Welcome to day three of our budget workshops.

We are happy this day to have health, municipal courts, hits and ARA and HR today.

So we will be action-packed.

Starting us off today is the Health Department.

And I would like to welcome Health Department Director Teresa Tran and Darren Asher to present their proposed FY27 budget presentation.

And I'd like to welcome my colleagues.

I have my Vice Chair Mario Castillo, staff from Councilmember Twila Carter's office, Vice Mayor Pro Tem Amy Peck, staff from Mayor Pro Tem Casatex Tatum's office, Councilmember Julian Ramirez, staff from Councilmember Charcia Jackson's office, Abby Kayman's office, and Fred Flickinger's office.

So welcome everyone and Director Tran, the floor is yours.

Thank you so much, Chair Alcorn and everybody for um in a in a advance for your attention.

I'm really glad that we're at the beginning of the day and not your like four o'clock presentation.

So I wanted to recognize our health department team, our executive team sitting right here behind us.

And then they just became members of the health department, but um Victor with finance and Mr.

Velinski, who used to work for the city.

So really uh this budget presentation is going to show you that we're a department with a vision and a plan for this administration and whatever administration comes after.

So we can go to the next slide.

And there's our table of contents.

Next slide.

Okay, our organizational chart, as you can see, I have nine direct reports.

All of them are at the assistant director or um the deputy assistant director level.

Our deputy public health authority who has been, you know, really the person who's taught me how to become the public health authority is Dr.

Janina White.

We've got our Chief Communications Officer Tucker Wilson.

Our Chief Science Officer, Dr.

Lauren Hopkins is one of the premier chief um environmental scientists in the nation.

We're very grateful to have her at the department.

Mrs.

Moore is uh the direct deputy director and our chief of staff.

Um, and then we have um Dr.

Renita Madu, who's over public health infrastructure chronic disease quality, strategic planning.

Um, Mr.

Roger Seely, who many of you have been in contact with because he's over environmental health, and that includes consumer health and also our epidemiology and lab programs.

Um, Ms.

Naomi Masias, who is our director over public health services, and that's our clinics and patient-facing services such as the multi-service centers, and then our bureaus of immunization uh tuberculosis and HIV.

Um, Mark Seal is our um C our chief technology officer, probably one of the best, I think, in the city.

Um, and then Amber Haig is our assistant.

Oh, oops, I I skipped Lishonda Mallory Horn, who's our assistant director over human services.

Thanks, Darren.

Uh and she she is overseeing our re-entry program, our violence prevention, youth health, and uh WIC and AAA programs.

Uh, Amber Haig is over operation support, so all of the procurement and grants and um the billing that we have to do and as well as human resource needs, and then of course, Darren Asher over administrative services, which includes not only um finance, but logistics and grant administration and all of the administration it takes for us to actually run our department.

If I might interrupt you just a second to welcome a couple more people and also to say as I went through your budget, uh I noticed all of the restructuring.

You've done a lot of restructuring, and it seems to make a lot of sense to me.

So I hope that you'll you'll go into that some um during your budget presentation.

I do want to welcome um staff from council member Alejandra Salinas.

Perfect and anyone else.

Okay.

Um yes, you will see that our so our restructuring process is hopefully going to be completed by the end of the year.

It starts with financial restructuring, and it will then proceed after I'm done with my deep dives and um understanding deeply what all of the programs are, what they mean to the city, and whether they belong in public health or not.

We will uh continue and finish our restructuring.

Um, and we may need more things.

I don't know that yet until I do all of my deep dives.

I've made a commitment that I won't physically restructure our organizational chart until after I've done a deep dive to have a comprehensive view of what we are doing as a department in light of everything else that's going on in the community.

All right.

So our request was to show how our programs fall within strategic alignment, and so you'll see that within government that works public safety and quality of life, we are very heavy on the quality of life portion.

When you look at this the department budget by priority, uh we've got 33% under government that works, 23% under quality of life, and 43% under public safety.

What this structure does not allow us to really show is what I want to show on the next slide.

Which is that very much we are we have a greater return to the city than what we are expending from the city simply because so many of our programs are grant funded or special funded.

And so while under the structure that we are presenting to you today is really just the um general fund and the special funds, when you see all those things in red, those are services that we bring to the city and which our administrative services support bringing those to the city that the city is not paying for.

And so many of those, when you if we were to put our grant funded programs into the structure that from the slide before, you'd see the list just expand much far beyond what would be able to fit on that one slide, um, and you'd see a larger expanse even in quality of life and um and public safety.

All right, next slide.

So our expenditures by program, you will see, and I wanted to break this down specifically to you as well, just because the health department budget is different than other department budgets in that we are so heavily funded by grants, and you'll see that our only 22% of our operating budget comes from the general fund, and that the majority of our budget really comes from special revenue and grant funds.

And when we say special revenue, some of it is revenue producing activities where you think about like as a business brings in revenue from permitting or from um you know fee for service type activities, but some of that revenue also comes in, of course, from funding that we get as reimbursements from the state or federal level.

Uh so revenue in the health department is not just strictly fees, but we are so you know, you'll see there's that within our general and special revenue funds for the purposes of this meeting that accounts for about 55% of our budget.

Wherein out of 1,390 individuals that work at the health department, only 214 of those are covered by the general fund and uh another 390 or so.

I can't read that.

Thank you, 398 are on the special revenue funds.

What this should also um point to you is that 718 individuals at the health department have to sign a um a document at the beginning of every year saying, hey, I know that my funding may run out, that I may not have a job after this funding runs out.

