2010 Community Health Services System
Expenditures Summary Report
Introduction
The following report summarizes 2010 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 report expenditures by
funding source and area of public health responsibility. The funding sources are: local tax
levy, other federal funds, Medicaid, other local funds, Local Public Health (LPH) Act
state funds, other state funds, other fees, Medicare, Title V funds, Temporary Assistance
for Needy Families (TANF) funds, client fees, and private insurance. The areas of public
health responsibility are: assure health services, healthy communities, environmental
health, infrastructure, infectious disease, and emergency preparedness. Complete
explanations of the funding sources and areas of public health responsibility can be found
in Appendices A and B.
In 2010, there were 72 local public health reporting entities (referred to in this report as
local health departments) in Minnesota. Minnesota’s local public health system consists
of 52 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 72 local health departments included in this report: 28
are single-county CHBs, 11 are multi-county CHBs, 29 are single counties reporting
separately within multi-county CHBs, and 4 are city CHBs.
Per capita calculations are based on the 2010 population numbers from the State
Demographic Center.
The CHBs are split into geographic regions for analysis. Appendix C contains a map of
the regions.
The report is broken down into two sections:
Statewide Expenditures Summary
Regional Expenditures Comparisons
The appendices include:
A. Definitions of the Funding Sources
B. Areas of Public Health Responsibility
C. Map of the CHS System
2010 Community Health Services System Expenditures Summary Report
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August, 2011
Statewide Expenditures Summary
CHS System expenditures were $319 million ($60 per person) in 2010, representing a $21
million or 7% increase in expenditures from 2009. Overall, most (68%) LHDs had increases in
total expenditures from 2009. The median increase was 9% with a range of less than one to 29%.
The 23 LHDs with decreases had decreases that ranged from 1% to 26% with a median of 5%.
Table 1. Funding Sources of the CHS System
Funding Source
2010 Dollars (in millions)
2010 Percentage of Total
Local Tax Levy
$92.5
29%
Other Federal Funds
$58.2
18%
Medicaid
$35.8
11%
Other Fees
$35.4
11%
Other State Funds
$26.2
8%
LPH Act State Funds
$20.6
6%
Other Local Funds
$17.2
5%
Medicare
$13.4
4%
Federal TANF
$6.8
2%
Federal Title V
$6.0
2%
Client Fees
$4.5
1%
Private Insurance
$2.7
1%
Total
$319
----
The single largest funding source was local tax levy, accounting for 29% of all expenditures
(Table 1). This proportion is unchanged from 2009. Other federal funds, which include WIC and
public health preparedness funds, accounted for 18% of expenditures. The LPH Act state funds
accounted for 6% of all expenditures and decreased 1% from 2009. Other state funds increased
by $3.7 million or 16% from 2009.
A majority of the CHS System’s funding came from locally-generated funds, which include
reimbursements and fees for services, local tax levy, and other local funds (Figure 1). State funds
accounted for 18% of total expenditures and federal funds accounted for 22%. Together, state
and federal funds represent 40% of LHD expenditures. This percentage has increased since 1977
(14%) as more state and federal funds are available through grants and contracts.
2010 Community Health Services System Expenditures Summary Report
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August, 2011
Figure 2 shows the trends of three funding sources as a percentage of total expenditures. The
LPH Act state funds have decreased as a percentage of total expenditures over time. The local
tax levy, as percentage of total expenditures, has generally fluctuated between 25% and 35%,
with one outlier in 2002. In 2010 Medicaid accounted for 11% of total expenditures. In 1983, the
first year it was tracked, Medicaid represented 8% of total expenditures and has fluctuated
between 13% and 19% over the past decade. Reimbursement rates and the number of LHDs
providing home health care services affect the Medicaid percentage.
2010 Community Health Services System Expenditures Summary Report
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August, 2011
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 3 shows the proportion of flexible funding has decreased from 52% in
1972 to 35% in 2010. In 2002, flexible funding dipped to a low of 26% of total expenditures.
After climbing to 41% of total expenditures in 2005, flexible funding remained stable until a
decline to 35% of total expenditures in 2009 and 2010. Individual LHDs have a range of
“flexible funding” from 3% to 87% with a median of 28%.
2010 Community Health Services System Expenditures Summary Report
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August, 2011
Figure 4 compares funding for LHDs in Minnesota to the findings of a national survey of local
health departments conducted by the National Association of County and City Health Officials
(NACCHO) in 2008. LHD expenditures in Minnesota are similar to LHD expenditures
nationwide for funding through fees, Medicaid and Medicare , but the pattern differs in all other
funding areas. In 2010, Minnesota LHDs received slightly less state direct dollars than the
national average. Conversely, Minnesota LHDs received proportionately more funding from
local and federal sources.
