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HomeMy WebLinkAboutHealth & Human Services 09-18-03 X ° ST. CROIX COUNTY NOTICE OF COMMITTEE MEETING TO: Clarence Malick, Chairman St. Croix County Board FROM: Tom Dorsey (John Borup, 246-8223) COMMITTEE TITLE: St. Croix County Health and Human Services Board DATE: 09/18/03 TIME: 8:00 a.m. (Please note time change) LOCATION: St. Croix County Health and Human Services Complex, New Richmond CALL TO ORDER ROLL CALL ADOPTION OF AGENDA DATE OF NEXT MEETING: 10/10/03 ACTION ON PREVIOUS MINUTES: 09/12/03 ANNOUNCEMENTS APPOINTMENTS: UNFINISHED BUSINESS: NEW BUSINESS: 1. Presentation and action on 2004 Budget for Health and Human Services and Nursing Home ANNOUNCEMENTS & CORRESPONDENCE POSSIBLE AGENDA ITEMS FOR NEXT MEETING: ADJOURNMENT (Agenda not necessarily presented in this order) SUBMITTED BY: John M. Borup DATE: COPIES TO: COUNTY BOARD OFFICE COUNTY CLERK NEWS MEDIA/NOTICE o r ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD September 18, 2003 The St. Croix County Health and Human Services Board met on September 18, 2003 at the St. Croix County Health and Human Services/Health Center complex. MEMBERS PRESENT: Thomas Dorsey, Chair Leon Berenschot Chris Bethke Lois Burri Deb Rasmussen Ralph Swenson Esther Wentz MEMBERS ABSENT: Mary Louise Olson, Excused Dr. Michael Kretz, Excused STAFF PRESENT: John M. Borup, Health and Human Services Director Carolyn L. Krieger, Nursing Home Administrator Judy Ziegler, Accounting Supervisor Barbara Nelson, Public Health Supervisor-Health Officer Ron Lockwood, Long Term Support Coordinator Kathy Dunlap, Family and Children's Supervisor Fred Johnson, Family and Children's Supervisor Ron Kiesler, ADOA/Mental Health Coordinator Steve Kirt, Mental Health/AODA Clinical Services Supervisor Mary Squyer, W-2/Economic Support Supervisor Kathy Leisch, Secretary OTHERS PRESENT: Chuck Whiting, Administrative Coordinator Chair Dorsey called the meeting to order at 8:00 AM noting the meeting was properly and legally publicized. NEXT MEETING: The next Health and Human Services Board meeting is scheduled for Thursday, October 10 at 8:30 AM. Bethke will review vouchers at 8:00. AGENDA: Motion: A motion was introduced by Berenschot, seconded by Bethke, and unanimously adopted: That the agenda be approved as circulated. PRESENTATION AND ACTION ON 2004 BUDGET FOR HEALTH AND HUMAN SERVICES AND NURSING HOME: 2004 budget materials were distributed to board members for both Health and Human Services and Nursing Home. Borup opened the presentation by giving a summary of the Department's and Nursing Home highlights. Borup indicated that administration is primarily impacted by salary/fringe increases and transfer of a clerical support position from MH/AODA to Administration, increasing costs by $50,796 but reducing MH/AODA by the same amount. The HHS budget increased from $21,357,702 to $24,138,024 for a 13% increase. The net County levy is increased from $4,473,035 to $5,648,934 for an increase of $1,175,899 or 15.9%. County cost increases reflect growing unfunded State mandates. These numbers were arrived at by applying $200,000 St. Croix County Health and Human Services Board Page 2 September 18, 2003 in prior year carryover funds ($375,000 less than last year). The 2002 audit report shows a "designated" account balance of $292,934. We recognize this is a tight balance and have attached a carryover analysis. NOTE: After this budget was completed, Department Maintenance salaries were reduced by $23,709 and the Nursing Home by $12,869. We did not adjust the budget anticipating costs will be adjusted along with health insurance adjustments. Major factors impacting this budget are: Salary/Fringe increase +646,290.00 Prior year carryover -375,000.00 Liability Insurance + 66,297.00 Income Maintenance State funding reduced -138,909.00 Resulting in a County Allocation increase +106,853.00 Foster Care Recruitment Contract terminated, savings + 54,000.00 Worker's Compensation increase (includes claims) 56,000.00 Contract Increases: • Mental Health/AODA-Emergency detentions, inpatient costs a +$191,188 or 26.4% increase. • Family