The price of dirt, Part 5 -- the Medical Assistance Program, Auditor/Controller Report, and budget passage
Item 22: Health, Reconvening the Beilenson Hearing of Medical Assistance Program
Chairwoman Deidre Kelsey: We will reconvene the Beilenson hearing and I’ll have Mr. Volanti get us back on track.
Merced County Director of Public Health John Volanti told the board that when the program was reviewed staff recommended reducing services by $103,000. Those services would include optometry, podiatry, dental, audiology and speech therapy, and they would match the cuts in Medical optional services, which took place in July of this year. We also recommended limiting eligibility for Medical Assistance Program (MAP) to 100 percent of federal poverty level for a savings of $300,000 and that affected approximately 400 clients annually, and there was also a request to eliminate retroactive coverage in the emergency room, which would impact 280 people, for a savings of $42,000.
Kelsey: Retroactive in the emergency room? That means that after they’ve been seen and ... what do they have, 30 days to apply or something?
Volanti: The way it works now is if someone is not on MAP, but is eligible for MAP and happens to be in the emergency room, they are currently retro-covered to the point when the entered the emergency room. We would no longer do that. Under normal circumstances, either SCIAP or EMSA dollars would cover those physician services, but those programs have been cut this year, so it’s just that we will cover when they actually apply for MAP.
Kelsey: Any questions or comments from the board for Mr. Volanti at this point? … And your suggested action is the same as it was last time, two weeks ago?
Volanti: Right. So, those three items.
The tones of both their voices is one of defeat – the public health director cannot provide health services to the most needy in the county and the chairwoman of the board of supervisors can’t find the money, unless, perhaps, the county could dip into the rainy day fund, but that is off the table.
Kelsey opens the hearing for public comment. If you’d like to come to the podium, state your name and address and limit your testimony to five minutes, that would be good.
Clara Bareto, Merced: (she can’t take her hands off her glasses): I was a former MAP, before, and I was let go because I didn’t meet the 200 percent. I’m self-employed – housekeeper and caregiver. Now I feel bad because I’m the hospital’s problem now if I have to go. So my message is that knowing that our leaders – you leaders here – are unwilling … being God’s servants and all, so I pray for you all the time, because I know this is really hard. So the message is from the Central Valley … for Justice, Merced, I oppose to support this action and to not cut the MAP program because I feel it will cut – because it will cost us more if we get disabled or we lose our jobs. And, if there is any possible way to be able to have the supervisors dip in like everyone has been asking – across – I thank you.
Kelsey: Thank you.
Man in a wheelchair. Gets out of wheelchair at podium. Hi, my name is Jeff Martinez, Merced. I’m currently on MAP and this is a bag of all my prescriptions (holds up a plastic shopping bag half full of pill containers). My meter is in there. In the morning I start out by taking 10 pills, one inhaler, and foot cream. I think MAP is important to keep, because on May 5, I had my foot amputated and luckily I was on MAP and I would hate to think if someone else was without MAP and they had a major surgery such as mine that they wouldn’t have been retroactively covered. I mean that’s just pretty horrible. As a matter of fact, MAP is not covering my prosthetic. We’re trying to go to MediCal but MediCal is sitting on it, too. In the meantime, I’m pretty much in the chair. I just came to say that it is needed. I know that there is a lot of problems – everybody has a problem – my home was foreclosed upon, we had to move, and that happened this year as well. Everybody’s going through the same problems and money is really tight. I just showed up just to say that MAP is needed (hand over his heart), and if I hadn’t of had MAP, I don’t know where I would be now because of my diabetes and there was a foot infection, so, at the time, MAP really came through for me. Thanks for your time.
Gloria Sandoval: From here in Merced. I would just like to mention once again that our country right now is going through the debate and discussion about health care and I would like to request that the board of supervisors from Merced County take a stand to support single-payer, universal health care. This will bring savings to employers. It will bring savings to the County, and it will leave no one without medical care and I really think that that is the solution we need and you wouldn’t have to feel bad about people not having health care. Besides that, we’re already paying for that health care but we are not getting it. I hope that if some of you have not checked out HR 676 that you will do that. That is the best that we can have in Merced County and I hope that you will give a resolution to support that. This is connected to MAP, because I would not like to see people without health care, period. Thank you.
