• Discussion: Health and Education Service Area for Fiscal Year 2004 Budget

  • Rural Basic Block Grants (23)

  • General Basic Block Grants (20)

• Board of Public Health: Fiscal Year 2004 Budget

  • Public Health (04)

• Discussion: Health and Education Service Area for Fiscal Year 2004 Budget

  • Rural Basic Block Grants (23)

• Discussion: Fiscal Year 2004 Budget

Chairperson Harney called the Johnson County Board of Supervisors to order in the Johnson County Administration Building at 1:35 p.m. Members present were: Pat Harney, Sally Stutsman, and Carol Thompson.

A representative from the Solon Library said she just wants the Board to know that they are interested and concerned about library funding, but may not be able to remain at the meeting until the Board discusses it. Budget Coordinator Jeff Horne said he gave the Board the different library requests and added that there’s a new request from Tiffin this year. He said that the total requests from the libraries is an increase of about $30,000 and said that Tiffin’s request is $4,000 to $5,000. He added that the Board has a contract with Iowa City, which is reflected in the $10,734 change. He said that Coralville, Solon, and North Liberty follow the outline of the contract the County has with Iowa City even though they don’t actually have contracts themselves. He said Oxford and Tiffin have asked for a flat amount agreement. Stutsman said that the Board needs to have contracts in place with the libraries if they are providing funding according to contracts. She asked what the difference is between a contract and a 28E agreement. Horne explained that there is no difference, a 28E Agreement is just a specific form of a contract for intergovernmental agreements under Chapter 28E of the Iowa Code. He said the County Attorney’s Office has had the contracts for awhile. He said that in 256.69 of the Iowa Code it’s outlined that counties have to give to libraries at least 6& 3/4 cents per thousand dollars of assessed value on taxable value in the unincorporated areas, which would be a minimum of $65,000 for Johnson County. Thompson said the County would contribute $463,891 for next year based on the requests.

Thompson said that the contracts that the Board has with the libraries are for an amount that cannot be predicted because they take the rural portion of their circulation as a percentage and then the Board pays that percentage of the budget. She said that way if the library’s circulation or budget goes up, the Board pays more to the library. She said they don’t have any way to know how much they will pay in future years and the Board has become uncomfortable with that. Horne commented that there have been some large increases, like Solon increasing their request from $46,000 to $64,000 in 2 years. He said a lot of the increase comes from their new library. Stutsman asked if the Board will see an increase with Iowa City’s new library addition. Horne replied that the County will see some increase, especially since Iowa City’s is much larger to begin with, approximately $300,000. Stutsman said that Coralville is also planning an addition. Horne said that with those additions the Board will see the contributions increase. Harney asked what the increase is attributed to. Horne replied that it’s due to increased operations costs and Solon as a percentage has high rural usage. Stutsman said that the Board wants to be supportive of libraries, but it seems like they’re just pricing themselves out of the market. Horne said the County will soon get to the level of funding it would take to fund the operations of a County library.

Stutsman said that there’s part of her that thinks that this funding comes out of the rural side of the budget and there’s room in that side of the budget for library usage, but on the other hand there’s fewer taxpayers to absorb these costs. Harney said that regarding Solon’s library, the town’s population is only 1,000, but their usage is over 5,000 so there’s a lot of rural usage in that library, which is contributed to the developments in that area. Harney said that he didn’t want the Board to duplicate the discussion they would be having later in the meeting, but he wanted to give the people the opportunity to speak. Jack Miller wanted to express Solon's appreciation and commented that they cannot run their facility without the County’s assistance. He encouraged the Board to visit their new facility or have a meeting there so that the Board could see what they’re getting and how much use the library gets in their part of the County.

Thompson said that the way the money is apportioned works well for the libraries because it’s the same for each of the libraries except for Oxford and it feels like it’s fairly distributed. She asked if the Board could come up with an equitable arrangement if they only paid a set fee every year. The Solon Library Representative said that she could see the difficulty with circulation because it’s difficult to limit the use of the libraries and budgets are certainly based on the use of the libraries. Miller said that their library before the expansion was only as big as the Boardroom. He said the expansion took some time to get the usage where it is, which is why the budget increased. Stutsman said that when the Board started contracting with the Iowa City Library, the rural libraries had libraries that weren’t any bigger than the Boardroom, but because of the popularity they’ve all expanded their libraries and now require additional overhead and cost. She said that she feels that if the Board is going to make any changes, then they need to be fair and equitable across the board. She said that would mean to either come up with a new formula or have a block grant that they give to the libraries to distribute amongst themselves.

Harney asked how the libraries figure overhead into their budgets. The Solon Library Representative said that the figures the libraries give the Board are based on circulation. Stutsman said that the Board doesn’t pay for the building or the operating cost. Horne said that in Solon’s request they estimated operating expenses at $103,562 for FY04 with a net after subtracting fees and fines of $102,428. He said that 62.5% of their circulation comes from rural residents, so they took 62.5% of the $102,428 to come up with a request of $64,018. Stutsman asked what the percentage of Iowa City’s rural circulation is. Horne replied that it’s 8% or 9%, but their circulation overall is much higher. Stutsman suggested changing the formula to rural usage instead. She said that the Board needs to approve the figures that they put in place for this year, but then if they are thinking about making changes, then they need to form a subcommittee and spend time deciding what would be a fair and equitable way to make changes. She said that at this point the Board just wants to get a handle on the costs and not have to anticipate these huge increases every year because of the contracts. Horne said that one thing the Board must keep in mind is that when a library expands, their operational costs are going to go up. He said that the Board can anticipate that increase with Iowa City also. Thompson said that they’ve already budgeted for an additional staff person for next year. Horne said that the County will pay for 8% of that staff person.

