HHSCC Funding StudyHHSCC Funding StudyAn Analysis of Health and Human Services

Funding in Pinellas County

FY 2005-06

March 2008

PurposePurpose

Study was designed to answer the following:Study was designed to answer the following:

What are the sources of public funding directed What are the sources of public funding directed to health and human services in the county?to health and human services in the county?

For a designated financial period, what is the For a designated financial period, what is the amount of public funding in total and broken out amount of public funding in total and broken out by population and program types?by population and program types?

How are funds from the various sources How are funds from the various sources leveraged, linked, or dependent upon one leveraged, linked, or dependent upon one another? another?

MethodsMethods

March 2008

Levels of AnalysisLevels of Analysis

1.1. Federal – Florida in general and Pinellas Federal – Florida in general and Pinellas specifically specifically

2.2. State – Federal conduit, general revenue State – Federal conduit, general revenue and trust funds and trust funds

3.3. Local – Funding patterns and creative Local – Funding patterns and creative organizational structures organizational structures

Study examined funding sources, mechanisms, Study examined funding sources, mechanisms, and patterns from three perspectives:and patterns from three perspectives:

ScopeScope

Hospitals (n = 5), funders (n = 8), and Hospitals (n = 5), funders (n = 8), and governmental designees/lead agencies (n = 5) governmental designees/lead agencies (n = 5) were surveyed; all responded with the were surveyed; all responded with the exception of one hospital systemexception of one hospital system

Initial lists of provider agencies resulted from a Initial lists of provider agencies resulted from a query of 2-1-1 Tampa Bay Cares’ ServicePoint query of 2-1-1 Tampa Bay Cares’ ServicePoint database (n = 127); list refined through iterative database (n = 127); list refined through iterative process (n = 103)process (n = 103)

Data were received from 91 provider agencies - Data were received from 91 provider agencies - effective response rate = 88.3%effective response rate = 88.3%

Survey ParticipantsSurvey Participants

Federal Funding SummaryFederal Funding Summary

Total federal dollars to Florida and to Pinellas Total federal dollars to Florida and to Pinellas County have increased over the last ten yearsCounty have increased over the last ten years

Majority of funds came as direct payments to Majority of funds came as direct payments to individuals through programs (e.g., Medicare)individuals through programs (e.g., Medicare)

Florida ranked 45Florida ranked 45thth in per capita ranking for in per capita ranking for percentage of federal funds spent on health and percentage of federal funds spent on health and human serviceshuman services

Pinellas County receiving less than 3% of federal Pinellas County receiving less than 3% of federal grants to the stategrants to the state

State Funding SummaryState Funding Summary Florida State Constitution mandates balanced

budget

State acknowledges impact of long-term care spending (e.g., Medicaid) (e.g., Medicaid)

State left with three optionsState left with three options

1.1. Increase its revenuesIncrease its revenues2.2. Reduce its expendituresReduce its expenditures3.3. Assign some of its work to counties or other Assign some of its work to counties or other

subsidiary governments subsidiary governments

Total Revenue Total Revenue Health and Human Services Health and Human Services

1. Does not include the four HCA for-profit hospitals operating in Pinellas.

Total Revenue by Age GroupTotal Revenue by Age Group

23% 48%

29%

Children Adults BothTotal = $314,710,721

Source of Revenue by Age groupSource of Revenue by Age group

$0

$10

$20

$30

$40

$50

$60

Rev

enue

in M

illio

ns

Children

Adults

Both

Total = $314,710,721

Total Revenue by Service CategoryTotal Revenue by Service Category

12.7%

2.2%

2.1%

24.3%

25.0%

8.0%

< .1%

0.7%

24.4%

0.6%

Basic Needs Criminal Justice Income Support Behavioral Health

Consumer Services Education Health Individual and Family Life

Organizational Community Unable to Categorize

Total = $314,710,721

EducationalEducational

15.4%

4.1%

20.6%

Misc. and Cash < .01%

0.2%1.0%

57.7%

1.0%

Federal State LocalGov. Designee/Lead Agency Program Income Grant/FoundationFundraising Miscellaneous Cash

