fiscal year 2018 proposed budget and property tax rate · charity care $4.3m dsrip $22.8m sendero...
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Fiscal Year 2018 Proposed Budget and Property Tax Rate Central Health Board of Managers Aug. 16, 2017 Jeff Knodel, CFO Lisa Owens, Interim Deputy CFO
FY 2018 Proposed Budget Highlights
• Invest in health care strategies to provide better patient outcomes • Central Health Brackenridge Campus redevelopment
• Emergency Reserve maintains 15% of budgeted eligible expenditures
• Maintain lowest tax rate of any major Texas Hospital District
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Major Texas Hospital Districts: Debt Principal and Payments Comparison
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$720 million in FY 2016 DEBT PRINCIPAL $ 9.5 million in FY 2016 DEBT PAYMENTS
How Central Health Leverages Public Funding
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Central Health Funding Disproportionate Share (DSH) $31M
Uncompensated Care (UC) $42.9M
Charity Care $4.3M
DSRIP $22.8M
Sendero Risk-based Capital $5M
ACA Subsidized Premiums $270K
DSRIP $27.7M
CCC Member Payment $24.6M
Total $158.6M
Community Health Care Impact
Hospital Costs $274.8M • Care for low-income and uninsured
residents in Seton and St. David’s hospitals
Hospital DSRIP $53.2M • More than 93,000 patient encounters
Sendero $86M • More than 34,000 patients covered
• Medicaid, CHIP and ACA Marketplace plans
CCC $123.7M
• More than 95,000 people served by the CCC
• MAP eligibility now covers all residents below 50% FPL
Total $537.7M
Hospital Services
Health Coverage
Ambulatory Care
Result: Central Health leverages public dollars to create 3.4 times their original value
Fiscal Year 2016
5-Year Forecast: 4.5% Over Effective Property Tax Rate (in millions)
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$0
$20
$40
$60
$80
$100
$120
$140
$160
$180
$200
$220
$240
$260
FY18 FY19 FY20 FY21 FY22
4.5%OverEffec8vePropertyTaxRateYOY
TotalSources TotalUses TotalReserves EmergencyReserve
FY 2018 Proposed Tax Rate (4.5% over Effective Rate)
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FY17 FY18 (Proposed)
Average Homestead Value
$285,152 $305,173
Tax Rate 11.0541¢ 10.7385¢
Tax Bill $315.21 $327.71
Annual Increase = $12.50 (3.97%)
Homestead Exemption
Over 65 Homestead Exemption
Disability Homestead Exemption
20%* $5,000 Minimum $80,000 $80,000
*Maximum allowable by state law
Share of Local Property Taxes
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City of Austin 20.4%
Travis County 14.7%
Austin ISD 55.6%
Austin Community
College 5.0%
Central Health 4.3%
Preliminary FY 2018 Travis County Tax
Entity Percentages
City of Austin 20.2%
Travis County 15.3%
Austin ISD 55.1%
Austin Community
College 5.0%
Central Health 4.4%
FY 2017 Travis County Tax Entity Percentages
Central Health Property Tax Impact Statement: Fiscal Years 2017-2018
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FY 2017 Home Value
FY 2017 Taxable
Homestead Value*
FY 2017 Tax Rate
FY 2017 Tax Bill
Average Home Value Appreciation
FY 2018 Home Value
FY 2018 Taxable Home Value*
FY 2018 Tax Rate
(4.5% over effective)
FY 2018 Tax Bill
Annual Increase
Percent Increase
$200,000 $160,000 11.0541¢ $177 9.00% $218,000 $174,400 10.7385¢ $187 $10 5.9%
$300,000 $240,000 11.0541¢ $265 7.60% $322,800 $258,240 10.7385¢ $277 $12 4.5%
$400,000 $320,000 11.0541¢ $354 6.30% $425,200 $340,160 10.7385¢ $365 $12 3.3%
$500,000 $400,000 11.0541¢ $442 6.00% $530,000 $424,000 10.7385¢ $455 $13 3.0%
* 20 percent homestead exemption
Community Care Collaborative Accomplishments and Initiatives
FY 2017: • Expanded MAP eligibility • Improved case management • Expanded primary care • Improved specialty care • Implemented value-based care contracting FY 2018: • Expand specialty care service lines (dermatology, palliative care,
rheumatology and oncology) • Improve specialty care referral process • Enhance consultation process from primary care to specialty doctors • Expand MAP and sliding fee patient benefits
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Increasing Primary Care Visits
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Totals represent patient encounters for CommUnityCare and the CCC
