Travis County Commssioners Court
May 27, 2003
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Item 31
Let's call up item no. 31 next, that is to receive and discuss fy '03 budget challenges in health and human services and [indiscernible] and take appropriate action. 31. Review and discuss fy03 budget challenges in health and human services and veterans service department and take appropriate action.
>> good afternoon.
>> good afternoon.
>> basically, as we've been talking about for the last few months, the demand for health care and emergency assistance is actually exceeding the initial, our initial projections. And the relt of that is that our fy '03 budget for these services is projected to run out before the end of the fiscal year. Just as chronology or background on this, basically, in fy '03, we submitted a request for $1.5 million which was consistent with our projections for the demand for health care and emergency assistance. During the budget deliberations, we -- we got an additional $500,000 from the court to -- to spend toward those needs. As we've worked with that budget over the last few months, our budget projections are actually pretty much on target with what we thought they would be doing during the budget process. In November, we came forward with a proposal to where we had actually -- we had put forward some proposals for cuts and these social services contracts we also had frozen positions which amounted to more than $400,000 and came up with the $158,000 in one-time expenditures, which resulted in a million dollar safety net that was developed within our organization. The court's response to our proposal to -- to reduce services contracts was that we tip to fund those contracts and so we did that. With all of the action that's we are taking today, we then were left with the challenge of coming back to the court with options to meet the difference between our -- our budget projections and what we actually had and our budget. Excuse me, our demand and what we actually had in our budget. Beginning in March we started to discuss policy changes relative to programs that would have some marginal impacts on at least expenditures within the emergency assistance program. But those policies discussions also included a proposal to focus on several programmatic directions for all of health and human services. On may 13th, you passed those policy changes, which will, as I said earlier, have some impact on our costs. Currently our map enrollment is 526 which results in a 21% increase over last fiscal year. Emergency assistance program is also 21% over the previous year. And in their budget package, following the cover letter, you have a projected expenditure and at the current demand and spending levels, which shows that -- that primarily by the end of July, for -- for both programs, we will actually exceed what we have budgeted within the rmap program as well as the emergency assistance program. We have already transferred $250,000 from the safety net reserve within emergency assistance, which will take us through the end of July. We -- we had -- initially, I don't think the action has been taken, but proposed to transfer an additional $820,000 into the rmap program. To take us to the end of July. On page 2, you'll see a revised funding proper proper vehicles. Owe projection. Midpoint, worse case scenario. The midpoint projection that you see here is different than the last number that you saw. Since we have talked about this last, we have gotten additional bills and if we do a straight-line projections, based on those additional bills, that midpoint would be 1.5 instead of 1.4. On emergency assistance projections, you see that we have the initial $470,000 that we have projected. We are subtracting $250,000 which was the transfer from the internal safety net. We are -- we are projecting that we will be able to save an additional $100,000 in that program or I shouldn't say save, it's really a cost avoidance of about $100,000, given some of the policy changes that we are making and we would hope to make up that difference with other internal savings as time goes on. Which means that we still have a remaining gap in emergency assistance of $120,000. That number -- the total gap, which is slightly under $800,000, is the number that we have talked about before. But we are able to maintain that number given the $100,000 factor that I talked about relative to emergency assistance. On the next page, you will see a list of options that we have for the court. The first option is the option that we are recommending and that is we are recommending that the court provide $800,000 of new money, we are suggesting that you take it from one of the reserves in order to continue our programs through fiscal year '03. We are hoping to actually recognize some savings in rmap beginning the next fiscal year due to some savings that we believe we will be able to realize in the pharmaceutical line item, but that hasn't come to fruition yet. The second option that we have, basically, is to utilize the internal safety net reserve, we have already transferred $250,000. Also, use 200 -- excuse me, use the 800 or roughly $30,000 transferred into r map and then add an additional $673,000 in new money. What that would do is leave an amount of $120,000 in unfunded resource that's we need for the emergency assistance program. The first option would mean that we would meet the demand in both the emergency assistance program as well as the rmap program. The second option that we present or are presenting would leave us at $120,000 deficit based on the projections that we have for that program. Both of these options assume that we would recognize that $100,000 in cost avoidance that I spoke of earlier. We have a variety of option that's we are presenting to you if you want to us stay within the current budget. All of those options do result in our not meeting service demand levels and either the rmap program or the emergency assistance program. That's why it's our recommendation that we meet the demands that have been presented in both of these programs. Also, you will notice that the -- that the options that we are presenting here are slightly different from the options that we have presented over the last four or five months. The reason for that and -- and -- is because we have -- we had a projected implementation date of some of those programs, of some of those cost avoidance options of may 1, of course that date has passed.