Figure 5 shows that 20 LHDs (28%) had total expenditures of less than $1.5 million and 43
LHDs (60%) had total expenditures of less than $2.5 million. The median total expenditure was
$2.1 million, an increase of $219,626 (12%) from 2009. Total expenditures ranged from
$201,517 to $71.4 million. The smallest one-third of LHDs accounted for 6% of total the CHS
System expenditures. The largest LHD represented 18% of total expenditures of the CHS
System; the two largest LHDs represented 37% of total expenditures. The six LHDs with the
greatest total expenditures were all in the metro region.
2010 Community Health Services System Expenditures Summary Report
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August, 2011
Figure 6 shows per capita expenditures by LHDs. Twenty-two LHDs had per capita expenditures
of less than $40. Per capita expenditures by LHDs ranged from $15 to $211, with a median per
capita of $55; two dollars more than in 2009. Five of the eight LHDs with expenditures greater
than $100 per capita provided home health services, hospice services, or both to smaller, rural
populations.
Table 2 shows the dollar amount and percentage 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.
Table 2. Expenditures by Area of Public Health Responsibility
Area of Public Health
Dollars
Percentage of Total
Responsibility
Spending
(in millions)
Assure Health Services
$125.5
39%
Healthy Communities
$103.6
32%
Environmental Health
$34.7
11%
Infrastructure
$23.4
7%
Infectious Disease
$18.4
6%
Emergency Preparedness
$13.7
4%
Total Spending
$319
-----
2010 Community Health Services System Expenditures Summary Report
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August, 2011
Assure Health Services
Expenditures in the area of health services were the largest, totaling $125.5 million, $14.9
million more than in 2009, an increase of 13%. Twenty-nine LHDs had decreases in assure
health services, with one LHD accounting for a $17.7 million decrease. The median LHD
spending was $730,000 with a range from $12,000 to $45.3 million. Assure health services
expenditures were supported by local tax levy (34%) and Medicaid (22%). A significant part of
assure health services includes providing services through home health care, hospice,
correctional health, and emergency medical services programs. These services accounted for
38% of assure health services and 15% of all expenditures. Twelve percent ($15.1 million) of
health services spending was on home health care and hospice services. It is important to note
that one LHD expended $45.3 million dollars in assure health services, accounting for 36% of
overall expenditures.
Healthy Communities
Over $100 million (32% of total expenditures) were expended in the area of healthy
communities, an increase of $10.9 million dollars (12%) from 2009. Forty-eight LHDs had
increases in healthy communities spending. The median LHD spending was $757,000 with a
range from $101,000 to $14.2 million. Over one quarter of healthy communities expenditures
($27 million) were supported by other federal funds. Activities in healthy communities were
funded by a wide range of sources including other state funds (22%), local tax levy (19%),
Medicaid (8%), LPH Act state funds (7%), and TANF funds (7%). All or most health
departments used some Federal Title V, Federal TANF, Other State, Other Federal, and LPH Act
state funds to support healthy communities.
Environmental Health
Environmental health expenditures decreased by 10% ($4 million) from 2009 to $34.7 million in
2010. Thirty-one LHDs had decreases in environmental health funding. Twenty-four LHDs
spent less than $5000 on environmental health, including 9 with no expenditures in 2010. The
median LHD spending was $15,000 with a range from $0 to $18 million. Other fees supported
61% ($21.1 million) of the environmental health expenditures. Other funding sources included
local tax levy (23%), other state funds (7%), and other federal funds (3%). It is important to note
that two LHDs expended $25.2 million (73%) of spending in this area.
Infrastructure
Seven percent of total expenditures were in the area of infrastructure, a decrease of $2 million
(8%) caused by thirty-four LHDs reducing spending in infrastructure. The median LHD
spending was $145,000 with a range from $1,000 to $3.5 million. Of the $25.4 million expended,
most (66%) was funded by local tax levy. Eighty-two percent of LHDs used local tax levy to
fund infrastructure. The remaining funding sources included LPH Act state general funds (21%)
and other local sources (8%). Sixty-six of the 72 LHDs (92%) used LPH Act state funds for
infrastructure.
2010 Community Health Services System Expenditures Summary Report
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August, 2011
Infectious Disease
Six percent ($18.4 million) of total expenditures were in the area infectious disease, an increase
of 6% from 2009. The median LHD spending was $82,000 with a range from $1,700 to $8.1
million. Other federal funds supported 43% ($8.3 million) of infectious disease spending. Other
funding sources included local tax levy (25%), LPH Act state funds (14%), and client fees (6%).
