Richland County HHS: placement fund and institutional costs highlighted in monthly report

Richland County Health and Human Services staff told the Community and Health Services Standing Committee on May 1 that the department’s operating budget is generally on track but that institutional and inpatient placements remain the largest and most-variable cost.

Trish Clements, director of Richland County Health and Human Services, told the committee the department separates placement costs into a distinct fund to avoid destabilizing the core HHS budget. “We have a separate fund specifically for those placements because historically … we were covering it out of HHS's core budget,” Clements said.

Why it matters: institutional placements — court-ordered inpatient stays and long-term institutional care — can be expensive and unpredictable, and historically have caused large swings in HHS spending. The separate placement fund is meant to make those costs visible to the board and prevent one expensive case from appearing to blow the regular operating budget.

Committee members reviewed the placement report for January through March. Clements said January included 74 total placement days for three individuals, noting that insurance or third-party payers may reimburse some of those charges. She told the committee that Winnebago (the county’s institutional inpatient provider referenced in the report) bills about $1,430 per day for a placement: “$1,430, which is the daily cost for Winnebago for one day,” Clements said.

On the adult placement fund, Clements said the budgeted fund balance was $705,000 and that expenses to date were “just under $57,000.” She also discussed community residential placements, where six adults were in group homes or community-based residential facilities that provide 24-hour staff but are less restrictive than skilled nursing.

Children’s placements also factored into the conversation. The committee saw a report showing 11 children in paid placements covered by the placement budget; Clements said the department prefers family- or relative-based placements when appropriate and that the placement report tracks only placements paid from the placement fund, not all custody arrangements.

Committee members pressed staff for clarifications on how reimbursements flow from insurers and Medicaid. Clements explained that the county pays placement costs up front and that some funds are later reimbursed by state or private insurers; those reimbursements appear on subsequent reports.

Ending: The committee voted to receive the monthly budget and placement reports and asked staff to keep refining presentation of anticipated versus received revenues so supervisors can track how reimbursements affect the placement fund balance.