>> have any of these numbers been -- I want to use the right word, because I don't mean to insult anybody, but validated by p.b.o.
>> I will let them answer that. They very rarely question the numbers in r map.
>> p.b.o. Would like to emphasize that we -- the department projects and we confirm that even after distributing all of their safety net moneys, $1.079 million, that they are forecasted to be overbudget by $800,000 to one million. And that's our projections show that as well as the departments.
>> if the trends continue, the way that they have started this fiscal year.
>> so I'm trying to -- in that -- what line of stephen's is that, worst case, midpoint, best case --
>> if lieud at our worst case scenario, you would look at the million dollars that she's talking about. Of course we picked the mid point.
>> that's the range of 800,000 to one million is going from the midpoint to the worst case. So valerie, I'm sorry, is yours the net after all of the other good things have happened.
>> correct.
>> after the distribution of the entire safety net.
>> that's where I'm trying to get to, we are all saying the same thing, we are all validating each other's numbers so that we can speak with confidence as we move forward. That's all that I'm asking. Thank you.
>> the word confidence makes me nervous. [laughter]
>> I have got dice on the side of frame here.
>> you know the parameters that we have in the health care program. I always have to say that just so that beal be on the same page.
>> no different from our internal program related to our own employees about how expensive and the best assumptions sometimes prove not to be accurate because of the high cost of prescription drugs and the utilization.
>> yes.
>> thank you.
>> stephen, is there -- Commissioner, are you finished?
>> I'm done, thank you.
>> have there been any indication, I guess maybe I heard -- let me get to point where I'm trying to go. I heard this morning during our legislative update that there were additional federal dollars that can be drawn down to facilitate social service needs. The difference of 114 million -- I can't remember the exact number.
>> yes, I heard that.
>> that was disclosed this morning. But you heard the discussion.
>> yes, I did.
>> okay. Are those -- are those state dollars that's been set aside from the draw down of moneys, would that have any impact on what we are talking about here or is it outside of that range of what -- how that money will be distributed from the state down to the county.
>> in my opinion --
>> okay, let me hear you.
>> that just means that there would be less of an impact, resulting from the decisions made by the legislature. We were braced for I think a much worse scenario.
>> right.
>> you -- what you heard today is that -- the worst case may not occur because of that, but we are still --
>> as far as what we are talking about here today --
>> no. The worse case [multiple voices]
>> as far as what?
>> in terms of the impact of the decisions made by the state legislature.
>> state programs.
>> state programs.
>> that was really looking to '04 and beyond as opposed to where we are right now and we are trying to deal with where we are right now. I apologize for interrupting.
>> right. The second point is I asked earlier, in an earlier conversation, sometime back about possible faith based moneys that may be also part of what -- what was brought down --
>> let me explain that a little bit, because I think that we have a misconception about those faith based dollars.
>> but it's still --
>> they are not actually new dollars that are being added to the table.
>> not new dollars.
>> no, they are not new dollars. What that initiative is, is essentially those institutions that are faith based have an opportunity to go at some of the same dollars they had not been able to go at before. So there's no -- no windfall of dollars that will be set aside for faith based organizations that are going to be coming into communities throughout this country.
>> but yet still being able to provide a service, though. If those dollars were --
>> what I'm saying is that the amount of the -- of the service dollars are not necessarily increasing because of the faith based initiatives. It's just saying, it's just providing an opportunity for faith based organizations to go at some of the same service dollars that have been available over the years.
>> I have a couple of other questions, but I'm going to wait until you finish up with your presentation.
>> I'm finished with my presentation.
>> you are finished?
>> yes, I am.
>> well, good. [one moment please for change in captioners]
>> somewhere along the lines -- and I guess the number that's still being added to the basic needs and services that we're able to provide, and I guess those numbers continue to grow. How are you addressing that when there are people that may have to be turned away? Because there may not be enough money available to serve the needs of that person coming before Travis County.
