HomeMy WebLinkAboutMINUTES - 05032011 - D.1RECOMMENDATION(S):
ACKNOWLEDGE that the Board of Supervisors held Budget Hearings on April 12;
that public testimony was heard and considered;
1.
ADOPT the FY 2011-12 Recommended County Budget with no modification to the
budget proposed on April 12;
2.
ACKNOWLEDGE that pending action by the State regarding its budget may require
subsequent adjustments to this Recommended Budget;
3.
ACKNOWLEDGE that the County Administrator was directed to return to the Board
with a Resolution, authorizing the deletion of certain positions in affected County
departments (companion item – Resolution No. 2011-163);
4.
DIRECT the County Administrator to continue to work with department heads to
restore positions, to the extent possible, through increased revenues and changes to
departmental operations, and to return to the Board with any changes to the Position
Deletion Resolution by June 7;
5.
AUTHORIZE and REQUEST the Auditor-Controller to adjust FY 2010-11
appropriations and revenues by reallocating and balancing budgeted and actual
expenditures and revenues as needed for various budget units and special districts,
subject to Board approval in September; and
6.
APPROVE OTHER
RECOMMENDATION OF CNTY
ADMINISTRATOR
RECOMMENDATION OF BOARD
COMMITTEE
Action of Board On: 05/03/2011 APPROVED AS RECOMMENDED OTHER
Clerks Notes:
VOTE OF SUPERVISORS
AYE:John Gioia, District I Supervisor
Gayle B. Uilkema, District II Supervisor
Mary N. Piepho, District III Supervisor
Karen Mitchoff, District IV Supervisor
Federal D. Glover, District V Supervisor
Contact: Lisa Driscoll, County
Finance Director, 335-1023
I hereby certify that this is a true and correct copy of an action taken and entered on
the minutes of the Board of Supervisors on the date shown.
ATTESTED: May 3, 2011
David J. Twa, County Administrator and Clerk of the Board of
Supervisors
By: Carrie Del Bonta, Deputy
cc:
D.1
To:Board of Supervisors
From:David Twa, County Administrator
Date:May 3, 2011
Contra
Costa
County
Subject:ADOPTION OF FY 2011-12 COUNTY RECOMMENDED BUDGET
7.
RECOMMENDATION(S): (CONT'D)
AUTHORIZE the Auditor-Controller to make technical adjustments to the FY 2011-12
County and Special District Budgets when actual amounts are known.
FISCAL IMPACT:
The fiscal impact is described in the Fiscal Year 2011-12 Recommended Budget
available on-line at http://ca-contracostacounty.civicplus.com/index.aspx?NID=770.
BACKGROUND:
On April 12, 2011, the Board opened and conducted public hearings on the
Recommended Budget. The hearings began with an overview of the recommendations in
the FY 2011-12 Budget by the County Administrator. The County Administrator advised
the Board that the bound copy of the budget and the County Administrator’s Budget
Message (available on the internet at
http://ca-contracostacounty.civicplus.com/index.aspx?NID=770) contains details on
individual department budgets, programs, goals, and recommendations.
The budget and message represented a work plan to achieve the County's mission and
priorities in the coming year. A number of key issues that have informed the development
of the budget were included, such as the property tax reductions, employment benefits
and retiree health care/other post employment benefits, pension benefits, long-term
budget rebalancing, State budget uncertainties, infrastructure/facilities maintenance,
outstanding debt, debt service requirements, and the possibility of a Constitutional
Amendment and State Realignment.
At the conclusion of the County Administrator’s presentation, six department heads
addressed the Board on issues specific to their departments: Joseph Valentine, Director of
Employment and Human Services; Dr. William Walker, Director of Health Services;
Philip Kater, County Probation Officer; David Livingston, Sheriff-Coroner; Mark
Peterson, District Attorney; and Daryl Louder, Fire Chief. The Board asked for and
received public comment.
Taking into consideration the testimony it had received from staff and the public, the
Board deliberated regarding the Recommended Budget. At the conclusion of the
deliberations, the Board requested follow-up information on a variety of topics and then
directed the County Administrator to return to the Board on May 3, 2011, for adoption of
the FY 2011-12 County Budget.
