Tuesday, August 11, 2009
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Health department prepares for questionable financial times

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[August 11, 2009]  When the Logan County Board of Health met on Monday evening, public health administrator Mark Hilliard reviewed the department's current financial condition. He began by saying that his report on the past couple of months did not reflect "the number of sleepless nights and conversations with key staff regarding our financial situation."

While it is time to be passing a budget for next year, he recommended that the board would hold off, even if it would mean scheduling an extra meeting. There are many financial issues in the air, he said. "Budgeting is a real guessing game right now with state and county for next year," Hilliard said.

The department collects fees for services, in addition to a levy from the county for its operational costs, but is mostly subsided by state grants for its services.

Sally Gosda, director of finance, reviewed 2008 fiscal year figures just returned from the auditor. She said that the year ended with revenues exceeding expenditures by $10,343. It was projected to have a $106,000 deficit.

The 2008 fiscal year ended with a fund balance of $1,226,006. Hilliard added that those numbers were not as bad as anticipated, primarily because the extra principal payment of $100,000 was not made on the mortgage.

As of June 30, the health department showed a deficit for the current fiscal year of $534,992. Contributing to that deficit is that the state owed the health department $364,000 for grant expenditures through the end of June. Also, the interfund transfer of $43,000 from the tuberculosis fund had not been received yet. Gosda added that an investment account was also closed out and that the $182,910 was transferred into the checking account to prevent cash flow issues due to delays in payment.

Some payment has been received in July, but the department is still owed $250,000.

The biggest questions this year come from the state's financial condition. Areas of the state budget that affect the health department are still up in the air. While some grants are now beginning to trickle in, the health department has not received many of the grant contracts that usually arrive by April. Hilliard recalled that the governor has been given the task of making billions in cuts and has previously said that he would make those cuts to social services.

What troubles the administrator most in the financial planning is trusting the state. Much of the funding that the department depends on is from state grants, such as the Local Health Protection Grant that they have been awaiting word on receiving. It coincides with the start of the state fiscal year that began on July 1. Hilliard is concerned that the state could cut that grant by 10-20 percent or say they would pay only 10 of 12 months.

The challenge to all health departments at this time is not just the grant cuts, but that the state owes money. The health department was fortunate going into this year because we had some money to cover the state delays, Hilliard said. But the reimbursement delays are expected to slow even more in the next year. The health department is still owed $177,000 on a grant of over $400,000 for last year's Illinois Breast and Cervical Cancer Program.

The health department is required to maintain a significant reserve fund that would cover the costs if there would be any major health threat outbreak.

Some added challenges in this past year came when the county stopped paying the department's FICA and IMRF (retirement fund). The FICA and IMRF were approximately $106,000 each, $212,000 total.

Making up the differences created by the new responsibilities would be difficult, as the department receives many smaller grants that do not even allow to charge for time, let alone for benefits, Hilliard said.

The county is now preparing the budget for its next fiscal year, which begins Dec. 1. Hilliard said that the health department is asking for its full levy. The levy is derived from property taxes and would amount to an estimated $390,000. In recent years a portion of the health department levy has been diverted to aid the county's general fund.

Hilliard said he took several measures to cope with the financial challenges:

  1. He paid back his raise for this past year.

  2. A part-time employee working additional hours for IBCCP was discontinued for the summer.

  3. One employee on probationary status was terminated.

  4. Three positions were laid off: one health educator, a public health nurse and an IBCCP clerk.

Positions of two other employees slated for layoff were spared when, for legal reasons, the state could not eliminate the grant-funded program.

The 2009 expenditures were about 20 percent below base line. This figure was used with the anticipated revenue to create the fiscal 2010 budget. "Right now that budget has a $500,000-in-the-hole in it," Hilliard said. "If we don't get that money, then we will have to do some other things, maybe a huge combination of things, such as close one day a week, cut hours, require furloughs and more layoffs to get down where we need to be."

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Last month Hilliard participated by teleconference in a meeting of regional health administrators to find out what other departments are doing to cope with the state finances.

He learned that some health departments have borrowed from their county, some have done layoffs, some are allowing for a reduction in staff through attrition; and other departments the same size as Logan County have changed work schedules, reduced employee hours, reduced clinic hours or days that the department is open, and some have called for employees to take furlough.

A need for additional public health care

On other matters for future public health care, Hilliard is considering options that could get the dental clinic started. The hope of a large grant last year fell through, but he thought the project could be done a little at a time. The Illinois Department of Healthcare and Family Services offers a two-year grant that provides $70,000 the first year, which would go for readying three rooms with plumbing, remodeling and electricity; and $30,000 is available the second year to purchase additional equipment. This would get the project going, but more funds would still be needed to expand, he said.

Personnel matters

Hilliard said that he received a letter of resignation from Matt Ringenberg, director of environmental health. Ringenberg will be going to the Illinois Department of Public Health to serve as an emergency response coordinator. He will be representing the East Peoria Region. Logan County will be in his territory.

Depending on the status of grants, Hilliard said that Ringenberg's position may not be filled right away.

Health department activity updates

Some of the highlighted activities of the health department:

  • In health education, two billboards are up promoting oral cancer awareness.

  • There will be extra food inspections during the Lincoln Art & Balloon Festival.

  • In participation with other area responders in emergency preparedness exercises and planning teams, a three-year cycle will ramp up to a full-scale exercise in 2012. A functional tabletop exercise that includes actions from the health department is scheduled for later this month.

  • A couple of employees responded to the mutual aid request put out by Rock Island when that area had a hepatitis A outbreak. Mass vaccination was employed.

  • H1N1 "swine flu": Vaccine is expected to become available this October but will be in limited quantity at first. When it arrives, the vaccine will be administered to priority groups, with the most vulnerable population, the health community and emergency responders, getting the first round.

  • The Pandemic Flu Coalition, led by Shana Bean, emergency response coordinator, continues to meet, with plans to keep the community informed on what to do and how to stay healthy.

Board members present were Mike Rohrer, president; Robert Cox, vice president; Roger Bock; Paul Kasa, M.D.; Richard Bivin, M.D.; and Wm. Todd Walker, D.M.D.

The board welcomed Maxine Lolling to her first meeting. She's a former emergency room nurse who has taken over the unexpired term of Deidre Berger until December 2010.

Absent was David Hepler, D.C., county board representative.


For more information, visit the Logan County Department of Public Health on the Web at http://www.logancountyhealth.org/.

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