2023-405-Minutes for Meeting May 04,2023 Recorded 12/29/2023Recorded in Deschutes County CJ2023-405
Steve Dennison, County Clerk
Commissioners' Journal 12/29/2023 4:06:09 PM
BOARD OF
COMMISSIONERS
1300 NW Wall Street, Bend, Oregon
(541) 388-6570
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FOR RECORDING STAMP ONLY
DESCHUTES COUNTY BUDGET COMMITTEE MEETING
This 2023 Budget Meeting for Health Services was held in the Barnes Sawyer room at 1300
NW Wall Street, Bend and broadcast via livestream on YouTube and through the virtual
meeting platform Zoom. Audio and video recordings of the meetings may be accessed at
www.deschutes.org/meetings.
Present were Budget Committee Members Bruce Barrett, Jim Fister (via Zoom), and Judy
Trego, and Commissioners Anthony DeBone, Patti Adair, and Phil Chang. Also present
were County Administrator Nick Lelack, Deputy County Administrators Whitney Hale and
Erik Kropp, Health Services Director Janice Garceau, Deputy Director of Public Health
Heather Kaisner, Deputy Director of Behavioral Health Holly Harris, HS Business Officer
Cheryl Smallman, HS Operations Officer Chris Weiler, HS Compliance & Quality Assurance
Officer Jillian Weiser, Chief Financial Officer Robert Tintle, Budget and Financial Planning
Manager Dan Emerson, Budget Analyst Camilla Sparks, Management Analyst Laura
Skundrick and (via Zoom) BOCC Executive Assistant Brenda Fritsvold.
CaII to Order of Thursday, May 4, 2023:
Chair Barrett convened the Deschutes County Budget Meeting at 9:00 a.m.
HEALTH SERVICES BRIEFING —
Health Services Funds Overview:
Health Services Director Janice Garceau presented an overview of the Health Services
department, including its mission, services and challenges. Garceau briefly listed the
services provided by the behavioral health, public health and administrative divisions, and
spoke to staffing shortages which impact access, outcomes and revenue.
DESCHUTES COUNTY BUDGET MEETING
May 4, 2023 Page 1 of 5
FY 24 Proposed Budget:
Business Officer Cheryl Smallman presented an overview of the department's funds,
beginning with available resources which include government grants and payments,
capitation and fees for service (FFS), and transfers from the General Fund. Smallman
referred to a graph showing the amounts provided to HS by the General Fund since 2018
which illustrated the consistency in these allocations as a percentage of the department's
revenues, which have grown over that time. Smallman shared that HS plans to return
$1,172,405 to the General Fund in FY23 in accordance with the decision made by the
Budget Committee last year regarding the Behavioral Health reserves level.
Smallman reviewed standard expenditures, including personnel, materials and services, as
well as major one-time expenditures relating to the La Pine Community Health Center, the
secure residential treatment facility in North County and other capital needs.
Commissioner Adair asked about the plan to use $3.8 million on a secure residential
facility. Garceau emphasized the need to serve adults with mental illness or who are at risk
for incarceration due to being intellectually and developmentally delayed (IDD), noting this
vulnerable population can divert law enforcement and emergency room resources.
Garceau then identified short- and long-term fiscal issues, including personnel costs and
the Stabilization Center. In response to Fister, Garceau said the funds expected from the
State to address homelessness will not likely be able to be used by the Stabilization Center
as those are restricted for emergency shelter, which is not a core service offered by the
Center. Fister noted that the Deschutes County Sheriff's Office contributes ongoing support
to the operations of the Stabilization Center and advised that Health Services seek other
financial support from law enforcement agencies across the County for this facility.
Smallman next reviewed a graph showing department revenues and expenses from 2018
and out through 2027 (as projected), noting a forecasted $11 million difference between
revenues and expenses in 2027. Future budgets assume an increase in the annual transfer
from the General Fund equal to expected COLAs-4% in 2025 and 2% each in 2026 and
2027.
