Travis County Commssioners Court
August 14, 2003
FY ‘04 Budget Voting Session
The Closed Caption log for this Commissioners Court agenda item is provided by Travis County Internet Services. Since this file is derived from the Closed Captions created during live cablecasts, there are occasional spelling and grammatical errors. This Closed Caption log is not an official record the Commissioners Court Meeting and cannot be relied on for official purposes. For official records please contact the County Clerk at (512) 854-4722.
Health & Human Services
We have just returned from a short recess. The second department this afternoon is health and human services. Any everyview.
>> yeah, let me give an overview of the preliminary budget amounts for the general fund in hhs. The preliminary budget amount is 26,560,388. The target budget submission was 25,408,380 and fiscal year '03 adopted budget was 25,546,261. The key variances include the following: an increase of 800,000 to address enrollment and inflationary increases in the rural medical assistance program, an increase of 150,000 to address increased demand in the emergency assistance program. 98,448 in personnel increases for the city employed county reimbursed positions under the county's health and human services interlocal agreement with the city of Austin. We also have an increase of 174,869 in salary savings to al line that -- align that number with recent vacancy history. Also a decrease of 165,000 for one-time additional funding for outside social service contracts. The -- the department's request for the funding of 3 replacement vehicles is recommended in the t.n.r. Budget and the request for the caba auto nation conversion is in the its preliminary budget. Also the department froze 9.5 f.t.e. And reallocated, internally reallocated the 479 [indiscernible] 66 to the r map and emergency assistance programs. Now the fqhc fund. The fiscal year '04 preliminary budget amount is 2,069,235 in accordance with the auditor's third revenue estimate, the fiscal year '03 adopted budget was 2,092,816. The key variances in that fund include an increase of 2,383 in the general fund transfer -- 2,383 in order to fund a david powell clinic position in the fqhc fund instead of the general fund. Also a decrease of 13,309 to consolidate custodial contracts in the facilities management budget. Also a decrease of $210,655 due to a drop in the fund balance in operating revenues. The department in the fkhc fund internally funded a pharmacy tech position in order to assist clients with accessing lower cost pharmaceuticals, they did this through making an offsetting cut in the operating budget. They internally funded the health benefit increases, this amount was 13,966 for the city employed county reimbursed f.t.e. In the fqhc fund. Let me turn it over to the department if there are no questions.
>> the david powell amount was how much, now?
>> yeah, that was one employee and associated operating expenses, it simply went from the general fund to the fqhc sniewnd fund.
>> it was in response to the city's reorganization of the david powell clinic where it went from the Austin Travis County health and human services department to the community health centers.
>> okay.
>> good afternoon. Before starting, I want to do something that I haven't done in eight years, that is to thank christian and his staff. [laughter] on our budget discussions.
>> drum roll.
>> I want you to know that it is thundering and lightning outside. [laughter] his but actually our meeting was relatively short and to the point because we were pretty much in agreement on things and that is a first. So I'm appreciative. As you can see, with our vision, it is our goal and health and human services and veteran services to optimize self sufficiency for families and individuals in safe and healthy communities. I think the whole vision of self sufficiency is a theme we really have began to authorize more and more in all of our programs and services. With our mission I think the key word is partnership. We recognize that we cannot do everything ourselves. If you note in the last few years, we have not necessarily emphasized the direct service programs that we've had, but we have tried to serve as a facilitator, a catalyst to ensure that certain programs exist within the community to provide access for those individuals who need to access those programs. During this presentation, what I help to do is to give you a general outline of the community conditions that we are faced with in the health and human services arena. I also want to highlight some specific trends relative to our rmap program, our clinics and our emergency assistance program. I also want to just talk about a few relevant facts relating to children and youth within our community and then, of course, summarize our program recommendations then leading to a quick review of our budget requests. In community conditions, you see that on the first slide that unemployment has an impact on our demand for services. This is particularly true and health care and -- in health care and emergency assistance, I don't think that I really have to review that a lot with you because we just experienced it over the past few months. And as you can see in June of 2003, unemployment reached 6.4%, which really matched the national unemployment average. Traditionally, historically, excuse me, Austin has been a little bit under the national average. Layoffs, in January of this year, we saw layoffs from 12 different employers, employers, 10 or more with more than 50 employees each. While the largest was in high tech, 350 from a.m.d., And -- but during that month, layoffs actually hit a wide range of businesses from retail centers to call centers and semiconductor and the semiconductor industry, excuse me, I don't say that a lot. If you look at specific numbers from 211, relative to Travis County, 29% of households need assistance in paying rent. 45% increase in families needing assistance with mortgage payments, a 52% increase in families needing emergency food assistance, of course our numbers mirrored this also. A 10% in families needing assistance to pay utility bills. Now for more specific trends. As you can see, our rmap enrollment has gone up. When I talked to you a couple of years ago, we were talking 2200 people I think last year. We were -- and in the middle of -- around 25 or so. This year you see we are at 3,093. I submit that this is a direct relationship to some of the trends that I summarized earlier.
