New Local Health Officer Orientation

1. New Local Health Officer Orientation Budgeting July 29, 2013 Patti Wohlfeil, Health Officer, Waushara County Health Department Dale Hippensteel, Health Officer, Sheboygan County Human Services Department

2. Waushara County Patti Wohlfeil, Health Officer

3. Agenda • Budget Process • BOH Role • Reality Sets In • Solutions to Budget Cuts and Health Officer role in managing cuts • Differences and Similarities between DHHS and DPH budgeting at local level • Case Study

4. Budget Process Expenses-What services do you want to provide and how much will it cost to provide • Staffing costs and benefits (90% of budget) • Support staff • Operational costs • Indirect costs

5. Budget Considerations Revenues • Tax Levy • Grants • Fees • Contracts

6. Budget Timeline • Budget worksheets in July • Initial budget numbers to the county finance August • Submit to Board of Health in September • Meet with Finance Committee in October • Adopted by County Board of Supervisors in November

7. Board of Health Role • Approval of Budget • Discussion of fee changes • Discussion of services that could be added or eliminated based on budget • Approval of staff replacement and/or change in status to part or full time • Approval of resolutions for capital equipment or requests for funds from the general fund

8. Reality Sets In • Solutions to Budget Cuts and Health Officer role in managing cuts • Differences and Similarities between DHHS and DPH budgeting at local level

9. Case Study

10. Sheboygan County Dale Hippensteel, Health Officer

11. 2014 BUDGET INSTRUCTIONS Finance Committee: William C. Goehring, Chairperson Greg S. Weggeman, Vice-Chairperson Thomas Wegner, Secretary Devin LeMahieu, Member George J. Marthenze, Member Roger TeStroete, County Board Chairman Adam N. Payne, County Administrator Terry Hanson, County Finance Director Mary Wegmann, Deputy Finance Director

12. Goal and Targets • By statute, levy increases are limited to the greater of the change in equalized value due to net new construction or 0%. The Executive and Finance Committees have established the following goal and guiding principles: • Goal: Strive to succeed with existing financial resources and tax levy associated with net new construction, projected to be a property tax increase of less than 1%. • Guiding Principles: • Maintain essential quality programs and services • Improve departmental efficiency • Direct resources based on County priorities • Position the County for continued fiscal stability

13. Timetable • The following meeting schedule has been established: • June 26@ 3:30 PM Budget kick-off • June 27 to August 9 Base budget review and any variance request(s) with County Administrator and Finance Director • July 15 to August 23 Liaison Committee review and approval • August 5 to Sept 27 Joint meeting between Liaison Committee and Finance Committee • October 10 Budget notice published • October 22 Budget presented to County Board • October 29 Public Hearing and department review by County Board • November 5 County Board adopts budget

14. Department Budget Preparation Timeline

15. Sheboygan County 2014 Annual Budget

16. TUBERCULOSIS Sheboygan County Division of Public Health

17. Tuberculosis Mycobacterium Tuberculosis Transmitted in air Usually affects the lungs, but also other sites Common symptoms: cough, fever, weight loss

18. Case Study • April 15 • 1st lab confirmed active pulmonary TB case • April 23 • 4 children identified with active TB • May 3 • Total 12 infectious or highly suspect in 3 households

19. Key Findings Mycobacterium tuberculosis transmission among outbreak patients occurred within an extended family Isolated family Higher risk of transmission among close social contacts Lower risk for transmission at worksites and schools

20. Who Was All Involved? Public Health Centers for Disease Control State Health Department Mayo Health System Community Health Care Providers State Lab Pharmacies Public Safety Ems Mutual Aid from Neighboring Counties Emergency Management