Oxford Library Representative Ada Crow said that they a relatively small compared to the others and they appreciate all the County help they’ve received, but commented that they need it too. She said that their library operates almost completely on volunteer help, because if they didn’t, they wouldn’t be able to operate. She said that they don’t want to be left out in any changes that are made. She said it would be difficult to come up with something that would be equally fair to everyone. Stutsman said that this year the Board is adding Tiffin and next year they expect that they’ll add Lone Tree. Horne said that he didn’t know if they would add Lone Tree, but commented that somebody had contacted him from the Swisher Library. Stutsman noted that libraries are important to the community. Thompson agreed and added that the Board has been trying to promote family resources and communities and in those smaller towns the library is where the children are after school.

Horne addressed the Historical Society General Basic Block Grant. He said they should also address the Fairgrounds, but they didn’t ask for an increase. Thompson said that as part of the County’s review of cost Lehman had gone to talk to the people that run the Fairgrounds and they agreed to not ask for an increase this year. She said that she had no problem with their funding and Stutsman agreed. Horne explained that the Historic Preservation Commission budget covers services like copying. Thompson clarified that they only requested $500. She asked if Historical Society’s budget request changes from year to year. Horne replied that they are asking to be returned to their FY02 level, before last year’s budget cuts. Stutsman asked what they want the money for. Horne replied that they want the money for their ongoing mission of education, which includes their work at Plum Grove, Coralville schoolhouse, and the County Farm. He added that they didn’t ask for any specific projects. Horne asked the Board if they wanted to leave the increase on the table for now. Harney said that it would be all right since it’s a small amount, but at the same time if the Board needs to start looking at cuts, then it’s an option.

Horne commented that the Fairground is the only other grant in that group. He said the money the County gives them goes towards the County Fair, but also goes to maintain the buildings that the Board makes use of from time to time. Stutsman asked if they have their own levy. Horne replied that the Extension has a levy. Stutsman clarified that this is in addition to their own levy. Horne said that much of the money the County contributes goes towards the County Fair. Thompson said that Extension must also contribute to the Fair, but that’s not the primary use of that funding. Horne said that the State has cut their funding back as well, so they’ve had fundraiser for the 4H youth to be able to participate. He commented that the Extension also gives office space to Big Brothers, Big Sisters, which is one of the County’s United Way agencies.

Recessed at 1:55 p.m.; reconvened at 2:10 p.m.

Public Health Department Director Ralph Wilmoth said that the Board of Health is here at the invitation of the Board of Supervisors to talk about priorities, programs and issues that are pertinent to the budget. The Board of Health introduced themselves as Kelly Donham, Pam Willard, Maureen Connolly, Mary Anne Murray, and Donna Henn. Horne explained to the Board of Health that the Board of Supervisors is in the middle of their regular budget work sessions. This year the Board is reviewing the County budget by service area and today the emphasis is on physical health and education. He said that the Board will be talking about libraries later on and they’ve already talked about some educational groups like the Historical Society. He said that the Board would mostly like to talk about Public Health Programs that are primarily County funded. He said that the Board of Health obviously has many State mandated functions, but the Board is primarily interested in the program the County supports. He said they are also interested in a couple of the Human Service agencies including the Visiting Nurses Association, the Free Medical Clinic and the Elderly Services Agency health component.

Willard said that the Public Health Department Biannual Report lays out program by program the source of funding, how much the County contributes, and defines what the programs are. She said they found this format very helpful as a Board because they are a complex organization with different funding streams and many different programs that can make it confusing. She asked if the Board would like her to address programs that are totally County funded or at least partially County funded. Horne replied that some things have small County funding, but they’re interested in the bigger programs. He said that he and Sullivan had done a review of County services this past summer and they looked at the programs like the Child Health Clinic, Disease Prevention Program and the Wellness Program, which were all largely County funded programs. He said that the Board of Supervisors knows about the State mandated functions including food inspection, well water programs and those types of things.

Willard asked if most of the County funded money for the Maternal Child Health Program is pass through dollars. Wilmoth said that the majority of the Maternal Child Health Program funding comes from grants, Medicaid, fees and donations. He commented that while it is a large number of County dollars, it’s a small proportion of the program’s funding. He said that in FY 01, the program expended $247,000 of which the County contributed almost $60,000. He said if they are looking at proportions it’s a small amount, but if they are looking at the raw dollars, then it’s a fair amount. He added that in FY 02, the total expenditures were $240,000 with the County contributing only $19,000. Stutsman asked who put together this information. Wilmoth said that the Public Health staff put much of it together. Willard commented that it’s an excellent report and Stutsman agreed. Stutsman said that there has always been confusion on the Board as to what’s mandated, what’s County funded, what’s grant dollars and how it all balances out. Wilmoth commented that regarding this report, it is 2 years worth of information in one report since he was not able to get a report out last year since he just began at Public Health. He said that the version he handed out includes dollars and cents in FT information, so it is not the one that Public Health will provide to the Board. He added that they’ll take out the dollars, cents and FT information out because the general public is not interested in that level of detail. He said that this report is for the Board of Health and Board of Supervisors for working documents. He said another attachment that is also included breaks out the funding sources for each program and the funding sources are listed by prominence of funding. He noted that in many instances the proportions of the funding changes from year to year, which contributes to the complexity of the department. Willard said that it is difficult to say what the most important things are that the County contributes to because they may contribute a very small amount, but it may be a very vital amount like in the case of Maternal Child Health Program because of the expectations and requirements of County funding. She said she wanted to point out that when the Board of Health looks at programs, they have to make decisions as to how they prioritize and how they want Public Health’s staff to prioritize things. She said that listed in the handout are the guiding principals as to whether or not to apply for grants and contracts.

