Well, well, good morning, ladies and gentlemen. Welcome to the scheduled 900 a.m. June 16th board of county commission meetings. Meeting singular. I don't think it'll be plural today. Commissioner Adams, >> it's going to be long, but not plural.
>> It feels like it. We will start the morning uh with an invocation followed by the pledge of allegiance and the invocation this morning will be presented by executive minister Maria Pua. Please rise.
Good morning. I'm Reverend Dr. Marta Fioriti. I am the executive minister at the community church here in Vero Beach where I bring greetings to each and every one of you. Let us pray.
Holy one, source of wisdom and compassion, we give thanks for the opportunity to gather in service to this community. We ask your blessing upon these commissioners, staff members, and all who participate
in the work before them this morning. Grant them clarity of mind and courage of conviction and humility of spirit. Help them listen carefully to one another, especially when opinions
differ, and seek not only what is expedient, but what is just. May they remember the people behind every policy and every decision, the families seeking stability, the workers striving to make a living, the children dreaming of their future, and the elders
deserving dignity and care, and those whose voices are too often overlooked. Guide this body to lead with integrity and compassion and a commitment to the good, to the common good.
May their work contribute to a community where all people can flourish in safety, opportunity and belonging. And may each of us leave this place having honored one another with respect and grace.
Amen. >> Amen. >> Please join me in the pledge of allegiance. I pledge allegiance to the flag of the United States of America and to the republic for which it stands. One nation under God, indivisible, with liberty and
justice for all. >> Well, good morning again, ladies and gentlemen and fellow commissioners. At this time, we will include our additions and deletions from the agenda. I will say that item 13I has been removed and deleted until a future date.
Commissioners and in emergency item 12B uh will be dealing with the Senior Resource Association under the county administrators matters. >> What's your pleasure, >> Mr. Chair? Move approval. >> Second. >> We have a motion and we have a second.
Any further discussion? Hearing none. All in favor? >> I. Commissioners, next brings us to proclamations, presentations honoring Mr. Craig Sawyer on his retirement from the In River County Board of County Commissioner, Department of Utility Service and Wastewater Collections. Um,
and I will say commissioners that we often have uh proclamations with very very seasoned employees and it's refreshing for us to read that particularly to a gentleman that's been here almost 33 years. But what's equally impressive is when we have members from
the community, uh, particularly Rock Ridge, uh, that want to express their thanks as well. Uh, we might be able to coin him the mayor of Rock Ridge after this, maybe. Uh, so Craig, if you could come forward.
That's fine. Craig, good morning. It's my honor to declare this proclamation honoring Craig Sawyer for his retirement from any river county board of county commissioners department of utilities. Whereas Craig Sawyer will retire from the river county department of utilities effective June 30th, 2026.
And whereas Craig Sawyer began his career with any river county December of 1993. He began as a maintenance workers utility service solid waste and was promoted in September of 95 to maintenance worker for solid waste and was further promoted in October of 96 to
heavy equipment operator solid waste and again was promoted again in October of 97 to utility service work wastewater division and finally in October of 98 he was promoted to lift station mechanic. waste water remained in that capacity
and until his retirement he played a vital role in the building of the county's first vacuum system where he has monitored that system for over 18 years whereas Craig Sawyer has served the county and the public with distinction and selfishness during his
nearly 33 years of service. He was dedicated and his work was greatly appreciated by the employer, citizens and co-workers alike. Now therefore, be it proclaimed by the board of county commissioners of Indian River County that the board applauds Craig Sawyer for his efforts on behalf of the county and
the board wishes to congratulate Craig for his dedication and service to Indian River County for the last 33 years. Be it further complain proclaimed by the board of county commissioners and the staff that we extend the heartfelt wishes to Craig on his retirement and
this document is signed by all five county commissioners. Congratulations, Craig. >> Thank you. >> I think we >> No, you don't get away that easy. >> Not after 33 years. >> He wants to get back to Rockidge. >> He does. We have some some friends of
Rockidge that would like to come forward. Hey, mayor. >> Good morning. >> Good morning, >> Chairman Lure. our own honorable district representative, Madame Vice Chair Moss,
Commissioner Adams, Commissioner Man, Commissioner Flesher, Administrator Tonic, Councelor Schuler, and Madame Clerk.
Thank you for the opportunity to speak today. My name is Doug Oberbillig. I reside at 3101 14th Street in Rock Ridge and I am the president of the Rock Ridge Property Owners Association. I am here to present a special proclamation honoring the retirement of
a truly outstanding member of your county staff, Craig Sawyer. And speaking about Craig's role as an Indian River County wastewater lift station mechanic, it is easy to focus on his technical responsibilities.
But today, I am here on behalf of the Rock Ridge neighbors, past and present, who wish to recognize the intangible difference Craig made in our community over the past 18 years. For us, he
embodied what it means to be a true public servant. To honor his extraordinary efforts, I would like to present the following. A proclamation honoring Craig Sawyer. Whereas after hurricanes Florence and Jean hit
the Vero Beach, Florida region in 2004, the Rockidge subdivision was described as a devastating mess. >> Mhm. >> Because without power to run pumps, thousands of gallons of sewage mixed with six feet of storm surge backed up into the properties of 400 plus property
owners, resulting in massive gutting and discarding of virtually all their belongings, including sheetrock, carpets, furniture, cherished family memories. And whereas despite the losses, the Rockidge property owners and residents pulled together, uniting with local and federal
governments to find ways to mitigate future flooding issues. And whereas in 2008, one of those mitigations was the installation of an Airvac sewer system >> that included an Indian River wastewater
lift station mechanic by the name of Craig R. Sawyer. And whereas over the next 18 years, Craig, while doing his lift checks, consistently went above and beyond. He returned loose pets to their anxious
owners. He used personal funds many times, like when he replaced the wheels on a handicapped resident's bicycle. He attended his duties before and after every storm, whether day or night, only to return after his shift in his
personal jeep to help those he had seen in need. And whereas Craig's helpful, excuse me, helping hands played a large part in straightening out the mess we had been in after 2004, and as such has been more
than just a dedicated public servant to us. He has become a beloved friend, a trusted advocate, and an integral part of the Rock Ridge family history and local lore. And whereas as testament to Craig's outstanding
character, community impact, and the deep affection held by all residents, we formally and permanently recognize his extraordinary contributions to our neighborhood by proudly granting him an honorary lifetime membership to the
Rockidge Property Owners Association with all the assoc associated rights, privileges, and access. Now therefore, be it proclaimed that the Rock Ridge Property Owners Association does hereby formally recognize and commend Craig
Sawyer for his outstanding service, exemplary work ethic, and dedication to our neighborhood. And we wish him all the best in his retirement adopted this 16th day of June, 2026 by the Rockidge Property Owners Association of Indian
River County, Florida. Thank you very much. >> Wow. Thank you. Wow. >> Thank you very much. Appreciate it. >> Well, thank you, sir. And and Craig, thank you for your nearly 33 years of service. I can tell you, and I don't know if I want to speak for the board or not, but I don't know that we've ever
had uh an association present an employee with a proclamation. For that, we are very proud of you. Thank you. >> This was a first. Come on up. How about the guys in the back? Come on up. >> Come on.
>> You want your family to come up? >> Come on up. >> Yes, >> everybody. >> Well done, Mayor. Mayor, >> congratulations. >> Mayor, >> thank you.
>> Wow. Yeah, of course. Fantastic. >> I want to say something. >> You don't know this earlier. >> What said you didn't know him? That's why I said I know when he was a cop.
>> What? >> I was you. Yeah. >> You didn't know that? >> I know about Perfect. Thank you guys. >> Congratulations. >> 33 years. >> 33 years.
>> It must have been really >> No, Mr. Chair, I I thought that Craig was actually a resident of Rock Ridge. Uh I can go back to when I was wearing a uniform if you recall. >> I recall >> and I was in uh was in a cope unit. We
used to have community meetings and Craig was there uh on a regular basis and uh they mentioned the hurricanes. Well, we had uh ridden down through uh Rock Ridge and
yes, the seas were high and uh we were out there uh distributing some MREs and trying to comfort some folks and there was Craig. I thought it was a resident, so I gave him ME. He
was there so much that uh I think it's an honor that you just coined him as the mayor. >> He is the mayor. >> But dedicated work >> and see how unassuming he was after you gave that proclamation. He just wanted
to walk. >> Get back to work. >> Get back to work. >> There you go. >> Thank you, Craig. >> Thank you. >> Appreciate all of what you've done. Thank you, Commissioner Fletcher, for those kind words. Moving on to the
approval of minutes for May 5th, 2020 six approval. >> Second. >> And we have a motion. We have a second. Any further discussion? Hearing none. All in favor? >> I. >> And the regular minutes for May 19th, 2026. >> Move approval.
>> Second. We have a motion. We have a second. Any further discussion? Hearing none. All in favor? I. >> I. Commissioners, forformational purposes, uh just a few things. With the Fourth of July right upon us, you will see the uh the changes, slight changes
in the waste pickup. Uh you'll see two Sebastian, City of Sebastian voluntary annexation. Uh but one very important item to mention is honoring Miss Victoria Potter on a retirement for any river county clerk of the courts and comproller.
>> 27 years of service. Uh, I see Clerk Butler in the back, but I'm not sure if I see Victoria. So, if you see her, please say hello and thank you for her dedication. At this time, there's an opportunity for any public comment on agenda related
matters that are matters that are listed on the agenda. If you have any other comments, we will entertain those at the end of the meeting. Seeing none and hearing none, commissioners, that brings us to the consent agenda. What is your pleasure?
>> Mr. Chair, >> Commissioner Flesher, >> move approval. >> We have a motion. I'll second that. Any further discussion? Hearing none. All in favor? >> I. And the motion carries. There are no public notice items.
Commissioner brings us to the county administrator matters. Mr. Administrator. >> Yes, Mr. Chair. First item is >> is the renewal, >> Mr. Chair, >> of >> Excuse me. >> Oh, public items.
>> Mr. Administrator, are you going to discuss this >> 11 to make a motion to approve? >> No, we have we have >> we have section 11 public items. What? I I didn't hear you. >> The the board has approved the consent
agenda. Is that >> correct? >> Correct. >> That's correct. >> The next item is item 11 and we go to that >> for our public hearing items and then um we'll have the county administrator matters which I believe the board has added an item an agenda item.
>> Okay. I don't have anything under 11B for public notice items. >> It's nor do I. >> It's 11 A. >> I don't have that either. >> Oh, you have the capital operating. Yeah. >> Okay. >> So on 11A, we have public three public
hearings. One is 11 AI, which is the fiscal year 2026 grant application for capital and operating assistance and bus replacement from the Federal Transit Administration. We have 11 A um 2 I
guess A I but >> probably to make the >> the solid waste uh assessment collection and disposal ordinance amendment and then we have a third public hearing item which is the St. Lucy County Housing Authority Finance Authority bond hearing
terra hearing. >> It's on a separate page. >> Yeah. So we'll take those individually. Commissioners on 11 AI, the FY, there it is. >> 26 grant application for capital operating assistance and bus replacement
from the FTA. >> We have Brian Freeman here. >> Welcome, Sean. >> Good morning, uh, commission. I'm Brian Freeman. I'm staff director for the Indian River County MO. And the item you have before you today is the annual public hearing for our federal grant
application for funding assistance for the public transportation system. And there we go. Okay. providing public transportation in Indian River County is really a partnership with the county functioning as the designated grant recipient and the senior resource
association uh serving in the role as the operator of the public transportation system under contract with the county. And I'll just note that Karen Deagle and Chris Stevenson are both here today from SRRA. And then the NO provides planning and technical support to the system with
most of the funding coming from the Federal Transit Administration along with the uh additional funding assistance from Florida Department of Transportation and the Florida Commission for the Transportation Disadvantaged. And the Goline fixed route system
consists of 14 routes that provide service throughout Indian River County. And those routes run six days each week, Monday through Saturday. and uh county staff did an analysis a few years ago using 2020 census data and found that just over half of the county's
population lives within a quarter mile of a goal line route. So if you measure on either side of a goine route out a quarter mile, you capture just over half of the county's population. And when you increase that distance to 3/4 of a mile, you actually capture 84% of the county's
population within uh 3/4 of a mile of the go line route. Ridership on the go line has been in a continuous trend of uh growth over the last 20 years and it's gone from around a quarter million passengers annually
about 20 years ago to over 1.5 million with the most recent fiscal year that was completed and that was a 17% increase just in that last year alone. We only had one year in that 20-year period where there was a drop in ridership and that was the COVID year of 2020. And since then, ridership has
rebounded. And due to the high level of ridership on the go line, Indian River County's public transportation system has the lowest operating expense per passenger of any transit system in the state of Florida. And 2024 is the year
that we have the most most recent year that we have statewide data available. And the goal line provided service at $342 per passenger trip. And the next lowest system was Gainesville and that was almost a $150 more per trip.
So looking at the grant application for this year, the requested amount is just over 7.7 million, most of which is coming from the section 5307, which is the urban area program from the Federal Transit Administration. And there's also a little bit of funding that's coming
from a bus replacement program that's known as section 5339. I will note that the actual amount of the award will probably be less than that. Uh we have not yet received notice of what the uh award amount will be but should receive that information soon.
And then just looking at the uh components both capital and operating for the grant for uh the capital costs of the system. And the key thing to know is that the Federal Transit Administration essentially covers 100% of the cop the capital expenses for the
system. And that's because we're able to match the u the federal money with toll revenue credits that are provided from FDOT. And essentially that results in the capital expenses being 100% covered by FTA. And this year we have a request
of just over 4.7 million for this would cover replacement buses, bus shelters, equipment, and computers for the system as well as additional funding for the North County Transit Hub and the transit maintenance building expansion, both of which will be going under construction
in the next year. Then looking at the operating side, the request is for $3 million in operating assistance from FTA. The match for that will be a combination of state and local funds. The local funds will be funds that are already in the fiscal year 2026 budget.
So, it's not additional funding at this time. And one thing to know is that for every $1 of local money we put towards the operating of the system, we're able to draw down three additional dollars from the state and the federal governments. So, that's a good return on investment for the local funding. And at
this time, uh, staff's recommendation is to, uh, open the public hearing, consider public comment, and then adopt the proposed resolution. We'd be happy to address any questions you might have. Thank you. >> Thank you, Brian. >> At this time, I will open public
comment. Anyone has any comments about this grant opportunity? Hearing none or seeing none, I will close the public comment. Commissioners, >> Mr. Sh move approval. Second. >> We have a motion by Commissioner Flusher and a second by Commissioner Adams. Any
further discussion? Hearing none. All in favor? I. And the motion passes unanimously. >> Thank you, Brian. >> Back on track, commissioners. We will entertain 112 solid waste assessments collection disposal ordinance amendment.
>> Attorney Schulen. >> Thank you very much. Um, Mr. Chair, this is a amendment, ordinance amendment in front of you to uh modify part two of chapter 204 of the Indian River County Code. Uh this chapter in our code,
chapter 204 really regulates all things solid waste. If you look in part one of the code, you'll see things like um the solid waste generally ordinance regulations,
the the are how we cover franchises, sort of a lot of general things that have to do with how we regulate solid waste in the county. When you get to uh chap uh part two of chapter 204, you get to our solid waste disposal district.
And this part of our ordin of our code was actually created back in 1994. So it's pretty old. And this is an update to that part of our code. Um, back in 1994, the board of county commissioners
established the solid waste disposal district and it it talks about um operational issues and it also uh lays out a procedure whereby the solid waste disposal district can levy special assessments to pay for our disposal
uh of our solid waste. Last year, the board created or chapter 206 of our county code, which was a master capital and service assessment ordinance. And that was an effort to
create some uniformity and consistency in how the board creates and uh annually adopts our non-advalorum special assessments. The modifications you have in front of you today are really
procedural in nature. They modify this chapter 204 part two to simply um delete references to to delete the references to this separate special assessment procedure in this part of the code. and
instead this these types of special assessments will now be created annually adopted under our new uniform master assessment ordinance and in 204 I mean in chapter 206. So I'm happy to answer
any questions since this section of our code is so old. you'll see some updated definitions and and then really what you're going to see is is sort of a deletion of the annual process to adopt the special assessment and a reference
to chapter 206 in our code. I'm happy to answer any questions about that. Um if there are no questions, I recommend that the board open the public hearing, take public comment, and approve this ordinance. >> Thank you. At this time, we will open public
comment if anyone wants to speak on this particular issue. Hearing none, seeing none, we close public comment. Commissioners, this is essentially as cleanup language that uh general counsel Scheler has been working on for a while. What's your pleasure?
>> Give approval. >> Second. >> Have a motion by Commissioner Man and a second by Commissioner Adams. Any further discussion? Hearing none. All in favor? I and the motion carries unanimously. Next commissioners is 11 A3 St. Lucy
County Housing Finance Authority bond hearing Orchard Grove Tea. This is an annual exercise. Commissioners, I see Chris Hicks here, general counsel assistant. Welcome. >> Good morning, chairman. Good morning,
commissioners. As you said, this is an annual exercise. We This will only have to be done this time if everything goes well. As you recall, we had this last summer and this is a company that is getting bonds through the St. Lucy Housing Authority to improve already existing affordable housing and so they are making improvements through that. We
are not the citizens are not on the hook for the money. Nobody is other than the company. They just have to have permission since it's being done in our county. We do have a representative from them here, Mr. Summerwall. He is here to answer any questions if anybody has them. I can answer any questions if there are any. we would ask the um chair to open it up for public hearing and
then consider adoption of this so they can move forward. the funding unfortunately the dates didn't quite line up so we had to do another one and they will line up and they're getting started this September so should be good >> thank you like I said commissioners this is this is not an annual exercise
>> well it is this time >> we'll open for public comment anybody has any questions or concerns about this particular topic hearing none or seeing none we will close public comment thank you Mr. Hicks >> Mr. Mr. Chair, move approval. >> Second. >> Have a motion by Commissioner Flesher
and a second by Commissioner Adams. Any further discussion on this topic? Hearing none. All in favor? I. And the motion carries. Thank you, Mr. Hicks. >> Thank you. >> Now, that brings us to item 12 under the
county administrators matters. Uh 12A, Deputy County Administrator Employment Contract. >> Mr. Chairman, I'll make a motion to approve. >> We have a motion by Commissioner Urban and a second by Commissioner Flesher.
Any further comments? Hearing none. All in favor? I. Motion carries. Next is our emergency item 12B uh regarding uh Senior Resource Association. Mr. Administrator. Good morning. >> Yes, Mr. Chairman, members of the board.
Thank you for adding this item. Uh Karen Deagle, president of SRRA is here. Uh you've received a letter where they are projecting a shortfall and uh of about approximately $263,000 in the current fiscal year largely due to rising in
fuel costs as well as some of the timing as it related to uh uh the FDOT block grant for the be that will be fully expended by June 30th. So there's a gap there and I'll turn it over to Karen and let her you know present anything else. >> Thank you. Good morning everyone. Good
morning commissioners. Thank you. Um first of all, thank you uh for approving the 2026 uh 5307 and 5339 grant application this morning. Um so as as um county administrator explained, I'm here to
request an additional local operating support of $263,000 to sustain the public transportation go line in this current fiscal year. Uh this request is driven by factors of increased fuel costs uh block grant
timing gap and reduced local operating support stemming from previous COVID funding. And if you would like me to go into more detail, I'd be happy to. And I also have of course Chris Stevenson who's the transportation director and Brian Freeman director here to answer
any questions. >> Thank you commissioners. I met with the administrator yesterday and we researched the fuel cost throughout the the nation, the state and the county. In fact, I believe John was about 40 over 40% this time last year.
Um, and this is a a crisis that we're all facing. Every division, every department, every constitutional officer, what's your pleasure? >> Move approval. >> Second. >> Have a motion by Commissioner Flesher and a second by Commissioner Moss. Any further discussion? Hearing none.