Smallman described graphs showing each of the division's budgets over the same time
period (2018 through 2027), starting with Behavioral Health which anticipates a funding
gap of $5.5 million in 2027. Noting that the Public Health budget anticipates a funding gap
of $3.3 million in 2027, Smallman said the department's FY24 proposed budget will assume
a 13% OHP redetermination rate starting in July.
Responding to questions, Garceau and Emerson explained how and why increasing
capitation revenues lower CCBHC funding as happened between 2018 and 2022.
Continuing, Smallman reviewed staffing changes from FY 2023 which are expected to result
in a reduced workforce of 411.8 FTE from 422.8. She outlined the department's five special
requests which involve the Healthy Schools program, the outpatient team, the Family
May 4, 2023
BUDGET MEETING Page 2 of 5
Connects Oregon program, a conversion of system of care staff from limited duration to
regular, and a proposal to convert the DEI strategist position to regular.
Behavioral Health & Special Requests:
Holly Harris, Behavioral Health Director, presented an overview of the division's programs
and services, noting that the Stabilization Center is diverting approximately 30% of its
clients from emergency rooms. Harris described the special request to convert 1.0
Behavioral Health Supervisor limited duration to regular at a six-month cost of $85,613;
this would allow the person in this position to continue serving as the primary liaison with
the Mosaic Medical Team and help coordinate care and provide leadership to nine clinical
staff. This person will also track, report and improve team outcomes.
Continuing, Harris said the division's second special request is to convert 8.0 FTE from
limited duration to regular to continue to provide a System of Care program to address
mental health conditions which may lead to suicide of persons aged 10-24. These were
previously funded via a five-year SAMSA grant due to expire in August of 2024; the cost to
convert the positions would total $889,739.
Garceau explained the Intellectual & Developmental Disability services provided by Health
Services, which include case management, abuse investigation, and foster home licensing
and certification, and shared program outcomes from FY 23. Smallman presented the
proposal to redirect $423,207 in County General Funds from Behavioral Health programs
to I/DD in next year's budget; this would enable leveraging a total of $541,139 in General
Fi rods to maximize the federal match and secure $1,420,933 in federal funding for these
services.
A break was announced at 10:33 a.m.; the meeting resumed at 10:45 a.m.
Public Health & Special Requests:
Heather Kaisner, Public Health Director, presented an overview of the division's role and
services which include disease prevention, health promotion, emergency preparedness,
and environmental health services. Kaisner shared FY 23 accomplishments and said
challenges will require addressing emerging STD outbreaks such as syphilis, which can lead
to stillbirth, infant death and serious birth defects. She spoke to efforts to increase child
immunization rates and announced that the division has been selected to be a dedicated
Medical Reserve Corps.
Kaisner described the special budget request to add 1.0 FTE Public Health Educator II
position for the final phase build -out of the Healthy Schools program; this will be a shared
expense of the County and the Bend-LaPine School District and complete program
coverage for all of the district's high schools and their respective feeder middle schools.
The first full analysis of student outcomes resulting from this program will be conducted in
the fall of 2025.
May 4, 2023
BUDGET MEETING Page 3 of 5
Continuing, Kaisner said the division's second special request is to add two 1.0 Public
Health Nurse positions (one to start in July 2023 and the other to start in January 2024) and
to convert 2.5 FTE from limited duration to regular for the Family Connects Oregon
program which fulfills the State's requirement that all families with newborns be offered
the nurse home visiting service. Families who accept the service are provided one to three
in -home visits from a public health nurse to advise and educate in caring for a newborn.
Administrative Services & Special Requests:
Smallman provided an overview of the Administrative Services division, noting average FTE
by year from 2020 to 2023 and sharing FY 23 accomplishments, including the development
of an open source grant management software which won a 2022 NACo Achievement
Award.
Discussion ensued regarding space needs and remote work. Garceau said in -person work
is beneficial for many reasons, including that it increases collaboration while counteracting
loneliness.