So when you receive services, especially human services from the health department, please remember that the individuals that are rendering you your service are not acting as if they're temporary employees, they are acting as public servants who are not really sure if after their grant funding runs out, they will still have a job, and they still render the highest quality of service to the city.

And so I encourage everybody who can hear me to think a health department worker today.

Um our expenditures are aligned with our uh you know revenues, as you saw in that we expend, of course.

Uh oh, are we on the next slide yet?

That's extended, yeah.

Thank you.

Um this year, what you saw in the restructuring is really realigning where revenue it um goes into.

As I as I look at it, the general fund is what taxpayers are funding.

The programs that taxpayers are funding, that the reason why we're asking them to fund it is because these are public health needs that will never be able to bring in any revenue or generate any revenue, but that we need and nobody else will do.

And so, in the past, that was not necessarily how we aligned our budget, and this year we've made a very concerted effort to align our budget within the constraints that the finance department gave us.

So you'll see a lot of revenue actually leaving the general fund because it was always supposed to be on a special revenue fund because we're not bringing in revenue into services that the general fund provides anymore in this budget, and we've taken the expenditures for special revenue producing activities and put them on special revenue funds.

And I think that's what I meant.

Maybe I said restructuring, but it was really realigning the costs with where they made sense.

Yeah, this year, I don't think that the general fund was ready to for a full realignment yet.

I'm hoping that in the coming years, that you'll see that realignment more structured, and that means that when you're asking for more help on food, for example, permitting services or inspection services for apartments or pools or other safety services, that we're not as worried because in the past what we would happen is we'd have funds from that uh from that special revenue fund clawed back, and we'd have reductions in our general fund, which is where those positions were sitting.

So we're trying to make right and make transparent to you how much our activities are actually costing and and whenever we need more, we may have to add ask for support if we want increased services.

So now we'll go down into a breakdown of the programs, and this we'll try to fly through these for you, but um of what we do.

I know I gave a service delivery presentation a couple of weeks ago, which covers a lot of this, but I'll just remind you our administrative services with about 120 or about 130 individuals.

Um they provide personnel management for over 1,300 employees, our facility services for 13 or for 36 buildings.

Now you may wonder why does the health department need to have any facilities or buildings?

Well, remember that we are doing that work in the communities, and all of the programs that come after program one have to have a place to operate, and so we use those buildings as touch points for the community.

Um we have 230 uh fleet vehicles, we all of our inspectors need to be out on the road and use using these vehicles.

We have investigators, this is work that nobody else is gonna do.

Going waking up at 4 a.m.

to go to meet with the family before they have to go to work or school, and um working throughout the day, throughout the weekend, doing disease investigations, administering medications in a home, giving out meals.

Um, so that we have a fleet there for that.

Uh, like I mentioned, we are very heavily grant-funded, 44% grant funded, and that grant requires compliance and administration, and when you have 91 grants that have very, very strict compliance and regulatory conditions in order for us to maintain the grant to get reimbursed for the work that we've already done, or to maintain grant funding for future years, you have to have a strong administrative team to do that.

Our vital statistics bureau is also included in our administrative services budget, and that's all of the death and birth certificates that happen within for the city and all the amendments that happen within the city of Houston.

We also use our vital statistics and other departments use it as a of course trove of data for vital statistics in Houston.

Um, of course, and then the procurement IT and communications, and then we have a logistics team that I know that many um departments and some council members have relied on over the years, but we have daily large scale events because when you're public health, you're out there in the public, and we have large-scale events all the time that our logistics team works really, really hard to support.

So we'll go to the next slide.

If y'all have any questions, feel free to stop me because I feel like it's a long presentation.

Environmental health, we'll go through this.

So, you know, these are this is one of those services that if we don't do it, there's nobody else in our jurisdiction to do it.

And when you talk about combining, you know, there's talks about combining the city and the county on what we do and how we do it.

Really, we all work under a very similar umbrella anyway.

And when you have, you know, rest it it really comes down to a geographical footprint.

And so it makes sense that the geographical footprint of the city is within the city limits, and the geographical footprint of the county is within the county limits or outside of that.

And we do the same work though, and our teams work very closely together.

Um we do the laboratory testing for air, water, wastewater.

That's something we do countywide.

Um, of course, the safety inspections of the restaurants, food trucks, fog, which stands for fat oil and grease and other special waste producing entities.

You know, you don't want people dumping into the bayous.

There's special um uh what are they called, commissaries that they have to throw their waste into.

And so we regulate and we help to make sure that that's happening.

Um, all of our, all of the EMS that operates within the city of Houston.

We have the largest medical center with every specialty known to the world here in the TMC.

So we've got ambulances coming in and out.

You want to make sure that those ambulances have all of the right supplies, oxygen, the right medications, the bandages and supplies that are needed for the most critical patients.

We ensure that that happens within the city of Houston.

And then the pool inspection program because we know that drowning is one of the leading causes of death for young children.

Um, and then of course, I know that y'all have been talking about this a lot lately, but complaint-based investigations of apartments, which is a sorely needed, it's a kind of a new program, but a sorely needed program in the city.

And I thank council for your support of that program, and I'm hoping to grow that in in future years or now.

Um next is disease prevention control.

So I always go around saying that the health department is the safety net of the safety net.

Um part of the realignment took our clinical services and put it into a special revenue fund.

Um, and the reason I did that was because my way of on the finance side deduplicating a tax that we're paying already to the hospital district.

However, that does not mean that the services that we do are unneeded.

Um we do not do primary care services.

Patients need what's called a medical home, and we do not provide that medical home, and that is provided through our health care delivery providers.

