Good morning. If you can take your seats. Welcome. We will call this meeting to order on the 19th day of May, 2026. Um, Commissioner Joe Flesher is joining us uh by telephone or teams.
Commissioner Flesher, are you there? >> Okay, we will continue to search for him. At this time, we'll have a moment of silence and uh I will be leading the pledge in the absence of Commissioner Flesher and our invocation will be delivered by Dr. Reverend Crystal Bul.
Crystal Bejul, please rise. spirit of joy, gratitude and gentle guidance, we gather this morning with a thankful hearts for the women and men who choose the path of public service.
a path that asks for patience and courage and a steady generous spirit. Let gratitude rise in this room like soft morning light,
reminding each person here that their work matters, their presence matters, and their service reaches far beyond these walls into the daily lives of the people they serve.
And like a quiet joy, let it find its way. So that kindness places a small small smile in the heart and lightens the shoulders and reminds
us that even serious work can be carried with warmth and grace. May peace sit beside each person here and may joy tap them gently on the shoulders just when they need it the
most. Bless these commissioners with clarity, compassion, and the deep satisfaction of knowing that they are helping shape a community where all can thrive.
and bless these veterans here who have given their lives one way or another that I can stand here and offer this blessing. May gratitude steady all of us. May joy
accompany us and may peace guide every decision made today. And so it is. Amen. >> Amen. >> Please join me in the pledge, please. 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. >> Thank you, Reverend Juel, >> very much. >> And while I'm here,
>> Yes, ma'am. >> may I thank the commissioners for having supported us during our groundbreaking. It was wonderful to have your support and to see you there and also uh our county supervisor. Did I get that right?
>> Thank you. Blessings to you. >> Thank you very much, >> commissioners. with additions and deletions. We do have uh two items that uh I would like to add which would be uh 5e uh which is a presentation by the
city of Vero Beach which will be exciting and 5F uh which is another presentation u about affordable housing by Bethany Fortano. >> Move to approve as amended.
>> Second. >> We have a motion. We have a second. Any further discussion hearing? None. All in favor? >> I. >> Brings us to our proclamations and presentations. Uh the first one will be National Safe Boating Week presented by
Commissioner Joe Irman. Good morning. >> Thank you, Mr. Chairman. It's always a pleasure to to do this every year for this fine group that promotes safe boating week and and does what we need to do for everybody to be out there
that's on the water to join themselves. So, come on up, gentlemen. Again, it's it's my honor to to read this proclamation declaring May 16th through the 22nd, 2026 as National Safe Voting Week.
Whereas recreational boating and paddling is a popular pastime in our community enjoyed by residents and visitors alike. And whereas safe boating and paddling practices and the consistent use of life jackets are essential to preventing accidents and
saving lives on our waterways. And whereas the United States Coast Guard Auxiliary in partnership with local agencies and organizations is dedicated to promoting boating safety through education, vessel safety checks, and
public outreach. And whereas National Safe Boating Weeks observed May 16th to the 22nd, 2026 serves as an annual reminder for all Boers and paddlers to practice safe boating and paddling habits and to
always wear a life jacket while on the water. And whereas the National Safe Boating Week theme, wear it, emphasizes the importance of life jacket use and encourages all Boers and paddlers to set positive examples for others. Now,
therefore, proclaimed by the Board of County Commissioners of Indian River County, Florida, that May 16th through the 22nd, 2026 be designated as National Safe Voting Week. And we urge all citizens to support boating safety efforts.
Participate in boating safety education and always wear a life jacket while boating and paddling. Adopted this 19th day of May, 2026, signed by all five county commissioners. And as always, welcome gentlemen. We're glad to have you here to promote this.
>> Thank you and good morning. I know we've got a full agenda today, so I'll keep this very short. You've said everything there that I needed to say. So, we just appreciate your support. Hope everybody stays safe this voting season and we don't have any incidents in our county that we need to have bad news about. So,
wear our life jackets and have a great summer. >> Thank you. Come on up. Thank you. Thank you guys. I just I just want to thank them honestly. They do this every year and they go everywhere. Not just here. They go to very I know they
>> classes too. >> They go voting safety classes, but they go to city council. They're at downtown Friday. They just they they Wow. You cover the circuit. >> Thank you. >> Thank you. >> Thank you. Next, commissioners, we have a proclamation presented by Commissioner
Susan Adams recognizing mental health awareness month. If you're related to this topic, please come on down. >> Angela and Amy, you guys want to come on up? Wilfred. Fantastic. It's my pleasure to read a proclamation recognizing mental health
awareness month, May 2026. Whereas mental health is essential to overall health and well-being, influencing how individuals think, feel, act, make decisions, and maintain physical health. And whereas nationally, one in four
adults in the United States experiences a mental health illness each year, affecting millions of individuals and families across the nation. And an estimated 58 to 63% of adults in Florida with a mental illness do not receive treatment. And whereas federal health
data also finds roughly 19.2% of adolescents report depression symptoms in a given period. And whereas despite improvements in health insurance coverage, approximately 8% or 27.2 2 million of Americans remain uninsured,
creating ongoing barriers to accessing essential mental health services. And Florida continues to rank among the lowest states nationwide for access to mental health care. And whereas social stigma, financial challenges, and limited awareness remain significant
obstacles to seeking help, and communities must respond through education, outreach, prevention efforts, and expanded access to care. And whereas promoting mental wellness requires the collective commitment of residents,
health care providers, educators, businesses, and community leaders to ensure compassionate support and accessible resources for all. And whereas the commissioners of Indian River County are dedicated to fostering a community that supports mental
wellness by promoting access to treatment, strengthening educational resources, and encouraging opportunities that advance mental health and resilience for all citizens. Now therefore, be it proclaimed by the board of county commissioners of Indian River County, Florida, that we recognize May
2026 as mental health awareness month, adopted this 19th day of May, 2026, and signed by all five county commissioners. Welcome. Uh do you guys want to tell us a little bit about what's going on for mental health awareness month? >> Thank you. Um well, at the mental health
association, we do have the no barrier approach. We understand the community um is going through hard times and access is so important as well as services for our community really with the focus on that early intervention um and
prevention and also expanding care to children and and giving the knowledge and tools to help them. And as affiliate of Mental Health America, we are able to, you know, have that additional support and knowing what's going on with
mental health in the communities, any new trends and being able to work with our community and our community partners, of course, um to have a mentally well community and that access. And of course, we believe it's okay to
get help. Um and we appreciate uh this proclamation and thank you. Thank you. >> Thank you so much. Come on up. All right. Thank you. Commissioners, the next proclamation is honoring Payton Cooper on the 2026
Youth of the Year. If Payton and Miss Elizabeth Thompson can come down. It's my honor to read this proclamation on behalf of this board of county commissioners. This proclamation is
honoring Payton Cooper as the 2026 youth of the year. Whereas the Boys and Girls Club of Indian River County is dedicated to inspiring and enabling all young people to reach their full potential as productive, caring, and responsible citizens. And whereas the youth of the year title is the most prestigious honor
bestowed by this club for any member recognizing its contributions in members family, schools and community and boys and girls club as well as personal challenges overcome. And whereas Pton Cooper has been selected the 2026 youth
of the year of Indian River County representing the epitome of hard work, resilience, and leadership. Whereas Pton Cooper has shown exceptional academic initiative by earning her high school diploma from Vero Beach High School and her associates degree from D River
County, Indian River State College simultaneously. And whereas she has further distinguished herself by being successfully obtaining her certified nursing assistant certification or CNA, proving her commitment to career and service as well as being there for
others. And whereas Pton Cooper will attend the University of South Florida this summer, pursuing a premed degree. And whereas Pton Cooper serves as the beacon of hope in the role and a role model for her many years, demonstrate demonstrating that with dedication and
support of the Boys and Girls Club, great futures are truly within reach. Now therefore, be it proclaimed by this entire board of county commissioners of Indian River County, Florida, that we recognize and applaud Payton Cooper's accomplishments and extend her heartfelt
wishes to succeed at the University of South Florida. Go Bulls. Adopted this 19th day of May, 2026, and signed by all five county commissioners. Welcome and good morning. >> Good morning. Hi.
I'm not Payton. I'm not Payton. Payton actually couldn't be here today due to a scheduling conflict. She actually started a new job working as a CNA over the summer. Uh so she couldn't get today off unfortunately. Today was her first day. Uh
>> yeah, you got to make that one. >> So uh but she's a outstanding young lady and uh she has a lot of things that's going to offer this uh community when she gets back from USF. Um so she we're we're all proud of her and uh we thank y'all for accepting her for this
proclamation. So, >> thank you. Very proud of Pton. Come on up. We got sir. You don't want that. >> Thank you. Congratulations. F
>> commissioners. The next item on the agenda is a presentation by our public works department. I think I see Mr. Ronnie Jones, our director. David Shyiver, welcome. >> Good morning.
>> Good morning, Commissioner Chair, uh, fellow commissioners. My name is Ronnie Jones, uh, the director of public works, and with me today is >> David Scriber, assistant public, county surveyor, back of all trades. So, we are here today on behalf of our
public works team with a great deal of humility and gratitude. Over the past weeks, our organization has experienced an unimaginable loss with the tragic passing of two
colleagues, Mr. Danny Oie and Miss Stacy Mason. Their absence is felt deeply across our department and the memory continues to stay with us each day
during this diff difficult time. The support, the compassion and understanding shown to our employees has meant more than words can fully express.
On behalf of all public works employees both in the field and gathered here today, we would like to sincerely thank Chairman Lure and all county commissioners, Mr. John Tenage, our county
administrator, and the entire administration team. Your leadership allowed our staff, the people who serve this community every day, the time and the space to grieve,
to support one another, and to begin that healing process. That care and consideration have made a lasting impact on all of us. It is with deep appreciation and respect
that we present this plaque as a small token of our gratitude. We thank you for standing with us and supporting our staff and leading with your compassion during such a difficult time.
