2007 Community Health Services
System Expenditures Summary Report
Introduction
The following report summarizes the 2007 expenditures of the Community Health
Services (CHS) System. This information is submitted by Minnesota’s local
health departments to the Minnesota Department of Health. Local health
departments categorized expenditures into funding sources and areas of public
health responsibility. The funding sources are: 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 are: health services, healthy communities,
environmental health, infrastructure, infectious disease, and disaster
preparedness. Complete explanations of the funding sources and areas of public
health responsibility can be found in Appendices A and B.
In 2007, there were 75 local public health reporting entities (referred to in this
report as local health departments) in Minnesota. Minnesota’s local public health
system consists of 53 Community Health Boards (CHBs). CHBs are allowed to
decide the jurisdictional level at which they will report their data. For example, 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 included in this report: 28 are single-county CHBs, 9 are multicounty CHBs, 34 are single counties reporting separately 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 report is broken down into two sections:
• Statewide results
• Regional comparisons
The appendices include:
A. Definitions of the Funding Sources
B. Areas of Public Health Responsibility
C. Map of the CHS System
2007 Community Health Services System Expenditures Summary Report
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Statewide Results
The CHS System spent $302 million ($58 per person) in 2007 (Figure 1). This represents
an $8.5 million or three percent increase in expenditures from 2006. 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
2007 Dollars (in millions)
2007 Percent of Total
Local Tax Levy
$98.8
33%
Other Federal Funds
$50.3
17%
Medicaid
$38.8
13%
Other Fees
$28.0
9%
Other Local Funds
$19.9
7%
LPH Act State Funds
$21.8
7%
Other State Funds
$16.2
5%
Medicare
$9.8
3%
Federal Title V
$6.1
2%
Federal TANF
$4.7
2%
Client Fees
$4.5
1%
Private Insurance
$3.7
1%
Total
$302
----
2007 Community Health Services System Expenditures Summary Report
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Figure 2. Funding for the CHS System
(Aggregated by Major Funding Sources)
State Funds
13%
Federal Funds
20%
Locally Generated Funds
67%
Almost two-thirds of total funding for the CHS System came from locally-generated
funds, which include reimbursements and fees for services, local tax levy, and other local
funds (Figure 2). State funds accounted for 13 percent while federal funds accounted for
20 percent of total funding.
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 over time.
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, local governmental aid
was reduced, which may have affected the decrease in local tax levy allocated to local
health departments (LHDs).
In 2007 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.
2007 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 Expenditures (1983-2007)
40%
Percent of Total Expenditures
35%
30%
25%
20%
15%
10%
5%
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
0%
Year
CHS Subsidy/LPH Act State Funds
Local Tax Levy
Medicaid
Figure 4. Flexible Funding* as a Percent of Total Expenditures
(1979-2007)
*Flexible funding is the combination of local tax levy and LPH
Act state general funds.
40%
2007
41%
40%
2006
26%
30%
35%
33%
33%
1999
35%
38%
38%
1998
37%
36%
36%
1996
1994
1995
35%
35%
37%
33%
1993
Percent
40%
36%
41%
37%
43%
1987
44%
43%
1986
48%
49%
50%
47%
1980
51%
52%
52%
1979
60%
20%
10%
2005
2004
2003
2002
2001
2000
1997
1992
1991
1990
1989
1988
1985
1984
1983
1982
1981
0%
Year
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 2007. After dipping to a low of 26
percent of total expenditures in 2003, flexible funding has been increasing to levels seen
in the late eighties.
2007 Community Health Services System Expenditures Summary Report
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Figure 5. Comparison of Sources of Local Health Department Funding
Between Minnesota and the Nation*
35%
30%
33%
29%
Nation (2005)
Percent of Total
25%
Minnesota (2007)
23%
20% 20%
20%
15%
13%
13%
11%
12%
9%
10%
6%
5%
2%
7%
3%
0%
Local
Government
State Direct
Federal (Direct
& Passthrough)
Medicaid
Type of Funding
Medicare
Fees
Other
*2005 National Profile of Local Health Departments, National
Association of County and City Health Officials, July 2006.
