Washtenaw Community Health Organization
Proposed FY 2014 – 2015 ANNUAL
BUDGET
Presented to the Board September 16, 2014
WCHO MISSION STATEMENT
• Provide high quality, effective integrated behavioral
health, physical health and social support services to
persons with Chronic and/or Severe Mental Illness,
Developmental Disabilities, Substance Use Disorders
and Severe Emotional Disturbances
• Provide leadership and education to the community
• Develop and provide models to make these
integrated services available to all residents of
Washtenaw County
WCHO VALUES
•
•
•
•
•
•
•
Consumer and Family Involvement
Comprehensive, Quality Services
Community Based Services
Public Accountability
Integrated Care
Research and Medical Education
Adaptability
What is the WCHO?
• The Washtenaw Community Health Organization
(WCHO) is a multifaceted entity created by
Washtenaw County and the University of Michigan.
• It is a Community Mental Health Services Program
(CMHSP) under the state Mental Health Code, and a
creating partner of the Community Mental Health
Partnership of Southeast Michigan (CMHPSM) that
jointly administers specialty behavioral health
services as the Medicaid Prepaid Inpatient Health
Plan (PIHP) for Washtenaw, Lenawee, Livingston and
Monroe counties.
Who We Serve
• As the CMHSP, the WCHO is responsible for
contracting or providing a specified array of mental
health services within Washtenaw County and it is
required to direct its services to individuals who are
seriously mentally ill, seriously emotionally
disturbed, and/or developmentally disabled. Within
these priority groups, preference must be given to
persons with the most severe forms of illness and/or
in urgent or emergency situations.
The WCHO As A Partner Of The
CMHPSM
• As a Partner of the CMHPSM, the WCHO is the sole
sourced behavioral health contractor/provider for
particular Medicaid benefits included under
Michigan’s Medicaid specialty services waiver
programs.
• These waiver programs are aimed at the same
conditions (serious mental illness/serious emotional
disturbance, developmental disabilities, and
substance abuse disorders) as those targeted under
the Mental Health Code priority populations.
Medicaid & GF Consumers Served
Consumers Served
3,600
3,400
3,200
3,000
2,800
2,600
2,400
2,200
2,000
1,800
1,600
1,400
1,200
1,000
800
600
OCT
NOV
DEC
JAN
FY 2013 Medicaid
FEB
MAR
FYE 2014 Medicaid
APR
MAY
FY 2013 Gen. Fund
JUN
JUL
FYE 2014 Gen. Fund
AUG
SEP
FY 2014 – 2015 ANNUAL BUDGET
FY 2015 Budget Vs. FY 2014
Projected Revenues
FY 2015 Budget
FY 2014 Full Year
FY 2015 Budget
Projection
Projection
O/(U) FY 2014
Revenues
Medicaid
$ 61,213,858.00
$ 61,216,173.56
Healthy Michigan Plan
3,905,966.00
2,133,574.00
Health Homes
1,061,851.00
State General Funds
5,500,000.00
ABW
-
-
$
(2,315.56)
1,772,392.00
1,061,851.00
6,679,349.00
(1,179,349.00)
900,592.00
(900,592.00)
Child Waiver Fee-For-Service Revenue
1,100,000.00
1,010,224.00
89,776.00
J-Code Fee-For-Service Revenue
1,891,112.60
1,879,812.33
11,300.27
Funding From Washtenaw County
1,528,080.00
1,128,080.00
400,000.00
Use Of WCHO Local Fund Balance
247,824.51
Affiliate, CMHPSM & U of M Billings
1,518,334.60
1,559,551.25
(41,216.65)
Grants And Earned Contracts Incl. OBRA
1,261,018.00
1,679,453.00