And now the reading of the plaque. In grateful recognition of your leadership and on behalf of the public works department, we extend our sincere appreciation for your support during a time of profound loss. Your guidance
helped our team navigate this tragedy with strength, unity, and resilience. In honor and memory of Mr. Mr. Danny Ulie and Miss Stacy Mason presented on Tuesday, May 19th, 2026
to Chairman Daryl Lure and the board of county commissioners and to Mr. John Tennage, county administrator and administration. With deepest gratitude, public works department. At this time, we'd like to ask Chairman
Moore and administrator Canada to please come down and accept the plaque. >> Thank you. Thank you gentlemen. God bless the public works department. >> Thank you >> Mers. Our next presentation um will be
presented by the city of Vero Beach in collaboration with Indian River County Commission. Um I thought I saw Mr. Councilman Aaron Voss if he's here. I
see Tammy and some others. >> Good morning. >> Good morning. Thank you for adding us on to the agenda today to talk about the July 4th event. Um, and especially thank you for being our partner with the city of Vero Beach for so many years. I did some little
research yesterday to see how far we went back and it's been 30 years that we've been partnering with the July 4th event and this year is extra special because it's our 350th anniversary. So we wanted to make it huge event not for
the city of Vero Beach, not for Indian River County, but for this whole community. So we reached out to several different people about getting involved with the committee and I'm just going to go over a few things that are happening that have been happening throughout the
year. Um we start over with the barrier island and you know it's July 4th and the first thing that happens is swim to the wreck. This event has just gotten huge over the years. Did a little research to see where it started. Um
started many, many years ago with um an older running club, the Sun Runners. They started it with like five or six people swimming to the wreck and now it's just huge. The time that they always started was 8:00 a.m. Well, that's the time we're going to start our
July 4th activities. Not that there's not going to be people swimming out there at six o'clock, 7 o'clock, but our exact time is 8 o'clock. Swim to the wreck. Then we move on to the farmers market. That's going on Saturday morning. So, they wanted to be a part of
the event. They're going to have their um vendors dress up their um their tents with red, white, and blue. They're going to be dressed in red, white, and blue. Just helping with the festivities. Then we move on to the mainland. So, um, we
plan on having a really nice parade starting at 10:00. The parade will start on 14th Avenue, probably last between 10 to 12. Then at 12:00 in the community center, we're going to have our huge birthday cake,
sing happy birthday to our country. Um, in the meantime at the train station, there'll be the antique cars there. So, there's probably going to be about 25 cars there. Um, didn't really want to have them in the parade. We were told that they overheat at times, so they
will be there for everybody to come and see. Um, we also, um, recently did a really nice, um, art contest. We had Barry Shapiro, a local
artist, get with the different high schools in the area, and they came up with an um an art program for different students to paint different things that they see as the 250th anniversary. And I'm not kidding you, we have like 45 50
paintings that came through with that. They had um we had they had um actually people that jured those paintings. They had a first, second, and third place. And I mean, it was a really hard choice. They came out nice. But all those paintings will be displayed at the
community center on that day for everybody to see. Um, and I am forgetting a lot of different things that are going on, but you have the gest of it. Um, now I'm going to turn it over to Council Member Voss, who's going to
discuss the time capsule. >> Wow, that's enough. borrow to this august assembly, esteemed commissioners, local citizens, and ravel rousers. >> Nice.
>> Wow. On behalf of this community, we render our humblest thanks unto Indie River County Board of Commissioners for their bountiful providence and sponsoring this jubilee, marking the 250th year of our nation's
birth. Your steadfast devotion doth preserve the flame of liberty and the memory of our forefathers for generations yet to come. Likewise, we offer our hearty gratitude to the city of Vero Beach, which doth proudly
hosts this grand observance and standeth as a most valued partner in these historic festivities. We likewise uh in solemn witness to this day, the county hath bestowed three cylinders in remembrance, time
capsules, to be sealed and committed unto this earth at the heritage center on the third day of July at the 10th hour of the morning. Let these vessels carry forth the treasures and voices of our age that our children's childrens may one day behold
the legacy we bequeath unto them. As we cast our eyes upon the horizon of our nation's future, let us be stirred in the spirit of our indomitable captain John Paul Jones, that's me, who famously proclaimed,
"He who will not rise cannot win." Let it be known that our course is set, our resolve is firm, and by Jove, we have not yet begun to celebrate. God save the great state of Florida. May the Almighty continue to pour his
blessings upon the community, this country of this county, and the United States of America. Thank you. >> Wow. Thank you. Also on July 3rd at the Heritage Center starting at 6 PM, we'll have a Colonial
Ball period dress would be appropriate. Only $25. All are welcome. Thank you. >> Thank you very much. >> Great job. >> Come on up. >> Come on up. Thank you. >> We're going to give you the capsules.
>> We can put them here. >> Yeah, we can leave them there. >> We'll lose them. I think I think we should take a picture though. >> John Paul, >> Aaron, come on. >> I saw you earlier, John. Yes,
>> I'm probably have to get in the middle. Fantastic. >> We'll see you there. >> Thank you. Well done. >> Yes. My costume ready. >> That was great. >> Wow.
>> You could do that. Commissioners, next we have a presentation by Miss Bethany Fort. Uh, as a reminder, this is simply a presentation. There'll be no votes taken. There'll be no exchange of
dialogue. This is anformational purpose. Good morning. >> Good morning. >> Welcome. >> Thank you, Chairman Lure. Thank you, Vice Chairman Moss and Commissioners. I want to thank you, Chairman Laura, for giving me the opportunity to present in front of the commission today. And I would like to thank each of the
commissioners for taking the time to meet with me to individually to discuss what I believe is a sol at least a small solution to an ever growing problem of affordable housing. I know that each of
you are aware of my background, but for the benefit of the public, I'll give a brief description. My 40-year career was spent in the multif family affordable housing industry. And I worked in all aspects of underwriting and development, including market assessment, site selection, working with local governments on approvals, loan
packaging, overseeing construction, runup, and management. In 1996, I secured a 7acre site in Sebastian with the goal of developing affordable rental housing for seniors through the federal section 42 tax credit program administered in the state of Florida by Florida
Housing Finance Corporation. I worked with the city of Sebastian in getting their support and site plan approval that were necessary for the application as well as the county to get the utilities to the site. Commissioner Fran Adams was instrumental in helping me to work through the process with the
utilities department and ultimately got me in front of the board of county commissioners to request their approval to make a financial commitment to bring the utilities to the site which received unanimous approval. This was done in record time as I didn't secure the site until the third week of February and I
was under a hard deadline of April 9th for the filing of the tax credit application with Florida Housing. That's how fast things could move back then when there was little development going on because the majority of the land was still being farmed by growers in the citrus industry. I've often said that
without Fran Adams, there wouldn't be a Graces Landing. She understood how important this proposed development was to the seniors in her district. And it was who through her foresight and determination to do what was best for her district that provided the opportunity for affordable housing and
has served literally hundreds of seniors in Indian River County for the past 29 years. I would love the opportunity for each of you to tour Grace's Landing and meet the residents to hear firsthand what a difference it has made in their lives. After becoming semi-retired in 2020, I became very involved in the
community, staying on top of what's happening at the city council meetings and the county commission meetings. In 2024, I was appointed to the Vero Beach Planning Board. I also serve on the board of Indian River Habitat for Humanity, and I'm a member of the Indian River County Taxpayer Association, serve on the board of the local chapter of the
Military Officers Association of America, and I'm an active supporter of the Veterans Council. I have served on grant committees with impact 100 and United Ways citizen advisory panels assessing grant applications for nonprofits. Serving on the grant panels has been one of the most eye-opening
experiences in that it has given me an opportunity to learn about the very important work that nonprofits are doing in our community and gain firsthand knowledge about the populations that they serve. Regardless of where my interaction has been, there's one subject that continues to come up in each and every forum I attend, and that
is the need for affordable housing for working families. Whether it's input from an employer, a governmental agency, a nonprofit, or a citizen, the subject comes up over and over again. After attending two different back-to-back monthly lunchons where concern with the subject was raised, one in a question to
a local representative about what can be done about affordable housing with no ideas offered for a solution and one from a major employer who stated much of their workforce commutes from other counties because they can't afford to live here. And the employer spoke of concern for their employees safety when
they have a 45minute commute home at the end of a long shift with overtime. Again, problem stated, no solution. It occurred to me that if we really want to solve this problem, we got to quit talking about it and actually do something. Knowing that one of the main barriers to providing affordable housing is high land costs. And remembering that
the 120 units of lowcost housing for seniors at St. Francis Manor was developed in 1972 on county-owned land through a long-term lowcost lease, I began researching county-owned property and found a very suitable 7acre site at 1840 25th Street. It's located in the
city and is currently zoned age being it was the site of the old hospital. The adjacent property across 25th Street directly to the south is zoned residential multif family and would allow up to 12 units per acre. The city fully supports the reszoning of this parcel for up to 10 units per acre with
a design that respects the old Florida character of the surrounding neighborhood. To understand the necessity of this project, one has to look at the gap between wages and the cost of living. There have been over 1,200 units of market rate housing constructed, market rate rental housing
constructed in the county in the last three years, and there's even more in the pipeline. But with rents starting at 1,700 for a one-bedroom, 1,900 for a two-bedroom, and 2,300 for a three-bedroom, a three-person household would need to earn a minimum of 76,000 annually
for a two-bedroom unit to be at the 30% threshold of recommended housing costs. These properties are being built for the high-income retirees who are moving here and no longer want to own and care for their home. They are not being built for working families. An affordable housing development using tax credits would
serve families earning up to 80% of the area median income with 60% being the average. A threeperson family earning 60% of the 2026 county's area median income has an income cap of 55,200. In other words, they could earn up to
that amount and still qualify. This would qualify teachers, police officers, healthcare workers, firefighters, workers at Piper Aircraft as the major manufacturing employer, not to mention the hundreds of people who work in the service industry taking care of us and our tourists. Furthermore, between 30
and 40% of the county staff, roughly 360 to 490 individuals, earn less than 50,000 annually. From this location, they could walk to work, as could the Piper employees and those who work downtown. Rents at the 60% median income level would provide a significant monthly savings for a one-bedroom unit
and up to $900 on a three-bedroom unit. This translate to an annual savings of 7,200 to 10,800 over the average market rate rents of those 1,200 plus units I just mentioned. Committing this parcel to affordable housing for working families is the highest and best use of
this property and it is the right thing to do for the working people of Indian River County. This location for housing is absolutely optimal with its walkability to downtown, the county complex, Piper aircraft, groceries at the upcenter, and its location on the go line, as well as its easy access to all
the healthcare employers located on 37th Street. Although the county is on the deed, it's the taxpayers who own the property. As the elected officials, you are its stewards. I would ask you to take the first step and work with the city on the resoning of the parcel with a plan to commit it for future
development of affordable housing for working families. I believe the section 42 tax credit program would be the best vehicle to accomplish this. I have spoken with an experienced Florida tax credit developer who has an excellent reputation with Florida housing finance and the communities he has worked with.
He would be happy to meet with you to help accomplish this. In closing, I have zero financial interest or gain in the future of this parcel. I am just an interested citizen who has a passion for affordable housing. Having spent 40 years in the industry, I have seen
firsthand the improvements to communities who put working families and seniors first, like Commissioner Fran Adams did by helping to shepherd the local approvals at record speed for Grace's Landing. These hardworking people are the backbone of our community
and we need to provide for them here so that we can keep them here. They are what makes Vero Bureau. Thank you. I'd be happy to answer any questions if it's appropriate at this time. >> Thank you very much, Miss Forto. As as mentioned earlier, this is a
presentation. We don't have dialogue exchange, but we thank you for bringing this on our on our radar. I think we're all very familiar with it. And uh by virtue of this meeting, we'll have the administrator uh meet with uh Mr. Falls. >> Okay. >> And begin some type of dialogue.
>> Wonderful. Thank you so much. Thank you. >> Thank you very much. Thank you for what you do. Next, commissioners. That brings us to the approval minutes for our April 21st, 26 meeting. Is Commissioner Flesher on the line? >> Yes. Yes, >> he is.
>> Move approval. >> Second. >> We have a motion by Commissioner Adams and a second by Commissioner Man. Any further discussion on approval of the minutes? Hearing none. All in favor? >> I Commissioners, next is
informationational items from staff uh not requiring board action. Uh there is a notice of the third extension of the contract of construction of required roadway improvements uh on the project laaya point. You can read up on that if you desire.
