1.                  Financial Narrative

A.                 Expenditures

2019 Expenditures (forms 2, 3a, 3b)

For SFY19, the federal allocation funding of $1,646,441 was fully expended.    The amount of State Funds expended is $230,967 less than budgeted due to a reduction of newborn screening expenditures by $228,211 compared to the SFY19 Governor’s recommended budget request.  There is an increase of $3,779,760 for total expenditures compared to the budget mainly due to increased award received for Prescription Drug Overdose Prevention grant.

The FY19 budget partially supported 15 full time RIDOH employees for a total personnel cost of $369,193. General office and program supplies accounted for 4.34% of the total budget ($71,517) and consisted of costs for printing, copying, information technology, postage, telephone and computer supplies. Consultant costs made up 23.46% of the total expended and was primarily allocated towards our Rhode Island Parent Information Network (RIPIN) Resource Specialist program ($104,055), John Snow Inc. (JSI) Child Death Review analysis ($33,311), and the First Connections contracts ($47,356). Our contractual budget totaled $801,089 with supporting the Health Equity Zones (HEZ) at a total cost of $424,000. Other major contracts include the RIPIN Family Voices program ($228,373), Can we talk Healing program ($23,900), Trauma-informed schools program ($25,000).

RIDOH has invested resources in the HEZ initiative to develop place-based and community-owned infrastructure to address the social and environmental factors that affect health outcomes.  These factors, often described as social and environmental determinants of health (SDOH), are systemic barriers to achieving optimal health that exist outside the clinical setting in the places people live, work, and play. HEZs address SDOH through establishing diverse collaboratives of local stakeholders, conducting comprehensive needs assessments, and implementing data-driven plans of action. The model focuses on improving the health of communities at highest risk of adverse health outcomes, such as obesity, illness, injury, chronic disease, or poor maternal and child health outcomes, due to poverty or other social, economic, and environmental determinants of health. RIDOH currently has contracts with 10 Health Equity Zones that are located in communities throughout the state. Three are defined by inner-city neighborhood boundaries, several are city-wide, and one encompasses an entire county, largely rural in nature. The populations of the HEZs range from about 5,500 (the Olneyville neighborhood) to 178,000 (the City of Providence). Two of the neighborhood HEZs are located within the geographic bounds of another city-wide HEZ (the City of Providence—Rhode Island’s largest and arguably most diverse city). Rhode Island’s model is organized around a four-year funding cycle consisting of flexible funding, which helps communities develop their capacity to address the socioeconomic and environmental factors that prevent people in the community from being as healthy as possible. Traditionally, public health departments have provided communities with separate sources of funding to implement specific programs or address specific health concerns, such as diabetes or cancer. The HEZ model braids together state and federal funds from several sources, so that communities can work together to achieve shared goals for sustained community health and economic well-being. In Rhode Island, this grant funding is viewed as an initial seed investment to build capacity and spark community development. RIDOH is working with communities to identify sustainable investments with flexible funding to maintain and expand their efforts over the long term.

Budget and Expenditure Details by Type of Individuals Served (Form 3a )

Rhode Island has continued to be successful in meeting the budget requirements of at least 30% of our federal MCH funds being utilized for Preventive and Primary Care for Children ($497,031 at 30.19%) and at least 30% for Children with Special Health Care Needs ($677,606 at 41.16%). The proportion of federal MCH funds expended for FY19 for Administrative Costs is 8.20% ($134,949), which is under the allowable 10%.

Budget and Expenditure Details by Type of Services (Form 3b)

For FY19, there was $23,900 expended for direct services for Can we talk Healing program for Post-Traumatic Healing.  $650,683 (39.52%) of the FY19 budget was spent on enabling services. The largest portion, 59.03% of the FY18 budget, ($971,858) was spent on public health systems and services.

2019- 2020 Venture Capital Funds

Each year the Title V Program allows RIDOH MCH Programs to apply for “Venture Capital” funds to support special projects.  This funding is intended to augment, not replace other federal funds.  Projects must align with Title V priorities and strategies.  The MCH management team reviews the applications and decides which projects to fund based on the merit of the application and the amount of money that is available.  This past year, $401,671.25 was approved through this process.  The projects are outlined below.     

