SPRING HILL — Robin Wright has been on the job for nearly eight months, but in some ways her work as the new leader of the Hernando County Health Department has only begun.
Wright arrived in January, tasked in part with continuing the progress made by her predecessor to get the department, which was running in the red as recently as last year, on firmer financial ground. Thanks in part to staff attrition, the agency now has a healthy fund balance.
"I feel like we're on fairly solid footing with that," Wright said.
Now Wright is reviewing every program at the department as two big changes loom: the state of Florida's switch to a managed care system for Medicaid recipients and the impact of provisions in the federal Affordable Health Care Act.
The state managed care measure aims to eventually move all of Florida's estimated 3 million Medicaid recipients into privately managed health plans. People will choose or be assigned a managed care provider.
The federal law seeks to bolster the ranks of the insured.
Both are expected to affect the critical balance of patients that the Health Department serves, Wright said. The department stays financially viable by making sure the number of clients with insurance offsets the cost of care for uninsured, indigent patients.
"We still have to have the resources to run like a business," she said.
In most Florida counties, private entities are licensed by the federal government and receive public dollars to furnish basic health care services on a sliding income scale. In Hernando, the Hernando County Community Health Center — a component of the Health Department created to expand primary care services — is the federally qualified provider, receiving about $800,000 a year to provide primary care for poor, uninsured or underinsured residents.
As a federally qualified provider, the department will receive a guaranteed rate for services under the new managed care plan.
"But we still have to have the clients." Wright said. "The key is how many people are going to choose us as their provider."
The department expects to receive a $100,000 federal grant to hire two "navigators" assigned to educate the county's uninsured about the new federal law and help people sign up for health care plans.
Florida Surgeon General John Armstrong has directed the Hernando Health Department and about 10 other departments that serve as their county's federally qualified provider to seek out private-sector groups to apply for the grant. But the application is due this month, so the department will reapply and likely serve as the federal provider for the next three years, Wright said.
Meanwhile, she is tackling other major items on her "to do" list.
The department just approved a $6.8 million budget for the fiscal year that began July 1. The fund balance is about 12 percent of the budget. That's on the high end of the range that state officials recommend for departments the size of Hernando's.
Wright is in the midst of reviewing every program, checking wait times, client numbers and staffing levels to gauge efficiency. She started with the dental clinic, where progress has been made to bring in more insured clients.
The department staff is currently hovering at 90 people. There have been no layoffs since fall of 2011, when 10 people were let go.
The department just hired a new medical director who will split his time between Hernando and Pasco counties. Dr. Fermin Leguen comes with plenty of experience in public health, having served most recently as medical director for the Miami-Dade Health Department.
Wright said it is still too early to know when or even if the department will reverse the most significant change made to services during the recession: the closure of the Brooksville office three days a week.
The office, at 300 S Main St., had provided general clinical services Monday through Friday. Now it's open for services on Tuesdays and Fridays. On other weekdays, all services are provided at the department's building on Forest Oaks Boulevard in Spring Hill.
The number of clients walking through doors during the two open days in Brooksville is down, and the no-show rate is high, Wright said.
"I want to make the best decision I can based on the needs of the community," she said, "but at the same time I have to look at our staffing levels and what is feasible for them to accomplish."
Reach Tony Marrero at firstname.lastname@example.org or (352) 848-1431. Follow @tmarrerotimes on Twitter.