The following information was requested during the April 3, 2011 hearings:
A. The Board of Supervisors requested that the County Administrator provide detailed
information identifying sources of revenue by dollar amount and percentage for each
department. Attachment A provides that information for every budget unit within the
Governmental Funds described in the FY 2011-12 Recommended Budget.
B. The Board of Supervisors requested an update on the County's General Fund
Reserves. Attachment B provides that information.
C. The Board of Supervisors also requested that the County Administrator return with
options for additional cuts to other programs should the Board decide to reject some of
the reductions proposed in the Recommended Budget. Because the Health and Human
Services functions of the County comprise approximately 56% of General Fund
expenditures, these are the departments that the Board would need to consider reducing.
These Departments include: Health Services, Employment and Human Services,
Veterans Services, Child Support Services. Because Child Support Services is funded
100% from restricted State revenue there is no potential for savings to the General Fund.
The Veterans Service Department receives only about $0.5 million of which nearly all
goes to salaries and benefits of the six staff, there is little or no potential savings in this
Department.
Both the Health Services Department and the Employment and Human Services
Department met their Fiscal Year 2011/12 Budget Target. The Health Services
Department’s Recommended 2011/12 Recommended budget includes $8.3 million in
County General Fund reductions and the Employment and Human Services Department
has included $11.6 in reductions in their Recommended budgets from the baseline costs.
Major reductions in the 2011/12 Recommended Budget to the health and human services
programs include (but are not limited to) the following:
Employment and Human Services
Impact on staffing includes:
The elimination of 7 full time equivalent positions
Maintenance of a 4.7% vacancy factor (which is equivalent to holding 80 positions
vacant for the full year – total impact of 87 positions)
However, the impact on service reductions from funding limitations in the 2011/12
Recommended Budget is much more significant. Some of these reductions include:
$3,805,404 in Children and Family Service, resulting in significant service
reductions to severely emotionally disturbed children, substance abuse & HIV
infants, foster care youth and their resident families;
$1,481,053 in the Workforce Services program, resulting substantial reduction in
managerial oversight in a period of momentous caseload growth;
$295,760 in Adult and Aging Service, most importantly reducing Adult Protective
Services and In-Home Supportive Service which allows a senior citizen to receive
in-home care instead of a much more expensive nursing home admission; and
$257,601 in Administrative services, which will result in less fiscal oversight and
compliance monitoring of many Social service programs.
Nearly every general fund dollar spent on social service programs leverages additional
State and Federal revenue. The leveraging formulas vary from program to program. The
return on investment is generally four dollars in State and/or Federal revenue for each
dollar in County general fund dollar spent.
Health Services
HSD has reduced $4.6 in the Hospital by developing strategies to reduce the length
of hospital stays and unnecessary hospitalizations: $1.6 million in Mental Health by
holding 8 management level positions vacant (allowing them to keep line workers in
place) and aggressively managing the growth in caseloads (which could have an
adverse effect of access to care); $1 million in public health by holding positions
vacant for a minimum of three months each throughout the year, and finding
alternative ways to generate revenue.
The total County General Purpose subsidy to the Health Services Department
(inclusive of the Enterprise Funds) has decreased 17% in the five years between
2007/08 and 2011/12 from $108.6 million in 2007-08 to $89.7 million in 2011/12. In
the same time period the County General Purpose subsidy to the Enterprise Funds
has decreased from $62 million in 2007-08 to $40 million in 2011-12; a 36 percent
decline. Please see the chart below
2007/08
Actual
2008/09
Actual
2009/10
Actual
2010/11
Adjusted
Budget
2011/12
Recommended
Budget
Hospital
Subsidy $56,479,229 $57,830,866 $41,793,548 $41,319,095 $36,249,652
Health
Plan
Subsidy
5,641,124 3,518,820 5,423,094 3,686,996 3,770,138
Total
Subsidy $62,120,353 $61,349,686 $47,216,642 $45,006,091 $40,019,790
Percentage
Change (1%)(23%)(5%)(11%)
Cumulative Change ($22,100,563)
Cumulative Percentage Change (36%)
ADDITIONAL REDUCTIONS
Identified below are areas of potential service reductions to the Health Services
Department and Employment and Human Services Department 2011/12 Recommended
Budgets. If additional reductions are required the list will be modified and prioritized
when the exact reduction amount known.
