Kentucky health departments make severe cuts to services, staff

Kentucky workers will be faced with deepening austerity on July 1, as budget cuts beginning in the new fiscal year will affect health departments throughout the state.

The budget cuts will take the form of layoffs, reduced services, and furloughs in health departments that are already strapped for cash. Kentucky Health Department Association President Linda Sims suggested that many health departments will have to furlough, “reorganize staff” or raise taxes to make up for the cuts. In an interview with the Lexington Herald-Leader, Sims argued that the coming fiscal year will be the toughest in recent memory for the state’s public health infrastructure.

The recession has seen tax revenue for many health departments decrease. The minimum tax for county health departments is 1.8 percent, with some counties as high as 4 percent. Health departments in the state are independent organizations with only partial government association, and thus receive only a portion of their operating budget from tax revenue.

Kentucky’s public health infrastructure was already struggling to meet mandated services on a pittance. The cuts will have far-reaching consequences, the likes of which are difficult to measure. Among the possible negative outcomes are a further rise in preventable disease, outbreaks of food-borne illness, and—compounded by the broader economic crisis—public health disasters with possible international implications.

County and district health departments are integral to a healthy society, as they improve and monitor public health, track sexually transmitted diseases, monitor infectious diseases, perform cervical and breast cancer screenings, and even investigate dog and other animal bites. Furthermore, employees inspect restaurants, pools, hospitals and hotels to ensure cleanliness.

The irrational funding formula for the state health departments will become more cumbersome, with counties like Anderson and Franklin—which have a higher percentage of low-income workers who are uninsured—suffering the most from the cuts.

Fayette County Health Department—which has over 10 separate sites and serves a population of almost 300,000—will be losing 25 employees and likely a reduction in its modest $26 million annual operating budget. Other counties that will suffer from the cuts include, but are not limited to: Franklin County, whose 74 employees will be made to take 12 furloughs days in the upcoming fiscal year; and Anderson County, which will cut the workweek from 37.5 hours to 34.5 hours.

The Knox County Health Department has already cut back to a four-day workweek. “It has affected us, and it’s the budget cuts that’s the culprit,” Knox County Health Department’s Director Susan Liford told the Corbin Times Tribune June 25. “We’re getting $600,000 less in the budget for this (fiscal) year. That’s the story everywhere. The office hours are what the public will see first. For us, instead of laying people off, we’re going into a mandatory furlough, agency-wide, starting Monday.”

Lake Cumberland District Health Department (LCDH), which serves 10 counties in southeastern Kentucky, has lost $4 million during the last two years, as retirement and insurance costs have increased, and state funding has decreased. Services have decreased as well, such as diabetes prevention classes.

Christian County has lost 10 positions in recent years and is faced with another 2 percent funding cut this fiscal year. Mark Pyle, director of the Christian County Health Department, remarked, “funding doesn’t cover the core public health services designed to provide health outcomes.”

“Christian County has a high underinsured/uninsured population, low primary care physician to patient ratio and high instance of chronic disease,” Pyle said. “Yet our funding streams don’t provide for the level of chronic disease services we need in our community.”

Counties with extreme poverty rely more heavily on Medicaid and Medicare, which are federal health insurance programs for the poor and elderly respectively. Kentucky was one of a number of other states that recently privatized the management of Medicaid, a move aimed at shrinking the rolls and cutting back on costs.

CoventryCares, one of the four managed care companies in the state, has made efforts to clear out of many counties in the state. This plan has been halted for the time being by a federal court order until November 1 of this year. Nonetheless, reimbursement rates have plummeted under managed care.