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<br />FINANCIAL IMPACT: Development costs for this project are estimated at $1.47 million
<br />allocated in the followina cateaories:
<br />This estimate was developed by staff, the project architect — Corley Redfoot Zack (CRZ), and
<br />CostPlus Estimators, a third party estimating firm.
<br />Medicaid Maximization Cost Settlement Funds are the proposed funding source for this project.
<br />In the mid -90s, the federal Medicaid program recognized that health departments were often
<br />expending more funds in providing care for Medicaid recipients than the reimbursement that
<br />was provided. In order to bring health departments to a more equitable "cost reimbursement" in
<br />line with that received by federally qualified health centers and by public hospitals, the federal
<br />Medicaid program authorized a supplemental payment for health departments to adjust for the
<br />cost of providing Medicaid direct services on an annual basis. The amount reimbursed is only
<br />calculated on the federal portion of Medicaid, not on the state share. Federal regulations
<br />require the funds to be allocated and spent for the programs that actually earned the funds.
<br />The settlement amount is calculated on actual expenses and therefore generally paid one year
<br />after the fiscal year in which the services were provided. The first payment made to health
<br />departments in North Carolina was in late 1997 and represented a partial payment for the
<br />federal fiscal year October 1994 through September 1995. That payment was $37,721.48. In
<br />the fall of 1998, a second payment was received that was the balance of 1994 -95 and 1995 -96.
<br />Since then the Health Department has received an annual payment in late spring that
<br />represents payment for services in a previous year. As an example, the County received notice
<br />of payment for fiscal year 2006 -2007 on June 23, 2008 ($270,203.70). Each year, the Board of
<br />Commissioners has authorized budget amendments accepting these funds into this project
<br />account.
<br />The Board of Commissioners established a Medicaid Maximization Project Ordinance in 1998
<br />to allow for the receipt and use of these funds. The intent was to save and utilize the funds for
<br />renovation, capital building, equipment, and furnishings as needed by health and dental
<br />programs, thereby assisting the County in meeting service obligations to residents. Federal and
<br />State regulations require these funds to be budgeted and expended to further the objectives of
<br />the program that generates the funds. Allowed uses of these funds include public information
<br />and outreach, automation of administrative operations, capital improvements including
<br />equipment and furnishings, and program support services.
<br />In 2001 -2002, approximately $225,000 was used to renovate the clinical space in conjunction
<br />with the HVAC replacement at Whitted. Over the years, the Board of Commissioners has
<br />approved utilization of the funds to replace equipment on an emergency basis that has broken
<br />but was not able to be funded through the General Fund. These funds were also used to bring
<br />Health Department facilities and equipment into compliance with accreditation requirements in
<br />2007. The Health Department has been parsimonious in the use of these funds, anticipating
<br />the need to build or renovate adequately appointed space for the future. One such anticipated
<br />use was the upfit of Hillsborough Commons, discussed in 2007 and 2008.
<br />HEALTH ESTIMATED COSTS
<br />DENTAL ESTIMATED COSTS
<br />Construction
<br />$1,016,000
<br />$203,000
<br />Professional Services
<br />$ 83,000
<br />$ 15,000
<br />Furnishings
<br />$ 45,000
<br />$ 5,000
<br />Equipment
<br />$ 33;000
<br />$ 70,000
<br />Total
<br />$1,177,000
<br />$293,000
<br />This estimate was developed by staff, the project architect — Corley Redfoot Zack (CRZ), and
<br />CostPlus Estimators, a third party estimating firm.
<br />Medicaid Maximization Cost Settlement Funds are the proposed funding source for this project.
<br />In the mid -90s, the federal Medicaid program recognized that health departments were often
<br />expending more funds in providing care for Medicaid recipients than the reimbursement that
<br />was provided. In order to bring health departments to a more equitable "cost reimbursement" in
<br />line with that received by federally qualified health centers and by public hospitals, the federal
<br />Medicaid program authorized a supplemental payment for health departments to adjust for the
<br />cost of providing Medicaid direct services on an annual basis. The amount reimbursed is only
<br />calculated on the federal portion of Medicaid, not on the state share. Federal regulations
<br />require the funds to be allocated and spent for the programs that actually earned the funds.
<br />The settlement amount is calculated on actual expenses and therefore generally paid one year
<br />after the fiscal year in which the services were provided. The first payment made to health
<br />departments in North Carolina was in late 1997 and represented a partial payment for the
<br />federal fiscal year October 1994 through September 1995. That payment was $37,721.48. In
<br />the fall of 1998, a second payment was received that was the balance of 1994 -95 and 1995 -96.
<br />Since then the Health Department has received an annual payment in late spring that
<br />represents payment for services in a previous year. As an example, the County received notice
<br />of payment for fiscal year 2006 -2007 on June 23, 2008 ($270,203.70). Each year, the Board of
<br />Commissioners has authorized budget amendments accepting these funds into this project
<br />account.
<br />The Board of Commissioners established a Medicaid Maximization Project Ordinance in 1998
<br />to allow for the receipt and use of these funds. The intent was to save and utilize the funds for
<br />renovation, capital building, equipment, and furnishings as needed by health and dental
<br />programs, thereby assisting the County in meeting service obligations to residents. Federal and
<br />State regulations require these funds to be budgeted and expended to further the objectives of
<br />the program that generates the funds. Allowed uses of these funds include public information
<br />and outreach, automation of administrative operations, capital improvements including
<br />equipment and furnishings, and program support services.
<br />In 2001 -2002, approximately $225,000 was used to renovate the clinical space in conjunction
<br />with the HVAC replacement at Whitted. Over the years, the Board of Commissioners has
<br />approved utilization of the funds to replace equipment on an emergency basis that has broken
<br />but was not able to be funded through the General Fund. These funds were also used to bring
<br />Health Department facilities and equipment into compliance with accreditation requirements in
<br />2007. The Health Department has been parsimonious in the use of these funds, anticipating
<br />the need to build or renovate adequately appointed space for the future. One such anticipated
<br />use was the upfit of Hillsborough Commons, discussed in 2007 and 2008.
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