CLAYTON 鈥 Two months ago, St. 不良研究所导航网址 County Executive Sam Page announced what he called a 鈥渟ignificant milestone鈥 in a yearslong effort to transform the county鈥檚 Department of Public Health.
For several years, the county has been trying to achieve to operate its health clinics as Federal Qualified Health Care centers. The status would open the door to higher Medicaid reimbursements and discounted prescription drugs when patients use the county鈥檚 three clinics for primary care. The federal program rewards health clinics that serve patients in high poverty areas.
Last year, the federal government denied a 鈥渓ook-alike鈥 application from St. 不良研究所导航网址 County, citing numerous deficiencies.
Then, two months ago, Page and Dr. Kanika Cunningham, the health department鈥檚 director, touted that the county鈥檚 latest application had been 鈥渁ccepted鈥 by the federal government.
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鈥淭his is a monumental day in the history of Saint 不良研究所导航网址 County and for our residents,鈥 Page said in a news release.
But there was nothing monumental about the news. The county鈥檚 new application had simply passed one step in a long process, which will continue into next year.
鈥淩eview of the application, including a site visit, is not yet complete,鈥 Scott Kodish, a spokesman for the Health Resources and Services Administration told me in an email.
He declined to comment on the county鈥檚 news release but said the process could take another nine months.
So why is the county jumping the gun? Perhaps because it has been pouring money into the process for several years, with little to show for it. Meanwhile, the county is facing a budget crisis that has already cost 26 jobs in the public health department 鈥 10 layoffs and 16 open positions.
Those layoffs are what led me to start asking questions earlier this year about the attempt to achieve look-alike status. The process has been expensive, including the hiring of a CEO for the program, , with a salary topping $190,000 and a car allowance. Melton is one of the county鈥檚 highest-paid employees, and his job is to run a program that doesn鈥檛 yet exist.
Melton鈥檚 wife, LaShay, who works in Page鈥檚 office.
Cunningham, the health director, defends Melton鈥檚 hiring. She says the federal government requires the county to operate as though it is a FQHC before it can achieve the status. Melton was hired, she said, because of his previous experience. Melton worked for about a year as the director of operations for Care STL Health, a nonprofit FQHC that serves the city. Before that, he worked for about a year as the director of clinical operations at Washington University Orthopedics.
Since he was hired last August, Melton has spent a fair amount of time traveling 鈥 to San Diego, Washington, D.C., and Las Vegas 鈥 in part to get more training in the program, including attending a leadership academy. The trips cost the county about $20,000. But that鈥檚 nothing compared to what it wants to spend now.
On Sept. 23, Cunningham requested that the County Council approve a for a consultant to help the county achieve the status it already touted in a news release. That鈥檚 on top of the more than $144,000 it has paid a Jefferson City consultant 鈥 Susan Wilson, LLC 鈥 over the past several years to manage the application process.
When I asked Cunningham about the new request for a consultant, she said she didn鈥檛 know anything about it. 鈥淲e鈥檒l look at what that is so we can get back to you,鈥 she said.
On Friday, an email from Melton clarified that the new consultant contract will be to provide 鈥渆xpertise鈥 that the county鈥檚 鈥渃urrent structure鈥 lacks to 鈥渕aintain鈥 the FQHC look-alike status, if the county obtains it.
Meanwhile, the county has not yet provided a copy of its look-alike status application, which would presumably explain how the increase in revenue Page is planning for next year鈥檚 budget will be achieved. I filed a Sunshine Law request for the document 鈥 along with more details about Melton鈥檚 travel 鈥 on July 2. It hasn鈥檛 been fulfilled.
Cunningham has been handling the Sunshine Law request herself. She says it鈥檚 not unusual for department heads to be in charge of Sunshine Law requests. (Only 6 of 25 county department heads are custodians of records). This week, she said it鈥檚 difficult to provide the application because it was produced on a federal portal.
鈥淚t鈥檚 inside the portal,鈥 she told me. 鈥淣ow legal is reviewing it because we don鈥檛 have a physical copy.鈥
It鈥檚 hard to believe the county wouldn鈥檛 have a copy of the report that led to a 鈥渕onumental day in the history of St. 不良研究所导航网址 County,鈥 but that鈥檚 Cunningham鈥檚 answer and she鈥檚 sticking to it.
Her answers 鈥 or lack of them 鈥 raise plenty of questions about what might otherwise be a good idea. The county, pointing to a spreadsheet it says was produced by its consultant, says it could pull in an additional $11 million in federal reimbursements if it is approved for look-alike status. But that status is unusual for a county government. It鈥檚 more common for into FQHC facilities to shift emergency room patients to clinics and increase revenue.
So the evidence of that potential $11 million windfall is scant, yet the county touts mountains that actually look like mole hills. If the proposal is good for taxpayers, why is the county slow to provide the documentation that proves the point?
The County Council might want to ask that question before it approves the next consulting contract.