All in favor? I. And motion carries. Thank you. >> Thank you. >> Moving right along. Commissioners, uh, departmental matters. That would bring us down to human resources with group
health insurance plan funding plan design and premiums for FY26 27. I see director Bole here and her associates. Good morning. >> Good morning commissioners and thank you. Um our first item today is to
discuss the group health insurance plan funding and plan design and premiums for the upcoming fiscal year uh which begins October 1st of 2026. Uh we have met on a few occasions since uh January and most recently following
the May 19th board meeting um we went and uh did a intensive communication campaign towards our employees and our retirees uh to notify them of the proposed changes that were being
considered by the board. Uh we held four teams meetings. We had 191 attendees. Uh through those meetings, we had a lot of questions that were generated and uh we developed an FAQ that um we uh posted on
our HR staff portal uh that uh provided answers to employees questions. Uh we also had uh representatives from our uh benefits plans at our health fair. We had locked in present to be able to answer any questions that employees had about any upcoming and proposed changes.
So um we had some really good discussions. I'm really proud of our employees and our retirees. They really asked some great questions and we were able to uh provide the answers uh to those questions. Um just in summary, um the reason that we're here this this year considering the changes that we're
looking at is we are dealing with a plan shortfall. Um our deficit is projected to be 11.4 million for the upcoming plan year if we do nothing. Um we have uh presented to you at the prior meetings
some recommendations for some uh changes for the board to consider. Uh one of those is a plan design change to our deductible and out-ofpocket maximum ER co-pay and um expanded mental health benefits that that uh is estimated to
produce $749,000 in savings. We're looking at um implementing Bluec Cross Blue Shield specialty medication uh benefit management. Um this takes certain medications that might be um administered in a provider setting
and moves it to a more cost appropriate setting like an infusion center or in some cases it might be uh having the medication delivered in the home. Uh that's estimated to save an additional 39,000. We are recommending elimination of the GLP-1 weight loss coverage under
the health plan and adding support through Rightway Pharmacy for members to have access to direct to consumer program pricing for GLP-1 weight loss medications. And um Rightway would help transition our employees to the direct to consumer uh program so that they
could access the medications and and not have a a a break in coverage. Those savings uh for that program are uh $3.3 million. Um we're looking to uh shift uh with lantern surgical centers of
excellence from a voluntary to a mandatory plan design for two types of procedures. Those uh involving spine and joint procedures. The reason for that is um this is projected to give $627,000 in savings to the plan. Um, it
eliminates any out-of-pocket costs for the employees, but it does implement what we call a narrow network of surgeons of excellence for our members to access and have these services done. Um, travel benefits are provided if there's any travel that needs to occur
under that proposal. And um, that is is one that uh, generated a lot of questions from our members. um they they are used to having access to just whatever provider they want to go to within the Blue Cross Blue Shield
network. Um however, we do have good confidence in the surgeons of excellence model in the narrow network because we are we are finding that the outcomes are very positive and um the out-of- pocket cost to the members is is quite low,
virtually non non-existent, excuse me. Um, we are looking to expand virtual nutrition services to change nutrition counseling coverage to a no co-pay. Um, uh, adding a three visit limit and then a prior authorization. And this is
coverage that's intended for diagnosis of diabetes, kidney disease, celiac disease, or obesity. However, we also want to um allow coverage for people that don't have those diagnosis where they can do a primary care co-pay to access these um nutrition services with
just a modest co-pay under their plan. Um the savings associated with uh managing the digestive orders disorders and managing conditions and even, you know, potentially addressing issues before they become an issue. uh we're
looking at anywhere from uh $10,000 up to $100,000 per individual that's impacted through through having healthy lifestyle changes. And uh we're excited about that change. Uh we're looking to expand mental health coverage support uh
to provide expanded access through Teddoc for virtual benefits. This does not take away the brickandmortar access. Everybody would still be able to go to an actual um on-site uh provider that they choose. uh but it just provides an additional uh availability of virtual
benefits for our members uh to access and that's we're finding that people are accessing it um more and more as it as they it it's just very convenient for them. So uh we're excited about that one. Um managing uh uh situations
associated with depression that can be $12,000 per member per year, you know, if you avoid a serious situation related to uh depression. So, we're excited about that one. Um, also voluntary Medicare education and plan selection assistance for our retirees that are age
65 and above. There's no in no out-of-pocket cost to us uh to enter into this relationship unless somebody actually transitions from our plan and moves to um a a a market-based plan. Um,
in that case, there would be a a a cost of $3,500 for them providing that service to to that retiree. Um, we're looking at uh increasing our plan funding by $7.8 million uh with a cost share between the employer and the
employee. Uh, it would increase premiums for the employee by 25%. Um, retiree premiums uh would increase a little bit more than that. I think the range was like 31% to 33% 34%.
For the retirees and um that would allow us to uh recoup uh $7.8 million it well recoup to actually gain $7.8 million in additional funding which we project will be needed in the upcoming year based on the medical conditions that are
currently being treated uh with our membership today. And with that, um, I'll stop and pause. And >> do you have that on the slides? >> I do. It's the same presentation as last year. We can go through it again. I
didn't I would be happy to do that for you. So, um, these are our goals, affordable, competitive, and sustainable. Uh, we went through our plan experience and our renewal strategies.
Um this shows the five-year cost increase uh for the last five years where you can see that our spending has exceeded budget uh beginning in 2425 and as well projected to um exceed our budget in uh this current plan year as
well as the plan year that is um upcoming. We're looking at um having a shortfall this year of $ 8.1 million. Last year it was $2.5 million and then next year it will be more. Um,
this is information. Currently, we're at a $3.6 million deficit as of March 2026. We have 51 persons with $6.3 million in net claims, which is a substantial uh increase from prior years of high-cost claimants.
um our GLP-1 weight loss medication, it accounts for 27% of all our RX claims costs, which is why we are recommending that that um coverage be transition to a direct to consumer program. Um our health plan trend year-over-year is
increasing in all of our categories and uh the health insurance fund balance um is reducing down at a at a pretty substantial rate. uh that last quarter it reduced down by 20.31% um which was substantial. So the balance
as of the end of the second quarter in fiscal year 2526 was uh 17.1 million down from uh 21.5 million. As I stated earlier we are projecting an $ 8.1 million deficit.
These are excerpts from our plan reporting that we get um on the financials. You can see the overall stop-loss uh or uh loss ratio is 128.6% through March of 2026.
This is just reflective of our high-cost claimments. The uh information regarding the weight loss GLP um and and how that uh trend is continuing to increase. We don't see any downward trend there.
These were all the different categories where we're seeing in every single um uh category it our high-cost claimants as well as our non- highcost claimants expenses are going up. This is a report that is sent out quarterly through uh the office of
management and budget and this is the the one that we had through um the March 31st 2026 reflecting how that health fund is doing. And this is another look at our drivers of our health plan expenses. Um we've we
our high-cost claimants. Uh we've got uh areas related to cancer p uh prescription uh costs associated with um some pretty critical uh medical situations. We've got maternity, neonatal, and congenital
issues and neuro and muscular skeletal issues that we're dealing with. These are the projections uh that the actuary has stated. If we do nothing, this is where we're looking at a 44.6% rate increase or 11.4 million in
additional funding. However, we're we're recommending this one here where it's a 31.6% rate increase. The the stated uh increase is 8 million. Um but what we're projecting is with the rate increase, we may have a little bit of a migration
from the gold plan to the silver plan. So, we're probably going to bring in about $7.8 million in additional premium for the upcoming year. This is a uh uh an overview of the cost-saving renewal strategies that have been recommended to the board. Um,
option A is increasing the deductible under the um, gold plan from uh, $750 um, or up to $750 from $600 on single coverage and uh, up to $1,500 on the
family coverage up from $1,200. Uh, we're looking at increasing the out-ofpocket maximum under the gold plan um, up to uh, 4,000 and 8,000. Currently, it's 3006. And then we're looking at under the gold plan
increasing the ER co-pay up to $500. So, the majority of the changes are to the gold plan. We did have some of our membership that asked the question, why is so much happening with the gold plan? Well, the gold plan is actually the one that is over uh budget and this the silver plan is functioning well. So,
there's minimal changes on the silver plan. The gold plan has has uh the more of the changes recommended and that's expected to bring uh $749,000 savings to offset future costs.
We went over the uh medication management, the uh removal of the GLP1 and the direct to consumer uh program. I do want to say on this screen, if you'll look at the very bottom where it says annual cost for that elimination of the GLP1 direct to consumer, that $33,000,
that does not exist anymore. That that um Rightway did tell us that no, they're able to do it without any additional cost and provide that support. So, um your savings will be the full $3.3 million uh for that recommendation,
the lantern benefit. Um, you know, it's interesting how you can get such substantial savings uh out out of a small number of members. We had um uh 20 members with surgeries in the joint spend uh that totaled up to $512,000
under the medical plan. And we had 10 members with uh spinal surgeries that totaled up to $593. So that's a little over a million dollars for 30 30 members. Um but by transitioning to the lantern uh benefit which has no out-of- pocket cost for
your u members um that's projected to be a $627,000 savings. The uh virtual nutrition services under our um questions that came up um we were able to clarify that this does not remove your ability to go to the brickandmortar doctor's office.
It's just an expanded uh benefit to make it easier for people to get the nutrition support that they need. And then the Teddoc mental health support um is is again just a way of of uh providing increased access to um mental health support that might be needed.
And then the ALEP uh voluntary Medicare education. This is only for our retirees that are 65 and above who are eligible to transition to Medicare. And uh we we believe that this will really be beneficial to them. And in fact, we've already um received some phone calls from retirees who are interested in
talking with somebody about this and and evaluating those options. So um if this is approved, we will be working with Lockton to provide um access sooner to al than later um to allow our retirees to start, you know, looking at what
options might be available to them. Uh we went through the the uh questions and answers related to lantern. Um the types of procedures that would be required to uh go through lantern would be um revision surgeries, joint
replacement, uh shoulder, knee, hip, ankle, elbow, and wrist. Um common replacement uh or common procedures might include joint arthroscopy, ligament repair, rotator cuff repair, knee replacement, revision, and hip replacement and revision.
Uh we do have a provision in there that if if for some reason no lantern physician would accept the patient um that there will be an exemption process that we can uh implement and we would go through that process um and then they
would be able to uh seek a specialist uh within the blue cross network. Urgent situations would be handled through the blue cross network. Um lantern is only for planned non-emergency procedures. Surgery rehabilitation uh will still
follow up uh through the physical therapy benefit under the health plan. Uh lantern does not provide physical therapy benefits. It's just a surgery benefit. So um they would people would transition back to the health plan for their physical therapy.
And this just is a breakdown of um access uh to membership uh in our different populations. This is you know as you know we have our active employees and we have retirees uh living in all these different service areas. So um
lantern is a national um program and they do have access to providers. Um everything is either within uh under 50 miles or within the 50 to 150 mile range. The average distance um through all
surgical categories is 38 miles. We talked about our market position of our health plan. Um the current health plan, the silver plan and the gold plan is uh above benchmarks. uh we provide a a stronger benefit with lower out-of-pocket employee costs for those
benefits and um even with the proposals that are being made to modify the the plan slightly um we will still be in a strong place market-wise still very competitive. This uh slide shows you the overview of the option A changes uh that staff is
recommending. Uh you can see the um the uh increase in deductible for both the silver and the gold plan and then you can see the increase in the out-of- pocket uh maximum for uh the gold plan as well as a change in the ER deductible
uh for the gold plan. We actually have an improved uh co-pay for uh mental health, behavioral health, or substance abuse services. It's now um there's no specialist co-pay. It's all at the same level as a primary care visit would be. And then the outof network uh
out-ofpocket maximum under the gold plan is in is proposed to increase um up to 6,000 and 12,000 um to to mitigate our our costs and our expenses >> to go.
This was just a coverage decision um guide that we it just was looking at the various options related to the GLP1s and the uh direct to consumer pricing. It's really interesting. Some of the questions that came up related to that was what's the cost that you know I
would experience if I needed to get my medication through the direct consumer. Uh right now, you know, uh the co-pay for a pharmacy benefit is $25 to $50 for for a medication is what we're we're
finding. That would be increasing um to these outofpocket costs here. But what we're finding is that these costs um there's new new medications that are hitting the market and costs are are um you know changing all the time. They seem to be improving as opposed to
getting any worse. Um, so the the good news about Rightway is they will be watching that market for us and they will be working individually with people to transition them to the best option that might be available for them. If there's recommendations for potentially
considering a medication change that might be more affordable, they'll actually work with the provider um to to uh walk them through what that process might look like. This is just an overview of the um the average lantern savings for u joint
replacements or spinal surgery. So you can see that it's it's pretty substantial um when you're looking at the type of of coverage uh that's offered. Um you're looking at a savings of 59% on your joint replacements and 64.2% on spine replacement surgeries. So
those are those are some pretty substantial savings. This is an overview of the virtual nutrition services that we're looking at to expand to our membership. Um, again, it does cover all brick andmortar as well as virtual in network dietitionians
through Nourish or Teddoc. So, um, we're we're excited to see how this might might help support our workforce in a way that we haven't supported them before. And this is just an overview of the contingency pricing down at the bottom.
um we would pay ALEP if um if there is a participant that voluntarily selects alternate health coverage. And that potential savings is driven by um uh if a retiree chooses to go off of the plan, that would be a reduction in
our our uh costs, our future costs, estimated to be about $400,000 annually. We looked at um there was a a discussion about what would it be possible to go to a silver plan only and it would not make any changes for this year because our
membership is still the same. We'd still be treating the same individuals with the same conditions. So um going to a silver plan uh only option would be neutral. um it wouldn't result in any additional savings and um we'd still have all the expense and risk that that
is on our plan and we'd be collecting fewer premium dollars um from employee cost shares. Um there was a discussion from uh the FAQs and the the calls that we had with uh with the staff the teams uh calls um
people asked about what about a health savings account? Can we get a health savings account? Well, health savings account only um are associated with a a true highdeductible health plan, which is a a a plan design that we have not um looked at. It requires um there's
there's only a small percentage of employers who actually choose to go in that direction. It's a pretty aggressive plan design. It requires that employees spend a lot of money upfront to pay for um their medical costs before the plan starts paying. And um because we don't have a highdeductible health plan, we
can't set up a HSA account, but we do have a flexible spending account. Um and uh I it's like $3,100 now that individuals can defer to their flexible spending account to pay for their out-ofpocket um medical costs. They can
pay for their prescription costs. Um, so that is a mechanism uh that in in addition to the direct to consumer pricing access, if someone diverted their $3,000 annually, basically what you're doing is taking your $3,000. And
if I took it in take-home pay, it would be like maybe, you know, $2,200 or $2,300 after taxes. I'm leaving at $3,000. So I have more spending money to spend using uh money directed through a health saving u through a flexible
spending account. So we're going to encourage our membership to take advantage of that if they are expecting that they're going to have high out-of-pocket costs associated with medications. The contribution strategy that we looked at um is uh
consistent with $7.8 million in additional premium. Uh it's a 25% increase to our employees and um the employer's costs is is going up um uh by 31.9% on the uh single coverage and
33.9% on the family coverage. So uh the the employer total cost is $6.8 million and we're just uh right around under a million dollars for the employee contribution costs under that proposal. So just in summary, the the plan design
um option A is what we're asking the board to consider. The uh specialty medical benefit management for um certain medications that are uh delivered through infusion uh is is recommended. The um weight loss uh
removal of the GLP1 from the health plan and go to a direct consumer model. um the uh lantern mandatory spine and joint procedure uh recommendation, the expanded nutrition counseling
coverage to include um TEDoc nutrition support, expanded access to mental health support through TEDOC, and a partnership with ALEP to support our retirees who are Medicare eligible with considering um options that might be available to them in the marketplace.
and then uh as well as our um funding increase uh that we've recommended for the cost share between the employer and the employee. And with that, I will answer any questions. >> Well, Suzanne, I I want to thank you and
commissioners. It's it shouldn't be lost on any of us that Suzanne's role as a department head um is completely different than any other department head. She is monitoring not only our employees but the constitutionals and I
do not envy her. Her office probably gets more complaints than human services, building, planning, zoning and the like. And for that Suzanne, I thank you for that. >> Welcome. Earlier in the month or last
month, I think Commissioner Urban was uh wanting to be crystal clear about some of the things and in doing so in the interim we uh collectively have gathered over 190 uh positions of feedback so to speak. Uh
Suzanne is good at delivering bad news and not that this is bad news, but everything that she's outlined, if you talk to your friends in the private sector with respect to deductibles, for example, uh and coverage all the way around, she's been tasked with doing
something uh difficult and I believe she's done a fine job. We do have some specific questions uh about some of the specific things. We'll start with Commissioner Man. >> Thank you, Mr. Chairman. Um,
Suzanne, on the lantern issue, if I want to get my appendix taken out or have to get my appendix taken out, can I use lantern? >> No, it's an emergency. >> If if the appendix is >> if it's not an emergency, okay, I'll something else. I've got
>> gallbladder. I've got whatever other than other than spine and joint. Can can ler be used for that? >> Okay. >> Um is it I guess let me ask them from a technical standpoint.
>> Do you know what I'm asking? I mean is it for for some other elective type surgery or something the doctor says, "Well, you need to really get this taken out or something like that. It's going to continue to get worse." Is that something that that Lantern can do also?
>> Yes. So, Lantern is designed as a center of excellence network for any sort of planned procedures. So, as long as it's planned, it's not considered an emergency. You would still have that benefit available to you on a voluntary basis and you could call Lantern and they would navigate you to your three
options as far as those surgeries. Um and then it would be that no cost share for you and you would have that travel benefit available as well with the proposal on the table for the mandatory that is for spine and joint specifically where you would not have that selection of whether or not to use lantern.
>> Okay. So so you can um and that's a savings. I mean is that something we can encourage employees to do also other than just joint and spine? Absolutely. you know, more people when you get my age, you end up needing knee
replacements and and things like that. >> But is that something that we can encourage, you know? >> Yes, and we will definitely um in fact, there are mailers that go out on a regular basis to people's homes, encouraging them to uh use the lantern
benefit if they have a a voluntary procedure that they're going to have done today. Um, so I I get them all the time. So I know they're going out to the to the other members as well. And um I I think you know we'll look at how we can maybe showcase that through our open
enrollment process. And um the feedback that I've gotten, I have not personally used it, but the feedback that I've gotten is that it's it's a pretty easy process. You pick up the number, you call you you get what they call concierge treatment. They find out who your doctor is that's recommending the
surgery. They will take the heavy lift of making sure all your medical records are transferred over. They um coordinate the the appointment. They um uh you know send you the travel benefit card to pay for any gas expenses and food expenses.
Um they they really work to support the members uh through the surgery process. And um the the benefit to the plan is it's not running through claims. Uh there's direct pricing with with the surgeons that Lantern has made and the
savings is um you know 59% to 60ome percent off of what the cost would be if it if it ran through the health plan. >> Okay. Thanks. Yeah. I mean I think it it' be you know in our best interest to even encourage those type of surgeries that are h you know that we have to use
lantern if it's something absolutely serious other than you know just a dermatologist taking something off. >> Yeah. And we get um the invoicing that we get of course I don't get any of the names of the individuals but I I do get detail about the types of procedures. We've had um uh gallbladder surgery.
We've had people that have had to have esophagal um there's stretching that takes place. those types of procedures. We've had um colonoscopies that happen uh through the lantern benefit. Um a lot of different outpatient surgeries um
that that happen the the the joints, the repairs of ligaments and things like that. So um it is being utilized and and we are realizing a savings now. Um but we would realize further savings by routing people specifically for those um
high cost procedures related to spine and uh joint. >> Okay. My my next question is is on the retirees and those age 65. I know we we've had this conversation out out of this room about
>> ALIP and stuff like that. I think it's a great idea, but but yes, the conversation when I had to switch over from retiree to employee and u so this is not this is not for me. This is a lot of my fellow workers that
retired here that are my age. But when you get 65, our plan becomes more expensive than what you could get in the open market. Correct. So, we need to encourage them, the ones that are on it, we still have
their mailing address, whatever. We need to encourage them or tell people when they turn 65, look, you need to you exit the county plan because first of all, you're paying more. And second of all, I'll say it, you know, that when you get 65, you become probably, I guess, a
little more of a liability. I don't know if that's a nice thing to say, but it's it's the truth because I have more aches and pains now that I just turned 65 than I did when I was 35. For sure. But, uh,
should we not advise these people just like you do when you sign up for Medicare Part A or Part B or you sign up for Social Security, when your birthday comes, they give you a leeway either way. They encourage you to f to sign up early and then we'll give you 60 days
after after your birthday to sign up. I mean, it's almost in our benefit to to do that and tell retirees or people that are getting off that that need to go on
Medicare and and supplemental insurance to say, "Hey, you know, you the county is not going to keep you on our insurance indefinitely. You are going to have to move off the insurance plan." And we can put a time frame. we can
match what the federal government does with with with Social Security or or Medicare. >> So, there is Florida statute that gives a retiree from a public agency the legal right to remain on our plan for their lifetime.