Bill Hatch, Merced: I was unclear about the total number of people that will be affected by this and I was unclear from what Mr. Volanti said, what actually is going to happen to these people in the emergency room.
Kelsey: Before I close the public hearing I would like Mr. Volanti to answer those questions. I assume that’s the number of residents. (Hatch agrees from audience)
Volanti: Well, potential MAP is something else. Of the current MAP clients, the service impacts are this: for optometry, 290 clients would be impacted; for podiatry, 15 clients would be impacted; for dental services, 475 clients would be impacted; and for speech therapy and audiology, no current clients would be impacted. No services had been requested in the 12 months for either of these services.
For the limiting of eligibility from 200 percent to 100 percent of federal poverty level, there would be approximately 400 clients that would be affected. (Hatch asks if there is overlap). Some of those are overlap, yes.
Kelsey: Now, stay there John. It looks like Mr. Nelson has a question and Mr. Pedrozo.
Nelson: No question, just a comment. I want to thank you, John, for the work you’ve done on this. I appreciate the information yesterday about prescription drugs. The example you gave us was interesting. It gave us a heavy prescription load yet by comparison shopping it could potentially save quite a bit of money on their prescriptions. And also, I want to point out, too, that we have the … drug card that is available to residents of Merced County and the United Way also have a prescription drug card as well.
Pedrozo: I, too, want to thank you, John, for briefing me numerous times so I could get a better understanding of the severity of this. And again, it’s another one of those nightmare things that we never thought in a million years was gunna affect us as bad as it has. But after meeting with you numerous times, I’m not happy with it but I can live with it knowing that – and this – what you did show us on your report or breakdown – that with the right guidance – which we could provide if someone needed to call – we could provide – to give them assistance in finding the price of their meds, medications, at a way lower level than one of my constituents has showed me. That’s first and foremost. So I felt better with this travesty if you want – of this whole mess – but I can’t thank you enough for breaking it down and I thank Mr. Brown also making it a little more clear for me – I mean it’s about as clear as mud but I mean I understand what’s going on here – so – and it’s unfortunate but it’s just the way it is – so, thank you.
Kelsey. OK. Mr. Walsh.
Walsh: Mr. Volanti. Thank you very much. I’ve got a couple of questions. In terms of the proposal, the effective date for this, since we have continued it, would be …
Volanti: September 1.
Walsh: And, in other discussions with providers, we are still at least pursuing and seeking possibility of movement of MAP discussions to the Alliance.
Volanti: We have broached the subject with the Alliance and actually we have – Mme. Chair and other members of the board, the Alliance is the Central California Alliance for Health, a MediCal-managed care program, which will begin operating MediCal in Merced County October 1. We actually had discussions with them before they even became the MediCal provider that this is something we would be interested in looking at. They have told us that both Monterey and Santa Cruz counties are also interested in having their indigent programs administered by the Alliance so there might be some way that we could something on a tri-county basis.
Kelsey: Right. I also got your memo, your little booklet of information on some of the options and some of the things regarding the pharmacy program. Is counseling of MAP patients on pharmaceuticals and where to buy them and proper generics for those prescriptions – is that something you already do?
Volanti: I think it’s done on a limited basis but the pharmacy services provided to MAP patients are part of the hospital contract. The hospital provides the MAP pharmacy and the MAP pharmacy program. There was a time – and maybe Mr. McLaughlin (representing the hospital) could answer this – but there was a time when the hospital actually enrolled all the MAP patients in the various programs that the various pharmaceutical companies have so that they could get really reduced meds. But the hospital does also get medications at a reduced price through the 314 D program. But, in terms of individual counseling, no more than the law requires, which is to counsel patients on new …
Kelsey: But, if we were to refer someone to the Public Health Department …
Volanti: Absolutely.
Kelsey: If there are questions about their medications, you could do that.
Volanti: Yes, we could do that. But, if you’re asking if we could do that on a regular basis that would be a new program that I would like to come back and talk to you about. But, certainly for the 400 MAP clients that are affected by this proposed reduction, we would be very happy to work with them and do similar kinds of finding for them so that their medication cost could be reduced.
Kelsey: Well, I know that there is a trick to the whole thing. Does the HI-CAP or anyone else do that?
