DHSS tightens public health center services

State budget cuts will set some limits on access to services at Alaska’s public health clinics.

The Alaska Department of Health and Social Services’ Section of Public Health Nursing took a 20 percent budget cut in the final fiscal year 2017 budget. In combination with the cuts from fiscal year 2016’s budget, the Section of Public Health Nursing has lost 25 percent of its funding in two years. The repeated decreases have resulted in staff reductions.

The state’s 19 public health centers provide services like sexually transmitted infection checks, welfare exams for children, and immunizations, among other services, and are staffed by public health nurses.

To accommodate the staff reductions, the public health centers will change the parameters for five services. Immunizations, reproductive health and STI screenings will only be available for those 29 or younger, STI contact screenings will only be available to pregnant women, and child health and well child exams will only be available for children 6 or younger, according to a letter circulated from the Kenai Public Health center. The changes go into effect immediately.

Statewide, 31 positions were eliminated from the Section of Public Health Nursing. Half of those were already vacant, but the rest will have to be laid off. In Kenai, the Public Health Center was able to plan for the layoffs by not filling positions when they came open, said Kenai Peninsula Nurse Manager Leslie Felts.

“This part of the state section of public health nursing realized its cuts due to people leaving, not refilling positions as opposed to laying people off,” Felts said. “We’ve been very lucky.”

Other parts of the state were not so lucky — staff had to be laid off, and some centers do not have a public health nurse at all, such as Cordova, Haines and Wrangell. The Section of Public Health Nursing will try to cover the services there with traveling nurses from other areas, said Jerry Troshynski, the regional nurse manager for Southcentral Alaska.

“It’s not ideal, but it’s the best we can do,” Troshynski said. “We experienced about a 20 percent budget cut this year. Most of our budget is staffing. That’s what we do. That’s our product as public health nurses. It’s impossible to lose that much of your budget and not impact services.”

In the process of determining where to cut, the department’s administrators tried to reduce the individual services they felt would least impact the most vulnerable people, he said.

Individual services are not the only services public health nurses provide. Troshynski described their role as a three-legged stool: individual services, community services such as education and communicable disease prevention, and systems changes, such as implementing the statewide vaccine registry. While the individual services are the most readily recognizable service public health nurses provide, the others are part of a larger role as well, he said.

Public health centers are part of a health safety net for the most vulnerable populations, but the nurses will always try to direct people to a medical home with primary care providers in the community, he said.

“The relationship has always been strong with (community primary care providers in Kenai),” Troshynski said. “I think it will continue to be strong and we’ll work with them to try to do the best job of providing services as we can.”

Felts said the Kenai Public Health Center staff would try to engage in more community events, such as education at schools, in the future, and host events like the upcoming back-to-school vaccination clinic on Aug. 13.

“We’re just glad to still be able to provide services to all of our communities, and we are still considering ourselves part of the safety net,” Felts said.

The reductions to the Section of Public Health Nursing are among a set of other reductions to the Department of Health and Social Services that came down from the state budget discussions. The department announced earlier in July that it will discontinue its heating assistance program for low-income households. The department has also requested a feasibility study for privatizing four of its youth detention facilities to reduce expenses. For the second year, the department will not make inflation adjustments to the state’s Medicaid program because of “significant fiscal challenges,” according to an announcement issued May 31.

The department has also trimmed some of the public assistance for Alaskans older than 65 who have low to moderate incomes. In March 2016, payments for seniors in the highest eligible income bracket were cut from $125 to $47 per month; some was restored for fiscal year 2017 to that income bracket, though they will receive $76 per month instead of the full $125. About 44.9 percent or 5,318 of the recipients fall into the highest bracket, according to a June 30 fact sheet issued by the Department of Health and Social Services.

A phrase included under the Public Health Nursing section of House Bill 256, the appropriations bill for fiscal year 2017, states that “it is the intent of the legislature that, where possible, Public Health Nursing charge for services provided.” The Legislature included a similar phrase in the bill for fiscal year 2016, urging the Division of Public Health to “evaluate and implement strategies to maximize collections for billable services where possible.”

Reach Elizabeth Earl at elizabeth.earl@peninsulaclarion.com.

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