>> So, we're not able to say that you have to go. >> Okay? >> But, um >> we can encourage it though. We do encourage it and and we currently encourage people to um work with a it's it's a um an an association of volunteers through the Shine program,
but ALP is is a professional company that does this as a part of their business. They're not volunteers. They're paid, right? >> Um to to provide uh professional >> um assessment one- on-one. What's your
situation? What type of medication are you taking? What's your medical needs? How would that compare to these marketplace plans? What's your part B premium? What would your premium be under say a Medicare advantage plan or a a Medicare a true Medicare supplement?
Because the county's plan isn't a Medicare supplement. It's it's just a regular PO plan. So, uh, a lot of our retirees are going to find that their cost in regard to premium, deductible, co- insurance, and co-pays that they're
having under our plan today, they would drastically reduce their out-ofpocket costs by moving to a true Medicare um, supplement or a Medicare advantage plan, right? Um, so that's what we we're really encouraged by. Even though we put
in every single letter to retirees, um, and Marcela has them sign things about age 65 and, you know, consider other options that are out there. It's it's a hard path to to to navigate on your own. And so, ALEP is going to help our our
retirees be able to navigate that with confidence, with good information. >> Okay. since we since we didn't know since we can't remove them from the plan is something we need to strongly encourage because I know that's some of our >> our high end claims we have going on
right now with that >> the other thing about retirees I'd like to present this to my commissioners is that fellow commissioners is that speaking of the retirees the retirees have taken the biggest hit in the percentage >> of increase even though they have a
subsidy in it and I don't know if you wanna briefly explain to maybe what the subsidy means and what it does for the retirees before I finish. So, >> sure. >> Um, we have different uh subsidy arrangements with our retirees.
>> Um, we have retirees receiving a subsidy of anywhere from 20% up to 60%. Uh so what that means is the retiree rate that they pay is reduced by that percentage of subsidy that the that the county provides them. This was um we have a
retiree subsidy policy that um gives gives this benefit to certain retirees. um after a point in time, new hires that come on board with Indian River County that are going to retire, there is not a subsidy benefit, but they still have the
statutory right to stay on the plan. Um so what we're finding is the people that aren't receiving the subsidy um when they hit 65, they're moving. Um but where where we're what we're targeting for the ALP are the people who are
receiving the subsidy but don't know that they could actually have a better option out there even even without subsidy you know that it might be less expensive for them to move. Um, so our retiree uh premiums, just just so
that you know, um, if somebody had single coverage and was receiving a uh 20% subsidy, um, their coverage would be going up from $636 a month today to $833.39
a month for single coverage on the gold. For the the member that might be receiving a 60% subsidy for single coverage, their premium would be 38 is 318 today. It would go up to $416.70. So you can see how that subsidy
substantially changes the price of coverage. Um I also have retirees that have uh insured their families. They either have a spouse or a spouse and dependent uh children that are that are um covered. So that relationship, that
premium relationship carries over. So our retirees for single coverage, their rates are going up 31%. 31.04%. And for family coverage, it's going up 32.61% um for family. So similar to what the countyy's paying as an increase at on
the employer perspective, that's about where what the retirees are experiencing. And some of the retirees that were on the call, they said, "Well, how come such a big hit? Couldn't we have done it, you know, smaller incremental changes um and and we did talk about that last year about doing a
rate increase last year?" Uh but, you know, the decision was made that we would um withhold that increase. We had a good fund balance at the time. Um so, unfortunately, this year is the year that that we're we're hit pretty hard and it is hitting our retirees uh pretty
hard. Okay, because like like I was said, thank you. And uh the retirees are being hit with a 32% increase when everybody else or the the employees are a 25% increase. And they they do get the
subsidy, but I think it would be wise for us to look at making everybody 25% the employees and the retirees because the retirees that that I know of are they're pretty much on a fixed income. uh with regards to, you know, they can
get social security and and stuff like that. But some of them that this retirement, you know, is their main source of money. You know, hopefully they invested in something and they have some money in the savings account. But
that would be my only change to this other than the encouragement portions that I that I mentioned early. And that would be a $144,239 cost to to uh cover the difference of that and in the in the OPED. So other
than that, I I you know, as a as a commissioner, this is the this is the worst thing we have to do, I think, when we talk about insurance. One of the hardest things we have to do. I know Commissioner Flagger's been doing this longer than longer than me, but >> longer than any
>> this is always a tough subject to talk about because you're talking about what the employees have to pay and >> and uh you know what we all have to pay with with regards to here for service for for medical. I mean, it's part of the the the plan we use to to hire
people because we do have good insurance and it's still one of the lowest around as far as I know of anywhere public or private in this area and mo in good parts of the state >> and it's always it's always done pretty well, but
I don't see a whole lot of wiggle room to change these other than I think that we should make the retirees the same as the employees and give them a little bit of a break on their on their how much they pay with regards to this.
There will be I know from from a standpoint of my days on the fire department here, there's a lot of them that'll be turning 65 pretty soon. So, we'll move some off of that hopefully and in other places um other I'm sure
other employees. So, I think I don't think it'll be a big hit in the long run to do to spend $144,000 for our retirees to help them in this uh you know economy we're having right now. So, that's uh that's really the only
questions I have. Mr. Chairman, >> thank you. Commissioner Flesher, good morning. Senior Commissioner Flesher >> has been established by >> Senior. Yeah. Well, he did. >> Yeah. >> Yeah. Well, thank you. Thank you, Mr. chair
uh for those kind words. U I have to agree wholeheartedly uh with this input. Okay, Commissioner Ammon set the point and and I want to
say that uh specifically on the uh direction on retirees. I know that everyone's aware that I'll be retiring, but it has nothing to do with that
because you're aware that I have lifetime coverage. >> So, I it would not apply to me. Okay, full disclosure. However, I fully agree with the concept
of leveling the playing field for the retirees. um they're paying a high premium and I can reflect back to 2008 2016 where we had to do something for our
retirees and it is unfortunate um you know when when you're shopping you're looking at retirees and everybody thinks well they they're in the golden time and they have a nice pension.
Our retirees are negotiating chopped meat at the grocery store as we all are because of the high cost of insurance. Insurance. I'll tell you what, we
abolished insurance across the board. We'd all be happier. I don't know what position we'd be in, but between the homes, vehicles, and health, and life,
we spend a large premium in insurance, ensuring our future. So, with that, as I stated, I I I agree with so much of this. and to level the playing field.
>> Also want to talk about the uh the clinic. I know we're going to be talking about that. >> I also want to talk about some of the communication that we're doing. >> Are we doing a communication with the
retirees on a regular basis? do we offer that to ensure that they're up to date with what is happening. >> So, following the May 19th meeting, uh we actually uh went and identified the retirees that we didn't have email
addresses for and made one-on-one outreach to try to attempt to get email addresses so we could send communications to them. Um some of the challenges are um related to mailing addresses. We have had situations with
retirees that um were uh perhaps they transitioned to an assisted living facility or a nursing home um and trying to get a family member. So, we we did do a strategic um uh communication push, if you would, and um we sent emails out to
all of the retirees that we had emails for and uh then mailed out uh information um to the individuals that we just had mailing addresses for. So, I think we did a a really good job. I'd like to thank Marcella and Dan and benefits. They they really they focused
on that following the May 19th meeting uh to be able to do that. And then of course for open enrollment, in fact, a discussion with Marcela this morning is she said, "I I've got to get my retiree letters uh ready." And I said, "Well, we'll have some information today and then we'll we'll be able to get information out to our retirees so that
they can be informed and uh related to the ALUP benefit, related to any premium changes uh and related to uh plan design changes. Reason why I I ask it is that you know we we look at and again there is some
difficulties again people move on to they move out of state they move to uh assisted uh living environments there there are many uh categories of a
barrier of communication but I think we need to up the strategy because if we're relying upon on the and if we uh and I look back at the inception of the clinic, yeah, I'll talk about a little bit. Uh it was slow to go. It did not
take off like wildfire. Now it's a very busy place and I believe the retirees can also benefit by participating in that facility
uh reducing costs and reducing future costs and I think a relationship has to be established and we need to kick it up a little bit. Uh that's one of the recommendations.
In addition, uh we we discussed GOP one, we finally got to the the end zone as we say, but when it was about the 50 yard line, uh we talked about um
the transition and I think the consultants recommended that Rightway would be doing a referral u at a cost factor. Is that correct? There was an initial fee of $33,000 for providing that
service, but now that fee is uh has been waved and they will transition um any member who is on the GLP weight loss medication to a direct to consumer program uh for no additional cost and provide them support >> at no additional cost. >> Correct. I just want to show so that was
absorbed somehow and okay I have to look at the fine fine lines because uh I was a little concerned because all you have to do is pick up this phone and you can
participate in several programs that you know it's selfinitiated but you can you can have the GLP1 in many forms
uh and it's readily available and the price is well uh adjusted uh since our initial discussion. >> Right. And the thing that's great about um Rightway is they actually have pharmacists on staff. So they can talk
through from a from a a medical perspective, you know, medication um the different nuances of the various medications for the members and may be able to make recommendations and suggestions uh for cost-effective um weight loss medications.
you have a very difficult uh job and it's very complicated and there's many nuances and avenues to travel. So I want to reiterate uh the uh kind words from the chair. Uh you did do a great job. >> Thank you.
>> Uh but there are some things we need to look at even for for the future for a reduction. uh what can we do uh for what should we do for the retirees
to make that equalization and where would that come from? I don't know if I understand the question being asked >> when we wanted to reduce the amount of burden on the retirement
>> if we wanted to u for the retirey inc the retiree increase to be a 25% increase from their current premiums. >> Yes. >> Is that so? Um I ran the numbers yesterday and um thought you did >> what? Yeah. Um uh and what uh Commissioner Earman stated um the
additional cost uh would be $144,239.33 to uh for the for us to reduce the employee the retiree premium and basically the county would pick up the difference. You know, we still have to put the the money into the fund. Um so that that would be what that additional
cost is. um the premium calculation uh the retiree premium for single coverage um under the gold plan if they had zero um co-pay or I'm sorry zero subsidy it would uh reduce it to $994
from the $1,60.50 50. If they were on the single uh gold plan or silver plan, um the premium would have been 94176. It's going to reduce it to 875. Um so basically what we're doing is reducing
the retiree premium amount and then applying the subsidy to that so that their rate increase does not exceed 25%. I think it came out to like 25.03%. Um, and then for family coverage, it was
pretty substantial on the family coverage. Um, the gold premium would be 1,980, but uh with the reduced uh premium it would be 1,622. So, it's um I think three $358
reduction off the family coverage. And then for the silver, it's uh it would have been $1,739.38, but it's reducing it down to $1,382. So, by knocking down the retiree premium um that the subsidy is based on, that
caps their increase to a 25%. Um and it it uh the additional funding would come from the county in the amount of 144,239.33 based on our $286 retirees that are currently enrolled today. >> Right. Well, again, we have within the
next three to five years, we're going to have substantial amount of retirees. >> Yes. >> And uh in in that and considering that uh I I think this is looking for the future and uh setting setting the pace.
I I think 144,000 is not a huge amount of uh funding uh to provide at least that benefit. Thank you, Commissioner Flesher. Uh, I would just caution my two colleagues to the right.
140 here, 140 there, 140 otherwise does add up, but I certainly echo your your thoughts and the 280 retirees obviously is probably going to be a solid average with our friend Craig Sawyer that
retired today and others. Some get in, some get out. And as Commissioner Man has mentioned, we all know retirees and we all know personally uh the decisions that they have to make. In fact, most recently, I spoke to a gentleman that uh
realized that uh getting off of the county plan would save him dollars. >> So, that has to be taken into consideration as well. Also remember that they are getting his payments through their uh you know
their their pension as well as the supplement that Suzanne talked about starting in 1999 1998 I believe was June 1 where uh for example some get 20% some get 60% depending on so that has to be taken in consideration but at the end of
the day we have to remember that the county employees that have reached retirement started at a heck of a lot less salary than most in the private sector. So for that I agree with you Commissioner Flet Commissioner Flesher
and Commissioner Man. I will like to ask a couple questions about lantern. Um, in that if one of our employees or retirees schedules a colonoscopy, for example, uh, I'm told that they are directed to
Sanford or somewhere other than Vo Beach. >> I have not seen a provider listing for colonoscopies. Um, and I haven't had a request come in for that. So, it's possible. Uh, but the way that it works with Lantern is they
provide you three providers. >> I'm sorry. >> There is a gastroenterenterologist in Orlando Health. >> Oh, in Orlando Health. >> That's Lantern. Yes. >> Yeah. I was I was going to suggest that sometimes the preparation for a
colonoscopy may not allow you to get to Sanford, but That's where the travel benefit comes in. >> Yeah. And then some. >> So, so that is that can happen locally.
May not be where you've gone in the past, but uh it can happen locally. Also, if you decide to go to a particular place for a colonoscopy that is not lantern approved, can you still go
there? or so colonoscopies are not under the mandatory provision. That's just joint and spine. So yes, under the health plan for a colonoscopy, if if you wanted to use lantern, you could. If you wanted to go under the health plan, you could.
>> This what what we're considering doesn't impact that. >> Okay, let's say that uh Well, thank you for that. If you have a planned uh rotator cuff and you go through lantern and uh I think the administrator may
have said Sebastian may be a participant now, but if not, my question to you Suzanne is >> uh if I have shoulder surgery or whatever and I have to go out of town and the physical therapy and the
followup, does all of that take place out of town as well? So, um, the surgeon providing the surgery would would handle a follow-up visit as well, but a travel benefit is provided to cover the cost of getting
there if you if you had to go to that follow-up visit. Usually, there's one follow-up visit following a typical procedure and then there you're like, you're good and they transition you over to physical therapy and then you go through that. That's that's the normal
routine. But if you if you needed um physical therapy, you're back in the health plan. If there was and and and the wonderful thing about Lantern is their their complication rate or revision rate is like below 1%. I think
it's 6% which is because they focus on surgeons of excellence and they have a very high criteria. Um if there was something that needed to be done, you wouldn't have to go back to that provider to get it done uh based on the information. And Rachel perhaps you could provide a little bit more information about that.
>> Correct. So again to Suzanne's point the revision light is revision rate for lantern is very low which what makes them the center of excellence. So if there was any sort of complication um which we wouldn't expect to happen lantern would work with the member to be able to utilize their health plan
locally if they had traveled initially for that procedure to avoid having to leave again. Um so that is a benefit. And then additionally, I'll remind you that there is an exemption process. If there's not um a provider within, you know, the the mileing the mileage range
um that that exemption process can be initiated and so that member would be exempted from having to use a lantern provider for spine and joint. So that that process does exist if there's an access issue. >> Okay. Thank you. And and finally, I would like to say that,
you know, we can't nobody's going to be happy. we're not going to have the perfect plan, right? So, we have to uh be somewhat flexible with respect to that. And at the end of the day, we're trying to do the best that we can uh you know, within our so-called budget. So,
thank you, Commissioner Adams. >> Sure. Thank you. Um I mean, I still have a lot of the same concerns that I've voiced throughout this whole process. So I think it's been a very consultantheavy
process. I don't I don't think that there has been enough done to craft the process or customize the process to us. I feel like what has been given to us could have any county or
city's name stamped upon it just as a study that's given out. That being said, um I also, you know, agree that we need to do something that things have to be done to bring those prices down. I'm just a little disappointed in some of
the options that we're being given because I don't feel like they are reflective of what is in the best interest of our employees andor our retirees. Um, for instance, I I find it
just ridiculous that it would cost three um $3,500 per participant to try to have them switch from a retiree from our plan to Medicaid. I think that's just
astronomical to provide information and walk somebody through the process when just as Commissioner Flesher said that's something that really could have been encouraged and done over time through the proper communication. Um I don't disagree that we need to
transition them. I disagree with the option that we're being given to transition them. Mhm. >> Um I appreciate that Rightway has waved the cost for transitioning or providing
information for GLP1s. My whole issue with that was not that I had a problem with us not covering it is that we weren't going to give information to people to help them get there. That being said, what I was really looking for was well, I think apparently Commissioner Flesher, we
might have been on the same page and didn't even know it. >> No way. um was just reaching out and giving people I know. Well, you never know. Um giving people the websites and the opportunities to go to to know where they need to fill out that information
to basically check the box that my insurance no longer covers this and participate in those programs because that's all they have to do. But when we first started this conversation, that wasn't anything that it was even presented and it could have been as simple as an email that wouldn't have
cost us anything. So, I'm glad that Rightway has decided not to charge us on that. Um, the virtual nutrition services, I'm I'm happy that that's included and that we're going to offer expanded
opportunities there. However, it's my understanding since this process has started, I've had several employees reach out to me that they are actually utilizing nutrition services locally and that is being covered by insurance. So, I have concerns that perhaps we
don't really know what our insurance is and is not covering. So, that gives me an added level of distrust with what is being presented to us today. Um, I really have um a major concern with
lantern. I I don't I know that these are um you know not emergency procedures, but I don't like limiting people to who they might be able to choose and giving that control to uh a corporate entity on the
other end of the phone versus the patient themselves. And every time we seem to ask questions about the provider network, there hasn't been a lot of ability to answer that question as to what providers are local and what
providers are not. Um, I'm glad that we keep hanging our hats on centers of excellence and surgeons of excellence, but you know, I don't we haven't been able to talk about what that criteria is to become one, how many are in our
community. um and revisions. So, new surgeries and revisions will be forced to go through lantern. If you have a revision and your current doctor is not a surgeon of excellence, you will be forced to go to a new doctor
for that hip or knee revision. And if I had a hip or knee surgery, I don't know if I would be comfortable with the only option being some new surgeon revising somebody else's surgery
if it was necessary. Um, so I do I do have concerns about that. The the last thing I'll say is, you know, something that I have been saying and I said this five years ago when this came up with highcost
um patients and and when we had to deal with that several years ago, there's still no strategy really being presented that would address the high cost claimants that crop up about every 5 years. It seems like we have to deal
with a year or two years where there's an extreme amount of high-cost claimants. So, I haven't really seen a strategy and that strategy could be as simple as a different budgeting model knowing that that's going to happen every 5 years to
help absorb that. I don't know. But I have seen nothing regarding that. So my fear is we're going to do this and then in five or six years we're going to be ringing our hands again because we have another spate of high-cost claimants at no, you know, no fault of their own.
It's the way medical issues work. I get that everything kind of runs runs in phases, but we we're going to have a self-insured program. That's something that should be considered prior to it happening. And I
just haven't seen that. and we had the same conversation several years ago when when we had to address it then. So I don't disagree that things need to be done. I'm not comfortable with what's being presented that it's really what's
going to be effective. So, you know, that's that's just where I am on it, but I appreciate the conversation. >> Thank you, Vice Chair Moss. Well, >> yes. Um, some very good points. Thank you, Commissioner Adams. Um I I had
questions just on the retirees. I think you said um that it's no longer available the subsidies to retirees like new people, >> new employees don't are not offered subsidies upon retirement. Is that correct? >> Right. For like for somebody like me for
example that hired in 2016, um I'm not eligible for a retiree subsidy from Indian River County because I was hired after 2011. So, um the subsidy offering was only for people that were employed prior to a certain date and then those
subsidy amounts are based on uh when somebody initially hired and when they retire as to what percentage they qualify for under the retirey subsidy program. >> So, so if you know what years were the subsidies offered? You said it ended in
2011. >> 1998 through 2011. >> Mhm. 1998 I believe >> 2011 approximately. Um so what was if you know what was the rationale behind that? >> I mean we you stopped it a long time ago
or we stopped it a long time ago. >> It was it was budgetary. It was it was funding. Um there was a change from u from a budgeting perspective where you had to allocate funds out of your current budget to fund future benefits
for retirees. So when that happened um it was taking a very large portion of agency budgets to fund future they call it OPEB you may have heard that discussion. Um so that oped funding was becoming a greater and greater liability. So um many organizations
decided to uh stop providing a subsidy for future employees but they um had a commitment to maintain what was already promised to the retirees that that um uh had >> Oh yeah. I mean, that's that's the number that caught my eye. The current
amount of county paid subsidies is uh 1,982,242. That's a I we're concerned about 144,000. We're already paying almost 2 million. So, I mean, that's huge. Um
so how many uh people currently are receiving subsidies? I mean what percentage of people if you know are subsidized? >> I don't have the percentage breakdown. Um I have it on a a spreadsheet but I didn't bring it with me but we'd have
286 retirees. The majority of them are receiving subsidy. >> Okay. because they they uh retired and were promised that benefit. >> If you and if you know are most of them approaching 65 or over 65 that they
could be transitioned >> to another has those numbers. Yeah, I know that there's 84 65 and over retirees and of those 55 are receiving the 50 to 60% subsidy. 14 are receiving the 30 to 40% subsidy and eight are
receiving 0 to 20% subsidy and those are the retiree onlyies and then of those covering a spouse age 65 there are seven retirees and of course they're not receiving any subsidy. >> So can we expect to see that the two million drop and over what time period?