-
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Primary Care Visits
Projection
Dell Medical School Accomplishments and Initiatives
FY 2017: • 130 Dell Med residents and fellows, and 49 faculty rotating in CommUnityCare clinics
– Family medicine – Internal medicine – OB/GYN – Pediatrics – Psychiatry
• Inaugural class begins working in clinical settings • Post-partum follow-ups increase from an estimated 40 percent to 79 percent at
CommUnityCare FY 2018 • Begin clinical services at the Health Transformation Building • Third class of students begin
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Central Health FY 2018 Proposed Budget
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Description FY 2017 Approved Budget FY 2018 Proposed Budget
Sources
Property Taxes $169,806,722 $181,839,054 Seton Lease Revenue 31,544,675 10,303,467 Interest 400,000 400,000 Tobacco Litigation Settlement 1,800,000 1,800,000 Subtotal Revenue 203,551,397 194,342,521 Contingency Reserve 36,600,000 57,886,845
Total Sources 240,151,397 252,229,366 Uses
Healthcare Delivery 229,738,205 241,433,090 Administration 8,926,601 9,143,516 Tax Collection 1,486,591 1,652,760
Total Uses 240,151,397 252,229,366 Reserves (ending balance)
Capital - - HMO Risk-based Capital Reserve - - Contingency Reserve - - Emergency Reserve 29,895,000 32,035,084
Total Reserves $29,895,000 $32,035,084
Central Health FY 2018 Proposed Budget
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Property taxes 72%
Contingency Reserve
23%
Lease Revenue 4%
Other 1%
Health care delivery
96%
Administration 3%
Tax collection 1%
Sources: $252.2M Uses: $252.2M (includes contingency appropriation of $28.6 million)
FY 2018 Proposed Budget Expense Highlights
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CCC Member Payment• Expand MAP eligibility period • Specialty care• Expanded urgent care and convenient care network• Dell Medical School partnership
Health Coverage• Sendero risk-based capital • Affordable Care Act subsidy program
Health Care Initiatives • Women’s health, cancer care, health care workforce development
Investments in Capital Projects• Rosewood-Zaragosa• Central Health Brackenridge Campus infrastructure• East Travis County collaboration
FY 2018 Proposed Budget: Central Health Brackenridge Campus
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Timeline • Operations transition September 2017 • RFP in process • Master developer agreement negotiated in 2018
Description FY 2017 Approved Budget
FY 2018 Proposed Budget
Building operations and management - $2,416,906 Campus infrastructure and development $2,047,675 1,943,738 Total $2,047,675 $4,360,644
FY 2018 Proposed Capital Budget Highlights • Rosewood-Zaragosa redevelopment—$4,700,000*
• Brackenridge Campus infrastructure—$2,600,000
• Eastside infrastructure collaboration—$1,500,000
• Facilities maintenance—$350,000
• IT equipment—$250,000
*updated estimate
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FY 2018 Proposed Budget– Uses/Health Care Delivery/IGTs
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Intergovernmental transfers: FY 2017 Approved Budget
FY 2018 Proposed Budget
IGT - Private UC $27,900,000 $27,900,000
IGT - Public UC 25,000,000 25,000,000
IGT - Disproportionate Share 32,500,000 35,000,000
IGT - CCC DSRIP 29,300,000 29,300,000
IGT - Seton DSRIP 26,250,000 29,000,000
IGT - St. David's DSRIP 620,000 620,000
Total $141,570,000 $146,820,000
TheFederalandStateGovernmentsul8matelydeterminethe8mingandamountsoffederalmatchingfunds.AssumingCentralHealthprovidedlocalfunding(IGT)atFY2018budgetedlevels,itises8matedtodrawanaddi8onal$176.4millionoffederalfundsforatotal(bothlocalandfederalfunds)amountof$323.2million.Thetotalamountis2.28mesthelocalfundingamount
FY 2018 Proposed Budget– Uses/Health Care Delivery/Operations
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Description FY17 Approved Budget FY18 Proposed Budget Subtotal Intergovernmental Transfers $141,570,000 $146,820,000
Healthcare Services: Member Payment to CCC 26,245,166 29,245,166 Charity Care - Seton 4,251,733 4,251,733 Primary Care - Planned Parenthood 585,000 731,800 Integrated Care Collaboration (ICC) 617,275 666,657
