On August 22nd, Integral Care held a virtual update on our FY24 Budget. Members of the Executive Management Team, Human Resources, and Finance shared information on the funding streams that support our programs, our budget process and challenges, and our proposed FY24 budget. We invited the community to submit questions.
If you have questions or comments, please send them to info@integralcare.org or anonymously through our website form. Select Budget in the dropdown menu.
1. Is Integral Care leadership including meaningful feedback from employees?
Leadership has invited staff to submit questions about the budget via email and anonymously through a form. Responses have been shared with and continue to be shared with staff as they come in. Leadership and staff have worked diligently to ensure client care is not impacted due to these budget challenges.
2. What areas of Integral Care will most likely be cut, that will affect clients, in order to meet a reduced revenue stream?
All services currently provided by impacted programs will be integrated into existing programs. Clients will continue to receive services. In addition, fewer than 5% of filled positions – across programs and administration – are planned to be affected. Some affected staff will be eligible to transfer to other open positions they qualify for at Integral Care.
3. Have all alternative budget solutions besides laying off staff and cutting programs been thoroughly explored? Including seeking additional emergency funding from city and county elected officials?
Yes. Integral Care has explored new revenue streams, expanding existing revenue streams and scrutinizing expenditures.
4. Can the Board delay any employee layoffs and program cuts until such time as all possible alternative budget solutions have been thoroughly explored?
Please refer to the answer to Question 3 regarding exploration of possible alternative budget solutions.
5. How does the EMT and Board intend to deal with the yearly budget uncertainties created by the DPP funding formula moving forward?
Integral Care will continue to make appropriate adjustments based on the changing financial landscape and funding streams to meet requirements.
6. How can the EMT assure city and county leaders that their particularly funded programs won’t be impacted by the layoffs and program cuts when many FTEs are partially funded by multiple funding streams and most IC programs have overlapping services, staff, and clients?
There will be no impact on contracts with City of Austin, Travis County, Central Health and Downtown Austin Community Court.
7. Specifically at 15th Street – where there are Austin and Travis County resources are these proposed program cuts due to reductions in HHSC funding? What about our commitment to the city and county?
Integral Care is preparing the 15th Street location for a new community mental health diversion pilot that is slated to receive funding from Travis County, the City of Austin, Central Health, and Texas HHSC. Clients recently served at our 15th Street location have been transitioned to other residential programs to meet their needs.
8. How long does the EMT project the hiring freeze to last?
There are 70 funded vacancies. Beginning 9/1, staff who have been impacted by the reduction in force will be notified of all open positions for which they may qualify. HR will help connect any of those staff who are interested in a position with the hiring manager for the open position. The impacted staff and hiring manager of an open position must agree on the transfer. After all impacted staff have an opportunity to show interest in any available funded vacancies, Integral Care will determine when hiring for any remaining funded positions will begin.
9. How long after any employees are potentially laid off will they have a right to be recalled to their former position when/if that position reopens? Who will be responsible for notifying former employees of reopened positions?
Once someone is no longer employed by Integral Care, they can apply for available positions for which they qualify.
10. What will be done to address employee morale after layoffs conclude that is bound to decrease due to a lack of job security?
We will continue to support team members’ wellbeing during this difficult time and provide opportunities for growth.
11. How does the EMT intend to meet client delivery expectations with fewer staff?
We will collaborate with staff to strengthen processes that best optimize clinic operations and services.
12. Does Integral Care have a reserve fund for unexpected budget shortfalls like this?
Integral Care has a fund balance that must remain at an amount sufficient to cover at least 60 days of operating costs for the agency (per board policy). The Board of Trustees approves the use of the fund balance.
13. The 2024 Proposed Budget appears to have an approximate $4m Fund Balance – a significant portion was used for St. John renovations – can other capital funds be used for this so that reserves could be used to offset layoffs?
The proposed fund balance for FY24 is $1.7M. The capital outlay for the FY24 budget includes funds that will be used for the renovation of a new housing community – Bungalows at Century Park, funded by the City of Austin.
14. Why does it appear that other LMHA’s like Harris Center are seeing no budgetary dips in the Charity Care Pool and DPP and instead, through July 2023 saw an increase in funds?
The information used by the state to estimate FY22 payments was based on client service provision data for the period March 2019 to February 2020, before the COVID-19 pandemic. Each LMHA is provided with a different payment estimate based on the organization’s data. Integral Care did not meet the estimated amount of service provision during the FY22 measurement period.
15. Why does the proposed FY 2024 budget project a dip in SAMHSA funding since there seem to be the same number of accounts as FY 2023?
The amount of SAMSHA grant funding can change based on the amount of federal government funding that SAMSHA receives. Not all SAMSHA grants are funded the same from year to year, and different grants and programs are funded differently.
16. Did ongoing staff vacancies in CFS and other Medicaid funded programs contribute to fewer service units being provided and IC having to pay back the $1.6million?
No.
