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Agency of Human Services, Agency of Human Services, Agency of Human Services, Agency of Human Services, Secretary’s OfficeSecretary’s OfficeSecretary’s OfficeSecretary’s OfficeFY 2019 Governor’s Recommend BudgetFY 2019 Governor’s Recommend BudgetFY 2019 Governor’s Recommend BudgetFY 2019 Governor’s Recommend Budget
MISSION: AHS strives to improve the health and well-being
of Vermonters today and tomorrow and to protect those
among us who are unable to protect themselves.
FY 2019 SUMMARY & HIGHLIGHTS
• 0.6% increase in General Fund budget;
• 102 Exempt, 3450 Classified positions;
• Given limited resources, tough decisions
were necessary to develop this budget;
• Funds Caseload & Utilization pressures AHS-
wide including Medicaid, DS, nursing homes,
FSD and DOC out-of-state;
• Funds Initiatives AHS-wide including
Prevention, Forensics Unit, Street Outreach
& Family Services;
• Makes a variety of adjustments across AHS
including administrative and programmatic
reductions;
GF,
$677.0,
27%SF, $94.3,
4%
Tobacco,
$22.3, 1%
SHCRF,
$287.6,
11%IDT,
$40.6, 2%
Ptrust,
$0.0, 0%
ISF, $2.0,
0%
FF,
$1,366.5,
55%
Governor's Recommend
Budget - $2.5B
FY 2019 ($ millions)
Note: Removes GC double count.
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AAAA HHHH SSSS FFFF YYYY 2222 0000 1111 9999 BBBB UUUU DDDD GGGG EEEE TTTT
AHS – FY2019 Budget Picture
$672.8M FY2018 General Fund
+ $9.7M
+ $35.0M
$717.6M
- $672.8M
$44.8M
- $8.6M
$36.2M
- $32.0M
+$4.2M
Medicaid Revenue Shortfall
Includes 5% assumed average
budget growth and priorities
Need to reduce for level fund to FY2018
Improving FMAP due to Vermont’s economy
Proposed FY2019 Budget increase over FY2018
Identified downs in FY2019
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AAAA HHHH SSSS FFFF YYYY 2222 0000 1111 9999 BBBB UUUU DDDD GGGG EEEE TTTT
AHS - FY19 Budget by Department
Secretary's
Office
2%
Secretary's
Office - GC
40%
DVHA
11%
VDH
2%
DMH
1%
DCF
19%
DAIL
4%
DOC
21%
GF ($ millions) - $677M
3
Secretary's
Office
2%
DVHA
48%
VDH
6%
DMH
10%
DCF
16%
DAIL
12%
DOC
6%
All funds ($ millions) - $2.5B
All funds – removes
GC double count
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AAAA HHHH SSSS FFFF YYYY 2222 0000 1111 9999 BBBB UUUU DDDD GGGG EEEE TTTT
AHS – Positions by Department – 3,552Secretary's
Office, 81
DVHA, 371
VDH, 516
DMH, 269
DCF, 1006
DAIL, 283
DOC, 1026
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Vermonters Served by Department:Vermonters Served by Department:Vermonters Served by Department:Vermonters Served by Department:
• DCF – 155,000
• DOC – 9,626 in the community and 1,784 in the facilities
• DAIL – 92,064
• DMH – 24,600
• DVHA – 206,955
• VDH – all Vermonters
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AHS General Fund Budget
$459
$431
$477$533
$578$601
$615$668
$674
$673
$677
$0
$100
$200
$300
$400
$500
$600
$700
$800
FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18* FY19**
Total GF ($ Millions)
Total GF ($ Millions)
Backfill of
ARRA funds,
FY12
ACA
Implementation
Challenges
5
Enhanced
ARRA FMAP,
FY10 – FY11
Source: AHS Ups & Downs documents thru BAA. * FY18 amount reflects FY18 As Passed Post-
rescission & management savings.
**FY19 amount reflects current proposed AHS budget.
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AHS All Funds (Excluding GC) Budget
$1,739
$1,874
$1,961
$1,989$2,100
$2,216$2,332
$2,486
$2,507
$2,490
$2,490
$0
$500
$1,000
$1,500
$2,000
$2,500
FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18* FY19**
Total All Funds ($ Millions)
Total All Funds ($ Millions)
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Source: AHS Ups & Downs documents thru BAA. * FY18 amount reflects FY18 Gov. Rec BAA.