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 similar to the national
averages in the funding sources of federal and Medicare funding but are somewhat
different all other funding areas.
Figure 6 shows that 28 LHDs (37 percent) had total expenditures of less than $1.5 million
and that 52 LHDs (69 percent) had total expenditure of less than $2.5 million. The
median total expenditure was $1.6 million, a slight increase ($70,000) from 2006. Total
expenditures ranged from $212,000 to $70 million. The smallest one-third of LHDs
accounted for six percent of total the CHS System expenditures. The largest LHD
represented 23 percent of total expenditures of the CHS System; the two largest LHDs
represented 39 percent. The five LHDs with the greatest total expenditures were in the
metro region.
1
2005 National Profile of Local Health Departments, National Association of County and City Health
Officials, July 2006.
2007 Community Health Services System Expenditures Summary Report
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Figure 6. Total Expenditures by Local Health Departments in Minnesota
30
Number of Local Health Departments
25
24
20
20
15
12
10
8
7
5
2
1
1
$4,500,000 $5,499,999
$5,500,000 $6,499,999
0
< $500,000
$500,000 $1,499,999
$1,500,000 $2,499,999
$2,500,000 $3,499,999
$3,500,000 $4,499,999
> $6,500,000
Total Expenditures
Figure 7. Per Capita Expenditures by Local Health Departments
30
24
Number of Local Health Departments
25
20
20
17
15
10
6
6
$80-$100
> $100
5
2
0
< $20
$20-$39
$40-$59
$60-$79
Per Capita Expenditures
2007 Community Health Services System Expenditures Summary Report
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Figure 7 shows per capita expenditures by LHDs. Twenty-six LHDs had per capita
expenditures of less than $40. Per capita expenditures by LHDs ranged from $13 to $194,
with a median per capita of $51. The five of the six 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. 2007 Expenditures by Area of Public Health Responsibility
Area of Public Health
Dollars
Percent of Total Spending
Responsibility
(in millions)
Assure Health Services
$126.7
42%
Healthy Communities
$81.1
27%
Environmental Health
$42.5
14%
Infrastructure
$25.2
8%
Infectious Disease
$15.8
5%
Emergency Preparedness
$11.3
4%
Total Spending
$302
----Assure Health Services
Expenditures in the area of health services were by far the largest, totaling $127 million,
slightly higher than 2006. Assure health services expenditures were supported by local
tax levy (36 percent) and Medicaid (24 percent). Fourteen percent ($17.6 million) of
spending was on home health services. It is important to note that one local health
department expended $49 million dollars in assure health services, accounting for 39
percent of overall expenditures, 74 percent of all local tax levy dollars, and 29 percent of
the Medicaid dollars spent in the area of assure health services.
Healthy Communities
Over $81 million (27 percent of total expenditures) were expended in the area of healthy
communities, almost seven million more dollars than 2006. Of that $81 million, almost
one third ($24.2 million) came from other federal funds. All but one LHD used other
federal funds to support these activities. Healthy communities was funded by a wide
range of sources including local tax levy (23 percent), LPH Act state funds (11 percent),
Medicaid (10 percent), other state funds (6 percent), and other local funds (7 percent).
Nearly all health departments (95 percent) used some LPH Act state funds to support
healthy communities.
Environmental Health
Environmental health expenditures incresed six percent increase in spending, from $40.0
million in 2006 to $42.5 million in 2007. Other fees supported 54 percent ($23 million)
of the environmental health expenditures. Other funding sources included local tax levy
(27 percent), other local funds (8 percent), and other state funds (four percent). It is
important to note that one LHD represented 50 percent of spending in this area,
accounting for 77 percent of the other fees expended. Another LHD represented 20
percent of spending, accounting for over 50 percent of local tax levy expended. Nine
LHD had no spending in the area of environmental health.