>> what's bizarre, stephen is you've had massive annexations into the city of Austin where some of those r map people became m.a.p. Patients and it is still going up.
>> yes, that it is. Enrollment for the most part in our rmap program will drive our costs. Let's look at utilization trends. [indiscernible]% of those enrolled in m.a.p. Have full benefits, they are not just there for prescription benefits, but they receive an array of services from primary to specialty care to hospitalization and of course prescription benefits. You see a comparison of the average monthly in-patient bed days from fy '01-'02, it went from -- it was 23 in fy '02, in '03 it was 31. You see of course an increase in the emergency room visits from fy '02 to fy '03 and an average number of outpatient specialty visits from fy '03 to fy -- from fy 2003 '02 to -- '02 to 2003.
>> what is an increase in bed days.
>> more people staying in the hospital, it could be the same number of people or same people staying longer. I would say it's probably more people spending more time in inpatient setting. You see the tame trend in emergency room visits and in other costly -- another costly service is specialty care, outpatient specialty care. You see that number, in my opinion, went up dramatically. In addition to what you see here, our pharmaceutical costs went up 5%, our professional services also up 3%. This is not a -- these are trends that you are also seeing with your health care program internally. Clinic utilization and in fy '02 you see that it was 12,000 -- 12,000 roughly 200. Of course the year prior to that it was 9,000. With just three quarters we have 11,114 encounters, we are projected to go slightly under 15,000 encounters, which would represent a 22% increase over fy '02. I think -- the projections that we are using for our fy '04 budget are based on 15,105 visits, which is a 3% increase over fy '03 and of course that is extremely conservative. Looking at our trends from -- remember I said from fy '01 to '02 we went from 9,000 to 12,000 visits. This year from 12,000 you see to an almost 15,000 visits. So -- now we are saying that there is limited capacity within the clinics to -- top accommodate more individuals. But one thing that we have to consider is the fact that we are bringing on Pflugerville. Which means that there should be some increased capacity there. By the way, Pflugerville is where we are seeing pretty much all of our increases. In demand. So the people who go to the Pflugerville clinic can't all live in Pflugerville.
>> no.
>> or outside of Pflugerville.
>> no.
>> they can live anywhere in the county.
>> okay.
>> outside of the -- well, they could live anywhere in the county outside of the city of Austin.
>> they could be in the city -- any of the other cities, but not Austin?
>> yes, they could live in Pflugerville, in manor. There are people out in western Travis County, sometimes, go over to the Pflugerville clinic. Because we have more provider time within that clinic.
>> other thing that's going on is sometimes they do it because of where they work. We have a lot of folks that work in that dell corridor and so Pflugerville clinic is convenient for some folks that [inaudible - no mic] if we look at family support services utilization trends. The number of clients receiving county funded utility assistance is down. It's down due to increased utilization of grantsd other sources to provide assistance -- not necessarily due to the demand. The graph also does not include food assistance since the number of food vouchers is down, but that change is more offset by increases in frequency of food pantry assistance. In other words our folks are giving food pantry assistance instead of vouchers oftentimes and a lot of times that is in response to the immediacy of the need.
>> stephen, do you know the percentage of single parents in this category? Is that something that's available?
>> we have statistics. I don't know whether we track single parents. We might track single heads of households.
