Health & Human Services Budget & Policy Committee. Dennis Albrecht Fiscal Analyst

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1 Health & Human Services Budget & Policy Committee Dennis Albrecht Fiscal Analyst

2 Health & Human Services Budget & Policy Committee Department of Human Services Department of Health Emergency Medical Services Board Council on Disability MH/DD Ombudsperson Ombudsperson for Families Health Related Boards 2

3 Health & Human Services Budget & Policy Committee All Funds Budget = $ Billion 41.4% of the State All Funds Budget 3

4 Health & Human Services All Funds Allocation by Fund Fund Total (000) Percent of Total General Fund $11,630, % State Government Special Revenue Fund $122, % Health Care Access Fund $1,452, % Special Revenue Fund $802,316 3% Federal Fund $12,139, % Federal TANF Reserve Fund $421, % Environmental Fund $ % Remediation Fund $ % Medical Education Endowment Fund $169, % Gift Fund $ % Endowment Fund $2 0.0% Total $26,739, % 4

5 Health & Human Services General Fund General Fund Budget = $ Billion 30.1% of the State General Fund Budget 5

6 Health & Human Services General Fund Allocations MA Expansion Contingency, MH/DD $383,698, 3% Ombudsperson, $3,310, 0% Department of EMSRB, $5,484, Health, 152,189 0% 1% Council on Disability, $1,048, 0% Ombudsperson for Families, $530, 0% Department of Human Services, $11,084,506, 95% 6

7 Health & Human Services State Gov Special Revenue Fund Fees from licensing, exams, permits, registrations and certifications Funds received must be appropriated by legislature to be spent Used primarily to fund activities of relevant licensing agency or activity within an agency 7

8 Health & Human Services State Gov Special Revenue Fund Emergency Medical Services Board, $1,436, 1% Health Related Boards, $29,124, 24% Department of Human Services, $1,130, 1% Department of Health, $91,093, 74% 8

9 Health & Human Services Health Care Access Fund Funds Received Include: 2% Provider Tax Paid by Medical Providers 1% Gross Premium Tax on Insurance Premiums FFP for Administration Primary Use is for MinnesotaCare Program Also Used to Fund Health Care Access and Quality Improvement Initiatives 9

10 Health & Human Services Health Care Access Fund Department of Health, $25,369, 1% MA Expansion Contingency, $(415,474), - 18% Department of Human Services, $1,842,745, 81% 10

11 Health & Human Services Special Revenue Fund Accounts in Fund are Dedicated by Statute to Specific Purposes May include amounts transferred from another fund, often the General Fund (e.g. CCDTF) Some revolving funds and internal service funds Many Uses are Statutory Appropriations, Including Statutory Transfer Authority Few Direct Appropriations 11

12 Health & Human Services Special Revenue Fund Ombudsperson for Families, $261, 0% Health Related Boards, $428, 0% Department of Health, $130,491, 16% Emergency Medical Services Board, $3,672, 1% Department of Human Services, $667,464, 83% 12

13 Health & Human Services Federal Fund Source of Funds is Federal Grants to State Agencies Agencies have statutory authority to seek federal funds Acceptance of funds is subject to legislative review Funds are statutorily appropriated subject to legislative review 13

14 Health & Human Services Federal Fund Disability Council, $71, 0% Department of Health, $502,081, 4% Emergency Medical Services Board, $484, 0% Department of Human Services, $11,636,552, 96% 14

15 Health & Human Services Federal TANF Reserve Fund Separate Federal Fund to Meet Federal Requirement that TANF Funds be Specifically Appropriated by Legislature. Also Supports Reporting Requirements. Funds MFIP, DWP, and Support Services Grants 15

16 Health & Human Services Federal TANF Reserve Fund Department of Health, $23,466, 6% Department of Human Services, $397,600, 94% 16

17 Health & Human Services Environmental Fund Source of Funds is Environmental Related Fees, Taxes, and Assessments MDH Receives $57,000 each year for a program to identify and monitor toxic chemicals in products used by children. 17

18 Health & Human Services Remediation Fund Sources of Funds are Superfund Reimbursements and Penalties, Insurance Settlements, Fines and Fees related to environmental damage MDH receives $252,000 each year for Environment Health Monitoring. 18

19 Health & Human Services Medical Education & Research Costs Fund Revenue Sources are Cigarette Tax and PMAP $ Million in Funding is distributed annually to Medical Education Programs according to statutory requirements. Administered by Department of Health 19