But you will never find, well, I'm not gonna say never, but it is hard to justify even being a loss leader, doing tuberculosis prevention activities, going out into the homes and giving uh direct observed directly observed therapy to individuals at 4 a.m.

like we do, going out into the community and doing the the education and prevention between you know the doctor's visits that happen every three months, having touch points for individuals.

The healthcare system does not and is not able to support that because that is such a expense.

So in that we do disease prevention and control, we we there is a place for public health.

The only clinics that we run are within the dental health, and so there is a huge need for dental services, especially for children.

So we run that mostly through the Title V program, which is dental services for children.

We do natural family planning, or sorry, not natural, um family planning, which is uh family planning services mainly um administered through a everybody Texas grant.

Um, and then we do immunization services uh, kind of small immunization services, but within our immunization bureau, we are the regulatory entity for Texas vaccines for children and adult safety net vaccines.

Now the two clinics that are needed because I cannot, I don't, I don't see right now public health being able to get out of that business immediately, but I'd love to be able to to be honest, is our HIV and our tuberculosis clinics.

And the current, even our wonderful FQHCs and our wonderful hospital district and FQHC lookalikes are not able to absorb all of the patients that we see or all of the new diagnoses of HIV and tuberculosis that need such immediate treatment within the amount of time that is designated by the state.

And so, in order to not set our community up for failure and be able to prevent the spread of disease, we have those important clinics.

So we are continuing to work with our partners to see how much we can push that envelope and try to get health care delivery for this very big and difficult to reach population if we're not if we don't actually have it for free sometimes or at a reduced cost or make made available the way that we have at the health department.

We're trying to work better with our health care delivery partners on those services.

I'll tell you this budget season, we're just not there yet for this cycle.

And then, of course, we uh coordinate services and support between federal, state, and local entities, and you'll see that our Bureau of Epidemiology, that is another public health absolute necessity service that some unfortunately sometimes depends on grant funding, but the grant funding doesn't account for when we have uh threat of an outbreak in the city.

Um and I can tell you that we they work really, really hard.

We're preparing for the World Cup for and we are the home entity for all of the information for healthcare providers when it comes to diseases that we may see during the World Cup.

Um and then we don't see big outbreaks in Houston, and it's the things that you don't hear about that you may hear about in other places and outbreaks that you hear about in other places that you're not hearing about in Houston being the almost now third largest city in the US, is a testament to the success and the hard work of our epidemiology program.

All right, next slide.

And you may see in there, you know, we've got a lab and pharmacy.

Oh, let me go back real quick.

Um I've gotten questions in the past about why does the city have to have a lab, why does it have to have a pharmacy?

Why does it, you know, why are we running a lab or pharmacy?

So there are some labs that are going to get paid for, like the labs that you you ask your doctor asks for, um, but what about the labs for um you know whether there's an outbreak going on or whether a strain of E.

coli actually came from the same source, or whether you know, there's actual measles going around in the wastewater.

Uh those are the services that no one else will do that we have to exist to do.

So we do that proudly, not only for our city, but for 17 surrounding counties, and we are the reference laboratory for those as well as a part of a national network of labs for the CDC.

As far as pharmacy goes, um, we receive medications that are received through grant funding that can only be received at the city level.

Um, and so that's what we'd run a Class D pharmacy for.

All right, uh re-entry and youth violence prevention.

This is an area where I also hope to see growth.

I uh part of the when we think about health care outcomes, which we're always interested in.

One of the places where there's not enough attention and there's not enough dollars that are going to it is these historically difficult populations.

Um the reentry population, the youths in in high priority neighborhoods.

We provide, I mean, it's it's easy for us to say, you know, okay, well, why don't we have this under law and order under public safety of some sort?

But these individuals, and I was just at Jones Futures Academy yesterday with one with our peer wellness program where we are employing 21-year-olds who are a not a full generation older than the high school students out there, but they are mentoring these students in a very humanistic way.

You're talking to a friend, not a police officer, not some somebody who's there to enforce anything.

Um but through our uh through the programs like that, we're actually capturing and trying to make an intervention that is generational for these individuals and for these communities.

So that is, you know, that is why under you know, as a quality of life issue, this is just super important.

And we do it through the lens of health.

We're teaching them healthy behaviors, healthy ways to deal with stress, healthy ways to stay out of violence, and and that hopefully then becomes a you know generational knowledge for them and their families.

Um as well as you know, we have a wonderful reentry program that I think is pretty well known in the city and nationally.

Uh, I'll remind you that 40,000 inmates get released out of the prison system to Houston every year, or sorry, out of to Texas every year, 10,000 of those are in Houston.

Our reentry program graduates about 75 to 80 individuals every six months and has a 10% recidivism rate compared to the 20% recidivism rate that you see across the state.

So we are helping keep Houston safe through programs like that.

And not only are we keeping them safe, but those individuals that we touch every year are actually getting, you know, they're they're becoming sustainable and they they are gaining dignity and a quality of life through the mentorship and the help of our programs.

All right, and I uh oh yeah, we'll go back.

We also are the backbone entity for the My Brothers Keeper program.

I will admit I haven't done I've not done my deep dive in the My Brothers Keeper program yet, and so that is still forthcoming.

But um that is a program um that is we're the backbone for a coalition of about 200 programs that each have their own metrics, but that um improves the um the well-being of individuals of uh of color.

All right, multi-service centers.

So I want to see in this um fiscal year the multi-service centers become the jewels of the city.

Now, eventually that's gonna take more capital improvement dollars.

Um, if you've been to our multi-service centers, you've seen that um, you know, they they could look better, as could a lot of city buildings, I think.

But um, but we're hoping that we are able to get a bigger investment in these multi-service centers because those are where people want to go.