>> I would like to know that. I would like to know the average number of children per family. On this family services chart.
>> we usually track by head of household. We do, I think have a record of children. Something that -- something that you probably feel pretty close to on the next slide, our family support services and trends. Because it was just in March of this year that -- where we had to actually add additional dollars. In fy '03 we had an additional $441,000 to the initial budget and the emergency assistance program. This was the -- a direct response to the demand. Of course we did that with the combination of internal reallocations and new resources from this court. In the preliminary budget, p.b.o. Recommended $922,000, for the emergency assistance program and this actually, if trends continue would put us about $100,000 short of that. But I have a recommendation as to what I think -- what I hope your response to that is. Children and youth. Although we have no direct request for new resources within the children and youth area, I thought that it would be important for us to at least talk about the area of children and youth. In doing this presentation. What you see before you are some proposed cuts, in some cases cuts that will be realized in the children and youth area. I'm -- one of the reasons that I want to relay this to you is because there is a potential impact on some of the resources that we have in the children and youth areas. I'm going -- under the specifics we don't know yet. But there is being proposed on the city of Austin site a 16% reduction in youth participants in structured recreational programs. A 40% reduction in participants in youth development programs. A 30% reduction in youth employment. And potentially a 10% reduction in the school through the aisd interlocal.
>> youth employment, that's a summer youth program?
>> yes. There is some flexibility. We have been talking about ways to do that in a way that would not impact the number of -- the number of -- youth, I started to say slots, but that's not quite appropriate. Of course you've heard this -- this from -- from the news from the state. Of course the state will no longer be funding a healthy families program. But we have a recommendation to absorb that internally. And --
>> [indiscernible]
>> $120,000. Right? 125, I was off by 5:00.
>> 125?
>> yes.
>> I said the first day, we need to very -- keep very close track of things that happened at the state budget and at the Travis County budget so we can report back to the state legislature the next time they come back into town.
>> that would be 125. What we actually did, we had an -- we experienced an increase during the last part of this fiscal year. We projected that we would incur this, so therefore we took some internal actions to create some savings so we can continue that program since we believe that it is a very important prevention program for children and youth. Of course availability for -- reduced under the chip program, everybody has been talking about. Stephen why do you talk about the children and youth issues, the next slide will show you just a few -- community conditions regarding youth, characteristics of youth. A.p.d. Has investigated nine in the first quarter of this year, a 75% increase. '98, sorry, what did I say?
>> nine. I was really just testing. 98. It's 98. I just read it. You are seeing statistics children under 18 dying in Travis County. [one moment please for change in captioners]
>> we will find out -- we have got that annual report.
>> [indiscernible], in Travis County, 2002. Cover -- I really would be interested to see how these children --
>> my guess is you want me to compare it with other areas.
>> I want to know is that a greater percentage, given that we have more children, I'm sure.
>> okay. We can tell you that. All of these are follow-up.
>> okay.
>> that I will give back to you.
>> okay.
>> of course we are very close to [indiscernible] considering the community conditions, we have the following programmatic recommendations. In health care, we recommend that you continue to provide primary tertiary and specialty care and dental services to indigent residents of Travis County. We recommend that you maintain the current level of benefits and scope of service. Recommend what you approve certain costs of strategies that we will bring back to you on Tuesday. And emergency assistance, we recommend that you continue to provide crisis stabilization service. Of course you have actually approved our moving forwards with effort to streamline the service delivery. We have talked about a notion of improving linkages to workforce development. Staff have a scheduled training and they will have specific recommendations for -- regarding how we are going to do that in a couple of weeks. We want -- we want you to -- to continue to support us in promoting individual responsibility and accountability. An area of children and youth, in the area of children and youth, we recommend that you maintain cost effective prevention and early intervention efforts for children and youth and that we work and -- community partners to identify needs at the schooling gap period activities and we want to increase resources to expand family driven holistic interventions through systems of care. That would be through reallocation of current resources. A again ral overview of our -- general overview of our budget. If you include veterans services and cooperative extension service you will see that we have 202 employees, that number threw me off, we have 180 not counting --
>> is that the extension service figure is the general fund amount.
>> yes, that's the general fund amount, not including your state budget.