(418,435.00)
729,548.01
688,813.00
40,735.01
$ 79,957,592.72
$ 78,875,622.14
$ 1,081,970.58
All Other
Total Revenues
-
247,824.51
Affiliation Charges And
Reimbursements, $1,518,335 , 2%
Grants And Earned Contracts
(OBRA), $1,261,018 , 2%
J-Code Revenue, $1,891,113 , 2%
Mental Health Funding Sources
Total = $79,957,593
All Other, $977,372 , 1%
Washtenaw County Local Funding,
$1,528,080 , 2%
Child Waiver Fee-For-Service
Revenue, $1,100,000 , 1%
State General Fund, $5,500,000 ,
7%
Healthy Michigan Plan,
$3,905,966 , 5%
Medicaid (Including Health Home
Funding), $62,275,709 , 78%
REVENUE ASSUMPTIONS AND KEY POINTS
•
Medicaid Revenue
– Total Regional Entity Capitated Medicaid revenue is projected at $134.0 million
– $119.7 million (after CMHPSM costs) appropriated to LEN, LIV, MON & WCHO
– Projected FY 2014 Carry Forward of $4.2 mil. has also been appropriated to the Partners
•
Healthy Michigan Plan (Medicaid) Revenue
– Based On August 29, 2014 reduced rate of $51.57 ($38.69 for MH & $12.88 for SUD) and
Plan enrollment level as of August 25, 2014
– Rates for FY 2014 are 31.5% lower than rates presently being paid for FY 2014
•
Health Home Project (Medicaid) Revenue
– WCHO is paid $137.19/month for each Enrolled Consumer who receives a service
– WCHO is assuming 645 Consumers/month (75% of the 860 who qualify in Wash. Co.)
•
State General Fund Appropriation
– FY 2014 Budget was set at $8.4 million (same as FY 2013 Actual)
– FY 2014 Final State General Fund Authorization is $7.0 million
– FY 2015 Budget set at $5.5 million (FY 2014 Final GF Auth. less non-recurring
appropriations)
•
Washtenaw Co. Local Funding is of $1,528,080 ($400,000 increase from FY 2014)
FY 2015 Budget Vs. FY 2014 Projected Expenses
FY 2015 Budget
Projection
FY 2014 Full Year
Projection
FY 2015 Budget
O/(U) FY 2014
Expenses
Total Administrative Expenses
$ 5,175,915.83
$ 5,921,992.54
$
Core Provider Contract
CSTS -- BU 211
OBRA
Total Core Provider Costs
$ 31,477,708.40
798,137.00
$ 32,275,845.40
$ 29,987,025.06
682,766.40
$ 30,669,791.46
$ 1,490,683.34
115,370.60
$ 1,606,053.94
Specialty Service Contracts
Community Inpatient
$ 3,080,006.65
$ 3,080,006.65
$
21,405,478.72
256,185.94
21,905,478.72
256,185.94
(500,000.00)
-
If needed,
Licensed Facilities
Peer Supports/Drop-In
PERS
PSR/Clubhouse
Respite
8,226,520.27
288,496.09
157,873.87
542,278.15
680,463.56
8,526,520.27
288,496.09
157,873.87
542,278.15
680,463.56
(300,000.00)
-
Regionally held
Carryforward or
FY 2015
Medicaid
Surplus
Skill Building
Specialty Services
1,555,928.59
72,872.46
1,705,928.59
72,872.46
(150,000.00)
-
State Facilities Full Mgmt
State Facilities Local Share
Supported Employment
Supports Coordination
All Other Contracted Services
1,560,740.00
446,784.00
448,891.34
8,994.35
325,594.19
1,917,836.40
446,784.00
448,891.34
8,994.35
325,594.19
(357,096.40)
-
$ 39,057,108.18
$ 40,364,204.58
$ (1,307,096.40)
Other Non-Service Costs
$ 2,985,842.31
$ 3,262,134.56
$
(276,292.25)
Grants And Contracts
$
462,881.00
$ 1,277,693.36
$
(814,812.36)
$ 79,957,592.72
$ 81,495,816.50
$ (1,538,223.78)
Community Living Supports
Autism Services
Total Specialty Service Contracts
Total Expenses
(746,076.71)
-
Grants And Earned Contracts
(OBRA), $1,261,018 , 2%
Other Costs (Including J-Code