Budget

Reorganization

As part of the Rhode Island Department of Health’s reorganization in 2016, the MCH Title V block grant was transferred to the Health Equity Institute (HEI).  HEI is comprised of the Minority Health Program, Refugee Health Program, Maternal and Child Health Program, Special Needs Systems Integration Program, Disability and Health Program, Prevention Block Grant, and Health Equity Zones.

In addition to RIDOH’s programs transferring to better align with the department’s priorities, Central Management has also been spending some time on restructuring the operations and finance core functions to better support the department as well as our partners. Core function teams are being developed in the following areas: state budgeting, purchasing, grants management, revenue, Medicaid and cooperative agreements, and human resources.  Each core function team will have a lead, a dedicated staff person and expert/support staff.  The core function team serves as a resource to bring expertise to all the divisions.  It supports the standardization of processes and communication of those processes. In addition, the structure provides opportunities to support workforce development and ensures capacity for operations and finance responsibilities. 

RIDOH Budget 

The SFY 2021 Governor’s Recommended budget for RIDOH is a total of $186,724,931 which is $32,999,978 (17.67%) in general revenue, $104,298,145 (55.86%) in federal funds, $49,026,808 (26.26%) in restricted receipts, and $400,000 (0.21%) in operating transfers from other funding sources.

Below is the list of the Department’s Departmental Divisions including their SFY 2021 budgets:

1. Division of Central Management ($15,696,096) provides leadership, administrative, and

programmatic oversight to the various programs and operations of the Department. The HEI is strategically positioned within the Director of Health’s Office and applies the health equity lens to all RIDOH programs and policies to a priority population of people with disabilities and racial/ethnic minorities.

2. Division of Policy, Information and Communications ($5,347,758) responsible for the acquisition and use of clear, accurate and appropriate data to inform public health policy as well as the provision of high-quality, timely, and accurate health information to the public so they can understand health risks and make healthy and safe choices.
3. Division of State Laboratories and Medical Examiner ($13,370,906) supports the Department’s mission of "safe and healthy lives in safe and healthy communities" through scientific identification of pathogenic microorganisms, toxic substances, and criminals that threaten the health and safety of Rhode Islanders, and through the investigation of suspicious or unexpected deaths.
4. Division of Preparedness, Response, Infectious Disease & Emergency Medical Services ($15,702,040) creates and promotes a state of readiness and prompt response to protect the health of Rhode Islanders during catastrophic events, large-scale disasters, and other types of emergencies; controlling person-to-person spread of infectious diseases; and licensing, regulating, and oversight of emergency medical services.
5. Division of Community Health and Equity ($106,737,511) aims to achieve health equity for all populations by eliminating health disparities, assuring healthy child development, preventing and controlling disease and disability, and working to make communities healthy.
6. Division of Environmental Health ($14,559,634) regulates and provides oversight of population-based activities related to safe food; potable water; healthy homes in the areas of lead, asbestos, radon; and health and safety in the workplace.
7. Division of Customer Services ($15,310,986) assures that minimum standards for the provision of health care services are met. To that end, the program licenses, investigates and disciplines health care professionals, healthcare facilities, and health-related facilities. The Customer Services division also includes the public-facing Center for Vital Records which ensures the integrity and appropriate access to permanent records related to births, deaths, marriages, and civil unions for Rhode Island.

Title V Budget

In FY2021, RIDOH proposes to spend $1,900,000. Title V funds rarely fund direct services. Instead, they are used to improve systems by working with and leveraging other programs and assets that improve maternal and child health outcomes throughout the state.  The Title V program ensures program coordination and collaboration both internally (e.g., Family Visiting, Family Planning, Oral Health, Immunization) and externally (e.g., Medicaid, Accountable Entities, Hospitals, Insurers).

Personnel costs are allocated across population domain categories that are reflective of staff time and effort and account for $562,632 (29.61%) of the total budget.

