1. City and County of San Francisco MCAH
Budgetary Effects of Replacing TCM with FFP
MCAH Action, 5/20/2015
MCAH Director Mary Hansell, DrPH, RN, & Chief Fiscal Analyst Joshua Nossiter
The goal was to both integrate and expand the reach of our programs while minimizing the burden on local general funds. Where TCM Field Nursing, NFP, and MCAH were three, we made them one.

2. Added 30 TCM and NFP staff Increased average MCF from 48% to 74%

3. Local funds more than doubled FFP nearly quadrupled

4. TCM Revenues vs FFP Revenues
Prior years TCM revenues budgeted at 37% of total Field Nursing Unit expenses; current FFP Revenues budgeted at 44% of total expenses
12-13 TCM revenue actuals (last representative year) were 33% of total Field Nursing expenses; YTD MCAH FFP actuals are 43% of total MCAH expenses

5. The Halo Effect on the Budget
Larger number of high MCF staff and “program” MCFs along with base MCF lead to:
Higher rate of match for non-salary expenses, and indirect expense driven revenue, which contribute to the halo effect
40% increase in rate of budgeted FFP reimbursement of total MCAH expenses in over (45% to 32%)
Estimated savings to county general fund in FY 2015 = more than $500,000
Consider budgeting true costs of rent, indirect, other costs to fully capture program expenses