INTRO TO PUBLIC HEALTH ADMIN,

GRANTS & REPORTS

Presentation to the AMSSA ConferenceJune 24, 2014Dave Greeman, Budget Director

MDH Mission• To protect, maintain and improve the health of all Minnesotans

• Health Protection• Health Improvement• Health Care Reform

Departmental Program StructureHealth Improvement Bureau• Community and Family Health• Health Promotion and Chronic

Disease• Center for Health Equity• Office of Statewide Health

Improvement

Policy, Quality and Compliance Bureau• Compliance Monitoring• Health Policy

Health Protection Bureau• Environmental Health• Infectious Disease Epid.,

Prevention and Control• Public Health Laboratory• Office of Emergency

Preparedness

Administrative Services• Finance and Facilities Mgmt• Human Resources• Internal Audits• Information Technology

MDH Budget by Funding Source

General14% Health Care Access

6%

State Government Special Revenue

8%

Temporary Assistance for Needy Families

2%

Medical Education 13%

Special Revenue12%

Other1%

Federal 44%

FY 2014 Budget$595 million

How Sources of Funding Have ChangedSource FY 2002-03 FY 2006-07 FY 2010-11 FY 2014-15

GF 16% 16% 14% 14%

SGSR 7% 8% 9% 8%

HCAF 3% 2% 7% 6%

Spec. Rev. 10% 9% 9% 12%

Federal 40% 44% 42% 46%

MERC 24% 21% 19% 13%

Largest Sources of Federal Funding2014-15

Federal Agency Amount

US Department of Agriculture $235 million

Centers for Disease Control (CDC) $101 million

Health Resources and Services Administration (HRSA)

$77 million

Administration for Children and Families (ACF) $25 million

Environmental Protection Agency (EPA) $20 million

MDH Sections Most Reliant on Federal Funds

Section % of Funding from Federal Sources

Office of Emergency Preparedness 97%

Infectious Disease Epidemiology Prevention and Control

79%

Community and Family Health 76%

Health Promotion and Chronic Disease 63%

How Funds Are SpentTotal FY 2014 Budget of $595 billion • Grants: $393 million (66%)• Payroll: $113 million (19%)• Non-payroll Operating: $89 million (15%)

StaffingBase FY 2014-15 MDH Staffing Levels • Total FTEs: 1,264• General Fund FTEs: 135 (10.7%)

Health ImprovementCommunity and Family Health

General

Fund19%

TANF5%

Federal 76%

FY 2014 $208 million• Manages and oversees

programs to support families and young children, including WIC and family home visiting

• Provides grants and technical assistance for pre-pregnancy family planning

• Works with providers and local agencies to improve health and development screenings and follow-up services for children

Health ImprovementHealth Promotion and Chronic Disease

General Fund23%

Special Revenue

12%

Envi-ronmen-

tal3%

Federal 63%

FY 2014 $25 million

• Works to improve prevention and treatment of conditions such stroke, diabetes, asthma, arthritis, etc.

• Operates breast and cervical cancer screening programs for low-income women

• Provides grants for services that improve and protect health including dental sealants, poison control and asthma treatment

• Operates a statewide cancer registry

Health ImprovementCenter for Health Equity

General Fund65%

TANF35%

FY 2014 $6 million

• Collects racial, ethnic, and language data to inform policy makers about the health of populations of color and develops appropriate indicators to measure progress.

• Administers the Eliminating Health Disparities Initiative (EHDI) grant program

• Connects populations of color with MDH and local public health experts to identify and address actions essential to eliminating heath disparities.

Health ImprovementStatewide Health Improvement

General Fund10%

Federal 34%

Other 1%

Health Care

Access56%

FY 2014$35 million

• Supports all Minnesotans in leading healthier lives, raising healthier families and building healthier communities by preventing disease well before it starts.

• Operates programs that address the leading causes of chronic disease, including tobacco use, poor nutrition and lack of physical activity

• Operates tobacco cessation programs throughout the state

Policy, Quality and ComplianceCompliance Monitoring

General Fund8%

SGSR28%

Special Revenue

40%

Federal 23%

FY 2014$36 million

• Regulates approximately 870 health and long-term care facilities in the state, including hospitals and nursing homes

• Regulates health-related professionals.

• Investigates reports of maltreatment under the Vulnerable Adults Act

• Regulates HMOs and county-based purchasing plans in the state

Policy, Quality and ComplianceHealth Policy

GF5%

SGSR4%

HCAF12%

Federal 11%

Special Revenue

3%

MERC65%

FY 2014$123 million

• Performs research to monitor and understand health care access and quality, market conditions, and care spending.