The second is an announcement from district 5 SESAC appointee, Miss Miriam Michael. >> Um Mr. Chair, may I have a ma'am? >> Thank you. I'd just like to uh thank Miriam Michaels for agreeing to volunteer for SEESAC. She hadn't heard
of it before, so it was kind of a a leap of faith, but she's got a great resume for it. Um she served as vice president of information technology at Credential Financial and she brings a strong analytical and financial background to
uh SEESAC including a bachelor of science degree in statistics with a minor in economics. I mean that's that's pretty heavy duty. But I I know of her dedication to the community. We've both been members of uh Vero Beach Museum of Art uh the circle which is a
philanthropic group for more than 10 years. She's very dedicated and I just want to take this opportunity to thank her publicly and to invite the community if you want to serve in any capacity not just SEESAC but there are a number of boards and commissions uh that have
vacancies um here and and ongoing uh please just take a look at the website indian.gov gov. Thank you, Mr. Chair. >> Thank you. And we all echo what Vice Chair Moss said with volunteering.
Oftentimes we struggle with those positions. The next is 7C. This is our partnership with Route 6C Hyende Parks and Recreation Conservation Department. There is backup information commissioners for your review. Does not
require action. The next item commissioners is 7D and that is a request for closed litigation session which will be June 2nd our next meeting time certain probably 10:30 and this will be discussion of pending lettuce
litigation between inner river county versus 22 beachfront properties which is one LLC not exactly 22 properties. So, uh, I think we're all have been briefed on that and we look forward to some type of resolution.
>> Mr. Chairman, I got a >> Commissioner Irvin, >> can I make an announcement that >> Yes, sir. >> I've done it. You've done it this weekend. Commissioner Adams did it. >> She was outstanding in her Dancing with the Stars debut, I would tell you.
>> Congratulations. >> And she raised a lot of money. But the biggest thing is the whole group of them raised a record amount of money of almost $700,000 for healthy start this weekend. >> Congratulations. >> Thank you. >> So she did. >> You were terrific. Really?
>> Thank you. I did not twirl off stage and I hope I represented you guys appropriately. So >> very well. >> All good. It was a lot of fun and I'm glad it's over. >> And I heard Mr. Tatanic is doing it next year. >> Yes. We already volunteered down. >> Great. Fantastic.
>> He'll be doing the West Coast swing. He doesn't know that yet, but >> I'm sure he knows it. The next item is the public comment. Any agenda related matters except for public hearings. If anyone has anything to talk about, anything on the agenda, otherwise at the
conclusion of the meeting, you will have an opportunity to also address this body. Hearing none, seeing none, commissioners, now is our review of consent agenda. Uh, and I will entertain any motion to
further examine a particular item on the consent agenda. >> If nobody has anything to pull, I'll be happy to move approval. >> Have a motion by Commissioner Adams and a second by Commissioner Man. Is Commissioner Flesher on the line?
>> He is on the line. >> Any objections to the consent agenda? Commissioner Flesher, >> he's muted. He is himself muted. >> Okay. Hearing none. All in favor? >> I >> and the motion carries.
>> Next commissioners is a presentation or discussion over the constitutional office governmental agencies. This is a request by the inter county sheriff's office emergency repairs of correctional facility fire suppression system. The information is in your backup. I saw two
members of the agency here earlier. Commission, Mr. Administrator. >> Yes, Mr. Chairman. Uh, recently I had conversations with the sheriff and also
uh the deputy chief uh Kent Campbell and they have been go undergoing some renovations and actually some very needed renovations and upgrades at the at the jail. And in the process of doing
that, um, they identified a a leak in the suppression lines of the fire suppression system. And in the in the backup of the letter from the sheriff, you'll see some photos that show some pretty significant corrosion.
And if that system was to fail or activate right now, it would probably present some a significant health hazard. Uh, so they have asked uh there there's four mods that they're going to be doing. They'll have the echo mod and
I guess they they'll rotate them in and out and I think the deputy chief can talk to this. But um I I would say uh that uh I recently toured the jail and and got a a glimpse of some of the conditions
and I appreciate that opportunity and time with Deputy Campbell and his and his staff. But uh clearly if they uh if this is not addressed obviously there's health concerns issues for them inmates but then it would be c more costly in
more likelihood become more costly to transport and relocate the the inmates. Uh the request is for $343,772 and is it is expected to take 6 to8 weeks per building. Um, so the
administration is recommending approval and again, Deputy Chief Campbell is here for that. Commissioners, any discussion on this matter? >> Obviously, it is a county-owned building and we have a responsibility.
>> Have approval. >> Motion by Commissioner Adams and a second by Commissioner Man. Any further discussions? Any comments from Commissioner Flesher? Hearing none. Seeing none, all in favor? >> I. And the motion carries. Thank you,
gentlemen. >> Mers, next up is the public hearings 11 A 11 A1. I see uh Assistant General Counsel Miss Prada here to discuss local option tax interlocal agreement ordinance adopted. This is legislative
in nature. Miss Prada, welcome. Yes. Good morning, commissioners. Susan PTO, deputy county attorney for Indian County, Florida. Um, today I am bringing with you a the local option gas tax. It's three things in one, if you will. Um, it is the meeting or the hearing, public hearing, if you will, that's
required to happen every two years um under our ordinance and Florida statute. Um it is the adoption of the new local option gas tax interlocal agreements with all five of the municipalities as well as the um amendment of the
ordinances that we have on the books to bring them up to date with the current uh with the current dates in this new agreement. So uh just a quick background on this. So this particular local option 6 cent local option gas tax was adopted in 1986.
Um, and back in '95 is when this current agreement that we're under now was entered into back in 95 um 96. That current agreement that we're under now expires August 31st, 2026. That's a 30-year agreement. That is the length of
time that Florida statute allows us to have those agreements for. Um, since that's expiring, we needed to bring this back in front of you and have this heard today. also because there's a deadline in the statute of June 1st for the calculations. Um so we need to make sure
that we meet all of those deadlines. Um that is under Florida statute 336.025. So with that being said, I'm not sure if the board has any questions for me, but the it's the all five of the interlocal
agreements have been signed by all five of the municipalities. They did update a new um method of computing the uh what comes in from the gas tax for the distribution. Um it has been agreed to by all of the municipalities. I think our public works
director can speak more to that if you have questions about how that would work. Um but what's left here today is for there to be the public hearing, allow the public to be heard on this if they have any questions or concerns. I'm not sure if anybody from the municipalities are here to talk about
it. Um, and then it's I would ask that once the public hearing is done that the board go ahead and accept and enter into the new interlocal agreements with all five of the municipalities that they make an a motion to adopt the
ordinance changes to section 20903 and 20904. And those changes, as I said, are simply just updating the dates and the method of collection that is referenced in the actual agreements. Um, and have this count as our every two-year meeting
that's required under that code section. >> Thank you, Miss Prada. Commissioners, as you know, this is an annual exercise. Uh, the backup material is with you and as indicated, all signatures on the agreements have been obtained. At this time I will open the meeting for public
comment. Anyone wanting to speak on the local option gas tax interlocal agreements ordinance now is your time hearing. Hearing none and seeing none commissioners I will close the public hearing. Commissioners what's your
pleasure? >> Mr. Chairman I'll make a motion to adopt the ordinance changes to section 209.03 03 and 04 of the Indian River County Code and approve the updated method of distribution of the local option fuel tax revenues on all five interlocal
agreements with the five municipalities. >> Second. >> We have a motion by Commissioner Man and a second by Commissioner Vice Chair Moss. Any further discussion? Any comments from Commissioner Flesher?
Hearing none, all in favor? I >> I and the motion carries. Thank you, Commissioner Man. Next up, commissioners, again, it's a public hearing. Uh we heard this last uh meeting. This is our second reading of the Reams Glenn amended and reinstated
developer agreement. Uh again, I see Assistant General Counsel Prada. Welcome again. >> Yes, good morning again. Susan Praa, deputy county attorney for the record. Um yes, uh Mr. Chair, this is in fact, as you just stated, the second reading of this particular developers agreement.
Um it is an amended and restated developers agreement. Um it is simply from changing where the lines were being proposed to be put in front of these particular houses in an already existing community to moving them to the rear lot lines of the houses. It's um changed I
think a little bit of the the cost which has caused us to come back and look at this agreement again um to change some of the terms but all that's changing essentially is just switching the lines from being run through the private right ofway in the front of the property to switching them to the back of the
property with um in the utility easement that exists there. Um, so with that, this is the second public hearing that's required under Florida statute 163225. Um, the first public hearing was, as you
stated last time on May, I'm sorry, May the 5th. Um, therefore, I would ask that you open the public hearing, take public comment, um, close the public hearing, and have a motion to approve this developers agree, this amended and restated developers agreement.
Masers, any comment before the public hearing? This time we will open the public comment public hearing. Anybody have any uh concerns or questions for staff or any of the commissioners with respect to RES amended RES Glenn amended
reinstatement of the development agreement hearing? None. And seeing none, I will now close the public hearing. Commissioners, as mentioned, this came before us. First reading, last meeting. What is your pleasure? >> Move approval.
>> Sec. Have a motion and I'll second that. Have a motion by Commissioner Adams and a second by myself. Any further discussion? Any questions or comments by Commissioner Flesher? Hearing none or seeing none. All in favor? >> I. And the motion carries.
>> Thank you, commissioners. Have a wonderful week. >> Thank you, Susan. measures before you uh today is item 11 A3 an ordinance authorizing the extension of the temporary moratorum on zoning changes and comprehensive planned
amendments respect to the Oslo corridor study area this is legislative and manner so there will be an opportunity for public hearings I see Mr. Stall present. Good morning. >> Good morning. Uh my name is John Stall. I'm the planning and development
services director for the county. I wanted to take a brief moment to inter uh to introduce our new uh neighborhood planning manager. This is Stephan Manard and he comes to us after a long illustrious career with the federal government. Um we're really happy to have him here. He's going to be helping us out with the Gford neighborhood plan. He'll be taking the lead on that and should be an exciting opportunity for
everyone in the community. Um but thank you. >> Thank you very much. It's a pleasure to be here. Honored to serve. Thank you. >> Thank you. Thank you. >> Okay, so we'll start with just a quick brief background. I won't be long. Um, in 2023, um, Florida Department of Transportation began construction on the
long anticipated I95 uh interchange Osler Road. In preparation for this, at May 20th, 2025, the board of county commissioners supported the following recommendations. Uh, USB extension. Um the board directed the planning and development service department to extend the urban services boundary from 58th
Avenue Southwest to 98th Avenue Southwest between Fifth Street Southwest and 13th Street Southwest. Number two, to create an overlay district um a quarter specific regulations for site and building design, landscaping and allowable uses for consistency and quality. And number three, the board enacted a temporary
moratorium. It was a one-year moratorium on resoning. That was to allow time for us to evaluate and revise our future land use designations, develop corridor specific development guidelines, and establish architectural and urban design standards to ensure cohesive growth. Um once the Oslo project is complete, we
will bring forward comprehensive plan amendments and a recommendation for extension of the USB uh a comprehensive plan amendments for new future land use designations for all parcels within the study area and LDR amendments, land development regulations to adopt the Oslo corridor overlay district. Um the
temporary moratorium is set to expire on June 17, 2026 of this year. Staff has made considerable progress on the previously mentioned items including analysis of future land use patterns, preparation of draft overlay concepts, coordination with stakeholders, and evaluation of infrastructure and development impacts within the corridor.