17. How does the EMT plan to meet client service needs and service unit delivery estimates with fewer staff in FY 2024?
Integral Care will collaborate with staff to strengthen processes that best optimize clinic operations and services. Any client services impacted by program reorganization will be provided through other existing Integral Care programs.
18. What specific new technologies does the EMT think will create better efficiencies so that client services will not be impacted by the proposed staff layoffs and program cuts? How? Are these technologies already in use? If not, what is their timeline for rollout and employee training?
Integral Care will continue to work with staff to support EHR and Bells AI proficiencies. We will analyze data from our EHR to train staff and strengthen agency performance. Training will be available to staff who want to strengthen their EHR and Bells AI skills.
19. When is Integral Care notified of funding for pending grants?
Notification varies by grant/funding agency. If a grant is awarded, we receive official notice and contract negotiations begin.
20. What positions identified for reduction in force (RIF) qualify for open positions?
Staff identified in 20 program positions hold qualifications that make them eligible to apply for open positions. Staff who have been impacted by RIF will be notified of all open positions for which they may qualify and will have priority for those positions.
| Positions | Current Openings | RIF/Re-Org |
|---|---|---|
| QMHP | 36 | 10 |
| LPHA | 17 | 3 |
| PA/APN | 2 | 3 |
| MD | 1 | 0 |
| Admin | 1 | 2 |
| Auth Specialist | 1 | 1 |
| Direct Support | 4 | 0 |
| Peer Support | 4 | 1 |
| Pharmacy Tech | 1 | 0 |
| Program Manager | 1 | 1 |
| RN Supervisor | 1 | 0 |
| DON | 1 | 0 |
| Nurse (RN) | 0 | 6 |
| LVN | 0 | 1 |
| Practice Manager | 0 | 2 |
| TOTAL | 70 | 30 |
21. What assumptions went into the calculation that the same number of individuals can be served due to various efficiencies?
We have implemented a streamlined and efficient process for clinic operations, functions and positions as well as new technology to help with documentation. Any client services impacted by program reorganization will be provided through other existing Integral Care programs.
22. Is the 15th Street Program being folded into the Diversion Pilot? What happens with the current 15th Street employees and clients?
No. Integral Care is preparing the 15th Street location for a new community mental health diversion program that is slated to receive funding from Travis County, the City of Austin, Central Health, and Texas HHSC. Clients recently served at our 15th Street location have been transitioned to other residential programs to meet their needs. Staff who have been impacted by the RIF will be notified of all open positions for which they may qualify and will have priority for those positions.
23. Are the Office-Based Opioid Treatment (OBOT) services rolling into another program. Are OBOT clients eligible for the same services?
Yes and yes.
24. What will happen to the Chronic Disease Management program employees and clients?
Clients will receive these services at other Integral Care clinics. Staff who have been impacted by the reduction in force (RIF) will be notified of all open positions for which they may qualify and will have priority for those positions.
25. What will happen with Mood Treatment Center clients?
Clients will receive these services at other Integral Care clinics.
26. What will happen with the IDD Community Behavioral Health employees and clients?
Staff will be transitioned to our Mobile Crisis Outreach Team (MCOT) as they are crisis-trained staff and often co- respond with MCOT.
27. What will happen to OPTUM clients?
These clients already enrolled in Integral Care services will continue to receive services. The remaining clients will be offered clinical care.
28. Will these budget issues impact David Evans’ retirement plans and the agency’s transition to a new CEO?
No. The Board of Trustees hired The Meyers Group, an executive search firm, in August. The Meyers Group is currently leading the search for a new Integral Care CEO.
29. What feedback has Integral Care received from elected officials/APH/Travis County since it has become public that the agency will be implementing layoffs
Integral Care has received messages of support from stakeholders as well as requests for additional information. Integral Care provides information when requested.
30. Is there evidence of decreased funding levels from city/county funds since it has become public that Integral Care has not been meeting performance metrics by HHSC? Will there be funding decreases from other funders due to the agency implementing punitive actions such as staff layoffs?
Integral Care receives funds from federal, state, and local contracts as well as fee-for-service and private grants. There will be no impact on contracts with City of Austin, Travis County, Central Health and Downtown Austin Community Court. The Directed Payment Pool (DPP) is one source of funding – shared among Texas Local Mental Health Authorities (LMHAs). LMHAs receive a percentage of DPP funding based on their own performance metrics. Integral Care is meeting HHSC performance metrics.
31. It is possible that Integral Care is not spending all of the funding it receives during a fiscal year from other funding sources and grants (i.e., city funds). What happens to that funding when a new fiscal year starts and those contracts are renewed?
With most funding sources, funds are only available for the duration of the funding contract, which is usually one year. If there are unspent funds at the end of the contract term, in most cases, the awarding agency keeps the funds. In rare cases, the awarding agency may allow unspent funds to be rolled over into the next contract term, but those funds can only be spent on the objectives and budgeted expenses of that program.