>> we've all sent out information regarding any potential shortfalls in emergency assistance until the court has actually made a decision. A couple of weeks ago you did approve some recommended policy changes. We are communicating that information to our clientele as well as other agencies. That's the only information that we plan to communicate. Any additional information relative to finances and resources available is predicated upon whatever decision you -- or whatever direction you give me regarding funding limitations or availability.
>> okay. Thank you, steven.
>> pbo, right now we have the allocated reserve. And we also have the emergency reserve, right?
>> correct. Yeah, we have allocated reserve, 1.97 million, emergency reserve, # point -- 2.3 million.
>> what's the effective date of the policy changes we approved?
>> June 15th.
>> so it would be probably July 15th before we start seeing results?
>> possibly. I think we need a little bit more time because some of the changes were subtle in my opinion.
>> yeah.
>> also is it more accurate to say that we actually have a whole lot more in the allocated reserve, but we have a number of ear marks still that are outstanding that is netting out the ear marks, which may or may not come to pass because there are things in there about overtime costs. Well, let's say there's a long list on the budget amendments and transfers, page 21, ear marks that have not occurred, but the state is a conservative number that we will use of 1.9.
>> any new money that you will receive, unless there are additional policy changes, will be spent on pretty much the same ratio as set out on page 2, p-2, revised funding projections?
>> yes. And looking at overall financial challenges, that's why we were willing to try to stretch some more to come up with that extra $100,000.
>> okay. So we're spending, I guess, five and a half times more for health care than emergency assistance, right?
>> yes.
>> but health care, we don't have any reason to think it may go down between now and the end of the year? [ laughter ]
>> no, sir.
>> pharmaceuticals, emergency room...
>> yes, ancillary services, specialty care.
>> move that we authorize the transfer of $250,000 from the emergency reserve with the understanding that we'll probably see steven back in four or five weeks.
>> second.
>> let's try to keep applying any cost saving measures we can.
>> okay.
>> I guess I feel better doing it this way than trying on to pick a larger amount. We know that this will not get you to the end of the fiscal year. My guess is four to five weeks we're looking at a similar transfer because of the level of need. I don't know any way to get around that other than just closing the doors or changing to the extent we serve.
>> it's more critical in the emergency assistance program in how the bills come in on the health care part. What we will probably do is make that whole and then we'll monitor the health care fees. But the understanding that I would have is that we will cap the expenditures of emergency assistance at the numbers that are presented to you.
>> judge, would you accept as a friendly earmarking of 500,000-dollar amount on the mnl reserve, that way we're kind of keeping it out there, that we're aware of it and certainly it's impossible to us not to take a look at it whenever we take a look at the emergency reserve fund? It's really more of out there in terms of that it be there. And the 250 plus 500 gets us to 750, which is close to the 796 that you guys were talking about.
>> that's friendly to me.
>> friendly to the seconder.
>> and already -- cleanup measure. Have we already transferred the 829?
>> I don't think so. I don't think we transferred the 829.
>> it hasn't been transferred out of its reserve line item, so to speak. It is in the department's budget, but it hasn't been transferred to either our or to the emergency assistance.
>> it needs to be transferred first.
>> thank you. It would seem to me that just in terms of a just in time how this gets parcelled out, I think it seems to me that the 829 should go first because that's the monies we already said first up and that we would then, if it's all right, earmark the full 750 out of the emergency reserve, which basically says you'll get to it when you get to it. Does that make sense?
>> that makes a lot of sense to me.
>> any objections to that?
>> I have none whatsoever.
>> let's do this.
>> Commissioner Daugherty?
>> steven, bear with me for a moment. I I'm just trying to make sure that I have the background information right here. But you basically came in last year during the budget time, and if you add the 350, the 726 and the 414, you've got about a million and a half bucks. And what you were given was 500,000, those were your projections?
>> yeah, close.
>> and given now that you're saying that around 800,000 is -- so this is not any big surprise to anybody because you said a year ago or over a year ago that you probably were going to need at least that much money out of this, but the court only gave you 500,000, right?
>> yes.
>> and then y'all picked up the additional million over the savings, the inner savings and things like that.
>> actually, the million includes the 1.07 includes the 500,000.
