Margaret Donnelly, Director, Missouri Department of Health and Senior Services presented at the NSC 2012 Missouri Budget Forum

1. FISCAL YEAR 2013 BUDGET PRESENTATION
DEPARTMENT OF HEALTH AND SENIOR SERVICES
MARGARET T. DONNELLY, DIRECTOR

2. Principal Units
Comprising DHSS
 Director’s Office
 Division of Administration
 Division of Community and Public Health
 Division of Senior and Disability Services
 Division of Regulation and Licensure

3. What DHSS Does: Division of
Community and Public Health (DCPH)
 Genetics and Healthy Childhood  Supplemental Nutrition for Women,
 Newborn Screening Infants and Children (WIC)
 Immunization Assessment and  Bureau of Environmental Epidemiology
Assurance  Healthy Indoor Environments
 Immunizations Registry (ShowMeVax)  Bureau of Environmental Health
 Special Health Care Needs Services
 Adult Head Injury  Food Safety
 Cancer and Chronic Disease Control  Communicable Disease Control and
 Organ Donor Program Prevention
 Show Me Healthy Women  Veterinary Public Health
 Health Promotion  Bureau of HIV, STD and Hepatitis
 Comprehensive Tobacco Control Program  Office of Epidemiology
 Injury & Violence Prevention/ Safe Kids  Cancer Registry
Coalition
 Vital Records
 Community Food and Nutrition
 Birth and Death Certificates
Assistance  Marriage and Marriage Dissolution Records
 Summer Food Service Program

4. What DHSS Does: Division of
Regulation and Licensure
 The Section for Child Care Regulation licenses, regulates
and inspects 4,147 child care facilities.
 The Section for Long Term Care licenses and inspects
1,141 Long Term Care Facilities, including
 499 Skilled Nursing Facilities (SNFs)
 31 Intermediate Care Facilities (ICFs)
 420 Residential Care Facilities (RCFs)
 191 Assisted Living Facilities (ALFs)
 The Section for Health Standards and Licensure Bureau
of Hospital Standards licenses and inspects 165 hospitals.

5. What DHSS Does: Division of
Senior and Disability Services
 In FY 2011, 60,423 Missourians received Home and
Community Based Services (HCBS).
 In FY 2011, DSDS took 26,114 hotline call reports of abuse,
neglect or exploitation.
 The department is currently using a combination of
existing staff and new, temporary hires to provide
necessary services for individuals eligible for HCBS.
 The Governor’s FY 2013 recommended budget
includes funding for 90 staff to provide prescreening,
level of care assessments, authorizations and care
planning.

6. How DHSS Delivers Services
DHSS directly performs some functions
The department works with local partners and through contracts
with private sector companies to provide services. Examples
include:
 DHSS contracts with the 115 Local Public Health Agencies.
 DHSS contracts with the 10 Area Agencies on Aging.
 DHSS contracts with institutions of higher education.
 DHSS works with home and community based service providers.
 DHSS works with not-for-profits and schools to provide a variety
of services.

7. Sources/Uses of DHSS Funds
Federal
Funds
71.4%
General Other
Revenue Funds
26.8% 1.8%
•71.4 percent of all DHSS funding comes from federal funds.
•26.8 percent of DHSS funding comes from General Revenue.

8. Funding by Division, FY 2010-2013
700
600
500
Millions of Dollars
400
300
200
100
0
2010 2011 2012 2013*
Fiscal Years
Director's Office/Support Services Division of Community and Public Health
Division of Senior and Disability Services Division of Regulation and Licensure
*Governor's recommendations

9. DHSS General Revenue Funding History
38% Increase
220,918,787
230,000,000
204,090,950
210,000,000
186,238,071
172,438,881
190,000,000
159,590,239
170,000,000
150,000,000
35% Decrease
130,000,000
110,000,000
84,017,755
74,808,136
90,000,000
61,167,649
56,540,886 54,464,616
70,000,000
50,000,000
FY-09 FY-10 FY-11 FY-12 FY-13 Gov. Rec.
GR Medicaid In-Home Services Budget GR Budget excluding Medicaid In-Home Services

10. Fiscal Year 2013 Budget
Core Reductions
 The $4.1 million dollar General Revenue core reduction is an 8 percent
reduction to DHSS (excluding Medicaid Home and Community-Based
Services).
 Staff and expenses were reduced in each unit of the
department, including:
 $742,317 for 21.71 FTE; and
 $103,802 (a 5 percent reduction) to selected expense and equipment
categories.
 DHSS programs were also reduced significantly ($3.8 million General
Revenue).

11. DHSS Budget Sources: Overall Breakdown
Governor's Recommended FY2013 Budget for DHSS is:
$1,026,538,178
Sources:
 $275,383,403 General Revenue
 $732,526,785 Federal Funding
 $18,627,990 Other Sources

12. FY 2013 DHSS Budget by Division/Program
Governor’s Recommendations
Percent of
Division/Program Amount Total FTE
Director's Office $2,611,753 0.3% 44.29
Center for Health Equity $6,160,260 0.6% 25.98
Division of Administration $6,238,575 0.6% 70.73
Federal Grants and Donated Funds $3,449,989 0.3%
Disaster Fund $1 0.0%
Division of Community and Public Health Program Operations $27,464,250 2.7% 548.63
Aid to Local Public Health Agencies $5,665,842 0.6%
Division of Community and Public Health Programs and Contracts $62,806,481 6.1%
Nutrition Services $178,761,640 17.4%
Center for Emergency Response and Terrorism $23,345,020 2.3% 61.51
State Public Health Laboratory $9,064,818 0.9% 93.52
Division of Senior and Disability Services Program Operations $20,226,377 2.0% 485.59
Naturalization Assistance $200,000 0.0%
Adult Protective Services and NME Programs $2,309,546 0.2%
Medicaid Home and Community Based Services $610,820,562 59.5%
Alzheimer Grants $517,000 0.1%
Senior Programs - Area Agencies on Aging Contracts and Grants $42,084,040 4.1%
Naturally Occurring Retirement Communities $127,500 0.0%
Missouri Quality Home Care Council $150,000 0.0%
Division of Regulation and Licensure Program Operations $23,937,484 2.3% 460.96
Childcare Improvement Program $461,675 0.0%
Missouri Health Facilities Review Committee $135,365 0.0% 2.00
Total $1,026,538,178 100.0% 1,793.21