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Janice Garceau, HS Director
Holly Harris, BH Director
Heather Kaisner, PH Director
Cheryl Smallman, Business Officer
▪FY23-24 Pre-Budget Briefing Presentation
Agenda
•May 4 Budget Briefing Recap
•Challenges and Opportunities
•Fiscal Issues
•FY24 Proposed Budget Recap
•Medicaid Revenue, FY18-FY23
•OHP Mental Health Reserve
•Special Requests
•Summary
2
FY23 Challenges
Staffing
•Historic and prolonged vacancies in key roles
•Impacts to access, outcomes and revenue
Housing
•Houslessness crisis
•Lack of affordable workforce housing
Acuity
•Growing acuity of service populations
•Increase impacts of health inequities, climate and disease risk
Infrastructure
•Technical supports stretched to capacity
•Space needs critical as staff return to in-person services
3
FY24 Opportunities
•Maximize on Behavioral Health, Public Health & Primary Care Co-location and Integration
•Apply lessons learned from multiple emergencies to Emergency Preparedness
Integration
Mitigation
•Aggressively target disease outbreak risk
•Apply recent investments to target intervention
to high need service populations: perinatal
women and children; unhoused individuals
struggling with mental illness and addiction; at-
risk youth; vulnerable service populations
4
FY 23-24 Department Fiscal Issues
•Public Health funding
•Stabilization Center
•Space in Downtown Area
•Client acuity and team-based
service model impact on
billable hours
•OHP Redetermination
•Increased personnel costs
•Increased indirect expenses
•Expiring funds
•COVID-19
•CJC IMPACTS –Stabilization
Short-term Fiscal Issues Long-term Fiscal Issues
5
•Total FY24 Budget: $79,568,046 (+3% from FY23)
•County General Fund: $6,780,140 (+3% from FY23; 9% of Resources)
•Transient Room Tax: $368,417 (-12% from FY23)
•Major one-time expenses: appx. $6.4M
•FTE: 412.8*(-2.4% from FY23) (414.8 FTE with special requests)
* Includes 1.0 FTE for Healthy Schools Year 3 Special Request
FY24 Budget Overview –Fund 274
-
10
20
30
40
50
60
70
80
90
100
2018 2019 2020 2021 2022 2023 2024 2025 2026 2027Millions
General Fund Other Gov't Payments Capitation CCBHC BWC Expenses
Health Services Outlook
Requested Forecasted Forecasted Forecasted
7
-$11M
-
10
20
30
40
50
60
70
80
90
2018 2019 2020 2021 2022 2023 2024 2025 2026 2027Millions
General Fund Other Gov't Payments Capitation CCBHC BWC Expenses
Requested Forecasted Forecasted Forecasted
FY23-24 Behavioral Health Budget 8
-$5.5M
FY23-24 Public Health Budget 9
(5)
-
5
10
15
20
25
2018 2019 2020 2021 2022 2023 2024 2025 2026 2027Millions
General Fund Other Gov't Payments Capitation CCBHC BWC Expenses
Requested Forecasted Forecasted Forecasted
-$5.4M
-
20
40
60
80
100
120
2018 2019 2020 2021 2022 2023 2024 2025 2026 2027Millions
General Fund Other Gov't Payments Capitation CCBHC BWC 10% Surprise Expenses
Outlook w/Unplanned Resources
Requested Forecasted Forecasted Forecasted
10
Medicaid Revenue: Cap/FFS & CCBHC PPS
0
10
20
30
40
50
60
70
80
90
$-
$5
$10
$15
$20
$25
2018 2019 2020 2021 2022 2023 ThousandsMillionsOHP Capitation/FFS CCBHC PPS Billable Services Avg. Monthly OHP Enrolled
Projected
Fund 270: OHP Mental Health Reserves
•PPS generated revenue that DCHS
did not budget due to uncertainty.
•PPS was continued several times,
sometimes retroactively, resulting in
significant unanticipated revenue.
•Dollars must be used for BH services
(current and future needs).
