Approved Minutes of August 28, 2024

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MINUTES ORANGE COUNTY BOARD OF HEALTH August 28,2024 • OCHD has many resources for revenue, including Medicaid settlement funds, service revenues, state allocations, grants, and donations. • The goal is to meet or exceed the budget each year. Looking at trends since 2018, there has been overall good progress in service revenues and use across Dental Services, Environmental Health, and Personal Health Services. However, in the past the budget line was higher than it is now which presents some challenges and creates the objective to move that budget line up, which can be justified with increases to service revenue. • Mr. Perschau explained that OCHD spent down its expense budget, which is important because the county will take away funding in future years if the expense budget is not adequately spent down. He shared that the Dental Clinic recently replaced its panoramic machine for 3600 x-rays and that the Medical Clinic purchased new fridges and freezers for vaccine storage. He also commented on the Bioterrorism Prep Truck, which was purchased at the beginning of FY2023-2024, and upgrades to the Environmental Health conference room. • There was a spike of revenue in May related to Medicaid Cost Settlement, which is distributed based on how the money was initially generated. Personal Health Services and Dental Services are eligible for Medicaid Settlement Funds, as they provide services covered by Medicaid. • The FY2024-2025 budget was approved for$9.1 M net, an increase largely related to people-costs (salaries and benefits). Training and travel costs, which had previously largely been supplemented by ARPA, have been reduced significantly and are now limited largely to required licensures and certifications. Additionally, there is a hiring freeze in effect for FY2024-2025, though direct care positions are not affected. • Dr. Crandell observed that OCHD is slightly over budget (101.6%) and asked if this is a big deal, to which Mr. Perschau explained that this is considered within normal range and did not exceed the allotted budget. Ms. Stewart added that for the past few years, the health department has been under budget, largely because of ARPA funding. • Commissioner Fowler shared that it was a painful budget year for all departments and that training and travel was cut across the board. • In response to Dr. Royce's question about recent fee changes impacting Environmental Health Services' return, Victoria Hudson, Environmental Health Director, said that the fee changes were reinvested in the community and didn't affect the bottom line. Ms. Hudson added that fluctuations in Environmental Health Services are usually related to the building and development climate, as it is an on-demand service. • Mr. Whitaker observed that in May there was a spike in both Medicaid Settlement Funds and Environmental Health Services and asked if these were related, but Ms. Hudson explained that the increase for Environmental Health was related to swimming pools. Ms. Stewart added that Environmental Health is not eligible for Medicaid reimbursement, as their services are not covered by Medicaid. Ms. Stewart added that some of the Medicaid Settlement Funds had been set aside over time to help save for a large clinic renovation. Commissioner Fowler commented that during the budget process this year, every department was required to discuss use of any extra funds or savings, as the Medicaid Hold Harmless Agreement was flipped this year and rather than being reimbursed $2M, Orange County owed that amount. • In response to Dr. Stuebe's question about ways to increase service revenue and increase primary care patients, Ms. Stewart said that this is an ongoing challenge, and that the health department is in the process of completing a clinic assessment with AHEC to better understand clinic workflow and staffing capacity. We anticipate the findings will support future requests for additional staffing. • Mr. Perschau concluded his presentation by thanking his team for all their hard work. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ August Page 7