MINUTES OF THE

FUNDING OF STATE AND COUNTY HEALTH AND HUMAN SERVICES TASK FORCE

Thursday, August 15, 2002 - 9:00 a.m. - Room 403 State Capitol

Note: A list of others present and a copy of materials can be found at http://image.le.utah.gov/imaging/history.asp or by contacting the committee secretary, Alicia Laughlin, at 538-1032.

1. Committee Business

Chair Seitz called the meeting to order at 9:03 a.m.

MOTION: Rep. Pace moved to approve the minutes of the July 11, 2002 meeting. The motion passed unanimously, with Sen. Davis, Sen. Jenkins, Sen. Walker, and Rep. Hogue absent for the vote.

2. Principles (continued)

Chair Seitz asked for recommendations regarding the Task Force principles. He indicated that the Task Force will finalize the principles at the last meeting.

Rep. Pace requested that the Task Force address Part I-C of the Utah Association of Counties' recommended principles. She asked Mr. Rees if they would run into problems by not equally applying truth in taxation to every county. Mr. Rees indicated that it is a policy call to authorize that certain persons be exempted from the truth in taxation hearing process.

Rep. Hogue indicated that making any exemptions to the truth and taxation process would bring about some resistance from those who created it. Rep. Shurtliff requested that the Task Force study this issue.

Chair Seitz requested that Rep. Pace and Rep. Shurtliff work together to reword the principle.

3. Roles of State and Local Government

Mr. Steinagel addressed the roles of state and local government in planning and providing health and human services. He addressed various concerns of local government and discussed several solutions to improving the budgetary process.

Rep. Pace asked if legislation would be required to formalize a meeting between the Governor and local government authorities. Mr. Steinagel indicated that the Governor could initiate the change.

Dir. Steadman indicated that there is not an official recognition of a process where the local government is included. He stated that their input should be respected and included in both the Governor's and the Legislature's part of the process.

Mr. Mark Walsh, Utah Association of Counties, indicated that they would like to see local government become an integral part of the budget process in the state. He requested that a mechanism be put in place that recognizes the relationship the counties have with the State in delivering services under the various programs.

Mr. Randy Bachman, Director, Division of Mental Health, indicated that the partnership between the state departments and local government needs to be strengthened in order to improve the budgetary planning process.

Sen. Jenkins requested that the Task Force identify a funding stream for health and human services in order to solve the problem.

Mr. Steinagel discussed the concerns that exist between State and local governments within the aging partnership. He pointed out possible solutions.

Ms. Helen Goddard, Executive Director, Division of Aging and Adult Services, addressed the various concerns of the partnership between the Division and local government.

Sen. Davis asked if contracting out would allow the Division to provide quality services at a reduced cost. Ms. Goddard indicated that the state board would prepare standards for those services the state requires, and the bidding entities must have a track record of delivering quality services. She indicated that if an area agency does not perform in the current system, the Division must go through a lot to try and help them improve their performance because their funding is given as more of a grant then a contract. Sen. Davis indicated his concern with finding quality contractors in the rural parts of the state.

MOTION: Rep. Pace moved to have Ms. Goddard work with the Association of Counties to prepare recommended statutory changes to provide flexibility for the Division. The motion passed unanimously with Sen. Davis, Sen. Walker, and Rep. Hogue absent for the vote.

4. Funding of Services

Mr. Steinagel discussed solutions for improving funding for health and human services in the State. He indicated that the demand for services is much greater then the supply.

Mr. Thor Nilsen, Fiscal Analyst, Office of the Legislative Fiscal Analyst, distributed "State Funds Appropriated for Human Services Programs Operated by Local Authorities and at the State Level." He discussed how the main budgets dealing with local services compare to other state-operated services and explained the appropriation amount for each area.

Dir. Steadman requested information on how the weighted pupil unit (WPU) has increased over the last five years. Chair Seitz requested that staff prepare information on this issue.

Sen. Jenkins asked how much services are currently being affected. Dir. Steadman indicated that the eligibility criteria has been re-prioritized with the funding limits, and a more critical and needy population is being served in Salt Lake County. Sen. Jenkins requested that staff provide information on whether the most needy people are being served and how the limited funding is working currently.

