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Health department reports postage, rabies bills and jail mental-health costs among budget pressures
Summary
Health department fiscal staff told Ways and Means that clinic billing lags, a large April rabies bill and county-paid jail mental-health services are notable budget items; early intervention preschools and transportation are the department’s highest uncontrollable costs.
Roselyn Fagan, the health department’s fiscal manager, told the Ways and Means Committee on April 9 that the county health department’s general public-health programs are tracking near expectations through March but that a few lines warrant attention.
Fagan and department accountant Carol identified postage and rabies-related expenses as lines likely to exceed budget this year. The department said it had to add roughly $3,000 to postage at the end of March and expected a nearly $15,000 rabies-related invoice in April that was not yet reflected in the first-quarter report.
On clinic operations and mental-health services, department staff said salary lines were lower than year-to-date budget because of vacancies. The department noted that some social-work and clinic positions are revenue-generating (billable) and that vacancies reduce billable revenue; staffing vacancies have therefore created both payroll savings and lower clinic revenue.
Staff explained two specific county exposures: - Family-court and forensic inpatient evaluations (referred to in the meeting as “7 30” competency evaluations and “5 0 8” treatment commitments) are unpredictable and county-funded when ordered. Presenters said these placements to state hospitals are expensive, with costs that can exceed $1,000 per day, and that the county budgets a limited amount for these events; a 5 0 8 placement was expected next week. - Mental-health services provided in the county jail are largely unreimbursable. The health department said it budgets roughly $142,000 for 1.5 social-worker positions at the jail plus an additional about $46,000 in nurse practitioner stipends; those amounts are not currently billable to Medicaid when inmates are incarcerated, producing a net local cost of about $188,000 for jail mental-health services.
Early intervention and preschool services also carry significant local share and are hard to control. Fagan said 312 children had qualified for early intervention services this year, with 33 attending tuition-based preschool programs and 42 children on a wait list. The county pays tuition and, separately, transportation; Fagan said transportation billing is currently behind and that transportation is a frequent source of cost growth.
The department also discussed federal and state grant activity, including an ongoing SAMHSA grant supporting school-based services; staff said they have applied to continue funding and expected to know results by August. The health department said it participates in Medicaid enhancement rates tied to quality improvement projects but that those payments are occasional and retroactive.
Ending Committee members asked staff to continue monthly budget monitoring and to flag large, unpredictable costs (forensic hospitalizations, rabies bills, and transportation) in future reports. No committee action was required at the April 9 meeting on the presentation.
