Board of Health Proposed 2011 Public Health Budget October 29, 2010 Dr. David Fleming Director and Health Officer

Overview of today’s Proposed Budget discussion ●Background and context: 2009 / 2010 budgets ●Proposed 2011 budget funded by County GF ●State budget shortfall impacts on the Public Health budget

Public Health’s funding comes from many different sources Public Health Fund Funding Sources

2009 Reductions 139 positions $14.5 million total reduction Examples of reductions ●Eliminated street outreach to pregnant women with substance abuse ●Reduced number of Immunization clinics ●Eliminated HIV/AIDS Hotline and perinatal case management ●Eliminated county-funded dental sealants ●Reduced services to Children with Special Health Care Needs ●Reduced MEO death investigators ●Reduced Public Health laboratory testing Total reductions 2009 $14.5M total

2010 Reductions $10.7 million total reductions Examples of reductions ●Eliminated childcare nurse visits outside Seattle ●Eliminated senior exercise and nutrition ●Reduced HIV/AIDS education and outreach ●Cut family planning ●Closed remaining immunization clinics ●Reduced Public Health services at Northshore ●Closed the Kent Teen Clinic 139 Jobs Total reductions positions 139 positions $25.2M total $10.7M $14.5M 217 positions

Proposed 2011 Reductions $32.9M total 344 positions Total reductions $10.7M $14.5M $7.7M 139 positions 127 positions 78 positions $7.7 million total reduction Cuts will be felt by all members of the King County community who are touched by the population- based and personal health care services that Public Health provides.

Rationale for County General Fund dollars ●Implement business model changes as part of continuous quality improvement ●Fund services where Public Health is the only provider (e.g. communicable disease, public health laboratory, Medical Examiner, epidemiology, policy assessment and development) ●Work from the OMP blueprint to maintain focus on core Public Health goals In 2011 Public Health was assigned a target GF reduction of 12% totaling $3.4 million

Decline in County General Fund County – 2% $632M County $641M

Decline in County General Fund Public Health Fund – 22% Public Health $31M $24M County $641M County – 2% $632M

Prioritizing budget choices when there are no good cuts Examples of reductions ●HIV/STD services at Juvenile Detention ($50K) ●Medical Examiner’s Office ($290K) ●Cuts to Community Clinics ($115K) ●Children and Family Commission ($1.2M) ●Maternity Support Services (MSS) backfill ($1.5M)

Children and Family Commission ●Many CFC services are aimed at:  Supporting young, high risk parents  Keeping youth out of the criminal justice system  Strengthening and leveraging partnerships in the community ●If voters approve the new sales tax some programs could be restored Eliminate $1.2M contribution to Commission 1.5 FTE (out of 2 FTE)

Public Health Center Infrastructure Cut $1.4 million cut 14 FTE (33 positions) ●County had been using County GF to fund Center infrastructure ●MSS program model change savings were planned to offset anticipated MSS reductions from state ●County GF reduction meant shift of this revenue to backfill GF cuts to infrastructure

Assuring the community’s health: Public Health core services ●Core functions must be maintained that assure health across the community including:  Traditional disease protection services  Assessment and policy development to address leading causes of illness and premature death and promote good health  Provision when system can’t or won’t provide safety net

State Budget Cuts ●$770 million gap required Governor to ask for 6.3% across the board cuts in all programs ●Cuts to Public Health total $30 million across state agencies ●Affects all Public Health services, particularly clinical services ●Cuts impact leveraged dollars ● budget will likely bring more cuts, estimated now at 10%

Washington Department of Health reductions ●$600,000 in state assistance to PH-SKC, including STD, HIV, chronic disease, injury prevention, PH Lab & infrastructure

Washington Department of Social and Health Services Examples of impacts to King County: ●Eligibility reduction in Apple Health for Kids (8,110 children; $3M) ●Adult Dental Services (31,500 adults; $2.5M) ●Take Charge Family Planning (19,000 clients; $4M) ●First Steps/Maternity Support Services/Infant Case Management (30,000 clients; $22M)

Take Charge / Family Planning ●Eliminates on March 1, 2011 family planning services for low-income women and girls ●24% of women will get pregnant in the year following the loss of family planning services ●Delivery plus first-year of life costs ~ $9,000 ●Washington will lose $9 in federal match for every dollar spent ●$641,000 cut to Public Health

Maternity Support Services ●Elimination of Maternity Support Services (MSS), First Steps and Infant Case Management ●No pregnant woman with Medicaid will receive pregnancy support; no newborns or mothers will receive infant case management ●Affects 30,000 at-risk women and children in King County of which >90% clients are low income and > 66% are people of color ●May lead to increased infant & maternal deaths; adverse birth outcomes with increased long-term health care costs; long-term impact on education, productivity, criminal justice

Maternity Support Services ●Elimination March 1, 2011 ●Public Health – Seattle & King County would lose $22 million of heavily leveraged state and federal money ●Significant impact on Public Health jobs

What does this mean for Public Health Centers? 1.We are focusing on solutions that allow Centers to continue to serve clients in innovative ways 2.Wide mix of services providing convenience and access to core public health and other needed services 3.Northshore model 4.Global to Local (G2L)

What needs to happen to avert this crisis? ●Minimize county reductions ●Protect against additional cuts to mandated and core community- based services ●Restore MSS and Family Planning  Advocate for innovative financing models where such models improve service and are cost neutral