20 Health & Human Services Gift Fund Fund Exists to Receive Gifts, Bequests, or Endowments to the State DHS Allocation: $67,000 in MDH Allocation: $292,000 in EMSB Allocation: $4,000 in

21 Health & Human Services Endowment Fund Receives Gifts, Donations, and Endowments with Restrictions Defined by the Donor Investment Income is Available to Agency DHS Allocation is $2,000 in

22 Department of Human Services (DHS) All Funds Budget = $ Billion 39.6% of the State All Funds Budget 22

23 Department of Human Services All Funds Allocations by Fund Fund Total (000) Percent of Total General Fund $11,468, % State Government Special Revenue Fund $1, % Health Care Access Fund $1,427, % Special Revenue Fund $667, % Federal Fund $11,636, % Federal TANF Reserve Fund $397, % Gift Fund $67 0.0% Endowment Fund $2 0.0% Total $25,598, % 23

24 Department of Human Services General Fund General Fund Budget = $ Billion 29.7% of the State General Fund Budget 83% of the DHS General Fund Budget is for Health Care/Long Term Care 24

25 Department of Human Services General Fund Allocations MA Expansion Contingency, $383,698, 3% State Operated Services, $510,108, 5% Agency Management, $195,439, 2% Continuing Care Grants, $3,802,381, 33% Basic Health Care Grants, $5,429,735, 47% Children & Economic Assistance, $1,146,843, 10% 25

26 Department of Human Services State Gov Special Revenue Fund $565,000 Each year for Licensing Administrative Operations. 26

27 HCAF Systems Transfer, $8,878, 0% Department of Human Services MA Expansion Contingency, $(415,474), - 18% MinnesotaCare Administration, $61,759, 3% Health Care Access Fund Other, $11,971, 1% MinnesotaCare Grants, $1,760,137, 78% 27

28 Department of Human Services Special Revenue Fund General Fund Appropriations for Some Programs are Transferred to Combine with Revenue from Other Sources (e.g. CCDTF) Fees paid by Program Participants are Deposited (e.g. Child Support Fees) Various Program Revenues are Deposited to This Fund (e.g. Work Activity Funds for DD programs, Fees for Background Studies) 28

29 Department of Human Services Special Revenue Fund MA Grants, $69,879, 10% MinnesotaCare Premiums, $81,135, 12% Elder Waiver Control Processing, $64,000, 10% Other, $107,618, 16% DHS Systems Fund, $245,156, 37% CCDTF Grants & Administration, $99,676, 15% 29

30 Department of Human Services Federal Fund 1% 1% 2% 0% 2% 1% 2% 10% 81% Total Federal Fund: $11,636,552 Medical Assistance Food Stamps S-CHIP Foster Care & Adoption Assistance Child Care Admin & Development Chemical Dependency Child Support Administration SSBG-Title XX Other 30

31 Department of Human Services Described Earlier: Other Funds Federal TANF Reserve Fund $397.6 Million Gift Fund: $67,000 Endowment Fund: $2,000 31

32 Department of Human Services Major Programs Medical Assistance (MA) Minnesota Care (MnCare) Minnesota Family Investment Plan (MFIP) State Operated Services (SOS) General Assistance (GA) Minnesota Sex Offender Program (MSOP) Mental Health Services Chemical Dependency Services Child Welfare Services (Children s Services Grants) 32

33 Department of Human Services Medical Assistance (MA) Federal Health Care Entitlement Program 50% State Match Eligible Individuals are low income families, elderly, and disabled persons Adults without Children (MA Expansion) Federal requirements for eligibility and services States have option to expand above the federal minimum requirements 33

34 MA Average Monthly Recipients Monthly Average: 773,328 Elderly & Disabled All Services, 183,040, 24% Families with Children, 492,220, 63% Adults With No Children, 98,070, 13% 34

35 Department of Human Services MA Expenditures Adults With No Children, $1,073,905, 11% Families & Children Basic Care, $2,394,185, 25% Elderly & Disabled All Services, $6,260,972, 64% 35

36 Department of Human Services Minnesota Care Provides health care services to people who do not have access to affordable health insurance. Must meet income and program guidelines. Must pay monthly premium based on income. 73.4% of enrolled participants have income below 150% of Federal Poverty Guideline. Approx 118,000 enrolled participants per Month 36

37 Department of Human Services Minnesota Care Special Revenue Fund, $81,135, 4% Federal Fund, $499,794, 21% Health Care Access Fund, $1,760,137, 75% 37

38 Department of Human Services Minnesota Family Investment Plan Minnesota s TANF Program 60-month Lifetime Limit for Cash Assistance Employment focused program with access to health care, child care, and employment services. 36,900 Average Monthly Participant Families Approx 100,400 individuals Includes Diversionary Work Program 38