Service Expansion 2,000,000 2,000,000 Subtotal Healthcare Services 33,699,174 36,895,356
Health Care Initiatives: UMCB Redevelopment and Operations 2,047,675 4,360,644 Health Care Initiatives: Cancer Care, Women’s Health, Workforce Development - 500,000
Subtotal Health Care Initiatives 2,047,675 4,860,644 Operating Expenses:
Salary and fringe benefits 3,763,563 3,773,584 ACA education and enrollment 2,745,000 2,700,000 Health Promotion 353,713 358,713 Legal 25,000 26,200 Consulting 234,000 289,000 Other professional services 519,271 401,085 Marketing & community relations 523,500 557,326 Leases, security & maintenance 894,847 739,876 UT land lease for teaching hospital - 903,467 Phones, computer equipment & utilities 703,029 932,021 Printing, copying, postage & signage 194,269 198,694 Travel, training and professional development 34,339 47,044 Other operating expenses 207,369 234,892
Subtotal Operating Expense 10,197,900 11,161,902 Subtotal Healthcare Delivery IGT, Services,
Initiatives and Operations $187,514,749 $199,737,902
FY 2018 Proposed Budget–Uses/ Health Care Delivery/Reserves and Debt Service
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Description FY 2017 Approved Budget
FY 2018 Proposed Budget 8/9/2017
FY 2018 Proposed Budget 8/16/2017 Variance
Subtotal Health Care Delivery (IGT, Services, Initiatives and Operations)
$187,514,749 $199,737,902 $199,737,902 -
Reserves, Appropriated Uses and Transfers:
Transfer to capital reserve 1,500,000 4,407,542 5,607,542 $1,200,000 Transfer to emergency reserve 1,380,000 2,139,460 2,139,460 -
Sendero risk-based capital 6,000,000 4,000,000 4,000,000 - Contingency reserve appropriation 31,970,653 29,775,391 28,575,391 ($1,200,000)
Subtotal Reserves, Appropriated Uses and
Transfers 40,850,653 40,322,393 40,322,393 -
Debt service: Debt service - principal retirement 975,000 1,000,000 1,000,000 -
Debt service - interest & amortized costs 397,803 372,795 372,795 -
Subtotal Debt Service 1,372,803 1,372,795 1,372,795 -
Total Health Care Delivery $229,738,205 $241,433,090 $241,433,090 -
FY 2018 Proposed Budget– Uses/Administration and Tax Collection
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DESCRIPTION FY 2017 APPROVED BUDGET FY 2018 PROPOSED BUDGET Total Healthcare Delivery $229,738,205 $241,433,090
Administration Operating Expenses
Salary and fringe benefits $4,268,817 $4,413,183 Legal 1,166,500 926,200 Consulting 1,038,000 1,208,800 Investment Services (Travis County) 103,351 105,000
Benefits & Payroll administrative services 296,940 249,920 Other professional services 485,300 483,200 Marketing & Community Relations 181,400 192,400 Leases, security & maintenance 183,842 273,348 Insurance & Risk Management 150,000 157,500 Phones, computer equipment & utilities 164,794 204,930
Printing, copying, postage & signage 99,570 136,560 Travel, training and professional development 263,737 259,625
Other operating expenses 524,350 532,850 Total Administration 8,926,601 9,143,516
Tax Collection Appraisal District Services 924,000 970,200 Tax Collection Expense 562,591 682,560
Subtotal Tax Collection Expense 1,486,591 1,652,760 Total Uses $240,151,397 $252,229,366
Next Steps ü May 24 — Central Health Board of Managers (5-year forecast) ü May 30 — Travis County Commissioners Court (FY 2017 update and FY 2018 budget guidelines) ü June 21 — Central Health Budget and Finance Committee (budget update) ü June 28 — Central Health Board of Managers (proposed budget) ü July 19 — Central Health Budget and Finance Committee (FY 2018 CCC proposed budget) ü July 26 — Central Health Board of Managers (FY 2018 CCC proposed budget and Central Health
budget update) ü Aug. 9 — Central Health Budget and Finance Committee (FY 2018 Central Health proposed
budget and property tax rate) ü Aug. 16 — Central Health Board of Managers (FY 2018 Central Health proposed budget and
property tax rate) • Aug. 22 — Travis County Commissioners Court (Central Health proposed budget and property
tax rate) • Aug. 30 — First public hearing • Sept. 6 — Second public hearing • Sept. 13 — Central Health Board of Managers (FY 2018 budget adopted) • Sept. 19 — Travis County Commissioners Court (FY 2018 Central Health proposed
budget and property tax rate)
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