NSC Nonprofit Budget Forum 2011

The following presentation was made at theThe following presentation was made at the

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An annual An annual convening of convening of the:the:

MissouriMissouriBudgetBudgetUpdateUpdate

February 2011February 2011

Missouri Division of Budget and Planning

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MISSOURI BUDGET UPDATEMISSOURI BUDGET UPDATEFebruary 2011February 2011

Economic Data.

State revenue update.

State spending update.

What’s ahead for FY 2012.

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Personal Income growth dropped off sharply in 2009, but slow growth has returned.

Salaries and wages declined every quarter of 2009. The decline abated in 2010, and a slow recovery has started

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Total $6,774.3

FY 2010 NET GENERAL REVENUE COLLECTIONS($ in millions)

NET GENERAL REVENUE COLLECTIONSNET GENERAL REVENUE COLLECTIONS($s in millions)($s in millions)

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FEDERAL STABILIZATION FUNDS($s in millions)

FY 09 FY 10 FY 11 FY 12 TotalResources

Enhanced FMAP $432.1 $702.8 $605.8 $0.0 $1,740.7

Education $0.0 $753.2 $0.0 $0.0 $753.2

General Purpose $0.0 $167.6 $0.0 $0.0 $167.6

Education Jobs $0.0 $0.0 $189.7 $0.0 $189.7 Total $432.1 $1,623.6 $795.5 $0.0 $2,851.2

Estimated Expenditures

Enhanced FMAP $255.8 $611.7 $595.9 $277.3 $1,740.7

Education $0.0 $530.0 $158.3 $64.9 $753.2

General Purpose $0.0 $88.5 $79.1 $0.0 $167.6

Education Jobs $0.0 $0.0 $189.7 $0.0 $189.7

Total $255.8 $1,230.2 $1,023.0 $342.2 $2,851.2 8

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All Other$96112%

Higher Education$86311%

Judiciary, Elected Officials, &General Assembly

$2754%

Elementary & Secondary Education

$2,83436%

Corrections & Public Safety$6348%

Human Services$2,28929%

Total $7,856

FY 2011 General Revenue Available SpendingIncludes Federal Stabilization Funds ($ in millions)

FY 2009-2012 OPERATING BUDGET FY 2009-2012 OPERATING BUDGET ($s in millions)($s in millions)

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FY 2009 FY 2010 FY 2011 FY 2011 FY 2012Expenditures Expenditures Budgeted* Available* Gov Rec

Total Operating BudgetGeneral Revenue $ 8,380.1 $ 7,530.3 $ 7,939.2 $ 7,633.1 7,904.7Federal Funds 6,264.9 6,818.0 7,341.8 7,341.8 7,449.6Federal Stabilization 0.0 811.4 288.5 222.6 64.9Other Funds 7,465.2 7,458.9 8,134.3 8,122.8 7,674.4 Total $ 22,110.1 $ 22,618.6 $ 23,703.8 $ 23,320.3 23,093.6

* Includes Supplemental Recommendations

FY 2012 BUDGETFY 2012 BUDGETWHAT’S AHEAD?WHAT’S AHEAD?

Phase out of Federal Stabilization Funds -- $680 million reduction.

Increasing revenue (4%), but increasing health care costs.

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FY 2012 BUDGETFY 2012 BUDGETHOW DO WE MAKE IT WORK?HOW DO WE MAKE IT WORK?

Saved some federal stabilization dollars for FY 2012.

More focused use of tax credits.

Improved collections of existing taxes.

- Improving enforcement – legislative and reallocating resources.

Reduced spending.

More people working in good jobs!

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Missouri Missouri Department of Health Department of Health

& Senior Services& Senior Services

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Margaret DonnellyDirector

Department ResponsibilitiesDepartment Responsibilities Improving the public health, safety, and well being of all Missourians. Preparing for and responding to health-related emergencies. Providing in-home and community-based programs for Missouri’s seniors and

adults with disabilities allowing them to remain in their homes and communities.

Preventing and controlling communicable and genetic diseases. Preventing and reducing the burden of chronic disease. Protecting Missourians through regulation and inspection of facilities, including

hospitals, nursing homes, and child and adult day care programs. Promoting health equity through education and outreach, and enhancing

awareness of inequities in the health care delivery system. Participating in efforts to create a system that provides all Missourians with

access to health care. Protecting Missouri seniors and adults with disabilities through the

investigation of hotline reports alleging abuse, neglect, or financial exploitation.

Protecting Missourians through background screenings of those who care for children, seniors, and persons with disabilities.

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DHSS Budget FactsDHSS Budget Facts 70.7% of all DHSS funding comes from federal funds—Medicaid, Maternal Child and

Health, Women, Infants and Children (WIC), etc. Only 27.4% of DHSS funding comes from General Revenue. Approximately 87% of all DHSS General Revenue funding is used as match for DHSS

services, so most General Revenue cuts result in the loss of federal funds. Federal funding received by DHSS is designated for specific, programmatic purposes,

so General Revenue reductions cannot be covered through use of federal funds. Of DHSS’ General Revenue funding, 78.4% is for the Medicaid Home and Community

Based program.