>> it does? Okay. So an additional six. Five to 600,000. Well, I mean, it's only reasonable that you would be in here asking for this since you projected over a year ago that this is what you were going to need, so it shouldn't be a great surprise to anybody. I guess the thing that frightens me the most is, you know, when you -- when you give these monies -- and I'm supportive of that. Obviously it's a need that we have. You knew that there was going to be a need. Everybody knew there was going to be a need a year ago. But we know that times aren't getting better. I mean, in this community. And I don't think they're going to get better for a little while. I don't mean to be a dooms daier, but we all know what's going on out there. Do you have any fear with those numbers that you have given us that you're going to come back -- because knees numbers have changed quite a bit in the last 60 or 90 days to some degree. I realize y'all have taken some out of the million 7, 1,000,079 and applied it. That's not to say that the numbers have grown expo nen sheal. I know you have a worst case and a best case. Do you really feel given some of these policy changes that you've been directed that you really are -- if you thought we were going to just kind of give you a little bit each time that you really are going to be able to toe the line and that we're just going to the last 60 days of this fiscal year, just say, do you know what, you've got to get back in the allocated reserves and wherever you can because that's what we're going to get. Are you seeing those numbers frighten you any?
>> we're not frightened by it. We can truly control the emergency assistance program. It's the health care piece. That's why I responded to Commissioner Sonleitner as I did when I said I was a little nervous about the piece that she put in there. Because remember, we don't have a cap on, for instance, catastrophic assistance program. There's no way I can predict whether there's going to be a catastrophic case or two within the program. Three or four years ago I can remember we had a couple of cases and our numbers just skyrocketed, but overall with the exception of maybe the last year or so that our map numbers have pretty -- the rmap vbz have pretty much been level. A spike occurred within the last couple of years where we've seen a tremendous increase in the enrollment itself. Of course, when we've had challenges before, they are more related to hospitalization and pharmaceuticals than the actual enrollment. And this year we're seeing an increase in the number of enroll the. I think when we were doing the '03 budget we were somewhere around 24, 2600 people enrolled in the rmap program. Now we're right at 3,000.
>> and I guess maybe this is just a question that I would almost ask the cowr, anybody that wants to weigh in on this for me. Is there a limit in our minds as to kind of the breaking point for us? Is there a number there where we just say, do you know what, steech, we should have probably told you -- steven, we should have probably told you may the 27th that this is the most that we're going to be able to get out of allocated reserves or wherever. So you know that that's the case versus saying, well, we did a pretty good job today, we did 250,000. We could probably go back and get another 250,000 and we could do that again. I mean, is there a point where we get to saying, king's x, time out, we can't do any more, or is that just on kind of the basis that somebody comes up here and says, hey, we're closing the doors? Is that kind of what generally happens?
>> I think it's easier when you go through the budget process. The problem is we did see trend, but they were early. And now those trend are several months later. It's kind of like employee health insurance. The trend was to keep increasing -- the trend was not to increase this much, but this fiscal year we have seen since October the amount of the trend increase biweekly. And so you don't have to be a genius to figure out how much it is going to continue, and I think health & human services is the same way. Through the budget process, I think it's easier to budget a certain amount of money and stick to it if you realistically do so. I think we all hope that it would not take as much money as we were being told. And we did increase it over last year's amount, but frankly, we would not -- we all kind of harbored the belief that I think the economy would turn around midyear. And now that jobs are plentiful that a lot more people would be working, not quite as many would people would need to ask health & human services and Travis County, generally speaking, we were hoping we would not have to spend as much. Even if you make the changes and become more strict, it seems to me that the numbers are big compared to what they've been like in the last year or two years.
>> it's good to remember that county government is -- [ inaudible ]. What they ought to do is send it on to us. We do have to kind of balance by watching the expenditures, watching the policies and being real careful about that. But I think sooner or later it comes down to us. This is where people come, especially when they're elderly and they're ill and they're children, healthy or not, we're responsible for them as well. I think it's just a balancing act that we need to carry on on an ongoing basis.
>> I think if there was a recurring theme from last year in terms of okay, what made it really go out of has been whack, it had to do with the jail population and the mandates and the homeless people. You have to take whoever comes in the front door. And it's interesting that the same kind of levels of dollars that we had set aside in this year's budget of the potential that we could not get the jail population crisis under control, this year that recurring theme is it's all about health insurance, people losing their jobs, losing their health insurance, not only within our own internal program in terms of how people are accessing the health care system internally, and I think it screams in terms of a lack after prescription drug benefit from the federal government is impacting us with our own employee program in terms of the costs, but also we're seeing the costs in the jail and we are seeing those costs in terms of people losing their health insurance and winding up in our rural medical assistance program. I think the other thing that I would just call to everyone's attention is this -- yeah, there are some other options here in terms of either eliminating or cutting back these benefits, but if you look at what is the result of doing that, you basically say, well, it isn't on our backs. We shift it over to being uncompensated care over at brackenridge hospital,. And they are us. It's all the same dollars coming out of the same community. And it's actually just proportionately impacting the city of Austin residents. I don't consider that to be a solution at all in terms of saying not our problem, stick it on brack.
