governor's recommend budget -$2 · agency of human services, secretary’s office fy 2019...

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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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


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


AHS – Positions by Department – 3,552Secretary's

Office, 81

DVHA, 371

VDH, 516

DMH, 269

DCF, 1006

DAIL, 283

DOC, 1026

4

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


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.


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)


6

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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$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


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.

8


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


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


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)


FY18 and FY19

reflect projected

end balances,

including the AHS

operating reserve

of $15M.

11 FY18 and FY19 reflect projected end balances

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

12


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

13


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

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

15

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


• 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

16

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


• 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

17

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

18

FY19 Budget - DMH


• 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

19

FY19 Budget - DCF


• 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


• 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

20

FY19 Budget - DAIL


• 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

21

FY19 Budget - DOC


• Salary & Fringe

• Parole Board Position

• Out-of-State Caseload


• Contract & Grant Reductions

• Increase Vacancy Savings

• Reduce Education Positions (2)

• Removes Remaining Base SESCF Funding

• Other Operating Reductions

22

governor's recommend budget -$2 · agency of human services, secretary’s office fy 2019...

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