However, due to the scale and long-term importance of this project, staff believe additional time is necessary to ensure the final product is comprehensive, consistent, and ready for adoption without unintended gaps or errors. Uh this includes ensuring that future land use designations are accurate, that the overlay standards are clear and enforceable, and that the
resulting regulations properly balance economic development, infrastructure capacity, aesthetics, and compatibility with the surrounding areas. Given the significance of the Oslo interchange and the anticipated development pressure within the corridor, staff believe it is critical that these regulations and mapping updates are done correctly the first time rather than rush to
completion prematurely. An extension of the temporary moratorium through December 31st of 2026 will allow sufficient time to finalize the comprehensive plan amendments, complete the Oslo corridor overlay district regulations, and return to the board with a coordinated and adoption ready package. Accordingly, staff recommends
that the board of county commissioners approve the ordinance establishing an extension to the temporary moratorium until December 31st, 2026 on reszonings and comprehensive plan future land use map amendments within the defined Oslo corridor study area. Thank you. I'm available for any questions. Thank you
commissioners. Any questions or concerns for Mr. Stole? Hearing none. Seeing none, I will open this meeting this topic for public comment as it is in legislative in nature. If you have any questions or
concerns for staff or any of these commissioners or administrator or our general counsel, please step forward. Hearing none. Seeing none, I will close public hearing. Commissioners, we've had an opportunity to review this and discuss this for
several years. >> We have a motion by Commissioner M. Staff recommendation. I will second that motion. Motion to second. Uh any further discussion? Any discussion by Commissioner Flesher?
Hearing none, seeing none from anyone else and Commissioner Flesher. All in favor? I >> and the motion carries. Thank you, Mr. Stole. >> Thank you, >> commissioners. At this time, we will take a brief recess and we will
reconvene at 10:05. Time is 10:05. >> Commissioner, >> the May 19th board of county commissioners will reconvene. Do we have Commissioner Flesher on the line? >> We're working on it. We'll
>> give him 30 seconds as we wait on Commissioner Herman. >> He's not in the back. Commissioners, this is item 13D under human resources. This is uh recap of two weeks ago uh group health insurance
recommendations for plan fiscal year 2627. And I see our director, Miss Suzanne Bole. Good morning and welcome. >> Good morning, commissioners, and thank you, Suzanne Bole, human resources director. Um, I have a copy of uh today's presentation
um that we're going to be reviewing, and it will also be available on screen. >> And this one has a couple of edits from last night. So, um, if you'll take the copy that that, uh, Rachel, did you did everybody get a copy? Okay.
All right. We'll get started. Okay. Can you pull up the presentation? Thank you so much. All right. May 19th, uh, we came back, uh, after meeting with the board on May 5th. I presented you
with a lot of information at that time and I wanted you to be able to have the opportunity to uh collect any other additional information that uh was available. Um just to review our guiding philosophies for our group insurance
program are that um they remain Oops, doesn't seem to be working. Kim, thank you. That the insurance is affordable, that it is competitive, and that it is sustainable. Our discussion topics today
are going to be our plan experience and our funding projections, our renewal strategies that we discussed uh last meeting to manage our increased costs. Uh we're going to talk about um something that we looked at was going down to a single plan, a silver plan
only option and uh the lantern network. Uh this was related to mandating um joint and spine surgeries through Lantern. and then also up our contribution strategy for the upcoming plan year beginning in October. Um last meeting we looked at our plan
and how it was performing and uh you know since 2021 we've had no rate increases. Uh our plan has been doing really well until last year when we saw that that was the first uh time that we actually had um a higher spend than what
we had budgeted in in our income and our premiums for the plan. Uh this year we're projecting to uh have uh about an $8 million shortfall and uh Locked In has recommended that we um collect that
much in premium for the upcoming year to cover our expenses. Um last year we ended with a $2.5 million deficit which we expected but we had a good uh fund balance and we made the decision at that time uh the board to leave our premium rates the way that
they were. Um in March our financials came in and show that we continue to operate at a deficit but that's grown a little bit to $3.6 million in deficit for this uh 6 months into the plan year. That's a 128.6% 6% loss ratio
through March. Uh we also talked about this last last meeting. Uh we do have uh an increase in our high-cost claimants. Those are the individuals whose health care expenses exceed $50,000 and uh we are now at 51 individuals uh with a $6.3
million in net claims uh for those 51 individuals. Um we talked about our GLP1 weight loss expenses. That's accounting for about 27% of all our prescription cost and that's running about 3.3 million for the plan year.
And then we looked at our health plan trend year-over-year and our increases in all of our categories. And then we went to our health insurance fund balance which again up to this point had been functioning very very well until we started having to dip into
it uh because of our budget shortfalls. And uh the most recent balance reflected that it is $17,123,154 which was a a 20% decrease uh from the prior account balance of 21 basically.5 million. Our updated projections from
locked in reflect that they are uh looking at uh uh 8.1 in additional 8.1 million in additional premium will be needed to fund our upcoming plan year. Um we attached the March financials to
the agenda item so it's available to you but this is just an overview of where we're at. If you look on this screen on the far right, you'll see that losh ratio is consistently over 100%. Which means we're dipping in and uh spending more than we have in the budget.
This is an overview of our highcost claimants. Um these change yeartoear. Uh people's medical events change yeartoyear. In this particular instance, we now have five who have exceeded the stop loss of $300,000. But you'll see that there's a couple that are pretty close behind. I have
another uh uh claim that's running at $270,000 and one at 231. So those may very likely by the end of the plan year um also exceed exceed our stop-loss um experiences.
This is totaling the $6.3 million in uh claims paid out after receiving $55,000 in stop-loss reimbursements. So, we are receiving money back from our stop-loss rein uh reinsurance. It's it's actually an offset on our every two weeks we get
a claims bill that we pay to Bluec Cross Blue Shield for the claims that have been paid out. And this stop-loss insurance is an offset to that bill. Uh we talked a little bit about our our weight loss our GLP-1 weight loss medications and this is the information
through March. These were the components of the health plan trend and and I guess it's just important to note that across all lines is where we're seeing increases. So it isn't just uh related to high-cost claimants or GLP1. It's across all lines
that we're seeing these increases. This is uh the information provided by the office of management and budget related to the health insurance fund. And again, this is just that other illustration where we can see the gray are those expenses that are um over
where we were in the prior year related to these different uh categories of inpatient hospital, outpatient surgery, outpatient, non-surgery, emergency room, brand name medications, and specialty medications. These are the projections uh of funding
needs that uh Lockton prepares for us. It's an actuarial uh preparation uh that is done in analysis. And this uh slide in front of you reflects that we would need 11.4 million to uh keep everything the way that it is today.
That would require an overall increase in our premiums uh for the employer and the employee combined. the total monthly premium of 44.6%. Uh then we look at that same projection without the GLP-1 weight loss medications. Uh the rate action would be
lowered to about 31.6% or an additional $ 8.1 million. We also presented some costsaving renewal strategies that LockTen presented to us. Um, we have uh option A, which is to increase our deductibles
on both the gold and the silver plan as well as the out-ofpocket maxes and also to increase uh ER co-pays um for individuals that are going to the emergency room that that um will help offset $749,000
in projected costs. uh we have a uh a recommendation for uh doing it they call it care steerage. This is related to um uh uh those types of medications that are administered um
at certain uh providers and we're looking to direct that more to infusion centers or the members home for that and that's a $39,000 savings. uh you see the GLP1 recommendation there for the $3.3 million
that would be removing that medication uh and transitioning to a direct to consumer plan. Um I there is another option there that does involve the rightway um uh program that would help our individuals that are on GLP1s
through the health plan today be able to access the direct to consumer pricing. The cost of that program would be $33,000. Uh which is is a a very low cost for helping to provide some additional support to our members. Um it isn't
listed as a locked in recommendation. Uh but it is something that um staff is is supportive of for our individuals that need to transition to the direct to consumer model. The lantern lantern mandatory spine and
joint. I have a little bit more information on that. That is a $627,000 uh savings. Um there will be some disruption to that because it would be individuals who would be having the voluntary uh surgeries, elective surgeries uh for certain joint
replacements or joint revisions or ligament repair, those kinds of things. Um they would be required to use Lantern for that um service rather than going into the network of physicians that are available through the health plan. uh there is a provision to utilize the
health plan if however um it is not uh a patient is not a candidate to use lantern like if they can't if they're not accepted by a lantern physician if it's a more complex case that would require it to go back into the um into the health plan there are provisions for
that but by and large this would be requiring individuals who might need a knee replacement or a shoulder surgery or things of that nature to utilize lantern for that benefit. Um, we have had uh experience with members who have actually had their surgeries through
Lantern and I have not received anyone who's gone through Lantern and had the surgery. Nothing has come back to me related to that that there was an issue with that service. Um, they do provide mileage and reimbursements and meals if
somebody has to travel to get to a provider out of the local area. Let's say they need to go to Orlando or something like that. There's mileage cards and things like that that are provided to them so they don't experience an out-of- pocket expense. Um we are also uh re there's a
recommendation for uh virtual nutrition services to help support just our membership in whole. Um we did talk about that last um uh meeting that it would be good to go beyond just individuals that might have a diagnosis of diabetes, kidney disease, celiac
disease or obesity and provide access to nutrition services. So that can be done through our health plan. We can modify that to with u a co-pay like a PCP co-pay. you can actually uh take advantage of these nutrition services uh without a diagnosis if you wanted to
focus on uh health and nutrition uh before a diagnosis was was actually given. And then we are also looking at expanding uh the TEDoc mental health uh support uh which is um uh to help individuals who might be uh needing uh
services for uh behavioral health mental health issues uh to access those services uh through the TEDoc benefit making it much easier for people rather than having to take time off and go somewhere to to seek those services. And then lastly, we would like to
provide uh volunteer or not volunteer but a voluntary Medicare education to our retirees um who might be 65 or older to be able to help them navigate the marketplace with regard to plans that might be actually more affordable and work better with their Medicare than uh
the county's group insurance plan that they could be on today. And that's an estimated savings of of the individuals transitioning from our plan uh off to a marketplace plan uh projected savings of $196,000
for that. Um there would be an expense related to that, but that expense only kicks in if an individual moves uh from our plan to that plan. So um it would um just be based on uh if somebody actually chose to go.
Some of the information that was requested from the board was related to lantern. Uh we had some questions that came in. Uh one of them was which joint procedures will be mandatory with lantern. It it would cover joint replacement and revision surgeries for the shoulder, the knee, the hip, the
ankle, the elbow, and the wrist. Most common procedures include joint arthroscopy, ligament repair, rotator cuff repair, knee replacement revision, and hip replacement revision. uh what happens if there is no lantern physician who will accept the patient? I
spoke about this earlier. Um if there's no lantern provider that would accept a patient that would uh initiate an exemption process um that would allow the member to receive treatment to through their traditional insurance. The process would be that they would alert us Indian River County um that the
member qualifies for the exemption. Um, and once we're aware of that, we would open that up and then they would Lantern would coordinate with uh, Blue Cross Blue Shield to ensure the handoff back into the into the uh, group insurance.
And I I I do want to just remind you this is for non-emergent. It's not for emergencies. Emergencies would still fall under the plan. That's what it says here. What happens in an urgent situation? This is lantern is only for planned situations not for emergent
situations. So the emerent access to um services for uh joints and things like that would still be in place under the group insurance plan. Um where will the surgery rehabilitation and follow-up exams take place? Lantern does not cover the physical therapy.
