As CHOICES ends, future form at issue

Published: Sunday, January 9, 2011 at 11:26 p.m.
Last Modified: Sunday, January 9, 2011 at 11:26 p.m.

The county's CHOICES health services program has $41.6 million in its trust fund, and county officials are trying to determine how long that money will last.

The quarter-cent sales tax funding CHOICES sunsets at year's end, as once sluggish enrollment among the working uninsured has now reached 3,500. While revenues still outpace expenditures, the gap has narrowed.

Last fiscal year, the sales tax brought in $8.43 million and expenditures exceeded $7.9 million, according to the county finance office. By comparison, in the 2006-2007 fiscal year, when membership was less than 1,000, the tax generated more than $11.9 million and expenditures were just more than $1.2 million.

County officials' goal is to make the program last until 2014, when the bulk of the federal health care legislation is scheduled to take effect if it survives legal challenges and a repeal effort in the Republican-controlled House.

"There's a possibility the funds might not last if the membership rises to some of the current projections," CHOICES Director Bob Bailey said.

Based on enrollment trends from 2006 to the current day, staff projections have 5,000 members in the program by late 2013. Based on the enrollment spike of approximately 1,000 new members since last February, enrollment could hit 7,500 by then.

Against that backdrop, CHOICES staff will start identifying different scenarios for the program's future — and seek direction on which options to pursue — at a CHOICES advisory board meeting today and a County Commission workshop scheduled for Feb. 1.

Possibilities that could extend the program's life might include enrollment caps, benefit reductions or a move not to fund outside agencies in the future.

As for the possibility of another sales tax referendum for CHOICES, at this point, even supporters call it a long shot.

"It's probably never going to happen, but I would certainly think that is a prudent thing to do," County Commissioner Paula DeLaney said of the potential for an additional referendum.

Approved by 85 votes during the August 2004 primary, CHOICES was established to provide the working uninsured with access to health care and to fund "cost-effective" and "innovative" health and wellness programs for all county residents.

The quarter-cent sales tax that is funding the program went on the books in 2005. The initial projection was the tax would raise about $7 million a year and 14,000 working uninsured residents in the county could benefit from CHOICES. The revenue estimate turned out to be low and the enrollment projection high — a combination of factors that led to pointed criticism of the program from some.

One critic is County Commissioner Susan Baird, who defeated former Commissioner Cynthia Chestnut, a driving force in the establishment of CHOICES, in November's election. Baird feels the program has moved beyond its core focus of providing health care access to workers without insurance and criticizes the funding of health and wellness programs for all citizens, often bringing up the Zumba classes offered through a contract with the Alachua County Health Department.

Campaigning, Baird floated one idea for the future of the CHOICES trust fund — another referendum to move some money out of the fund in order to put it toward the county's backlog of road-repaving needs. Now in office, she says she is concerned by the pace at which the program's money is being spent down.

"There's going to be no money left to move," Baird said of the possibility of a 2012 referendum.

Any potential referendum to move money out of CHOICES, she added, should come through a voter petition drive.

To date, the quarter-cent sales tax for CHOICES has generated approximately $60.55 million, while total expenditures are a little more than $18.9 million. To date, administrative expenses — salaries, operating costs, marketing and contracts with the third-party administrators who handle claims — have been just less than $5.6 million, or approximately 9.1 percent of the total sales tax revenue. By ordinance, administrative costs cannot exceed 15 percent of the sales tax revenue.

In the current fiscal year, CHOICES will provide $843,000 to outside agencies. Some of those expenditures include $500,000 for the Alachua County Health Department to provide health and wellness programs across the county, $107,000 for the University of Florida mobile health clinic and $80,000 for the FluMist program in area schools.

In a presentation prepared for the Feb. 1 County Commission meeting, CHOICES staff notes that any increase in funding for outside agencies will deplete the trust fund more rapidly and possibly "eliminate the possibility of (CHOICES) being a bridge to health reform."

County Commission Chairman Lee Pinkoson believes that staying the program's current course would bring a "relatively smooth transition" from CHOICES to the federal health care changes.

DeLaney, meanwhile, expects there will have to be some reduction in benefits to make the program last.

"I think we will have to cut back on what we've got and eventually when there's no money, there's no program," she said

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