This blog series, which will run over the course of the next several months, will serve to educate public officials and others on the significant role of Maryland’s health departments, highlight the many budgetary challenges resulting from reductions over the past few years, and describe the expanding pressures placed on these agencies through health care reform and the economic downturn.  The final piece of this series will draw final conclusions on the vital role of health departments and raise specific issues to be addressed to ensure our health departments can meet growing citizen demands.

Health Departments – Introduction

Local health departments (LHDs) provide essential front line services to the public.  However, substantial funding reductions are threatening their capacity to deliver crucial services.  Funding for Maryland’s LHDs is a combination of federal, State (Core Funding), and county funds as well as fee collections.  Core Funding is determined through a statutory formula.  The minimum funding level for the program was established at $41.0 million in fiscal 1997, with subsequent increases based on inflation and population growth.  These inflationary factors increased funding to a high of almost $70 million in FY 2008.  However, cost containment actions of the Board of Public Works in August 2010 and further action during the 2010 General Assembly session, reduced the base funding level to $37.3 million for FY 2010 to FY 2012.  The base funding level will remain at this level for FY 2013, but instead of the inflationary increases providing for cumulative growth, due to a new interpretation of the statute, the inflationary increases would only be applied as one year’s growth in inflation and population, permanently reducing and restructuring LHD funding.  These actions have already had a profound impact on LHDs and will continue to do so for years to come unless action is taken to restore funding and provide for inflationary increases to accommodate expanding needs.

Since FY 2008,  Core Funding for LHDs has been reduced by approximately 45%.  This is a substantial reduction considering Core Funding accounts for approximately 41% of the LHD budget.  The link below contains a pie chart which shows funding for LHDs by source – Local Government, Federal Direct, State Direct, Medicaid and Medicare, Federal Pass-through, and Other.

Funding by Source

Although federal H1N1 funding helped LHDs accommodate some of these reductions, when these funds ran out, LHDs had no other option but to eliminate positions.  From FY 2009-2011, 449 regular and contractual positions have been eliminated statewide.  The link below contains a pie chart which summarizes these positions by service area – Wellness Promotion, Administration and Communication, Adult/Clinical/Dental, Communicable Disease Control, Environmental Health, Family Planning, and Maternal and Child Health.

FTEs Reduced

As this bi-weekly blog series continues, these issues will be examined in much closer detail.  Future blogs will discuss LHD structure, staffing, and funding; the history of the core funding formula; the current core funding formula, its new legal interpretation and its shortcomings; the effects of funding reductions in terms of services and staffing; and the expanding role of LHDs due to health care reform and the economy.

Next Post:  Local Health Departments – Structure, Staffing, and Funding