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Increased Demand for DHSS ServicesIncreased Demand for DHSS Services DHSS operates a toll-free number for reporting allegations of abuse/neglect/exploitation of

seniors and persons with disabilities. Each report must be investigated by DHSS staff. The number of hotline reports has increased from 16,815 to 26,069 since FY 2006, a 55 percent increase.

DHSS administers the Family Care Safety Registry to protect children, the elderly, and persons with disabilities by providing background information on potential caregivers. Family Care Safety Registry background screenings increased from 184,890 in FY 2006 to 277,557 in FY 2010, a 50 percent increase.

DHSS provides technical assistance/consultation to local public health agencies and/or healthcare providers on the control and prevention of communicable diseases.  The number of requests received increased from 25,852 to 32,111, a 24 percent increase from CY 2008 to CY 2009.

DHSS is required to be notified and must inspect all lead abatement projects in Missouri.  The number of lead abatement inspections increased from 424 to 694, a 64 percent increase from CY 2008 to CY 2009.

DHSS is required by statute to track reportable cases of disease including Hepatitis B, C and E, sexually transmitted diseases, and tuberculosis.  The number of reportable disease cases received increased from 43,390 to 46,776, an 8 percent increase from CY 2008 to CY 2009.

DHSS inspectors investigate complaints to ensure standards of care and treatment are being met. Health services complaints regarding hospitals, ambulatory surgical centers, labs, etc., increased from 404 in FY 2006 to 798 in FY 2010, a 98 percent increase.

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Summary of ARRA Grants AwardedSummary of ARRA Grants AwardedGrant-Program Name Amount

WIC- Information Technology Systems Upgrade $1,630,769

WIC- Electronic Benefits $300,000

Immunizations $1,816,289

Healthcare Associated Infections $203,730

State Primary Care Office Initiative $51,310

State Loan Repayment Program $300,000

Senior Citizens- Congregate Meals $1,284,714

Senior Citizens- Home Delivered Meals $632,475

Senior Community Service Employment $586,706

Ambulatory Surgical Centers Healthcare- Associated Infection Prevention Initiative

$239.103

Child Care Development Block Grant $3,813,778

Communities Putting Prevention to Work- Tobacco $1,015,150

Communities Putting Prevention to Work- Policy and Environmental $891,160

Chronic Disease Self Management $632, 864

ARRA BRFSS Supplemental-Component IV $225,004

TANF Summer Food $960,000

Total ARRA Grants Awarded $14,583,052

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Affordable Care Act GrantsAffordable Care Act Grants

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Grant Amount

Early Childhood Home Visiting Grant $1.5 million

Teen Pregnancy Prevention $2 million (approx)

Public Health Infrastructure $300,000

Money Follows the Person $400,000

BRIAN KINKADEDEPARTMENT DEPUTY DIRECTOR

photos ©JUPITERIMAGES 2009

FEBRUARY 11, 2011

PROGRAMS & PROGRAMS & FUNCTIONSFUNCTIONS

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Family Support Division•Income Assistance Programs•Medicaid Eligibility•Child Support•Rehabilitative Services for the Blind

Division of Youth Services•Rehabilitative Treatment for Juvenile Offenders

Children’s Division•Child Abuse Investigation•Child Protective Services•Subsidized Child Care•Early Childhood

MO HealthNet Division•Medicaid•MORx

Financial and Legal Support Services•Tax Credit Administration•MO-HITECH

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BUDGET SUMMARYBUDGET SUMMARY

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SFY-12 GOVERNOR’S SFY-12 GOVERNOR’S RECOMMENDATIONSRECOMMENDATIONS

SFY-12 GOVERNOR’S SFY-12 GOVERNOR’S RECOMMENDATIONSRECOMMENDATIONS

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(in millions)

FTEGeneral Revenue Federal Other Total

Major IncreasesMedicaid Supplemental and Caseload $180.5 $180.7 $12.9 $374.1

Medicaid Rate Adjustments $44.7 $94.5 $8.8 $148.0

HITECH Act Incentive Grants $60.0 $60.0

Mental Health - Health Care Home Model $9.0 $9.0

Child Welfare Supplemental and Caseload Growth $3.3 $3.6 $6.9

Foster Care Tuition Waivers $0.1 $0.1

Medicaid Audit Staff Expansion 36.0 $0.3 $0.7 $0.4 $1.5

DYS Education $1.1 $1.1

Major DecreasesCut Current Year Restrictions (70.0) ($12.3) ($8.6) ($0.1) ($21.0)

Medicaid Cost Containments ($38.6) ($27.8) ($6.7) ($73.0)

One Time MMIS Modernization Costs ($10.6) ($1.2) ($11.8)

Restructuring Business Operations (252.5) ($0.3) ($0.3)

Administrative Staffing Cuts (37.0) ($1.0) ($0.2) ($1.2)

DYS Restructure Facility Maintenance (38.5) ($1.6) ($1.6)

DYS Bed Conversion (2.0) ($0.1) ($0.1)

326 South 21326 South 21stst Street, Suite 301 Street, Suite 301St. Louis, MO 63103St. Louis, MO 63103

314.436.9580 phone | 866.433.9580 toll free314.436.9580 phone | 866.433.9580 toll freewww.nonprofitservices.orgwww.nonprofitservices.org

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