That would go right back into the plan just like it would somebody goes and has a surgery under the plan. They get a referral to physical therapy and then they um are there's outreach that that comes to the member and they get that scheduled and they they would uh access
that through through the group insurance plan. Um Lantern doesn't uh uh does cover post-operative surgical appointments. So those post-operative surgical appointments with the lantern provider are still covered. And it's interesting to know under Lantern the
the thing that's nice about it for our members um is that they don't have any co-pays. They don't have to meet a deductible. They don't have any co- insurance. Um however, under this mandatory provision, we are saying you
need to go to Lantern for that because there's a a substantial savings to the plan in doing so by redirecting that care. This is referred to as a narrow network. Think of it as that where we are narrowing a network and restricting it to individuals within a certain
category. Um some information here. This slide was a little bit um I didn't quite understand it and I received some clarification this morning. uh the slide that when you see um Sebastian which is
MSA4 so column four over and it's anything that you see in the green is um in the light green is there are providers within that mileage range. So uh let's go down to joints. you'll see
within 10 miles um that's a there is access for joint um surgeries within 10 miles. Now that doesn't mean that the member has to go to that individual. The way that it works with lantern is you call up and they give you three uh surgeons of excellence for your
condition and then you get to do the research and you get to pick out of those and if you want another another group you could say you know yeah let me let me see some more and they'll send you some more. So, you still have access to choice. It's just choice within the lantern network. I could choose perhaps
um maybe there's a a local provider, but I'm wanting to go to this specific provider in another service area. I could choose to do that. They're not going to say you go to the closest one. They will give me a mileage card. They actually preload a card with mileage um
money and credits and meals on there. And in some instances they actually pay for lodging and accommodations when needed if the travel is beyond a certain amount. So um uh it it lessens any impact that somebody might have if they
do have to travel. And they also um if somebody needs somebody to go with them, they will pay that expense as well and provide for meals related to that person. Um, interestingly, doing all that still ends up costing less than having those claims run through the health plan. Uh, and the reason for that
is that there is a direct contract with these providers that that Lantern has and uh they reimburse them directly. Um, another uh component of this program that I think it's important to know is not every surgeon gets into the lantern
network. It's surgeons of excellence. They only look for specific criteria. They look for reinfection rates, revision rates. They they study a lot of data. So, they're only going to allow into their network um a very limited limited uh group of individuals that
they believe qualify as surgeons of excellence after the after it's vetted through their process. So, um it sounds a little bit it's it's very different. Let me just put it that way. It's very different, but it is a narrow network, but there's choice within the narrow
network that the member has. However, they don't have choice to leave that network and go to an to the group plan unless it is I can't there is not a a provider who will accept me or um something along those lines. Did I cover
that pretty well? >> Yes, that's correct. >> Okay. Um, so related to the spine, you're going to see uh for spinal coverage, you're looking at more of the 50 to 150 mile range and you're looking at a seven that's a 79 mile that that
provider is 79 miles away from the Sebastian Vero Beach area. So that's where all that mileage reimbursement would kick in if somebody needed to stay overnight and those things. Um, so with that I pause. Well, one more thing.
nationwide. We have retirees who are nationwide and uh Lantern also uh has these service areas. Um metropolitan what was it? Metropolitan >> metropolitan statist >> metropolitan statistical area. >> Metropolitan statistical areas. So
that's where the the service areas are and um the disruption was looked at and do we have access for all of our retirees? >> Yes. So on the prior slide it talked about the top 10 FSAs and so you can see there are some retirees retirees captured there based on the South
Florida population Asheville and so it notes that those actually those are more populated areas where those retirees are living and so there is access. Um Lake City was an area that would be across the board lower access. Um but other than that everyone else had pretty
decent access as far as those top retirey groups. And um thank you for bringing that up, Rachel. Um if you look at that where it says number of employees and percent of population, uh what they did with this analysis was they actually looked at our
total um uh geographical uh where our employees are living. And then they take a percentage of that number and um based on that they assume that there are potentially 25 uh members
that live down in that um MSA number one who may utilize the lantern benefit. So overall, we're looking at maybe 98 individuals out of the 4,000 members on the plan who might fall into a situation where um they would require this
elective surgery and and use the narrowet network through lantern. Um Rachel, could you remind me of the what drove locked into making this recommendation? We had some some surgeries that happened in this past
plan year and what was that experience? >> Yeah. So just that category of spend um I think it was noted on a prior slide but in general it is a little bit elevated. They have the plan has had good success with lantern as a vendor over the last several years and this is
an area and opportunity an additional lever that can be pulled. It does come at some disruption um but it's a different lever as opposed to plan design or layered on top of plan design to drive additional income and savings for the plan. So again, this is just an
option that's on the table. Um, but we felt that it was worth a discussion uh so that you could consider whether or not that was something that that would fit for us. Uh we reviewed last last meeting what our market position was and you can see
that our uh related to our employee contributions as well as the um richer benefits our plan uh exceeds benchmarks in in the category. So our current plan is a very very strong plan both the silver and the gold.
Uh this is just a different way to look at the option that Lockton has proposed on the deductible increases and the out-of-pocket maximum increases as well as the ER uh co-pay uh increase. And um
uh then we also are showing in their mental health and behavioral health uh making sure that access uh to outpatient services is consistent with the um primary care co-pay under the plan. And uh you'll see that um everything
highlighted in yellow would be a change from the current under the plan. And the value of that was was it $728,000 of these changes? >> Yes, option A was $750,000 and option B was 1.09 million.
>> Uh the decision guide, we've already talked about this previously. Um staff is recommending that we uh remove the GLP-1 weight loss coverage from our current plan and uh we are encouraging
uh that direct to consumer um pricing uh support uh with rightway. This is an overview that was provided last uh time related to the costs um associated with the direct to consumer pricing
and it ranges depending upon um this the level of medication that someone's receiving. Uh this is again an overview of the virtual nutrition services and um uh we are uh wanting to make sure that people
have access to nutrition services. So um for individuals with the diagnosis they will have access uh with no cost share uh for the first three visits and beyond that as long as they have a prior authorization that's on file for that. And then we're we're uh recommending to
expand it uh with people without a diagnosis have access for a a primary care C co-pay. A little bit additional information on the ALEP benefit to support our retirees. Um it's a contingency feebased model that we only pay if somebody
chooses to um to select a marketplace plan. And the estimated savings there is um uh over a three-year period. Um but it's it's I think it was 196,000 for year one. So, something that is new that we
looked at, um the county administrator and I were were discussing this and and we wanted to know what if we went down to one plan, you know, could we mitigate some of our uh premium increases and our cost um and the impact to the employer and the employees uh cost share uh if we
went to a silver plan only option. um locked and evaluated this and the cost would be neutral in year one. Uh since our employer contributions are the same across both plans and additionally uh the migration would go entirely to the
silver plan. So any expense and risk that is currently on the gold plan would shift to the silver plan. So, um, and you'd be receiving less employee premiums, um, and providing a a not as rich a benefit as the gold plan, but
still a very rich benefit, um, under the silver plan. So, it was not going to give us any immediate savings in the year. Um, they did state that the strategy would be more impactful if we had what was called a true HSA
compatible, high deductible health plan. Uh however um those types of plans are you pay for everything out of pocket um up until a certain limit. So that's a pretty substantial change when you deal with a high high deductible health plan.
Um and currently only 7% of employers with 500 or more employees are are offering an HSA only plan according to the Mercer National Survey of Employer sponsored health plans. And when you look in the government services industry, uh just 9% uh in the
government services industry are offering uh that type of a plan. So that would be a a a big change and little return on investment for this upcoming year. So with that um uh we are reviewing our
contribution strategy and funding needs um for 2627. Uh this is just reflecting what our current contribution levels are. Um you can see that our employees currently pay $110 a month for the gold plan and $400
a month for the family plan. And under the silver plan uh they pay $15 a month and $27.50 a month for the uh family silver plan. The employer's cost is fixed at 700 a
month for sig single coverage and $1,15 a month for family coverage. When I transition over to um well, we we already talked about our funding uh needs. I do want to um let you know that we are
looking rather than the 8.1 million um we've adjusted our funding request a little bit because uh we we wanted the um the the numbers to be 25% for the employees and have a a fixed cost for both plans for the employer just like we
have today. So that's coming in at $7.8 million. And this is what uh staff's recommendation is for the um uh new premiums for the upcoming plan year. Um this model assumes that we're going to
have a 10% migration from the gold plan to the silver plan uh as the costs go up a little bit. Some people might choose to sit on the silver plan um as opposed to the gold plan to save a little bit on the monthly premiums. Um the premium would increase on the gold plan for
single coverage by $27.50. 50 a month for the employee. Uh so it would total $137.50 a month for single coverage under the gold. Uh the family coverage under the gold would increase $100 a month uh and
and come up to $500 a month for family coverage. The um employee single coverage would still be very affordable at $18.76 a month under the silver plan and the family coverage again very affordable
under the um silver plan at $259.38 a month for those premiums. You can see down in the boxes below uh on the left uh that the employee increase in their premium is uh it equates to 25%. It's
25.1% for the um the penny rounding that we had to do on the silver single plan. But the bi-weekly change for our employees is going to range anywhere from a $188 uh bi-weekly up to $50 um bi-weekly uh
for those changes. Then over in the box on the right, you're going to see what the employer contribution is going to um increase by. Um, under the under both plans, the employer will be paying $223 more for single coverage and we will be
paying $375 more for family coverage. So, the county is carrying the lion share of that increase. Um, overall, uh, $6.8 million will be coming, uh, from employer contributions and almost an additional
million from employee contributions for a total of $7.8 8 million in additional premiums for the upcoming plan year. And this assumes the removal of the GLP1. Um if we uh if if the board um elects to
retain the GLP1 as a medication under the plan, we would be looking more to the $11 million in premium. And I' I'd need locked in to revisit what those amounts would be. So the recommendations that we're asking you to consider is uh the plan design um
options either A or B. Uh Lockton is recommending A. Uh the Blue Cross Blue Shield specialty medication benefit which would uh bring um those infusion services into either a home setting or an infusion center setting uh which is a
savings of $39,000. um the elimination of the GLP-1 medication from the plan and uh look at the direct to consumer um model which would be um uh the overall savings of that one would be the $3.28
million. Um the lantern mandatory spine and joint procedures would be a savings of $627,000. And then this uh change in the nutrition counseling coverage to zero co-pay. Um,
this is a cost, but it's a minimal cost. Um, so, uh, we didn't show it. Uh, but we we believe there's overall savings because we're looking at, um, uh, providing additional support to people to help them if they're managing a
chronic condition or uh providing nutrition support without a diagnosis for the PCP co-pay, TEDoc mental health support. uh we we are recommending adding that behavioral health service for increased access to mental health support
and uh partnering with ALUP uh to provide our retirees who are Medicare eligible with plan selection assistance. Now I I do just want to make sure that you understand we are not forcing our retirees to to go anywhere. They can
stay on our plan if they choose to. We just believe it's really important that they have good information to evaluate and make that decision because they will be experiencing a rate increase as well. And then the contribution increase that I just reviewed on that last slide um is
is uh would provide a 7 uh.8 million in additional funding. Um, and it assumes that there's going to be a slight migration over to the silver plan, which is why you have less the 7.8 million is going to be coming in a little bit less
because we're migrating about 10%. We're assuming that um, as people move over to that plan. So, with that, I I open it up for any questions. >> So, just uh, >> Mr. administrator.
