2006 Community Health Services
System Expenditures Summary Report
Introduction
The following report summarizes the results of 2006 expenditures information for
the Community Health Services (CHS) System, which is submitted by
Minnesota’s local health departments to the Minnesota Department of Health.
Local health departments categorize expenditures into funding sources and areas
of public health responsibility. Funding sources refer to local tax levy, other
federal funds, Medicaid, other local funds, LPH Act state funds, other state funds,
other fees, Medicare, Title V funds, TANF funds, client fees, and private
insurance. The areas of public health responsibility refer to health services,
healthy communities, environmental health, infrastructure, infectious disease, and
disaster preparedness. Complete explanations of the funding sources and areas of
public health responsibility are in the appendices A and B.
In 2006, there were 75 local public health reporting entities (referred to in this
report as local health departments) in Minnesota. Local health departments are
organized into 53 Community Health Boards (CHBs). CHBs decide for
themselves the jurisdictional level at which they will report their data. For
examples, a multi-county CHB could have each county in the CHB report as an
individual county or could choose to report collectively as one CHB. Of the 75
local health departments: 28 are single-county CHBs, 9 are multi-county CHBs,
34 are single counties within multi-county CHBs, and 4 are city CHBs.
The CHBs are split into geographic regions that are used for analysis. Appendix C
contains a map of the regions.
The analysis is based on the 75 local health departments, except for the per capita
staffing analysis. The lowest unit of per capita analysis used in this report is the
county level, therefore the four city CHBs (Bloomington, Edina, Minneapolis, and
Richfield) were calculated as part of Hennepin County.
The report is broken down into three sections:
• Statewide results
• Regional comparisons
• Conclusion
The appendices include:
• Areas of Public Health Responsibility
• Definitions of the Funding Sources
• Map of the CHS System
2006 Community Health Services System Expenditures Summary Report
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Statewide Results
The CHS System spent $294 million ($56 per person) in 2006. This represents a $7
million or two percent increase in expenditures from 2005. The single largest funding
source was local tax levy, accounting for almost one third of all funding (Figure 1).
Medicaid funds accounted for 13 percent of expenditures. The LPH Act state funds
(formerly referred to as the CHS subsidy) accounted for seven percent of all funding.
Figure 1. Funding Sources of the CHS System
Funding Source
Dollars (in millions)
Percent of Total
Local Tax Levy
$94.7
32%
Other Federal Funds
$50.2
17%
Medicaid
$37.2
13%
Other Local Funds
$31.8
11%
LPH Act State Funds
$21.6
7%
Other State Funds
$20.5
7%
Other Fees
$11.1
4%
Medicare
$7.5
3%
Federal Title V
$6.2
2%
Client Fees
$4.1
1%
Federal TANF
$3.5
1%
Private Insurance
$3.2
1%
Total
$294.0
---Almost two-thirds of total funding for the CHS System came from locally generated
funds, including reimbursements and fees for services, local tax levy, and other local
funds (Figure 2). State funds accounted for 14 percent while federal funds accounted for
20 percent of total funding.
Figure 2. Funding for the CHS System
(Aggregated by Major Funding Sources)
Federal Funds
20%
State Funds
14%
Locally Generated Funds
66%
2006 Community Health Services System Expenditures Summary Report
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Figure 3. LPH Act State Funds, Local Tax Levy, and Medicaid as a
Percent of Total CHS System Expenditures (1983-2006)
40%
Percent of Total Expenditures
35%
30%
25%
20%
15%
10%
5%
5
4
3
6
20
0
20
0
20
0
1
0
2
20
0
20
0
20
0
20
0
8
7
6
9
19
9
19
9
19
9
4
3
2
1
5
19
9
19
9
19
9
19
9
19
9
9
8
7
0
19
9
19
9
19
8
19
8
5
4
6
19
8
19
8
19
8
19
8
19
8
3
0%
Year
LPH Act State Funds
Local Tax Levy
Medicaid
Figure 3 shows the trends of three funding sources as a percent of total expenditures. The
LPH Act state funds have decreased as a percentage of total expenditures overtime. Since
2004 those funds have comprised seven percent of total expenditures.
