Millions for state health upgrades go unspent CDC funds

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Millions for state health upgrades go unspent

Georgia among dozens with CDC funds left

By Alison Young, The Atlanta Journal-Constitution, 01/18/07

The Centers for Disease Control and Prevention gives states about $1

billion a year to prepare for a bioterrorism attack or other health

disaster by improving their laboratories, hiring staff and buying

critical equipment.

But dozens of health departments, including Georgia's, have let

millions of dollars go unspent in recent years, according to a

report by the Inspector General of the U.S. Department of Health and

Human Services.

More than $157 million —- nearly 16 percent of the amount awarded —-

wasn't used during the program year ending Aug. 30, 2005, the report

said.

The health department upgrades funded by the CDC program are

considered crucial to the nation's security, and the program

specifically calls for the money to be spent quickly. Yet some

health departments haven't spent large percentages of their money.

In 2004 and 2005, the District of Columbia —- an obvious potential

target for a bioterror attack —- only spent about half the money it

received from CDC. The nation's capital had an unspent balance of

$12.2 million as of Aug. 30, 2005 —- 61 percent of the money it was

awarded that year.

Georgia failed to spend nearly $13 million —- 38 percent of its

allocation —- in the funding year ending Aug. 30, 2004, according to

the Dec. 5 report. More recent figures for the state were

unavailable to the inspector general's office because Georgia

repeatedly has missed federal deadlines for filing financial reports

with the CDC.

" We're very concerned that these funds are used in a timely fashion

for preparedness, " said Dr. Besser, director of CDC's

terrorism preparedness office. Besser said slow state contracting

bureaucracies and local hiring freezes have contributed to some

states having difficulty spending the bioterrorism funds quickly.

To read the inspector general's report, which includes details on

each health department's unspent balances, for 2004 and 2005, go to:

oig.hhs.gov/oas/reports/region5/50500031.pdf

To contact staff writer Alison Young, call 404-526-7372.

http://www.ajc.com/news/content/printedition/2007/01/18/meshcdc0118a.

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Why do state health departments not spend money awarded to them?

1. Because of how federal funding is awarded. Categorical funds (and

lately preparedness funds have become their own narrow category) do

not fit the reality of intertwined public health surveillance

systems and services. And the partial FTEs (e.g. 1/2 FTE program

manager or .1 FTE administrative assistant) which are often funded

can be hard to use without crossing categories to get the other

fraction of an FTE so a real person can be hired.

2. Because of byzantine administrative, personnel, and purchasing

rules and mindless bureaucrats at the state and local level who

would spend $100 to show that they " saved " 1 cent. The health dept.

staff who apply for cooperative agreements or grants may be

committed to fulfilling the terms of the award. However, it may be

near impossible to hire, contract, or purchase because of the lack

of flexibility and vision of those who approve these actions. Some

state systems won't allow partial FTEs to be combined to make a

whole position because it is too difficult for their financial

systems to handle. In this day and age of technology! Pencils and

ledgers would be more useful! IT technocrats may micromanage and

delay IT purchases.

What's maddening is that state residents pay federal taxes. When CDC

funds awarded are not spent, state residents are missing out on

their fair share of the programs and services that CDC supports in

states. Unspent funds either go to other states or balance CDC's

budget.

To address the inability of some states to spend the funding they

truly need and are awarded, both state and CDC administrators and

financial folks are going to have to adapt better to one another. It

would be nice if CDC and/or other other federal agencies could

convene governors and/or state legislators and/or state financial

officials to develop and agree upon some standard best practices in

awarding and using cooperative agreements and grants. That might

allow federal support to be more efficiently and completely

delivered to the state residents for whom they were intended.