and Children's - out of home costs (foster care, correctional costs) up $34,300. The State sets rates. ➢ Long Term Support - caseload increases and increased levels of treatment needs have resulted in increased costs of $1,925,114. However, with use of State/Federal monies, the County levy increase is $152,946. ➢ Mental Health/AODA salary/fringe and inpatient residential increases = $386,400.00. County allocation increase only $104,000.00 with increased user fees and third party revenues. ➢ Department vehicles resulting in annual savings of $32,000/year. ➢ Budget includes $67,500 farm rent to cover capital improvements. ➢ Budget includes $30,000 secure detention costs (formerly Sheriff's expense). ➢ Budget includes additional costs of $49,332 for 2096-hour year- two extra days including leap year. This results in one extra day of institutional costs and two extra days salary/fringe costs. ➢ Includes social workers leaving the union adding $100,000+ increase due to budget over 2003. ' r St. Croix County Health and Human Services Board Page 3 September 18, 2003 The Nursing Home County Allocation is as follows: 2004 2003 Operations $1,147,234 $1,035,467 Remodeling 342,050 Total $1,489,284 Major impacts on the budget: Remodeling/Capital +$342,050.00 Revenue Cuts/Downsizing -$997,096.00 Mental Health/AODA: Kiesler reported his budget has been impacted by emergency detentions leading to increased inpatient expenses. Costs are rising both in terms of placements and per diem costs. Kiesler also indicated he is pursuing development of inpatient diversionary program along with a full-time psyciatrist as a way to reduce inpatient costs. Other increases include salary/fringe costs. MH Program costs increased 8.1%. Swenson asked how it is determined where the carryover money is put into the budget. Ziegler said it is based on the allocation last year by each program. Swenson suggested the carryover money be shown as an overall amount instead of putting carryover money into each unit. This way an accurate figure would be shown for each unit. ALCOHOL-DRUG ABUSE: 2004 TOTAL EXPENSE 2004 COUNTY LEVY PERCENT OF CHANGE $464,686 $0.00 -100.0% MENTAL HEALTH SERVICES: 2004 TOTAL EXPENSE 2004 COUNTY LEVY PERCENT OF CHANGE $2,768,641 $958,016 8.1% Long Term Support: Lockwood reported there are no County monies paid for the production program of St. Croix Industries. Work Services is basically the in-house factory style work program. Production would be that same program but looking only at materials that were purchased and worked with in the production process and the revenues gained from the sale or money received from that work. Lockwood stated that no County dollars go into that production budget. All of the County and discretionary state aid go into the work services program, which includes the salary/fringe benefits and costs related to providing the counseling, support and staffing for the persons with severe disabilities that are working at St. Croix Industries. Lockwood stated that Helping Hands is a small program without County money that assists people with snow shoveling, yard care, etc. Rest area maintenance is a contract with the State department of transportation to do the maintenance at the rest areas. This program is self-supported and no County dollars are involved. Lockwood stated the Vocational Placement program is where people are supported in jobs in the community, such as McDonald's, Burger King, etc. for disabled persons. The Day Services Program is provided mainly to elderly people with mental retardation. Lockwood stated we get income from the CIP II/COP W program for elderly and younger physically disabled persons that go into supporting the day services program. County costs have increased for St. Croix Industries and the State community aid dollars that were allocated for St. Croix County Health and Human Services Board Page 4 September 18, 2003 the program remains the same. Lockwood stated the main increases have been salary/fringe benefits for the staff of 55 employees. Lockwood said the largest increase in expenditures is in the Community Integration 1B(CIP 