The local tax levy, as percent of total expenditures, has generally fluctuated between 35
percent and 25 percent, with one extreme outlier in 2002. In 2002, there were cuts to
local governmental aid, which may have accounted for the decrease in local tax levy
allocated to local health departments (LHDs).
In 2006 Medicaid accounted for 13 percent of total expenditures. In 1983, the first year it
was tracked, it was eight percent of total expenditures and has fluctuated between 13 and
19 percent over the past decade.
The LPH Act state funds and local tax levy are “flexible funding,” meaning that these
two funding sources are not associated with specific contractual requirements, categorical
grants, or reimbursements. Figure 4 shows the proportion of flexible funding has
decreased from 52 percent in 1972 to 40 percent in 2006. After dipping to a low of 26
percent of total expenditures in 2003, flexible funding has been increasing to levels seen
in the late the eighties.
Figure 5 compares the funding of Minnesota to the findings of a national survey of local
health departments conducted by the National Association of County and City Health
Officials (NACCHO) 1 in 2005. Minnesota expenditures are comparable to the national
averages with differences occurring in state direct funding, Medicaid, and local tax levy.
1
2005 National Profile of Local Health Departments, National Association of County and City Health
Officials, July 2006.
2006 Community Health Services System Expenditures Summary Report
Page 3 of 17
Figure 4. Flexible Funding as a Percent of Total
CHS System Expenditures (1979-2006)
40%
35%
33%
33%
38%
38%
37%
36%
36%
35%
33%
35%
37%
36%
37%
30%
26%
Percent
40%
35%
43%
41%
44%
43%
50%
41%
48%
47%
49%
51%
52%
52%
60%
20%
10%
6
20
0
5
20
0
4
3
20
0
20
0
1
2
20
0
20
0
0
20
0
9
19
9
8
19
9
7
19
9
6
19
9
5
19
9
4
19
9
3
19
9
2
1
19
9
19
9
0
9
19
9
19
8
7
8
19
8
19
8
19
8
6
4
5
19
8
19
8
2
3
19
8
19
8
1
19
8
0
19
8
19
7
9
0%
Year
Figure 5. Comparison of Sources of Local Health Department Funding
Between Minnesota and NACCHO Results
35%
32%
30%
29%
NACCHO Report (2005)
Percent of Total
25%
Minnesota (2006)
23%
20% 20%
20%
14%
15%
13%
12% 12%
9%
10%
6%
5%
2%
5%
3%
0%
Local
Government
State Direct
Federal (Direct
& Passthrough)
Medicaid
Medicare
Fees
Other
Type of Funding
2006 Community Health Services System Expenditures Summary Report
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Figure 6. Total Expenditures by Local Health Departmants in Minnesota
Number of Local Health Departments
35
29
30
25
21
20
15
10
7
7
7
5
2
1
1
0,
00
0
6,
50
$
>
$
5,
50
0,
00
0
-$
6,
50
0
,0
00
5,
50
0,
00
-$
0,
00
0
$
4,
50
0
3,
50
0,
00
$
$
2,
50
0,
00
0
-$
-$
4,
50
0
3,
50
0
,0
00
,0
00
,0
00
2,
50
0
-$
0
1,
50
0,
00
$
$
50
0
,0
00
<
-$
$5
1,
50
0,
00
00
,0
00
0
0
Total Expenditures
Figure 6 shows that 36 LHDs (48 percent) had total expenditures of less than $1.5 million
and that 57 LHDs (76 percent) had total expenditure of less than $2.5 million. The
median total expenditure was $1.6 million, a slight increase from 2005. Total
expenditures ranged from $180,000 to $76 million with the smallest one-third of LHDs
accounting for six percent of total the CHS System expenditures. The largest LHD
represented 25 percent of total expenditures of the CHS System. Five of the six LHDs
with the greatest total expenditures were in the metro region.
2006 Community Health Services System Expenditures Summary Report
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Figure 7. Per Capita Spending by Local Health Departments
25
22
Number of Local Health Departments
21
20
15
15
10
5
5
4
4
0
< $20
$20-$40
$40-$60
$60-$80
$80-$100
> $100
Per Capita Spending
Figure 7 shows per capita expenditures by LHDs. Twenty-six LHDs had per capita
expenditures less than $40. Per capita expenditures by LHDs ranged from $12 to $186,
with a median per capita of $51. The four LHDs with per capita expenditures greater than
$100 all provided home health services to smaller, more rural populations.
