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Counties face public-health cuts

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North country counties will face more than $700,000 in state funding cuts to public health for services including early intervention coordination for children, long-term home health care and a medical examiner.


The proposal, which cuts state reimbursements for optional services under municipal public health service funding, appears to have both houses and the governor on board, Assemblyman Kenneth D. Blankenbush, R-Black River, said.


"The state calls them optional for counties, but you really need, in our area, most of the services that are being cut," he said. "I don't consider them to be optional."


The proposal originally came from Gov. Andrew M. Cuomo's executive budget. The reimbursements would end July 1 and would save $10.5 million in the 2011-12 budget year, which grows to $52.8 million in 2012-13.


Morris Peters, spokesman from the state Division of Budget, pointed out that the general public health work budget would increase under Gov. Cuomo's overall budget by $28 million, to $319 million in the 2011-12 budget.


"The total impact of the executive budget on counties represents less than one percent of their budgets," he said in an email. "Counties must adjust to the new fiscal reality, just like every family and small businesses has had to do."


Jefferson County Public Health Director Jean A. Bilow said the programs aren't truly optional; the state considers them additional to the basic programs that public health services in the state usually provide. The basic programs earn the services a certain base grant, while the additional services garner money from the state at a rate of 36 percent of the deficit between cost and any revenue the county accrues for the service.


Jefferson County's department stands to lose about $448,000 of its $747,200 in annual state aid falling under the optional category in the 2011 budget.


"Quite honestly, these local public health programs are really essential services," Ms. Bilow said. "We're preventing disease, saving lives, improving an individual's condition, and we certainly feel that the quality of life in the community is improved by public health services."


The optional services include: medical examiner, early intervention service coordination for special needs children under 3, visiting nurses for those receiving long-term care at home, emergency medical services, dental services for children under 21, inspection and review of X-ray and radiation equipment and environmental health services.


The New York State Association of Counties opposed the move, saying the cuts are essential services.


"When counties are forced to cut back, it will be programs just like this," association spokesman Mark F. LaVigne said. "Program cuts are what will happen without mandate relief."


And early intervention is a required service for counties to provide, he said, but the state doesn't require public health services to provide it. For example, in Jefferson County, Community Services provides early intervention services.


Though the Legislature has taken a property tax cap off the table, these cuts shift costs of essential programs to counties, he said.


Assemblywoman Addie J. Russell, D-Theresa, said the Assembly has fought for a significant restoration to early intervention services funding. She used the topic as an opportunity to advocate extending the so-called millionaire's tax, an income tax surcharge that in its present form takes more money from those who make $200,000 or more.


"While my neighboring Assembly members and senators are advocating for a tax break for millionaires, I'm advocating on behalf of property tax payers," she said. "Without more revenue, we're passing on more cost from the state level to the counties and from income tax payers onto property tax payers."


Proposed cuts in state aid could mean a loss of $250,000 to $300,000 for St. Lawrence County, but the impact is not clear because of uncertainty over how the state wants to change the rules, Public Health Director Susan J. Hathaway said.


"We're just waiting," she said. "It's been very frustrating."


The county pays coroners directly and does not inspect X-ray and radiation equipment or offer environmental health services, which include inspections of restaurants, beaches, campgrounds and hotels. But the state may compound the loss for early intervention service coordination by changing the billing system and reimbursement for travel time.


Lewis County would feel the cut only in reimbursement for an early intervention coordinator, estimated at $31,000 this year, County Manager David H. Pendergast said.


However, the plan is yet another example of state leaders promising no new taxes while shifting a greater financial burden onto counties, Mr. Pendergast said.


"It's just proof that Albany talks out of both sides of their mouth," he said. "And it appears they have three mouths: the governor, the Assembly and the Senate."


In Jefferson County, the loss of funding will mean considering program cuts, Miss Bilow said.


"The county and public health would need to look at the programs and the actual services under each of the programs and how operations are being conducted," she said. "We always try to improve productivity and efficiencies, but we reach a point where we would be looking at the services that are essential services and what we really need to provide to the public."

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