So, as retirees leave the plan, um that subsidy amount will reduce be for the retirees that are currently receiving a subsidy if they choose to leave the plan. >> I mean, like, do you have those numbers? Do we know what we're going to save out of this 2 million almost? Do we know do
we know what we're going to save over what period of time? >> Well, we're looking at about $196,000 savings. >> Yeah. Uh so ALP uses the rate of about $17,500 as the annual cost of each member on the plan. And so for each member you migrate
off the plan, it would be a savings of $17,500. And then you would net out that $3,500 fee that also charges only if they successfully um transition someone to the Medicare plan alternative coverage. >> Yeah. Yeah. And so that also service includes not only those one-to-one
consultations but also educational workshops, all communications to your retirees. >> Yeah. Speaking of all, why is this so expensive? I mean, I agree with Commissioner Adams on that. That also caught my eye. What is it? 3500 per individual. Like what what do they do?
>> So, they'll go as far as completing any Medicare forms that need to be completed. They will completely hold the member's hand from start to finish. show it truly is like having your own personal concierge to enroll you in Medicare and so it's a very can be a very challenging overwhelming process to
members. >> How many forms are there? I mean seriously we've all dealt with government forms for all kinds of things but you know sure how many forms are there just out of curiosity. >> There would be a form to enroll in the actual advantage plan or supplement plan and then if someone needed to enroll in
Medicare part A or part B as they're turning 65. So that could potentially be three. Um, so certainly yes, a person could complete those on their own, but it's just part of having that expertise service. And again, they're only compensated if a member actually
completes the enrollment into Medicare. So just for having that comparative value, they're not charging anything for that. >> No, I'm I'm not in favor of that. I would I could not support that. That's just it's too much money. >> One of >> They get a commission. Is that what you said? They get a commission if somebody
signs up. No, they're only compensated the $3,500 if someone enrolls. So, they're not compensated if someone doesn't enroll. >> Isn't that the definition of a fee? >> I'm sorry. >> Isn't that the definition of a of a commission? >> Yeah. >> So, it's a contingency fee. Um, a
commission would be a percentage of of something, but the way this was structured is a contingency fee. The reason why we um we are uh recommending that ALSA provide this service um we in HR Marcella for you know since she's
been here an Ranken when she was here she would have discussions with retirees related to other plan options. However, we can't provide advice on plans. You have to have like an insurance license to be able to serve in
that capacity to somebody. So, we can point them and direct them and we've been pointing them and directing them to the the Medicare.gov website where you can do some online things. We've walked them through that process. We've been pointing them to the Shine uh pro
volunteer program where you can go and meet one-on-one with volunteers that can help explain different options. Um, but we haven't been able to serve in that capacity of really providing the level of support that results in people actually transitioning. um because they
they just don't feel comfortable about it and we can't encourage them one way or the other in our capacity as the employer. um if something were to uh >> it could come back on us as the employer um you told me to do this and now look
and so we we we would be placing us in in a risk that we're not >> and I would just like to add that as a licensed Medicare provider part of their licensing they're required to provide a clear selection process and if it does not work in favor of the member based on
their individual um prescription needs medical needs the cost of everything compared to the county plan also will in all good faith tell the member to stay where they're at. And so they would lose their license if they were providing incorrect advice to the member, which is what allows them to maintain that
license. And so it would be no different than just referring members out to a local individual agency who would also be paid that commission or compensation only if they successfully wrote that Medicare plan. So it would be the same concept as the individual market. We're just recommending this particular vendor because we've had a lot of experience
with them with our other clients and other clients have been very happy with their work. >> Yeah. >> I don't know. I still can't support it. I do have one more question on um Lantern. So again, I share Commissioner Adams concern with that with directing people. How are we going to or you're
how are you going to monitor um over time outcomes of doing that and also patient satisfaction? I mean, how do we know that that's the right choice? >> Sure. >> So, Lantern gathers information on patient satisfaction. So, we would rely
on them to report that back as well as any feedback that you get directly from patients. >> I think you need like an independent audit kind of thing. I think I think you're going to have lantern reporting on lantern. So as it relates to outcomes that we can measure as locked in the information
that we receive um we have the ability uh because of the data feeds that we get from Indian River County and from Lantern to understand and actually estimate what we would have expected the savings to be based on what Lantern
proposes and and sets their estimated savings rate versus what was actually realized. >> Right? I'm not talking about savings though. I'm talking about uh medical outcomes, patient outcomes, and patient satisfaction. I mean, how do we how should we know that we are doing the
right thing? We're doing right by patients, by our employees. We can get some picture of that through the claims, understanding things like readmission rates, complications, etc., as well as the total cost of care for
that member. We don't have a level of detail to see that individual member's outcome, right? So, we see the claims. So, we see the very objective experience of the member. We don't quite always get a picture of what that subjective experience has been. Lantern is a quite
a wellestablished vendor in the employer space in terms of directing those surg surgical centers of excellence or those surgeons of excellence based on pretty rigorous criteria that they have to meet around their outcomes complication rates.
>> Yeah. >> Maybe you already said it but how many years have they been in business? Lantern >> I don't know that I have that answer. I know that Lantern first approached us in 2017. Um there were initial
discussions um back at that time. >> Well, maybe this is something we could do internally uh just to make sure. Absolutely. You know, I might think we're doing a good thing and it might not be a good thing. You know, if patient outcomes are not what they should be, if patient satisfaction is not what it should be.
>> Um >> I think we need to know that. >> Thank you. Commissioner Flusher, if you want to bring it in for a landing. >> Yeah, we'll bring it in for a landing. Yeah, you already identified that I'm I'm on the other end, right? >> You are.
>> Uh, you know, I heard Commissioner Adams um you know, you you you amplified something uh that uh little bit concerned and Commissioner Moss as well. Um and
Commissioner Herman, you know, we have to look out for the ultimate patient. That's what our job is. Our job is not to give something out there. I want to
just want to reflect on something. When I was wearing about 30 years ago, I was wearing a uniform and you know what the cost of insurance was? $12. >> $12.75. >> Wow. >> Single family,
diversified, and it was considered the gold plan. Okay. Now, the gold plan, you're giving up half your social security check, if not all of it in some cases. Wow.
And then as we're mentioning the years, I'm reflecting back And I want to bring up Lantern. >> Mhm. >> When Lantern was only because you say
tomato, I'm going with tomorrow. Okay. There's a big understanding that we had in the past about 2019 uh about what Lantern was
and it's different from what Lantern is from what I see. You see, if someone's getting a shoulder replacement, a hip replacement, they're not getting a haircut or shine
in their shoes. It's a very serious action. It's a commitment. It's ex well explored, well defined. We ask for referrals. We talk with individuals. We look at the background of the surgeon.
And with that, whether it's successful or not is in someone else's hands. It's a very important decision. And when Lantern was brought forward, it was considered a an
option. You can choose to go to Lantern. Uh you can get different service or you can go to your own physician. Now, I understand that's not the case. now. And if that's not the case,
we're not doing the right thing by our employees. >> So, currently the lantern is a voluntary benefit under this. >> That's not what it sounds like. under the proposal that's before you for consideration with the lantern benefit a
portion of it would remain excuse me voluntary but the joint and spine portion would be mandatory it's a we would be directing care to the narrow network through lantern and that's what results in the estimated savings
to your point it is a change from what it started off as as being completely voluntary for all services. So this is just a proposal before the board.
>> Very nice. Uh just a proposal. >> Yes. But this proposal is transitioning two types of procedures through lantern the joint procedures and the spine procedures to be mandatory. So it is important that we understand that
October 1 under this proposal those types of procedures would be mandatory through lantern. >> If that was a proposal that was adopted by the board. >> Wow.
>> So you're amplifying my point. Uh, I I I think people need to go to the surgeon that's going to do what they need done at their choosing
and not being directed to be mandatorily driven to lantern. Again, there may be very fine surgeons, but a hip and a shoulder, a spine
is something that takes grave understanding, exploration, and choosing to have the right gifted hands to do the job. I I I don't I don't think we should be
doing We brought up the uh compensation that is a commission. That referral is a commission. I don't know how how we just choosing words to soften the blow
to change it. creative writing and and it's it's not not being mean. It just it's a commission very much so. And earlier we said you'll be able to go to the doctor of your
choosing. No, we're not. No, we're not. There's a dichotomy here. And could you clarify it? So just to clarify on the lantern
proposal, there is a proposal before you to require procedures that would be spine or joint to be mandatory through lantern and they wouldn't travel under
the health plan unless there was no lantern surgeon available for that procedure or the lantern didn't accept a patient uh for a procedure for whatever you know specific reasons would be unique to that individual. Um in that
case there would be an exception uh process to go through to then transition that member back to the plan. But the intention of of realizing the proposed savings of the $627,000
would be a mandatory thing. we can still offer lantern as a voluntary benefit. Um we can work to encourage people to utilize it. Um and and hope that they do. Um we have had
some people who through word of mouth found out about it through somebody else having a really good experience and then they went and had their good experience. So um and we have we are having people utilize lantern today. Um and we are realizing savings. It's just in the
plan. When we look back at the plan experience, we had 30 members who had spine and joint procedures. Under the medical plan, little over a million dollars in cost. That type of redirection under a mandatory program.
We could have cut that in half uh in in in plan expense, but it it does it is a disruption to members. to your point, it does take away choice um to where the choices would now be within the network of surgeons of excellence, not the full Blue Cross Blue
Shield network that people have today. So, it is a change. Absolutely. >> Let me ask a question on this. >> You could we could certainly not vote to utilize that option. >> That's correct. >> That is correct. >> Right.
>> These are all we we presented you. We were trying to balance the cost of the plan, the increase, trying to minimize the impact financially with it, keeping in mind obviously the benefits afforded to the employees. So these are all options. That's what we've emphasized. I
think two other meetings. These are all options for discussion. >> It's like an allocart menu. We can choose exactly which side we want. >> Exactly. >> Mr. Chairman, if I may, Commissioner, >> maybe between the two of y'all, you can answer this. If I have to get a knee
replacement because I can't, it's hurting so bad I can't walk anymore. I use lantern. There's no deductible. There's no co-pay. There's basically it is you don't have to pay a dime. >> That's correct.
>> So that's encouragement. What is the normal cost on say a knee replacement? >> I don't have those numbers available, but I would have to say I mean there's going to be a I I think the bigger point there is that there's such a variability
in the providers who conduct those types of surgeries, spine and joint. And so that would that's what Lantern is trying to solve for because there is such variability in what providers are charging in that space from facility to facility. And so Lantern is seeking very
specific providers based on the rigorous vetting criteria to be able to contract with them under bundled rates. And that's where a lot of that discount comes into play from what you would pay through the Blue Cross plan. >> So the advantage to the employee would be and let's say we make it optional. We
keep it optional. So the advantage to employee is you don't there's no out-of- pocket expenses for you to get this surgery done. >> That's correct. >> It's covered by the lantern program and that would be the incentive that you don't have to pay anything. >> That's right. Versus under the >> you're getting a and you're getting a
good surgeon, >> right? under the Bluec Cross plan, they would most likely end up meeting their deductible. So there would be at least $500 or $1,000 out of their pocket plus any additional co insurance towards their out-of- pocket maximum. >> Right. >> And then just to follow up, Commissioner Moss, on your previous question, Lantern
was established in 2011. >> Thank you. >> That's all I got. >> Commissioners, any further discussions? Commissioner Man, >> I would um >> I'm just going to throw this out. I
would accept the plan as presented by staff >> keeping the retiree rate at the same as the employee rate of 25%. And I would still say we need to keep
lantern optional for this year and further look at what encourage our employees to do that because their benefit is there's no out of pocket. >> Correct. >> That that should be huge uh to them.
that that's kind of what I would present to the board and and that that's good you you bring that out, but we have that uh North Carolina uh coverage and uh that procedure is going to be covered.
So I I I don't think there's a huge co-pay involved in diverting break. I think the the the benefit is to the employee or the member is they're not paying anything out of pocket and
then also our plan is not incurring the costs as well. So it's two twofold benefit both to the employer and the employee >> but it it's the savings to the person
undergoing the surgery is extremely minimal. I Okay, I'll just 2000. In 2000, I can tell you I had a cervical dasectomy. It was like $38,000. That was 2,000. So, I mean, and you know, I had
insurance, but I still had out of pocket and stuff. I mean, that's just, you know, how much it's spiraled up since then. So, I I think the maybe if we had costs of some of the procedures, you'd understand the impact to the plan. I think the 20 was about $1 million. Was
it combined? >> Yeah, we had 30 people. Um it was a little over a million dollars and the savings um is 50 something% to 60 something% based on the procedure that's being performed, the average savings is
uh through Lantern because of their bundled pricing um is it it cuts it in half. So that's where the $627,000 in projected savings comes from. But but I am I mean >> I'm sensitive to the issue because if I
have to have this worked on, >> I would want to go back and probably talk to the 20 some years ago, 26 years ago that I've had no minor issues with. >> Was that work done? >> Here's what we're going to do. >> 2000 2000. So it wasn't with our plan.
>> No. Here I just want to commissioners. Here's what we're going to do. We're going to take a recess until 11:15. I'm going to ask the administrator to meet with Suzanne and our consultants, talk about lantern, give us a price of it being optional and or the retirees. We
will resume at 11:15. Time now is 11:15 and we will resume our port of county commission meeting June 16th of 2026. Uh prior to the break, we asked the Mr.
Administrator and Miss Bole and others to communicate. Mr. Administrator, welcome. >> So, Mr. Mr. Chairman, uh, members of the board, uh, the the request on the the concerning the retiree capping it at 25%
increase to the employees. Uh, if you know that amount, it's $144,239.33 for based on 286 enrolled retirees. So, the county would just have to absorb that cost. Uh, with regard to lantern being optional, uh, again, it's an
option of the board. It's uh in terms of uh we just was not real we would not realize this $627,000 projected savings if there's less surgeries or there's greater usage of lantern
u then we could see that so you could we could leave it as optional and monitor it and try to get some of the information the metrics about which you're talking I don't know how with HIPPO we could do customer service satisfaction ction because I don't know
maybe there's some way we can do that and monitor the usage but this was that was last year was 30 people that had surgeries that were in excess of uh were close to a million dollars so we could do that and then I just for the alup
there was two pricing models that was presented uh one was where it was straight $1,200 per year per retiree you know and then that we have them on they're engaged and they're working to
get our retirees into uh Medicare or a supplemental plan. And we chose the one that's been recommended is because we're spending 17,500 on average. That's just the premium. That wouldn't include any if any of these 65 are high claimants.
It wouldn't include any of those costs. So, but at a bare minimum, you're looking at if they're it's 175 and there's they're successful and as was noted, we can't we can't provide that service ourselves because our benefit uh
administrator or benefit advisor. They're not they're not licensed in search insurance agents. They don't have a 220 license nor do they have the requisite uh license related to Medicare. So, we can't do that. So, this was a service that was being presented
as an opportunity if they were successful in migrating somebody from our current plan coverage to the the uh voluntarily to go to uh um Medicare and and our supplemental
that would uh reduce the cost to the county by $14,000 that that particular year and then that would acrue every year going forward. I mean actually going to whatever the amount is. >> So that's entirely a decision by the board if you want to pursue that. Uh
it's what we do right now is we advise them of the Medicare website and we also provide them the information related to the volunteer program where they can get the requisite information uh from people that are more qualified and more you know I think licensed to
provide them. They're actually it's just volunteers and so they go to a training program and u but they aren't licensed that's just peer-to-peer retirey to retiree. Hey, this is what I did. This is what I learned. This is what I'm I'm
familiar with. And um they walk people through the process peer-to-peer. There's no charge. That's through the Shine program. Um and then um on the medicare.gov gov website. You can actually uh enter in your own information and shop the market uh as
just a consumer um on the Medicare website. You can shop the supplemental plans, Medicare Advantage plans and uh part D pharmacy benefit plans on that. >> Yeah. So I in the end I think what the the the purpose of going looking at alup
as a solution was to help drive those retirees that could benefit as not just they benefit but we would benefit as well. So it was it was a matter of a cost potential cost savings and uh I mean so it really we're talking about
the disruption versus savings I think is the and we're saying that we can do the lantern optional so that that would minimize the disruption and mon continue to monitor it last year if you recall we were at a decision point on GLP1 and
there was a lot of information coming out of Washington and we chose to extend it one more year and we covered that that cost and so I mean we can do the same with lantern uh it is I will say it's also keep in mind just while there's other governments that use it
local governments it's also the state of Florida uses lantern as well I think we've had some people come to us and tell us you know about their experience as well so uh but we can you work to voluntarily encourage or at least get make step up the educational
campaign internally through our newsletter or whatever besides the mailers that we all get from Lantern. >> Right. I appreciate that, Mr. Administrator. One thing that we uh I think all have collectively recognized and Commissioner Adams specifically
I don't want to say it's frequent that we have spying and joint situations but if we adequately inform our our users the fact of the essentially zero cost uh I think that
becomes u either word of mouth but more importantly the agency will put those those thoughts out and that will redirect them. So I appreciate that. So with respect to the the funding, Mr.
Administrator, you're looking at 14677 as opposed to last year as we all know uh the deep dive that we took uh because of GLP. Essentially, this is less than a third of that dive this year. I know that's a
budget question, but I think >> Well, it it we know the the concrete there's 140 145,000. We'll just round it up. $145,000 of costs because the the lantern was a it's a projected savings.
It's all dependent upon what surgeries or what may happen. >> Correct. >> So, it's it's projected based I think was 27 claimments or 23 you were projecting. So that was based on 23 potential similar types of surgeries that were related to the spine andor
joints. >> Gotcha. The minimus commissioner >> Mr. Chairman, thank you. Uh you brought up the the peerto-peer that peerto-peer is normally reserved for professional to professional for evaluation and
consideration for a procedure or uh other related matters to an insurance company and a patient. But >> I like the idea >> because it's
personal information. And I want to remind us all that 211 is also volunteers. Okay? They they have some training, but they're volunteers saving lives. So, uh
that's a tremendous benefit. We often say that talk is talk is cheap. communication has the highest value and I really do believe that coupled with that and an outreach to our retirees
uh and again you've identified that there are some difficulties but a concerted effort to ensure that we can actually reduce the burden for the following year just with some communication principles being applied.
Thank you, >> Mr. Chairman. >> Yes, Commissioner. >> I want to address the uh ALOP thing real quick. We were talking about the different ways it does and how much they get paid and all that sort of stuff. The bottom line
is is that we need to get the our savings is getting the 65 and over off our insurance. That's where the big savings is. The other stuff is just in my opinion clerical and I don't think we need to worry about the weeds growing in
this. The big thing is is that we're getting these 65 and over off our insurance and and able to move on because you can also do it on your own. You can sign up for Medicare, right? Part A and part B. And you can go
>> to one of the local um I know there's one over by Vincent's Pizza that that that uh Blue Cross >> that I know the person that that runs it. I haven't needed them yet, but >> but they uh they do that. They sell the the you know the the additional
insurance. That's where we actually went for my mom like 10 years ago before she passed away. and her insurance was fabulous. I mean, they encompass took her in and the hospital gave her the best room and and the whole thing. So, the the the thing is here is let's don't
get hung up on that is the benefit is getting the people off our thing. So, >> right and as Mr. Administrator said, we have to be at some arms linked in making these suggestions. So, I do appreciate that. We do have members of the public
here that are either retirees and or current employees. We'd love to have an opportunity for them to to chat. Uh I see my friend, retired Captain Rick Lane. Uh welcome. >> Good morning, commissioners. Um Rick
Lane in Emer County and also a retiree utilizing the health insurance program for the county uh that the county offers. Couple things I'd like to reserve a statement for later before a motion and a vote. Uh there are a few questions that I have. Uh a couple
things I would like to address in relationship to um Commissioner Moss's uh queries on the health insurance subsidy. That health insurance subsidy once the retiree becomes Medicare eligible goes away.
