The recession and property tax cuts have found their latest victim – the Fort Wayne-Allen County Department of Health, prompting the department to debate charging fees for some medical services.

Health officials faced cutting $350,000 to balance the department’s 2010 budget. But the Allen County Council supplemented the budget this year to cover escalating costs and circuit-breaker effects that limit property tax money, which the department heavily relies on.

Since the budget was adopted last fall, the department has lost grant money, forcing a reduction in staff and pay. Another job could be cut this year if another grant is lost.

Next year, new property tax caps will further reduce the department’s budget.

To cope with the losses, the department is considering charging fees for some medical services as it continues to try to get Medicaid reimbursement, which it currently doesn’t receive. At least one elected county official believes immunizations should be the next service cut.

But officials worry that fees could prevent residents from receiving needed services like immunizations or tests for sexually transmitted diseases.

When such testing or immunizations drop, the entire community is at greater risk for disease, health officials said.

Fewer grants

This year the department is working with a $3.7 million budget and will receive about $2.6 million in property taxes.

Tax caps will reduce property tax collections by an estimated $195,000. But increases for employee health insurance and retirement benefits and utilities for a new clinical building further hurt this year’s budget for a combined hit of $350,000.

To cover the shortfall, department administrator Mindy Waldron said, the department closed its laboratory, which analyzed samples for the sexually transmitted diseases clinic and tested water for pollutants and contamination, and eliminated one position.

Because of the recession’s effect on revenue, the County Council provided $400,000 to the department this year. The health department receives no income taxes, leaving its budget more vulnerable to property tax caps, Deputy Auditor Tera Klutz said.

Waldron considers the extra funding from the council a one-time boost.

“All of those budgets are seeing cuts and impacts due to some of the property tax changes. Every one of those departments and issues are of equal importance. Our hope is to gain supplemental funding,” Waldron said of other county departments and offices.

This year, the department has nine grants supporting the wages of 12 employees. But a loss of some grants has forced the department to lay off three full-time employees since 2008. Several other employees saw their pay shrink, she said.

The county lost more than $100,000 in federal HIV-prevention grants that were funneled through the state, Waldron said, and more cuts are expected this year.

That funding allows the health department to serve an 11-county area with preventive-education campaigns and outreach. The financial hit means the department will focus on counseling and education efforts to patients, not to the general public, she said.

Of more than 6,000 patient visits seeking STD testing last year, about 2,300 required follow-up treatment, counseling and education sessions. The majority of patients are from Allen County, Waldron said.

Without the lab, patient samples are sent to an outsourced lab, which delays treating patients, she said.

According to Melissa Dexter, spokeswoman for the state health department, federal HIV-prevention funds, for the first time, were distributed through competitive bidding, altering how money from the U.S. Centers for Disease Control and Prevention was disbursed.

But federal spending hasn’t increased to keep up with inflation. The result is the same amount of dollars pays for less, said Donna Brown, government affairs counsel with the National Association of County and City Health Officials.

Reductions in revenue at the local, state and federal levels are affecting health departments large and small nationwide, Brown said.

During the first half of 2009, about 8,000 public health employees were laid off, and 12,000 more took unpaid furloughs, according to a national survey compiled by Brown’s association.

In Indiana, the number of public health employees shrank an estimated 18 percent, the survey said.

Running health departments with fewer workers also reduces the ability to respond to public health emergencies, like last fall’s H1N1 vaccination campaign, Brown said.

Fighting demand

Although running daily H1N1 vaccination clinics and sending teams into minority communities was an expensive effort, it was well-funded, Waldron said.

As of January, the county health department had spent $400,000 to respond to the H1N1 outbreak. But the state has reimbursed the county for all of those expenses, including hiring extra staff, Waldron said.

But screening and treating the influx of Burmese refugees during the past two years was a cost to county taxpayers.

In 2007 and 2008, the county screened almost 1,500 refugees for a variety of health conditions including tuberculosis and HIV. And refugees continue to make Fort Wayne their home.

“They have a lot of health issues that we must continuously treat. We need to seek funding for that,” Waldron said. “That’s just another additional factor why we may need to charge a fee.”

The expense of treating the refugees also spurred the department to seek Medicaid reimbursement, she said.

When the federal government resettles refugees in Fort Wayne, the refugees receive Medicaid coverage. And the health department would like to bill the state’s program to recoup the costs of treating refugees, instead of charging local taxpayers, Waldron said.

Few health departments in Indiana are Medicaid providers, Waldron said, and the process is complicated.

Meeting mandates

Local officials are worried that the fees will keep some residents from seeking care.

The county wants to be able to provide services mandated by statute, such as controlling the spread of tuberculosis, but the department needs money to pay for them, Waldron said.

In Allen County, most doctors’ offices have stopped providing childhood vaccines. It’s easier to send them to the county or to Super Shot, Waldron said.

Super Shot is an independent, privately funded, non-governmental organization that provides free vaccines to children.

Although the county is not required by state statute to provide immunizations, it’s an important preventive tool. Super Shot and doctors’ offices could not handle the demand alone, Waldron said.

But County Councilman Paul Moss, R-at large, believes the county shouldn’t provide immunizations because Super Shot can handle the work.

Eliminating the service is one area the county could cut to shave expenses, he said.

Moss said charging fees for services is an appropriate step, and he doesn’t believe additional property taxes should go to the department.

But Councilwoman Maye Johnson, D-1st, disagrees. She said health and other social issues should be a priority and should be treated equally with economic development concerns.

She is worried that the county would charge people who are already strapped financially.

“We have to find additional funding,” she said. “That’s a priority.”

aiacone@jg.net