Commissioner Moran proposes ‘healthy exercise’ to determine programs that would have to be cut if only dedicated county health services revenue was used, without General Fund subsidy
After approximately 50 minutes of discussion, the Sarasota County Commission voted unanimously on June 7 to approve the projects that its Health Services Advisory Council (HSAC) recommended for funding in the 2023 fiscal year.
The total for those services is $4,175,324. Among the top recipients will be the Florida Center for Early Childhood — $698,675; the Boys & Girls Clubs of Sarasota and DeSoto Counties — $474,500; Children First, $416,789; First Step of Sarasota — $318,235; Safe Children Coalition — $265,471; All Faiths Food Bank — $204,405; and Senior Friendship Centers — $194,438.
However, at the request of Commissioner Michael Moran, the board members also asked Chuck Henry, director of the county’s Health and Human Services Department, to work with the members of the HSAC and county staff — as well as a new Behavioral Health Advisory Council and the Mental Health Assessment Task Force — to take what Moran and other commissioners called a “deep dive” into the county’s annual spending for health care services.
His goal, Moran explained, is to learn what recommendations would result if programs for which the county contracts could be paid for only with revenue generated by 0.1661 mills. That is the level specified in a county ordinance to cover all of the county health care services — including those related to mental health and substance abuse. (One mill represents $1 per $1,000 of property value. Thus, the owner of a home valued at $200,000 would pay $200 in property taxes.)
As Moran pointed out, the County Commission for years has supplemented that dedicated revenue with money from the county’s General Fund.
The General Fund is made up largely of the property tax revenue that the county receives each year. A 2020 county budget document points out that it “contains the operating expenditures that are County-wide in Nature.” For example, it pays for the Parks, Recreation and Natural Resources; Health and Human Services; Human Resources; and Communications departments.
Given the rise in property values this year, Henry told the commissioners on June 7 that he anticipated only about $460,000 more would be needed from the General Fund to make up the difference between the money from the dedicated millage and the health care allocations that have been approved for the 2023 fiscal year.
Vague priorities and overlapping services
At the outset of his June 7 remarks to the commissioners, Henry noted that the overlying priority for the HSAC members in making their recommendations was a board policy set in 2016 that called for a focus on Families on the Economic Edge.
Two sub-priorities added in 2020, Henry noted, are housing and aging services.
A memorandum that Henry provided to the commissioners in their June 7 agenda packet explained that the Families on the Economic Edge policy targets those families and individuals who earn less than 200% of the current Federal Poverty Level, which is $55,500 for a family of four.
The HSAC members, the memo indicated, review applications for funding and score them on the basis of how they serve that priority; supporting data is critical to that.
During the ensuing discussion, Moran was the first commissioner to address the HSAC recommendations. The priorities and sub-priorities are “really important, as you know,” he said, “but sometimes, in my opinion, way too vague.”
For example, Moran continued, what does “Preventing homelessness” mean as a priority? It could involve providing rent payments, mental health services and skills training, he added. “It’s just really broad.”
Then Moran referenced a spreadsheet he had compiled, copies of which he provided to his colleagues. “I took every program that we fund,” he explained, and identified it as an HSAC recommendation or a Core program.
“Core” refers to programs that the County Commission “considers essential to the quality of life in our community or which are required to be funding through a statutory obligation,” Henry pointed out in a 2018 memo to the board members.
Moran referred to the revenue generated by the 0.1661 mills each year as money “we have actually walled off …”
He added, “What might be a good exercise” is to have the HSAC and staff revise the HSAC recommendations to reflect spending only from that revenue.
Then he noted particular programs that won HSAC approval for the 2023 fiscal year that raised questions. For example, Moran said, county money goes to the Early Learning Coalition of Sarasota County. “You are paying for daycare,” he added. When he questioned staff members about that, he continued, he learned that “they hadn’t asked the [Sarasota County] School Board for money” for that expense.
Moran acknowledged that he understands some programs are funded because the county allocations makes those programs eligible for matching grants from the state and/or federal governments. Yet, he stressed, “If it’s not a priority [of the commission], I don’t care how much they’re matching it. … We shouldn’t be funding it.”
Commissioner Nancy Detert also questioned that funding from the county.
Henry responded that the commission traditionally has provided the matching funds that the Coalition needs.
Then Detert noted that county money also goes to Head Start and Early Head Start programs. Doesn’t the School Board get money that it can use for such initiatives, she asked.