Um offense, I don't think they really want to come get services here in downtown where there's no parking in City Hall.

They want to go to these areas um of community within their own neighborhoods, and that's what the MSEs do.

They uh when we are not operating as a warming or cooling center or as an emergency center for the Red Cross.

Um, I I don't know if you know this, but whenever there's like say an apartment fire, some kind of an emergency, the Red Cross calls uh Naomi and says, Hey, is can you open up one of our multi-service centers?

And we have somebody go out in the middle of the night, open up the doors, ready to take in anybody who needs shelter.

Um, but we we do outreach programs, that's where we operate our WIC programs out of.

Head start it um operates out of one of them.

Uh we have chronic disease and prevention services.

Like I said, uh, you know, these chronic disease and prevention services are something that we can we do well, that we do better than, and that we are more capable of doing than the healthcare delivery system, which is oftentimes based on just that, you know, care episode.

And when you think about quality adjusted life years, which we talk about like what is the ROI on programs, the quality adjusted life year of preventative services and preventing somebody from having events from hypertension, for example, which we have we help people manage their blood pressure.

We help them with lifestyle and you know modifying activities in order to keep them from having hypertension.

That's between 700,000 and 2 million dollars per person per year when you think about the prevention of strokes and heart attacks and emergency visits and all of the rehab that comes after that.

So we are actually we are as a public service, what we do with our chronic disease prevention, and that's that's just hypertension.

We're not talking about diabetes and all the other and kidney disease and other chronic diseases, but that's what our chronic disease prevention services do as a public health department in outreach, and we do that in our multi-service centers as well as in the community.

We provide congregate meals.

We have space for Baker Ripley inside of our some of our multi-service centers.

In others, we do the meal program ourselves through the we are the designated area agency on aging.

And so we do meal programs.

The congregate meal program is a great way for seniors to come and actually have you know a community, and then we also do home-based meal programs.

Um we also do on-site service linkages for families.

I think that's one of the big strengths of the department that can be an even bigger strength.

But we try to be what we call no wrong door for services, and people know that when they see the multi-service center health department sign that they're coming to a place where they'll be able to find help.

Another thing, of course, the multi-service centers is a space for meetings and events, super neighborhood events.

Um I know council members, y'all have events at our multi-service centers and uh and just other places for like other community events as needed.

I know we have weddings there.

I think it would be awesome if you know we're able to serve alcohol there, and then we can actually have even more weddings.

Um, but I what I want to see this year for the multi-services center, multi-service centers, like I said, is that we see even more community services, that we see more uh community-based organizations or even you know, other departments put life into our community centers, and and see the services and the vibrancy of that community of our multi-servant centers grow.

Okay, that's next slide.

All right, family health and human services.

This is a hodgepodge of services across several areas, but um really I think I've already told you what we do here, but we you know, we try to support self-sufficiency.

We do receive every um every time some opioid abatement funding comes in, we uh that goes into our opioid abatement fund.

Um the majority of that funding goes towards naloxone um provision for our our EMS providers.

I will tell you as an ER doc that naloxone has just like has been a game changer for how we've been able to deal with patients.

Having EMS that's able to give naloxone before a patient comes into the ER prevents them from going to the ICU, prevents me from having to intubate them, actually prevent prevents brain damage.

And the return on investment there is anywhere between you know a million to a hundred million, depending on how many times an individual may need it on their way to um to improvement of their substance use disorder.

Um we, you know, we do we our um ADRC or aging disability resource center and our client access services are who connect with the community in order to connect them with health care and resources.

Everybody in the United States, and certainly everybody in Houston ought to have access to a medical home.

While we are not that medical home, our client access center provides the resources and the, you know, they sit down with clients.

And I've sat down with these people.

It takes sometimes an hour and a half to register a person through all of the systems in order to get eligible for health care services.

So these they are working long and hard hours in order to make sure that we're able to coordinate somebody into their next step of care or insurance.

And then, like I said before, we do peer support and mentorship to at youth, at risk youth and young adults.

If you have not been able to interact with our credible messengers program, you're missing out.

I cried when I watched their presentation, and they they did a uh a play.

And what was so fascinating to me was that through our mentorship and through our programming with these youths, okay, and they don't turn anybody away.

I saw the recognition of trauma, their the self-recognition of trauma, and the self um awareness of their place in their journey to healing.

That speaks volumes to the type of life these kids get to live afterwards.

Our um, and and let me just put another thing in there that uh, you know, through the through a grant, a very small grant that was um provided by the health department to a community-based organization in Acres Home.

There was a um, there were was it 17 or 19?

Okay, I mean it's either 17 or 19 lives that were saved from gun violence, the preventions of gun violence or prevention of gun death, and you can't put a number on that in just that one neighborhood.

So I'm very, very proud of that program.

Um, so there you go.

Moving on, before I get teary.

All right.

I've already talked a little bit about chronic disease health and education and wellness.

Like I said, this is something that we do to fill the gap between doctor visits, between visits to any type of touch point that you get with a health care provider, and if the health department's not doing it, who is there are programs out there, but they're not in the neighborhoods and they aren't doing it with the reach that our health department does.

We have a farmers market, we have um disease or diabetes management and self aware uh self self-management education programs and diabetes prevention programs.

Um, and we are also working within that front with uh in the time that I've been here, at least I know of uh working with other organizations for um for improved chronic disease awareness.

I'll give you an example.

We were working with the American Heart Association and Melina Health to put, or we already did, but in Kashmir Multi-Service Center, we've got a blood pressure monitor along with lots of awesome information for uh individuals to go check their blood pressure, and then what do you do with it?

Well, we have a log for you to write it down in.