Willard explained that the 10 Essential Public Health Services are a guideline that came out from an Institute of Medicine Report in the late ‘80s that stated that Public Health has 3 functions, which are assessment, assurance and policy development. She said that those functions are an over-riding goal for all Public Health Departments because they are nationally mandated. She said the second priority is what is required by Iowa Code or County regulations. She said that the third priority is current Board of Health issues, which are the things that the Board thinks requires attention. She said that these include access to health care because there are many issues regarding who can or cannot get care and the Board of Health wants to be proactive in addressing those. She added that the rural health services or rural services related to health and sanitation are also included in that area. She said the 4th priority is the Community Health Needs Assessment. She added that the Assessment will be repeated in the upcoming years because the State has said they will. She said the 5th priority is the Board of Health’s own strategic plan, which has been a work in progress for about 4 years. She said these are just the top 5 priorities among a whole list of priorities. She said those priorities are going to provide direction. She added that when any agency hears that the State or Federal Government is sending down money, they figure out how to apply for it because there’s always a reason to do programs. She said that Johnson County’s Public Health Department wants to stay more focused than that, so they use these priorities to look at how these RFPs respond to the priorities the Board of Health has set. She said that they have in mind a system that would state the reason for asking for different kinds of funding from any source.

Stutsman asked if the Public Health Department works with the MH/DD Department in dealing with the Community Assessment for Mental Health needs. Wilmoth replied that the most honest answer is not enough. He said that they do some things to try to make sure they’re working together, but they don’t do a very good job of that. He added that MH/DD was involved in the Community Health Needs Assessment. He said that the identification of Mental Health is a very important need but it’s hard for them to make the bridge between the departments with the activities they’re involved in except with their involvement with other community organizations that provide some of those services. He said that mental health is such a focused area and nationally there is a lot of discussion on the link between mental health and other health services. He said when it gets down to the service delivery level it’s hard to get that connection made. He said that they might do referrals back and forth, but it’s hard to make that bridge.

Horne asked the Board of Health to address their fees and added that some fees are limited by the State. He said that the Public Health Department is part of the General Fund, which had a big pinch last year due to low interest rates. He said the County was at the taxing cap of $3.50 per $1,000 of taxable value, and the jail situation is driving costs up and eating away any new growth, so they are trying to lower tax askings anywhere that they can. Horne said that in any department that has fees, the Board has asked them to evaluate fee schedules so that they’re appropriate. Willard replied that the Board of Health has talked about that in their meetings. She said that they think it’s something to look at very carefully, and they would like to raise some fees. Wilmoth said that Public Health spends more tax dollars then what they receive in fees for the Food Safety Inspection Program. Wilmoth said this is a great source of frustration for him as well as others. He said that as the County meets with the legislators annually they need to continue to pursue that. He added that he recently discovered that the Department of Inspections and Appeals doesn’t have a concrete plan to do that this year. He said that he’s expressed his frustration to them about that and they’re having ongoing discussion. He said he visited with Assistant Public Health Department Director Kot Flora about looking at the program and trying to make a fair balance between delivering only the amount of program deliverable for the dollars generated by fees, even though every County that does this in the State of Iowa has said that they can’t do a quality program for the fees that are generated. Wilmoth said that there’s an option to scale back the program to what the fees generate or say the department wants to deliver a quality service and do the best they can to protect the health of the public even if they have to pay County tax dollars for it. He said as time has gone on with inflation, those fees have not increased for 5 years, so the County absorbs every cost increase in personnel dollars. He said that as a County, they would like some flexibility to be able to generate some additional revenue. He said there are a lot of possibilities, but the State Department of Inspections and Appeals is the agency charged with this responsibility and Public Health contracts to do it for them. He said that one of his goals is to push them and the legislature to raise the fees and to give them some additional ability to generate fees. He explained that if an inspector inspects a restaurant or grocery store and they don’t meet all of the criteria and a recheck is scheduled, then if the inspectors have to go back a third time the business should have to pay extra for that. He said if the inspectors have to spend an inordinate amount of time in preparing for an opening of a new facility, then they should pay extra for that. He said the overall program has a set cost, but if there are additional activities, the State needs to give the County the authority to charge additional fees. He said in some instances the Code would allow for it, but the Department of Inspections and Appeals has to pass rules to give the County the structure to do it. Thompson said that they’ve talked about inspection fees for 4 years now and it seems so simple to her to that since they doubled the number of inspections, why didn’t they double the fee as well. Wilmoth replied that the legislature has to approve it and there’s no interest in the legislature in raising fees. He said he can only speak authoritatively from 2 years ago because he was there and it was assigned to committees and subcommittees that had persons with an interest in not getting it onto the floor. Wilmoth explained that it didn’t come out of subcommittees, so it couldn’t go to committee or the floor for debate. He said he had a number of legislators tell him during the spring of 2001 that it didn’t matter what it was, if it involved the increase of anything, they were voting no.