I know this is a very sensitive topic and it's a obviously it's one that I know many of the employees there's some angst and I I I will just say that we are seeking a delicate balance between providing reasonable you know
affordable coverage health insurance um with the resources that we have and recognizing the impact on the fund balance uh within the context of presenting and maintaining a financially sustainable model. I do think going
forward we are going to be looking at potentially uh looking at incremental increases to mitigate and minimize you know I mean while we've had five years of positive plan performance this past year we had to you know dip into the fund balance to
to the tune about 2.1 >> 2.5 >> 2.5 million and then this year we're looking at you know eight $8 million. So what so I think with the plan changes the incre increase in premiums
um we are trying to um make it so we can still provide a a a benefit that is healthy but also that is uh reasonable recognizing that we have certain financial constraints. And the one thing
I do want to me I want to emphasize is uh I would recommend that if the board eliminates the GLP1s that you absolutely elect the option for right way to help
those employees that are on using GLP1s to transition to direct consumer pricing combined with the u the uh added service ofut nutrition of uh being able to access a nutritionist. I think that's
critical to help our employees land softly for those that may be using it strictly for you know for the weight loss. So uh with that I mean last year we were hopeful that the loss ratio was
an anomaly and that we and we undertook that cost and we absorbed it entirely. Uh however, the the projections reflect a deficit of potentially 8.1 without the GLP1s, 11.3 with the GLP1s. Uh not an
easy decision or recommendation, but one that we think is in the best interest of the taxpayers while also still providing a a a reasonable and a actually very rich benefit to our employees. >> Thank you, Mr. Administrator.
I'll say that uh commissioners, you've heard me say this before that probably get tired of hearing it, but we are commissioned and our primary commission is to effectively control the budget and
control policy. This particular item is budget and policy. Suzanne did a very fine job in explaining the direction that she has examined and in partnership with Lockton and others. And the three key components were
affordability uh which I think we can check that box, competitiveness for sure, and sustainability. When we look at what we were tasked with two weeks ago, we talk about how we had to globally attack this. Uh it's not
lost on any of us that our rates have been the same for the last 5 years. Uh when we talk to our friends in the private sector, uh we hear horror stories about their premiums. U there's no doubt about that. When we bore down
and we look at what is costing us the most, obviously the elephant in the room is the GLP, but I don't think we should completely focus on that. In fact, when we look at Lantern, for example, uh and there's
been a lot of discussion about that, uh I think Suzanne did a fine job again outlining that that is particularly not a case for trauma, uh if you're involved in a car crash and whatnot. And this is a specifically defined
um use and need by our employees. With over 1,800 uh active members, we are responsible for somehow managing that. We can look in the past and say, well, maybe we should have incrementally
raised two to 4% per year. U that didn't happen. And we are in a position now to cure that. We've talked about curing that in the past. When you look at the contributions by our employees, the
proposed increase uh would be between $800 and a million dollars. But the fact is the county itself has skin in the game to about $7.8 million and increasing our employer cost. Uh and that's often lost um sad to say on our
employees on the amount that the county contributes. It's significant when you go from 11:05 to uh which has been 11:05 employer costs for probably 10 years Suzanne uh to 1550 for gold and to 1320 for
silver respectively. Uh it still is consistent with affordability, competitive and sustainability. the global approach by looking and educating our uh retirees not only through our other postemployment
benefits. Uh but that clearly is and can be a challenge Suzanne for a lot of our retirees on how to get to the next level, how to get to Medicare. >> Uh and if we in fact can save $200,000 by ushering them. Uh, and I will tell you, um, there's plenty of people that
that have a lot of questions, and if that helps us save $200,000, uh, even better. With respect to folks that are on the GLP that have, uh, some type of diabetes, this does not affect them. >> Correct.
>> Uh, this is clearly something that we've talked about for the last two years that, um, has been an advantage to weight loss. uh it is a challenging decision to make uh and some of us
recall when we had um acupuncture uh and that was I don't want to call it a fad but that was something that each of us are familiar with that we had to make that bold decision to eliminate acupuncture this is no fault of the agency or the
employees uh this is business and we have a responsibility um to stabilize this. And we look at all of the other factors involved to include the teleaalth to include our
partnership uh with the pharmaceutical company that will guide and direct our employees. In fact, I spoke with John yesterday about this about some type of a soft landing for our GLP users. Uh we understand that
and we recognize that. Uh but again in summary, we are tasked with solving this problem and I will yield my time. Commissioner Adams. >> Well, I appreciate those comments. I'm
not exactly on the same page with you on that, which I think is not a surprise to the rest of the commission because I've been pretty consistent since we started this process. But, you know, the first thing I'll say is I understand
completely that we need to do something to make our insurance program sustainable. I think that's very obvious. What I don't really agree with is the process that we've gone through to get to where we are today. I feel
like this is a very consultantheavy process. It's been driven primarily by the consultants, not by Indian River County. every thing that we're hearing um is very much from the consultant locked and locked and locked in is all
that I'm hearing Suzanne. That's all we've heard this whole time. I also um think it's been pulling teeth to try to offer wellness alternatives to our to our employees. And I think it's our job to try to provide those things
to our employees so they can better themselves from a health perspective. And I don't understand why it has seemed to be so hard to have those included. I mean, they're included now, but it's taken three or four conversations to get
those in there. The lantern situation, that has taken three or four conversations to get that clarified. And that should have been those should have been included originally. If you're taking things away, you should also be giving options of how you can have those
soft landings. It shouldn't be something that we are having to reiterate time and time again. It's just not you don't treat your members that way. The other thing is um
I thought a survey was supposed to be sent out. I haven't seen that. I haven't seen anything from the survey related to um GLP1 weight loss programs. I believe from John that there was a lastm minute survey sent out to a handful of
employees. But when this first came up, if you recall, I asked for something meaningful to be done to relay to employees what was going on and to try to get some feedback from them so we knew where they stood. That hasn't
happened and we're on our third or fourth meeting about this. So I find that to be a problematic. And then the last thing I'll say is if we want to talk about sustainability, there's no strategy in any of this to
address what the actual problem is, which is the high medical and pharmaceutical costs for our high-cost employees. And you know, we're going to continue to have that. So, I just want you guys to be aware that nothing in
this really addresses those employees or those members that are over that stop-loss. And I'm not suggesting that um there's a problem with that, that medical issues need to
be taken care of, but I'm not seeing any strategies or any conversations about how to coordinate some of those name brand and highcost pharmaceuticals and some of those more specialized care
that some of our members might seek. And this is not the first time this has come up. The last time this came up five years ago, I think we've had this exact same conversation and now here we are five years later ringing our hands because we're in the same boat again.
So, I get we have to do something. I'm not saying we shouldn't. We do need to be sustainable and fiscally um responsible, but I don't like this process and I've said that from the beginning and I haven't seen anything change through it.
appreciate >> Mr. Moss. >> Yes. Thank Thank you for all of this. Um and I appreciate what Commissioner Adams just said. Um I I'm concerned about that GLP1 um eliminating it and I wish we did
have more information in terms of feedback from the employees and how they might feel about it. Uh but that being said, um I think it's probably something that we do need to go forward with um provided that we include that uh we give
them access to the manufacturer, you know, and help them uh obtain a low cost or a lower cost uh prescription rate than what they would get otherwise. Um with the rest of it, yeah, I don't know how you address that. I mean, I
understand Commissioner Adams made a good point. I don't know how you address that group that's high cost. Um, you know, it's I I don't know that you can I mean, can you I'll ask Lockton, you know, what's is there a way to
address that that high really that high cost category or is it just um you know, bad luck and that's what you just have to >> Yeah, that's a great question. So I would say on the whole once you have the population the 2% really that's the
high-cost claimants once they've reached that point there is not a lot you can do to mitigate those costs there are additional enhanced case management programs that are available whether through blue cross blue shield your current vendor or a separate vendor that
can help to improve the case management those high-cost and complex conditions are receiving. Um but on the whole one of the thought processes is prevention and helping to keep those members that are either in the lowrisk category or
medium risk there and not progressing progressing up that risk continuum. And so there are additional programs in place whether it's through BlueC Cross Blue Shield or thirdparty vendors that could be looked at. That is a multi-year approach and requires investment on the
front end. So those typically come with some sort of PEPM fee and then you would expect to see eventual savings, but it does take time um and effort and you know methodical um trying to to keep those members at a lower risk or
preventing them from becoming those high-cost claimments. >> So the nutrition counseling is that considered to be a prevention program would that fall within that category? that would fall into that category because it's twofold. Both, you know, nutrition therapy would be the
prevention portion of that toward geared towards all of your population, not just those with a diagnosis. And the med medical nutrition therapy would be the portion geared towards those who already have a diagnosis, which would help to support the GLP1 users as well. So what what other kinds of programs would
should we consider for prevention to uh to minimize or this um high cost category? >> So we've looked at cardioabolic support programs as we know that that's one of your um condition cost drivers within your population. Um those programs one
we looked at was through TEDoc. Um it does require engagement and enrollment in the population. So it it takes some effort from employees and you know from the Teddoc team and from the Indian River team in conjunction with Loctton to engage that population into those
programs but they provide continuous glucose monitoring. They provide um uh connected scales and there's uh automatic uh connection that's going on between those devices and a TEDoc health clinician that's helping to guide that
member's journey to help improve their quality as far as dealing with conditions like diabetes or obesity. So that was one program that we vetted but ultimately it does require a significant level of engagement and return is not immediate. And so I think what we were
focusing on for this year is the immediate issue at hand and making a lot of changes at once sometimes is not effective as far as getting that engagement which is what you need to get that return. >> Yeah. No, I understand right now we just want to stop the bleeding, but I'm
wondering going forward um if we want to do some kind of outreach to the employees and try to understand, you know, what their response to any of this might be that we could do that in the GLP1, ask them about that, but also ask them about different prevention
programs. You know, would they would they have an interest in it? And there's probably more than what we have time to talk about right now, but maybe the two of you could talk to each other. Come up with some kind of uh list, proposed list of of prevention programs. And then when you reach out to the employees for the
GLP1, include that, you know, some kind of survey or, you know, questionnaire, include that and see what kind of interest there might be in the different prevention programs. >> Yes. And based on Commissioner Adams feedback previously as well as the rest of the commission, there was a health and well-being surveys interest survey
conducted a couple of months ago through the rightway portal as a means to engage members and give them access to that survey. And so we did receive responses there as far as their interest level with employer provided nutrition um nutrition related services they would
find valuable, their primary nutritional or health goals. And so that did support the recommendation to um kind of liberalize the nutrition services that are available through the self-funded plan both for preventive purposes and diagnosis purposes.
>> Yeah. Well, let me continue along that line. I think the outreach to employees is really important. Thank you for bringing >> I just have a followup. When we had that conversation about reaching out to employees, it was to reach out to them directly, not through the rightway portal because that is a second step
that people have to go to to even know there's a survey. And the conversation was honestly to send an email to everybody with a survey link. So I just and and I believe that that
survey was only sent out like five days before that commission meeting. So again, I don't think it was meaningful outreach and we can professionally disagree on that, but from my perspective, that was not getting meaningful input from employees at all.