Figure 8 shows the dollar amount and percent of total expended in each area of public
health responsibility. Each area of public health responsibility was funded through a
different mix of funding sources. Brief funding summaries for each area of public health
responsibility are described below.
Figure 8. 2006 Expenditures by Area of Public Health Responsibility
Area of Public Health
Dollars
Percent of Total Spending
Responsibility
(in millions)
Health Services
$123.0
42%
Healthy Communities
$74.5
25%
Environmental Health
$40.0
14%
Infrastructure
$28.5
10%
Infectious Disease
$13.7
5%
Disaster Preparedness
$13.6
5%
Total Spending
$294.0
-----
2006 Community Health Services System Expenditures Summary Report
Page 6 of 17
Health Services
Expenditures in the area of health services were by far the largest, totaling $123 million.
Health services expenditures were supported by local tax levy (35 percent) and Medicaid
(24 percent). Eighteen percent of spending was on home health services. It is important to
note that one local health department expended over $50 million dollars in health
services, accounting for 43 percent of overall expenditures and 43 percent of the
Medicaid dollars spent in the area of health services.
Healthy Communities
Almost $75 million (25 percent of total expenditures) were expended in the area of
healthy communities. Of that $75 million, over one quarter ($21.1 million) came from
other federal funds. All but five LHDs used other federal funds to support these activities.
Healthy communities was funded by a wide range of sources including local tax levy (22
percent), LPH Act state funds (11 percent), other state funds (10 percent), Medicaid (9
percent), and other local funds (7 percent). Nearly all health departments (96 percent)
used some LPH Act state funds to support healthy communities.
Environmental Health
Almost 14 percent of total expenditures went toward environmental health. Other local
funds supported 40 percent ($16 million) of environmental health expenditures. Other
funding sources included local tax levy (26 percent), other fees (19 percent), and other
state funds (six percent). It is important to note that one LHD represented 45 percent of
spending in this area, accounting for 90 percent of the other local funds. Another LHD
represented 18 percent of spending, accounting for almost 50 percent of local tax levy.
Seven LHD had no spending in the area of environmental health.
Infrastructure
Slightly less than 10 percent of total expenditures were in the area of infrastructure. Of
the $28.6 million expended, most (72 percent) was funded by local tax levy. Eighty-three
percent of LHDs used local tax levy to fund infrastructure. The remaining funding
sources included LPH Act state funds (19 percent) and other local sources (five percent).
Sixty-six of the 75 LHDs (88 percent) used LPH Act state funds for infrastructure.
Infectious Disease
Nearly five percent ($13.7 million) of total expenditures were in the area infectious
disease. Other federal funds supported 40 percent ($5.4 million) of infectious disease
spending. Other funding sources included local tax levy (22 percent), LPH Act state
funds (12 percent), and client fees (eight percent). It is important to note that one LHD
accounted for 40 percent of infectious disease spending and accounted for 93 percent of
the other federal funds in infectious disease.
Disaster Preparedness
Disaster preparedness represented the smallest amount of funding per area at $13.6
million, or less than five percent of total expenditures. Almost 60 percent ($8 million) of
funding was from other federal funds. Federal preparedness and pandemic flu planning
dollars comprise the majority of other federal funds. The remaining funding came from
other state funds (14 percent), local tax levy (12 percent), and other fees (11 percent).
2006 Community Health Services System Expenditures Summary Report
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Regional Comparisons
Figure 9 shows total expenditures and population by region. The central region expended
eight percent of total expenditures and served 13 percent of the population. Figure 10
compares the funding sources of each region. Local Tax Levy as a percent of total
expenditures ranges from seven percent to 39 percent.
