Monroe County officials flag health self‑insurance shortfall; council weighs $3M+ supplemental requests

Monroe County officials told the County Council on Aug. 26 that unexpectedly high medical claims this year have created a large shortfall in the county’s self‑insurance fund and forced requests for supplemental appropriations and accounting changes.

Auditor Bree Gregory told councilors that the county’s total anticipated revenue for 2026 is $127,000,655 while departments requested about $137,000,000, producing a roughly $9.4 million gap. The more urgent problem she and HR Director Ethan Starn described was a spike in health claims for 2025 that has driven near‑term cash needs higher than projected.

“We received invoices from Anthem in August that indicate costs have increased significantly,” Starn said. He told councilors that the county receives insurance invoices twice a month; recent invoices have ranged from about $250,000 on average to $1 million for a recent payment and another invoice next week of over $500,000.

Starn and other staff told the council they expect to ask for several additional appropriations this year: a roughly $3.0 million sweep from county general into the self‑insurance fund to fund per‑employee cash equivalents, plus an additional appropriation of about $2.5 million to pay outstanding claims and invoices through the rest of 2025. That combination would raise near‑term cash on hand, they said, and help reduce the 2026 per‑employee equivalent that departments must budget.

HR and county staff had earlier proposed budgeting $18,000 per full‑time equivalent (FTE) for 2026 to cover the county’s 80% share of premiums. During discussion, councilors and staff talked about reducing that assumption to $16,000 per FTE if additional appropriations or end‑of‑year cash balances allow. Starn said the auditor’s office and HR have discussed lowering the per‑FTE number if council wishes, but cautioned that “this is a crystal ball that’s not particularly clear.”

Councilors pressed staff for more precise forecasts. Councilor Henry said the scale of additional requests—“when we are talking $3 million in the third quarter of the fiscal year”—requires a tighter projection of burn rate and outstanding liabilities. Auditor Gregory said the county has been sharing claims trending with staff and acknowledging large monthly spikes in claims cost this summer.

Several councilors asked for clarity about which employees and funds are being counted in the sweep and whether non‑general fund departments (for example, stormwater or highway) were being charged into county general. County staff said the 2026 budget submission consolidates self‑insurance charges for employees who are paid from multiple funds, and that some departments had moved positions into general fund accounting this year; staff said they will produce a fund‑by‑fund breakdown to clarify which positions and funds are affected.

The council took formal steps during the meeting to acknowledge the staffing and fund discussions: councilors approved an amended Employee Services general fund budget as presented and later opened and approved the separate self‑insurance fund budget for 2026. In separate votes the council passed the Employee Services budget amendment (6–1) and the proposed Self Insurance fund budget (6–1), reflecting the council’s willingness to move the items forward while reserving the right to revisit specific per‑employee assumptions later in the budget cycle.

Staff recommended continued monitoring and said they would return with appropriation requests and refined projections. “If you think that we need to budget less, advise us, but we’ll be back because we’re not going to have the money,” the HR director said.

Why it matters: The county’s ability to pay employee health claims affects operations across departments. Large midyear appropriations reduce the pool of discretionary funds and can push pressure onto the general fund going into 2026. The council and staff asked for more detailed, line‑by‑line forecasts before final adoption of the 2026 budget.

What’s next: County staff said they will bring formal appropriation requests and a tighter claims forecast to the council in the coming weeks and produce a fund‑by‑fund breakdown showing which positions and departments are included in the self‑insurance sweep proposed for 2025.