>> what percentage of the total budget is that?
>> [inaudible - no mic]
>> oh, really? [laughter]
>> jeff says with a big smile on his face.
>> it was a -- full partner, that's good. Uh-oh. You see, total -- total general fund is 26.5 without the fqhc, with the fqhc it's 28.6 within our preliminary budget.
>> [inaudible - no mic] if a health district is successful, [indiscernible] voters, at some point we would need to delineate. What of this -- would -- would be transferred because I think that's one of the message that's -- that is out there is that a whole lot of stuff that is related to health still stays with Travis County.
>> yes.
>> and the general fund and you would be taxing, including e.m.s. And -- and inmate health services.
>> public health.
>> yeah, but not today. Just putting agents tick clear out there. -- a little ticker out there.
>> thank you. Health district, how much transfer.
>> I see the fqhc budget here, a little more than $2 million.
>> yes.
>> that is -- that is client money, federal money, state money, but not county money.
>> yeah, that's everything. Including county money.
>> about how much of that is county money?
>> yes, it includes a transfer of 1,250,675 from the general fund. It's part of that -- of that 206 --
>> everything else would be revenue.
>> about 55% of that is really county money.
>> yeah, non-revenue. [one moment please for change in captioners]
>> if you look at the pbo recommendation of $800,000. You will see that our net request would be $667,000 actually. That would be a net health care request. Actually, that is our net. The next slide actually summarizes our total ned. It would be 1.2 if you add the fqac $500,000 and the rfm $600,000. But we're anticipating some savings on the 340-b program on the pharmaceuticals, so we anticipate $250,000. So unfunded need for that would be slightly on the million dillard's of 983 -- dollars of $983,000. If you told me to say with that budget and still operate under the current policies, these are examples of options that we would consider. Under the emergency assistance program, you see that our initial department request was $250,000. With that preliminary budget recommendation, I spoke to this earlier, we said we would be short $100,000, but we're not really going to ask for that. We believe that gif ensome of the current policy changes and some of the steps we might be able to take throughout the year we might be able to absorb that. If it goes past the $100,000, it would get pretty iffy. In conclusion, you will see a summary of our request. For rmap, we recommend that you fund that because we're online to funding that. For the fqhc, we remain that for maintenance of effort and the revenue shortage that you fund that. The class a pharmacy in Pflugerville, we could live with the reserve dependent on when that clinic came on board and when we would be able to make that pharmacy operational. And as you can see in the emergency assistance program, we're saying that we would like for you to at least earmark, and I heard what you said earlier, $100,000 in the reserve knowing that we would have to cover the projected shortfall and the emergency assistance program. And children and youth, we don't have any specific request, but we just want to keep that at the forefront of our priorities. I'll entertain any questions.
>> there's that deal where they say there's some folks that have been dismissed and have been unemployed. Do we do that here in Travis County?
>> they no longer qualify for benefits?
>> yeah. They're not really --
>> they stopped looking.
>> it's possible the numbers that you look at in terms of what the total labor force is that includes people looking for work, that number has continued to climb locally. So it doesn't appear -- statistically we didn't receive that decline in the actual number of people that are looking. So it doesn't appear that we're seeing a large number of these people that are giving up entirely and creating artificially depressing that rate.
>> those folks will be part of the effort to put them in to top training programs, right?
>> yes. What we're going to try to do within our programs and emergency assistance, is to link those individuals that are not elderly our disabled to workforce development efforts. Remember earlier in this year you passed a policy that said we would not serve individuals unless they were able to document some efforts towards workforce development or toward work. We won't feel the impact of that until June because that is when the policy was passed. If that number were to rise, that policy may not have the impact on our program that we were thinking it would have because your demand would din tin to grow. There would be folks replacing those folks.
>> but have we implemented any part of that policy yet?
>> we've implemented a policy, but we started in June, so therefore --
>> you're saying the numbers aren't showing up yet?
>> the that won't start occurring until June of '04.
>> so are records being kept so we know?
>> we have files on everybody that we see.
