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DocuSign Envelope ID: E7784BE7- 82AF- 4AF1- AA11- 944D2300E76D <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />• Triangle United Way <br />• State Government <br />• Federal Government (CDBG /HOME /etc.) <br />• Private Foundation Grants <br />o Other Revenue <br />• Expenditures <br />• Compensation <br />• Rent & Utilities <br />• Supplies & Equipment <br />• Travel & Training <br />• Other Expenses <br />iii. Does your agency budget show a Surplus or Deficit? Deficit <br />Is there a significant change? Yes /No No <br />Please provide a brief explanation for Surplus or Deficit, and significant changes <br />Decreases in Medicaid reimbursement rates still represent an annual loss of funding, and <br />threaten our ability to serve all of the children referred. Medicaid funding is a large part of <br />our revenue. Although we are successful at accessing Medicaid funds, the entire mental <br />health system is remains underfunded and fragile. The volatility of the federal, state, and <br />local economic picture continues to threaten our funding as well. The uncertainly of the <br />future of the mental health system under DHHS, including the possibility of outsourcing <br />mental health /Medicaid to the private sector, has everything on hold. Until this crucial <br />decision is resolved, issues regarding rate increases and development and implementation <br />of new services will remain unstable. <br />iv. What is your agency's fiscal year? June 30, 2018- July 1, 2019 <br />(Example: July 1, 2016 through June 30, 2017) <br />Agency Information 1/22/2018 3:23:54 PM <br />