Similarly, travel costs are spread across all Title V population domains for a total $23,958. General office and program supplies are classified as Administrative costs and are budgeted at $51,311. The contractual budget is $750,000 and consists of Rhode Island Parent Information Network (RIPIN) Family Voices program, multiple First Connection contracts, and support for Health Equity Zones (HEZ). The RIPIN Family Voices contract is $200,000 is 100% in support of Children with Special Health Care Needs. A total of $50,000 is budgeted for our First Connection contracts, a postnatal home visiting program for high risk mothers and babies.

Our $311,000 consultant budget consists of support for our Behavioral Risk Factor Surveillance System ($10,500), John Snow Inc. ($50,000) for the Child Death Review Committee, University of Utah ($27,500) for the Medical Home Portal, ADIL Business Systems for needs assessment and evaluations ($108,000) and RIPIN ($115,000) for community health workers, family/consumer input, and systems development for CSHCNs.

Annually, the Title V Program offers other internal RIDOH programs an opportunity to apply for up to $25,000 for one-time funds to support an MCH projects related to the ten priority areas. Approximately, $130,000 is reserved to support the approved Venture Capital Requests (VCR) during the FY21 budget period and $25,000 is budgeted for obligated VCR from FY20 budget period.  Once applications are received the MCH Management team meets to review and make final decisions.  These projects area monitored closely for spending at the regular meetings with finance staff. 

Details by Type of Services

 Of the $1,900,000 proposed, 48.23% ($916,383) will support Enabling Services and 51.77% ($983,617) will support Public Health Systems and Services.

Budget Details by Type of Individuals Served

The FY2021 MCH Title V budget allocates 15.81% ($300,306) for pregnant womxn, 32.72% ($621,672) for preventive and primary care services, 36.25% ($688,750) for children with special care needs and 4.43% ($84,142) for administrative costs. 

Federal Grant Monitoring Procedures

 RIDOH Operations and Finance team monitors all federal grants on a monthly basis.  Every grant is assigned to an Operations Liaison, who works with the Program Manager throughout the duration of the federal grant.  When a Notice of Award is received by the Division, the grant budget is reviewed and purchasing mechanisms are discussed.  The Operations Liaison continues to meet at least quarterly with the Program Manager to review expenditures, budget re-directions (if necessary), and projections for the federal grant. Monthly expenditures are tracked by the Operations Liaison in a Uniform Grant Spreadsheet (UGS) by line item in comparison to the grant budget that was submitted and approved by the federal funding agency.  Scheduled meetings assist the Operations Liaison in completing timely and accurate Federal Financial Reports.

Staff time is tracked through a quarterly time and effort workbook in which the staff enter their hours worked in a certain program on a daily basis and submit weekly.  The workbook includes the time worked and the time the employee is allocated to each account and has a variance report which captures all 13 weeks within the quarter.  Any variances from the budgeted allocation are adjusted on a quarterly basis by the finance division liaison.  RIDOH has developed a policy and procedure for the time and effort tracking while our Department of Administration is working on the possibility of an electronic system. 

The Operations and Finance Team maintains budget documentation for block grant funding/expenditures for reporting consistent with Section 505(a) and section 506(a)(1) for auditing. For the Title V MCH Block Grant, the Operations Administrator meets with RIDOH’s Executive Director and MCH Program Manager to review spending, performance, and quality assurance issues for the Title V MCH federal grant. The MCH Program Manager is responsible for monitoring the MCH funded projects performance and assuring the projects align with the National Performance Measures and selected State Priorities.

Audits from both the state Office of the Auditor General and the state Bureau of Audits are conducted at RIDOH annually. Within the past 2 years, the WIC and 1422 programs were audited by the Auditor’s General’s Office and last year the state Bureau of Audits conducted an audit review of 16 federal grants, in which the Title V MCH block grant was one of the grants selected.

RIDOH participates in an Executive Office of Health and Human Services audit workgroup.  The workgroup is responsible for determining the subrecipients who meet the threshold of receiving a minimum of $750,000 of federal funding per the Uniform Grant Guidance. Audits are being reviewed for finds and if needed, follow-up on the status of the corrective actions of the findings and/or subrecipient financial site visits.