Figure 9. Regional Spending and Population as a Percent of the Total
Percent of
Percent of
Total
Total
Region
Total
Total
2
Expenditures
Population
Expenditures
Population
Central
$ 24,007,121
8%
703,521
13%
Metro
$ 183,835,942
63%
2,821,779
54%
Northeast
$12,515,002
4%
321,177
6%
Northwest
$10,479,139
4%
199,109
4%
Southeast
$ 27,464,494
9%
486,556
9%
Southwest/
South Central
$ 24,515,092
8%
512,480
10%
West Central
$ 11,161,463
4%
186,484
4%
$ 293,978,253
---5,231,106
---Total
Central
Metro
Northeast
Northwest
Southeast
Southwest/
South
Central
West
Central
CHS
System
Figure 10. Regional Comparison of Funding Sources
State Funds (LPH Act)
10%
7%
12%
10%
6%
9%
7%
7%
Federal Title V
3%
2%
4%
3%
2%
3%
2%
2%
Federal TANF
1%
1%
2%
1%
1%
1%
1%
1%
Medicaid
12%
11%
9%
18%
23%
14%
19%
13%
Medicare
10%
0%
1%
11%
3%
5%
12%
3%
Private Insurance
1%
1%
2%
3%
1%
5%
2%
1%
Local Tax
25%
39%
28%
7%
25%
19%
17%
32%
Client Fees
1%
0%
8%
3%
3%
2%
3%
1%
Other Fees
1%
5%
1%
1%
4%
4%
3%
4%
Other Local Funds
6%
12%
3%
8%
9%
9%
12%
11%
Other State Funds
9%
7%
5%
10%
9%
5%
4%
7%
Other Federal Funds
21%
15%
25%
24%
14%
24%
19%
17%
2
Minnesota State Demographic Center, www.demography.state.mn.us, Accessed August 1, 2007
2006 Community Health Services System Expenditures Summary Report
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Figure 11. 2006 Per Capita CHS System Total Expenditures by Region
$70
$65
$60
$60
$56
$53
$50
Per Capita
$48
$40
$39
$34
$30
$20
$10
$Central
Metro
Northeast
Northwest
Southeast
Southwest/South
Central
West Central
Regions
Figure 11 represents per capita expenditures by region. The metro region has the largest
per capita at $65 and the central region has the smallest at $34. Expenditures by area of
public health responsibility for each region are shown in Figure 12. Expenditures in
environmental health ranged from zero percent to 18 percent. There is little variation
between regions in the areas of infectious disease and disaster preparedness, both ranged
between three percent and five percent.
Metro
Northeast
Northwest
Southeast
Southwest/
South
Central
West
Central
Healthy
Communities
Infectious
Disease
Environmental
Health
Disaster
Preparedness
Health Services
Central
Infrastructure
CHS
System
Figure 12. 2006 Regional Spending by Area of Public Health Responsibility
10%
9%
9%
21%
8%
13%
6%
9%
25%
34%
21%
28%
23%
36%
36%
29%
5%
4%
5%
3%
4%
3%
4%
4%
14%
4%
18%
14%
0%
6%
7%
5%
5%
5%
5%
4%
4%
3%
5%
4%
42%
44%
42%
29%
60%
39%
42%
49%
2006 Community Health Services System Expenditures Summary Report
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Conclusion
The information presented in this report provides an overview of how local public health
services were funded in Minnesota during 2006; how expenditures were allocated
between the six areas of public health responsibility; and how both of those varied by
region. In addition to providing a current picture of local health department funding,
looking at the annual Community Health Services System Expenditures reports over time
can provide a way to look at rend and changes over a period of years.
2006 Community Health Services System Expenditures Summary Report
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Appendix A:
Areas of Public Health Responsibility
2006 Community Health Services System Expenditures Summary Report
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Assure an Adequate Local Public Health Infrastructure
This area of public health responsibility describes aspects of the public health
infrastructure that are essential to a well-functioning public health system – including
assessment, planning, and policy development. This includes those components of the
infrastructure that are required by law for community health boards. It also includes
activities that assure the diversity of public health services and prevents the deterioration
of the public health system.
Promote Healthy Communities and Healthy Behaviors
This area of public health responsibility addresses the promotion of positive health
behaviors and the prevention of adverse health behaviors – in all populations across the
lifespan. It also includes activities that enhance the overall health of communities.
Prevent the Spread of Infectious Disease
This area of responsibility focuses on infectious diseases that are spread person to person,
not diseases that are initially transmitted through the environment, such as food, water,
vectors and/or animals. It also includes the public health department activities to detect
acute and communicable diseases, assure the reporting of communicable diseases,
prevent the transmission of disease (including immunizations), and implement control
measures during communicable disease outbreaks.