Volanti: HI-CAP does do that for seniors and those under Medicare.
Kelsey: OK. OK. All right. I think that somehow that information needs to be made available if you are a senior that this is available. And MediCal, where do they go? Do they get …it’s just reimbursed, right?
Volanti: Yes.
Kelsey: OK. It’s important to me that people know that they can get medications at a reasonable price. There’s no sense – if you can get the medication cheaper that you shouldn’t be able to.
Volanti: With a little guidance – in the example that was provided, the – you can request the doctor to change the medication from one within that class to another and WalMart will make it a $4 drug and change it from an $80 or $100 drug. And it does take a little guidance, so …
Kelsey: Right. And somebody needs to ask the question…With that, I will close the Beilenson hearing and we will consider what to do with this item. Mr. O’Banion.
Supervisor Jerry O’Banion: I would move to approve the recommendations as presented in the staff report and take all actions that are recommended.
Kelsey: Is there a second? … All right, we have a motion and a second to approve the recommended actions. Any further discussion? Mr. Walsh.
Walsh: Would the maker of the motion – I mean I’m not opposed to those recommendations but – also include in there at least a request an update on the option for exploring the medicine education and counseling option? You know, an option for a more educational – because when I was sitting there going through that – you were showing us that scenario where there’s information – and I think I am a – I don’t say the best consumer of medicine but I am somewhat informed and I was surprised by that. So, sort of educational – bring it back to us at least if there’s a possibility?
Kelsey: If I may, I would wonder if we couldn’t do that through our county public relations, you know if it’s something that could be put together in a brochure as an example of how that might work and have that brochure available, you know …
Walsh: I think we could brainstorm ideas. I was just wondering if we could include …
O’Banion: Maybe add it on to the brochure that Mike Nelson brought to us as far as the prescriptions from …
Kelsey: Right.
O’Banion: Maybe elaborate it and have more of a folder than just the one program, maybe add the two programs we have currently but I don’t think it’s necessary – I mean I think it’s a good idea but I don’t know if it necessarily needs to be a part of the action …
Walsh: OK, then.
Kelsey: OK. All right. Mr. Walsh, did you have anything else? Mr. O’Banion, are you finished? All right, I’ll call for the question and all those in favor of the motion signify by saying Aye… Any opposition? So carried.
What do we have left? Ah, Ms. Cardella-Presto. You are one and I won’t even put the button on you so go ahead and take your time and tell us what we’re doing here.
Merced County Auditor/Controller Lisa Cardella-Presto: Mme. Chair and the board, this item before you is a request for adoption of the 2009-2010 budget schedules. These budget schedules display the components of fund balance, reserves, and changes in reserves for all general, special revenue, debt service and capital project funds. Following the accounting standards and procedures for counties, prescribed by the state Controller pursuant to the County Budget Act, our office compiled these schedules as outlined in the Government Code. I’d like to thank my staff in the Auditor/Controller office for their timely and professional work They have worked diligently through this process and are to be commended for a job well done, especially in light of a new department head. I had to say that for Hub. (This is evidently county humor beyond the understanding of ordinary citizens.)
I’ll give you some details so bear with me for just a moment. The general fund balance has decreased by $14.9 million as a result of expenses exceeding revenues by $12.4 million and changes in encumbrances and reserves, the net $2.5 million. Special revenue fund balance increased by $13.6 million, mainly due to changes in encumbrances over all in these funds, which includes roads, MAP, SCIAP, Affordable Housing, Sheriff Inmate Welfare, RDA, Spring Fair, Fish and Game, Child Support, First Five and Workforce Investment. Debt service fund balance decreased by $1.1 million due to debt service payments exceeding revenues. Capital projects fund balance increased due to a decreases in encumbrances of $7.4 million and expenses exceeding revenues by $1.9 million.
These schedules reflect the final recommendations brought before you today. We have worked closely with administration to analyze and estimate revenues in a time when the state is looking to raid our government to balance their budget.
