provider (e.g. communicable disease, public health laboratory, Medical Examiner, epidemiology, policy assessment and development) • Work from the OMP blueprint to maintain focus on core Public Health goals

  8. 2009 2011 Decline in County General Fund County – 2% County $641M $632M

  9. 2009 2011 Decline in County General Fund County – 2% County $641M $632M Public Health $31M $24M Public Health Fund – 22%

  10. Prioritizing budget choices when there are no good cuts Examples of reductions • HIV/STD services at Juvenile Detention ($50K) • Medical Examiner’s Office ($290K) • Cuts to Community Clinics ($115K) • Children and Family Commission ($1.2M) • Maternity Support Services (MSS) backfill ($1.5M)

  11. Children and Family Commission • Many CFC services are aimed at: • Supporting young, high risk parents • Keeping youth out of the criminal justice system • Strengthening and leveraging partnerships in the community • If voters approve the new sales tax some programs could be restored Eliminate $1.2M contribution to Commission 1.5 FTE (out of 2 FTE)

  12. Public Health Center Infrastructure Cut $1.4 million cut 14 FTE (33 positions) • County had been using County GF to fund Center infrastructure • MSS program model change savings were planned to offset anticipated MSS reductions from state • County GF reduction meant shift of this revenue to backfill GF cuts to infrastructure

  13. Assuring the community’s health:Public Health core services • Core functions must be maintained that assure health across the community including: • Traditional disease protection services • Assessment and policy development to address leading causes of illness and premature death and promote good health • Provision when system can’t or won’t provide safety net

  14. State Budget Cuts • $770 million gap required Governor to ask for 6.3% across the board cuts in all programs • Cuts to Public Health total $30 million across state agencies • Affects all Public Health services, particularly clinical services • Cuts impact leveraged dollars • 2011-2013 budget will likely bring more cuts, estimated now at 10%

  15. Washington Departmentof Health reductions • $600,000 in state assistance to PH-SKC, including STD, HIV, chronic disease, injury prevention, PH Lab & infrastructure

  16. Washington Department of Social and Health Services Examples of impacts to King County: • Eligibility reduction in Apple Health for Kids (8,110 children; $3M) • Adult Dental Services (31,500 adults; $2.5M) • Take Charge Family Planning (19,000 clients; $4M) • First Steps/Maternity Support Services/Infant Case Management (30,000 clients; $22M)

  17. Take Charge / Family Planning • Eliminates on March 1, 2011 family planning services for low-income women and girls • 24% of women will get pregnant in the year following the loss of family planning services • Delivery plus first-year of life costs ~ $9,000 • Washington will lose $9 in federal match for every dollar spent • $641,000 cut to Public Health

  18. Maternity Support Services • Elimination of Maternity Support Services (MSS), First Steps and Infant Case Management • No pregnant woman with Medicaid will receive pregnancy support; no newborns or mothers will receive infant case management • Affects 30,000 at-risk women and children in King County of which >90% clients are low income and > 66% are people of color • May lead to increased infant & maternal deaths; adverse birth outcomes with increased long-term health care costs; long-term impact on education, productivity, criminal justice

  19. Maternity Support Services • Elimination March 1, 2011 • Public Health – Seattle & King County would lose $22 million of heavily leveraged state and federal money • Significant impact on Public Health jobs

  20. What does this mean for Public Health Centers? • We are focusing on solutions that allow Centers to continue to serve clients in innovative ways • Wide mix of services providing convenience and access to core public health and other needed services • Northshore model • Global to Local (G2L)

  21. What needs to happen toavert this crisis? • Minimize county reductions • Protect against additional cuts to mandated and core community-based services • Restore MSS and Family Planning • Advocate for innovative financing models where such models improve service and are cost neutral

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