FRANKFORT — Come July 1, many county public health departments across Kentucky will be open fewer hours, and some will have smaller staffs.
"I doubt that there are many health departments out there that will not have to furlough or reorganize their staff in some way or raise taxes," said Linda Sims, president of the Kentucky Health Department Association. Sims, executive director of the Lincoln Trail District Health Department, which covers Hardin and six other counties, said the upcoming fiscal year will be one of the toughest in recent years for local health departments.
In Franklin County, the health department's 74 full- and part-time staff will be asked to take 12 furlough days in the coming year. Some staff will be moving from full-time to part-time, said Paula Alexander, executive director of the Franklin County Health Department.
In nearby Anderson County, staff will be cutting back three hours a week — going from a 37.5-hour work-week to 34.5 hours a week. "It's about 211/2 furlough days. We are going to work 12 months and get paid for 11," said Tim Wright, interim executive director of the department.
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In Fayette County, health officials announced last week they expect 25 people to be laid off.
As state and local funding has dropped in recent months, the state's 59 county and district health departments are struggling to deliver mandated services on a shoestring while continuing to improve and monitor public health. County health departments track sexually transmitted diseases, monitor infectious diseases such as whooping cough, do cervical and breast cancer screenings, and investigate dog bites. Their employees inspect restaurants, pools, hospitals and hotels to ensure cleanliness.
Each of Kentucky's local health departments is an independent quasi-governmental agency and receives a portion of its budget from local taxes. The minimum tax for county health departments is 1.8 percent. Some counties' public health tax is as a high as 4 percent. With the recession, many local health departments saw local tax revenue flatten or decrease.
The departments also receive state and federal money and may charge for clinical services such as family planning.
Jill Midkiff, a spokeswoman for the state Cabinet for Health and Family Services, which oversees public health, said the total amount of funding to local public health departments did not decrease with the exception of some one-time money.
But departments are feeling the effect of a change in how state funds were allocated. Part of the new formula took into account the population served and percentage of population below the poverty level. Counties such as Anderson and Franklin were hurt the most by the formula because they serve more "working poor" — or people who have jobs but not insurance. Counties with extreme poverty serve more people who qualify for government programs such as Medicaid or Medicare.
The state also moved Medicaid to managed care, which has lowered reimbursement rates. At the same time, retirement and insurance costs continue to climb for county health departments.
Shawn Crabtree, executive director of the Lake Cumberland District Health Department, which covers 10 southeastern Kentucky counties, said his department will not have furloughs this year.
In fact, state funding for his district actually increased, partly because the district serves one of the highest-poverty areas in the state.
But Crabtree also said that his department has downsized during the past three years.
In total, he said, the district has taken about a $4 million hit during the past few years as other costs such as retirement and insurance have increased and state funding has gone down. In the past 21/2 years, the district has gone from about 330 employees to 250, he said.
"We've had to scale back in nearly every division," Crabtree said.
"There are certain things like diabetes education classes, they just aren't as available as they once were," he said. "There are less staff to run our clinics. There are times when we have to postpone appointments if we don't have enough staff."
Wright said Anderson County has managed to stave off staff reductions during the past three years by using reserves to plug holes. But those reserves are gone. Additionally, the Anderson County Health Department has a new building and a mortgage to pay. In addition to furloughs, the department has renegotiated contracts and consolidated positions. Wright serves as interim executive director and director of the environmental regulation division, which oversees all inspections.
In Christian County, the health department lost 10 positions in recent years. It is trying to determine how it will absorb a 2 percent cut in funding for the upcoming fiscal year.
"It is not as much about how much was cut but how funding doesn't cover the core public health services designed to provide health outcomes," said Mark Pyle, director of the Christian County Health Department. "Christian County has a high underinsured/uninsured population, low primary care physician to patient ratio and high instance of chronic disease, yet our funding streams don't provide for the level of chronic disease services we need in our community."
Health departments receive a lot of federal money through the state for federal programs such as Women, Infants and Children. "These are great programs, but we need funding for all programs to move the health needle, not just the programs the state can get federal funding for," Pyle said.
Christian County has the minimum health tax of 1.8 percent, he said. The county Board of Health, which oversees the department, might consider an increase to 2.8 percent.
"Bottom line is, we are facing a $730,000 shortfall in funding and we are going to have to make some tough decisions," Pyle said.