I would like to just briefly reflect on some major influences that have affected the property tax revenue specifically this year. Changes in general fund property tax revenue between proposed budget and final budget can be attributed mainly to an overall decrease in the county’s assessed property values and state legislative actions. This last fiscal year brought with it a rapid decline in Merced County’s property values and this is reflected in an estimated 15-percent decrease in property tax revenue for ’09-’10. Also affected by property taxes is in lieu vehicle license fees, part of which is referred to as the ‘triple flip.’ This calculation, established by R&T Code, Section 97.7, requires that the controller calculate the percentage variance from year to year. This calculation for property tax in lieu decreased by $3 million. General fund items for these line items were appropriately reduced in these schedules to reflect changes from proposed to final budget.
On July 28, 2009, the governor signed into law AB 15, dealing with property tax revenue allocations. Part of this bill has been discussed today with regard to the securitization of the future repayment of what is being called the state Proposition 1A loan. Existing property tax requires the auditor to allocate property tax revenue among local jurisdictions. This includes counties, cities and special districts. I wanted to make you aware of the implications of this bill to our office. These property tax allocations are done in accordance with specified formulas and procedures and generally require that each jurisdiction be allocated an amount equal to the total amount of revenue allocated to that jurisdiction in the prior fiscal year as well as that jurisdiction’s portion of the annual tax increment, which is also referred to as growth. This new bill requires the auditor to reduce the amount of ad valorum property tax revenue apportionments to each local agency for the ’09-’10 fiscal year by 8 percent. Of the total amount of the property tax revenue apportioned to that agency in the ’08-’09 fiscal year. These funds are then to be transferred to a supplemental revenue augmentation fund. These funds will then be transferred to the County Office of Education and by them to the state Controller in amounts as directed by the Department of Finance. This is to reimburse the state for costs for providing various services in the county.
In addition to this, the auditor shall report to the Department of Finance, the Legislative Analyst’s Office, and each local agency located in the county, including cities and special districts, with information detailing how each local agency’s reduction amount was calculated. The amount calculated to loan to the state from Merced County is $4,998, 552.
These additional reporting requirements and calculation processes continue to increase and the demand for timely and accurate financial information in a time of fewer resources in a major concern of mine. Thank you for an opportunity to comment on these schedules.
Kelsey: Thank you. Any questions? Mr. O’Banion.
O’Banion: Mme. Chair. I would like to have a copy of those written comments if you please. And with that, I would move to approve the budget schedules … including the reserves and appropriations for encumbrances and carryover for the 2009-2010 budget year.
Kelsey: OK. Is there a second? OK. We have a motion and a second to approve the budget schedules … as well as the appropriation limit for the fiscal year 2009-2010.
Now, Mr. Walsh? OK. You had nothing else. Mr. Pedrozo? … If there is no further discussion, I’ll call for the question. All those in favor, please signify by saying Aye. Any opposition. So carried.
Then the supervisors considered Item 1, concerning population figures.
Kelsey: We have a motion and a second to approve the population statistics and the appropriations. …
It passed.
The last item was adoption of the budget for the 2009-2010 fiscal year.
Walsh: Two questions real quick. One, with regard to the library and our estimated dollars for this year, we’re estimating – and this is a question, Mme. Chair for Mr. Brown and Mr... …, we anticipated for the library redevelopment dollars from the city … the amount of the previous years or less? Or more … as a step up?
Merced County Librarian: I guess the nice thing about being last is that you are in a room full of friends. I think at budget time when we were conversing we decided to go with what was in the contract, with what was supposed to receive. Of course that was before the state budget came out and the governor is taking some RDA money. So …
Walsh: We have to revisit this at some date later if the dollars were realized to be less.
Kelsey: No one seems real interested in answering that question tonight, but I’m sure that we’ll bring it up.
Librarian: We’ll have to. I’ve already panicked.
Kelsey: Um hmm. OK.
Walsh: My final two recommendations or suggestions are – and I don’t know if this is the right place – is we had a lot of discussion today about budget reduction days and my suggestion would be we … by the example and the example would be that we forego 5 percent of our salaries starting effective whenever so as to set that example for budget reduction days. Just a thought.
O’Banion: A response to that thought. I don’t have any problem with the budget at this point but there are going to be some continued discussions as far as on furlough days and things like that and I am sure that we will share in the agony that everyone else shares in. So I would say that at that point is went we do, and not determining that we are going to take 5 percent, 10 percent, 20 percent – whatever we work with the rest of the employees of this county appropriately should be adjusted with us also. I have some other things after he’s through.