>> The county no longer has to pay that. So if the uh retiree is on the county health insurance is receiving the subsidy when they become Medicare eligible that's something that u that particular funding disappears from. I
don't know that that was brought up. >> Yeah. that also may um help facilitate one of the concerns that Commissioner Man has with regards to getting retirees to move along to a program that is more beneficial for them um at a at a better
finance financial rate. Um, one of the concerns that I have with regards to options A and options B, um, is very similar to, uh, I believe a concern that Commissioner Adams echoed earlier was u,
an issue with the consultants. Um, one of the questions I have, um, it's my understanding that when we did the financial modeling for option A and option B, it was based on instructing
Lockton um, to do a 25% premium increase and a corresponding 25% premium increase uh, in participant contributions. Um, when Lockton developed their
actual aerial projections were all of the participants that were utilized to come up with these numbers um based on the 25% increase.
>> No. So, so maybe I can help. Um Kim, would you pull up the So on this particular screen um locked in presents funding recommendations to us and then we as the plan um we'll call
us the plan sponsor owner of the plan. It's our plan. We determine the uh relationship of the employer cost share and the employee cost share. So, the information that came from locked in um
this was the projections for the upcoming plan year and and this is probably a good time to explain. Locked in looks back at all the claims data. They see um uh they they have all of the
information on all of the high-cost claimants, on the types of diagnoses that are out there, and they statistically analyze our plan and project future claims costs based on every member, all the 4,000 lives that
are currently on the plan today. And there's assumptions that they make that are medical standard medical trend assumptions that they make. Um this particular recommendation was we need 11.4 million dollars more than today. That
particular rate increase would have been an overall rate increase of 44.6%. Um the other recommendation was if we remove the GLP1 weight loss medications, how much funding would we need? And that
number was about $ 8.1 million or 31.6% 6% in additional premiums. Then um what we did administratively and this was not locked in but this was the county administratively was starting to look at
cost sharing and a reasonable cost share distribution between the employer the county and its members. And that's where we landed on um the 25% employee contribution. We went through several
iterations of that and um that's where uh we landed on it. Um so what we did is we backed in to the the 8.1 million that was needed. Um we actually adjusted it slightly and and it's
basically 7.8 million rather than the 8.1. But you can see on this worksheet these are all the enrolled uh members in each plan. uh the employees or the ones with family uh 800 or 1,856
units of coverage if you would. And um then these are the uh the associated premiums based on a um 25% increase to the employee contribution. And then the county's premium went up 31.9%
for single coverage and 31.9 uh 33.9% on family coverage. So, um, does this help explain that? >> Uh, I believe to some extent it does without sitting down and >> really digesting the spreadsheet.
>> So, we we kind of backed into how can we get 7.8, you know, what what do the numbers look like? And we we wanted to keep the employee contribution to the 25%. >> So, okay. So I believe the answer is
then you focus primarily on the employee contributions being the 25% the retiree contributions ranging anywhere from 31 to 34%. >> And and the real focus was on the per per um employee per month rate. You see
that column that says the 2027 monthly rate? >> Yes. So that's the amount of money that needs to come in for single coverage and the amount of money that needs to come in for family coverage. Then it just became cost share. Employer pays this
much, employee pays this much. Does that help explain it? >> Yes, absolutely. >> Okay. um when when they start to look at the numbers, I know that we look at the health insurance plan is one plan, but
essentially it's one plan with two sub plans. We have gold and silver. when we, and when I say we, I mean the county, when the county looks at the numbers and trying to establish what they need for
that 60-day aotment um in funding and future funding, do you co-mingle the claims from gold and silver? >> So, we I'll show you a report that we get. It's our March financials, and it
actually breaks it down. Um, let's see. That's perfect. Kim, if you can share it on the screen. Perfect. Okay. So, uh, is there a way to make that a little bigger way? >> Oops. >> We have a vision plan.
>> Yeah. Glad we have vision plan, right? >> Yeah. Control and then plus sign. >> Control plus right there. >> Oh, yay. Okay. So, um, this is >> Oh, yeah. as much >> both plans. This is the plan experience
from both plans. And um the loss ratio for both plans is $128.6% through March. Um meaning that we were um under budget by uh $3.7 million
basically um in the six-month period. Um could you go to the ne Oh, actually I can do that, Kim. I have the power. Um this is a rolling 12 month experience. Uh so it's April uh 2025 through March
2026. Our loss ratio was 123.8% overall. And then um if I go down further, those are my high-cost claimants. This is how the gold plan performed. So the gold plans loss ratio is 145.5%.
meaning for every uh dollar of of premium coming in we're spending a $145 going out and then uh the silver plan is performing within budget at 87.4%. So um when we look at establishing the
the premium amount it's based on overall how much we need to fund the plan um in in this instance this $7.8 8 million. We're assuming that we might have a 10% migration from the gold plan to the silver plan as a result of the higher
premium increases. So, it's all going to depend on where people choose to sit. You know, do I want to stay on the gold, pay a little bit more for it, or do I want to transition to the silver because that will be a more affordable option for me. So, does that answer your questions? >> I I believe it does. And because I
believe you mentioned earlier that the silver plan as far as loss claims we were doing we were performing better there from the standpoint of expenditures than we were the gold plan. >> Yes. So I guess my question or
suggestion would be that maybe in the future rather than look at the health insurance plan as one plan in its totality and saying we need to increase um employee contributions by 25% or retiree contributions by 35%.
Maybe we need to look at each of those sub plans, gold and silver, separately because there may be an argument that the gold plan which is providing far greater benefits um to participants than
the silver plan is to other participants. Maybe the premiums need to increase say an additional 3% for gold and silver may need to come down an additional 3%. that may be something that that from the standpoint of being
good custodians of the dollars, maybe we would want to look at that. >> So, um, >> we actually did. >> Yeah. >> Yeah, >> we did. >> We looked at that. You'll you'll see that the dollar increase in premium for the silver is less than the dollar
increase for the gold. It's >> like going from $15 a month to $1875 a month, >> right? You're right. >> Just 25% on the higher amount versus lower amount. >> Okay.
And I think they would also if we did >> looked at them individually, we'd probably see the gold plan, which has most users, there would be a higher increase for the gold plan users and that would just drive them into the silver plan with their costs because
they still have the same claims experience and they bring all those costs into a lower deductible, you know, option, right? >> Okay. Very good. That's all the questions I have. I'll reserve some time later for a statement if you
>> Rick, if if I could ask you very briefly, could you give us a history on the supplemental uh plan that Commissioner Moss was asking the dates? I know you're a stickler for dates and percentages and ending dates.
>> I don't have the specific date in my head. I believe you were correct. somewhere around 97 or 98. Uh the impetus behind that was uh the then county administrator was engaged in a conversation with members of the road
and bridge department and at that point in time some of those members were respectfully getting up there in age and he asked the simple question you know you're eligible to retire. Why are you still working here at Roaden Bridge? you're out there subjecting
yourself to 95 degree heat in in the midst of summer, working on asphalt, digging water lines. Why are you still here? And the response that he received was, we're here for the health insurance benefits. We can't afford health
insurance. And um one of the things that I think was was probably uh the most personable thing that the county administrator at that time could have ever done in my mind was he addressed the issue. He says we need to figure out a way to uh help our
employees when they leave the agency so they can continue to have their benefits. >> Um that plan went through a couple different modifications uh where individuals who uh retired that I don't have specifically. I do have it.
Just a second. Um, >> so it was somehow prrated by your length of service. >> Yes, it was for every year of service you would receive uh >> 2%. >> Yes. >> 2% for every year of service up to a
maximum depending on which plan you got in. If you got in on the first plan, it was up to 60%. When the county changed it, went with the second plan, it was up to 40%. >> Joe knows about it. >> I was Yes, I was on that. >> Yeah. >> And currently, um, we have, uh, for
people who retired on or before January 31st, 2009. Um, their subsidy does not cease when they hit Medicare eligible. They actually received an additional 20%. So, those are where the 60% subsidy came from. So, we do have a a component
of our retirey group that um has lifetime subsidy, if you would. Um and then uh those that retired uh after January 31st, 2009 um but were hired before um February
1st, 2006. They uh received the subsidy up to a maximum of 40%, but it does cease when either the retiree or their spouse reaches age 65. And then anyone who was hired on or after February 1st, 2006
does not receive any subsidy. >> Correct. >> Thank you, Rick. He's quite a historian. Maybe he'll be our county historian one day. >> Captain, do we know each other? Have we met before? >> Captain, weren't you tasked for uh
>> human resources >> human resources and benefits? >> I was in a past life. In response to that, I'm just going to save this for later comment, but in response to that, I'd like to echo the comments of the chair from earlier in uh applauding
Susanna and um yes, >> Suzanne Marcella for their hard work because I I recognize that when they get into, you know, it's not just crunching these numbers to see what works. It's not just counting beans. It's about recognizing that every being you count
has an effect because every being is a person. And you know, their their job is complex and there are times that I may call them to task on a couple issues or something along those lines, but it's only meant to strengthen what the program is that we're offering to our
retirees or our employees for that matter. and uh their their staff is they've got a lot on their plate and uh as far as I'm concerned in the responses that they've provided to me even over the last couple weeks uh they have been
very quick to respond and provide me valuable information and even throughout the course of of the year when reaching out to them for some other issues. They're good. >> Thank you. >> You're welcome. Pass that along >> very much. Um, Commissioner, would you
like to yield to me to finish out some statement or >> My pleasure. >> We want to see if anyone else has any comments. >> Go ahead. >> Thank you. Um, so I want to begin by saying, look, I understand health care costs are increasing. I frankly do not
object to paying more, but I'm going to throw out the caveat. I would prefer not to, but I'm also a realist. I understand that we have to. One of the things that I object to and concur with some members of the commission based upon what you've
articulated today is retirees being required to absorb a larger percentage increase than active employees for the same county sponsored health insurance program. Active employees generally have ways to offset their increases whether it's annual raises, merit raises, cost
of living adjustments, promotions, or even overtime opportunities. Retirees, however, are in a vastly different position. Many of them live on fixed incomes, limited colas, social security, and have far fewer opportunities to
generate additional income. As a result, when they have this larger health care increase, it actually presents to them a much greater financial impact on retirees than it does to our employees. Yes, there are some retirees that are
benefiting from the health insurance subsidy afforded by the county. There are other retirees who, as uh the chair acknowledged earlier, they get a state subsidy. That state subsidy is $7.50 for every year that you've worked. And I
don't think that number has changed since 1984. Uh so that state subsidy is by far not keeping up with um with the cost of health care. Many retirees when they
were working they made career decisions. um they made retirement decisions and those decisions were based on the reasonable expectation again let me use that word again reasonable expectation that postretirement health insurance would remain reasonably comparable to
what active employees receive that expectation is not merely personal it's also supported by Florida state statute 112.0801 0801. And essentially what that says is the state has the intent that you're
going to provide insurance benefits to retirees at the same cost as what's being provided to employees. Um, I don't believe that we are adhering to the spirit or
the legislative intent that was designed or that was utilized in creating that subsidy. Um, and I I think that's important that we need to recognize we're not comparing apples and oranges here. Yes, we are
comparing different classifications of employees or retirees, but the fact is um that debt, that liability is being passed on to retirees at a greater amount of money percentage-wise than
what's being passed on to employees. We've we've got the numbers. Um I'm not going to dive into the numbers. You all have a better appreciation and com uh and uh ability to comprehend those numbers than I do based on the percentages. But let's face it, we acknowledge that there's a difference.
That difference can be anywhere from 31% to 34% more for a retiree than what's currently being paid uh for by um employees. Um I've asked the question earlier if there were any plan changes
uh that could be made. One of the questions that I do have, um, the difference between option A and option B, has staff calculated out, and I believe you answered the question earlier. If you did, I apologize for asking it again. Has staff calculated
out what the savings would be to the county, to the retirees, and to the employees if the county chose to use option B as opposed to option A? Um we have an overall
cost in um the presentation the one from last month. >> Yes. >> There we go. Oops, too far. Okay. Um, so it's 749,000 in projected savings for option A
changes and option B changes, the projected savings are a million uh 92. So um when you start distributing it um what are we looking at an additional 200
and 60 340 >> 340 see I'm not the mathematician 340 in additional savings overall so um we were targeting 8.1 million uh for our
premiums but we end landed on 7.8 8 million. So, um it wouldn't be substantial when you start looking at at the overall numbers. Um and we try to we want to be be conservative with
change recognizing that premium and plan changes. Um it it it does increase cost to the members themselves. So we were trying to land on a couple of options that weren't too aggressive uh for consideration.
>> So B was to that point B was more put putting more in addition to the cost it was putting increasing the out of pocket and the deductibles at a higher level. >> Yes. >> Okay. Very good. >> For the retiree and the employee. >> Thank you Susan. That's why we chose a
>> I'll I'll close by saying look I understand that the health care costs continue to rise and that everyone must share in those increases both the county commission the taxpayers the employees and the retirees. Um retirees are not asking to be exempt from higher costs
nor are we asking for any form of special treatment here. We're simply asking to be treated fairly and consistent consistently. And when I say fairly inconsistently, I mean if it's 25% increase for one, >> should be 25% increase for another. If
we all leave here and go to lunch today and we have >> the chair's favorite for lunch meatloaf, um, you know, no one is going to be happy if they're paying 10% more than the guy sitting next to them. Uh, we're looking at reasonable and fair. So, I'll
finish with saying this. Many of our dedicated um many of our retirees dedicated decades of their lives serving the county and its citizens. They made career decisions and retirement plans with the understanding that access to county sponsored health insurance would
remain available and affordable. Today, retirees are the least able to offset the rising costs through raises, promotions, overtime opportunities. Now, for those reasons, I'm going to echo the words that I heard two of the commissioners mention earlier. I'm going
to ask that the county seriously consider making the uh 25% contribution increase for employees the same as for retirees. Equal raises for equal coverage would demonstrate fairness, consistency, and respect for those who
devoted their careers to public service. And it's important to remember retirees here. They're not asking for special treatment. They're just asking for equal treatment. >> Thank you. I appreciate your time. >> Thank you. And I I think we're going on
in the direction of the 25% for retirees. Anyone else from the audience? Good morning. Got me thinking about meatloaf. Now, >> just a couple comments I wanted to make. I can't Rick pretty much summed it up as
far as the retirees go. Um, but our retirees as firefighters are required to keep the county insurance for 10 years after we retire so that we can hold on to the cancer presumption coverage. So depending on when we retire, some of us may not be able to come off at age 65.
So just keep that in the back of your minds. Some of us will have to hold on to that a little bit longer. Um, and as far as Lantern is concerned, Commissioner Adams and Commissioner Moss, I have the same concerns as they do. So, when you guys are voting on this, please think about it. Um, making
it mandatory will directly affect some of my members that I've spoken to you all about >> oneon-one. So, when you're you're thinking about that, you are d and making that vote, you are directly affecting their healthcare choice. Lantern does seem to remove that from
the employee. It removes their right to choose their own position. I understand that there's no cost. I would prefer to pay a little bit of cost to be able to pick the surgeon that I would like to have. So, I just want you guys to keep that in mind and thank you for everything that you guys are up
here doing. I know this is a big decision for you guys, but we appreciate all the work you put into it. Suzanne, too. >> Thank you very much. Anyone else? Commissioners, I think we have a unique blend today with somewhat of a consensus with respect to
the retirees 25% as well as uh having lantern optional and I think it puts us in a good place compared to where we were the last two or three years. What's your pleasure? >> Actually, compared to what we were this
morning. >> Yes, Mr. Mr. Chairman, I'm I'll be glad to make a motion that we accept option A. And with that, the 25 the uh retirees are at the same increase as the regular
employees at 25 and some change percent and that lantern be optional still at this time, but that we encourage the lantern use. And then we also
encourage our 65 and plus employees to look at different options for their insurance coverage. Second with discussion. >> We have a motion with a second with discussion by Commissioner Flesher. Commissioner Flesher. Yes. Uh I I would
also u want to encourage the uh the idea of enhanced communication and I think there is a a very high value in that. Uh I I think that we're we are
missing an opportunity that would have been done financially will be done through very positive broad communication in the form of education to our retirees
and and active members as well. Not to say it's not being done. We just have to raise the bar. >> Understood. >> Thank you, Commissioner Flusher. We have a motion. We have a second. Is there further discussion? Mr. Administrator, >> I just want to clarify. So, we're
talking there's a couple other decisions. So, plan design option A uh implementing the specialty medical benefit management plan, elimination of the weight loss coverage and uh we're keeping the lantern as
optional. Expanding the the nutritional plan, the nutritional services for to include the teleaalth. expanding the mental health support. Now, the question about the ALUP, the voluntary Medicare education and plan selection assistance
for eligible retirees. What do you want to do with that? >> I would >> I think the motion was to leave it in. >> Okay. I I wasn't sure. I wanted to clarify that. >> All right. And then >> Okay. Okay. >> Yes. >> Director Bole, anything additional?
>> No. The county administrator covered it. Thank you. >> Thank you. We have a motion and we have a second. Those in favor? >> I. And the motion carries. Commissioners, we will address the next two health related issues and we will be taking a break at the end of that. Welcome again, Director Bole.
