The Madison County Health Department is facing deep funding cuts over the next two years after the General Assembly slashed public health funding and created a new formula for how the money is distributed.

Madison Public Health Director Nancy Crewe relayed the bad news to the health board Wednesday night. The health department is expecting a funding reduction of $220,000 in 2013 and $440,000 in 2014, Crewe said. The agency also is expecting cuts in federal funding, Crewe added.

“It’s a big hit,” said David Reed, the health department’s financial director. “The next budget cycle will probably be the most difficult I’ll ever face.”

There is currently $480 million in public health state funding, Crewe said. Since 2008, there has been a $40 million decrease in money available to local health departments, and a $23 million reduction at the local level, she said.

In the state’s 2013-2014 budget, the Senate and House budgets both decreased public health funding by $5 million, according to an informational sheet handed out at the meeting. To deal with the reductions, Crewe explained that $21 million of the public health funds will be “carved out” for a new funding method called a Core Public Health Block Grant. The block grant will cover services that must be provided by health departments under state and federal law, like maternal and child services, environmental services, public health education and communicable disease services.

The new formula for calculating the block grant distribution has put Madison County as a disadvantage and will result in a loss of funds, Reed reported. Each county gets a weighted rank based on population, need (poverty rates) and local health tax collection. Madison County is 50th in the state for poverty and 12th in health property tax collection. A larger percentage of the grant money is allocated for the neediest counties based on the ranking formula.

Reed questioned how Madison County fell within the rankings and said he would seek further information from the state.

In other business:

• Crewe discussed the ongoing structural problems with the Martha Pride building, in which the Berea Clinic is housed. A complete assessment of the structure by a architectural and engineering firm was completed last week, Crewe said. Representatives from the firm will discuss its findings and costs associated with fixing the problems at the June 6 health board meeting in Berea.

There were three major problem areas within in the building, which the health department has occupied since 2004, Crewe said. There is a significant amount of water leaking through the walls, subsidence has caused gaps between the walls and foundation, and the window sills are separating from the windows.

• Reed gave a presentation about the health department’s revenues and expenses through the end of February, the eighth month of the fiscal year. The agency was in the black for the month of February, but is still operating at a nearly $152,000 deficit for the fiscal year.

Reed also highlighted the revenues and expenses of MEPCO, the home health provider run by the Madison Board of Health. The provider has struggled to receive timely Medicaid reimbursements since the state switched to a system in which managed care organizations (MCOs) handle reimbursements instead of state employees.

MEPCO was in the red $20,733 for the month of February, and so far has a deficit of nearly $753,000 for the fiscal year, which ends June 30. Reed expected some of that deficit to be offset by an expected $526,000 Medicaid cost settlement from the state.

However, Reed still projected MEPCO would end the fiscal year with a $584,000 deficit.

Reed also presented information that showed reimbursement rates from the three MCOs operating in Kentucky are improving. At the end of February, only $109,450 was reimbursed to MEPCO out of $530,000 billed to Medicaid. By the end of March, $339,600 had been reimbursed out of $732,000 billed.

Nursing Administrator Billie Dyer said MEPCO home health employees are making efforts toward improving productivity to deal with the reduction in Medicaid funding.

• Dyer reported on several audits that took place recently at the health department. A state WIC auditor visited in February and observed the health department’s registration, nutrition education counseling, food benefit issuance and check-out procedures. A few problems were found that had to do with how foster children were recorded and the counting of the unused eWIC cards. Dyer said the problems were discussed with support staff.

The health department also had a state Medicaid chart audit and a Joint Commission Accreditation audit. Crewe said no major problems were found with either audits.

• Dyer reported that the health department ordered 1,970 flu vaccines and only 946 doses were given this fall and winter. Some of the excess vaccine can be returned for a refund. Many people are now getting their flu shots at their primary provider’s office and at places such as Kroger and Walmart, Dyer said. For the next flu season, the health department plans to reduce the order to 650 doses.

Madison County did not have many confirmed cases of the flu this year and averaged 40 to 50 cases of flu-like illness visits per month at the Pattie A. Clay Regional Medical Center emergency room throughout the winter, Dyer said.

• Three employees received Good Citizen awards, including Stacy Sandlin, Daphne Durham and Jessica Thompson, all of the Berea Clinic. New hires were Janet Walters, LPN with MEPCO, and Karen King, nurse specialist with the Richmond Clinic.

Sarah Hogsed can be reached at or 624-6694.

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