>> I had forwarded to you an article from the houston chronicle I guess about a week ago on the va stuff. Did we get any further information? Because we've been real concerned about partnerships with the va or not. They were mentioning that they were doing -- making greater access available for va programs, teaming up with clinics in cities. And one of the cities that was mentioned was Austin. This is coming out of the houston paper and they of course were very specific about what was going on in houston. Did we get any information?
>> I haven't got that yet.
>> okay. If you could please follow-up on that that would be very much appreciated. Because we offered ourselves to be that kind of a partnership, and I found it interesting that they definitely have done that down in the houston area.
>> so the amount in the preliminary budget is how much greater than the adjusted '03 budget?
>> yeah, the amount would be --
>> you said greater than the adjusted '03 budget?
>> yes.
>> it would only be the amount of the interlocals.
>> yeah, it would --
>> cash money throughout the year.
>> we had 750,000 --
>> I have two questions. People are going to interpret adjust understand two different ways. That's why you've got some -- [overlapping speakers].
>> the amount in the preliminary budget today is how much greater than the adopted budget for '03?
>> that's a good question.
>> and part b of that question is how much did we add after the adopted '03 budget?
>> the adopted '03 budget was 25,546,261. We've added from emergency reserves 750,000. In the fiscal year '04 preliminary budget we've added $850,000, plus 98,004 for the interlocal requirements. So it would be roughly $100,000 plus the interlocal requirement greater than the adjusted fy '03 budget, yeah.
>> okay. So the preliminary budget now has $948,000 more than the adjusted budget for '03?
>> yes, I believe that's correct.
>> and the adjusted budget or the adopted budget?
>> in the adopted budget.
>> than the I dopted budget. It's only two hundred more than that, the adjusted budget.
>> no, we added 750,000 midyear or emergency reserve. Then you said we added 850,000 plus [ inaudible ]
>> it would be added 850,000 to the original budget, to the adopted budget, not with that 750,000-dollar increase. [overlapping speakers]
>> it needed to be adjusted because we didn't get it right and this time we hope we got it right.
>> so we added 100,000 and 98448.
>> right, the 98,448.
>> so the preliminary budget is $198,448 over the adjusted '03 budget.
>> correct.
>> so when you said we had added amillion dollars to the budget, we added a million over the adopted '03.
>> original adopted '03. Now, I should note that the department is coming back with a 240,000-dollar request this Tuesday for additional resources. Just to put that out on the table. There's an agenda item to that effect.
>> and that is for?
>> this year.
>> but that is for what?
>> [overlapping speakers].
>> it's a -- it's the same really reason as the original 750,000.
>> so what we're getting to is we've all talked about trying to right size what are really hard numbers to right size? So in institutionalizing the 750 that we added, did we go far enough based on the request that we're getting from steven on Tuesday? That just a one-time spike or is that part of the trend that need to be incorporated in the budget. In which case we have not gotten there yet.
>> that is e issue before the Commissioners court. If nothing changes and there are no modifications, what steven is saying is we really don't have debate with what he is saying, is we will have the same problem. And if the court wishes to not make any of those changes, they are probably undersized by a million dollars. You are correct. On the other hand, if you wish to make some of those changes, you can right size them with the additional million that really represents what we've added in '03.
>> let me ask the question in a different way. Are there any procedures, he gibility, whatever that we have, that are different from the city of Austin in terms of we do more in terms of having quealt, in terms of everybody is doing the same things in terms of same standards, same whatever, is there anything that we do differently.
>> I don't remember some of the specifics. I have the city map people that are -- they're not that great.
>> is there anything that the city of Austin is proposing in their budget specifically related to eligibility. That's not changing. They're going to --
>> because as I understand the eligibility requirements are going to be the same. There is a slight, I think, decrease in the number of eligibility workers. But the difference between the city of Austin eligibility requirements and the county's eligibility requirements for rmap.
>> the only difference is with the undocumented, and for the city of Austin the income guidelines are up to 21%. And in the county the guidelines for the undocumented equal the guidelines -- everyone's guidelines are the same.
>> what is the price differential if we were to match what the city of Austin does and the cap for that bracket?
>> we can run that. We can get that for you.
>> I think it was about 180,000, but I wouldn't trust the number that I pulled out.