Employment and Human Services:
The Employment and Human Services Department (EHSD) has reduced all excess
County General Fund from the fiscal year 2011/12 Budget. The General Fund dollars in
the 2011/12 EHSD Recommended Budget have been primarily budgeted as follows: to
provide mandated Maintenance of Effort (MOE) county funds against federal and state
allocations, to provide required match for the administration of social service and
entitlement programs, to provide the required match for entitlement payments to
recipients, and to provide 100% county funds for the administration and assistance
payments for the General Assistance program. Possible further reductions and their
impact are as follows:
1. Eliminate In Home Support Services (IHSS) Provider Pension Benefits – Eliminating
IHSS Pension Benefits could save over $500,000 in County General Fund.
Program Impact Statement: The IHSS Provider Pension Plan is authorized by the
existing Memorandum of Understanding (MOU) with United Healthcare Workers –
West (UHW) and the Contra Costa County Public Authority. By law, any changes to
this MOU must be negotiated between the County (Public Authority) and UHW.
The current contract with UHW expires September 30, 2011. Negotiations will
begin this summer.
2. Reduce In Home Support Services (IHSS) Administration– EHSD anticipates that this
program will be under-spent in this program by approximately $500,000 in outside
revenue in fiscal year 2011/12 due to lack of County General funds to draw down all
available federal and state revenue. For each caseworker cut in the program, there will be
a savings of 15% in County General Fund and a loss of 85% in federal and state revenue.
Program Impact Statement: A reduction in IHSS social workers will significantly
reduce the County’s ability to effectively manage the IHSS program. An adequate
number of social workers is needed to maximize and target the available service
hours to low income aged, blind and disabled individuals. When hours of service
cannot be targeted and managed to ensure maximum utilization, a significant
increase in the direct cost to the County will occur.
A reduction in IHSS social workers will restrict and impede the IHSS application
and screening process. Clients will see an increase in delays to access the program
putting many frail individuals at risk. Cases, including those with protective
supervision, could be delayed creating a significant safety issue for many
individuals. Protective supervision is authorized for approximately 400 individuals
at present.
The State requires IHSS reassessments to be conducted every 12 months. The ability
of the County to meet this mandate would be in jeopardy if IHSS social workers are
reduced. With the existing caseload being distributed to the remaining social
workers, waivers to reassess at 18 month intervals, rather than at 12, will be required
and over-utilized. This will cause critical hours of service to be delivered
unnecessarily due to the unmanageable length of time between home visits and
reassessments with the County responsible for 18% of the cost.
Caseloads for the IHSS social worker average 300-325 per worker. This ratio is
already too high to deliver quality assessments and service plans. Further reductions
would increase the caseloads to over 400 cases per worker. The ratio would become
difficult to manage.
Reducing IHSS social workers is contrary to the County’s direction and ability to
adequately integrate, coordinate and effectively manage home and community based
services.
3. Reduce General Assistance (GA) Staff– Funded with 100% County General Funds.
Program Impact Statement: As a result of the Lugo Lawsuit, the GA program is
required to grant or deny applications within a 30 day time frame. There are
approximately 1,000 applications monthly to the GA program county wide that are
processed by 19 Social Service Program Assistants. Any reduction in GA intake
staff would put the Department at risk of further litigation due to the inability to
meet the 30 day timelines.
Since the GA program redesign resulting from the lawsuit, the ongoing caseload has
jumped to approximately 1,500 cases and is carried by 5 Eligibility Workers. With
caseloads of over 300 clients, the workers are unable to initiate timely actions
causing GA costs to increase. Any reduction in GA field staff would further
compromise the timely management of the ongoing cases increasing cost.
The GA program is currently struggling to comply with 30 day granting time frames
as a result of the Lugo Lawsuit. Any staff reduction in the GA program would
compromise the programs ability to meet these time frames placing the Department
at risk of further litigation.
4. Reduce Child Welfare Services Casework (CWS) Staff- Multiple allocations fund
Child Welfare Services staff. The CWS Basic Allocation, which requires a 15-30%
County match, funds over 70% of the CWS caseworkers, supervisors, and support costs.