**FY19 amount reflects current proposed AHS budget.
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AAAA HHHH SSSS FFFF YYYY 2222 0000 1111 9999 BBBB UUUU DDDD GGGG EEEE TTTT
Ho
use
ho
ld In
com
e (Fa
mily o
f 4)
Pe
rce
nta
ge o
f Fe
de
ral
Po
vert
y Le
vel
$0.00
$10,000.00
$20,000.00
$30,000.00
$40,000.00
$50,000.00
$60,000.00
$70,000.00
$80,000.00
$90,000.00
0%
50%
100%
150%
200%
250%
300%
350%
400%
Programs
Eligibility for Programs as Percentage of FPL and
Income Threshold
$72,900.00
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Medicaid (& Medicaid-Related) Spending
$1,138
$1,189
$1,231
$1,286
$1,415
$1,491 $1,558$1,612
$1,617
$1,650
$1,666
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
$1,800
FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19
Total Medicaid & Medicaid Related Expenses ($ Millions)
$ Millions
Includes Global Commitment, State Only Programs, DSH, Clawback and SCHIP.
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AHS Funding for Designated Agencies and Specialized Services Agencies
$199
$237$253 $267
$273 $279$289
$315$338
$359$371
$387$407
$414
$0
$50
$100
$150
$200
$250
$300
$350
$400
$450
$500
FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18* FY19**
All funds ($ Millions)
DAs and SSAs
FY19 includes new funding for the following:
1 - $6.4M Gross at DAIL for DS caseload
2 – $300K Gross at DAIL for sick leave
3 - $606K GF at DMH for Street outreach &
HUD funding
Data Source: E-fins and AHS ups & downs. * FY18 amount reflects FY18 Gov. Rec BAA.
**FY19 amount reflects current proposed AHS budget.9
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Medicaid - Global Commitment – Balance Sheet
$25
$62
$87$87
$87
$29
$48
$87$82
$80
$0$0
$10
$20
$30
$40
$50
$60
$70
$80
$90
$100
FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19
Total GC Fund Balance($ Millions)
Total GC Fund ($ Millions)
FY18 and FY19 reflect projected end balances. In the FY19 budget, the balance of the
GC fund is transferred to the human services caseload reserve.10
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Non-budgeted Revenue Balance
$7
$13$14
$18
$35
$32
$47
$60
$61
$61 $51
$23
$16
$0
$10
$20
$30
$40
$50
$60
$70
FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19
Total $ (Millions)
Total All Funds ($ Millions)
FY18 and FY19
reflect projected
end balances,
including the AHS
operating reserve
of $15M.
11 FY18 and FY19 reflect projected end balances
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Department of Corrections: Vermont Inmate Population
1217
2,681
0
500
1000
1500
2000
2500
3000
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
End-of-Fiscal Year
2,600
1722
From 2008 to 2016 the jail & prison population
decreased by 18 percent
All years are census counts
from June 30th at end of each
fiscal year.
Actual Inmate Population
2007 CSG Projection for 2018
878 less than
projected
2007 CSG Projection for 2016
Projected Inmate Population
CY2006: Annual Average Population reaches 2,187, prior
to 2007 Council of State Government study. The CSG
projects an increase of 26 percent from 2008 to 2018,
based on the trend at that time.
2007: Justice
Reinvestment Act
signed into law
2011: War on
Recidivism Act
signed into law
From 1997 to 2008, the jail & prison population increased by
86 percent
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AHS Budget Highlights: Initiatives
• Invests $500,000 $500,000 $500,000 $500,000 in General funds for Prevention
• Universal Home Visiting
• School based dental health sealant program
• Invests $1.5M$1.5M$1.5M$1.5M in General funds for Forensics Unit operating costs in SFY
2019 at Northwest State Correctional Facility
• Funding for approximately three months of operating costs during SFY 2019 after the
completion of capital improvements to prepare the intermediate facility
• Provides $400,000$400,000$400,000$400,000 in General funds for Street Outreach Workers
• Provides $500,000 $500,000 $500,000 $500,000 in General funds for DCF Family Services to support
increased parent child contact
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AHS Budget Highlights: AHS-wide Proposals
• $2M GF in grant/contract savings – over the next three months, AHS will conduct a systematic review of grants and contracts and identify areas for savings.