>> it's one of the things that we're talking about consistency in terms of our systems of care, I would have a really hard time understanding why there would be -- we are an extraordinarily generous community and we do so much more than anybody else has done. And our numbers and our he will jinlt. And I think rightfully, because the numbers are ridiculously low oz to what puts you at a property level, but I would find it very difficult to explain to somebody why we would use one number in the county and the city would use another number, and they are dealing with a whole lot more folks and don't seem to be running into problems of people saying, well, that's just not fair. It is what it is.
>> I'm not sure I understand the 21%.
>> that's the state mandated --
>> the poverty level.
>> what the city uses.
>> we use for the county, our map uses 100%. And for the persons that are disabled or over 65 -- (indiscernible), which is consistent with the city.
>> if someone's disabled or over 65, the income -- poverty income guidelines are up to 200%.
>> [inaudible - no mic].
>> that's right. Right, federal.
>> but we match on the 65 and older and we match on everything except the undocumented, so I would just appreciate getting some more information about why that differential is what it is and what are the implications of the city being where they are and what are the implications of the county being where we are. Not as a follow-up before we finish.
>> so legally now, if an undocumented person arrives at brackenridge hospital, is a city resident, is the city obligated to provide brackenridge services?
>> well, I think -- I'm not the financial guru here, but I think most of that is probably covered through the charity care fund that is supported at the hospital.
>> let's find out because I had been left with the impression that if you present yourself to a hospital, whether you are a resident of an unincorporated area or an incorporated area, you were legally bound to provide emergency services.
>> oh, yes. You're absolutely correct.
>> they cannot turn anyone down.
>> but how they pay for it is determined later.
>> that's right.
>> now, the -- seton, st.david's, when they figure out how to allocate charity care dollars, do they factor in whether you're a resident of a city or unincorporated area?
>> I'm not sure.
>> I see you made a mental note of that. I have seen huge charity care figures as we looked at the health care district from st.david's and seton and I never thought about it. I just assumed that it was really for like central Texas.
>> here's where I'm going with this question because if we talk about things that do get transferred, and again that's going to be up to the voters. That's a big f. But if it does, you're not going to have inconsistency in terms of levels if it all goes to a county-wide hospital district. So even if it doesn't happen, it's something I would like to get more information about because I don't have enough -- I have only enough information to be dangerous, so I would just like to know how it is that that happened. When does the city change to a different number than what we've got and what are the implications of changing that number or not?
>> okay. They handle that a little bit differently than what we do, but I will handle all your questions in a memo back to you.
>> that would be great.
>> and if we can determine what the Travis County bill is from brackenridge hospital for hospital services provided to rural residents. We'll get to that matter, whether we pay for it on rural residents.
>> we have that. A line item is in our budget.
>> we talk about this, but we need the county attorney to tell us what authority we have to bill other counties for services provided out of city residents that we may get billed for.
>> are we getting billed or is the city getting billed?
>> actually, it's the providers that they're the -- they bill the county -- the out of area county. So --
>> I thought we learned during our discussions that we were getting almost zero from the counties.
>> you mean during the hospital district discussion?
>> yeah.
>> but it's brackenridge that's getting short.
>> that's a good question.
>> it really is. If brackenridge keeps that expense, is it paid by the city of Austin or seton, Travis County, all of us or what?
>> I'm sure they factor that into their costs.
>> it's that big thing called uncompensated care and there are requirements that everybody who gets federal dollars have to provide a certain amount of uncompensated care.
>> it seems to me that what may be the best thing for us is to pick up the load at the clinics. It costs a whole lot less. The thing about undocumented workers is you have to pay for them if they go to brackenridge hospital, it makes a lot more sense to pay a lot less for the same thing.
>> that we know is true.
>> is there training going on to make sure that everybody understands that it's to iewt -- if they utilized the clinics rather than utilizing the hospital, is that going on?
>> yes.
>> how do we get that done?
>> i'll let claudia answer that.
>> I have to talk for map. What we do is that we daily look at the emergency room census and we look at persons -- the reasons that they go to the emergency room, especially persons that are -- really the people on the medical assistance program. So we call them and we talk to them when we reach them or we send them a letter and we facilitate the appointment from them for the clinic if they need it. We educate them on how to access the clinic. And then we try to assess if there are any barriers or if there are any special health care needs that they have.