Thompson asked what fees Public Health controls. Wilmoth said that one program is Employee Wellness, but it’s to County employees so there’s a reluctance to charge more than what it costs to provide the service. He said for Wellness they are only paying for the tests the Department sends out. He said the next fee program is the Communicable Disease Follow-up, which has only a limited number of fees, and the majority of those are required by Iowa Code, but they might provide the immunization or some other service that they can charge a small fee for. He said that Senior Health is included, but similar to Employee Wellness, because the fee that they’re charged is for lab tests. Thompson clarified that the fees are for the actual cost of the tests. Wilmoth said that for Clinic Services there are very few dollars generated because that’s not a big program. He said the funeral home, tanning, tattoos, and hotel inspection programs are State programs, so they have no input regarding fees. He said the Daycare Inspection Program, Private Water Wells and Onsite Waste Water programs are County programs, so they can raise fees. He said there’s been a reluctance to do that, but in this current environment he’s asked Flora to look at that. He said there are 3 options regarding raising fees, one is to raise the fees to equal the cost of the program, secondly you can reduce the program services to meet the generated fees or do some combination. He said they are going to look at those options to see if they are doing things they shouldn't be doing unless they charge fees. He said that he is sure that is the case in both programs. He said that Swimming Pool Inspections are State controlled fees. Zoning is a County controlled fee that they can look at to generates some money because it currently brings in very few dollars. He said the rest of the activities they either don’t charge fees or have no control over the fees. He said they are limited to the Environmental Health Programs, which they have started to review to see what they can do. He added that they are also going to see how other counties have addressed this in a dollar per dollar comparison. He said that one thing that is making them hesitate is some people believe that the fees are already as high as they need to be. He said there are many instances where it’s been looked at in other counties, where there is a change in property ownership where these inspections take place and raising the fees is not going to make a difference to the person making the fee. He said that people building new homes say that it will cost an extra $400 to get the inspection done, but for a good portion of those that have never had one done it would just be the cost of doing business. Stutsman asked in what category the Restaurant Inspections fall. Wilmoth replied that they fall under the Food Protection Program.

Neuzil entered at 2:30 p.m.

Stutsman said that the report contains good information to take to the legislature. Wilmoth said that he has taken it to 6 of the County’s legislators. Thompson said that they bring up the food inspections fees everywhere they go and everyone agrees that the fees need to be raised, which is why it is so puzzling that nothing happens. Stutsman commented that for one of the ISAC lobbyists, Bob McQueen, this is a personal issue. She said that he’s concerned from a public health standpoint, because sooner or later there’s going to be an outbreak of some kind. Willard said that it’s a shame that every county is harmed by it, but one lobby organization can outweigh every county. Wilmoth said there are 31 contracts to do food protection activities in the State of Iowa. He said that not all 99 counties do there own, some counties are inspected by a State employee. Wilmoth0 said that in the past Johnson County also inspected Iowa County, but a decision was made not to inspect Iowa County because County dollars were supporting part of the program. He said that the State stepped in and started inspecting Iowa County. Thompson asked if the State charged for the service. Wilmoth replied that the State gets the same fees. He added that some people may express the opinion that the State doesn't do as good a job as the County. He said the interesting piece about how the increase was defeated was that there was only 2 voices opposing the legislation, which was opposed to ISAC and the Iowa Public Health Association supporting it and the Department of Inspections and Appeals supporting it among others. He said that 2 that opposed it were the Iowa Hospitality Association and the Iowa Grocers Association. He said the Hospitality Association was primarily responsible for the defeat. He said the Department of Inspections and Appeals has told him that they have a proposal to change the fee structure but they haven’t presented it and he hasn’t seen it. He said the new structure is linked to the participation in a food safety-training program of which they are beneficiaries. He said he’s suspicious of that approach, but at least it’s being talked about.

Harney asked Wilmoth if the Transient Non-community Water Supply Program to assess non-community public wells included things like inspections for the Poweshiek water that the Board of Supervisors just approved for the Amana area. Wilmoth said the answer comes from how many people drink out of that well on either a daily or annual basis and if it’s over a certain threshold, then it’s a non-community water supply. He said that there are a number of wells like a campground or a park that would fall into that category, where a number of people drink water there, but it’s not the same people every day so it’s called transient. He said that they don’t serve enough people for them to fall under DNR regulations and told Harney that he would look into it for him. Harney said that the Board just approved Poweshiek water to go into the area around the Amana’s where their wells are actually out of Tama County. Wilmoth said that if it is regularly supplying water to a rural water system, then it would be a community water supply, not a transient water supply, so it falls under the DNR regulations.

Stutsman asked if the Board wants to talk about contracts with Free Med, VNA, Chore Services and Elderly Services. Horne said that Elderly Services does the Health component, but they also do other components. He said that Free Med asked for increases this year. Stutsman said that these monies that come from the County go all through the Health Department. Horne said that they provide services for the Health Department. Wilmoth said that the funds don’t flow through the Health Department, the payments go to Horne, but they do report to the Health Department. Horne said that they’re General Basic Block Grants. He said that the County funds them through the United Way and all the County does is set them up on a quarterly payment schedule. Thompson asked if the County has a contract with them. Horne replied that is a question for JCCOG Human Services Coordinator Linda Severson. Thompson asked if the Board of Health reviews them every year. Wilmoth said that they review the reports on a monthly basis as well as the minutes from their meetings and services delivered. Stutsman said that she thought the Board of Health determined how much the County gives to those programs. Horne said that they do. Wilmoth said that the request goes through United Way, both Public Health and United Way hears the request, but it then comes to the Board. Thompson asked what Public Health is recommending for those programs this year. Wilmoth replied that all 3 programs are a critical part of the public health system in Johnson County. He said historically the Health Department has not provided public health nursing services, but it’s contracted with VNA to do that. He said in addition to County funds, VNA also gets money from the State through Public Health. He said that Public Health contracts with VNA to give them some State dollars for public health nursing services and home care aid. Wilmoth commented that Public Health doesn’t have the staff to do that so they literally could not provide those services if VNA wasn’t there. Horne interjected that one of VNA’s problems is with paying insurance customers because they are in competition with Mercy Hospital and others, which has caused some financial stress for VNA. Wilmoth said that there’s a variety of historical factors, but a big issue is that they get compensated less per patient than what it costs them to provide the services, so they use County dollars and State Public Health Nursing dollars to help provide those services. He said the reason the State funds those programs is that it’s been demonstrated that it costs less for somebody to stay at home so the State funds the activities to keep from paying hospitalization care or long-term care.