1B) program. The program provides support services for developmentally disabled persons, which include persons with mental retardation. The State has virtually frozen its contributions to this program so that any growth that has occurred in the last 4 or 5 years has had to be supported by County dollars matching the Federal dollars. Federal dollars currently pay 60% of the cost and the County pays 40% of the cost. The growth in the program has occurred when persons have been moved to a residential care setting or a small group home setting where the costs are increased. Lockwood stated the other programs are relatively stable. Lockwood stated the community residential census is 350. Swenson asked about projections about possible waiting lists at St. Croix Industries and how much it would cost the County if we did not have a waiting list. There are 85 persons in the program now with a possible 4 or 5 on a waiting list in the workshop. The main demand is in the supportive employment and not in the factory, which is easier than doing it in the workshop. Borup stated we would be holding the levels of census in the workshop if monies permit to expand the community jobs. LONG TERM SUPPORT: 2004 TOTAL EXPENSE 2004 COUNTY LEVY PERCENT OF CHANGE $14,656,239 $1,756,708 9.50 Family and Children's: Dunlap and Johnson gave the following summary: • 2004 Budget request $2,868,237 • 2003 Budget $2,648,969 $ 219,208 increase • Salary/Fringe/Worker's Comp/Liability increase $197,076 Note: This is a comparison with 2003 budgeted salaries versus actual salaries-does not take into consideration 2003 social worker eccretion. • 2004 purchase of service request $906,000 • 2003 purchase of service budget $871,700 $ 34,300 increase • Moved money (substantial increase from $2,500 to $65,000 in both youth aids and child protective services) to pay for YES (Youth Encountering Success) program, which is included in the total purchase of service request for 2004. • 2004 County allocation request $1,476,897 • 2003 County allocation budget $1,263,322 County levy $ 213,575 increase (Includes revenue line items and prior year carryover) FAMILY & CHILDREN'S SERVICES: F2004 TOTAL EXPENSE 2004 COUNTY LEVY PERCENT OF CHANGE $2,868,237 $1,476,897 16.9% The Board recessed from 9:20 to 9:35. St. Croix County Health and Human Services Board Page 5 September 18, 2003 Economic Support: Borup indicated the biggest impact in Economic Support was the termination of the W-2 contract. Borup expressed concern about the loss in revenue of $138,909 for programs that continue to be mandated by the State of Wisconsin, specifically Food Stamps and Medical Assistance. This results in a County allocation increase of $106,853. He further expressed concerns about the caseload increase of 50+ per month. Borup indicated there has not been an increase in IM dollars in 18 years. Squyer stated there has been a reduction in Child Care administration dollars because there were no Child Care grants to apply for this year. Squyer stated that Economic Support is down three positions, one position ended in 2002 and two positions ended in 2003. Squyer stated that Workforce Connections will be subcontracting the W-2 program. We will be keeping the Child Care portion of the program and will be charging Workforce Connections $40.00 per Child Care case. Revenues should be between $5,000 to $10,000. Squyer stated the WHEAP Coordinator salary will be reduced by seven days during the summer months. Swenson asked why the ES Administrative costs were shown at $715,000 because it seemed high. Borup reminded the Board that department administrative expenses had previously been partially paid out of W-2 monies. ECONOMIC SUPPORT: 2004 TOTAL EXPENSE 2004 COUNTY LEVY PERCENT OF CHANGE $971,250 $166,416 183.20 Public Health: Nelson indicated the largest increase is in the Public Health Operations portion of the budget, which includes salary/fringe/worker's compensation/disability. Bethke asked about the WIC Farmer's Market portion of the budget. Nelson stated this is the second year for this program, which allows participants in the WIC program to utilize vouchers for