>> but that's going on actively in our clinics.
>> well, she's speaking about how it occurs from the r map standpoint. If you look at the insurer, the payer, she's talking about how they intervene to insure appropriate utilization of primary care.
>> what is your name and who are you with? We know you're with the government and here to help. [ laughter ]
>> I'm claudia liendeburg and I'm with the Travis County health & human services a, city of Austin and I manage the nurses' area for the rural and the city medical sis sense program.
>> you're the sis reimbursement --
>> I'm a city employee.
>> but we pay for other positions before you make this too complicated.
>> and you're the right person I can ask this question. This came up last week when I was in Pflugerville for their employee awards. Did we lose a doctor again out at the Jonestown clinic? And my question is, what have we contracted for in terms of service? Is that being delivered. And if it is not, are we paying for something we're not getting? Because as I understand the doctors' hours have been substantially reduced again.
>> it my understanding that they are currently --
>> it's not my area any more.
>> they are currently recruit fog a doctor at Jonestown. We do not reimburse the city, the city of Austin for provider time that we don't receive. Because that is in the personnel costs that we get.
>> are we also seeing difference revenues because they're not getting the time that they're supposed to.
>> it's my understanding that our revenue projections are off. I don't know exactly why.
>> if you can follow up on Jonestown, i'd appreciate it.
>> I will.
>> [inaudible - no mic]. Is there a possibility -- is there a possibility that because of the hours that the clinics are open as opposed to when they're not open, as opposed to the emergency facility being 24-hour at brackenridge and we find people coming to brackenridge because of the hours of non-operational activity at some of our rural clinics.
>> I'm pretty sure that's a factor. To what extent --
>> it probably is another factor. Urks excuse me. You --
>> excuse me. You have five minutes left. I see you have some of your managers here today.
>> what do you want us to do, sing? [ laughter ]
>> I want to meet all of them.
>> why don't they introduce themselves.
>> arlene [inaudible - no mic].
>> [inaudible - no mic]. [ laughter ]
>> you can call him anything until after the budget. [ laughter ]
>> [inaudible - no mic].
>> and you can lawrence lyman, who is a senior planner who you've known for years. Who else? Oh, I thought maybe that was it. David salazar, my assistant. You know them more than me. [ laughter ]
>> that's what I hired her for.
>> any closing remarks?
>> sure. Well, I think we've pretty much laid out the case for our medical assistance program. And the need for an increase in resources for health care overall. I think you also know through my discussions with you that we have been really and in other areas really streamlined to the extent that we can in terms of trying to reduce the cost of delivering those services. And you see that we're continuing to try to stretch our resources, our recommendation that we not cap additional resources for the emergency assistance program, but let us give a shot at trying to cover the 100,000-dollar projected shortfall for next year. Thanks for coming through for us this year for the projected shortfalls that we have projected and that we have realized.
>> I don't know if you got the feedback from last night. There were quite a number of folks here related to social service, but I was very pleased to get the feedback related to the children's partnership change in strategy, families determine with a chunk of money that was allocated to help them to choose what's appropriate for them. And I thought it was very brave for some of them to bring their kid who are recipients and I know it's extraordinarily expensive, but it seems that the families at least appreciate the new strategy.
>> yes, a lot less expensive than residential.
>> we got that loud and clear.
>> what we have is in the preliminary budget there's no health & human services reserve.
>> that's correct. In the discussion we had about reserves, this is a very good example where if -- if the preliminary budget numbers stay exactly the way they are and there are no changes to protocols, procedures, then steven is going to be back and he's going to say I told you. And you're going to go, I know, and you're going to wrestle with it throughout the year just as we wrestled with it before. That's my parting comment. It's a little bit like indigent attorney's fees, that sometimes we're always a year behind. There are choices.
>> yeah. I guess my only comment is I really don't have a huge problem with trying to deal with the issues and the need that human beings have in this community. I just want an assurance that no human being will be left behind.
>> I think we can help.
>> thank you.
>> okay. Thank y'all very much.
Last Modified: Thursday, August 14, 2003 8:52 PM