Willard said that historically, until the mid-80’s hospitals and private agencies weren’t doing home care, so it was all volunteer organizations like VNA. She said when Medicare started paying for more home care and length of stay was shortening due to DRTs coming in, it was seen as another revenue stream for hospitals and other private agencies. She said a law came down that stated that all options for home care must be given to hospitalized patients. For example, someone in Mercy is given the option of having VNA or Mercy nurses come visit for home care. She said VNA has been hurting for a long time because they always get the lowest paid option, but since 1949 they’ve been doing an incredible job with the neediest people regardless. She said the VNA helps the Board of Health assure that those who need care can get it regardless of ability to pay. She said that comes out of County dollars, but the Board of Health thinks it’s vital. Wilmoth pointed out that one of the places they don’t get adequate compensation is with mental health patients because those dollars come from the State and they’re set by a contract agency that administers those funds. He said that every year they’ve addressed additional funding with that agency, but each patient gets X numbers of dollars regardless of number of visits. He said because they’re the organization they are, they’re not going to let patients go without care. He said that since they’ve been struggling financially, they hired a financial consultant to come in and give them direction, which has helped their financial situation improve monthly. He said that they’re making adjustments and have been able to negotiate more compensation in some instances. Stutsman clarified that both State and County dollars go into VNA. Thompson said that their whole budget would be in the United Way book.

Neuzil asked if the Board traditionally rubberstamps the requests from these organizations. Horne said that the Board traditionally follows the recommendations from the Board of Health. Thompson said that last year they didn’t. Horne commented that last year everyone was cut. Wilmoth said that pages 8 and 9 show the amount of State dollars that go to VNA. He said that there are two listings; one with services provided and the second is actual dollars spent. He said that most of the money went for public health nursing, $45,000 in FY 01 and $48,000 in FY 02. He added that home care aid was the majority of the dollars in FY 01, $125,000 and FY 02 $196,000, but that’s the State dollars that are passed through the County from the State. He said the amount passed through has gone down every year for the past 3 years. Thompson asked since they got more revenue than expenses for the grant if the difference went towards administration. Wilmoth replied that they bill Public Health for their services and then Public Health compensates them back, which takes about 2 months, so across budget years sometimes they get more or less dollars than they pay out, but over time it equals out. He said that every year VNA spends all the dollars that are available, so it’s just dependent on the billing time. Horne commented that the 3 organizations didn’t ask for large increases this year. Wilmoth said that they didn’t except Elder Services, which he would address.

Wilmoth said that the Free Medical Clinic also provides services that are not provided in the Health Department because they don’t have the staff or facilities to provide those services. He said as an example, the Health Department does not have a sexually transmitted disease clinic, so when they have a patient that calls about that service, they refer them to Free Med. He said if Free Med wasn't there, then they couldn’t make that referral. He said one of the Board of Health’s priorities is access to health care, so they have to have someone in the community to provide care to people that don’t have funds. He said that there is a myth that anyone can go to the University and get care. Thompson commented that it used to be true. Wilmoth said it did, but there are financial qualifiers and also people have to meet certain criteria for services. He said one of those criteria is the issue of whether or not that person will not survive if they are not cared for immediately. He said that every hospital is under the restriction that if someone comes to them with an urgent life threatening circumstance, then it must be addressed, but beyond that they do not have to provide health care to anyone. He added that the State Papers Program is a program where if someone meets the criteria and the funds are available, then they can get services. He commented that one situation that comes up is when someone with an insurance policy has pre-existing exclusions so that they are employed with a good policy but at the time they were insured they had a pre-existing condition, which is true of almost every insurance policy. He said a similar situation is when a person’s insurance policy only covers certain situations and they are underemployed to the point where they don’t have the resources to pay for expensive medications particularly in chronic illnesses. He added that the Free Medical Clinic is seeing approximately 30% of its patients who have chronic illnesses. He stressed that it’s a vital service to the community and it’s an efficient way to pay for those services.

Wilmoth addressed Elderly Services, calling it a safety net program that provides services to the community. He said that the programs are not all safety net programs because they provide a lot of different services, but for many of the programs they provide, no one else in the community is providing similar services. He said they have a lot of programs that target the aging population, although he doesn’t know what the current definition is of aging population. He said in their request this year there is an additional $25,000 because they assumed the Senior Dining Program responsibilities. He said if the Board pulls that out of the request, then they are very inline with other requests only asking for an additional 3% to 5%. Horne commented that the Senior Dining portion of the request is in the Elderly Services block grant, not in elderly health.

Willard said that the Board of Health appreciated being asked to have this hour and they would like to meet a couple times a year, instead of only during the budget season. She reiterated that Public Health is a complex organization and that they’re helping to provide essential services to the County, so they want to be understood and have a good dialog with the Board. She said that there’s been some smoke and mirrors in the past, but they want to be transparent with the Board. She would welcome a meeting just to have a dialog to hear what the Board thinks is important or things that they should be focusing on more. Stutsman said she thought this was a great idea and commented that the report helps.