The CWS Augmentation Title XX and CWS Augmentation allocations do not require a
county match and are only received after the Basic allocation has been utilized. The
CWS Augmentation allocations are over $2.1 million dollars. Therefore, no County
General Funds can be saved unless expenditures are reduced above and beyond the $2.1
million in CWS Augmentation funds earned once the CWS Basic allocation is exceeded.
The CWS Augmentation allocations fund approximately 10 caseworkers and supervisors
and all the associated support costs. These caseworkers, support staff, and overhead
would have to be cut before we could begin saving county General Fund.
Program Impact Statement: In January 2009, Child Welfare started the year with a
42% reduction in staffing to reduce the county overmatch of more than $19 million
dollars. Since that time the Child Welfare program has no county overmatch and
currently operates the program with only the county funding required to meet the
federal and state funding obligations.
The ultimate impact of additional reductions to Contra Costa County’s Child
Welfare program below the required county match after already reducing the
program by 42% from staffing levels of December 2008 will expose children to
greater risk of injury and fatality. The county will not be able to manage the
program to meet the mandated state and federal requirements leaving the most
vulnerable in our county unsupported.
The reductions to the child welfare program can only be realized by layoffs of social
work staff. A reduction in child welfare social workers will directly affect the
services that are provided to the families and children served. The reductions that
would be required to save county general fund dollars will require a significant
increase in cases to the remaining social workers. This increased caseload would not
allow the staff to provide families with the needed/mandated services. Increasing the
caseload for social workers has already shown to be the single greatest risk factor
for increased abuse to children who have been identified. This increased risk has
clearly been documented in every newspaper around the country when a child dies
and the child welfare agency was aware but did not have the manpower to address
the issues.
Clients will experience insurmountable delays to access the appropriate services
which will allow for the reduction of risk to their children. As a result of this
increase of workload, children will reside in foster care longer as staff will be unable
to provide timely services. This increase in foster care stay will cost the children
precious years, months, days, in out of the care of their family. These increases
already have increased cost documented in the foster population with an increase in
mental and physical health cost. The children who stay in foster care longer have
tragic outcomes. They are our homeless population; they are our prison population.
In a recent article from San Diego, the homeless population numbers have now
shifted from war veterans to the majority being emancipated foster youth.
The cost to the county with additional reductions will also result in an increase of
foster care cost. This cost will average $650 per child, per month but as children
linger in the foster care system the cost jumps to $8900 per month, per child.
Additional costs to the county will include fiscal penalties from the federal and state
governments for the failure to provide mandated services. The county will also see
an increase of judicial orders as a result of failing to provide appropriate services to
the families. These judicial orders for services will result in increased all county
dollar cost to pay for the services. The other area that the county will see an increase
will be the civil lawsuits that will result in any child death, injury or any child who is
abused either in foster care or in the home of the parent where adequate supports
were not provided.
Reducing any child welfare social workers is contrary to appropriate services to
children and families in Contra Costa County. This is a core protection program that
must be fully funded at the current levels to provide adequate services. The current
protections do not provide what is known to be best practice as those services were
eliminated with the 42% reductions to child welfare staffing in December of 2008.
An adequate number of social workers are needed to maximize funding and ensure
support to children and their families.
Health Services:
Detention:
The Board has assigned responsibility for the provision of medical care to inmates under
the custody of the Sheriff to the Health Services Department. The general purpose
revenue contained in the 2011/12 Health Department budget for this function is $18.4
million or 21 percent of the Departments General Fund budget. It should be noted that
although budgeted with Health Services this cost is reflected under the Proposition 172
(Safety) Maintenance of Effort and is reported to the State Controller’s office as a Public
Safety expense.
For all Health Services Divisions except Detention the budgeted expenditure amount is
$1 Billion. Revenue generated by these divisions is $929 million. General Purpose
revenue provided to these divisions is $71 million (8 percent operating subsidy).
The Detention budgeted expenditure is $18.6 million. General Purpose revenue provided
to Detention is $18.4 million (99 percent operating subsidy).