OHP Reserve Balance, FY09 –FY27
-
2
4
6
8
10
12
14
16
18
2009201020112012201320142015201620172018201920202021202220232024202520262027($) MillionsReserve level 25% Operational Budget
Special Requests
#Title Area Purpose
1 Healthy Schools –Year 3 PH Continue 3rd year of project by adding
planned FTE
2 Convert PIPBHC Supervisor BH Maintain key integration leadership and
liaison role for Outpatient Team
3 Family Connects Oregon & PCC PH Add new and maintain existing staff to
provide revenue generating service
4 Convert System of Care staff BH Maintain critical services to children,youth
and families
5 Convert DEI Strategist AD Meet grant requirements and reduce health
disparities
13
SR #1 Healthy Schools
KEY FACTS:
•Approved three-year phase-in includes final high school,
Caldera, and its direct feeder schools: High Desert Middle
School and Three Rivers K-8 School.
•Cost-sharing partnership with BLS integrates effective
prevention and health promotion initiatives into school and
district.
•95% of middle and high school Health teachers indicate
improved knowledge, skills, & confidence to deliver effective
health education because of Healthy Schools.
ASK: Add 1.0 FTE Public Health Educator II and
increase approved year 3 CGF amount by $23,096.
COST: $119,761 (PHEII)
Funding: 50-50% CGF and BLS
14
SR #2 Integrated Care Team (PIPBHC) Supervisor
KEY FACTS:
•Primary liaison with Mosaic Medical Team;
integral to ensuring integration success
•Coordinates care; fine-tunes pathways to
access for shared patients; provides expert
leadership to staff; ensures team meets
program goals
•Tracks, reports and improves on outcomes
ASK: Convert 1.0 BH Supervisor LD to regular
COST: $85,613
FUNDING SOURCE: OHP revenue. No CGF
Requested.
15 15
Outcomes
91%of
shared
patients seen
by a provider
in last 30
days
Of those,
patients 82%
have low ED
use in last 6
months
80% of Adult
OP clients
with
hypertension
met goal of
hypertension
control
SR #3 –Family Connects Oregon
KEY FACTS:
•Highly effective PH Nurse Home Visiting service now available to all families of newborns.
•State requirement to offer to all families & reimbursable by all Oregon insurances.
•Successful early roll-out. Need to prepare for a substantial enrollment increase of 60% (~1,140/year) of families in Deschutes County.
ASK:
Add 1.0 Public Health Nurse II (start 7/1/23)
Add 1.0 Public Health Nurse II (start 1/1/24)
Convert 2.5 FTE from LTD to regular
COST : $499,014
FUNDING: No CGF requested. Revenue from
enhanced Medicaid and commercial
billing rates.
16
KEY FACTS:
•CDC data shows suicide is leading cause of death among Oregon youth ages 10-24.
•At risk youth have poor school engagement, SOC targets youth at risk for out of school or home placement
•Provides cross system collaboration & intensive supports to children, youth, young adults and families with complex and significant mental health needs
•Helped expand Wraparound services in Redmond, Sisters and La Pine.
ASK: Convert 8.0 FTE from LTD to regular
COST: $889,739
FUNDING: OHP & Enhanced Case Rate. No CGF
Requested.
SR #4 System of Care Program Staff
17
SR #5 -Convert DEI Strategist to Regular
KEY FACTS:
•State and federal rules/requirements
increasingly incorporate DEI and
cultural sensitivity.
•2020 Central Oregon Health Equity
Report speaks to health disparities.
ASK: Convert 1.0 FTE to regular
COST: $142,510
FUNDING: No CGF requested. Cost
$142,510 indirect to department programs.https://phnci.org/national-frameworks/10-ephs
18
Special Requests
#Title
New
FTE
Cont.
FTE Cost Revenue
CGF
Requested
1 Healthy Schools –Year 3 1.0*-$119,761 $96,665 $ 23,096*
2 Convert PIPBHC Supervisor -1.0 $85,613 $85,613 $ -
3 Family Connects Oregon & PCC 2.0 2.5 $499,014 $499,014 $ -
4 Convert SOC staff -8.0 $889,739 $889,739 $ -
5 Convert DEI Strategist -1.0 $142,510 $142,510 $ -
TOTAL 3.0 12.5 $1.7M $1.7M $ 23,096
19
* Amount and FTE is included in the Proposed Budget
Thank you