Stutsman asked about expenditures for bio-terrorism. Wilmoth replied that the report only covers FY 01 and FY 02, and while the Department has started talking about bio-terrorism, they have yet to receive any funds for it but there will be a section addressing it in the FY 03 report. Several members of Wilmoth's staff has been going through a training activity at the University of Iowa to give them a some additional information regarding how to work in the community with this issue. He added that he was one of the facilitators for that program as well. He said that the Department needs to be prepared for different circumstances that might arise and the way to do it is to plan collectively as a State. He added that they also have a 14 County Regional Planning Group and he has an upcoming meeting to discuss how the counties involved want to conduct their business. Stutsman asked if he is expecting Federal dollars to pay for those initiatives or if it’s something that will be supplemented by County dollars. Wilmoth said that right now County dollars are paying a portion of the cost. He said that the Department has a contract for $18,008 dollars, which is 2/10 of 1% of what the State received. He said that they’ve already spent more time than what those dollars will pay for. Wilmoth said that because his salary is a fixed cost, he went to represent the County in 99% of those meetings and activities so it will not cost the County any additional dollars. Harney asked if the $18,000 came through the Department of Homeland Security. Wilmoth replied that it came through the CDC's bio-terrorism grant. He added that over $6,000 of the $18,000 is to distribute materials relating to bio-terrorism activities, disease reporting and surveillance to health care professions in the County. He said that it is very doubtful that they will spend all those dollars, so they won’t receive the full benefit, which is a great source of frustration to every county as well as the State. He said to illustrate that idea, with the small pox vaccine effort that is currently underway, when the first 1,000 First Responders are vaccinated in Iowa, it will cost over $400,000 of State dollars and if it goes further they haven’t even identified the cost. He said the cost will be tremendous and the State will have to bear it. He said the Federal Government is providing the vaccine and some training, but the majority of the cost is in sending staff out to the site to do the vaccinations and the follow-up activities. Willard commented that there is also a lot of talk about the wisdom of it in the first place. Harney commented that a similar thing happened with the Homeland Security Dollars, where a lot of it was supposed to go to the counties, but it’s been intercepted by the State and been used in other ways. Wilmoth said that the request for next year’s bio-terrorism dollars is due in May and he’s done everything he can to express his concern about being involved in that process, so that they can make sure that counties can get funds to meet the requirements they’re obligated to meet. He said that he went with 4 other representatives of the Iowa Association of Local Public Health Officials to meet with the Governor’s Chief of Staff, Dr. Gleason, and pointed out that they need adequate funds to do their jobs at a county level.

Willard noted that Wilmoth has been an outstanding spokesperson by taking messages to the State level, to the Governor’s Office and Chief of Staff, to the Public Health Department. She said that Wilmoth also has the perspective from working in the State Health Department, so that he understands the issues on both sides and has been forceful in making the County’s case in a reasoned way for why they need to be aware of the needs of public health. She said that just anybody won’t be able to fill the opening as the Director of the State Health Department and there are some important decisions coming down the pipe. She said that the Board of Health is proud to have him. Donham said that one of the concerns the Board of Health has with the State Health Department is that there hasn’t been a "public health" person in the position for the last several years. He said they’re now in the process of selecting a new State Public Health Department Director. He said that they’re hoping that they will hire a public health person that really understands all the complexities of how the different programs fit together with the funding. He said it’s important to have a public health person who has empathy and understands what it’s all about. He commented that one of the concerns he’s had in his 6 years on the Board of Health is in sorting out how all the different programs and funding streams come together. He said that with Wilmoth in charge and since they’ve devised a matrix form so that they can put the programs in the right box of where the funding streams come from, it helps them the Board of Health to make decisions regarding whether or not programs are worthwhile. He said the other thing is with programs having 50% of the total budget coming in from outside, so if they hire someone and that funding stops, will the County have to pick it up. He said that is a concern of the Board of Health and this way of looking at where funding streams come from will help them keep better track of that. He said that in this time of budget concerns, they’re trying to keep an eye on that.

Donham asked the Board of Supervisors what type of cut they were currently expecting for the Department of Public Health. Thompson said that the Board of Health was conservative in their requests, which they appreciate. Neuzil said that they anticipate that the growth in Johnson County will only cover employee health insurance. Horne said that the health insurance will go up another 10%, but the growth will cover the Jail costs. He said that the Board won’t have the same situation it had last year running into the caps, but there is an issue with overall taxation levels. He said that there are items that are increasing that the Board has no control over like Juvenile Detention and Shelter Costs. Neuzil said that in a nut shell, the Board might not have enough to pay employees without raising taxes. Horne said that the Department of Public Health, along with many other departments, have bargaining union employees and those COLAs are being negotiated currently. He said that he’s starting to crunch the numbers for the overall budget and the Board will start deliberations on that next week. Harney said that the Health Department is a very important part of County Government in serving the needs of the community. He said that Public Health’s budget is conservative and the Board will probably look at that pretty positively as far as meeting the needs without large inflation. He said that from his perspective, if they can hold their own they’ll be doing well. Stutsman said that having such a clear report is to the Department’s advantage because now the Board has a clear picture of where the Department is going and does away with the question of where these services are appropriate.

Recessed at 3:10 p.m.; reconvened at 3:15 a.m.

Horne said that since they had already began the discussion on libraries earlier in the meeting they would reiterate what they’ve discussed. He said that this year public library funding requests increased around $30,000 and if approved, County funding for libraries this year would increase to $463,000. He said that this year the Board also received a new request from Tiffin. He commented that the Board only has one library contract in place with Iowa City. He said the other libraries, North Liberty, Solon, Coralville, follow the model of the Iowa City contract, while Oxford and Tiffin are requesting a flat level block grant. He added that Oxford is requesting $7,000, which is the same as last year and Tiffin is requesting $4,000 or $5,000. He commented that under Code each County within the unincorporated area of the County shall levy a tax of at least $.06 and 3/4 per $1,000 of assessed value on taxable property, which is about $65,000 total. Horne said in FY 03, the Board gave $430,000 to libraries. He said that this area has notably increased over the last few years; Solon especially, which went from $46,268 in FY 02 to $56,795 in FY 03 to $64,018 this year. North Liberty Public Library Director Dee Crowder said that Solon is a special case because 2/3 of their patrons are rural. Horne said that Iowa City has grown from $270,000 in FY 02 to $298,000 for the FY 04 budget. He said that from discussing it before, Solon’s total operational budget is $100,000 and the County is paying $400,000. Thompson said that the County is paying $62% of their budget.