Walsh: This really is my last – that we consider because of the discussion today that we consider some adjustment to our special district funds beyond the 35 percent, simply in keeping with the discussion that folks had had about in these tough times might be to reduce it to a lower figure and/or might it simply be that those folks who have some kind of balance in theirs reduce theirs to a lower figure. I don’t know if this is a place to have that discussion or if that will be part of our future discussions.
Kelsey: All right. Thank you Mr. Walsh.
Walsh: Sorry.
O’Banion: When there’s no money, there’s no really big fighting and I think the case again – there were 15 … 18 action items were unanimously approved, there were two that were 4-1, and there was one that was actually kind of a fight and that was 3-2. Of course there was one that was 3-0 which I didn’t get a chance to participate in. I would just say that I respect the decision that you folks made while we were out. It wudn’t an easy decision. Probably I would have went along with that decision. I can’t tell you for sure. But, you know what, there was discussion about it and you came to some recommendation and consideration for the future. The only thing in regards to the hearings, the only thing I was offended by was the email that we received a copy of that basically said that we know that there are some supervisors that would like to use this as a stepping stone to destroy the Williamson Act. That’s terrible to send an email like that out publicly saying that this board, which excluding Hub, were on the board when the Williamson Act was enacted. And they think we’re trying to kill it.
Kelsey: The only ones on the board at that time I think were Jerry and I. Yeah. So, we’re the only ones left.
Walsh: I find it intriguing about that email. I didn’t get a copy of it. I haven’t seen it. (O’Banion gives him a copy). But being one of the folks that would be designated clearly up from that I was going to be able to address this because I didn’t have a conflict, I can tell you – No one talked to me about the Williamson Act in advance of our discussion.
O’Banion: Anyhow, there wasn’t a lot of fighting and arguing with regards to the budget. We’ve got an approved budget, I think, we’ll find out in a few minutes, and I would like to thank all the staff that have worked on the budget. It was probably one of the most difficult situations that we have had as far as budgets in the last 19 years. And it’s even tougher than it was back in the early 1990’s, I think. I mean when you affect people’s lives like we’ve had to affect them, it is not an easy decision to make. Hopefully, we can do some things to help improve the environment for those individuals who are still here and maybe bring some of the individuals back in the future.
Nelson: I also want to thank staff, especially those that are still here….don’t necessarily have to be. Good to see a friendly face out in the audience. I’ll just piggyback a little on Mr. O’Banion’s comments on that email. I agree with you. It isn’t right and it’s always amazing to me how some people will come before us asking us to vote their way in their favor and yet they insist on making derisive comments about certain board members.
Pedrozo: I want to thank all the staff that has worked on this. I know that this has been a challenging, challenging, challenging budget to do and I,I,I – this is probably one of the hardest things I’ve ever had to do. I think of the poor people that it’s affected and it’s beyond our control and I hate that when we can’t solve something because it just bugs the hell out of me. But, it’s affecting me too. My daughter’s lost her job. She had a signed contract, a teacher in Fresno. She lost her job. My brother had a job, he lost his job. So I know somewhat of what the pain is and I just hope and pray that somehow, someway this thing gets better because this is really taking effect on all of us and I want the people that make this county what it is – and that’s all our employees – to realize that we feel their pain and we are going to do all we all that we can to help them.
Kelsey: I just want to say that this is the worst meeting if not almost the worst meeting I’ve ever attended just because of the nature of what we had to do today and the questions that were before us and the pain that we knew we were going to be inflicting. It’s really sad that we’ve dismantled so many programs and dismantled, in my opinion, much of the safety net that we’ve been able to provide our county – especially during this critical time. I’m not a very happy camper and I’m hoping that things don’t get worse.
But, the other question is, how the heck to you ever put the whole thing back together? You know, you break it and it goes into a million pieces and how are you going to pick it all up? I don’t know but I do appreciate the work that the staff has put into this and their efforts in helping us make the hard choices and all the research and effort that’s gone into the budget. All the budget guys have done a good job.
Thank you. We will persevere and see what the new day brings.
It passes unanimously.
Kelsey. Oh, yeah, I forgot. Is there any more public comment? Is there anyone who wants to say anything else? … Seeing no one come forward, I will close the public comment and adjourn the meeting.