Lansing Hasn't Kept Its Promise

March 28, 2008
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Administrators of county health departments across Michigan feel they are facing at least a two-year struggle to get the state government to fulfill a pledge it made in 1998.

Along the way, they’ve picked up some allies in the tussle, most notably the Michigan Association of Counties, a fairly strong lobbying group that has all 83 county governments as members.

The Michigan Association for Local Public Health also has its 45 county health departments in the frontline trenches, and Kent County Administrative Health Officer Kathy Raevsky is leading that charge as president of the association.

“We’ve put together a resolution that was passed by my organization and was passed by MAC. Then individual health officers took it back to their local boards of commissioners or boards of health, depending on what their governing entities were at the local level, and it was supported by all, except for maybe seven,” said Raevsky.

“For some of those seven, it was just not politically feasible for them to bring it forward, in the sense that, in their local jurisdictions, if the state wasn’t paying its fair share, then the local jurisdiction that was strapped for dollars might decide why should they pay. So they really didn’t want to raise that issue at their local level,” she explained.

The resolution Raevsky pointed to calls for the state government to pay its share of the 50-50 cost-savings agreement it freely entered into with Michigan’s health departments when Lansing mandated that these agencies perform eight local public health operations. The eight LPHOs, as they are called, require all county departments to perform food service sanitation, on-site sewage management, water supplies testing, vision screenings, hearing screenings, immunizations, sexually transmitted disease control and general communicable disease control.

Lansing agreed to fund half the costs of the program because it wanted to ensure that the same quality and type of public health services would be offered throughout Michigan.

The Michigan Association for Local Public Health said its members have performed those operations, but the state hasn’t kept its part of the bargain. Instead of funding the county agencies with half of the costs as promised, Lansing has paid only about 30 percent of the total tab. That has left county departments holding the bag by having to fill the nearly 20 percent void. Some of the agencies have had to raise charges to residents for their services.

The Michigan association reported in FY 2005-06 that the state’s funding for the required services was only 33 percent of the net cost. Local appropriations to the health departments covered 43 percent of those costs, 10 percent more than the state did, and local fees charged to residents accounted for 24 percent.

For the same fiscal year, the association reported that total financing from local public health departments surpassed $523 million. That figure represents a 33 percent increase over the past 10 years, with user fees for those services growing by 100 percent over that decade.

Raevsky said the state has met its commitment only once.

“Only one year did the state pick up half the cost of those services. The following year they passed minimum program requirements, and that has been the basis of frustration. Since then, the state has never covered 50 percent of the cost,” she said.

Last year, the health department received $1.68 million from the Michigan Departments of Community Health and Environmental Quality to provide services under the LHPO banner. Total funding last year for all county departments from both state agencies was $40.6 million.

Raevsky said county departments can’t provide the services residents have asked for, which are different from those the state mandates, because the local dollars that would normally go toward filling the citizens’ requests are being spent on the state’s funding share.

In Kent County, Raevsky said local research has revealed that resident baby boomers want the department to offer more heart disease, diabetes and cancer prevention services, none of which are included in the LPHO.

“But so much of our local resources are drawn into supporting the cost of the services that were mandated for us to provide that we really don’t have much of anything left over,” she said.

Recent budget figures bear out her statement. The health department’s intergovernmental revenue fund, which largely consists of state dollars, fell by $1.2 million from budget year 2005 to 2006. The department received $10.94 million from that fund in 2005, but only $9.92 million in 2006. Total revenue from all sources to the department in 2006 was $25.1 million, down by about $3 million from the $28 million it received in 2005.

Even with fewer dollars in 2006, the health department still managed to:

  • Investigate 14,828 cases of reportable disease.

  • Distribute 5,000 flu survival kits to residents.

  • Conduct 75,958 Women and Infant Children appointments.

  • Administer 7,018 tests for sexually transmitted infections.

  • Immunize 17,609 children.

  • Make 2,993 immunization visits.

  • Counsel 76 families who had a child die.

  • Serve 375 families with a lead-poisoning program.

  • Complete 5,511 food safety inspections.

A few years after it didn’t meet its pledge to fund half the cost, the state quit referring to the program’s money as “50-50 cost-sharing dollars” — the original label. The state now calls these monies “Local Public Health Operations,” a name change that leaves out any indication that Lansing has any financial responsibility in the program it mandated.

But Raevsky prefers to remain optimistic that relief is on the way, because the plea from the Michigan Association for Local Public Health is beginning to be heard in Lansing.

“The legislators we have talked to have been supportive, at least in concept,” she said. HQX

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