>> I think whether it's county or city or --
>> we're all in this.
>> or rural or faith-based, it's all us.
>> if you have -- I understand and appreciate all those comments, but I do know that there are also sides out there from people when they're like, you all manage this thing the best that you can because we can't be everything to everybody. And it's sort of like what the judge was saying that if the numbers kept coming in and it's like digging a hole in the sand on the beach. You can throw a handful out and before you know it it's all figure filled up again. And given the times we have, I do think that it is incumbent upon somebody, you know, either the Commissioners or the department, to say, do you know what, we are going to have much more coming out as to what we can deal with. We know that. So if we're trying to deal with, you know, more people, then we have to find a way to say okay, then we have to spend less because the government does say yes, you spend it. They don't tell you how much to spend. And unfortunately, $100 doesn't go as far as -- or 750 or whatever it is. But at some point in time I'm going to feel very compelled to say I can't do any more, unless you just say we'll stick all this over here in reserves. Shroption we've got it in reserves, I think it's the only practical thing to do and the only humanitarian thing to do is to take care of the needs. The reason I'm talking is because I want you to see that eventually I'm going to get to the point where I'm just -- I can't see any more. And the argument about, well, they're there, you've got to take care of them or whoever it is, we've got to find a better way to deal with that. And I don't -- I'm not seasoned enough to do that, but i'll work at it. But I do appreciate the work that you've done, steven, all of your department. Because I know how hard it is. Y'all are over there with people coming in wanting help, and so it's easier sometimes to sit up here and not have to be over there telling people no, so I don't want to --
>> if you go through the budget process and we look at what we think it takes and here's the budget.
>> I guess along with that from the court's point of view as far as thanks for making daybreak a part of your day making some changes in policy -- as far as making some changes in policy, earlier when I asked steve a question of what will we know the results of the policy changes. Also give us a better indicator of where we are and who we serve and how we serve based on policy and a whole lot of other things. If we're not there yet, those are still out there. And I think steven responded he will have something in by June 15th, which would be within the course of the budget cycle in terms of that nature. But I think all of the specifics are going to be addressed and I'm real supportive of it because there is a big need for -- there's been a strong proposal of basic needs since i've been here, and I'm going to continue to serve the basic needs here on this Commissioners court. Commissioner Sonleitner I think made some good suggestions as far as the motion that the judge had made and the amendments. And if you could repeat those friendly amendments, I would appreciate that, Commissioner. I know I seconded the motion that the judge made, but there was another one that you brought in, and I wanted to make sure that it's all wrapped up in that motion.
>> well, and the friendly -- and this, of course, is the judge's motion, is what I had suggested is that the $829,842 that was already in the internal safety net be transferred and that there be an earmark of $750,000 on the emergency reserve. And that should get the department where it needs to be in a logical manner in terms of which money gets spent first. And for this court to keep a close watch on the expenditures coming out of the emergency reserve and for us to be let in on if there are any sudden spikes upward or downward related to the spending of those dollars.
>> I accept it.
>> I think as you've been doing is a good idea. And secondly, I think the first 250 from the emergency reserve could come as a budget transfer. We may need to discuss the second one, though. About the time I suggested earlier.
>> okay.
>> given what you have right now, 250 from the emergency reserve as a budget transfer as needed and then let's have a conversation after that. But I do think that the monthly reports you've been generating have been useful and it helps to keep seeing them.
>> okay.
>> any more discussio
>> the only thing, gald, you have to look forward for is as Margaret and the judge and I have been on this court I guess the longest, there are challenges when it's an up economy because we had challenges within tnr of keeping up with plat and subdivisions and people wanting to build and then there are challenges related to a town and related to attorney's fees and always something.
>> if you need anything, i'll be working for you in six months.
>> unless the economy has changed.
>> it may not be next year either.
>> I look forward to it.
Last Modified: Wednesday, May 27, 2003 7:52 PM