• Develops and leads health reform efforts

• Sets standards for primary care clinics and certifies health care homes

• Oversees a secure, web-based system for registering all Minnesota births and deaths and issuing certified birth/death records

• Supports rural and primary healthcare facilities and providers through technical assistance, grants and workforce support

Health ProtectionEnvironmental Health

General Fund6%

SGSR49%

Special Revenue

11%

Other 2%

Federal19%

Clean Water12%

FY 2014$47 million

• Monitors the quality of drinking water and prevents contamination

• Protects indoor air quality from risks associated with lead, asbestos, radon and tobacco smoke

• Protects the safety of food served in commercial establishments

• Identifies and responds to emerging environmental health risks

Health ProtectionInfectious Disease Epid., Prev. and Control

General Fund11%

Special Revenue

9%Other

1%

Federal79%

FY 2014$34 million

• Detects, investigates and mitigates infectious disease threats and outbreaks using 24/7 response capability

• Promotes vaccination to prevent disease and provides vaccines for low-income children

• Prevents the spread of disease through HIV prevention grants, providing medications for TB and coordinating health screenings

• Prevents and investigates foodborne disease outbreaks

Health ProtectionPublic Health Lab

General Fund10%

Special Revenue

27%

SGSR37%

Federal25%

Other1%

FY 2014$23 million

• Screens newborns for over 50 serious congenital conditions

• Analyzes a wide variety of environmental samples to identify contaminants of emerging concern

• Performs tests on patient specimens to determine the presence or absence of disease- causing agents

• Trains a network of microbiology laboratories in rapid identification, notification and referral of potential agents of bioterrorism

Health ProtectionOffice of Emergency Preparedness

Other 1%

Federal97%

Special2%

FY 2014$15 million

• Coordinates state response to public health emergencies caused by infectious disease outbreaks, natural disasters and criminal activities

• Maintains communication systems to provide timely information to providers, local governments and the public

• Plans and oversees the inventory and distribution systems to disseminate medications and medical supplies in a public health emergency

Administrative Services

General Fund23%

Special Revenue

75%

Federal 2%

FY 2014$42 million

• Manages the MDH budget to ensure that resources are properly tracked, budgets are well-planned, and financial activities meet standards set by federal, state and private funders

• Manages facilities space in five metro and eight Greater Minnesota locations

• Collects and analyzes data to measure performance of MDH in meeting statewide goals

• Operates an internal audit section • Provides legal and internal audit

services to the department

State Public Health System

Under Minnesota’s Local Public Health Act, “a community health board [CHB] has the general responsibility for development and maintenance of a system of community health services under local administration and within a system of state guidelines and standards.” Minn. Stat. §145A.04, subdivision 1

State Public Health System• A CHB is the governing body for local public health in Minnesota. A CHB may be comprised of a single county, multiple contiguous counties, or in a limited number of cases, a single city.

• The powers and duties of a CHB can be assigned to human services board.

State Public Health SystemCHBS are responsible for addressing areas of public health responsibility, which include: (1) assuring an adequate local public health infrastructure;(2) promoting healthy communities and healthy behaviors;(3) preventing the spread of communicable disease;(4) protecting against environmental health hazards; and(5) preparing for and responding to emergencies.

Public Health Grants• MDH operates approximately 100 grant programs to address public health needs in the state.

• Funding for the programs comes from state and federal sources.

• Requirements for the programs are set by the Legislature, Congress, and state and federal rules related to budgeting and accounting

• Grants are awarded to CHBs, local government units and non-profits depending on the requirements

Types of Public Health GrantsGrants are awarded either competitively or through a formula.• Examples of competitive grants include

• Family Planning Special Project• Tobacco Use Prevention

• Examples of Formula Grants• Maternal and Child Health Block Grants• Local Public Health Grants

• Examples of Grants that combined aspects of both a formula and competition• Statewide Health Improvement Program• Medical Education and Research

Timing of Grants and Grant Cycles• Timing of federal grants and reporting cycles are generally driven by:• The budgeting period established by the funding agency• The timing of obtaining legislative approval to spend federal funds.

• Many federal grants do not coincide with fiscal or calendar year periods.

• MDH must award grants on the cycles dictated by funders in order to ensure that the funds are expended within the grant cycle.

Public Health Grant Payments• The Office of Grants Management has established a

grants management policy for all state executive branch agencies.

• The most recent update of the policy finds that cost reimbursement is the preferred method for making grant payments.

• Since January 1, 2013, a number of public health grants, including the Local Public Health Act grant and the Maternal and Child Health Block grant have been distributed through a cost reimbursement system.

Public Health Grant Payments• Advance payments may be allowed if an agency believes that a grantee will account for the grant funds and abide by the terms of the agreement.

• In order to make advance payments, agencies must prepare a written justification.

Public Health Grant Monitoring• State agencies must conduct one monitoring visit per grant period for each grant over $50,000 and once per year for grants over $250,000.

• State agencies must also conduct financial reconciliation of grantees’ expenditures at least once during the grant period on grants over $50,000.

Reporting and Claiming Administrative Costs

• Generally local government grantees that do not have a federally approved indirect cost rate may use an indirect cost rate equal to 10% of modified total direct costs

• Local grantees may account for staffing costs as direct expenditures if those costs can be directly attributed to the program.

Local Public Health Grant• CHBs that comply with the LPHA are eligible for funding through the LPHA Grant

• LPHA grant funds awarded in CY 2014 totaled $32.9 million

• LPHA grants include state General Funds, Federal TANF funds and Federal Title V funds

• Each CHBs allocation is based on 2003 allocations for a number of categorical grants.

Local Public Health Grant• CHBs must provide a 75% match for state funds received through the LPHA grant.

• Funds eligible for the local match include property taxes, reimbursements from third parties, fees, other local funds, and donations or non-federal grants used to address public health activities.

• CHBs may use LPHA grants to address areas of public health responsibility and local priorities developed through a community health assessment and community health improvement planning process.

Contact Information

Dave GreemanBudget Director Minnesota Department of Health

Phone: 651 201-5235E-mail: dave.greeman@state.mn.us