Approved Minutes of February 28, 2024

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MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2024 and that no one person is receiving pay for only 0.09 FTE workload. Several of these positions, such as a new dental hygienist, are considered revenue generating. • Dr. Royce asked if positions that generate revenue should be compensated at a higher rate, as they provide value to the county, to which Mr. Perschau responded that this is a loaded question. He went on to say that many of these roles are part-time and that in all cases the health department considers equity and tries to meet the market rate. Ms. Stewart clarified that the specific role being discussed, part-time foreign language interpreter, is a role that allows other services to be used but does not directly generate revenue, as the county provides interpretation services to patients at no charge. • In response to Dr. Crandell's question about what "reallocated expenses" means, Mr. Perschau explained that this means the money is already being spent on something comparable (e.g., paying salary for a temporary position rather than a permanent position) and that the expense will be sustained going forward. • Medicaid cost settlement offers a substantial revenue source but is only settled at the end of the fiscal year. Because of recent Medicaid expansion, it is expected for the Medicaid cost settlement to increase over the 2024-2025 fiscal year. • Mr. Perschau shared a photo of the new Communicable Diseases (CD) suite in the Whitted Medical Clinic for use by the nursing staff and mentioned a new conference room at Environmental Health. • In response to Dr. Crandell's question about the expense increase for Public Health Infrastructure, Ms. Stewart explained that this is due to new funding from the CDC covering a five-year period to help support workforce development as ARPA funds are ending —this new funding can be used to assist with staffing needs, workforce development, and training across all divisions. She added that some of this will be used to increase staff capacity to meet the increase in demand from Medicaid expansion. Dr. Crandell said that he'd like to know how much of the Public Health Infrastructure cost increases are related to new programs vs. expansions of existing programs, to which Ms. Stewart replied that most are expansions of existing programs and that these increases will be fully offset by corresponding revenue increases. • Dr. Stuebe asked about the decrease in NCCARE360 funds and Carla Julian, Public Health Nursing Director, said that this was a grant that had expired. • Dr. Royce asked if the decrease in funding for STD services was related to a decrease in STDs in the community. Ms. Stewart explained that this is a projection based on the previous year's use of STD services. Mr. Perschau said that there is still some flexibility and that this can be adjusted if there is more demand for STD services than expected. • In response to Dr. Jonnal's question about the goal for dental fees, Mr. Perschau explained that the department is implementing a stepwise increase that is intended to keep OCHD dental fees on par with health departments in surrounding counties without overwhelming patients. Ms. Stewart added that the fees are needed to cover the costs to the health department related to providing services, e.g., the cost of staff time and supplies. As the market rate of dental services is unaffordable without dental insurance, Dr. Jonnal asked if it was possible to charge different fees to those with and without dental insurance. Ms. Stewart replied unfortunately no, our fee is our fee regardless of insurance status, but we are a safety net and for those unable to afford the increased fee there are options available, such as sliding scales and fee waivers. Motion to approve the total budget requested in the amount of$8,111,112 for FY 2024- 2025 as presented, and approve an increase in the personnel budget by$56,793, and forward to the Board of County Commissioners for action was made by Dr. Shielda Rodgers, seconded by Commissioner Amy Fowler, and carried without dissent. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ February Page 6