39 Department of Human Services Minnesota Family Investment Program Special Revenue Fund, $6,200, 1% Federal Fund General Fund, (Food), $175,632, 26% $331,316, 49% Federal TANF, $166,728, 24% 39

40 Department of Human Services State Operated Services Provides Direct Service to Persons with Mental Illness, NeurocognitiveDisabilities, and Chemical Addiction Mental Health Services: FY 2010 Average Daily Population was 261 Individuals; 2,900 Individuals Received Services in FY 2010 Also Operates Minnesota Security Hospital and Forensics Nursing Home. 40

41 Department of Human Services State Operated Services Special Revenue Fund, $30,673, 8% Gift Fund, $18, 0% General Fund, $374,968, 92% 41

42 Department of Human Services General Assistance Provides maximum of $203 per month to Individuals and Couples Without Children Eligibility Primarily Related to Inability to Work and Disability Approximately 20,000 Recipients per Month General Fund: $101.8 million for Special Revenue Fund: $200,000 for

43 Department of Human Services Minnesota Sex Offender Program Provides Services to Individuals who have Completed Prison Sentences and are Civilly Committed by Courts and Placed in Sex Offender Treatment FY 2010 had 575 Clients General Fund: $135.1 Million in

44 Department of Human Services Mental Health Services Children s Mental Health Grants Fund Services for Children with Mental Illness General Fund: $ Million in Grants to Counties, Schools, and Other Entities. 10,000 Children in Child Welfare and Juvenile Justice Screened 2,800 Children Received Case Management Additional Children Receive Services 44

45 Department of Human Services Mental Health Services Adult Mental Health Grants Fund Services for Approximately 55,000 People Each Year with Serious Mental Illness Fund (000) General Fund $155,078 90% Health Care Access Fund % $1,500 1% Special Revenue $680 0% Fund Lottery Cash Flow $3,016 2% Federal Fund $11,432 7% Total $171, % 45

46 Department of Human Services Chemical Dependency Services CD Entitlement Grants Provides Financially Eligible Individuals with Residential and Outpatient Addiction Treatment Services Need to be Assessed as Needing Treatment 27,100 Placements in FY 2009 Average Cost per Admission is $3,800 Fund (000) General Fund $236,113 73% Special Revenue Fund % $88,179 27% Total $324, % 46

47 Department of Human Services Chemical Dependency Services Non-Entitlement Grants Funds prevention, intervention and Case Management, treatment support, recovery maintenance 7-Region System Administered by regional Prevention Coordinators 41,000 People Served in Some Fashion Fund Amount (000) General Fund $2,672 8% Special Revenue Fund $2,800 8% Federal Fund $28,871 84% Total $34, % % 47

48 Department of Human Services Child Welfare Services Grants for Children who are at Risk of Abuse or Neglect, Have Been Abused or Neglected, are in Out of Home Placement, Waiting for Adoption or Under State Guardianship. 48,250 Children in FY 2009 (Approx) Fund (000) General Fund $90,254 54% Federal TANF Fund $280 0% Special Revenue Fund % $5,949 3% Federal Fund $72,125 43% Gift Fund $29 0% Total $168, % 48

49 Department of Health All Funds Budget = $1.095 Billion 1.7% of the State All Funds Budget Approximately 58% of the All Funds budget is passed through to local governments, non-profit organizations, community hospitals, and teaching institutions. 49

50 Department of Health All Funds Allocation by Fund Fund (000) Percent General Fund $152, % State Government Special Revenue Fund $91, % Health Care Access Fund $25, % Special Revenue Fund $130, % Federal Fund $502, % Environmental Fund $ % Remediation Fund $ % Medical Education Endowment Fund $169, % Gift Fund $ % Total $1,094, % 50

51 Department of Health General Fund Allocation General Fund Budget = $152million 0.4% of the State General Fund Budget Approximately 64% of the MDH General Fund budget is passed through to local governments, non-profit organizations, community hospitals, and teaching institutions. 51

52 Department of Health Major Program Areas Community & Family Health Promotion Policy, Quality & Compliance Health Protection Administrative Support 52

53 Department of Health Community & Family Health Promotion Federal TANF Fund, $23,466, 5% Federal Fund, $354,538, 73% Gift Fund, $92, 0% General Fund, $95,999, 20% State Gov Special Revenue Fund, $2,066, 0% Health Care Access Fund, $3,438, 1% Special Revenue Fund, $5,175, 1% 53