>> Uh thank you, commissioners. Um we are here to provide an update on our uh Marathon Health and Wellness Center. Um the Health and Wellness Center. Uh back in 2013, the board of county commissioners approved a five-year agreement with Everside Health and we
proceeded with an implementation plan. Um we uh had some guiding principles. We wanted to establish a highquality health center to attract and retain employees. Uh we wanted a location for care that needed to be convenient and easily accessible and the um health center
should be financially sound producing a plan savings over time. We actually opened the health and wellness center on October 30th of 2023 and we began serving our eligible employees, retirees, dependent, and uh over the age
of two uh for all of our um insured members under the uh board of county commissioners, the sheriff's office, clerk of court, tax collector, property appraiser, and supervisor of elections. Uh we have a great location. Um the uh health center is the clinic model is two
nurse practitioners and two medical assistants and we operate Monday through Friday 7 am to 6 pm. Uh we provide preventive care, lifestyle and disease management, chronic care counseling, acute or personal care. There's some ancillary services related to
immunizations, vaccinations. Um uh we we dispense uh pharmaceuticals there. Um uh we coordinate this is a big piece is the the health center staff helps coordinate people with the other benefits that are available beyond the health center under
our health plan and uh we do radiology referral. Um the board approved an agreement to uh have uh an agreement with an imaging center. That center has since closed their business and we are in the process of uh finalizing a new
agreement with Hope Imaging um that's been underway for several months now. So, um, Kim, would you pull up the, uh, health center report? So, every month I receive a monthly report from Marathon, and this is the most recent one from May. Um, if we go through this report,
and I'm not Yep. Okay. So, you can see in the upper left corner, we have 4,080 eligible members that uh, participate in our health plan. 4,000. And out of that, you can see a breakdown of employees, spouses, dependents, retirees, and the
others are probably people that continue under COBRA for a period of time. Anyone who's on our health plan is eligible to go to the health center. Um we have uh you can see a comparison of our appointments uh from May of 2025 to May
of 2026. So uh the the monthly uh appointments 443. You can see our engagement has increased from 21% to uh 24.9%. So, ever since the health plan opened it, we were right out of the gate our our engagement was
really strong um and and doing well. I came uh to the board uh back in 2024 asked for the additional provider. We added that additional provider and um we are serving uh uh patients that have
chronic conditions. You can see uh uh 42.8% of our patients at the health center have chronic conditions. So we are reaching a population with chronic conditions. That was part of our strategy was to get um you know connect with the people with chronic conditions
to help them manage those conditions. Um out of that uh 71.6% of our patients have at least one or high moderate risk biometric risk. So their labs um they might not have a chronic condition diagnosis but they they're kind of a higher risk for their
their biometrics. Um and out of that group 81.7% of these at risk people have made progress in the last 24 months. So that means they're improving their numbers which is a really uh good goal of the health center. Um you can see that we um
uh uh our our same day next day visits for appointments 33.2% 2% in the month of May were same day next day. This is an area of opportunity for us to be able to make that health center available uh for time. So I've been uh working with
Locked in not Locked in with Marathon um to uh to make sure that the app is working well that people have the ability to um get into the office and be seen when needed. Um this particular one, this is just a breakdown of the
eligibles, um employees, spouses and dependents, uh male and female. This is not necessarily important to you, but it's just interesting information. So um you know, we're we're seeing really high preventive visits. Uh 49.6%
of the visits to this health center are preventive. That's greater than the book of business, which is at 42.5% for Marathon. So our preventive visits are really really strong. You can see a breakdown of visits by category um to be
uh uh what preventive visits, acute visits and people that just show up to get their labs drawn. Um we also have a breakdown of the frequency of visits within the period. So we have some people that see that are really well connected uh with the health center and
and helping to manage those chronic conditions. Um the way that these visits are performed is we have 91.1% are in person, 8.6 are telephonic and you have a a less than um half a percent are
virtual but we do provide those options to the members. Uh you can see the breakdown of um visits by patient risk. Uh 24.7% are moderate risk. Um 56.4% 4% are high
or chronic uh risk and then 18.9% the risk is low or unknown. So you know really um you the one you want to keep people in the low bucket. You want to keep the moderate from getting into the high and you want to help the high-risisk manage their condition. So
that's that's really the strategy of the health center. Um this is just a breakdown of the prescriptions that we're offering. Um, uh, you know, the in in-house prescriptions are basically generic, but this is really helpful because it helps our our members get get
in, get out, get a prescription without having to take a whole lot of time off. So, um, we have 4,080 individuals that are eligible for the health center and, uh, 626 or 38.3% of our employees have actually
engaged with the health and wellness center. 1,5 eligible persons total are engaged with the health center and that's a 3.9% increase over the prior year. So, we're pretty pleased about that. The average new engagement each month is 33 persons. So, um we do have
new people coming in. Let's see. Um we're assisting the medications. Uh we actually uh there's been 4,798 brand and generic prescriptions with
1,892 prescriptions actually dispenseed directly from the health center. So that's a really really good number. Um are our members satisfied with the health and wellness center? Well, in the month of May, uh we we hit 100% for our
um overall score, but uh we have had some bumps in the road. you know, we have had some um issues with people getting in uh with communication. Uh we have had we have frequent discussions with Marathon. We meet with them on a regular basis. We go over any of the
concerns that have been expressed. So, I appreciate um any information that comes your way. Please pass it along to me and we do share it with Marathon and they um they are very receptive to uh uh addressing those concerns. Um, as I
stated earlier, our radiology services through the health and wellness center, we're working on getting an agreement in place and we're expecting that to be within the next 60 days. And then um I don't have it in a presentation, but I
can tell you the ROI. Um so our return on investment um in 2025 um we are looking at a total savings of of um the value of the visits is $941,850.
That's based on um an average cost of a visit being $137 and we have had a substantial number of visits. Um we have the chronic condition improvements. Um that uh number is $896,856
because when you um improve from high risk to low risk in an A1C category, we had 20 people who improved in the last 20 24 months in that area, which is huge. Um that's an annual estimated savings of $15,600.
And then we have 206 who improved in their blood pressure, which you know that that's that's substantial. And then u that savings is about $1,920 per patient annually. And 92 who improved in their body mass index, which uh saves
$2,58 annually. So the management of those conditions um just under $900,000. Um referral savings. This is really good because um a lot of times you'll go into a provider and I don't know if you've experienced this, but you go in, you meet with your doctor and they refer you
to somebody else and you have to have another appointment. Well, because of Rubicon MD, which uh Marathon has access to, they're actually able to get referral physician referral information right there through that uh Rubicon MD.
So, it saves on the referrals for our members. So there's a dollar savings to our plan because of that because they're not having to go somewhere else and see another doctor and a savings to the member. They're not having to incur an out-of-pocket co-pay. So you you save on a claim, you save on an out-of- pocket
co-pay. So the savings of that is uh $69,46. And then we have ER urgent care avoidance by having this health center open. A savings of $74,400. and um co-pays savings. We're saving
hundred almost $114,000 for members who would have to have a co-pay to go see a primary care uh for that office visit or go to an urgent care or in the event of going to an ER visit. And then lastly, the reduction in
lost work time. If we take uh take the a conservative estimate of a $90,000 reduction in uh lost time, and again this is very conservative. We're just saying, you know, maybe they're saving an hour of of time, you know, by going
to the health center. Um that brings our total savings to 2,186 uh,527 and our investment into the health center, meaning what have we been paying out for that 2025 year uh was 1.1
million. So that's basic almost a a 1 to2 uh ROI. We're at um one to 1.92 return on investment for the health center. So um we're we're really pleased with those numbers. Um we uh the health center is providing uh generally
stress-free access to medical coverage. The high utilization and the high level of patient satisfaction is supporting our goal of improved health and well-being for our employees and their families. And um through the health and wellness center, our employees and their families have convenient access to
quality care, prescriptions, labs, and appropriate referrals to specialists, which provide our employees and their families with a resource to address their health and wellness needs without lengthy delays. This allows our members who may be experiencing financial stress the ability to pursue health and
wellness without additional financial strain. So, we're really uh pleased about that. Um I we do have opportunities for improvement. And I want to be very transparent with you about what those opportunities are that we've communicated with Marathon. Um uh we've communicated that there's
opportunities to improve in the areas of appointment availability, same day, next day availability, accessibility of appointments on the marathon app, provider blocked appointment times uh being kept to a minimum and uh communication uh improvement with
patients uh from the health center back to the patient, returned calls and things like that. Uh Marathon has been responsive to addressing our concern and is taking steps to improve in these areas and they are also working to ensure that the health and wellness center operations are efficient and
consistent with their their benchmarks that they have established for their health center. So with that I would love to um introduce to you Micah Mohan. Micah is um our what is your actual title with Marathon? >> Client success manager.
>> So he is our client success manager. Micah and I have a lot of time uh communicating. He's just going to go uh quickly um through uh some information that he wants to share with you about um Marathon's commitment to Indian River County and supporting this health and wellness center. And Kim, if you could
pull that up and then Michael, I will turn this over to you. Kim has your presentation. >> Good afternoon, Michael. >> Good afternoon. Thank you so much for having me. I really appreciate it. Um feel free to pause at any time and we can elaborate on what we are discussing
but I will just um >> that's the one >> this one. >> Yes, that is it. Yes. >> Thank you. >> Right. It's already >> all right. Well, thank you for having me, Mr. Chairman and commissioners. It's a privilege to speak to you all about
Marathon Health and what we have been up to both last year and this year. So, what we'll be doing today is just asking four simple questions. Um, first of all, we'll just do an overview of Marathon Health and ask, are people using the
health center? Are they liking the health center? Is their health improving? And are we generating positive financial impact? Those are the four factors that make our primary care model successful. So, first just a little bit about Marathon Health. We exist because
primary care is broken. Many people don't have access to a primary care provider. When they try to get one, it takes a month to get into one. Once they finally get the appointment scheduled, the appointment length is about 15 minutes long. The provider is on their
computer asking lots of questions that have nothing to do with why you came in, and then you're kicked out at the end. And it's a very dehumanizing experience for both a provider and a patient. And so what we aspire to do at Marathon Health is
>> make primary care um what providers aspired to do when they went into health care, which is develop relationships with patients. And so almost a third of our patient almost a third of our visits are same or next day. And our average
appointment length is 35 minutes. So last year we treated nearly 900 employees, spouses, and dependents of Indian River County across over 4,100 completed appointments. That's over four
appointments per patient. That's one of the highest engagement rates we have across our book of business. Um 82% of our patients were repeat patients last year. It's 84% as Suzanne mentioned as of May of this year. um we generated a
92 net promoter score and 80% of our patients are making improvement on at least one biometric measure. So what's going well are the people who are engaged are very engaged. Where we would like to see improvement on is opening it up to more patients so that when they
want to come visit the health center um it's available to them. We recently made some operational changes in January. We assigned one of our higher performing um medical directors of operations to the
Indian River County Health Center. On her team is Kim Lee Murphy and they have been very attentive to the concerns of this health center and it shows in the results that I'm about to show you which are our members using the health center.
So, this just looks at the visit volume since we opened on a quarterly basis. I want to call out a couple things. First of all, you'll notice that the visits in orange are the preventative visits. There has been a substantial increase in
those. Those are the visits that um head off the major illnesses that end in that culminate in a heart attack or stroke or cancer. And so we're always happy to do a lab draw to treat your sniffles, but what we really want to do is that
primary care, that um longitudinal um care that takes care of you as the whole person. And then next, we look at the same information just on a monthly basis. Again, you're seeing a substantial increase in the orange preventative
visits. Um what you're seeing in the green line is it compares each month's visit volume to the same month the previous year. I want to call out that before this year there was only one month where we had at least 400
completed appointments. Since the beginning of this year when um Melanie joined as the operations director, all but one of the months has had at least 400 completed appointments. April set a record for completed appointments and then May set a record again and beat
that record. And so um Melanie has been working very diligently to optimize the schedule to ensure that um there is plenty of fill-in coverage when there are a lot of PTO requests so that patients can get in um when they need
to. Here we're seeing the engagement rate by um by relation grouping. Um engagement has increased steadily among employee, spouses, dependents and retirees.
And then here we can see that patients we can just see the level of engagement that patients have. >> Mike, if you can go back real quick. >> Yes. >> I see the retirees started in 25. Is that when we began accepting retirees? >> Um no. So, we've been accepting retirees
from the beginning. So, what we commonly see across all of our health centers is that when we open a health center, retirees usually don't come. It's usually the employees who get engaged and then a year or two after the health center opens and they're engaged. Then
they retire and so they're no longer in the employee category, they shift to the retirey category. >> Gotcha. Thank you. >> Definitely. Here we're seeing the level of engagement. And so what you'll see on the first graph is that the average
patient is much more likely to have six or more PA visits in a single year than just one single visit. And so when they come in for the first time, they have a good experience. And our primary challenge is just opening up enough
appointment availability for them to come in. And then on the right, you'll see what the average appointment length is. Um, we certainly do have some visits that are 15 minutes, such as a simple medication refill, a flu shot, but the majority of our visits are longer than
the primary care average. And then finally, um, we also talked about the same or next day visits. Um, so in the purple line, you'll see what our book of business benchmark is and what Indian River County has been below
that in the orange. Um, and so Our constant challenge is to balance the schedule so that we fill up the provider availability Indian River County pays for the staff. And so we want to be a good steward of those dollars and ensure
that when they're working they're visiting patients. We want to balance that with enough free time for people who need to get in same or next day with an urgent issue because if they don't come visit us then they'll go to the urgent care or the emergency room which
is a lot more expensive. And so um you'll see that since the beginning of the year Melanie has been working diligently to increase that rate. And so it was 27% um for all of last year. In May it was
33% and we continue to work on that. So before I proceed, any questions about utilization, whether people are using the health center. >> Any questions commissioners? >> Hearing none, proceed. Michael.
>> Okay. So the next um the next part is are people enjoying the experience? And so just to set the context, um most people do not trust medical professionals. We've seen a dramatic decline in that. And part of that has
been fueled by they say that their providers are distracted and burnt out. And so what we aspire to do at Marathon Health is create a working environment that the most compassionate people among us aspired to when they chose medicine
as a profession. And so after every appointment, we send out surveys to our patients and ask them to evaluate their experience. And so what we're finding is that most of our patients um have wait
less than 10 minutes in the waiting room and to see the provider. That's good for Indian River County because that means that people are back at work and not taking as much time off of work. Um the majority of our patients are um
reporting that they're getting better quality care at Marathon Health than they could in the community and that and um they are able to schedule at the preferred time. Now I do want to double click on scheduling at the preferred
time. Um when we look at the um the first that first graph whe which is whether people can get an convenient appointment. It was consistently about 100% until about fall of last year. And
so we have seen some drop off in that and we have been very attentive to that to ensure that the schedule is optimized. Um here we um this compares the net promoter score of the Indian River
County Health Center to several other of our clients in the region. And so it is um about average um for this book of business. I do want to acknowledge that this is based off of the survey results
that we have received and there's always a halo effect there because you focus on the portion of patients who have come in who have visited who have had a good experience. Um we do want to be very attentive to those who do struggle to
get into the health center. And so one change that um our executive leadership made toward the beginning of this year is to add patient support services to the um health center. And so with that,
the calls that are made to the health center route to a um centralized call center that defays a lot of the call volume in the health center and frees up the staff to focus on the patients in the health center. that also alerts us
to patients who cannot get into the health center. And so Kim and Melanie have been very attentive to those patients and have been following up with them to ensure that they get an appointment. Um the next section is whether health is
improving. So again the majority of Americans live with chronic disease. if that is not treated, it culminates in a high-cost claimment and that is the majority of what health plan spend is. And so we want to head that off. Um so
what we're seeing here is that all the relation groupings, those who have higher chronic conditions are more likely to engage with Marathon Health than the overall population. And we determined this by using a methodology
from John's Hopkins that combines both claims data and Marathon Health visit data. And so we focus on those patients who have chronic conditions. Over half our visits are for patients with higher chronic conditions and they are
improving. And so there are a lot of numbers on this slide. Um what let's just focus on A1C. It's one of the gra It's one of the bars in the middle. It's at 74%. What this is saying is for a patient who had their A1C tested twice
in 2024 and 2025, it compares the first reading to the most recent reading and compares those two. 74% of patients improved in their A1C. A1C determines whether you have diabetes or not. And so
that's a very important metric. And so we want the number to be above 50% for all of these measures because it means that the the population is more likely to improve on these measures than either maintain or regress. So 80% of our
patients have made improvement on at least one of these measures. Suzanne mentioned 82% earlier. That was from May. And so the longer people are engaged with us, the better those numbers improve.
And then finally, um, this is what Suzanne mentioned about the financial impact. Lots of numbers and text here. And so I will just answer questions if we want to dive a little bit deeper onto that. But this kind of explains um what
the over two million dollars of value how that was um distributed. >> So any questions? >> Thank you, Micah. Very informative. Um, we've obviously have had a lot of
feedback from our uh colleagues and and co-workers and like anything you're going to have a few growing pains here and there. Um, but I my experience has been that when we compare these to our program to let's say a walk-in clinic or
whatever, uh, certainly positive, but I'm very proud that we have this for our employees again at no cost to our employees. Commissioners, any questions for Micah? >> Yeah. Thank you. >> Thank you, Micah. >> Thank you,
>> Director Bole. I have one more item before you uh today. So um in prior years you'll remember that I would come with a group insurance recommendation and it it talked about all the benefits. Um this particular year is a little bit
different. We we um addressed the group insurance um under the medical plan, the health plan separately under the previous agenda item. But now I need to talk to you about um one of our benefits which is our group life uh long-term and
short-term disability um and our voluntary insurance program. Um that particular program was uh the one program that was up for um uh renewal and um locked in uh went out and
marketed uh that program and um the agenda item that is before you is uh related to um uh what we're recommending for that uh coverage. So all of our other coverages are intact. Uh we have
secured rate uh rates in place. There are no changes. Um so just to go over our our administrative service with Blue Cross, uh no change. Our pharmacy advocacy and navigation with Rightway, no change. Dental self-funded, no
change. Vision, uh no changes. Um our flexible spending in Cobra through Lively, uh no changes. Our EAP program, um intact, no changes. our uh lantern uh surgery agreement rate is um no changes.
And um then we we come on to the coverages that we have through Mutual of Omaha uh for um >> uh uh life and disability and critical illness, accident and hospital indemnity which is called our work site benefits.
Um those are the ones that are before you. We've got identity theft, no changes, and legal plan coverage, no changes. So, um, Lockton went out, uh, for RFP. And, um, if you could pull up, Kim, the the results. Uh, that's
perfect. Um, so under this, um, do I have my Yes. Okay. So, um, this this Oops. is related to the accident, critical illness and hospital indemnity
coverage. Uh that was um that they went out for. Um under these benefits uh we had several respondents that came back uh Mutual of Omaha, uh Metife, New
York Life, and UNM. Um and uh under that there were some um uh improvements that Mutual of Omaha made. I want to uh tell you that we became aware earlier in I
guess it was last week at the end of last week that um Mutual of Omaha had identified some enhancements uh to the um accident program, but those enhancements were actually already in
place. So, this is updated information than what was included in the agenda item um that was uploaded into into um Civic Plus. Uh so, under the accident program, uh the enhancement that uh Mutual of Omaha was making was to
increase the accidental death and dismemberment benefit um by uh uh $25,000 uh up from $75,000. um critical illness. They are making these enhancements to the program um
from what it was today. So you'll see the current is in the left side of of the columns and um they're making improvements in these other areas to enhance the benefit levels. Uh they're doing that with no increase in premium.
And then um this is the pricing that came in. So, Mutual of Omaha RA retained all of their rates and they came in um with the uh with pricing that exceeded that of Metife and UNM. It looks like New York Life kind of met their met
their rates there. Um and then under the hospital indemnity program, uh Mutual of Omaha still of really strong benefit. Couple of the other providers had um uh some stronger benefits, but overall we weren't
recommending um those. Kim, did you have one more? That one right there. Okay. This is what was uploaded with the agenda item um for life and disability. So um these are the different uh respondents. We had uh the
incumbent which is Mutual of Omaha, uh AFLAC, Lincoln, MetLife, New York Life, and UNAM. And um they were they all provided three-year rate guarantees uh for the life and accidental death and dismemberment. That life benefit um we
provide a core benefit as the employer, but there's voluntary benefits that uh that I can choose to have spouse coverage or child coverage or additional coverages. um short-term disability benefit is is something that the employee pays, but the long-term disability benefit is paid by the
employer with a buyup option that's available. So, they all came in within with three-year rate guarantees. Um the under the executive summary, um there was an analysis done as far as the rankings. um when you look at a
quantitative ranking uh New York Life came out um with a little bit better pricing uh on it, but at the end of the day um when we when we looked at what the overall financial summary was um we
could get a 14% uh overall savings uh through Mutual of Omaha without having any disruption to our members and and what it really came down to from a staff perspective Um, if you've ever had anyone who
suffered a loss of of of and needed to actually submit a claim, um, this is an area that you don't want there to be any problems with getting claims paid. You want them to pay and process timely because it's the worst time of
somebody's life. Um, Mutual of Omaha has provided excellent service. So when I was talking with um uh Loctton about it, I I I said, "Tell me about the service of these other agencies that might give us a little bit more savings." And and
they they weren't able to say that they would do a better job than Mutual of Omaha. So it was kind of a we're recommending staying with Mutual of Omaha because it's known. We're we're um comfortable with them and the pricing is coming up as an overall savings uh for
the county of um $173,000 in overall savings. And with that, I guess I'll take any questions that you might have. And if I can't answer them, I think um Rachel will be able to answer them. >> Commissioners, and thank you again,
Suzanne. Uh, I will tell you personally, Mutual of Omaha has uh done a great job by my experiences and that $174,000 savings ironically offsets something earlier that Commissioner Man brought up.
>> Any questions for Suzanne? Need a motion on this. Commissioners motion approve staff recommendation. >> We have a motion by Commissioner and a second by Commissioner Flesher. Any further discussion hearing? None. And the motion passes. Commissioners, as we wrap up the day, we
will now be in recess until 12:40. 16th, 2026. We call the board of county commission meeting back to order. That brings us to item 14, county attorney matters. I see Mr. Chris Hicks. Good afternoon, sir.