2007 Community Health Services System Expenditures Summary Report
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Infrastructure
Slightly more than $25 million of total expenditures were in the area of infrastructure, a
decrease of $3.3 million or 12 percent. One LHD decreased infrastructure funding by
$3.2 million, accounting for a large portion of the decrease. Of the $25.2 million
expended, most (68 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 (20 percent) and other local sources (six percent). Sixty-eight of the 75
LHDs (91 percent) used LPH Act state funds for infrastructure.
Infectious Disease
Nearly five percent ($15.8 million) of total expenditures were in the area infectious
disease, an increase of 15 percent ($2.1 million). Other federal funds supported 35
percent ($6.0 million) of infectious disease spending. Other funding sources included
local tax levy (29 percent), LPH Act state funds (12 percent), and client fees (nine
percent). It is important to note that one LHD accounted for 38 percent of infectious
disease spending and accounted for 90 percent of the other federal funds in infectious
disease.
Emergency Preparedness
Emergency preparedness expenditures were the smallest of the six areas of public health
responsibility, with $11.3 million or four percent of total expenditures. Emergency
preparedness had a three percent decrease in expenditures from 2006 to 2007. Almost 79
percent ($9.0 million) of the 2007 emergency preparedness 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 local tax levy
(15 percent) and state general funds (3 percent).
Regional Comparisons
Figure 9 shows total and per capita expenditures by region. The metro region had the
largest per capita at $65 and the northeast region has the smallest at $38. In most regions
the per capita expenditures stayed the same or fluctuated slightly from 2006. Two
regions, southeast and west central, increased by $5 and $6 respectively.
Figure 9. Regional Expenditures and Per Capita
Total
Region
Per Capita
Expenditures
Metro
$184,104,445
$
65
Southeast
$ 29,663,858
$
61
Central
$ 27,553,400
$
39
South Central
$ 14,045,589
$
49
Northeast
$ 12,358,197
$
38
West Central
$ 12,265,360
$
66
Southwest
$ 11,977,185
$
53
Northwest
$ 10,520,980
$
53
Total
$ 302,489,014
$
58
2007 Community Health Services System Expenditures Summary Report
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Metro
Northeast
Northwest
South
Central
Southeast
Southwest
West
Central
State Funds (LPH Act)
9%
7%
12%
9%
8%
6%
9%
7%
7%
Federal Title V
3%
2%
4%
3%
2%
2%
3%
2%
2%
Federal TANF
2%
1%
3%
2%
2%
1%
2%
2%
2%
Medicaid
15%
10%
13%
16%
15%
24%
15%
22%
13%
Medicare
10%
0%
6%
8%
10%
4%
4%
13%
3%
Private Insurance
1%
1%
1%
4%
4%
1%
1%
3%
1%
Local Tax
26%
40%
26%
10%
20%
25%
21%
14%
33%
Client Fees
2%
0%
8%
4%
2%
4%
3%
3%
1%
Other Fees
2%
13%
1%
0%
3%
3%
8%
2%
9%
Other Local Funds
5%
6%
4%
7%
10%
7%
9%
13%
7%
Other State Funds
8%
4%
3%
9%
8%
10%
7%
8%
5%
Other Federal Funds
18%
16%
20%
27%
16%
12%
19%
11%
17%
Figure 10 compares the funding sources of each region. Local tax levy as a percent of
total expenditures ranged from ten percent to 40 percent. The LPH Act funding which
includes the state general funds, Title V, and TANF accounted for between 9 and 19
percent of total expenditures for a region.