Drugs), $2,985,843 , 4%
Contracted Services Costs,
$39,057,108 , 49%
Administrative Costs, $5,175,916 ,
6% ($3.7 Million Net Cost, 4.6%)
Mental Health Expenses
Total = $79,957,593
Core Provider Costs (CSTS),
$31,477,708 , 39%
EXPENSE ASSUMPTIONS AND KEY POINTS
•
Administrative Costs
– FY 2015 Budget of $5.2 million -- $0.7 million under FY 2014 Projection and $1.0 million
under FY 2014 Budget (includes $300,000 tbd Administration efficiency reduction)
– Net Administrative Expense of $3.7 million after $1.5 million of billings to Partners, U of
M & CMHPSM
•
Core Provider Costs
– FY 2015 Budget of $31.5 million to fund Washtenaw County’s CSTS Department
– Base services such as Case Management, Supports Coordination, Skill
Building/Supported Employment and Outpatient
– OBRA Nursing Home screenings
•
Contracted Service Costs
– Costs paid to the WCHO’s Specialty Services Network
– FY 2015 Budget set at FY 2014 Projected levels except for:
•
•
•
•
•
Community Living Supports (CLS) -- $21.4 million, $500,000 under FY 2014 Projection
Licensed Residential Facilities -- $8.2 million, $300,000 under FY 2014 Projection
Skill Building -- $1.6 million, $150,000 under FY 2014 Projection
State Hospital Costs -- $1.6 million, $357,000 under FY 2014 Projection
Other Non-Service Costs
– Primarily $2.1 million for J-Code Drug Costs and $689,948 for Medicaid Local Match
FY 2015 REVENUE & EXPENSE BY CATEGORY
Revenue & Expense By Category
Dollars
Percent Of Total
Revenues
Medicaid (Including Health Home Funding)
$
62,275,709
78%
Healthy Michigan Plan
3,905,966
5%
State General Fund
5,500,000
7%
Child Waiver Fee-For-Service Revenue
1,100,000
1%
Washtenaw County Local Funding
1,528,080
2%
Affiliation Charges And Reimbursements
1,518,335
2%
Grants And Earned Contracts (OBRA)
1,261,018
2%
J-Code Revenue
1,891,113
2%
977,372
1%
$
79,957,593
100%
$
5,175,916
7%
Core Provider Costs (CSTS)
31,477,708
39%
Contracted Services Costs
39,057,108
49%
Other Costs (Including J-Code Drugs)
2,985,843
4%
Grants And Earned Contracts (OBRA)
1,261,018
2%
79,957,593
100%
All Other (Including WCHO Fund Balance)
Total Revenues
Expenses
Administrative Costs
Total Expenses
Revenues Over/(Under) Expenses
$
$
-
FY 2015 REVENUE & EXPENSE BY FUND SOURCE
Revenue & Expense By Fund Source
Funding Source
Medicaid (Including Health Home Funding)
$
Healthy Michigan Plan
Revenue
Expense
Revenue O/(U)
Budget
Budget
Expense
62,275,709
$
62,381,424
$
(105,715)
3,905,966
3,905,966
-
83,996
83,996
-
State General Fund
5,500,000
5,500,000
-
Child Waiver Fee-For-Service Revenue
1,100,000
1,410,474
1,000
1,000
-
MIChild
91,431
91,431
-
MIChild Autism
20,754
20,754
-
186,242
186,242
-
Local
2,106,856
1,495,717
611,139
All Other (Including J-Code Drugs FFS Billings)
3,424,621
3,619,571
(194,950)
Grants And Earned Contracts (OBRA)
1,261,018
1,261,018
Medicaid Autism
Serious Emotionally Disturbed Waiver (SEDW)
County Of Financial Responsibility (COFR)
Total Budget
$
79,957,593
$
79,957,593
(310,474)
$
-
REVENUE & EXPENSE BY FUND
SOURCE KEY POINTS
• Fee-For-Service Revenue shortfalls are projected for
Child Waiver Services ($310,474) and J-Code Drugs
($194,950)
• Local Funds, including $247,825 of WCHO Fund
Balance, will be used to cover the deficits noted
above.