>> Good afternoon, chairman. We are here for a consideration of a purchase of property under the ELAP program. This property that we're here for today is an Archie car property on A1A. It's in the Archie car refuge and we have had
appraisals done. Has all the information is included in the staff report. We've had the appraisals done. The purchase price that the parties have agreed to is $5.5 million. That is within the two appraisals. However, it is higher than the average. So it would require a vote of four of the five commissioners in
order to approve it. There is an opportunity, no guarantees, but opportunity for some significant cost share based upon its location and what the purchase does as far as taking land off the beach. This land goes from the beach side all the way to the river. And it is a small piece of land, but it is
according to people who are way smarter than I am in biology and diversity and all the the ecosystems that they can tell you that it's a very important piece of land for that. And Miss Swindell is here in case you have any questions about that. Um but it that is the purchase price again is $5.5 million. It is estimated
to be 5.58 to close and that would be um once we go through all the due diligence and all those things. We are asking the board to consider this property. Ask any questions you have and approve us to go ahead and sign the contract and go
through closing once all of the prerequisites to that are met during that period. Commissioners, I think each of us have had the opportunity to meet separately with our ELAP team. Any questions for Mr. Hicks?
>> Mr. Chairman, >> Commissioner Man, >> the uh the ELAP of course, you know, vetted this and and they were all they were, you know, too concerned about were also concerned about the the cost, but it's in it it's in such a unique
location uh right there next to the Archie Car. It's part of the Archar National Wildlife Refuge and it does go into into into the into the lagoon and but the biggest thing and I just talked to Wendy about it again is this is probably available. This is probably one
property that's truly available for money that is probably available if that makes any sense. >> Makes sense to me. So, it's it's uh like I said, it might it might tend to look a little pricey, but I think it's a really a really good uh good buy in the long
term for us and what we can do with it. So, I mean, I'll I'll make a staff recommendation to approve. >> Have a motion. >> I have a question. >> Oh, you have a question, too? >> I do have a question. >> Go ahead. >> Well, there's a motion. >> Motion. I'll second the motion for
discussion. Commissioner Moss. Um, I had a question on the uh 6.73 acres of submerged land. That's, you know, twothirds of the property is submerged. And by that, I'm assuming it's under the lagoon. Is that is that correct?
>> Partially under the lagoon and there's also wetlands on the property. >> Well, how much of it is actually under the lagoon? I mean looking at the photos >> roughly that the amount that you that is listed in the appraisal or listed which is >> because I wasn't clear what the benefit of that was like twothirds of it. So
that's uh 2/3 of 5.5 million you know you're paying I don't know 3.6 or you know between three and a half and $4 million for submerged land. >> Yes. So that sounded pretty pricey for submerged land and I understand that you
know cost depends on location but my question is about location. It's submerged. So what's >> part of it is and by going into conservation status nothing can be built there. There can't be a dock up here. There can't be anything there that would start having more activity and and hurting the environment from that side
of the lagoon as well because whoever purchased it does have rights to that bottom. And so by purchasing it part of the purpose of ELAP was to protect those things from having more incursions into the lagoon. because that is available. >> I thought I read in this that there wasn't enough um property, actual land,
I guess I'll call it, uh to to have a do to have any kind of dock, boating dock. There wasn't I guess there's not enough space for a parking lot or or something like that. >> There's not enough space for a parking lot. >> I thought that was in here, >> but the there is it is currently being marketed or it was until we reached a tenative agreement pending the board
approval. It was being marketed for $6 million for to have a house rebuilt on it. there's currently a house there. They have the right to rebuild that house and any associated infrastructure around that. And then they would have they would have to go through the permitting process and all those things in order to try to build docks. However,
for our purposes, it's more of pulling the land off of private development than it is for putting parking lots or and turning this into a park or anything like that. And again, I don't know if I'm stating. >> So, well, so the concern is that the house will be rebuilt. Is is that what you're saying? a that house or another
house would be put there and this would have another driveway onto A1A. It would have more people using a protected part of the beach and have more >> everything associated with it. They they could have a dock going out into the lagoon. >> And part of Elap's purpose is to protect land that is
>> it is one of the last pieces of land that would be available that doesn't already have houses on it being used in that refuge area. >> Yeah. It just I just it's a it's a lot of money for submerged land. um in my humble opinion >> and I don't disagree it is that's but it
is within the appraisal values I but I understand >> as much as I love elap um I'm trying to remember now is this the most expensive piece of property that's come to us it's got to be up one of the one of the more expensive at any rate >> because this is you know the bond was 50
million and this is you know 10% or I guess you know more than 10% of the uh of the entire amount that we have to spend >> the jungle Trail was 5.8. So it is close. It's in the it's in the range. Jungle trail was the most expensive so far. >> Yeah. So I mean, you know, it's it's
it's a lot proportionally, too. Anyway, I yield to Commissioner Adams. >> So is there there's a house on it? >> There is a house that is in poor shape. >> Be demoing the house, >> right? >> I believe that would be the plan based
upon the shape of the house there. If there are um pictures of the house in the appraisals and the ceilings falling down, there's duct work. It hasn't been surveyed yet. So there's no we're not sure whether there's any asbestous in the walls or in in the ceilings. We don't know any of that. >> That would be part of the due diligence.
>> So what's the cost of the demo for the house? >> We don't have a cost for the demo right now. That would be part of the due diligence is having those investigation's done. >> Okay. I have questions about the Deep Water Horizon dollars.
>> Okay. >> Can you give me more information about that and at what point will we know if we're going to get those dollars or not? >> Uh Wendy Swendell, assistant director, parks, recreation, conservation. Um the
conservation fund approached us about a 5050 match. At the time, I believe the price that they were looking at was 4.6 6 to4.7 million. So it would be a 5050 match for that. We don't have a commitment on a time frame just yet, but we've been coordinating with them
closely. So I would imagine within the first six to 12 months, we would be looking at moving towards reimbursement for that. And then we also would like to apply for HMGP funding for taking that house off of the beach. Basically, you get hazard mitigation funding for removing that threat. And that can be
also up to a 75% reimbursement. How confident are we on the Deep Water Horizon dollars since like the other side of the state? >> They approached us from the very beginning and they seem very confident and they've negotiated this successfully
some parcels in Bvard County already >> for the Archie Car portion that's in Bvard County. >> Okay. Because I mean I don't disagree with Commissioner Moss. a it's a large monetary amount for property that's largely submerged with a house that we
would have to demo and take out which is an additional cost. So, but you're you are more than 50% confident that we are going to get >> I mean I won't hold you to it. I know you can't say that, but >> I I feel very strongly that that is
going to come to fruition. >> Okay. And that's uh 50% cost >> for the conservation fund and then the HMDP funding. We have to get it on the LMS, but that's a 75% reimbursement. So even if we got a portion of that, which
we feel pretty confident, we would be ranked well for that as well. >> Okay. So it sounds even though it we're looking at what five 5 million 5.5 with the reimbursement from the Deep Water Horizon potential we're looking
more at 2.7. >> I would say that would be a more realistic final price on the property. I mean the only caveat being I don't know the duration for how long until the actual money comes back in. But the grant agreement certainly would be moving along fairly quickly is my
reassurance from the conservation fund. >> And then those reimbursement dollars would go back into the elap pot to be used. >> Okay. >> Exactly how when um the original bond came out and it was leveraged from 75 million to 138 million. The same
precedent basically that money goes back in towards additional acquisition or restoration enhancement. >> Okay. I mean, originally I was very leery, but >> if that's what the conversations have been and have been at ELAP, then I'm I'm more comfortable being supportive. Thank
you. >> Thank you. And this is a tier one property. >> Yes. >> We have a motion. We have a second. Commissioner Flesher for discussion. >> I I appreciate the uh excitement for
additional funding. I don't know if it reduces my fear of the albatross and that that's what I have the same reservation that they had at the uh elap
about the value to the citizen. It's been pointed out a couple of times already. Uh we're talking about submerged property and a de debilitated building. Um
when we've done conservation projects in the past and made commitment, it's been brought up many times. What will we have to put into it? It's not
the value of the take the acceptance. It's how do we deliver benefit to the citizens? It's their dollars. And I
while the citizens approve the bond, they expect us to be good stewards and proper judgment being applied to ensure that their intentions are met with the
intentions of others and with the county. I quite frankly I I I don't see it with the amount of submerged property that is that is there. It is rather large. Uh
unless we're looking at to protect the seaggrass, it's underwater. >> One last comparison though would be Lost Tree Island. Actually, a large percentage of that acquisition was submerged property that the county does own and we have the ability to control
the activities in that area like Chris was mentioning. >> And how much was put into Lost Tree Island? >> I don't remember the purchase price off the top of my head. I'd have to look that up. >> No, how much labor? How much >> labor with respect to the planning
process? because we had the ability to do um shoreline restoration projects and all of that without the burden of having to do sovereign submerged leases because the county actually owns that property. And like Chris said, that person that buys that lot has the ability, it's a
regulation that based on the linear footage of their shoreline, they're allowed to build a dock. So that does remove that potential additional impact to the lagoon. 10% of the available funding for submerged property and future work
involved. I I still hold the same concerns that I had going into this. Um, thank you, Mr. Chairman. Some of these same questions were asked in ELAP about this
same same piece of property. And yes, while while it is submerged, it does allow us to do some things. And remember, it's right on the point of Pelican Island. So it I mean observatory whatever you want to make out of it you could put over that over that in that
submerged area because it's in a vital area by Archie car on one side Pelican Island surrounded on other side and you get and you got the beach and this is this Archie car beach area including this property is one of the top sea
turtle nesting areas in the in the state if not the world uh when it comes to sea turtle nesting I too had concerns, but you know, I've spoken with Wendy about it and we talked about it in ELAP. This is is
seems to be u there seems to be money available for this such as Commissioner Adams asked earlier. There seems to be money available. I think it is a different touch. Yeah, part of it's underwater, but there there you could also look at that being as being a benefit in some cases. You can't
physically walk on it. You could swim on it. You could wait in it, but but it's it is underwater. >> I I appreciate that, Commissioner Man, and I appreciate Commissioner Man's um
longstanding um representative of ELAP from this body. >> And I also appreciate our expert staff members to include uh Wendy, Chris, and Beth and others.
We have a motion. We have a second on the floor. >> And just a reminder, chairman, that this would have to be a vote by four of the five members. >> I'm aware. >> All Yes, sir.
>> Come on down. Good afternoon. Name and address for the record. >> Sure. Uh Bob Bruce, um 12396 uh right next door uh to this property. Not right next door, but very close.
>> Um we Janine is the realtor sitting back there. She's representing the owner. Uh I worked on this a long time. Uh my
understanding was that we had a firm commitment from the conservation fund. I really think this is kind of premature until you get that commitment.
It's just uh business. Um, there's no incentive for the conservation fund. Once the county buys it, there's no incentive for them to put money into this. >> Okay.
Good afternoon. >> Was set aside for the Deep Water Horizon fund is $4 million solely for the can't spend it anywhere else. So, it's not like the conservation fund would be taking this money. And >> if you could just let Wendy talk because I can't hear both of you at the same
time. >> No, I was saying that the money that's been set aside that the conservation fund is talking about was set aside $4 million specifically for Archie Carr because it's part of Deep Water Horizon. So, it's BP oil spill money, right, >> to fix the refuge. So, it's not as if
the conservation fund can just willy-nilly say, "No, we're going to go spend it on another project." >> Right. Well, they can go find another property uh that meets the same criteria and if they find it outside of Indian River
County, Indian River County ends up a loser. >> Do we do we have that commitment in writing? >> The they we don't have it in writing. They approached us initially and they've come to the ELAP meetings. They've done presentations. They're waiting on the
bureaucracy of the federal government really. They're not waiting on any other technical thing. It's simply they need to get the documentation from the federal government in order to move forward with the project. So, I have not heard anything but positive feedback from them. They've come to multiple
meetings. They've expressed that they're committed to this project. They simply they actually made offers to the land owner and Miss Kenworthy can probably comment on this, but their appraisals just weren't exactly fitting with what they needed to do. So, they had to regroup. But now with the county's
additional um interest in the property, they're able to move forward. >> Yeah. But we don't have anything. We don't have any kind of written commitment from >> Well, they can't really make a commitment until they have a commitment from the federal government is what basically this it's a stairstep process that goes on
>> and who the owner is. >> They can't call share with without having us own the property. Correct. >> No, I understand that. But there can be a written commitment that if you if you buy it, we'll, you know, we're partners. >> Um, >> I don't know that they are able in a
position to really do that. Like I said, until they have the commitment from the federal government, their agreement, because it's like I said, it's a it's one depends on the other. But I've gotten no um feedback from them at all that there's any issue with any of this.
It's simply a matter of things have been moving more slowly because funding has been shifting around in all federal departments right now. So this is just they're kind of the victim of a lot of bureaucracy at the moment. >> So well when would they know what's the
what's the timeline? >> I was told by Rebecca a few months back that they expected within the next six months to have all of this hammered out. >> Okay is the >> at at five and a half million. I don't want it. Um, you know, at at at h at
half that price, you know, that's that that sounds a lot more reasonable. Um, so maybe we should be delaying this. >> I Yeah, I'm hear >> answers on the the technical part of it.
Chris would have to speak to the >> if the board can decide whether to purchase it, not purchase it, ask to extend the we have a letter of intent signed. I can't speak for the owner whether they would be willing to extend that or not. If they are, we can negotiate with them and see if they are. It's purely up to the board how you wish
to go from here. We can do any of those things. I just can't speak for the extend extend their >> cont. So extending the letter of intent would be you could do that for six months. Is that how that would work? >> If the owner was willing to extend it or they could say no and then they could put it back on the market and attempt to
sell it that way. We don't have a I don't know that they would even be able to answer that today because I don't think the owners are here. Their representative is. Um that that that would be a possibility. Yes. >> And the only other relative to the conservation fund, I could reach out to them and find out if they've had a
similar circumstance where they could provide some assurance. Um, I don't know what form that would be, but we could also include that in any kind of >> Yeah, because I mean at five and a half million, I don't feel that we're being good stewards of the taxpayer money.
>> I just don't if I'm uncomfortable with that. >> Understood. >> So, we can call a question and see how that goes. And I'm suppose if it doesn't go favorable, Elap perhaps could come back to us at another time. >> Yeah.
>> Any further comments? I I'll say a couple of things about this property. Um it's adjacent to about oh somewhere a little over 1,200 ft of oceanfront that
is owned by Archie Carar right now. Uh so it's it's a good a good fit uh a perfect fit actually. Um and as he said the house is uh it's really needs to be knocked down but u that's neither
here nor there. The property adjacent to it on the north uh sold um a couple of years back for 100 foot lot. This is 300 ft. Uh sold for about
two and a half million. and it's a one-bedroom bungalow there. So, the value in my opinion is is there. Uh it's just a question of I would like to see a commitment from
conservation fund before going forward. >> Yes, Commissioner Adams >> is will somebody remind me what the motion is on the floor. The motion from Herman, second by me, is the staff recommendation to move forward. >> Okay. And that was going to require a
fourperson majority to move it forward. >> Yes. >> Is um is there an ability to if that doesn't go to make a motion to extend
or is that what you guys are going to do anyway? Are you going to extend the offer anyway no matter what happens here and try to work through something with the conservation? >> Well, we'll take direction from the board as far as that because we we were following the ELAP process which we got appraisals and we had to we were
negotiating within those appraisals and so we brought it to the board. If the board wants to make a motion to ask us to try to extend it and continue negotiations and get come back with more information, we'll absolutely do that. We were just following that and again I we can speak with the representative and speak with the owners and see if they're
willing to extend it and if they are then we can come back in whatever time frame the board gives us to do that. >> What is the likelihood of getting anything Wendy on a confirmation basis from the conservation club? >> Like what would that even look like and
would they be able to do that? I would assume that they would be able to at least provide us hopefully with a letter outlining the process at a minimum and giving us some precedent for how it moves forward, giving us background on why they approached the
county in the first place about this parcel, their level of interest in their commitment to the project. Um hopefully a timeline in there. Um that would be what I would seek if I if you if the board directs us to talk to them. Those would be the milestones that I would be
looking for with any more guidance on other things that you'd like us to talk to them about. Happy to do that. I don't know that you would get a letter saying we've secured all the funding and because I don't know if they're at that step at this point. >> I just wanted to make sure we're all like using the same words to mean the
same things and that. So, all right. Thank you. >> Tomato tomato. Thank you. >> Yes, exactly. >> Commissioner Man, do you understand your motion today? >> You want to stick with your motion? I'm I'm I have no problem with it with have Chris working and see if it can be extended if that's the will of the board
of that that the money can be done. >> So that's not what the motion >> and that's not so you would amend your motion. >> I could amend my motion for that. >> Keep in mind if we are not the owners of the property, how do we expect the federal government to >> negotiate with us? Because their
decision would be based on this board's future decision, >> right? So, I'm good with making a motion. Staff recommendation pending further approval of >> That's not staff recommendation. >> No. Well, okay. How about we do this?
You're right. It's not a staff recommendation. I make a motion to approve the purchase pending on financial assistance
confirmation. Does that make any sense? >> No. >> According to the attorney, that's not doable. >> Correct. >> And to work and to work with the owner and realtor to see if possible. >> I'm hearing from this end discussion about uh some type of correspondence
quasi agreement with the federal government. It's what I'm hearing over here. >> Look, if Commissioner Adams has a better can make a better motion than I did. >> I was just trying to clarify if it needs four votes, >> right? And I'm hearing there might not be four votes. >> I understand.
>> What's the alternative other than just I mean we would need to provide some direction. Either it's off the list or we want you to go back and get other information. I I just I'm fine voting it up and down and seeing what happens and then going from
there. But I was just trying to seek clarification on what a next step was. >> Okay. If if we want if what I'm hearing is there's commissioners that want more concrete >> right >> evidence that the money there was some
meeting of the minds that we would actually be getting it >> right understand that this was all discussed it was discussed the ELAP Wendy and Beth I know have been working on it with regards to you know to secure financing because that's the mode that the whole ELAP is in right now. We've
done some purchases. We've got another purchase we're looking at today. the direction they were given was to kind of reel back a little bit on purchasing new stuff in order to to get financing for some of the lands we purchased because
as you all know you don't get money unless you own it in in most if all not all the cases you don't get any grant money back until you own the property. If y'all are uncomfortable with this, I'm okay with making a motion to say,
"Let's delay this purchase at this time until we can get clarification on confirmation from funding." >> And one option, the board could approve the the contract because this isn't approving the purchase. We still have
due diligence and other periods. Approve the contract. The current contract that was proposed has a 90-day due diligence period. And if the board wishes to review this and to ask see if the owners would agree to extending that period and you could come back and before the due diligence period is over review all the
things you have and make a final decision at that point where it couldn't be closed it couldn't be it would we'd have a contract again if they would agree to they we have a tenative contract that they agreed to but we could extend the due diligence period for >> say seven months if you have your entire
six-month period have it back before the board at that time to review any new information including all of the reports that would go along with due diligence and you would still have an opportunity at that time to to either decide to move forward or not move forward
>> even if they don't want to extend to do >> if they don't wish to then we can't force them to extend >> we can't force their hand >> correct >> so then we run the risk of somebody else wanting this submerged piece of property that has no benefit to the turtles >> right
>> correct if if we chose to make a ask make a counter offer essentially and say we would like more time. They don't have to move forward with it. They can back out. >> You, >> Mr. Chair. >> Yes. Another option would be to have Commissioner Earman withdraw his motion and just thinking
>> if that if that's agreeable to the person who made the second and um make a new motion to uh direct staff to well to to request that the property owner extend the letter of intent, the letter
of agreement, letter of intent, right? Yes. for an additional six months and direct staff to work with the conservation fund to get a commitment in writing as to the level of their funding and to bring that back to the board
with a proposed contract if it's if those conditions can be met, >> which he said is what my motion. >> Does the clerk have >> That was pretty crafty. I like that. I like You know, this guy's got a gift. >> Madam clerk has the motion. You
>> you have the motion. >> She said >> we have the motion >> state >> to move this along commissioner man as a motion like you just said. I will second that. Any further discussion? >> Yes.
>> Did not counselor say that that was not possible? >> No. >> I said it was completely up to them. They could they could say no. They don't want us to extend it. >> Right. If they don't want to extend it but >> right we can't force them to extend it. Wait, I I know I heard it from somebody
in the room that we can't get the commitment from the Fed without being owners of the property. And since we're not owners of the property until the deed is done,
>> I don't think that that was what was said. I think what was said was we are not going to get a firm commitment >> period because it's the federal government and they don't give you a commitment on anything until
whatever >> house of Congress is in for that day and if they decide to do any work. But >> beyond that, I think what Wendy was saying is >> we can get a letter that outlines the process, when a commitment would be
made, those types of things. And if we're in a negotiation position of trying to purchase the pro property, that is completely doable and reasonable because they have already reached out to us saying that they would like to participate. It's just unclear at what
level that participation would be. if we decided to move forward. So, they've already reached out to us without us even having this on the agenda. >> Correct. >> But, no, that was pointed out that we
unless we own the property, we we can't >> Well, they're not going to write us a check unless we're the owners of the vehicle, right? I mean, but the bank will say, "If you want to go down and purchase this prop, this vehicle, I will
give you such and such amount, and you take that and you walk down to the dealership and >> and that's what's done." So, this is basically what we're doing. >> Do that, too. >> Yeah. >> Yeah. >> Okay. >> Okay. All right.