Because Detention Health Services represents such a large component of the Health
Departments general purpose subsidy, there is no ability to leverage funding and there are
no other dedicated revenue streams e.g. Proposition 172, it represents an area for
potential savings. Accordingly options would include:
1. A reduction in nursing hours at West County Detention Facility (WCDF). Medical
emergencies after 11:00pm and before 8:00 am will be sent to Doctors San Pablo or to
CCRMC. No transfer preparation will be done at night, leaving that work to the daytime
or evening nursing shift. Approximately 343 transfers are completed a month. Patients
with diabetes or experiencing alcohol and opiate withdrawal will no longer be housed at
WCDF but moved to the Main Detention Facility (MDF).
2. A reduction in mental health services at WCDF. Acute mentally ill inmates will not be
eligible for housing at WCDF. Any inmate patient developing acute symptoms will need
to be transported back to MDF. Assessment will fall to medical and custody services.
Patient’s psychological stability may be compromised. Increases in case load and
assessment for the Monday through Friday clinician will occur. Increases in overall work
load of MDF Mental Health Clinicians will occur.
3. Eliminate nursing services at Marsh Creek Detention Facility and Orin Allen Youth
Facilitation Facility. By eliminating nursing services to the lowest security facilities all
medical screenings would have to be done at either Martinez Detention Facility (adults)
or at Juvenile Hall (youth). All medications would be "carry on body" increasing the risk
of inappropriate usage, trading or selling. If a medical emergency arises, Custody staff
would be required to transport to the nearest emergency room, leaving either facility
without full deputy support. In addition, the elimination of these services may not be in
compliance for Title V regulations for detention facilities.
In addition to Detention reductions other areas that could be considered are as follows:
Mental Health Division:
1. Reduction in allocation for supported housing. Availability of residential placement for
adults diagnosed with serious and persistent mental illness would be diminished. The
result would be an increase in homelessness and "discharge to homelessness," increased
utilization of law enforcement resources, increased incarceration rates, and increased
hospital recidivism.
2. Reduction in allocation for psychiatric medications. Reduction in the provision of
essential psychiatric medications to uninsured adults diagnosed with serious and
persistent mental illness would contribute to decreased ability of mental health consumers
to maintain independent living in the community, increased need for uncompensated
psychiatric hospital care, increased utilization of uncompensated care in Emergency
Departments, increased involuntary detentions pursuant to Welfare and Institutions Code
Section 5150 and increased utilization of Institutes of Mental Disorder (IMDs) and
Mental Health Rehabilitation Centers (MHRCs) with increased numbers of mental health
consumers requiring designated conservators..
3. Reduction of County general purpose funding to the Mental Health Division would
decrease funds available as match to the Medi-Cal program. The net effect would be a
decrease in essential services to adult Medi-Cal beneficiaries diagnosed with serious
mental health conditions by a factor of two. Resultant decrease in access to outpatient
care would create increased need for higher, more expensive levels of care, some of
which are not Medi-Cal reimbursed and would require expenditure of County funds in
order to meet contractual obligations with the State Department of Mental Health to
provide emergency care to those in crisis.
4. Elimination of Juvenile Hall Assessment and Counseling Services. Uncompensated
mental health screening, assessment and treatment of minors housed in Juvenile Hall and
Orin Allen Youth Facility no longer would be provided resulting in no access to mental
health care, assessment of risk factors and continuity of treatment.
Public Health Division:
1. Eliminate Public Health Nurses (PHN) in clinic services. Each PHN does 911 visits to
high risk moms and new born babies annually. Decrease in PHN staffing would mean
fewer high-risk babies discharged from CCRMC will be seen within recommended
guidelines. Significant revenue loss would occur. Approximately 25 percent of the
program is County funded.
2. Reduce the dental program. The dental program provides dental instruction to 12,000
elementary school children in class, 7,000 dental assessments, applies dental sealants to
1,300 and fluoride varnish treatment to 6,300 children annually. Dental disease is the
leading diagnosis in children in Contra Costa on CHDP well-child exams, and leads to
infection and pain which makes it difficult for children to concentrate in school.
3. Eliminate PHN in the Child Health and Disability Prevention program. These nurses
work with EHSD with foster children. Decreased medical case management of foster
children with increased chance of them having avoidable poor medical outcomes.
Approximately 35% County funded.
4. Reduce Prenatal Care Guidance (PCG). This program does home visiting using
paraprofessionals (outreach workers) to high risk families and pregnant women. Annually
provides comprehensive home visiting services to approximately 320 high risk families,
including education in attachment and bonding and parenting skills. Provides contact,
referral and makes appointments for more than 700 pregnant women into prenatal care.