We have papers to tell you exactly like you know what you should do, how you should talk to your doctor about it, what kind of food and exercise activities that you can do to bring your blood pressure down, how to decrease stress.

So we try to be a resource in the community, and you know, it's at Cashmere Multi-Service Center where people may be going for other services, but they have that available to them.

All right, we'll move on.

Okay, so um this is just going to reflect, you know, what really I think, you know, where we spend our money.

Most of the money, as you can imagine, is spent in personnel costs, um, and so red is non-personnel costs, and then uh blue is in personnel, of course, because you need people to do the things that you want to do.

In our health special revenue fund, we carry a lot of we uh the non-personnel costs because like I said, and this is for FY27, right?

Um, this is a uh, this is us alleviating the cost of running clinics on the general fund.

And so you will see how expensive it is to run clinics, which is why our department this year is also putting a lot, a lot a lot of effort into trying to generate revenue, not to make a not turning a profit.

There's a difference between turning profit and generating revenue, but actually billing on the clinical services that we're doing so that we can try and somewhat decrease the cost of it, the clinical services and administration of care.

Okay, so lab operations, this is mainly on lab supplies.

We have a special fund for lab supplies, swimming pool, our swimming pool fund, mainly personnel, and then our um this is 20 uh yeah, 2010 fund.

We um also mainly personnel.

And then we've got that opioid abatement fund.

Like I said, most of the money goes towards actual um harm reduction uh things like naloxone and naloxone kits.

Okay, I this is um kind of just showing you a trend, and I really wish that I could show you the trend before FY25.

If you go all the way back to like the beginning of Darren's time here at the department, you will have seen that the expenditures on the general fund have gone from like 85 million down to this year, we're at 41 million.

Um, that reflects a change in you know administration priorities and a continual squeeze on the general fund.

And so um the realignment really of our health department strategy and um these deep dives is helping to maintain the idea is to help to maintain our department services and the stability of what the health department is that it does, that it promises to do within whatever the administration's uh and budget priorities are for the whole city.

Okay, and that's just a breakdown in number, like on a table of what you just saw.

So uh we're getting to the end of my presentation.

Sorry, it's so long.

Um, but the highlights that you've already uh called out at the beginning are, you know, we're we moved, so there are some programs that I moved to the general fund, because like I hope that you saw, there are certain things that taxpayers should be paying for.

They taxpayers should be okay with providing 10,000 pairs of glasses to children who would otherwise never get glasses.

And the only reason why they're able to get glasses is through this program because they're on the unresolved list from HISD or other school districts in the area, leading to improvement in obviously their vision, their ability to excel in school, and their ability to um to excel in life.

Uh TB Rapid Treatment was on a special fund before, but like I said, that is something that is never going to make us any revenue, but the city would be really sorry not to have.

So I do expect taxpayers to pay for the for our TB program.

Um, so that's a 2.0 sorry, $3.29 million dollar increase in the expenditures to the general fund.

Um what we moved to the special revenue fund in an attempt to actually as a self, I guess, like putting our feet to the fire attempt is to actually try and make revenue on things that can make revenue.

Um, and that includes our Vital Statistics Consumer Bureau, Oral Health Health Center, and Medical Services.

That uh was a total of a um $14 million expenditure that came off of the general fund onto uh one uh onto mainly two special funds, which is the 2010 fund and 2002 fund.

Um we also added three FTEs for the public health laboratory, like I hope I explained to you earlier.

Some of those lab services you will you need, um, and so I think that it's appropriate for taxpayers to pay for those lab services.

Um, and then uh so in general, the general fund expenditure was reduced by $10 million, hoping that we can make revenue in special funds for for that amount at some point.

Um, and we're working towards that.

We have a runway, or we're gonna have to tell you as a department that the city can't we can't afford to do those services and you're gonna lose out.

Next slide.

Um this is mainly what I just explained.

Um something else that we a new expenditure this year that is added on to the 2010 fund, which I'm gonna tell you right now the way that it's realigned.

If we're not able, if if we are expending on fund 2010 the way that we have been without any changes, that fund will run out of money in two years.

Okay, so this is not like some treasure trove that we just have as a savings or an endowment for the city.

Um, these are where actual services are.

Uh in case you so let me take a break on 2010 real quick and just highlight.

We used to make a lot of money in that, or when I say make a lot of money, we used to bring in a lot of revenue in our 2010 fund under the 1115 Medicaid waiver program, where we were getting reimbursements for outcome based um programs that were innovative.

The state in 2023 or 24 changed to an uncompensated care fund, where the maximum of the fund that we can the maximum allocation for the entire state, which includes all of public health and mental health, is 499 million and a hundred thousand and something dollars.

So out of that amount, we are able to draw down a proportionate share for what we bill.

So that has drastically reduced what we're able to bring down.

I'll give you an example.

I think this year we build that um uh that pool, what we call it an uncompensated care pool.

We build it for about 11 million dollars, and our proportionate share was 8 million, eight or nine million.

Um that is drastically reduced from the revenue that we were able to bring in from the 1115 uh waiver fund the way that it used to be administered, and um that this pool this 499 million dollar pool will not be revisited again until 2030.

Um we hope that there is an increase in that pool or that the public health share carve out becomes larger, but um, you know, as somebody in public health now I can say that I think that public health is unfortunately an afterthought, and we're working under those constraints.

So our 2010 fund is uh is feeling a lot of pressure, especially based on that, and and moving special revenue and aligning our revenue um our revenues and our expenditures for revenue potentially revenue producing services.

We did uh earmark uh 1.6 million dollars at for a lease payment for a respite center.