FY 2015 Administrative Cost Detail
Total Administrative Costs
FY 2015 Budget
FTEs
Amount
Salary & Fringe
Administration
Compliance
Finance
Information Management
Customer Service
Provider Network
Office Of Recipient Rights
Total WCHO
FY 2014 Budget
FTEs
Amount
FY2015 O/(U) 2014 Budget
FTEs
Amount
5.75
1.00
7.00
6.00
0.25
1.00
12.00
$
802,552
161,224
746,428
677,343
87,610
1,136,131
7.50
1.00
10.00
7.00
0.50
2.00
12.00
$
923,084
157,103
890,342
760,065
77,858
249,286
1,106,117
(1.75)
(3.00)
(1.00)
(0.25)
(1.00)
-
$
(120,532)
4,121
(143,914)
(82,722)
(77,858)
(161,676)
30,014
33.00
$
3,611,288
40.00
$
4,163,855
(7.00)
$
(552,567)
Total Administrative Contracts
1,096,208
996,307
Total Other Administrative Costs
850,775
1,079,308
TBD Administrative Efficiencies
(302,355)
Grand Total Administrative Costs
Memo:
Salary & Fringe Billed To Partners
Salary & Fringe Excl. Amount Billed
7.20
25.80
$
5,255,916
$
692,516
2,918,772
99,901
(228,533)
-
7.20
32.80
$
6,239,470
$
682,095
3,481,760
(302,355)
$
(983,554)
Challenges For FY 2015
• Identify and implement Administrative cost
efficiencies
• Identify Contract Services savings (presently focused
on CLS, Licensed Residential and Skill Building)
• Notify Organizations/Individuals that their contracts
will be reduced or not renewed for FY 2015
• Contain General Fund Expenses within the $5.5
million budget (and hope that GF Funding is not cut
any further)
CONTRACTS INCLUDED IN THE BUDGET
• Administrative Expenses (Total Cost of $5.3 million)
– $1,096,208 worth of contracts are included in the Budget.
• Contracted Services (Total Cost of $39.1 million)
– Specialty Service Main Panel Provider Contracts
o Comprised of Community Living Supports, Licensed Residential, Case
Management/Supports Coordination, Supported Employment, Skill Building and
Respite
o Contract term from 10/1/2014 through 9/30/2015
o All contracts are fee-for-service based on authorizations within the FY 2015 Service
Budgets
– Other Mental Health Service Contracts
o Includes COFR, Community Hospitals, State Hospitals, Club House and Drop-In
Center
o All contracts except the Drop-In Center are fee-for-service based on authorizations
within the FY 2015 Service Budgets
CONTRACTS CONTINUED
• Administrative & Other Contracts
–
–
–
–
–
Michigan Department Of Community Health (MDCH) Contracts
Community Mental Health Partnership Of Southeast Michigan Contract
Contracts with Lenawee, Livingston and Monroe
CSTS Core Provider Contract
Other non-direct Service Contracts
• Lease Contracts (Total Cost Of $460,927)
– Licensed Residential Group Homes – Various Landlords ($324,360)
– Clubhouse – State Street Enterprises ($68,976)
– Drop-In Center – Washtenaw County ($67,591)
• In addition to leasing eleven Licensed Residential Group Homes, the
WCHO owns nine Licensed Residential Group Homes and a tenth home
that is rented to Consumers who receive CLS services paid for by the
WCHO.
BOARD ACTION REQUESTED
1. Approve the WCHO CMHSP Budget As Presented
Revenue
$80 million
Expense
80 million
Revenue O/(U) Expense
$ 0 million
2. Approve The Contracts As Presented, Excluding Those With
Potential Conflicts Of Interest (NAMI And Washtenaw
Community College)
3. Separately Approve The Following Two Contracts:
a) NAMI
b) Washtenaw Community College