“I don’t have the answer to that,” Henry replied.
“I just don’t see why Head Start is in a health budget,” Detert told him.
She could understand the inclusion of housing programs in the health care budget, she added. “We don’t want people on the streets.” However, she continued, money from the state and the federal governments go to local school districts for programs such as Head Start and universal pre-kindergarten initiatives.
Henry added that all of the programs the HSAC approved for funding in the 2023 fiscal year — which will begin on Oct. 1 — meet the criteria governed by the board priority to serve families.
Detert responded that she thinks the HSAC’s scoring system for funding allocations “probably needs to be reviewed, too. It just seems wrong, frankly,” she pointed out, for county health care money to be dedicated to some of the programs on the list.
Henry did note that early childhood programs enable “all children get off to a good start,” with the goal of helping them achieve lifelong success from both health and economic standpoints.
“They do become important in building the health of our community,” he said of those programs.
Then Commissioner Christian Ziegler told his colleagues and Henry, “What a lot of people don’t know about me” is that he lived in a household with a single mother. “I saw my dad every four or five years.”
His mother, Ziegler continued, “worked three jobs. … We were on government assistance. … I do realize the benefits of the government stepping in to help people become successful.”
What frustrated him, Ziegler indicated, was the fact that the commissioners were looking at increasing funding for some programs that appeared to fall under the School Board’s umbrella, for example, without hearing from that board. “I’m not sure if all of the … different players are really chatting and working together.”
Perhaps it would be better, Ziegler suggested, for the private sector to fund some of the programs, as it is easier for representatives of private agencies to collaborate with each other than for local government bodies to do so.
Henry did point out that all of the contracts with the service providers would have to come back to the commission for final approval. What was before them that day was just the list of HSAC recommendations, he noted.
“I think we should move forward today,” Commissioner Ron Cutsinger said. A “deep dive” into the issues brought up during the discussion could be handled later, he added.
Making tough decisions to live within the budget
“The HSAC process is actually fabulous,” Commissioner Moran pointed out. “It is very thorough.”
However, Moran continued, “What troubles me is that [the commission] has always done amazing things” in picking its priorities and making tough decisions about paying for them. Again, he voiced his concern that the priorities Henry mentioned early on were too broad. Then Moran added that addressing young people’s problems is his top priority.
Detert noted the emphasis on mental health and substance abuse services over the past couple of years. Given the continued school shootings in the nation and problems with homelessness, she continued, ensuring adequate mental health care resources is especially important.
She also voiced opposition to restricting the county’s health care funding allocations to the use of revenue generated by the 0.1661 mills, even though she acknowledged, “The property values pretty much go up automatically …” (See the related article in this issue.)
Detert proposed asking staff to track the funding for contracted mental health care and substance abuse services for the next couple of years “and see how we’re doing.”
Chair Alan Maio offered support for the exercise Moran had proposed — asking the HSAC, staff and the two advisory boards to take another look at the county’s health care spending on programs as though only the revenue from the 0.1661 mills would be available. “What if we ever hit a wall?” Maio asked. “What would be cut?”
“In the end,” Moran said, “it’s really a board policy decision on what we fund and what we don’t fund.”
He also pointed out that the board members decided last year to dedicate to the funding of mental health care and substance abuse services the revenue that one-tenth of a mill would generate; that money also would come out of the total provided by the 0.1661 mills.
Moran indicated that, after the funds for the mental health and substance abuse programs, and the allocations for CORE services, were added up, “Very little [would be] left over for HSAC.”
Henry concurred. “Something’s going to have to give” in the HSAC budget, if no General Fund subsidy were expected, he added.
Then Henry will let the commissioners know what programs the HSAC members, the two advisory boards and county staff would propose cutting, if just the revenue from the 0.1661 mills could be used for health care services, Moran said. “I want the exercise.” Nonetheless, Moran acknowledged, “It’s going to look like a hatchet through HSAC.”
“We don’t want people living in the streets,” Detert said. “We don’t want children starving. We want food banks.” The board’s goal, she continued, is “healthy residents and families.”
If the nation were in a depression, Detert pointed out, the board members would have to “spend hours and hours to cut line by line” in the health care services budgets. “You only do that in extremely painful times.”
Finally, Moran made the motion to approve the HSAC recommendations for the 2023 fiscal year, and Detert seconded the motion.
Moran indicated that Henry had sufficient direction from the discussion to undertake the funding exercise.