Horne said that the main issue is the shrinking rural tax base in the County because the towns are expanding, but at the same time the costs for the libraries are continually increasing. Neuzil said that one of the big problems is that the library money comes from the rural tax base, which is shrinking so it becomes more of a percentage increase in taxes. He said that the Board has to then tell rural people that their taxes are going up significantly. He commented that if they drew out of the General Fund, it would be easier to accommodate. Crowder said that she understands that, but on the other hand the rural residents must be using the libraries more because their percentage has gone up. She said that it seems like there’s more rural people using them whether there’s less people in the tax base or not. She said that in asking their patrons, she didn’t think they would object to a slight increase in taxes. Neuzil said that the other problem comes from the way the Rural Fund can draw money, which means people that live in very nice homes in the rural area pay the same amount as someone that lives in the rural areas without a nice home but they’re in the same category. Thompson said also that the Board works very hard to keep taxes low on rural people because they’re farmers and agriculture is still important to Johnson County, which means that the half million dollars hours in the North Corridor pay the same tax rates. She explained that the most needy and the least needy fall together, which is a dilemma the Board doesn’t have a good way to address. Harney said that there’s a difference between rural ag residential and rural residential. Horne said that the 2 are classified as different, but they’re taxed the same. Stutsman said that the patron Crowder mentioned that probably wouldn’t care to have their taxes raised because they’re using the library is not the same patron the Board deals with. Crowder said that she isn’t sure about that because she’s asked a variety of patrons. Stutsman added that Neuzil and Harney went to the Farm Bureau Monday night and they didn’t say anything about raising the rural side of the budget. Harney said that they did, but not as far as libraries. Neuzil said that no one on the Board wants to be anti-library, so that’s not what this is about. He said that when he and Horne had met with the group it was to ask how to control a situation where the tax base is decreasing, but the libraries’ costs are increasing. He said they posed a question to the libraries to ask them to help come up with a system or the Board will have to, that the libraries won’t like as well.

Iowa City Public Library Board of Trustees Vice President Shaner Magalhaes said that while they were discussing it amongst the Iowa City Public Library Board of Trustees, there’s been some confusion about whether this is going to be a big issue for FY 04 or if it’s something they are starting to discuss now for the future. Neuzil said that looking at their budget, there’s not going to be a lot of room for movement other than paying for employees. He said that he would like to think that this is something that everyone needs to work on and it will be a gradual change. He added that last year there was an 8% increase and next year it will increase 4 to 5% when the County only has 1 to 2% growth. Stutsman said that Horne made a good point, where the Board started out with a contract with the Iowa City Library and at that time nobody foresaw the increases in size with the other libraries. She said that the Board wants to treat everybody fairly, so they treated everyone like Iowa City. She said that the Board isn’t part of the discussions amongst the libraries to begin building projects, but maybe they should be so that they can say that if the library is going to be expanding that they need have an agreement on how to handle it in the future. She said that the Board has always been supportive of libraries and community resource centers, which is what these libraries have evolved as, but the Board is alarmed at what this is starting to cost. Harney said that for example the population of Solon is about 1,000 and their library has grown to over 5,000 users. He said that although there’s a lot of growth in that area, one would think that in the computer age they would be obtaining information from home, but they are still using a lot of books. He said that the Board wants to support the libraries, but they are only required to give $65,000 while they’re currently contributing $433,000. He said that it’s a lot of money and although it’s going to a good purpose, he isn’t sure how the Board can balance it with the budget situations they’ve had in the past few years.

Neuzil said that Coralville and North Liberty will be expanding, Iowa City will have higher usage once it’s completed, Tiffin is being added and Swisher might be added in the future. He said that it’s just another piece of the pie. Harney said that when the libraries expand the Board doesn’t see it lower usage in any other areas, like when Solon’s usage increased to 5,000 it didn’t decrease in Iowa City or North Liberty. He said it just seems to be a lot more demand. Iowa City Public Library Board of Trustrees Member Linda Dellsperger commented that the more attractive a library is, the more users there will be, which isn’t necessarily a bad thing. She said that then the libraries are reaching more people by enticing them to come into the new facility. She said that over the last quarter circulation at Iowa City was up 6% even with all the construction. She said that Harney is right that people can get information online, but it goes to show the power of the resources in a library and how they're used. She said that people still want to hold the book or check a reference book that’s only available at the library. Iowa City Public Library Assistant Director Elizabeth Nichols said that the facilities are being used as community centers as well, so not only checking out materials, but using meeting rooms, so it becomes a great public resource in many respects. Neuzil said the Board can’t have 8% increases in taxes and asked how to pay for the increased circulation.

Magalhaes asked for clarification on whether part of the funding problem comes because now the rural fund is being used to cover other areas as well. Stutsman said that the Board keeps looking for other things to move into the Rural Fund since they aren’t at the maximum levy. Harney said that roads need more repairs as well and that also comes out of the Rural side. He asked Horne how much a 1% increase amounts to in increased taxes. Horne replied that in the FY 03 budget, an increase of $100,000 in spending is an increase of 3.3% for an ag dwelling. Horne said that adding a bridge is $70 to $80,000 so adding 2 or 3 of those to the budget causes the taxes to skyrocket. Horne said that the Board is mandated by the State to tax for Secondary Roads primarily through the Rural Fund for Secondary Roads, which amounts to approximately $2 million a year based on the tax base. Neuzil said that there will be many Farm Bureau members attending the meetings when the Board starts talking about adding anything to the Rural side of the budget. He said that’s why the Rural Fund has only a few things that are allowed to be funded out of that fund. Nichols said that it’s appropriate that the libraries are part of the Rural Fund because if it was paid for out of the General Fund there would be double taxation on city residents when there is already a large per capita support on the City side.

