) STOKES COUNTY GOVERNMENT
COUNTY OF STOKES ) DANBURY, NORTH CAROLINA
) JUNE 4, 2003
The Board of Commissioners of the County of Stokes, State of North Carolina, met in recessed session (recessed from
the June 3, 2003 meeting) in the Council Chambers of the Administrative Building, located in Danbury, North Carolina,
on Wednesday, June 4, 2003, at 6:00 pm with the following members present:
Chairman Sandy McHugh
Vice-Chairman John Turpin
Commissioner Howard Mabe
Commissioner Leon Inman
Commissioner Joe Turpin
Darlene Bullins, Clerk to the Board
Chairman McHugh called the meeting to order.
Dr. Ron Carroll, Stokes County School Superintendent delivered the invocation.
Chairman McHugh opened the meeting by inviting the citizens in attendance to join the Board with the Pledge of Allegiance.
My comments tonight will be restricted to the recommended budget for the Health Department in Danbury. Our other primary budget components, Home Health and the King Clinic consume no local dollars and had relatively minor changes to their respective budgets so they are not an issue.
The focus of my comments tonight will be on the recommended funding level for local appropriations for the Health Department budget because there are important implications for the future of the Health Department and the County.
· The Health Department requested $443,000 in local funding for the 2003-2004 fiscal year. The recommended amount for local funding is approximately $178,000. This reduction represents a 60% decrease in local funding. Local dollars have generally comprised about 29% of our total budget so every local dollar lost equates to at least two additional dollars being lost from other revenue streams. In some cases, the decreased amount of local dollars will jeopardize entire allotments of funding.
· The strategy utilized in the budget cutting process was to eliminate expenditures that were paid in whole or in part by non-local funds and then reflect that full cost cutting in local appropriations. A prime example is Medical Supplies. That line does not have local funding in it. It was decreased by $28,000 and then that reduction was reflected by diminishing local appropriations $28,000.
Another example would be full-time and part-time salaries. The total salary base for these two categories was reduced by approximately $202,000 and then again, local appropriations were reduced by the same amount. Local funding only supported $54,000 of those salaries.
· Please consider the actual funding level vs. the amount listed as being recommended for local appropriations ($178,000). Home Health returned approximately $85,000 in revenues to the County for the 2001-2002 fiscal year. We are on track to earn that much or more this fiscal year. In the past, the Health Department had been able to negotiate having some of those funds returned for specific public health needs. We didn’t get a dime from the revenues for the 2001-2002 fiscal year and we don’t expect a dime this year. If you subtract those revenues from the local appropriations for the Health Center, your actual local funding for all public health needs in this County is $93,000. $93,000 for every man, woman and child in this County – 45,000 people.
· The NC Department of Health and Human Services/Division of Public Health expects a certain level of local funding for Women and Children’s Health (WCH) programs. They use a baseline index for those local contributions based on 1985. Our MOE (Maintenance of Effort) amount for Stokes County is approximately $70,000. If we can not demonstrate that level of investment for those local health programs, all DPH (Division of Public Health) funding may be withdrawn. The total amount of funding we receive from DPH exceeds $380,000.
Please consider this commitment in addition to mandated services and mandated personnel.
· The budget document lists a specific prohibition on purchasing medical supplies for the Family Planning program. It is not the Commissioner’s role to dictate the utilization of non-local funds for the Health Department. The Board of Health is statutorily referenced as the policy making entity for the Health Department and they continue to endorse the continuation of the Family Planning program as it is currently structured. Interference with their desires directly usurps their authority for Health Department policy.
· Please refer to North Carolina General Statute 130A-9 and then to the various mandated services listed in the North Carolina Administrative Code. The statute and the associated rules clearly outline Communicable Disease (including certain obligations with Immunizations), Environmental Health and Vital Records as the responsibility of the County Health Department. In addition to these mandated services, 15A NCAC 25 .0301 stipulates a minimum standard for Health Department staffing which includes a full-time health director, a full-time public health nurse, a full-time registered sanitarian and a full-time secretary. It is my opinion that the proposed amount of local funding ($178,000) will not meet the County’s minimum obligations under these rules.
Local dollars in last year’s program budget for:
Communicable Disease - $ 40,588
Environmental Health - $153,595
This doesn’t include costs associated with Vital Records, Immunizations, Maintenance of Effort and mandated staffing.
If local appropriations for the Health Department remain at the $178,000 level, I would have to pursue major alterations to Environmental Health staffing levels to more equitably distribute local dollars among all public health programs and even then I don’t think we could accomplish all mandated responsibilities.
If it is the Commissioner’s desire to sustain local funding support for Environmental Health and local appropriations stay at $178,000 – the Health Department for all intents and purposes is closed. The budget document currently being shared with the public does not reflect our ability to maintain programs and staffing based on a local appropriation amount of $178,000. I can not magically fill a $265,000 reduction in local funds by “moving money around”. It is my estimation that our shared responsibilities for public health will require baseline funding of $300,000. Remember that Environmental Health consumes $150,000 so I’m asking for that same amount to support all other public health programs. Also remember that a request for $300,000 only entails actual funding of $215,000. $215,000 represents 1.4% of ad valorem taxes collected last year – less than 2 cents on the tax dollar for every service and program administered by the Health Department.
Please give every consideration to my comments. I understand the obligations Commissioners feel toward being fiscally responsible, but we have developed too much “tunnel vision” regarding this goal. The proposed budget may solve one singular problem, but will do so by creating many others. That’s not the kind of trade off that our citizens expect. The County Commissioners are treating Departments the same way that the Governor treated municipalities. The budget crisis for the entire County should not be balanced on the back of departmental budgets. We didn’t get into this situation in one year and we aren’t going to get out of it in one year. There has to be room for compromise and negotiation regarding local funding support.
Thank you for your time.
Steven E. Smith, MPA
Health Director – Stokes County
FY ’02-’03 (Current Fiscal Year):
We requested $1,562,434 for salaries
We were approved $1,553,772 for salaries (county dollars were $756,756)
We requested $1,471,148 which is $82,624 less than the amount we were approved for this year (county dollars will be $562,468; this amount is less than last year’s amount due to so many experienced staff leaving for other jobs. New staff have come in at the minimum amount of pay)
Savings from last year are $ 756,756
$194,288 (All County Dollars)
(Due to reduction-in-force, savings were actually much greater)
Due to the Federal Government assuming a greater portion of the Medicaid costs, Stokes County will see a reduction of the Medicaid costs of approximately 8% in COUNTY DOLLARS. This translates to approximately $160,000 in COUNTY DOLLARS that will be saved!!
To fund our total request of 55.5 workers, DSS only needs $193,000 additional COUNTY DOLLARS. We currently have 38 workers (17.5 staff are needed)
Please consider the budget package that the DSS Board approved and that I feel will adequately serve the needs of the citizens of Stokes County. Anything less will seriously compromise our ability to provide adequate services and may place children and the elderly at risk of harm.
Thank you in advance for your consideration.
Jan Spencer, Interim Director
There being no further business to come before the Board, Vice Chairman John Turpin move to recess until Thursday, June 5, 2003 at 6:00pm.
Commissioner Mabe seconded and the motion carried unanimously.
Darlene Bullins Sandy McHugh
Clerk to the Board Chairman