>> We have a motion by Commissioner Herman. >> I second it. All in favor? >> I >> I motion carries 5 and >> is opposed. >> Any opposed?
>> Yes. >> Okay, we have a 41 and we will see you at a later date. Next item. Good afternoon again, Chris. >> Good afternoon, sir. And this property is another ELAP property as we discussed. This one, if
you recall, came before the board to cancel the contract a few months ago because of some title issues. And due to some serious work on the an attorney on behalf of the owners, the owners and a surveyor, they've been able to secure title insurance and secure an commitment
to that. And so we bringing back the exact same contract that was previously approved. It it was known as the Luther parcel. Um and there are two parcels actually and we bringing the same contract back back asking for approval again based upon it is a tier one
property. It was approved previously and only didn't finalize because of the title issue which has now been solved. >> That purchase price is $ 1.5 million and this would close within the next 45 days. >> So for clarification, this is something that we've already discussed. We were
all fine with it except they couldn't get title insurance because there was some weird thing happening and now that's been cleared up >> and here it is again back before us. Correct. Yes, ma'am. >> Move approval. >> Second. >> We have a motion and we have a very quick second by Vice Chair Moss and a
third by Commissioner Man. You can tell it's getting late. >> Any further discussion? Hearing none. Those in favor. >> Any opposed? Motion carries. >> Thanks for asking. Thank you.
>> My pleasure. Thank you, Mr. Hicks. Have a wonderful afternoon. >> Oh boy. >> That brings us now to 16B, Solid Waste Disposal District,
>> Annual SWID Preliminary Rate Resolution. >> M Mr. Chair. >> Yes. >> I'm going to kick this one off if that's okay with you. >> Okay, kick it off. >> All right. Um, this is every year the board adopts its solid waste um special
assessments and uh last year they added the collection special assessment and we have annually had a disposal special assessment under our new master assessment ordinance. This is the first step in
adopting both the collection and the disposal uh special assessments. It's these are a preliminary rate resolution for the solid waste disposal assessment and the solid waste universal waste
collection assessment. Um it the rates are largely flat except there is a slight increase in the um solid waste collection services special assessment that is related to the CPI increases
that the board approved back in May for some of our providers >> 1.22% increase. So basically this is not the final adoption. This is the first step in the process and what it does is makes your findings of fact. It directs your
county administrator to prepare those assessment roles to publish and and provide for notice to property owners about these special assessments. So, I wanted to explain the legal significance of this item. If you have questions about that, I'm happy to answer them. If
you have questions about solid waste services generally, I know Miss Lions is here on behalf of that department. My our recommendation is that the board approve and adopt these two preliminary rate resolutions.
>> Thank you, General Counsel. And Mr. Administrator, I recall the 1.38 that is $1.38. >> Or is that 1.38%. I thought it was $2 and comes out $25. I believe
>> it's going from 181 to $22. Yeah. >> Yeah. 22 >> for the year. >> For the year. >> Gotcha. Any questions, commissioners? >> No.
>> I have a motion to approve. We have a motion by Commissioner Man or Commissioner Flesher. It is late. >> What is going on? >> Man, you needed that meatloaf. >> So hungry. >> And a second by myself. Any further
discussion on this matter? >> Hearing none. All in favor? >> And the motion carries. >> I'm opposed. >> I'm so sorry. >> You didn't ask. >> She's We have opposition here. >> No. And and >> motion carries 41. Thank you. Reason being, I've always been against
universal collection. >> All right, that brings us to it. >> I I just wanted to let everybody know this was all discussed when the contracts were already set and
we were aware that this was going to happen. This is a cost increase. >> Yes. The only thing I'll >> So, somebody goes back, I'll just say that we we didn't touch other rates. That's great. >> We we had them rerun the model to not
have the rate >> increase. Stay on course. >> Yes. >> Thank you, sir. >> Thank you. And good afternoon, Katherine. Again, item 16B2 is a request by No Petro Eco District LLC for commercial environmental improvements
for landfill gas collection. Good afternoon again, Katherine. >> Um, good afternoon. I'm just here to say um and introduce um Mr. George who is going to speak about no pro and their investment that they will be making at the um Indian River County landfill.
>> Thank you. Thank you. Good afternoon. Uh Chairman Lure, Vice Chairwoman Moss, Commissioners George Herrera, CEO of No Petro Energy. Pleasure to be here this afternoon. I have with us uh two of my colleagues, Mike Whitney, senior VP of operations and Melissa Monroa,
engineering manager. So just uh as you all participated last year at the ribbon cutting the facility kind of right around this time uh was turning on and everything very successful on that front. Facility fully operational through the end of last year. And one of
the issues that we have been having though has been just the gas generation at the landfill isn't what the scientific reports had projected. And so one of the items that we are doing is in offering to make an investment into the
landfill to expand some of the wells so we can capture more gas for the benefit of the project. So that's essentially the action item before you today. And there is a mechanism in the contract that asks no pro to present these ideas,
these solutions and then go before the county commission to get final approval. And so I've got with us our two my two colleagues to chime in on any of the technical but happy to answer any questions. And we're going to be making an investment of about you know $1.5
million of capital to get the gas flow up. So, um, based on the staff report, there's no need for us to do any kind of permit modifications with D and you guys are paying for all this. >> That's absolutely correct. >> Move approval. Second.
>> Second. >> We have a motion. We have a second by Commissioner Flesher. Any further discussion? Hearing none. All in favor? >> Anybody opposed? >> No. And the motion carries unanimously. Thank you for your patience, Jorge.
>> Thank you. Thank you everybody. Thank you >> commissioners. That brings us to public comment for any non-aggenda related matters. Any non-aggenda related matters. If you have comments, please step forward. Good afternoon. Name and address for the
record. >> Good afternoon. Um chairman, commissioners, county staff, Marawn Green, 5830, 58th Court. Um, I am the executive director for Pioneering Change Incorporated. I'm here today to
respectfully request your support for Gford's application to become a designated Florida Children's Initiative community. Specifically, we are requesting the commission support through a um resolution recognizing GER as a community that would benefit from
additional resources and opportunities to help children and families thrive. Your support will demonstrate in Rivera Countyy's commitment to investing in the future of Gford's children and families and ensuring that every child has the opportunity to reach their full
potential. I would also like to note that there is no financial commitment required from the county. Um we are simply requesting a resolution of support. Um our application must be submitted to the state of Florida by June 30th. So in two weeks um the
Florida Children's Initiative was established by Florida legislature in 2008 under section 409.147. Um modeled after the Harlem Children's Zone. It is it was created to help communities facing concentrated challenges related to poverty,
education, health, and access to services by coordinating programs and resources that improve outcomes for children and families. Over the pa over the past several months, residents, educators, service providers, faith leaders, nonprofit organizations, and
community stakeholders have participated in comprehensive planning processes focused on the future of Gford. Through six community workshops, participants identify community strengths, challenges, priorities, and
opportunities, resulting in a community strategic plan that reflects the voices, experiences, and vision of those who live and work in Gford. This effort has been truly communitydriven. More than 45 organizations participated in the
planning process and over third 30 organizations have submitted letters of support for both the initiative and the strategic plan. Some of these organizations include the school district of Indian River County, Gford Youth Achievement Center, Indian River
County Sheriff's Office, the Learning Alliance, Treasure Coast Community Health, Healthy Families of Indian River, the Inner River County Pastor Association, Inner River County NAACP, The American Association of University Women, Crossover Mission, United Against
Poverty, Thrive, In River County Department of Health, Safe Families, Treasure Co girls coalition and many more. These organizations represent education, health care, youth development, public safety,
uh work workforce development, faith communities, and family support services. Their participation demonstrate that this is not the vision of a single organization. It is a collective commitment to improving outcomes for children and families in
Gford. The strategic plan focuses on eight areas um which were established by the Florida state state statute and they are early development and care of children, education of children and youth, youth support, parent and
guardian support, adult education, training and jobs, health and wellness, community safety and housing and community development. These priorities provide a framework for addressing the root cause of challenges facing our community while building upon its many
strengths. The Florida Children's Initiative designation will help Gford strengthen partnerships, attract additional resources, improve coordination among service providers, and develop innovative solutions that support children and families. Most
importantly, it will help ensure the children receive the services and support they need regardless of the circumstances their parents or guardians may be facing. So, it's not something like it's not a program that reinvents the wheel, but what it does, it serves
as a convening. It brings all the service providers together to ensure that it's streamlined in the Gford area and we're maximizing um potential with those organizations that we work with. And on behalf of the residents,
organizations, and stakeholders who contributed to this effort, we thank you for your time, your leadership, and your continued commitment to our community. and we ask uh respectfully for you to support this uh initiative by submitting a resolution um for our gifter
application and also I'm here if you have any questions um today or in the future. Thank you. >> Thank you very much. So commissioners before us we are being asked for a resolution I understand to support this
initiative without any dollars or organization. Is that what I'm hearing? As far as I know, I mean, we don't have anything in writing. Did you send something? >> I actually sent um an email in March um
to all of you. I sent the uh PowerPoint presentation as well. >> Um >> that is correct. And >> okay, >> I believe that general counsel had looked into that a little closer and there were some requirements from the
county. Is that correct? So, I did see the resolution. The first time I saw it was in our agenda preparation for this meeting and it was proposed to be put on consent and my recommendation was that it be put onto the regular agenda
because when I read the statute here and and first of all, I'm excited to hear about your planning process and it sounds like there's been a lot of involvement. Um, this is the first time that I'd heard it. So when I pulled up this statute, basically it says it's
it's Florida statute 40947. >> It states that after the governing body adopts the resolution that is proposed, the working groups shall develop objectives and identify strategies for each focus area.
And it's it's as you have disc discussed, there's this this process that's going to occur as as far as the community planning process and then um let's see
after that planning. So basically the way that I read this, the board appoints this planning group or the county appoints this planning group. That's that's and it sounds like the planning group exists. And then um the after the governing body
adopts the resolution described in subsection 4, the governing body establishes this planning team as provided in subsection five and develops and adopts a strategic community plan as provided in subsection six. The county
or municipality shall either identify an existing qualified not-for-profit corporation or create a notfor-profit corporation registered, incorporated, organized, and operated in compliance with 617 in order to facilitate the fundraising and secure the broad
community ownership of the initiative. So, the way that I read this statute, there was a significant responsibility of the local government. So my recommendation was to put this as a regular item on the agenda so there
could be discussion about what resources would be needed from the county to make sure that the the planning what we were basically agreeing to and I was not aware that you had a a deadline. >> Yes. So so there's two there's two
tracks to getting designated in Florida. So for the floor cheers initiative either it is if it is a county sponsor or municipality sponsor which is what you read or if a nonprofit um sponsors and gets the planning grant which is
what we did. We went the nonprofit route um which is why I did provide the city of Pompo um beaches resolution I think um because it was a nonprofit who actually applied for the um planning grant did the
community engagement and will actually be the convenor for it. So there's two routes like city of um Sulfur Springs has a nonprofit that actually is the one who got the planning grant and then got
the designation as does the um s the um Anderson community I think it is. And then Gold'sboro also did nonprofit route sponsoring. So
if it were you all that were actually doing the convening and everything, then it would be your responsibility. But since we did it at the nonprofit route, then it would be our responsibility. >> And it could very well be that the
process that is in actually in place in the state is what you describe. But what I but the resolution that I read identified this statute and in this statute it looks like it's the county's responsibility to take these actions. So
because I didn't understand there was a deadline, we had set up a working group internally early next week to discuss what is this, how would it work with our community development, children's services department, how um what is our role in it, what so we can learn more
about and I'm sorry because it sounds like you've had a very um comprehensive planning community planning process and this was just the first that I'd seen it and I wanted the board to make >> your children's um services department did attend. Okay. >> Yeah. Um I want to say two of the
workshops. >> Um would it would it be better if I had um the person who actually from the state who came down to visit? We showed her gift and everything. She met with our planning um committee
have set up a meeting for a conversation with her to understand the process. >> I do. It doesn't help right now because you have a deadline of June 30th and this is our last meeting in June.
>> So I I'm not quite sure how the board wants to proceed at this point. I mean >> next week >> I I you know I understand that I'd just like to hear from the board how you want to proceed from a action standpoint.
>> We could always I mean I don't know it's at the chair's prerogative. Commissioner Adams uh has been researching this as well. Go ahead. >> No, I was just we I know the attorney has the internal meeting for Monday. I think some of the answers will be
provided at that point. Maybe as a followup once there's the internal meeting. We can connect with the state representative. >> Um probably just through Teams would be fine there in Tallahassee. And
you know, probably I'm sure you'll want to talk to the rep the local representatives as well and we could always ask the chair to call a quick special meeting if this is something >> on a on a time constraint so we can meet the time frame. I think it just needs a
little bit more due diligence internally to make sure we're >> all on the same page. >> But I think we can >> at if that is the chair's pleasure. Sure, we can do that for sure. >> We'll bring him snacks so he doesn't >> Yes. >> Meatloaf.
>> We can do that. >> Not meatloaf apparently. >> So that would be my suggestion to kind of try to keep it moving forward within your time frame. >> Okay. Okay. Thank you. Let me let me ask general counsel. Could we in lie of having
a special call, could we agree today that if uh the meeting Monday goes well that we could uh imply a resolution to support would be agreed upon with satisfactory
with a satisfactory meeting. So, um, >> at this point there is this is not on the agenda and the board could by unanimous vote I think add this as an emergency item to the agenda and then
take some action. What that action is um could be. So, I would start there. I would I would have someone make a motion to add this item to our agenda on emergency basis and that would require an emer that would require a unanimous
vote. >> Mr. Chair, ba based on the circumstances and the misunderstanding and the deadline and the delay of the possible delivery of resolution and
decision. I would like to uh add this item to the agenda at this time >> as an emergency item. >> Yes, I believe the emergency or urgency is very clear. >> We have a motion to add this item. I
will second that. Keep in mind we need a full house. Those in favor? >> I. >> I. Any opposed? Motion carries. Now, Miss Green, we have an emergency item on the table today to entertain this.
>> Thank you. >> So, I um do feel like there are some times that the board delegates certain things to staff and the chair. In this case, um this resolution really needs to
make some findings. Um I and I would want to make sure that the state is satisfied or whoever you're turning your application is satisfied that that the resolution is adopted correctly and makes the findings that
you need. I know when I looked at the resolution I wanted to when we got to the item and I didn't realize we had a time I wanted to sit down with whoever wrote it just because the statute makes requires certain findings. I wanted to make sure we hit the nail on the head on
all those findings >> when it got to us. So, >> I suppose the board could delegate to the chair the ability to sign the resolution upon approval informed by the county attorney assuming
that the state would accept that >> and then it come back for ratification. That's not ideal. I mean the Go ahead. >> Yeah. I'd rather just have a special call meeting. I don't know why we're >> okay. >> And yes, and that's and >> just cuz then we're all sitting down
with the same information. >> I agree that that's >> side and it's not on you. >> I agree. I think that's >> our responsibility. Just have a special m >> Mr. Chair. Um uh I I believe that uh special call meeting is uh uh a rather
great idea. Unfortunately, there are many people here that knew that uh June there would be no meeting and you might find it difficult to get this board or all in in one chamber. Uh so with that I
would like to make a motion to uh direct general counsel to uh review uh this process to ensure that there are no unknown constraints
and obligations uh for the resolution in support of the program. and then in return uh make a recommendation to the chairman to
sign off on the decision as appropriate >> as a resolution. We have a motion to >> we have a second by Commissioner Man for discussion. >> Yeah. One thing I would add is that
again we focus on uh whatever comes of the resolution that it's clear that there will be no financial obligations as well as >> staff commitment >> and I I um the Mr. Canage suggested that
I read off if you could just take a minute to listen to me what the statute says that the resolution would find so that the board understands if they choose to delegate this to you generally speaking what you what they would be determinating Yes ma'am >> determining. So, the board would have to
adopt a resolution that one finds that an area exists in the county uh that chronically exhibits extreme and unacceptable levels of poverty, unemployment, physical deterioration, as well as limited access to quality educational, health care, and social
services. Two determines that the rehabilitation, conservation, or redevelopment or a combination thereof of the area is necessary for improving the health, wellness, education, living conditions, and livelihoods of the children and families who live in the
county or municipal municipality. And three, determines that the revitalization of the area can occur only if this state and the private sector invest resources to improve infrastructure and provision of
services. So I just wanted I state that on the record so that the board has that understanding if they choose to vote for this motion. >> Okay, we have a motion. We have a second. Is there any conflict with children service advisory council?
Administrators indicating no. >> The statute says that if this it occurs if the state and private sector invests resources to improve. infrastructure and it's I mean I think those three things that that that the county must find I think everybody in
this room can acknowledge that they exist in terms of the the conditions that are in terms of the the the level of poverty some of the deterioration some of the issues and the re the need for the rehabilitation conservation
redevelopment of the area I I mean it's >> Alice Alice data is going to show this. >> I just I would have a I think that we it's not fair to the attorney to make her the sole decider on
this. And I would just remind everybody that we call special meetings to approve plat several times. And I would argue that this is a much more important conversation and that it should be important that all the commissioners are
on the same page when it comes to this. So that is my personal feeling. I don't you know it would should not be a meeting that would take as long as today I would
imagine but I'm pretty sure we can figure out >> a time >> yes >> between before the 30th and if it's approved it would be in final form to be able to basically push send and submit.
So I think personally we owe it to the process and I don't I personally don't think it's fair in this situation because there seems to be a lot of questions or at least clarification points maybe not questions but clarification points that we need to
kind of work through. It's not like um just a due diligence for the Wabaso or the Winter Beach property that we just did >> in my in my opinion, but I recognize I'm not always on the same page as >> Okay. >> Mr. Chair, can I just state one more
thing? If the board decides to do a special meeting, I recommend the last week of June only because there's a lot of people out at FAC next week, Florida Association of County Attorneys including them. That's why I >> Florida Association of Counties,
including all the county attorneys. So, um, we wouldn't be much help to you. >> Well, that's exactly why I chose this path. >> Yeah, the path. >> And I would, the other thing that I would add is just that if there's an action item on the table since it's not been on the agenda yet, that you need to
open it up to see if there's public comment before the board makes a vote. >> Okay, we have a motion and a second. We will have public comment. public comment hearing. None. The public comment is closed. Commissioner Flesher.
>> Mr. Chair, and I understand the concern for the following week. Um, I I strongly recommend if we're going to go with a possibility of a special call to ensure that this gets done that we
look at our calendars as well because it's going to be touch and go. >> We're generally all here on Mondays, Monday the 29th >> or you have Tuesday the 30th. Well, >> I know Miss Schuler has a meeting, an
internal meeting on this Monday and then I would assume as we discussed there'll be a follow. >> Just a little ounce of prevention to ensure that we can have a meeting. >> We only need three people to have a meeting >> and we can do it remote if we have to. Commissioner Flesher, would you like to
withdraw your original motion >> about instructing general counsel and then get back with me? >> Yes, sir. So that's been withdrawn. >> That motion has been withdrawn. Would someone like to make a motion to set a special >> second? I'll withdraw my second. >> He withdrew a second.
>> Make a motion to set emergency meeting. >> Sure. I will make a motion that we move through the process with the attorney um doing due diligence and we set a special call meeting for whichever pleases the commission of the 29th or the 30th.
>> Second. >> Can we set a date? >> Yes. I'm open to either day. >> How about the 29th at 1 p.m.? >> Perfect. if she'd like to modify her motion for Monday the 29th. >> I will be happy to do that
>> and I will second that. Any further discussion? >> Hearing none and the motion carries. >> Thank you. All in favor? I >> I >> hearing none. Seeing none further. You
>> sure? >> This meeting is adjourned.