Travis County Commissioners Court
August 18, 2009,
Item 29
>> now let's call back to order the voting session of the Travis County Commissioners court, and this morning we indicated our intention to call up item number 29 this afternoon.
so a little bit after 1:30 we call up 29, receive and discuss the proposed budget of the Travis County health care district for fiscal year 2010 and the associated tax rate.
>> good afternoon.
>> afternoon.
>> good afternoon.
>> I'm trish young, president of the Travis County health care district.
and we have seated next to me our board chair, dr.
tom coopwood.
>> thank you.
>> and our chief financial officer, ms.
carolyn kinetiki and chris is handing out an addendum to the presentation that was submitted to you last week.
we have the opportunity to present our budget for the fiscal year 2010, 2010 for the Travis County health care district.
this is the budget that we do intend to present to the public.
we have two scheduled meetings on September 3rd and again on September 10th.
and you have received the backup for the budget as well as a copy of the presentation that we're going to walk through today.
i'm going to ask ms.
kinetiki to walk us through the presentation and we'll be happy to answer any questions that you have.
>> I also need to mention we have mr.
clark headrick in the audience with us.
you've seen him once or twice before.
>> welcome.
>> and since we happen to have him here, ed Gomez has just joined the district staff as our community relations person.
i think many of you know ed.
we're glad to him here today watching.
glad to have him here today watching.
>> good afternoon.
i'm going to go through the budget presentation with you and then I'm going to let trish answer all the hard questions.
so I believe you've all seen our vision and mission before.
even our focus areas of the budget haven't changed a lot from the prior year.
primary care, specialty care, mental health care.
patient coverage programs, that's the medical assistance program.
the community health centers transition from the city of Austin.
efficiency and integration of service delivery, regional collaborations and district infrastructure and resources.
to fund this vision this gives you a comparison of the budget for fiscal year 2009 and what actually happened.
the most meaningful thing on this graph is that we got more addition upl than we derived from the lease of brackenridge hospital than we budgeted for.
and that's partially due to the favorable federal climate right now where they're not cutting additional upl for hospitals.
the majority of the fiscal year 2009 expenses, 90% relate to the provision of health care.
of that 5.3 million, that blue part of the pie that's overhead, 1.5 million of that is depreciation, so the overhead of the district is very low.
>> why we think the health care system is better off for the money that we spent in this budget year, comparing fiscal year '08, fiscal year '09, primary care visits are up six percent.
admissions from mental health at Austin lakes and seton shoal creek that the district funds are up 119 percent.
and the medical assistance program enrollment has gone up from 9,144 last year to 14,000.
and that's nine months to nine months.
>> in the 20 '10 proposed budget, the operating budget is balanced at the effective tax rate.
so there's no increase in taxes, there's no use of reserves except for the capital items use of reserves.
in the budget we have 2.8 million more in total revenue and this is comparing budget 2010 to budget 2009.
reallocating 2.1 million from the prior year that was an operating expense, we're reallocating that back down to health care because we finished the transition.
those transition expenses that were in last year's budget, we won't need to expend those again and we can use it to purchase health care.
we have targeted service expansions for specialty care and dental it wases, primary care, plus another three million as yet undesignated serve as expansion funds.
this year we succeeded in successfully transitioning out of the city of Austin's administrative infrastructure to full operational autonomy.
with that infrastructure established, we're continuing to expand service levels and determine how we can coordinate most effectively with health care reform at the national level.
>> the next page gives you a quick snapshot of the budget.
you can see that the property taxes are at the effective tax rate and the increase in taxes is based on new property.
district operational expenses go down from the 13.7 million to 11.4.
and health care delivery goes up.
from 81.4 to 86.6 million.
you've got a snapshot of reserves, and the capital budget and the capital budget reserves will be used to pay for those two years of capital budget.
next page is an impact page to the average homeowner.
at the time we originally put this together and sent it to you, we did not have the effective tax rate yet.
we got it in the meantime so we note that we added this page for you, the effective tax rate is .0674, slightly down from last year's rate of .0679.
depending on where your property falls, whether you had an appraisal increase or you stayed the same, there could be a small increase to your taxes or even a decrease.
2010 program enhancements.
expansion of the medical assistance enrollment to 17,000.
i said a few minutes ago we're at 14,000 this year.
this would expand it to 17,000 in the budget.
additional primary care contracts at 3.1 million, funding an additional 30,000 visits.
inpatient mental health is continued at the 5.2 million budgeted in prior years, which account for about 1200 patient admissions.
and the reason why it's continued that the rate is because we haven't previously spent all the funds.
we're still trying to spend up to that level.
we're working with contracted primary care providers to include integrated behavioral help in their scope of care, and new funding of 500,000 in contracts with community providers for dental services.
if you look at this little graph you can see how our expenses are beginning to be close to our revenue.
and this just portrays the fact that expense and revenue are moving together as we've had service expansions and they're beginning to catch up with the amount of revenue that we have.
and we just wanted you to see how we're looking at sustainability.