That was checking a box. >> Thank you, Commissioner. >> Gee, thanks. >> You're welcome. >> Jump in. >> All right. Well, I've I've heard some en enlightening conversation, but I too
have my qu have questions and I will start off by saying that I do agree with Commissioner Adams. I think this has been driven and I appreciate everything that Lockton does and I like what they do. They
they've been good to us and they're they're they're very reputable and I can't say anything bad about them other than this seems like it has been kind of driven more by what they say more than what more than what we think. They're they're when it comes to health care, we all
know it's getting more expensive every year on Elvis. We pay more for everything. We we we got to think outside the box for our employees what they want. And I think the survey as was mentioned by Commissioner Adams and and others was is
um we need to know exactly what their needs are. I mean, we can read it on paper. We can see what we need. We can see what there is out there, but I'm just not convinced yet. I was I was reading this again. I've been reading this all week. I was reading again last night and I was kind of overwhelmed by
the numbers and the figures. You know, first of all, I know it's uh it's part of the employment package here where people some people come here just for the insurance. Maybe their their husband has a good job and, you know, he makes a lot of money, but his insurance is
terrible. So, you know, maybe the the the spouse will come here and work to to gain county insurance. And that's what it is. It's part of a competitive package that we have to to attract our employees. And um
I don't want to see it to be any less than it was with coverage wise and but we need to make it clear and into and to where we're going with this. I got a couple of questions I want to ask is for the GLP because that's come up. It seems like we're really focusing on that and
the GLP is a life-changing medicine for some of these people out there without a doubt. So what I saw the chart that we have what is the exact cost for somebody that goes if we come up with this direct to consumer plan
what are they paying now and what would they pay in the direct consumer plan for the diab and this is not related to diabetes let me get clear on that if they're on a if they're on I can't remember the names of them all
but ompic or something for for uh diabetes That's not affected. Correct. >> Correct. That's not >> Okay. So, what's the cost for weight loss? >> I think they're currently paying $60 for per month >> and depending on I think it's the level
of the injection depends on the cost. So, I think take the one that they that was at the top. I think it was going from be from $60 a month to $299 a month up to $49 $449 a month.
Um, and that's a 45day supply. So that's I think right now there that's that's a month and a half supply versus a month supply. So it it ranges depending on whether they do the injectable or the oral. There are several different ones like WGOIA
um does both and they have you can see on it's on page it's on the direct uh cons. Okay. Right there. Thank you. And and I do want to say u and I'll just ask Suzanne and um
and and um >> Rachel Fre. Thank you. I know we were on the phone the other day. Apologize. Uh, is today the drop dead date for a decision? I mean, absolutely a drop dead date for
a decision. >> No, we're we're actually planning on coming back uh in June uh for ROI on the health center >> um on June 16th. So, we we could come back on June 16th. So, I mean what I would suggest and I'll
take full responsibility, Commissioner Adams and board members, uh I'm not following up and uh because I do recall the request for the survey uh and I did think the right way, but I I don't disagree with you in terms of people
having to navigate through the app and and go do it voluntarily versus just providing an email to all employees with a hyperlink. let them take the survey and we could bring that back at the next meeting for you all because I think I think we've
unders we've projected that we're going to continue this current plan for this year throughout this year throughout this fiscal year and any changes would take place in October 1st. Um, I know on the budget side we'll have to work on
that, but it just uh I think if the the two week you're saying June 2nd or the >> It would be June 19th. >> June 19th >> or is it the 16th? I'm sorry. It's the 16th. Thank you. >> So that would provide approximately, you
know, two weeks and then allow us to aggregate the data and present it to the to the board at that meeting. I I appreciate that, county administrator, but I I I don't agree with with kicking the can. I don't know.
Survey is not going to change a whole lot. The question is is two things. One is uh you know, personal responsibility. Uh what did we do before GLP? That's a question that we all should ask. Second
is uh is it appropriate for 75% of the participants to pay collectively for 25% of the users? And I would strongly argue that that's uh
that's not appropriate. Um we have 27% of our prescriptions through this agency going to GLP1. Um the survey is not going to change anything, Commissioner Adams. Um, fact >> I'm not suggesting that we don't take a vote today. I was just making very clear
my issues with this process which I have stated all along and they haven't been addressed or changed. I get the outcome. We can vote. I have no problem. But I'm just pointing out I asked for certain things. Commissioners asked for certain
things and those things weren't done. >> Understood. Also with respect to vice chair moss through the years you will see uh some of your I don't want to call them high cost users you will see that kind of eb and flow in fact two years
ago we talked from this very das that we had a quote a good year uh and we can't fault anybody's health for that but we do know uh that next year could be significant not significantly but could be reduced and as commissioner man said,
"If we're being realistic, friends, if we look at five years, uh the cost of things have gone up and for us to sit uh and think that medical costs haven't gone up and how we can urgently try to control
that, you know, the fact is they've gone up to your point >> and and Mr. chair. I mean I think at the outset it was noted that there was five years of positive plan performance and
last year was the first you know at which we found oursel you know in a deficit and the board I think rightly so we thought that you know because it is a trend it does it it does eb and flow but we had five years
of positive plan experience claims experience generally speaking And last year was the first year and then it's followed up by this year. I don't you know so uh it's it's going to happen. It's it's it's that's and now we're
taking measures to increase the costs on both of which the employer the county is certainly bearing most of the cost in that increase. Uh and that presents issues for some of our agencies that also rely on us. So, we'll have to work
on that as well. But, um, I don't think that in light of the fact with a five-year plan performance, you could say that it's not working. It just it is, but we've had, you know, that's what insurance is for, is when the catastrophe or something happens and
it's there for the employees. >> Mr. Ar. >> All right. Let me let me finish. Let me let me go back to the finish up on the GOP. So, we still have the cost. How does the process work? If we go to if we go to the li or we go to the direct
consumer, let's say, okay, I need to I need to get a GOP. What do I got to do >> through writing? What do I have to do? >> Yeah, the member would connect through rightway. So, rightway would guide that entire process. They would be connected with a health guide at rightway and
rightway would be responsible for connecting them to the supplier the manufacturer for WGO or Zbound and they would hold that member's hand to walk them through that process. The member would receive a card that they would then link a cash pay card that they
would link to their own personal account and that would be the payment method to connect to that direct to consumer pricing to give them that access >> and they'd be able to get any discounts or something that maybe the manufacturers >> Correct. It's that payment card that would enable those discounts through the
manufacturer. um and essentially they would be getting a discount over what they would go direct and they would be able to do it um just with their hand being held. So it' be a lot smoother process for the member. >> Okay. And I think one of the things that would help with that is
>> I I don't have a big problem with that as long as it says specific with it. It's basically elective surgery, you know, to to get your knee repaired or something like that or your shoulder or something like that. That's that's probably a okay
way to do it, but I I'd still there might I still think there might be some might be a little push back on that, but I don't have a lot of heartburn with that. The deductible and co-pays formula that you came up with that I think that just going to take a
little more of me reviewing it to be comfortable with. It's not out of line by any means. I don't I don't think it is, but it's something that we need to to look at as a as a whole. As far as the retirees on
Medicare, and you and I had this conversation personally about about my insurance because when I turned 65, it was supposed to be, you know, that I get off the retiree plan and on to Medicare and and and this the supplement plan. I
got the impression then when we had our talk about that that that's that's an almost an automatic deal. You said, "Well, you can stay on the county's plan, but you pay a lot higher." I think we're actually doing a disservice to our retirees if we don't educate them and tell them basically,
you're paying more money by staying on our plan. You need to get on this supplement plan and Medicare. And and I can tell you some of those supplement plans, my mom had it when she was in the hospital and boy, they took her right in, gave her the best room and the best
care because it was a good paying thing and it wasn't very expensive. So I would say that's one of the solutions that we can do inhouse is get in touch with all those retirees and and tell them, you know, you need to save some money and
kind of, you know, move on to another move on to another plan. and it's almost not an option anymore. There's maybe a grace period after you turn 65 if we can do that, but that's almost something they need to they need to migrate out, >> right? And also will make that outreach.
They will they they have identified the individuals the retirees who qualify to move and they will do one-on-one personal consultations with them, search for plans in their service area wherever they reside and help guide them and make
those decisions based on what you would pay to stay on the county's insurance versus transitioning to a plan and what your your premiums and things would be. So that's that's that support that we're we're hoping to add. But is that something we need to pay for? Is that not something we that that that we could do on a staff level?
>> So from a staff level, staff doesn't have that Medicare experience to be able to understand those marketplace options. Um there's actual um you have to have a license if I understand in order to provide that type of a guidance to
someone and not place yourself at risk for potentially driving somebody and you didn't you weren't really the person in the best position to do that nor licensed to do that. So that's why ALUP does that. >> So I I turned 65 and I don't know what
I'm going to do. I call you and say, "Hey, Suzanne, you know, I know y'all want me to get off this plan. I don't really know which way to go." This is where ALS or whatever comes in and says, "Okay, this is so they're a just a
they're not a provider. They're just a somebody professional guidance." >> Yeah. Yeah. Yeah. other thirdparty consultant guidance to provide that education to your 65 plus population on their Medicare options that are licensed
um Medicare health guides. And so they'll run the quotes to have Medicare in their geography to see what that compares to the county plan. They'll bump up the premiums. They'll take all of the information from the retiree as far as their out-of- pocket costs today
and let them know what that would look like on the Medicare plan and then they would be able to help them make an informed decision. >> Is there a cost to us for that service? >> Only if somebody transitions off the plan. It's a it's a contingency fee for service. >> Okay. So, it's a one-time cost and per
in per individual or family and would move on. And so we've talked about a a three-year plan there where after the first couple of years, if ALIP is successful um in working with your members and guiding them to the best solution for them, that population will
essentially dwindle as far as those who are paying the less subsidized rate the county and then we would be able to terminate that all contract as there's no 30-day notification period to terminate. There's not a contractual period that you're left in. So you can terminate that at any time. So if
somebody options off and they get out and they go to med, they go to medic, they get on A&B and then they get on, you know, whoever company out there, Humanana or whatever on their on the over 65 as a supplement, they're off. So they're no longer a statistic for us
anymore. >> They're no longer on the plan. Yes. >> Okay. So that could be some of the high cost things maybe for somebody right now, but those go away because they're not anymore. The high cost thing I yeah I I I've been here long enough to
know that we've seen it come and go. I had one of my you know one of my dear friends that I worked with for many years Mike Davidson was a highcost employee at the time and and uh you know and I know those come and go but we have to be prepared for it but I think we
need to look at that how we can prepare better for that you know fundwise. Um I am still kind of I gotta agree with with Commissioner Adams on this with mostly I agree with
what Commissioner Lur said too, but I'm still kind of I don't know if I'm ready to necessarily even vote on it today. I need I think I just need to digest this a little more because this is a is every year I I I kind of every year we've come up with this there's been really easy years and
and not but uh I I don't know. Um, I mean, I will, but I'm not I'm just not ready to I don't think I'm ready to to commit yet until we get some more information and get some more ideas. And I'm not so sure I know what those ideas are yet, except for what what we've
talked about. But, u, if you know, if we've got time to bring it back on the 19th, it could have more information and it doesn't affect budgeting or anything like that, >> would it? Yes. No. would certainly affect. >> I'm not kicking the can down the road by any means because this is something that
I want. This is part of their employee package for their for their wages and services and everything else and I don't want to keep them hanging. But I don't want to do something that we didn't cover all our bases with. >> I I what I would say is there Well, I
got two thoughts. One, I don't believe it is kicking the can only because the plan changes wouldn't take effect till October 1st. regardless. Uh secondly, the other thing that the county does offer is a flexible spending account and
that would give the employees the opportunity to increase their by period their their bi-weekly increase. Uh just doing some of the math at the 45 days, you know, somebody at the lower end is looking at $2,700.
