1. TRIBAL FOUNDATIONAL PUBLIC HEALTH SERVICES PROJECT May 21, 2015 – Informal Consultation with Tribes Marilyn Scott, Vice Chairperson (Upper Skagit Indian Tribe) John Wiesman, Secretary of Health (Washington State)

2. 2 PURPOSE We are seeking…  Your general approval of a project:  The Tribal Foundational Public Health Services (FPHS) Project  Your interest and willingness to have your health directors engage with the Tribal FPHS Project

3. What  Defining foundational public health services  Estimating the cost to deliver them and the gap in funding  Recommending who should pay for them Why?  May bring additional funding or services to tribes to make them available  Could free up other funds that are currently being spent on them to be redirected to more clinical or contract care 3 PURPOSE (Cont.)

4. 4 CONTEXT: Health Spending

5. 5 CONTEXT: The difference between medical care and public health (examples)

6. CONTEXT: Medical care and public health are funded differently in tribal and non-tribal jurisdictions Medical CarePublic Health Tribal Tribal & Federal Government Tribal & Federal Government Non- tribal Insurance purchased by employers, groups or individuals, out of pocket, Federal & State Govt. for Medicare/Medicaid Grants, Donations, Community Benefit Funds from Non-profit Hospitals, Community Based Organizations County, State, Federal and Some City Governments 6

7. THE PROBLEM: Much Public Health Funding is Categorical (only for specific programs) THE GOAL: Develop a long-term strategy for predictable and appropriate levels of core public health funding 7 Current Status Funding for Categorical Program Limited Core Funding Desired Status Funding for Categorical Programs Core Funding to Support, Coordinate & Integrate Programs

8. FOUNDATIONAL PUBLIC HEALTH SERVICES (FPHS) National Workgroup 2013 - 2015  Define a ‘minimum package’* of public health services  Estimate the cost of a ‘minimum package’* of public health services  Develop a chart of accounts for use  by public health at all levels  Discuss the Federal role in funding  a ‘minimum package’* of public health service * Later changed to ‘foundational’ 8

9. 9 FOUNDATIONAL PUBLIC HEALTH SERVICES (FPHS) National Draft Framework 2014

10. Across all Programs Assessment (surveillance and epidemiology) Emergency preparedness and response (all hazards) Communications Policy development and support Community partnership development Business competencies Foundational Capabilities Chronic Disease & Injury Prevention Communi- cable Disease Control Maternal Child Family Health Environ- mental Public Health Access to Clinical Care Vital Records Foundational Programs Additional Important Services FOUNDATIONAL PUBLIC HEALTH SERVICES WASHINGTON STATE FPHS PROJECT: Framework

11.  Changed the terminology to:  Foundational Public Health Services (FPHS)  Defined what is included in FPHS  Estimated the cost of  delivering FPHS statewide  what is currently spent on FPHS statewide  any funding gap for FPHS statewide  A FPHS Policy workgroup recommended a new vision for the governmental public health network and funding model 11 FOUNDATIONAL PUBLIC HEALTH SERVICES (FPHS) Washington’s FPHS Work 2012 - 2014

12.  Key Recommendations from the FPHS Policy Workgroup  Endorsed the FPHS framework and definitions  Recommended a new funding model for state and local governments  Recommended a tribally lead process to define how the Foundational Public Health Services funding and delivery framework will apply to tribal public health, and how tribal public health, the Department of Health, and local health jurisdictions can work together to serve all people in Washington 12 WASHINGTON’S FPHS WORK: A New Vision for Washington state (December 2014)

13. 13 A TRIBALLY LEAD PROCESS TO What  Define foundational public health services  Estimate the cost to deliver FPHS, current spending, and any gap in funding FPHS  Recommend who should pay for FPHS Why?  May bring additional funding or services to tribes for FPHS  Could free up other funds that are currently being spent on FPHS to be redirected for more clinical or contract care

14. 14 WE ARE SEEKING  Your general approval of a project:  The Tribal Foundational Public Health Services (FPHS) Project  Your interest and willingness to have your health directors engage with the Tribal FPHS Project