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George A. Ralls M.D.Health Services Department
February 7, 2012
Legislative Update 2012
•Medicaid•DOH Reorganization
F.S. 409.915: County contributions to Medicaid
Medicaid
60 Days to pay State can withhold revenue sharing
funds if not paid
Medicaid Billed/Paid FY07-11
Medicaid
Orange County
Medicaid: Proposed Changes
• Balance between what we’ve paid and 75% of total billed– Approximately $20 Million Dollars
• 36 monthly installments directly out of revenue sharing dollars– $556,000 per month
Collection of Unpaid Bills for last 4 Years
Medicaid: Proposed Changes
• County’s eligible recipients will be determined solely on the address listed in the DCF system
• If no address, eligibility is based on the county where services were rendered– Tertiary referral centers– High risk obstetrics– Neonatal intensive care centers
Attributing Costs to Counties
Medicaid: Proposed Changes
• Beginning Dec. 2012:
–Future unpaid billings will be taken from revenue sharing after 6 months
–Counties will be paying the entire bill
–No reconciliation process or “re-billing”
Payment Method
Medicaid: Proposed Changes
• $20 Million in past denied bills
• Loss of our ability to determine County residence
• Services rendered at any of our tertiary referral centers may contribute to costs
• Mandate to pay entire bill submitted to us– 2011 billed amount was $29.5 M, versus
$17.4 M paid
Summary of local impact:
Medicaid: Proposed Changes
HB 1263 - Department of Health (DOH)
DOH Reorganization
• All CHDs have responsibilities in three functional areas:– Infectious disease prevention & control
• Surveillance, diagnosis, treatment, risk reduction
– Basic family health care services• Primary care, pre-natal care, school based
health care
– Environmental health services• Sanitary nuisances, on-site sewage disposal
systems, water well monitoring
DOH Reorganization
• Orange County Health Department:– Neighborhood Centers for Families– HUG-Me Program– Office of Community Health
• Health Disparities• Chronic Disease and Tobacco Prevention• Risk Communication• Prevention Research, Informatics, and
Health Education Center (PRIHEC)• “All In”
– PCAN Partner
DOH Reorganization
OCHD FY10 Annual Report
Orange County Health Dept
Revenues
$45 M $45.6 M
Expenditures
DOH Reorganization
FY10
OCHD Revenue Sources
DOH Reorganization
FY10
OCHD Expenditures
DOH Reorganization
• Summary of HB 1263:– Counties to take over local health depts
• Health dept employees become county employees
– DOH contracts with counties to maintain primary health department functions• Environmental Health • Communicable Disease• Primary Care
– State block grants will offset county costs
DOH Reorganization
• A significant shift of responsibilities.
• A significant increase in the County workforce.
• Will services be compromised?
• Will State block grants offset the added County costs?
• Amount based on population• No mention of funding formula yet
Concerns:
DOH Reorganization
George A. Ralls M.D.Health Services Department
February 7, 2012
Legislative Update 2012
•Medicaid•DOH Reorganization
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