The Union County Board of Health recently approved the health department’s 2023 budget, though officials noted a 10-year projection indicates the board may need to prioritize and reconsider some programming over the next several years.
The board unanimously approved appropriations for 2023 totaling $6,964,294.
Fiscal Officer Amy Hamilton noted that she expects the Union County Health Department to see a 12.18% increase, or $648,954, revenue increase from the 2022 original revenue.
The majority of the increase is from the “Confinement Facilities” grant, which will provide UCHD with $309,466 to be used for COVID-19 detection and mitigation within West Central Community Based Correctional Facility. Just over $289,000 will be passed through to WCCCF.
The rest of the increase is a result of an anticipated bump in levy revenue from the first collection of the replacement levy.
Hamilton explained that UCHD generates revenue from two levies – a 0.5 mill levy that will continue collection through 2032 and a 0.9 mill levy (which was a 0.75 renewal with a 0.15 increase) that will collect through 2029.
Levy revenue is particularly important to UCHD because 35% of all programmatic work is funded by grants, but “few, if any” programs are funded completely by grant dollars, Hamilton said.
She said levy dollars fill in the gaps when grant funding is not enough to meet the deliverables required for the program.
For instance, Health Commissioner Jason Orcena said the health department must be federally approved to charge “indirect costs” for program administration, like reporting deliverables to the state or federal government.
Because UCHD is not eligible for indirect costs, the administrative costs of programming must be covered by the levies instead of grant dollars.
Beyond that, Orcena said some grants that the health department has continuously received year after year may now be less impactful because they have not increased in value, but the workload remains the same or has increased.
He also noted that some grants that are lesser in value have the same workload as bigger grants, which means more administrative costs absorbed by the levy.
If grant funding doesn’t “keep up,” Orcena said “staffing becomes problematic at that point.”
The health commissioner said board members will “at some point” need to decide which programs levy dollars go toward, in order to have the most impact.
He said the nursing clinic is one area that is currently being reevaluated.
Hamilton noted that a reorganization of the Nursing Division occurred in 2020. The department director and business manager are still analyzing the “clinical structure and self-sustainability” of the division to make changes.
“We really don’t have apples to apples to compare to” because the reorganization occurred during the pandemic, Hamilton said.
She added that, throughout this year, nursing services were reduced because COVID-19 vaccinations occupied much of the capacity of the immunization clinic due to high demand.
While Orcena said he cannot envision a future in which the health department stops providing immunizations, the board may need to consider “at what level” they will continue doing so.
“How do we reduce our financial responsibility while still providing the service?” Orcena asked.
After approving the appropriations for next year, the board also heard from Orcena regarding a proposed salary schedule adjustment.
Orcena reiterated the health department’s struggles with attracting new employees.
He said a comparison between other public health agencies in the area indicated that UCHD’s starting rates for entry-level positions were “well below” what is offered elsewhere.
While starting wages are low, he said top salary ranges are “right where we want to be.”
In order to make UCHD more competitive, Orcena recommending increasing starting wages for entry-level positions.
He said, if approved, the changes would be “very, very limited,” as those hired within the past year will not be impacted. Only three individuals at the health department have been in an entry-level position for more than a year, so they would be eligible for the increase.
In total, he said the changes would impact the 2023 budget by less than $6,000.
The board did not take action on the salary schedule, as they will discuss the matter further at the December regular meeting.