It is important to note that two LHDs accounted for 55% of infectious disease spending.
Emergency Preparedness
Emergency preparedness expenditures were the least of the six areas of public health
responsibility, with $13.7 million or 4% of total expenditures. Emergency preparedness
expenditures increased by 6% from 2009 to 2010 due to in part to ongoing H1N1 response. The
median LHD spending was $104,000 with a range from $15,000 to $1.7 million. Almost 80%
($10.8 million) of the 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 (11%) and other state funds (7%).
Regional Expenditures Comparisons
Table 3 shows total and per capita expenditures by region. The west central region had the
highest per capita spending at $84 and the northeast region has the smallest at $40. One region
had a decrease in expenditures (Northwest) from 2009; the remaining seven regions had
increases. Increases in spending in healthy communities were seen in all regions and increases in
infectious disease spending were seen in all but one region.
Table 3. Regional Expenditures and Per Capita
Total
Expenditures
Region
Per Capita
West Central
$
15,960,325
$
84
Southeast
$
31,835,593
$
64
Southwest
$
13,881,831
$
62
South Central
$
16,889,496
$
58
Metro
$ 186,622,415
$
55
Northwest
$
11,077,070
$
55
Central
$
29,842,127
$
41
Northeast
$
13,160,254
$
40
Total
$ 319,269,111
$
60
Percent of expenditures by area of public health responsibility for each region are shown in
Table 4. There is little variation between regions in the areas of infectious disease and emergency
preparedness, both ranged between 2% and 7%. Assure health services had the highest
percentage of expenditures in all but three regions (central, northeast, and southwest); in these
regions health communities had the higher percent.
2010 Community Health Services System Expenditures Summary Report
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August, 2011
Northeast
Northwest
South
Central
Southeast
Southwest
West
Central
CHS
System
Healthy
Communities
Infectious
Disease
Environmental
Health
Emergency
Preparedness
Assure Health
Services
Metro
Infrastructure
Central
Table 4. Percent of Regional Expenditures by Area of Public Health Responsibility
8%
6%
11%
9%
6%
15%
7%
8%
7%
42%
27%
47%
32%
39%
37%
48%
36%
32%
5%
7%
4%
5%
3%
3%
6%
3%
6%
3%
17%
2%
0%
4%
4%
4%
2%
11%
6%
4%
6%
6%
6%
3%
5%
4%
4%
36%
40%
31%
48%
43%
38%
29%
47%
39%
Metro
Northeast
Northwest
South
Central
Southeast
Southwest
West
Central
State Funds (LPH Act)
8%
6%
11%
9%
7%
5%
8%
5%
6%
Federal Title V
2%
2%
3%
2%
2%
2%
2%
1%
2%
Federal TANF
3%
2%
4%
4%
2%
2%
2%
2%
2%
Medicaid
12%
9%
13%
15%
15%
20%
11%
14%
11%
Medicare
8%
1%
7%
8%
13%
6%
5%
22%
4%
Private Insurance
1%
1%
1%
2%
0%
1%
1%
1%
1%
Local Tax
21%
35%
19%
9%
20%
25%
20%
16%
29%
Client Fees
1%
1%
2%
12%
1%
2%
2%
2%
1%
Other Fees
2%
12%
1%
1%
3%
2%
5%
2%
8%
Other Local Funds
4%
5%
2%
5%
8%
5%
8%
11%
5%
Other State Funds
16%
9%
17%
11%
14%
14%
13%
11%
11%
Other Federal Funds
22%
18%
20%
22%
14%
16%
21%
13%
18%
CHS
System
Central
Table 5. Regional Comparison of Funding Sources
2010 Community Health Services System Expenditures Summary Report
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August, 2011
Table 5 compares the funding sources of each region. Local tax levy as a percentage of total
expenditures ranged from 9% to 35%. The LPH Act state general funds accounted for between
5% and 11% of total expenditures for a region. All regions had increases in Other State Funds
while four regions had decreases in the percentage of local tax levy as a proportion of total
expenditures (central, northeast, south central, and southeast).
2010 Community Health Services System Expenditures Summary Report
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August, 2011
Appendix A: Definitions of Funding Sources
Client Fees
Expenditures that had revenue received as a client fee (i.e., sliding fees for a health care or MCH
service) as their source.
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 revenue from local tax levies as their source.
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 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 from 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.
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Other Local Funds
Expenditures 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 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. Funds with a CFDA number are federal dollars.
Examples of other state funding include alternative care and family planning special project
grants. 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.
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.
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Appendix B: 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 (Healthy Communities)
This area of public health responsibility includes activities to promote 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
Local Public Health Regions
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