Um I think I told you this during the service delivery committee, but my in alignment with the city of Houston's um plan to end street homelessness, there is a huge gap that I think we can fill, and it's within medical respite that does not exist in this type of form or fashion, where individuals that leave the emergency department or leave hospital discharge are not discharged out onto the streets, but rather have a warm handoff into a place to stay and then a warm handoff into another place to stay and not back out onto the streets because um I know from my time in the ER that they all end up right back in my ER.

Um there were you know, we're we are paying for our own security services out of our fund 2010 because it exists and we can right now.

So you're welcome, City of Houston.

Uh and we are also paying for a 2.2 million dollar lease for a property on um Kirby.

So uh this lease agreement was entered when we had grant funding, was it COVID funding to pay for it?

Um the COVID funding ran out, but we were still responsible for the remainder of the lease, which will end in 2027.

Um also uh, yeah, and then there were of course the expenditures.

And then the revenues, I think that you'll, so when you see that massive decrease in the revenue for the general fund, like that blue has gone down to very, very little on the general fund, it reflects the realignment of our services in that our general fund expenditures and services don't make any revenue, so they're not getting any revenue back.

And then, I mean, we can go through this.

This is kind of the same thing that you just saw.

Revenue highlights.

I think in the expenditure slide, I think I explained my rationale, but in case you do too, we are.

You've covered it.

Thank you.

Okay, we can get going.

That's it.

There we go.

Um, Dr.

Tran and Mr.

Asher, wonderful presentation.

Uh, your passion for this job is so evident, and we are so grateful for your service, and we're really happy you're here.

I'll go to my vice chair Mario Castillo.

Thank you, Chair, and thank you, Director, to you and your team.

Um, such a thorough presentation, a lot to cover.

I I appreciated your comments about the employees, the the grant funded employees.

Um, there was a time when I was one of those grant funded employees, and I saw firsthand what what you talked about and how they go about delivering the services working for um Houstonians on those sort of special type of assignments.

But um the questions that I really wanted to focus on.

The first one is with the realignment.

So on slide 20, it it kind of highlights some of that the 10.5 million reduction moving C to succeed and TBR rapid treatment to the general fund.

Uh I think that's a strong indication of you know the value of those programs and institutionalizing them in a way, uh C to succeed has such a direct impact uh on our youth across the city.

That is uh I think a great idea.

Now the ones that were shifted to special revenue.

Uh you mentioned that if they're not bringing in enough revenue, the programs may not have enough money, right?

So what what does that look like if something like oral health or uh vital stats isn't meeting the projections that you're you're thinking?

Yeah, so it's part of my job to ensure that those programs are able to bring in revenue or that the services align with whatever they're able to make, and so um our vital statistics program is already charging way, way less than the county for much more expedited services.

So we could look at potentially increases in fees if we just if we see that we are not sustaining that program.

Um with uh oil health and um our health centers, I think that that's a that is a hard conversation that we're gonna have to have.

Um coming from the health care delivery side, oral health is pretty expensive.

Dental health is expensive.

We know that dental care and eye care are not covered by traditional medical insurance, and so a lot of people just don't have any insurance to pay for those services.

Especially, I mean, we're grateful here at the city of Houston that we actually have those types of insurance services.

But for most health care delivery systems, these are a pure expense or a loss leader if they're not able to do the services well or to bill for them.

And as a health department, that's something that we're going to have to ask ourselves is if we are not able to provide the services and they're just going to burn money.

A, where are we going to get the money from?

Is the city going to make that an investment as a core service that we need to maintain?

Or B, or B who are our partners that we'll be able to um partner with to maintain those services.

So we are talking to FQHCs, the county, the um uh other organizations, you can keep talking.

Sorry, um, to understand where uh what what we're able to do with oral health.

Um children's oral health tends to we're able to get some reimbursement for that.

So what happens is through Title V funding, we have an allocation every year after we expend that allocation, which we've already expended that entire allocation for this year because we take care of so many children.

Um we can ask for a reimbursement and ask for more dollars on top of that, and they may or may not give it to us.

Adults, it's a very difficult population to be able to um do oral health because there's not that type of grant program for adult oral health care.

Um and then the health centers, like I said, we're trying to work on our billing um and um you know services.

What I think would be an amazing idea would be to co-locate services that are primary care services in our um, you know, in our multi-service centers and being able to use potential revenue from rental and um from you from mixed use of the spaces in order to fund that type of programming.

Thank you.

I'll go back.

Yeah, thank you.

Yeah, the bell just means we need to be quiet, not you.

Um Councilmember Ramirez.

Thank you, madam chair.

Uh, director, thanks uh for the presentation.

Great to see you again here at committee.

Um, I was just noting uh again this year that the city has um truancy programs in three different departments, and I don't know that that's a bad thing, but I I just wonder if there are opportunities there for coordination and evaluation about how those efforts can be can work together uh effectively.

Um so I'd ask you to take a look at that when you get a chance.

I know there's plenty of things for you to do, but I think neighborhoods, department of neighborhoods has something, and I know courts has something.

Um I wanted to ask you about uh environmental health and specifically uh air quality monitors.

Um do you feel like you have enough of those to monitor air where the quality where you would like to do that or?

Um Roger.

Do we have enough of those?

Come on up, Roger.

You can get on the mic, or you can you can take council member Davis as chair, there.

Yeah.

Got a promotion today.

Okay.

We love working with Roger.

Roger's on it.

It's good to see all a bunch of friendly faces here.

We appreciate your support, certainly.

Um, our air monitor program, um, what we've done so far is um through um most of the funding comes from council member offices.