2007 Community Health Services System Expenditures Summary Report
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CHS
System
Central
Figure 10. Regional Comparison of Funding Sources
Northeast
Northwest
South
Central
Southeast
Southwest
West
Central
CHS
System
Healthy
Communities
Infectious
Disease
Environmental
Health
Emergency
Preparedness
Assure Health
Services
Metro
Infrastructure
Central
Figure 11. Regional Expenditures by Area of Public Health Responsibility
9%
7%
17%
8%
5%
14%
6%
11%
8%
36%
22%
37%
26%
33%
33%
42%
28%
27%
5%
6%
3%
4%
3%
3%
7%
3%
5%
4%
20%
11%
0%
7%
5%
7%
4%
14%
5%
4%
4%
4%
4%
3%
4%
4%
4%
41%
42%
28%
58%
48%
41%
34%
50%
41%
Expenditures by area of public health responsibility for each region are shown in Figure
11. Expenditures in environmental health ranged from zero percent to 20 percent. There
is little variation between regions in the areas of infectious disease and emergency
preparedness, both ranged between three percent and seven percent. Assure health
services had the largest percent of expenditures in all regions except for the northeast and
southwest.
2007 Community Health Services System Expenditures Summary Report
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Appendix A:
Definitions of Funding Sources
2007 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).
LPH Act State Funds
Expenditures that had the state general funds portion of the Local Public Health Act as
their source.
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
Report 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, Pandemic Flu Supplemental Funding, and Public
Health Preparedness. 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
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
2007 Community Health Services System Expenditures Summary Report
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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 percent state
funds and 70 percent 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.
TANF (Federal)
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 (Federal)
Expenditures of dollars that had the federal Title V (MCH) portion of the Local Public
Health Act as their source.
2007 Community Health Services System Expenditures Summary Report
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Appendix B:
Areas of Public Health Responsibility
2007 Community Health Services System Expenditures Summary Report
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Areas of Public Health Responsibility
Assure an Adequate Local Public Health Infrastructure (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 (Health Communities)
This area of public health responsibility includes activities to promote of positive health
behaviors and the prevention of adverse health behaviors – in all populations across the
lifespan in the areas of alcohol, arthritis, asthma, cancer, cardiovascular/stroke, diabetes,
health aging, HIV/AIDS, Infant, child, and adolescent growth and development, injury,
mental health, nutrition, oral/dental health, drug use, physical activity, pregnancy and
birth, STDs/STIs, tobacco, unintended pregnancies, and violence. It also includes
activities that enhance the overall health of communities.
Prevent the Spread of Infectious Disease (Infectious Disease)
This area of responsibility focuses on infectious diseases that are spread person to person,
as opposed to diseases that are initially transmitted through the environment (e.g.,
through 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 (Environmental Health)
This area of responsibility includes 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
(Emergency Preparedness)
This area of responsibility includes 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 (Assure Health Services)
This area of responsibility includes activities to assess health care capacity and assure
access to health care. It also includes activities relate to the 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.
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Appendix C:
Map of Regions
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Local Public Health Regions
Northwest
Kittson
Lake
of
the Woods
Roseau
Marshall
Koochiching
Beltrami
Pennington
St. Louis
Cook
Red Lake
Lake
Clearwater
Polk
Mahnomen
Norman
Itasca
Hubbard
Northeast
Cass
Becker
Clay
Aitkin
West
Central
Crow
Wing
Wadena
Wilkin
Carlton
Otter Tail
Mille
Lacs
Todd
Grant
Traverse
Pine
Kanabec
Morrison
Douglas
Central
Benton
Stevens
Pope
Stearns
Sherburne
Big
Stone
Swift
Lac
Qui
Parle
Washington
Meeker
Chippewa
Ramsey
Hennepin
McLeod Carver
Yellow Medicine
Renville
Scott
Sibley
Lincoln
Chisago
Anoka
Wright
Kandiyohi
Isanti
Lyon
Redwood
Southwest
Nicollet
Le Sueur
Dakota
Rice
Goodhue
Wabasha
Brown
Pipestone
Rock
Murray
Nobles
Cottonwood
Jackson
Watonwan Blue Earth
Martin
Faribault
Steele Dodge
Waseca
Metro
Freeborn
Olmsted
Mower
Fillmore
Southeast
Winona
Houston
South Central
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