The new year is only three weeks old and Mono County’s financial headaches are already getting started.
At Tuesday’s Board of Supervisors meeting, Public Health Director Sandra Pearce, Public Health Fiscal and Administrative Officer Kim Bunn, and Mono Finance Director Janet Dutcher gave a presentation on the Public Health Department’s perilous financial state.
The message, in flashing lights: help desperately needed.
“By the end of 2023, if we do nothing … at the end of that fiscal year there’ll insufficient resources to sustain and keep the level of service and number of programs that Public Health is performing at this time,” Dutcher told supervisors.
At that point, if no action is taken to stem the losses, Public Health will exhaust its reserve funds and “go over the cliff.”
“We’re not asking for solutions today,” Pearce noted, “but rather to open dialogue about opportunities and challenges that we face so we can be strategic moving forward.”
Pearce, Bunn, and Dutcher broke down the services that Public Health provides, breaking down aspects of those divisions into four categories: Mandated (required by law), Priority (fulfills a mandate but not required by law), “Cross-Cutting” (can be filled through collaboration), and Community Health Improvement Program (fulfills a need and improves public health but not mandated).
The hope in doing so was to determine what, if anything, can be put on the chopping block or shared with other entities to offset a portion of the cost.
Currently, Public Health has just over 18 employees, including a director and officer, spread across five divisions. According to Pearce, that number represents full capacity with personnel but they “continue to see more demands on the department at the state and federal levels.”
A large portion of Public Health’s funding comes from a policy referred to as “Public Health Realignment,” an annual allocation taken from two pots of revenue, vehicle license fees and a public health sales tax.
Realignment is used to fund mandates and backfill contracts with the statewide Public Health Department as well as the Department of Health Care Service.
Those funds have seen an overall decrease of nearly $400,000 since FY 2006-2007. For FY 2018-2019, the allocation was just shy of $1.4 million. The decrease stems from a number of factors including the Great Recession, a redirection of funds to Social Services, and a statewide redirection of funds to Medicaid expansion that resulted in an annual deficit of $370,000.
The two fiscal years before FY2018-2019 were marked by realignment allocations exceeding spending by a total of close to $500,000; 2018-2019 had a deficit of nearly $200,000.
The first division presented to the Supervisors was environmental health, which generates $344,000 in revenue from user charges and fees, a CalRecycle grant, the Solid a clock in at $1,022,000, creating in a $678,000 funding gap that represents largest funding gap within the department.
Other funding gaps within Public Health include:
-$63,000 in communicable disease control
-$43,000 in the the HIV/AIDS & STD program
-$96,000 in immunization
-$91,000 for the emergency preparedness program
-$98,000 in maternal, child, and adolescent health
-$106,000 in tobacco education and cessation
There’s a Catch 22 built into the funding for some these programs and departments that makes for a bit of a head-scratcher. Take the tobacco education and cessation program, which is funded by excise taxes on tobacco through Propositions 99 and 56. This creates a scenario where as the department has greater success in smoking cessation, their revenues drop because fewer people are buying tobacco.
The end game is completely eliminating the need for education and cessation, which is unrealistic as long as tobacco products are still readily available to the population and as Pearce stated, “We don’t believe that this doesn’t create less work for staff.”
Pair that knowledge with the information that many departments have no means of generating revenue aside from realignment and it becomes clear that the current system isn’t working.
So how can Public Health right the ship before it goes off the proverbial cliff in 2023? Pearce, Dutcher and Bunn presented four options: increase funding through grants and fees, delay expenditures, decrease programs and staffing, and regionalization.
All four have caveats that may make decision-makers shy away: grants can only be used for specific things, delaying spending means eventually replacing entire assets, decreasing staffing can increase the workload for others, and regionalization requires generating sufficient revenues.
Another wrench: salaries and benefits comprise the majority of the spending. Cutting staff would be an obvious choice if it didn’t potentially hamstring the remaining staff into doing even more work.
The current plan is to attempt to preserve staff and efficiency. If the funding gap persists, then reduce staff through attrition, regionalize services, and prioritize grants and services. If there’s still an issue, Public Health would begin to discontinue non-mandated services.
Both supervisors Peters and Gardner inquired about other counties, asking if the funding gaps were part of a trend and how others had attempted to rectify the issue.
Pearce explained that larger counties were seeing decreases as well in spite of greater funding, while Dutcher noted that grants “don’t take into account cost of living” and are not always as equal as the dollar amount may seem.
“Is there a sense that the state is trying to save more money on healthcare,” Gardner asked Pearce.
She stated that such a sentiment was “echoed by rural counties regularly.”
“We’re all struggling just to support basic infrastructure,” she said.
Peters also suggested looking into cannabis as a way of making up lost tobacco tax funds.
Supervisor Stump proposed using General Fund money to support Public Health with increased assistance from Mammoth Lakes, “Perhaps its time that we ask the town that if we’re going to start contributing general fund money, they’re going to start contributing general fund money.”