We've been able to supplement our uh the clarity monitor system, which is PM 2.5 uh monitoring across the city to fill in the gaps as much as possible where the TCEQ monitors are, but um yeah, there are still existing gaps, and we are always looking to supplement that as much as possible.

Uh the clarity monitor system is actually a uh relatively affordable system.

Um each monitor comes out at about twelve hundred dollars annually.

That's a subscription-based system.

Um so yeah, we're always looking to work with the council members to um increase the coverage of those within the city.

Great.

And by the way, you just got a drastic pay cut too, Roger.

It takes an entire team, and I am humble enough to know that.

Thanks, Roger.

Um and does the health department get involved in the TCEQ permitting process, you know.

They have have hearings for concrete batch plants and asphalt plants.

I think I can answer that.

I think there's one coming up Monday regarding uh uh a landfill.

We do comment on we do comment when asks, so TCEQ reaches out to us and um you know we'll we'll make comment, you know, commentary based on our knowledge.

But we don't get to you know do the permitting.

Right.

That's right.

Of course.

Um you mentioned naloxun, I think that's the correct pronunciation.

Yeah.

Um being a game changer, do you feel like um you've got an adequate supply of that as well, or is that something that can be enhanced?

It can always be enhanced.

I have three um vials of naloxone in my car right now.

If everybody in this room doesn't have at least one, then whether you use opioids or not, um then I would say yes, it can always be enhanced.

But we are providing um, we do have an opioid abatement fund, and we use that funding in order to um to to help supply naloxone.

Um but from a public health and from an emergency medicine perspective, we would love to see naloxone like in every you know, in homes, just like you see um, you know, I don't know what allergy medicine, I guess.

Yeah, okay, and just last thought I'll leave you with um youth intervention programs.

I know you're very passionate about that.

You spoke movingly about some of the success that that you've seen, and I would note Department of Neighborhoods has some as well, and I just wonder if there's uh room for coordination there.

Absolutely, and we've already been in connection with the Department of Neighborhoods as well as the uh Mayor's Office of Education on our um youth programs on how we can collaborate and where we can work together.

Um and you know, we've talked as well both um both director Sims and um uh Dr.

Oliveira's last name, I can't I forgot, but um we've talked about whether we should be combining our programs so those conversations are happening.

Um at the end of the day, and I told the program this that I think that we do it really, really well.

I would like to see those programs succeed in the place where they're gonna get the most funding and most support.

Right now, that's the health department.

Um, and because there is so much passion for that within the health department, same with the reentry program.

We are working with Chief Satter White on um using the health department program as a um as the expansion of re-entry services for the city.

So we're we're talking great, thank you.

You're welcome.

Councilmember Martin.

Oh, and let me just add not just with the city but the county as well.

So Leah Barton and I have been talking about how their um uh deflection and diversion program aligns with our reentry services and our youth violence prevention.

Sorry, Councilmember Martinez.

Thank you, Chair and Director.

I just um I think echoing a lot of what my colleagues are saying, just love the passion that you bring to the department and of course that kind of trickling down to everybody else as well.

Uh so appreciate the very um well-informed presentation as well.

Uh some of my uh my comments were gonna be a little bit of what Councilman Ramidez was was mentioning.

And I'm it's good to hear that you're already working on a lining on some of these programs, and I agree.

I think wherever the funding um ultimately comes from, where it could support it, um, but how you you do that uh, you know, please consider it as a partner.

I think the the structural reforms that you're doing as well is important uh to ensure that that uh funding is is available where it needs to be.

Um the uh the triage uh you know we've talked about this offline a couple times.

Um I appreciate you looking forward as um as we're looking at a house community and and how do we make sure that we support them.

Um as you start moving in that direction more and more, I think you probably you probably have a plan already.

Um what whatever that uh comes to fruition at the state level or whatnot, again just consider as a partner.

I think what you're doing right now within the health department is is also something that should be duplicated in other departments, right?

You gotta where the resources are available, use them.

Uh, but quite frankly, the government can't do everything as well.

Uh and so I just wanted to say thank you for the work that you're doing and the rest of the team as well from the health department.

Thank you.

Um I just have one comment.

You said it trickles down.

I really believe it trickles up.

Um I have been a removed student of my department from the front line all the way up.

And um they are they're really who it makes me uh um look good up here.

I'm completely in alignment with you as well on that end.

Councilmember Castillo.

Thank you, Chair.

I wanted to ask about the community and children's health led reduction um uh program.

So I saw the budget has um zero ftees for twenty seven there were two and twenty six are we still gonna be providing this service yeah um so the lead program is funded by grant funding um I don't know that's the only way to answer that why yeah on the general fund you saw it reduct reduced um and the program summary can we just the uh the FTE count is what I'm what what I was looking at can we go to that slide it's in the budget book um page v37 um we don't have any perceived reductions to that like I get uh yeah um and maybe there's a typo in there somewhere but that the lead um abatement program has not gone anywhere okay that was my concern that was it was going away so I wanted to know we get CDBG money I know for lead abatement but I don't know yeah it's 100% grant funded um and in fact so um there was a little bit of a concern last year in whether we were going to be able to expend our grant you know um because of the procurement process that it took to for us to actually have the um the remediators contractors in to work on to work on the homes um but we are pretty much caught up or catching up okay so we're not we're we're still gonna be that's a national program that's been going on for like 20 something years and we don't see an end to it yet.

And there's also I think like 12,000 homes in the Houston region that still need to be remediated.

Yeah that was well that was the other side of it is like we still have a lot of work to do there.

So okay thank you.

You're welcome I'm not worried.

And Anna with council member Kamen's office.