54 Department of Health Community & Family Health Promotion Community & Family Health Women, Infants & Children (WIC) Local Public Health Grants Positive Alternatives Grants Family Planning Grants Fetal Alcohol Syndrome Grant Maternal & Child Health Grant Health Care Homes 54

55 Department of Health Community & Family Health Promotion Health Promotion & Chronic Disease Chronic Disease Monitoring Cardio Vascular Diabetes Asthma Stroke Brain Injury/Trauma Registry Federal Grants Cancer Registry Sage Screening Poison Information Centers 55

56 Department of Health Community & Family Health Promotion Minority Multicultural Health Eliminating Health Disparities Grants Statewide Health Improvement Tobacco Prevention Statewide Health Improvement Program 56

57 Department of Health Policy, Quality, & Compliance Gift Fund, $62, 0% General Fund, $21,996, 8% State Gov Special Revenue Fund, $28,109, 10% Medical Education & Research Fund, $154,671, 54% Health Care Access Fund, $21,931, 8% Special Revenue Fund, $47,304, 16% Federal Fund, $11,438, 4% 57

58 Department of Health Policy, Quality, & Compliance Compliance Monitoring Medicaid Surveys & Reviews Health Professionals and Facility Oversight Vulnerable Adults Birth Centers Home Care/Assisted Living Managed Care Systems Health Facility Licensing & Certification 58

59 Department of Health Policy, Quality, & Compliance Health Policy Health Statistics State Registrar Health Care Transformation Health Economics Office of Rural Health Health Professionals Loan Forgiveness Program Medical Education & Research (MERC) 59

60 Department of Health Health Protection Gift Fund, $116, 0% General Fund, $18,740, 9% Federal Fund, $124,387, 56% State Gov Special Revenue Fund, $60,918, 27% Special Revenue Fund, $18,524, 8% 60

61 Department of Health Environmental Health Drinking Water Health Protection Food, Beverage, and Lodging Hospitality Swimming Pools Well Management X-Ray Equipment Radioactive Materials 61

62 Department of Health Health Protection Infectious Disease Epidemiology, Prevention, & Control Acute Disease Surveillance & Outbreak Investigation AIDS Program Grants/Community Prevention Immunizations & Vaccinations Tuberculosis Monitoring Hepatitis Monitoring Emerging Infections Monitoring 62

63 Department of Health Health Protection Public Health Laboratory Newborn Screening Environmental Lab Laboratory Accreditation Clinical Lab Bioterrorism Lab Emerging Infections Lab 63

64 Department of Health Health Protection Office of Emergency Preparedness Pandemic Flu Preparedness Local Public Health Preparedness Grants Hospital Preparedness 64

65 Department of Health Administrative Support Service Federal Fund, $11,718, 14% Gift Fund, $22, 0% General Fund, $15,454, 19% Special Revenue Fund, $55,692, 67% 65

66 Department of Health Administrative Support Service Administrative Services Rent Facilities Services Human Resources Information Technology Services Executive Office Policy Development/Government Relations Legal Communications 66

67 Health & Human Services Budget Other Agencies Emergency Medical Services Board Council on Disability MH/DD Ombudsperson Ombudsperson for Families Health Related Boards 67

68 Other Agencies All Funds Allocations Fund Total (000) Percent of Total General Fund $10, % State Government Special Revenue Fund $30, % Special Revenue Fund $4, % Federal Fund $ % Gift Fund $4 0.0% Total $45, % 68

69 Other Agencies General Fund Allocation Ombudsperson for Families, 530, 5% MH/DD Ombudsperson, 3,310, 32% Emergency Medical Services Board, 5,484, 53% Council on Disability, 1,048, 10% 69

70 Health Related Boards Board State Gov SR Fund Spec Rev Fund Total Chiropractors Board $912 $912 Dentistry Board $2,060 $2,060 Medical Practice Board $7,444 $7,444 Nursing Board $6,648 $6,648 Nursing Home Admin Board $2,220 $404 $2,624 Optometry Board $208 $208 Pharmacy Board $3,606 $3,606 Podiatry Board $154 $154 Psychology Board $1,636 $1,636 Veterinary Medicine Board $402 $402 Dietetics & Nutrition Practice Board $222 $222 Continued 70

71 Health Related Board (Cont d) Board State Gov SR Fund Spec Rev Fund Total Social Work Board $1,878 $24 $1,902 Marriage & Family Therapy Board $338 $338 Physical Therapy Board $608 $608 Behavioral Health & Therapy Board $788 $788 Total $29,124 $428 $29,552 71