BY TIM BONFIELD
The Cincinnati Enquirer
The Cincinnati Health Department is likely to ask for a small budget increase for 1999 and might need another increase in 2000 to pay for its lead paint abatement program, landfill inspections and the rising costs of care for the uninsured.
"We are probably going to propose additional funding, but no specific amount has been determined," said Health Commissioner Malcolm Adcock.
The Health Department is the city's second largest department, with a 1998 budget of $34.5 million. The department's functions include running six health clinics, home nursing services, monitoring local disease outbreaks, promoting public health, and inspecting city restaurants, groceries, swimming pools and landfills.
Most of the health department's budget -- $19 million -- comes from the city's general fund. The rest comes from billing for health services, license fees and grants from various sources.
The good news: the city does not expect to cut any basic services or jobs in 1999. The bad news: the forecast for 2000 isn't so rosy.
Among the troubling financial trends:
For the past five years, the proportion of uninsured patients coming to city clinics has risen from 52 percent to 65 percent. However, clinic revenue has fallen 27 percent -- largely due to a state requirement to put Medicaid patients in managed care health plans. The lower collections make it that much harder for the system to absorb the cost of uninsured care.
Home nursing visits to uninsured patients have soared in five years while revenue dipped 11 percent, again straining the system. Looking forward, city officials fear their program will wind up with even more expensive cases because private home health agencies have been stung by recent changes in Medicare payment rates.
On the environmental front, city health officials continue making frequent inspections of the soon-to-be-closed ELDA solid waste landfill and the Gray Road construction waste landfill. But tipping fees that once helped pay for the work have dried up.
At ELDA, the fees stopped when the trash hauling stopped. But city monitoring will continue at some level, possibly for years. At Gray Road, recent changes in state regulations killed the fees the city once charged for its twice-a-week inspections.
Meanwhile, the future of the city's lead paint abatement program remains in limbo, because a $6 million federal grant awarded in 1993 is slated to run out in early 1999.
Last year, the health department was criticized for its slow activity on the grant, which was supposed to result in 350 homes or apartments cleared of lead paint hazards. Since then, the city has stepped up its activity, but much-higher-than-expected costs have made it unlikely that 350 units will get repaired.
Now, responsibility for the lead paint program is planned to shift to the city's neighborhood services department, which has applied for a second, smaller grant. However, the city is still waiting for a decision from the U.S. Department of Housing and Urban Development.
If no grant money comes in, it will be up to city council to decide whether and how to subsidize the lead paint abatement program. The Health Department's financial picture could be worse, Dr. Adcock said.
The health department expects some relief on the uninsured care front from a recently launched state program to expand Medicaid eligibility for children. But the impact of that program remains unclear, especially since most of the city's uninsured clientele are adults.
The rising numbers of uninsured in Greater Cincinnati stem directly from welfare reforms that have successfully pushed people into jobs. The problem has been that many families leaving welfare lost their Medicaid health coverage, but people wound up taking jobs that offer no health benefits or extremely limited benefits. Two other local clinic systems serving low-income people have taken losses in the past year and have been forced to cut services. So far, the city health department has avoided service cuts because its clinics get a city subsidy not available to other area clinics. "We think we have managed our primary care services well during extremely challenging times," Dr. Adcock said.
More details on the health department budget are expected next month, when the department submits its proposals to the city manager. The city manager, in turn, expects to send budget recommendations to city council in October.
City council's budget hearings will occur in November and December, with a Dec. 16 target for passing the final budget.