Thank you chair hi director high health department I am really excited to be here because y'all have been such an invaluable partner to us Darren and Naomi I've been on a million calls lovely to see y'all with y'all this week to launch our gun uh safe pilot and director your team common cave with a dashboard are phenomenal Roger as well so many apartments so much help thank you um so yeah thank y'all so much for the work that you do just on the grant funding piece um do you know uh or have what percentage or amount you receive specifically from federal grants and if any have been identified as questionable or at risk for the upcoming fiscal year.

If not I can we can submit in writing I actually oh I emailed a slide to council member Martinez after the service delivery with that information on it I don't have it in front of me but we do have that information.

We are so when you look at big city departments we are funded so most of our grants are either um state or are are federal most of our I'm just gonna say this more than three quarters of our grants are federally funded either direct federal funding or pass through the okay yeah the exact number of that I can't tell you but we get a little bit more state we get a little a tiny bit of state funding certainly a lot less rec state funding from grants than other big cities.

So most of our like I mean yeah I don't know the exact percentage but the majority of it is federal funding.

As far as are there any at-risk grants right now the big one is uh the public health infrastructure grant which is ending in November of 2027.

That is a hugely what transformational grant for all um health departments and we as a department with the state and on a federal level are advocating for the continuation of that grant.

Okay.

That's yeah that's a big one.

6040 and I'm trying to squeeze squint to see it's about 6040.

There's a little bit of state funding in between then.

So about 60 federal, 40 local, and then yeah like three percent.

And that was so that was data from back before the it's a little bit less now because um we did have a large like 65 million dollars or something in federal grant funding that ended in 2025 though early.

Um so uh yes, I came into a department that had already lost sixty-five million dollars in federal grant funding.

Um but hopefully that time is over for a while.

Thank you.

And and I'll have most of my questions in writing, but but one thing I did want to focus on is your talk about the the different clinics and how you're trying to pull those in, maybe to the MSCs.

How many clinics out are are standalone without being part of the multi-service center?

Uh one, which is our um HIF.

So we only have three clinical sites, right?

Um that that provide more than the what you said one is TB and one is uh um so let me sorry, I think I'm speaking like a little bit to health department lingo and I forgot.

So when we say we have clinics, um there is there are three clinical spaces, physical clinical spaces, but the clinical service lines that we provide are multiple in that they're TB, HIV, family planning, immunizations, um yeah, and immunizations.

So those services and how any of those charge services or do we charge for some of those services?

I wish I could say that we currently not the not as much as we should, and not as in the way that we should.

And if somebody truly can't pay for them, then no.

Sure.

Okay, got it.

Well, I'll follow up on some questions on that, but we're at time, so I'm gonna allow for a public speaker, um Jack Valinski to arrive.

And again, thank you, health department.

Great job.

We love you guys.

Y'all are doing great work.

I'm gonna go find a health worker today and give them a big hug.

So thank you very much for your presentation.

We really are grateful for all that you do.

And um, Mr.

Balinski, the floor is yours.

It deserves more funding.

Um our multi-service centers, most part except for the new ones, are in deplorable state.

I know I worked out of the west end for many years.

The air conditioner would go down at least twice a year for months at a time, and those robots don't work very well.

The robot-looking things, they're noisy, they don't really cool.

Um, and again, as I said last year, HIV help is in so important.

I lost so many of my friends over the years, and it still continues.

And with the federal funding going down, we need to support our health department more than ever.

So thank you for the work everybody does in the health department.

Um, you're really great, and you know, I used to hate getting up early for the back to school, and the it wasn't the backpats, it was the work the health department did that was really so important.

You watched those kids come in and and get services they couldn't get anywhere else.

Thank you.

Thank you very much, Jack.

Appreciate your comments.

Laura Gallier.

Thank you so much, and thank you for this presentation.

I just wanted to briefly say uh I hadn't heard of the term medical respite, but uh I just want to add an anecdote.

I have a friend who was hospitalized in Ben Tob, a homeless friend, and because he had nowhere to go when he left, they kept him there for nine months.

I can't even imagine the cost of that.

When they did finally come up with some place for him to go upon release, it was only two weeks before he was back in Ben Tob for a very long extended stay.

And so I don't know the details of this medical respite, but homeless discharge is something that really needs to is like a very high, I would think a very high return on investment.

So I just wanted to throw give y'all that story.

That's a personal story of someone who I dearly love.

No, that's great, and we heard a little bit about that at service delivery.

I'm excited about that too.

I think it's great.

And and director, I I meant to ask you that $1.6 million, that's for this coming year will be spent at Cloud Break for apartments for that purpose.

Are we are we housing anybody now?

No.

No, we're under an exclusive negotiating agreement right now.

Okay.

And um, here's the deal.

We're not going to be able to start that program unless we get funding.

A lot of it will be federal and um contributions from our health care providers.

Okay.

Um that would be the but your projection is to spend $1.6 million in 27 for leasing apartments.

That's what we've earmarked in our 27 budget.

Okay.

Yeah.

Great.

Thank you very much.

If you if you get it, has that that money still needs to be received.

Yeah, and that, yeah.

I'm sorry.

The 1.6 is what we already have earmarked, and that would cover just the facility like lease, not the services.

Uh okay, but you have that that money.

Yes.

Okay.

Yes.

It's other money you have to seek for service.

That is, yes, that is in our that is in our 2010 budget.

In the 2010 budget.

Okay.

Got it.

Thank you.

We're done.

I really appreciate everybody here.

As I said before, we're grateful for your service.

We love the health department, and thank you very much.

Um, we're gonna take a break here.

Um municipal courts, and we'll get started in uh, you know, five, ten minutes.

Sorry, we're running a little behind.

Yesterday we were running ahead.

We never know here at the horseshoe.