Monroe County officials flag 2025 self-insurance shortfall; staff to seek supplemental appropriation in September

Monroe County officials told the Long‑Term Finance Planning Committee on a Friday in August 2025 that the county's self‑insured health plan is facing a funding shortfall this year and that staff will ask the full county council in September for a supplemental appropriation to cover 2025 costs.

The county's benefits broker, Apex Benefits, and county staff said medical and drug spending have risen materially and that an aging employee population is a key driver. County staff said they are budgeting $18,000 per position for plan funding in 2026, expect an across‑the‑plan premium increase in the low double digits, and projected an immediate 2025 shortfall they estimated at about $714,000. "We are going to set aside, in the reserve $2,000,000 and have the end of the year balance be around 1.5 for a total of 3.5," said Greg Garritos, a county staff presenter, during the meeting.

Why it matters: health insurance is the county's largest non‑payroll budget item and a persistent source of year‑to‑year volatility. Officials said leaving shortfalls unaddressed could force later, larger adjustments to department budgets or employee contributions.

What staff presented and recommended - Staff and the auditor's office showed trend projections and recommended budgeting at an $18,000 per‑position level for 2026 while using county reserves to smooth the transition. - County staff and benefits staff said they plan to request an additional appropriation to cover 2025 claims; one county employee stated the request will be presented to the full council at its September meeting. - The county plans to use the existing rainy‑day reserve rather than create a separate self‑insurance reserve fund; staff said the State Board of Accounts has previously provided financial guidance on these structures.

Costs and trend estimates - Staff estimated the 2025 shortfall at roughly $714,000 and said they had discussed setting aside $2,000,000 in reserves and targeting an end‑of‑year cash balance of about $1.5 million. - Apex Benefits staff described long‑term trends: "medical trend ... 7, 8, 9% per year" and pharmacy trend "about...13%, 14%," figures the broker presented as the drivers behind rising plan costs. - The county's benefits team said the county's renewal date is Jan. 1, which is a key input for the 2026 budget.

Coverage eligibility and legal questions - Committee members asked whether appointed board members, part‑time elected officials or other non‑employees were enrolled on the plan. County staff said the benefits administration system limits enrollment to eligible employees and that elected officials have historically been offered benefits in Monroe County. Bill Sylvester of Apex Benefits cited a recent Perry County court decision that affected how some counties classify elected officials for benefit eligibility and said local boards currently have discretion in some cases.

Cost‑control efforts - Officials described several cost‑management steps: monitoring high‑cost claimants, using a county health clinic and outside partners to provide preventive care, and exploring targeted programs to reduce large claims. The county's staff and Apex said these clinic and care‑coordination steps are intended to reduce long‑term claim severity despite an immediate funding gap.

Next steps - County staff and the auditor's office said they will finalize the updated spreadsheets and forward them to councilors; staff will present a request for an additional appropriation to the full council at its September meeting.

Ending: committee members thanked staff and the broker for the analysis and noted the item will return to the council for formal action in September.