>> I'll kind of step in right there.
i think it's important to note that that's an important graph to take note of because what we've experienced this year in our ability to set our budget at the tax rate is we're essentially in balance this year with the revenue that we expect to bring in with the service levels that we would like to achieve.
we do have the benefit of this coming budget year of benefit of some additional federal funds that will come down as part of the american reinvestment and recovery act.
a little bit unclear about whether that's sustainable into the future or will we drop back into levels that we're used to seeing in this budget year: we do have benefit of that in this coming budget year, but I think it does portray in following years, paints a scenario where we are essentially -- I think coming to the point where we understand that our current level of funding for the district is to some degree sort of stabilizing and the amount of service that we can deliver for that funding is somewhat stabilizing.
so in trying to -- in thinking about out years and how we continue to meet that ongoing need, we do need to be mindful of what our -- what funding our tax rate will bring to us.
knowing that even if we fix service levels, we know the costs associated with those services continues to grow, their typical medical consumer price increases from year to year anywhere from three to six percent.
so we do know that even if service levels sort of flatten out or even out, we do have ongoing cost increases related to those service delivery levels.
so it's just more of a head's up for the future to think about where the district is at right now.
we're in a good spot right now.
and we're grateful for the funding that we are getting this next fiscal year from the recovery act.
i'd be happy to answer any questions that you have.
>> questions?
>> just have a question in regard to you saying it's stabilized.
it's stabilized in regard to the revenue available to you and how much services you can provide with that revenue.
>> correct.
>> but that's not to say it's stabilized in regard to the need and the demand for --
>> that's exactly right.
>> -- for medical services so that the need and the demand doesn't actually increase due to lack of treatment.
>> that's exactly right.
i think we're -- I think we're coming into our own, but that does not necessarily mean that coming into our own meets community need.
and we know that we still have fairly significant demands for the services that are provided through the whole network of providers that we support, which would include community care, the federal qualified health care system as well as all the other community partners that we have such as peoples community clinic, maranto, etcetera, where they are providing services through district supported funding, and we know that they're at maximum capacity as well.
so we do still have a fairly significant community issue.
>> and in terms of demand, just laying foundation here because what I'm hearing you saying and maybe the listening audience doesn't hear it as clearly as I do, is that you're saying that y'all have stabilized in regard to your services now, but there's such a demand out there, in order to paint that picture we often hear that one in four individuals in Texas don't have health insurance dovment we have any statistics on what the percentage is of individuals who are underinsured?
they may have insurance, but it doesn't provide the coverage necessary for them to get treatment in advance of a health issue becoming a major health issue?
>> it's hard for us to pinpoint a statistic that would talk about underinsured.
but if you think about the categories of individuals who fall into that, you have those that as you've mentioned, just do not have insurance whatsoever.
then you have individuals who might be enrolled in certain government programs like medicaid, that they are often considered underinsured, not so much because of coverage, but their access to care is not guaranteed.
there aren't necessarily providers that will accept that medicaid reimbursement to care for them and therefore they're sort of directed into our safety net system for lack of other places to go.
so they will often be underinsured as well and do make their way into our system.
we are addressing a community need of folks who have both, some coverage, but lack of access.
and then those who have no coverage and no access than say in acknowledge emergency room.
>> thanks for that clarification.
>> I know we previously talked about the amount of unallocated reserve on hand.
it looks like this budget's 48,500,000.
but y'all were trying to get three months?
>> that's 150 days.
by policy that's 150 days of operating requirement.
>> the 48 million is?
>> 48.5, yes.
>> okay.
and inpatient mental health budgeted at the same level as last year.
i know y'all are partnering with others in our community to try to better address this need.
are we still in a situation where we probably have more cash than capacity right now?
>> I think that's a bit of a struggle.
it may vary from day-to-day, but on days there are people that need admission to either seton shoal creek to ash or to Austin lakes, and those facilities may not be able to take them immediately.
as she pointed out, we have funded the 5.2 million, but because of capacity restraints, we've not necessarily utilized all of those funds.
we think the need is out there and that's why we think it's important to continue to fund at that level even though we haven't utilized that funding, all of it to date.
the -- we still have concerns about individuals who are diverted to hospital emergency rooms for lack of service availability immediately.
that problem seems to be stabilizing to some degree.
we've been able to make some impact in terms of the number of people who are either diverted to the emergency room or reduced the length of stay that they spend in that emergency room await to go get to a more appropriate service setting such as shoal creek or Austin lakes.
so we do believe that the 5.2 million probably represents what could be the iewt -- the capacity availability if it were available all the time.
if that makes sense.
>> but as a community, I guess we still strive to locate or find and hire mental health professionals, and I guess increase mental health facilities.
>> yes, that's exactly right.
and often the capacity issues at the hospitals have to do with the staffing available on a particular day.
and also, of course, just the number of patients that might be in a facility on a particular point in time.
but we do still struggle with having enough psychiatrists in the community and having -- and with regard to the hospitals having the appropriately trained psychiatric staff that can work at those facilities.
so it's not necessarily a bed, a physical bed capacity issue, as it is a staffing issue.
>> a after today you will have a couple of public hearings?
>> yes, sir.
>> and your public hearings will be where?
>> the first one will be September 3rd at 1111 east cesar chavez, which is the district headquarters.
the meeting on September 10th will be here in the room we're at today in Commissioners court.
and then we will be back in front of you on September 22nd, I believe.
believe, for your approval of the budget.
>> and we're free to distribute this backup to any resident that requests it.
>> absolutely.
it will be on our website as well.
>> questions, comments?
any other input?
always a pleasure to see you.
thank you very much.
>> thank you.
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.
Last Modified:
Tuesday, August 18, 2009 3:07 PM