Garceau described the special request to convert the department's 1.0 FTE DEI Strategist
(Senior Management Analyst) to a regular position, noting the 2020 Central Oregon Health
Equity Report identified health disparities in the region. Garceau emphasized that Health
Services is required by nearly every contract, grant and statute under which it operates to
address diversity, equity and inclusion factors.
Suurmary and [Toeing Remarks:
Trego stated her support for the special requests as presented, which she deemed
reasonable and critical to the department's work.
In response to Trego, Smallman said Public Health has proposed returning $168,661 in
General Funds from the current budget which were not expended as the health officer
position was not filled as anticipated.
Discussion ensued regarding the decision made last year regarding the department's
obligation to return General Funds if its reserve is greater than $12,271,454 and the
beginning working capital of the Behavioral Health division is higher than $6 million.
Budget & Financial Planning Manager Dan Emerson explained that the Budget Committee
addressed this matter last year in order to make clear that General Funds transferred to
Health Services in FY 2022-23 which were not used would be returned to the General Fund
rather than remain in the Behavioral Health reserves account for future use by the
department. Emerson said this decision will allow funds not needed or used by Health
Services to be returned to the General Fund for County utilization in any manner identified
to be a priority.
Chief Financial Officer Robert Tintle noted that the County's long-term budget forecast
envisions Health Services returning $1.2 million to the General Fund as discussed.
May 4, 2023 BUDGET MEETING Page 4 of 5
Emerson added that the return by Health Services of monies to the General Fund was
contingent on the department's reserves growing by $1 million in FY 2022-23, which they
did.
Garceau spoke to considerable potential shortfalls in key services and the need to account
for staff space needs.
Commissioner Chang suggested that an appropriate reserve level be determined for
Behavioral Health, given the uncertainty of future revenue and the division's substantial
operating costs.
Chair Barrett expected that this matter will be taken up again as the Budget Committee
continues its deliberations later in May.
ADJOURNMENT:
At 12:00 noon, Chair Barrett declared the Budget Committee meeting for Health Services
adjourned.
DATED this
Day of
Commissioners.
ATTEST:
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RECORDING SECRETARY
2023 for the Deschutes County Board of
ANTHONY DEBONE, CHAIR
PATTI ADAIR, VICE CHAIR
PHIL CHANG, C
• MMISSIONER
May 4, 2023
BUDGET MEETING Page 5 of 5
BOARD OF
COMMISSIONERS
BUDGET COMMITTEE MEETING FOR HEALTH SERVICES
9:00 AM, THURSDAY, MAY 4, 2023
Barnes Sawyer Rooms - Deschutes Services Building - 1300 NW Wall St - Bend
(541) 388-6570 I www.deschutes.org
AGENDA
MEETING FORMAT: In accordance with Oregon state law, this meeting is open to the public and
can be accessed and attended in person or remotely.
Members of the public may view the meeting in real time via YouTube by copying and pasting
this link: http://bit.ly/3mminzy. To view the meeting via Zoom, see below.
Zoom Meeting Information: This meeting may be accessed via Zoom using a phone or
computer.
• To join the meeting from a computer, copy and paste this link: https://bit.ly/3ncCjJw.
• To join by phone, call 253-215-8782 and enter webinar ID # 850 3588 4805 followed by the
passcode 835339.
• If joining by a browser, use the raise hand icon to indicate you would like to provide public
comment, if and when allowed. If using a phone, press *6 to indicate you would like to speak and
*9 to unmute yourself when you are called on.
Deschutes County encourages persons with disabilities to participate in all programs
and activities. This event/location is accessible to people with disabilities. If you need
accommodations to make participation possible, call (541) 388-6572.
CALL TO ORDER
PLEDGE OF ALLEGIANCE
AGENDA:
1. Finance Department Remarks
2. Health Services Briefing
a) Introduction
b) Agenda & Health Services Funds Overview
c) Behavioral Health & Special Requests
RECESS 10 minutes
d) Public Health & Special Requests
e) Administrative Services & Special Requests
f) Summary and Closing Remarks
ADJOURNMENT
May 04, 2023
BUDGET COMMITTEE MEETING FOR HEALTH SERVICES Page 2 of 2