Total = $78,675,285

Individual and Family LifeIndividual and Family Life

38.1%

18.0%

3.5%

9.5%

24.4%

5.6%

0.04% 0.6%0.3%

Federal State LocalGov. Designee/Lead Agency Program Income Grant/FoundationFundraising Miscellaneous Cash

Total = = $76,816,088

Individual and Family LifeIndividual and Family LifeDetailed View of Program RevenueDetailed View of Program Revenue

0.3%

38.1%

18.0%

9.5%

0.6%

0.04%

0.01%

0.3%

1.4%

2.0%

3.5%5.6%

20.7%

24.4%

Federal State LocalGov. Designee/Lead Agency Grant/Foundation FundraisingMiscellaneous Cash Fees for ServiceInsurance Interest Income Medicaid/Medicaid HMOSales

Total = $76,816,088

Program Revenue

Behavioral HealthBehavioral Health

40.6%

15.0%

14.2%

6.3%

0.2%0.1%0.9%

2.4%

20.3%

Federal State LocalGov. Designee/Lead Agency Program Income Grant/FoundationFundraising Miscellaneous Cash

Total = $76,491,419

Behavioral Health Service SpecificBehavioral Health Service Specific

8.9%

33.7%

32.7%

11.1%

13.5%

Inpatient Mental Health Facilities Outpatient Mental Health Facilities

Residential Treatment Facilities Outpatient Substance Abuse Services

Inpatient Substance Abuse Services

Total = $76,491,419

Basic NeedsBasic Needs

16.9%

11.7%

14.3%

11.9%

21.5%

3.3%

14.5%

1.7% 4.3%

Federal State LocalGov. Designee/Lead Agency Program Income Grant/FoundationFundraising Miscellaneous Cash

Total = $40,005,774

Other Sources of RevenueOther Sources of Revenue

In-Kind Services In-Kind Services $4,789,879$4,789,879 FoundationsFoundations $7,665,484$7,665,484 Fund-RaisingFund-Raising $11,690,328$11,690,328 Matching $ and Pass-ThroughMatching $ and Pass-Through

71 programs = $18,650,16371 programs = $18,650,163

ConclusionsConclusions and and

Recommendations Recommendations

March 2008

RecommendationRecommendationLeadership Networks to conduct risk Leadership Networks to conduct risk assessmentsassessments vulnerability to future budget cutsvulnerability to future budget cuts strategies to mitigate riskstrategies to mitigate risk assure that all existing sources of revenueassure that all existing sources of revenue are maximized are maximized create contingency plans in event of future create contingency plans in event of future revenue loss revenue loss

ConclusionConclusionFunding for Health and Human Services is Funding for Health and Human Services is

at both short- and long-term risk at both short- and long-term risk

RecommendationRecommendation Analyze Fiscal And Clinical Effectiveness of Analyze Fiscal And Clinical Effectiveness of

New ModelsNew Models

ConclusionConclusionComplicated Funding Mechanisms Serve To Complicated Funding Mechanisms Serve To Hinder Coordinated And Integrated Service Hinder Coordinated And Integrated Service

DeliveryDelivery

RecommendationRecommendation Implement selected strategies identified by Implement selected strategies identified by the court. the court. Formulate strategy to reduce number of Formulate strategy to reduce number of mentally ill individuals in correctional system. mentally ill individuals in correctional system.

ConclusionConclusionCorrectional system functions as “de-facto Correctional system functions as “de-facto mental institutions” (Supreme Court for the mental institutions” (Supreme Court for the

State of Florida, 2007)State of Florida, 2007)

RecommendationRecommendationDevelop a process for collecting financial Develop a process for collecting financial

information across systems for accurate and information across systems for accurate and current informationcurrent information

ConclusionConclusionNo single system for collecting “real time” No single system for collecting “real time”

information on the fundinginformation on the funding

OPPORTUNITIESOPPORTUNITIESRISKSRISKS

Thank You!Thank You!The HHSCC gratefully acknowledges the

members of the HHSCC Administrative Forum, the Pinellas County charitable health and human services

agencies, funders and hospitals for their data contributions to this study.

To learn more about the HHSCC and/or download a complete copy of the report go to:

www.hhscc-pinellas.org