Getting to Zero Dollars: Tips and Tools for Budget Planning

Transcription

1 Getting to Zero Dollars: Tips and Tools for Budget Planning Karl Halfman, MA & Kevin Sitter, MSW, MPH California Department of Public Health Office of AIDS

2 California s Integrated Plan Ensuring that allocations are spent down to zero will help address clients unmet needs and support many of the Activities in the Integrated Plan.

3 HIV Care Program (X07) Expenditures by Fiscal Year Note: Unspent X07 funds are carried over to ADAP

4 Case Study: Past Spending (1 of 5) During a site visit, a contractor shares that clients have no way to get to their medical appointments in their rural county. The contractor has never budgeted for Medical Transportation Services. Their annual caseload is about 65 clients according to the ARIES Statistical Analysis Report (STAR).

5 Case Study: Past Spending (2 of 5) A quick look at the contractor s HCP Summary Tracking shows unspent funds in the last three fiscal years. $9,600 unspent last year $5,300 unspent on average

6 Case Study: Past Spending (3 of 5) What might you do?

7 Case Study: Past Spending (4 of 5) Consider funding Medical Transportation Services. Think beyond gas vouchers. For example, can you utilize Uber or Lyft in your community? Add travel to service categories so staff can provide rides to medical appointments or do home visits.

8 Case Study: Past Spending (5 of 5) When you submit your new budgets, or budget revisions, take a moment to consider past spending. Are there areas where you consistently underspend? Could these dollars be budgeted to other service categories?

9 Case Study: Examine Trends (1 of 5) In FY , a HCP contractor in a large county increased their Outpatient/ Ambulatory Health Services (OAHS) budget to 70% of their total allocation. Over the next three years, between 69% and 76% of the total allocation was budgeted to OAHS. During these years, the contractor left about 30% of their allocation unspent.

10 Case Study: Examine Trends (2 of 5) What was happening here?

11 Case Study: Examine Trends (3 of 5) During this time, clients were transitioning their medical care to the Low Income Health Program, and later Medi-Cal Expansion and Covered California. ARIES reflected the contractor s success enrolling clients in comprehensive health care coverage. ARIES also showed nearly 150 fewer clients using HCP-funded OAHS over these years.

12 Case Study: Examine Trends (4 of 5) Could this contractor have shifted funds to service categories related to ACA enrollment such as Outreach or Health Education?

13 Case Study: Examine Trends (5 of 5) Because the contractor s budget did not account for these changes, they were unable to spend their money effectively. It took three years before they adjusted their budget to address this problem. In FY , they changed who they subcontracted with and the services they funded.

14 Case Study: Consider Part A (1 of 7) There are special considerations for HCP contractors in EMAs and TGAs. There are basically three approaches to budgeting Part A and Part B (HCP) funds. There are pros and cons to each.

15 Case Study: Consider Part A (2 of 7) To illustrate, let s say we have a TGA with the following: Part A funding = $X Part B funding = $Y Four total providers Five funded services categories

16 Case Study: Consider Part A (3 of 7) One approach is to fund each provider with Part A and Part B. Some services may also be funded by both parts. What are the pros and cons to this approach?

17 Case Study: Consider Part A (4 of 7) What if the budgets were developed so Providers were either funded by Part A or B? Are there benefits to this approach?

18 Case Study: Consider Part A (5 of 7) What about budgeting so that service categories were funded discretely? What would be the benefits of this approach?

19 Case Study: Consider Part A (6 of 7) These more coordinated approaches to budgeting require collaboration with your Planning Council, and may take more time and effort, but the benefits of such approaches may be

20 Case Study: Consider Part A (7 of 7) Reduced administrative burden fewer contracts and budgets to manage Easier implementation of the forthcoming HCP s Standards of Care especially if standards differ between Parts Easier data entry staff don t need to determine which Part is paying for a given service Helps Part A Grantees meet their 75/25 core medical services requirement

21 Case Study: Identify Needs (1 of 4) A HOPWA contractor in a mid-size county serves 50 clients. ARIES shows that 80% of clients are stably housed, but only six clients received HOPWA-funded Housing Subsidy Assistance. The contractor's HOPWA budget for the new year moves funds from Housing Subsidy Assistance to Case Management.

