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Health Services Department (HSD)

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  1. Health Services Department(HSD)

  2. HEALTH SERVICES DEPARTMENT • Largest County Department • Fully Integrated Health Care Delivery System • Composed of Ten Operating Divisions and Six Special Funds

  3. DEPARTMENTOPERATING DIVISIONS • Regional Medical Center & Health Centers • Health Plan • Mental Health • Public Health • Alcohol and Other Drugs • Environmental Health/Hazardous Materials • Detention Inmate Care • Homeless Programs • Conservatorship • California Children’s Services

  4. SPECIAL FUNDS • Ambulance Service Area • Tobacco Tax Fund • Emergency Medical Services • Major Risk Insurance • Domestic Violence Assistance • Substance Abuse & Crime Prevention (Proposition 36)

  5. DEPARTMENT’S MISSION • Contra Costa Health Services cares for, and improves, the health of all people in Contra Costa County with special attention to those who are most vulnerable to health problems.

  6. CONTRA COSTA POPULATION • The population is growing and becoming more diverse. 18-22% increase since 1990. • Our patients and clients speak more than 20 different languages. • Twenty percent of the County population lives below 200% of the Federal poverty line. • African Americans, Latinos/Hispanics and those in low-income communities are at far greater risk for poor health outcomes.

  7. CONTRA COSTA RESIDENTS WITHOUT HEALTH INSURANCE • One in ten residents age 18-64 years old does not have health insurance. • Hispanic/Latinos and African Americans are 2 to 3 times more likely than Whites to be without health insurance. • People without health insurance are more likely to be sicker and die earlier than those who have coverage.

  8. MISSION & MANDATE • Section 17000 of the Welfare and Institutions Code places a general duty on the County to provide medical care for indigents. • The Conservatorship program is a State mandated function. • Hospital staffing ratios are State mandated. • The Mental Health Services Act requires county funding at no less than the 2004/05 level.

  9. MISSION & MANDATE • The provision of inmate medical care is a County legal obligation. • The California Children’s Services program requires a State-defined county match. • Every county in California is required to have a Public Health Program.

  10. HSD 2004/05 BUDGET (In Millions) • Total Expenditures All Units $ 687.4 • Total Revenue All Units (87%)$(596.5) • General Fund Contribution $ 90.9

  11. HSD 2005/06 REQUIRED EXPENDITURE INCREASES (In Millions) Wages: Salary COLA Growth$1.8 Employee Benefits: Pension 8.5 Health Insurance 1.7 Workers Compensation 3.2 Total Benefit Increase $13.4 Total S&EB COLA Growth $15.2

  12. HSD 2005/06 Expenditure Increases(In Millions) Services & Supplies: Pharmacy & Medical Supplies $6.3 Mental Health – Prop. 63 12.0 Reduction in AB-3632 Services (2.8) Reduction in payments to outside providers, Agency Expense, Miller Centers & Misc.(3.6) Total Net Services & Supplies Increase $11.9

  13. HSD2005/06 REVENUE CHANGES (In Millions) Revenue Increases : Proposition 63 $12 Third Party Payors 6 CCHP Premiums 4 All Other Revenues 1 Less: Miller Centers Revenue Decline(4) Total Net Revenue Increase $19

  14. 2005/06NET COUNTY COST REQUIREMENT(In Millions) Cost Increases $27.1 (S&EB $15.2; S&S $11.9) Less Revenue 19.0 BASELINE SHORTFALL $(8.1)

  15. 2005/06CAO RECOMMENDEDNET COUNTY COST(In Millions) Baseline Shortfall $8.1 CAO Reduction of Existing 2004/05 General Fund Support 6.6 Total HSD Reduction Required $14.7

  16. HSD NET COUNTY COST COMPARISON(In Millions) HSD 2004/05 Budget $91.0 CAO Recommended 84.4 REDUCTION $ 6.6 HSD 2005/06 Baseline $99.1 CAO Recommended 84.4 REDUCTION $14.7

  17. NET COUNTY COST2004/05 BUDGET vs. 2005/06 RECOMMENDED(In Millions)

  18. NET COUNTY COST2005/06 BASELINE vs. 2005/06 RECOMMENDED(In Millions)

  19. NET COUNTY COST2003/04 ACTUAL vs. 2005/06 RECOMMENDED BUDGET(In Millions) * Includes $10.0 Million Contingency Fund

  20. HEALTH SERVICES DEPT PROPOSED REDUCTIONS Reduction Process Focused On: • Preserving legally mandated services • Maintaining regulatory compliance • Protecting revenue generating programs • Reducing non-direct patient care areas to the extent possible

  21. HSD BUDGET BALANCING PLAN SUMMARY (In Millions) • Increase Revenue (#1-5)* $3.0 • Implement Health Plan Co-Pays (#6,7) .3 • Reduce Administrative Positions (#8,9) .5 • Eliminate EHSD nursing support (#10) .1 PAGE TOTAL $3.9 * # refers to pages 274-280 of the Preliminary Recommended Budget

  22. HSD BUDGET BALANCING PLAN SUMMARY (In Millions) • Reduce Public Health Programs e.g. Outreach, Clinic Services (#11-14) $.2 • Eliminate All Hospital Transportation (#15) .1 • Reduce GSD Requested Maintenance (#16) .6 • Reduce Public Health & Homeless Programs e.g. Nutrition, Crisis Hotline (#17-21) .7 PAGE TOTAL $1.6 CUMULATIVE TOTAL $5.5

  23. HSD BUDGET BALANCING PLAN SUMMARY (In Millions) • Eliminate Juvenile Hall Mental Health Services (#22) $.3 • Reduce Public Health Programs, e.g. Oral Health, CHDP (#23,24) .4 • Reduce Hospital Housekeeping Staff by 20% (#25) .8 • Close West County Detention Medical (#26) 1.4 PAGE TOTAL $2.9 CUMMULATIVE TOTAL $8.4

  24. HSD BUDGET BALANCING PLAN SUMMARY (In Millions) • Eliminate All Public Safety Officers (#27) $2.3 • Reduce the STAND & Comm. Violence Contracts (#28).2 • Reduce/Ration clinic appointment slots for Indigent Patients (#24)2.0 PAGE TOTAL $4.5 CUMMULATIVE TOTAL $12.9

  25. HSD BUDGET BALANCING PLAN SUMMARY (In Millions) • Reduce Public Health & Homeless Programs e.g. TB, Immunization Clinics, 25 Beds Concord Shelter (#30-37) $1.4 • Contract out Detention Medical Services(#38) 1.0 • Close the Hospital Pediatric Unit (#39) .5 • Reduce additional Public Health Programs e.g. Senior Nutrition, Clinic Services (#40-44) .8 PAGE TOTAL $3.7 CUMMULATIVE TOTAL $16.6

  26. HSD BUDGET BALANCING PLAN SUMMARY (In Millions) • Close the Homeless Shelters (#45, 46)$1.1 • Eliminate the Advice Nurses (#47) 1.0 • PAGE TOTAL $2.1 • Proposition 36 Proposed State allocation change; Impact unknown N/A GRAND TOTAL $18.7

  27. REDUCTIONS / SAVINGSBY DIVISION (In Millions)

  28. NET COUNTY COSTFY 2003/04, 2004/05, 2005/06 (a)

  29. FY 2005/06Health Services Department Program Reduction List

  30. PROGRAM REDUCTION LIST

  31. PROGRAM REDUCTION LIST

  32. PROGRAM REDUCTION LIST

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