OPEA

After years of standstill budgets and increasing costs, the Health Department is struggling to provide critical services to Oklahoma citizens.  At the September Board of Health meeting, Chief Financial Officer Ray Hankins presented the serious funding situation and possible repercussions on the state’s health and safety.

As in several other state agencies, the reasons for the budget crisis are increases in costs including fuel, medical supplies, and employee benefits; limited state funding; reduced federal funding; and increased workload and demand for services.

Since 2005, the agency has received $5 million in additional funding from state appropriations.  The additional appropriations were earmarked for special programs and an employee pay raise.  In actual purchasing power, the agency’s state appropriations have decreased by $10 million.

Protective Health Concerns

Deputy Commissioner Hank Hartsell presented issues for Protective Health Services.  Since 2004, the agency has received an additional $250,000 for this important program.  When inflation is considered, funding for protective health has actually decreased by $75,000.  To make ends meet the division has not refilled vacant positions.

“Day to day, we are forced to stretch staff,” said Hartsell.  “Morale is low, employees are asked to do more with less.  Turnover is a challenge.  It takes a full year to train and certify staff.”

Since 2004, the workload for the division has increased dramatically.  Medicare providers that must be inspected have increased from 944 to 1,016.  Business inspected by consumer health services has risen from 33,394 to 41,314.    The workload has increased by 23 percent with fewer staff.

The funding crisis is having a direct affect on important public safety services.

• Assisted living centers are inspected once every two years (administrative rules require annual inspections);
• Residential care homes are inspected once every four years (law requires biennial inspections and visits three times per year)
• Adult day care visits are limited to complaints
  • “Immediate jeopardy” complaints are investigated within 48 hours
  • 75 percent of the complaints are held until the next survey

• In hospitals, surgery centers, home health, hospice and dialysis:
  • State license program is complaint driven;
  • Regular license renewal inspections are delayed;
  • Medicare/Medicaid surveys are at lowest priority;
  • Funding is not adequate to meet all priorities; and
  • Equipment and training expenditures are delayed.

In Consumer Health Services, the agency oversees the licenses of 41,314 business including retail foods, manufacturers, pools, tattoos, body piercing, x-ray, bedding, medical micropigmentation, drugs/cosmetics, mammography, and hotels/motels.  Without additional funding, the agency cannot meet Voluntary National Retail Food Regulatory Program Standards issued by the federal government.  The Health Department is requesting 30 additional positions to help with the workload in protective health.  Funding could be raised to pay for the $2.5 million needed by increasing fees in long-term care, medical, food, and lodging providers.

“We are dealing with limited resources and unlimited demand,” concluded Hartsell.

Epidemiology Lab Seriously Underfunded

According to Julie Cox-Cain, Deputy Commissioner for Disease and Prevention Services, federal and state funding for prevention has flattened, effectively causing a cut in the agency’s ability to respond to public health needs.  With the increasing cost of medical supplies, fuel, and benefit costs, a standstill budget, seriously underfunds the division.

One of the most serious concerns presented by Cox-Cain was the condition of the state Epidemiology Lab.  With possible threats of bio-terrorism and quickly spreading epidemics, the 40-year-old lab should be brought up to today’s standards.  In addition, to ensure the safety of employees in the state Health Department building, the lab should be a free-standing facility, with additional security and environmental protection.

“OPEA is seriously concerned with the condition of the lab and the possible threat to state employees who work in close proximity to the lab,” said OPEA Policy and Research Director Trish Frazier.  “OPEA will be taking a tour of the lab in the next few weeks and reporting to the Health Department Council and the OPEA Board for action in the next legislative session.”

Community Health Funding Threatens Services

The Community Health Division has 115 vacant positions, with 10 percent of the Public Health Specialist (sanitarian) not filled at a time when the number of businesses requiring investigations is growing.  In addition, the demand for services in Health Departments across the state has increased, with over 14,000 additional services delivered in 2008.

“Workers are traveling between and among counties,” said Deputy Commissioner for Community Health Services Steve Ronk.  “We have been forced to close satellites some days.”

Ronk indicated that the agency would request that all counties increase their millage rates to 2.5 mills.  The agency will continue to explore third party reimbursement, such as insurance and Medicaid.  In addition, fee increases will be considered.

“OPEA has worked in the past to help the agency raise revenues through fees,” said Frazier.  “The swimming pool fees passed a few years ago were a joint effort of the Health Department and OPEA.  The OPEA Health Department Council will be discussing another effort for next session.”

SoonerStart Services Jeopardized

The SoonerStart program, which provides services for families with infants and toddlers who are developmentally delayed, has a deficit of $2.2 million.  Federal funds for the program are channeled through the Department of Education to the Health Department, who has been designated by statute to provide services. 

Although the division has 254 authorized FTE, the agency has implemented a hiring freeze with the current level at 219.  With less funding, children are not receiving the appropriate level of services, both in frequency and intensity, to address problems before learning is delayed.

“By accepting federal funds for these services, they become an entitlement,” said Deputy Commissioner for Family Health Services Edd Rhoades.  “We are not in compliance with federal law by delaying services to these children.”

OPEA Makes Plans for Legislative Session

The OPEA Health Department Council will be meeting soon to discuss the association’s action during the 2009 session on Health Department funding.  To be involved in the planning, contact Trish Frazier at the OPEA office 800-880-6732 or trishf@opea.org.

In addition, local OPEA chapters in Health Departments should invite legislators in for a pizza lunch to discuss the services provided to their constituents and the need for additional funding.  It is critical that OPEA members in the Health Department encourage coworkers to join the association and help fight for the funding and the critical services the agency provides.