Horne commented that another issue is that Solon’s total budget is $103,000 with a nice library, so if the Board is paying some $400,000, the County could basically fund 2 of those as a County library, one in the north and one in the south. Neuzil said that Scott County actually did that. Magalhaes said that it doesn’t take into consideration the money to build a facility to begin with. Horne agreed, but the operational cost year after year would be less if the County ran 2 libraries. Stutsman said that would just aggravate the problem. Neuzil said that the Board isn’t interested in doing it. Crowder said that although Scott County might have done it, it doesn’t mean that it would be feasible in other counties. Thompson said that while the Board might be able to afford one in the north and one in the south, now they have many libraries spread throughout the County.

Neuzil asked how the Board and the libraries can control the situation because the alternative is to start to cut. Stutsman asked where the Board is today. She said if the Board makes changes, they need to have a thorough discussion, which they won’t have done by the time they need to certify the budget. Stutsman said that she thinks the Board is committed to the requests and Neuzil agreed, but said that this is probably the last year the current system will be in place. Nichols asked when the Board would start talking with libraries then. Stutsman said they would begin right after they finished the budget. Nichols asked if there will be a taskforce. Stutsman replied that a taskforce is what she would envision. Crowder said that with the expansion of the North Liberty Community Center, not even thinking 3 years from now in expanding the library, she is anticipating a huge increase in library usage just with the expansion of the building next year. She said the rural people she’s talked to and even some that don’t use the library very much but use the building, know that they’re getting a good deal because they’re not having to pay as much in taxes for the use of that building as the people who live in North Liberty are having to pay. She said that she knows that is different and she doesn’t know how much of an increase they would accept, but she doesn’t think rural residents would object. She said that’s just representative of the people she’s talked to though.

Harney said that a lot of the rural residents who look at the libraries see a good cause and want the usage out there for the community, but on the other hand as Horne's example showed, the increases have a large effect on a rural farmer. He said another example is the County’s park areas where Graves is doing a great job making them more usable, but he has not had an additional staff person since 1986. He said that Graves is asking for help and his machinery is wearing out, but if the Board starts raising for Graves and the libraries, the rural tax increase has a large effect. Crowder commented that the Board is between a rock and a hard place. She said they took some of the things they had discussed with the previous meeting with the Board and discussed them with her library board who weren’t thrilled with any of the suggestions, but also couldn’t come up with good solutions either. She said that’s why a taskforce is needed. Neuzil said that he thought that what might happen is the Board will have to cap the amount of money spent and then the libraries will have to come up with a way to make it fair. Dellsperger suggested including representatives from the cities on the taskforce. She said she doesn’t understand the Solon process, but it seems odd to her regardless of the mix of users, that the County is funding half of their operational costs. She asked why Solon isn't paying more. Thompson replied that the Board takes rural circulation as a percent and then the Board takes that percentage of the operating budget. She added that Solon bore the full cost of the building project, but more then 1/2 of their users are rural. Harney said it just goes to show that the Board needs to come up with some sort of a formula that’s equitable for everyone. Dellsperger said she doesn’t want to have the taskforce so large that nothing gets done, but there are a lot of players involved.

Neuzil said that asking if rural people enjoy libraries is one thing, but asking a rural person if they want their taxes to go up 7 to 10% is another. He said that the proportion goes up because it’s a smaller amount of people, which is getting even smaller and smaller and the Board doesn’t want a large amount of growth in the County. Crowder said that it is amazing that the libraries have more and more usage with less and less people living in the County. Library Board of Trustees Member Pat Schnack said that in hard times, it’s been shown that library usage has gone up. Neuzil commented that the Board may need the County Attorney’s help, but they have to have contracts in place. Neuzil reiterated that he just sees a certain amount of money being given and the libraries having to divide it up. Horne commented that the Board can actually set a levy amount. Stutsman suggested putting it on the Board’s agenda to talk about forming a taskforce, who will be on it and how they will recruit people. Horne asked when they wanted it to appear. Neuzil replied at the end of March. He said the whole idea is to get a team so that the libraries are all a part of the decision. Magalhaes clarified that one or more Board members will be involved with the taskforce. Neuzil said that what’s important for the taskforce is that they understand balance, not just the need.

Lehman entered at 3:40 p.m.

Dellsperger asked if it’s true that the Board is looking at a $75,000 deficit in the Rural fund. Stutsman said the Board is only in the preliminary stages of the budget and once the Board knows what it wants to include then Horne comes back with what the impact and tax askings will be. She said that then they start looking at how to get to the level they want to be at. Magalhaes said that they’re hearing that overall the library portion will stay consistent. Stutsman said she hopes so. Lehman commented that the General Fund levy is limited, but the Rural is not, but the increases are large so the Board needs justification. He said that at looking at the Iowa City Library the County is getting a good deal with what they pay compared to the total. Neuzil said the numbers aren’t as high as he thought they’d be since they saw an 8% increase last year. Horne said that there’s about a $30,000 increase in library funding and the biggest increase is in Solon. Stutsman promised to be in touch regarding the taskforce.

Horne reported that the next budget work session will cover Social Services, Inter-Program Services and Human Resources. He said that he will give the Board the worksheet on Tuesday and they have a tentative meeting for Wednesday at noon, but the Board will probably tell him to make changes. He said they may need to schedule more meetings because he’ll have to redo the worksheet several times and then represent to the board each time. Horne said that they know what the COLAs will be. He said that on the 20th during the Board regular meeting, he wants to set the public hearing, which he wants to be on March 4th. Neuzil said that Monday the 3rd, Tuesday the 4th, Wednesday the 5th, Monday 10th, and Tuesday the 11th, they have budget meetings scheduled.

Adjourned at 3:50 p.m.

Attest: Tom Slockett, Auditor

By Casie Parkins, Recording Secretary