• Global Commitment investment phasedown:• Continues HIT investment phase down - DVHA
• Starts to phasedown Room & Board investments – DMH & DCF
• Starts to phasedown UVM Physician Training investment
• Positions Transfers:• Agency of Digital Services (AHS-wide to ADS)
• Medicaid Policy (AHS to DVHA)
• Integrated Family Services (AHS to DMH)
• AHS General Counsel (AHS to DVHA)14
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FY19 Budget - AHS Secretary’s Office
UPS ($836K GF):UPS ($836K GF):UPS ($836K GF):UPS ($836K GF):
• Salary & Fringe
• Vacancy Savings Adjustment
• Prevention Initiatives
DOWNS ($2.4M GF):DOWNS ($2.4M GF):DOWNS ($2.4M GF):DOWNS ($2.4M GF):
• AHS-wide Contract/Grant reduction
• Eliminate VISTA Volunteers
• Reduce Vermont Legal Aid Contract by 15%
• Lease Savings
• Single Audit
• Reduce Direct Service Dollars
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FY19 Budget - AHS Secretary’s Office Global Commitment
UPS ($15.3M GF):UPS ($15.3M GF):UPS ($15.3M GF):UPS ($15.3M GF):
• New Adult Caseload & Utilization Pressure
• Loss of Tobacco Revenue
• CHIP Qualifying Claims Shortfall
• SHCRF Revenue
• Loss of Dept of Finance Regulation Revenue
• HIT Fund Rebase
• VHC Alignment
DOWNS ($10.4M GF):DOWNS ($10.4M GF):DOWNS ($10.4M GF):DOWNS ($10.4M GF):
• Change in Base FMAP• FY18 – 53.72%
• FY19 – 53.79%
• Change in base enhanced FMAP for childless new adults
• FY18 – 88.37%
• FY19 – 91.48%
• Increase GF Carryforward
• Remove VVH Investment
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FY19 Budget - DVHAUPS ($6.8M GF):UPS ($6.8M GF):UPS ($6.8M GF):UPS ($6.8M GF):
• Salary & Fringe
• Increase in M&O Contracts – MMIS, PBM
• Align Vermont Health Connect funding
• Delivery System Reform (DSR) Investment
• Updated Medicaid Consensus
• Dartmouth Hitchcock Rate Increase
• Clawback Rate Increase
DOWNS ($14.1M GF):DOWNS ($14.1M GF):DOWNS ($14.1M GF):DOWNS ($14.1M GF):
• Delay Hiring Actions
• Realignment of Care Coordination
• Swap in match on OAPD Contracts
• Right sizes contracts for Design, Development & Implementation (DDI) for IT
• End Premium Processing Contract
• Eliminate Cost Sharing Reductions
• Eliminate Primary Care Case Mgmt (PCCM) Fee
• Durable Medical Equipment (DME) Rate Adjustment
• Increase COB & PI Activities
• DSH Reduction
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FY19 Budget - VDH
UPS ($711K GF):UPS ($711K GF):UPS ($711K GF):UPS ($711K GF):
• Salary & Fringe
DOWNS ($932K GF):DOWNS ($932K GF):DOWNS ($932K GF):DOWNS ($932K GF):
• Eliminate Health Professional Loan Repayment Program
• WIC Program Savings
• Epi/Lab/Stats Savings
• Other Savings VDH-wide
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FY19 Budget - DMH
UPS ($3.3M GF):UPS ($3.3M GF):UPS ($3.3M GF):UPS ($3.3M GF):
• Salary & Fringe
• Forensics Unit
• Street Outreach
• VPCH Operating
• Hill House Emergency Bed Funding
• PNMI Rate Increase & Extraordinary Relief
• HUD Funding
• Room & Board Investment Phasedown
DOWNS ($70K GF):DOWNS ($70K GF):DOWNS ($70K GF):DOWNS ($70K GF):
• Lease Savings
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FY19 Budget - DCF
UPS ($5.2M GF):UPS ($5.2M GF):UPS ($5.2M GF):UPS ($5.2M GF):
• Salary & Fringe – including Class RFRs
• Room & Board Investment Phasedown
• Family Services Initiative
• Sub adopt caseload & CPC
• PNMI Rate Increase
• Federal & Special Fund Adjustments
• Reach Up Caseload Correction
DOWNS ($6.3M GF):DOWNS ($6.3M GF):DOWNS ($6.3M GF):DOWNS ($6.3M GF):
• ESD Management Reorg
• Federal & Special Fund Adjustments
• LIHEAP State Median Income
• Sub care Caseload & CPC
• Early Intervention Evaluation & Treatment Overbudgeting
• Child Care Transportation Contracts
• Reach Up Caseload Savings
• Reach Up Grant Reductions
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FY19 Budget - DAIL
UPS ($9.1M GF):UPS ($9.1M GF):UPS ($9.1M GF):UPS ($9.1M GF):
• Salary & Fringe
• Nursing Home Inflationary Increase
• Home & Community Base Caseload Increase
• VT Veterans’ Home Rate Increase -UPL
• DS Caseload
• TBI Caseload
• Sick Leave Legislation
DOWNS: ($4.0M GF)DOWNS: ($4.0M GF)DOWNS: ($4.0M GF)DOWNS: ($4.0M GF)
• Reduces current DS waivers.
• Eliminates Attendant Services General Fund program
• Nursing Home Bed Day Utilization
• Other operating expense reductions
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FY19 Budget - DOC
UPS ($3.5M GF):UPS ($3.5M GF):UPS ($3.5M GF):UPS ($3.5M GF):
• Salary & Fringe
• Parole Board Position
• Out-of-State Caseload
DOWNS ($2.2M GF):DOWNS ($2.2M GF):DOWNS ($2.2M GF):DOWNS ($2.2M GF):
• Contract & Grant Reductions
• Increase Vacancy Savings
• Reduce Education Positions (2)
• Removes Remaining Base SESCF Funding
• Other Operating Reductions
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