Mr. Patrick Fleming, Director, Division of Substance Abuse, addressed the federal block grant requirements for prioritizing populations. He indicated that the Division has left it up to the local authorities to determine how they are going to prioritize services and that more and more dollars have been turned to serving the criminal justice population. Mr. Fleming expressed his fear that in order for people to become a priority they may be forced to commit a crime to receive the services.

Mr. Bachman indicated that they are currently working with county authorities and the state board to help clarify service priorities. He said that currently the code requires that those most in need receive the services first. He also indicated that they are working with Medicaid to try and come to terms on service priorities so that there can be coordination between the Department of Health and the Division of Mental Health.

Mr. Richard Melton, Director, Department of Health, commented on the budgeting process. He indicated that it is difficult for the agencies to try and include the local health departments in early budget discussions. He indicated that the Department does provide a hearing where the public can come and make recommendations and request increases in the budget.

Comm. Cox asked if the local government has any influence on the Health Advisory Council. Mr. Melton indicated that there are some local representatives on the Council that can make suggestions or recommendations and the Governor appoints the members.

5. Prioritizing Services

Mr. Steinagel addressed various concerns in prioritizing services within the State. He highlighted possible solutions and indicated that mandated services cannot be provided within available revenues.

Rep. Pace asked if the impression is that counties would feel more comfortable if the Legislature gave direction as to who should receive the services. Mr. Steinagel indicated that he did get that impression.

Dir. Steadman discussed looking at the state statute to see if some agreed changes could be made to provide local governments more flexibility. He also addressed putting together a plan each year which indicates the specific services that local governments are able to provide given the available funding. He indicated that by this process, they will be able to recognize a local area's available resources and identify their needs in order to continue a partnership.

Chair Seitz requested that staff pull related statutes to show what is mandated and the Departments will then list their policies so that the Task Force knows exactly what is being required of the local units.

Mr. David Cunningham, President, Local Health Officers Association, indicated that the roles and responsibilities of the local public health departments are listed in statute and in rule. He addressed prioritizing services and stated that relief from the minimum performance standards would help.

Rep. Pace requested that the sliding fee scales be studied by the Task Force.

Mr. Myron Bateman, Director, Tooele County Health Department, indicated that it is impossible to provide the same level of services while funding is being cut. He indicated that they have tried to subsidize their revenue source by charging individual fees to those receiving services, but funding increases do not come for population increases.

Rep. Jones stated that she would like to eliminate those who are taking advantage of services when they do not have a real need for them. She addressed providing services that will help families help themselves. She requested that the local authorities assess how effectively the services are being handled in each county.

Sen. Davis requested that staff prepare a matrix that would indicate what the State is mandating that the local authorities provide and the costs of each service.

Mr. Brent Bradford, Deputy Director, Department of Environmental Quality, addressed environmental health programs and their fees.

Sen. Jenkins asked if the fees are adequate to finance the needs of the Department. Mr. Bradford indicated that in general the fees are not adequate to maintain quality services.

Ms. Patti Pavey, Director, Salt Lake Valley Health Department, addressed the idea of charging fees for immunization services to keep up with funding costs. She indicated that there is an eroding of the funding that has not allowed them to keep up with their services as the population has grown. She indicated that they are concerned with being able to take care of problems as they arise and that the public trust that public health will be there.

6. Statutory Changes

Mr. Rees distributed "Recommendations for Statutory Changes" and briefly explained the recommendations made by the various departments. He indicated that some changes are technical in nature and some require modifications in policy. Mr. Rees discussed each recommended change and indicated how they would affect the statute.

Mr. Fleming requested that, in order to clear up confusion, sections of the code relating to county functions be taken out of the special districts title of the code and be placed in the title relating to counties.

7. Other Items / Adjourn

MOTION: Sen. Davis moved to adjourn the meeting. The motion passed unanimously with Sen. Walker, Rep. Hogue, and Rep. Shurtliff absent for the vote.

Chair Seitz adjourned the meeting at 11:35 a.m.