Protect Against Environmental Health Hazards
This area of responsibility addresses aspects of the environment that pose risks to human
health (broadly defined as any risk emerging from the environment), but does not include
injuries. This area also summarizes activities that identify and mitigate environmental
risks, including foodborne and waterborne diseases and public health nuisances.
Prepare For and Respond To Disasters, and Assist Communities in Recovery
This area of responsibility addresses activities that prepare public health to respond to
disasters and assist communities in responding to and recovering from disasters.
Assure the Quality and Accessibility of Health Services
This area of responsibility assesses health care capacity and access to health care. It also
addresses identification and reduction of barriers to health services. It describes public
health activities to fill health care gaps, reduce barriers and link people to needed
services.
2006 Community Health Services System Expenditures Summary Report
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Appendix B:
Definitions of Funding Sources
2006 Community Health Services System Expenditures Summary Report
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Client Fees
Expenditures that had as their source revenue received as a client fee (i.e. sliding fees for
a health care or MCH service).
Home Care Services
State licensed services delivered in a place of residence to a person whose illness,
disability, or physical condition creates a need for the services as according to Minnesota
Statute 144A.43. This does not include case management.
Local Tax Levy
Expenditures that had as their source revenue from local tax levies.
Medicaid
(Title XIX of the Social Security Act) Expenditures that had revenue from Medicaid
reimbursements as their source. This includes Prepaid Medical Assistance Plans
(PMAPs), community based purchasing and community alternative care (CAC),
community alternatives for disabled individuals (CADI), development disabled (DD)
(formerly known as mental retardation or related conditions (MR/RC)), elderly (EW),
and traumatic brain injury (TBI) waivers. This does not include alternative care (AC)
which is reported in Other State Funds.
Medicare
(Title XVIII of the Social Security Act) Expenditures that had Medicare reimbursements
as their source. Also include revenue from Minnesota Health Senior Options (MSHO).
Other Federal Funds
Expenditures that had as their source of revenue as the Federal Government other than
those specified elsewhere in the glossary (i.e. Medicaid, Medicare, TANF, and Title V).
This includes dollars that come directly and as pass thru funds. Any funds with a Catalog
of Federal Domestic Assistance (CFDA) number are federal funds. Examples include
WIC, Veteran's Administration, and Child & Teen Check-up. This does NOT include
Medicaid, Medicare, Medicaid waivers, Title V, and TANF funds. If a grant is funded by
both state and federal sources (e.g., 30% state funds and 70% federal funds) divide the
amount appropriately between Other State Funds and Other Federal Funds.
Other Fees (non-client)
Expenditures that had as their source revenue received as a fee for service, or for a
license or permit. Usually the charge has been set by statute, charter, ordinance, or board
resolution.
Other Local Funds
Expenditures that had their source from other local funds including in-kind and contracts,
grants or gifts from local agencies such as schools, social service agencies, community
action agencies, hospitals, regional groups, non profits, corporations or foundations.
Please confirm that these funds do not originate from a federal source.
Other State Funds
2006 Community Health Services System Expenditures Summary Report
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Expenditures of dollars spent from other state funds other than those specified including
grants and contracts from the Minnesota Department of Health and other state agencies
that are not "pass thru" dollars from the federal government. Funding with a CFDA
number are federal dollars. Examples of other state funding include alternative care and
family planning special project. Please confirm that these funds do not originate from a
federal source. If a grant is funded by both state and federal sources (e.g., 30% state funds
and 70% federal funds) divide the amount appropriately between Other State Funds and
Other Federal Funds.
Private Insurance
Expenditures that had reimbursements received from private insurance companies as their
source.
State General Funds
Expenditures that had the state general funds portion of the Local Public Health Act as
their source.
TANF
Total of invoices sent to MDH for reimbursement for the period of January 1st to
December 31tst that had Federal TANF from the Local Public Health Act as their funding
source.
Title V
Expenditures of dollars that had the federal Title V (MCH) portion of the Local Public
Health Act as their source.
2006 Community Health Services System Expenditures Summary Report
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Appendix C:
Map of CHS System
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2006 Community Health Services System Expenditures Summary Report
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