Approximately 35% County funded.
Ambulatory Care:
1. Eliminate Saturday Clinics at Pittsburg Health Center. Will result in reduced access to
primary care and neurology appointments. 3,600 fewer short notice appointments and
400 fewer neurology appointments. Reduced Medi-Cal and Medicare revenue. Potentially
increased Emergency department visits and hospitalizations due to unmet medical needs.
County savings approximately 9% of total expenditure reduction.
2. Eliminate Evening Clinics at Concord and Richmond Health Centers. Reduced access
to primary care family medicine appointments. 3,600 fewer short notice appointments at
Concord and 2,700 fewer appointments at Richmond. Reduced Medi-Cal and Medicare
revenue. Potentially increased Emergency department visits and hospitalizations due to
unmet medical needs. County savings approximately 9% of total expenditure reduction.
3. Eliminate Evening Clinics in Martinez Health Center. Reduced access to primary care
family medicine appointments. 1,350 fewer family medicine and short notice
appointments. Reduced Medi-Cal and Medicare revenue. Potentially increased
Emergency department visits and hospitalizations due to unmet medical needs. County
savings approximately 9% of total expenditure reduction.
Position Resolution
A position resolution is required to effectuate the position eliminations identified in the
Recommended Budget in addition to positions that are vacant and unfunded. The
resolution is being forwarded to the Board as a companion item to the Recommended
Budget adoption on May 3, 2011. In order to achieve full fiscal year savings, all positions
are slated for elimination on June 30 with the exception of 33 positions in Conservation
and Development. The Conservation and Development positions had been funded by
departmental revenues; however these revenues are no longer sufficient to fund these
positions. In order to achieve current year savings, these positions will be eliminated as of
May 31. Additional positions in various departments will be held vacant in order to
achieve prescribed vacancy factor dollar savings.
Tactical Employment Team Program (TETP)
The Tactical Employment Team Program (TETP) was reinstated in 2008 and is still in
operation. The objective of this program is to mitigate the negative impact that
anticipated layoffs will have on the County’s workforce. The team is up and running and
will continue to work towards finding employment for as many laid-off individuals as
possible; therefore, the employees occupying positions identified as ‘Filled’ in the lay-off
resolution will not necessarily be laid-off. In fact, due to a hard hiring freeze, there are
currently openings in several County departments awaiting authorization to fill much
needed positions.
CONSEQUENCE OF NEGATIVE ACTION:
Restoration of any recommended program reductions will require an equivalent reduction
in funds from other County priorities in order to adhere to the Budget Policy to adopt a
balanced budget.
CHILDREN'S IMPACT STATEMENT:
None.
CLERK'S ADDENDUM
Speakers: 1) Scott Brown, Public Employees Local One; 2) Aaron Scherbenske, Public
Speakers: 1) Scott Brown, Public Employees Local One; 2) Aaron Scherbenske, Public
Employees Union Local One; 3) Pete Ellis from Public Employees Union Local One,
4) John Gragnani, Public Employees Local One Mental Health; 5) Michael Elder;
6) Chris Wenzel, resident of Martinez; 7) Mariana Moore, Human Services Alliance of
Contra Costa; 8) Vincent Wells, Local 1230; 9) Teresa Pasquini, El Sobrante; 10)
William Swenson, Public Health Nurse and Public Employees Union Local One; 11)
Rollie Katz, Public Employees Union Local One; 12) Mark Peterson, District Attorney;
and 13) Suzanne H. Davis, resident of Concord. CLOSED the hearing; ADOPTED the
FY 2011-12 Recommended County Budget with no modification to the budget proposed
on April 12, including all program changes set forth in the NOTICE OF PUBLIC
HEARING (Beilenson Notice); ACKNOWLEDGED that pending action by the State
regarding its budget may require subsequent adjustments to this Recommended
Budget; ACKNOWLEDGED the County Administrator was directed to return to the
Board with a Resolution, authorizing the deletion of certain positions in affected
County departments (companion item – Resolution No. 2011/163). The Board
requested a meeting be scheduled between the Fire Protection District Board of
Commissioners and Board of Supervisors.
ATTACHMENTS
Attachment A
Attachment B