22 Case Study: Identify Needs (2 of 4) Would you approve this budget? Why or why not?

23 Case Study: Identify Needs (3 of 4) The point of HOPWA is housing. While HOPWA can pay for other services (e.g., Case Management, Employment Assistance and Training, etc.), HOPWA should prioritize housing assistance if there are people in need of housing.

24 Case Study: Identify Needs (4 of 4) That was the case here. In this county, HCP serves about 180 clients, 50% of whom did not have stable housing, and none of whom were being served by HOPWA. The contractor was asked to revise the budget to better reflect the needs of their county and work with HCP to house those 90 clients in need.

25 Case Study: Salary Savings (1 of 5) This suburban county has 45 clients who speak only Spanish. Three days into the fiscal year, the only bilingual case manager accepts a promotion in another program. The provider begins recruiting immediately, but the position is still unfilled four months later.

26 Case Study: Salary Savings (2 of 5) The first quarter invoice shows that Medical Case Management expenditures are half what they were last year.

27 Case Study: Salary Savings (3 of 5) What issues might you consider?

28 Case Study: Salary Savings (4 of 5) Staffing Broaden your search. Post on professional job sites, including the Ryan White job forum ( Consider hiring an English-speaking case manager and using Linguistic Services to establish a service order with a telephonic translation service.

29 Case Study: Salary Savings (5 of 5) Salary Savings Even if you hired a case manager today, there are salary savings to spend. Submit a budget revision to: Increase FTEs of current case managers or other staff. Fund non-personnel related service categories like Food Bank, Medical Transportation, Housing, etc. Make sure your service-related administrative costs are covered (see HAB Policy Notice for details).

30 Data Tools There are a number of data tools that can help you during when developing new, or revising current, budgets.

31 HCP Summary Tracking (1 of 2) The HCP Summary Tracking is an Excel file sent to each HCP contractor at the beginning fiscal year. It contains each contractor s current and historical budgets and expenditures broken out by service category and subcontractor (if any).

32 HCP Summary Tracking (2 of 2) HCP contractors should use the Summary Tracking to identify areas of underspending and submit budget revisions to ensure they spend their entire allocation by the end of the fiscal year. Beginning in August 2017, Care Advisors will reach out to HCP contractors whose expenditures seem low to provide technical assistance.

33 ARIES (1 of 4) So long as providers are entering (or importing) data into ARIES, you can find a wealth of information on clients served by Ryan White, HOPWA, Medi- Cal Waiver, and other programs.

34 ARIES (2 of 4) Some of the canned reports that can help with budgeting include: ARIES Statistical Analysis Report (STAR) (under Client Reports) HCP Summary Tracking Report (under Finance Reports) Cross Tab Wizard (under Reports)

35 ARIES (3 of 4) HCP contractors who have subcontractors should make sure they have access to their ARIES Administrative Agency (AA). You ll be able to run reports that give you the big picture for your county using the AA.

36 ARIES (4 of 4) Can t find the report you need? Call the ARIES Help Desk ( ARIES [2743]) to see if they can build it for you. Don t want to wait? Attend one of the ARIES workshops or sign up at the registration table for individual office hours with Help Desk staff.

37 Surveillance Data (1 of 3) OA s HIV Surveillance Section developed California Continuum of Care 2015 for each local health jurisdiction. These Excel files provide: LHJ statistics such as the time it takes to link newly-diagnosed individuals to care and achieve viral suppression, and in care rates among all diagnosed individuals LHJ statistics by demographic and exposure groups

38 Surveillance Data (2 of 3) HCP contractors can use these data to identify unmet needs and inform budgeting. For example, If large percent of people living with HIV are not in care in your county, you may want to fund Outreach Services to support data to care activities.

39 Surveillance Data (3 of 3) Or if newly-diagnosed individuals aren t being linked to care quickly enough, you may want to implement a RAPID model in your county. (For more details, check out Demystifying RAPID at 3:45 today in the Legacy Room) To access your county's report, please check with your local Surveillance Coordinator.

40 Contact Information If you need assistance with budgeting, budget revisions, or data, please contact your Care Advisor.

41 Questions