Ingham Health Plan, 911 Center Funding

Lots of important issues coming up next week for discussion in committee. County staff continue to put together the budget, but other issues are still on the front-burner and here are a few things coming up:

Human Services and Finance will consider the annual resolution to authorize a public health service agreement with the Ingham Health Plan Corporation. I have written previously about the Ingham Health Plan (IHP). It is a way for the county to provide health care benefits for those without health insurance. The IHP is not actual insurance, but is a plan that Ingham County residents can join to be covered for certain health services. People have to be at a certain funding level, and it has fluctuated between 150% of the poverty level and 250% of the poverty level over the last few years. The County Board had a glidepath to get to 100% coverage of county residents using the IHP for low-income residents (along with a third-share plan for small businesses to offer insurance to employees). We have gone a long way, and are not continuing to try to let residents know about this plan. In my area, this is especially important to many of the folks in the Baker-Donora area, and county staff have used federal grants to knock doors and let people know that they are available for these health benefits. We also work closely with the Baker-Donora Center.

But how is this funded? The federal government has a program that issues dollars called the Disproportionate Hospital Share (DSH) program. Ingham County provides dollars to the federal government, who then matches the county dollars at a 2:1 ratio. The money is then returned to the Ingham Health Plan Board, which is an independent Board. So if we send $1 million to the feds, they return $3 million back to the IHP Corporation. The IHPC then allocates that money as they see fit. They also decide on the rules for eligibility and how the money is spent on programming. It has been a tremendously successful program, and this week we will again approve the contract with the IHPC. purchase public health services provided to low income residents of Ingham County. The IHPC proposes to purchase services for up to $2,647,727. The purchased services include: Public Health Nursing, Adult Dental, Outreach and Enrollment, and Support for the Ingham Community Health Center Network.

Another issue coming up deals with the 911 center funding (which comes from the 911 millage and not from our general fund). With the City of Lansing passing the agreement this week (and East Lansing previously approving it), we are now good to move forward with building the new center. Because the build will happen later this year and be complete and operational in mid to late 2011, we have to approve one more resolution funding two separate centers. That will be before us this week in Law Enforcement and Finance committees. If the cap of 80% of annual 911 revenue is maintained, the appropriation would be at less than the traditional 95% of operational costs. This is due to the fact that the operational budget requests have exceeded the capital projects. The 2009/10 East Lansing contract was $1,502,886. The 2009/10 Lansing contract was $5,230,130.

Staff is providing us with two potential scenarios that we could consider (or we could do something else if we want). The first staff scenario would fund to the two 911 Centers at 95% of their operating budget costs within the 80% CAP limitation. This would fund the East Lansing center at $1,467,672 and the Lansing center at $5,099,162.

The 2010/2011 estimated Ingham County 911 revenue is $8,208,543. The combined Lansing/East Lansing contracts funded at 95% is $6,661,163. 80% of 911 revenue (scenario #1) is $6,566,834. The difference is $94,329, and the cities would have to make that up.

The second scenario is to fully fund the operational contracts at the traditional 95% of operational costs. The East Lansing contract would be for $1,488,755 (an increase of $21,082) and the Lansing contract would be for $5,172,408 (an increase of $73,246). The additional funding would require a supplemental appropriation out of the 911 Emergency Telephone Dispatch Services Management and System Improvements reserve to increase the contracts by the additional $94,329. Should we do that, approximately $1,600,000 will still remain for Management and System Improvements in the reserve fund (after lease and maintenance costs associated with the radio project are factored in). Staff is recommending this option because we are consolidating the centers and all parties have agreed, and the long-term cost saving measure will save funds and maintain the quality of 911 Emergency Telephone Dispatch Services. I tend to agree with this logic, but want to hear more about the reserve balance and I think we need to have a discussion about the 80% policy. Traditionally we have had limits to ensure operations did not overtake capital expenses and to ensure that capital expenses actually happen. We need to ensure that capital items will be maintained after the consolidation. But for now, with a new center being built, I tend to favor the full 95% funding option. Should be a good discussion.

Lots of other stuff going on next week also. So stay tuned for the blog after Finance on Wednesday night or Thursday morning!

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