fresh produce at the farmer's market. Swenson asked if there would be an increase in bio- terrorism dollars or if those costs would be paid by the County. Nelson stated that Public Health is getting a fairly small amount of money compared to other departments and agencies. Nelson stated there are a number of expectations and requirements that are required of Public Health that are defined by the State. Nelson said the money is divided into pots of money within the regions within Wisconsin. St. Croix County is part of the preparedness consortium consisting of nine counties. The State is dividing the money out within the consortiums. Swenson asked whether the licensing of the agent status - restaurant inspection program would break even again in 2004. Nelson stated the program is stable and revenues should break even with expenses. Public Health costs were up 23.1% reflecting the lack of State aid for local services. PUBLIC HEALTH: 2004 TOTAL EXPENSE 2004 COUNTY LEVY PERCENT OF CHANGE $1,547,287 $889,896 23.1% St. Croix County Health and Human Services Board Page 6 September 18, 2003 TOTAL HHS DEPT LESS PRIOR YEAR NET LEVY REQUEST CARRYOVER APPLIED 2004 TOTAL EXPENSE $24,138,024 2004 PROGRAM REVENUE $18,289,090 2004 COUNTY LEVY $ 5,848,934 $ 200,000 $5,648,934 2003 COUNTY LEVY $ 5,048,215 $ 575,000 $4,473,215 LEVY INCREASE (DECREASE) $ 800,899 PERCENT OF CHANGE 15.9% CAPITAL ACQUISITION: Computer software up-grade ECHO $25,000.00 2 servers $12,500.00 Optical imaging $10,000.00 Trade cost of two new cars $20,000.00 TOTAL - PAID FOR FROM FARM TRANSFER $67,500.00 BUDGET BUDGET PERCENT YEAR YEAR INCREASE OF 2003 2004 (DECREASE) CHANGE TOTAL BUDGET $21,357,702 $24,138,025 $2,780,322 13% TOTAL COUNTY DOLLARS $ 5,048,035 $ 5,848,934 $ 800,899 16% LEVY NET OF PRIOR YEAR CARRYOVER $ 4,473,035 $ 5,648,934 $1,175,899 26% PRIOR YEAR CARRYOVER $ 575,000 $ 200,000 $ (375,000) -65% Motion: A motion was introduced by Berenschot, seconded by Swenson, and unanimously adopted: That the Board approves the Health & Human Services budget totals as presented with a County Levy of $5,648,934 and to forward to Finance Committee for presentation on September 25. PRESENTATION AND ACTION ON 2004 BUDGET FOR NURSING HOME: Krieger discussed the following highlights of 2004 Nursing Home Budget: County Levy for Operations $1,147,234 County Levy for Capital $ 342,050 Total Levy Request $1,489,284 Revenues: Decreases in revenues are as follows: 1. Decrease in budgeted census of 88 to 70.5 2. Decrease in IGT of $233,681 3. Decrease in Medicare Part B $61,800 due to a federal cap Total 2004 Revenue Decrease: $997,096 Expenses: 1. Salaries/fringes decreased $657,263 consistent with downsizing 2. Operation costs decrease per ppd, but increase due to inflation and energy costs 3. Salaries/fringe cost increased by 1 day 2088 to 2096 4. Retirement fringes increase 5. Health insurance increase due to 0% for union contribution 6. Worker's compensation 5% added to salaries 7. Salaries increase by 3% St. Croix County Health and Human Services Board Page 7 September 18, 2003 Capital Acquisition: Total Request $342,050 with 3 highest listed 1. Remodeling for new dining areas $235,900 + Architect Fees of $22,800 2. Equipment replacement $10,500 3. Remodeling of Nursing Station, beauty shop, etc. $62,500 Swenson brought up issue of fund balance and discussion ensued. Borup distributed 1994 opinion from Tracey & Thole accounting firm showing that HHS department should keep a surplus of $200,000-$300,000 and the Nursing Home should keep a surplus of $450,000-$500,000. Motion: A motion was introduced by Berenschot, seconded by Bethke, and unanimously adopted: That the Board approves the Nursing Home budget totals as presented and to be forwarded to Finance Committee for presentation on September 25: County Levy for Operations $1,147,234 County Levy for Capital $ 342,050 Total Levy Request $1,489,284 Dorsey asked if there were any other issues to bring before the Board. Motion: A motion was introduced by Berenschot, seconded by Wentz, and unanimously adopted: that the meeting be adjourned. Time: 10:55 AM Chair: Attest: (Secretary)