Isn't the new limit going up to is it 6,000? I would have to check on the limit. >> I thought they changed it for this upcoming year from 5,000 to 6,000 which is pre-tax or some savings, you know, reduces their taxable income. And so
that would help, >> you know, that the employees to adjust because come October 1st, it frontloads that that flexible spending account. So, it's not a direct right out of the pocket. it's coming out over the remainder of the fiscal year to pay for
those costs. I'm not saying it's it's a panacea to to solve it, but it certainly helps, you know, by having a flexible spending account and using that wisely and maximizing that the taxable savings that you could get.
>> I want to make sure that all the constitutionals and stuff are good with this. I know the the the clerk of the court has a weird situation that we want to remedy with regards to how he's funded through the state in some of his areas and I know we want to remedy that
uh for him. So I'm I'm kind of whatever whatever y'all want to do, but I'm >> Does Commissioner Commissioner Flesher have any comments? >> He's muted. >> He's muted. Um, I appreciate that,
Commissioner Man, but the fact is, uh, we have had ample time to discuss this. Uh, I guess depending on how much time you want to put into it. The fact is, uh, it is very important for the budget process. Uh, I think we've each spoke
with, uh, Clerk Butler. Um, we don't have any control over his dollars coming in from a particular area. Um, you know, so I I obviously can't make a motion as the chair, but uh I think it's
time to move on. I think the hard work has been done not only by Suzanne, but our our consultant. Um, and sometimes it's a bitter pill that we have to swallow. >> I've been down this road before, sir. I knew I knew all that. I just feel like
there should I don't mean this in a negative way, but I I just think like I think I think we need to there's some more thoughts we I think there's more thought we can put into this and a little more information that that we
need. I I know how I know how this you know >> what type of information >> I know how this works but I I just I just want I'd like a little bit more thought on how the process is on this
whole process to clarify it for the employees and for all of us to make sure that you know I'm okay with the GLP going to direct cons to direct but until I asked you I didn't really know how worked today just five minutes ago. So,
I think we just need to make sure that these things are clear with all of us on the on some of the some of the options. Make sure the lantern thing is perfectly clear with with everybody. >> We do have our employee health fair coming up and we obviously would as we
always do educate our employees through the employee health fair which is in person if you recall. that think that this will be the third year it it's since its return and uh we would double our efforts and
identify those you know or those that are using currently GLP1s make sure that they're aware and maybe have a special session with them and rightway >> right well actually through our open enrollment process we would dedicate um
a a strategic uh outreach that would be uh coordinated with Rightway. Rightway has all the medication information on the 4,000 lives that we ensure on our on our plan across all constitutional agencies. We as an employer don't have
the specific individual. It's PHI. Um we would not know who is receiving u medications nor do we receive any reports that reflect that. Um everything is deidentified from from what we as an employer receive under the health plan. However, Rightway sees it and they
>> I was going to say could Rightway not send out a letter they would absolutely >> individually without our knowledge and saying at the employee health fair. Yep. because that's before open enrollment >> and say we will be there to help you
understand the direct to consumer options so they're aware well in advance that hey I need to go and I need to make sure I meet with rightway because we would then we would know who is being notified is that correct >> yes if a decision was made today we
could notify rightway immediately and work to meet that deadline of sending out a letter prior to that health fair which is about three and a half weeks away. >> Correct. >> Yes. >> Any further any of our stakeholders would like to comment?
>> Commissioners, what's your favor? Let me just add by John. I believe with the talking to our retirees perhaps could ultimately lower our oped a bit, not a lot, but a bit.
In other words, they would be off of our plan. >> Would it help to bring this back the first meeting in June? The the only reason why I think we were coming back in June initially was to do a review of the return on investment for
our employee health and wellness clinic and or center. Um so that was the intent for that particular to bring that update because we don't have that. So, uh, I if if the board is set to make a
decision, I think we're set to start implementing that. Um, but we can still I think with the decision that's made if if centered around the GLP1, it would give us more time now to
to reach out the right way and to make sure those employees or those members or family members are are aware and they so they take the time to attend the health fair and potentially meet or understand the options that they have as it relates
to the direct consumer. I'm fine with waiting until the first meeting in June if that's something that the other members would like. >> Is that a motion to continue this discussion until June second? >> If if we need a motion,
>> speak up. Susan Suzanne has some comments. >> So, um I am going to be out of town that week. Um I am planning on a June 16th uh uh presentation with our Marathon Health
Center. Um perhaps um if there are elements that the board wants to set aside from today that we could discuss on the 16th. Maybe you could resolve funding today and then if there are plan changes that you need further
information on or further discussion, we could come back and um revisit any of those recommendations. >> Well, when you say uh resolve funding, do you mean the premiums? >> Yes. >> Okay. Um, >> and then the other items, if there's
still some concern related to that, um, related to the plan changes, the recommendations, any additional information that's needed, uh, we could certainly get those questions answered before, um, the June 16th meeting, and that would be able to allow us to make a
a funding decision so that we could, you know, um, move forward with our budget. Right. >> Um and then the other items would be related to just plan design and things of that nature. That that might be an option. >> Yeah. Well, I'd make a motion to um
increase the premiums then. That takes care of the funding. The second >> if I understand the motion correctly, Vice Chair Moss has asked that we essentially continue this. >> Right. Well, no, we'd be voting on the
funding. That's what Suzan you would vote on the funding today >> on the funding which is the premium according to Suzanne. >> Well, >> then we can leave the rest of it. >> Right. We could do that. But Suzanne, I believe there's some things could change
if uh we were to closer examine certain things that could ultimately affect premiums. >> It the premiums would include the GLP1 removal. So that >> let's just so let's so you I think in order to do that I think if you're going
to discuss premium I think you need to look at the costsaving strategies and if there's one in particular that you don't that you want more information on that's the one we can bring back but you could go down like plan design yes or no do you like option A or option B what's
recommended by Lockton is you know the the increase they're all have increases in the deductible or the out pocket maximum one at a lesser extent plan A option A and that saves $749,000.
Option B saves a million 9,000. And then you go down to the medical, we could go through there if you want to go that and then this way we could start building this for the purposes of the health fair and everything else that we have to do. But if there's the if the GLP1 is the
one that is causing consternation, we can go through all the others and get that done and then come back if there's but I think to Commissioner Lur's point, Chairman Lur's point, when we ask for more information, what specific what
specifically do you want to know about more information? Mr. Chairman, I'm I'm good with that. I just think we just need to be crystal clear to our employees about
what we're looking at doing, how it works. say that I'll just use the GOP for example since that seems to be the hot topic that we're not taking your GOP away. It's just going to be that those people need are going to have to
pay a portion of the bill on this a little higher than what they what they what they've been paying. So I think the sooner the decision >> I think we got to be crystal clear on every aspect of we have to be crystal clear on the retiree thing because I think that's I think that's a major
thing we need to do is people that are 65 and older they they it's time to go to supplement just like I'm going to have to do thing things of that nature. Um, I like certain options versus other ones
um with regards to this, but we just need to make it we just need to make it crystal clear on on on what we're doing and and you know if if if there if we can make changes during the plan or something somehow, you know, before October 1st,
I want staff to bring those back to us to come up with come up with ideas of what we could do. This is could be ongoing, but if staff needs to know that we need to spend, how much is this costing us this year again? How much would it cost us to fund this
>> to fund which total cost of the insurance plan, health insurance? >> Uh this year we're we're looking at an $ 8.1 million shortfall out of our current year. Um so the uh that's what is um resulting in us requesting more funding
through premiums, increases in premiums and then we are also looking at proposing some uh cost savings uh mitigation strategies through plan design um through uh helping our retirees transition through removing the
GLP1 from being a pharmacy benefit under the plan but being a direct to consumer uh benefit. um through uh uh making changes to nutrition support uh for our members and uh through uh mandating the elective
surgeries for joint and spine with lantern. So >> So but to answer your question specifically, it's either $36.9 million next year or it's $33. >> 6 million next year.
>> Right. And it to be crystal clear, Commissioner Man, the the GLP absent diabetes and others will no longer be paid by the county. That employee will go through rightway
and they will triage their particular >> right their particular we need to be they need to be told that they need to be told this is this is this is how it's going to work. >> You know need to clear >> Mr. Chair, I think what I'm hearing what I'm hearing from Commissioner Earman and
Commissioner Moss is some concern that there's there needs to be some guarantee that there's going to be actual and meaningful outreach to the employees and there's concern that that's not going to happen and I think that's what's
delaying their want to make a decision and I don't know how you how you um guarantee that that's going to happen but the way it's happened in the past I don't think has provided the level of comfort that that's the way we
want to provide that outreach in the future because it's not has not necessarily been employee friendly it's been for the employees to go out and seek the information which perhaps maybe they
should be doing but at the same time I don't I don't think I'm hearing that that's the way We want to do it. We want to make sure that everybody is being um everybody is being visited and told about what's going to be going on and
that we as the plan providers are taking the initiative to reach out and have those conversations with them. And that's what I I kind of feel like is the concern about making a decision today. So perhaps somebody can talk about
exactly what that looks like so we can all understand what kind of outreach you're going to be doing and who's going to be doing it. >> So I mean I I think what we're talking about is uh I would say if the GLP is
not going to happen then we need to the sooner the better so we can get outreach. So I mean I think it's about increasing employee engagement in terms of one working with rightway having them send a specific letter to those that are on the GLP1 to understand that what
changes coming the sooner the better and then also making sure that there's rightways available at our health fair uh to be able to and the specific session for those that want to participate. uh making sure that we you
know for lack of it we we double down our efforts on the health fair although it has been well attended the last 3 years but I think it's just increasing the word and getting the word out because the health fair is where all of our employees get a lot of their
information prior to open enrollment and then be mindful that every year we do print a very detailed you know plan booklet that everybody can view to make decisions on their prior to open enrollment. And then maybe having a
special section that highlights just a p that highlights changes and that would identify things that you need to know changes that are happening rather than the existing health book that we what we put out have a specific page that ident
says here's the changes and then while they're incorporated later in the book and then also get that out to the employees as well. >> Yes. And I would just add to that, typically we'd recommend a first line of communication coming internal from the employer to notify your member base of
this change. That would be followed up by a direct letter from Rightway to Home mailboxes so that members are aware of the change in writing. And then that would be followed up by rightway outreach phone calls, emails, letters to notify them of the right rightway payment card direct to consumer program
to again hold their hand through that transition so that the members who are currently utilizing weight loss GLP1s are aware of the new access point. >> Well, for instance, I see well Dr. Smith did my left knee two, three years ago.
He did a great job. Now you're telling me I can't go back to him for my right knee replacement. It's got to be spelled out. They got to know. You just don't all of a sudden, you know, well, we went to this new plan and, you know, need they need to be
educated on that. >> Yes. >> See that happening, too. >> Moneywise, I'm okay. If we need to settle on different options, I'm willing to pick option A or option B, but we just
>> I think with all the discussion we've had, we probably Commissioner Moss, maybe you would want to uh simply with with all of the discussion we've had, modify your motion uh to bring this back
in totality because we start looking at particular items, those will be the item more than likely that'll be a major topic of discussion. Uh and that would be June
>> 16th. >> 16th? >> June 16th is when >> Commissioner Herman, you good with June 16th? >> I'm okay with that, sir. >> That's right. I'm okay with it. >> All right. I'll move to bring this matter back on June 16th.
>> Second. We have a motion. We have a second. Any further discussion? Hearing none. All in favor? I. This meeting will be adjourned until 11:15. 11:45 Commissioners, the time now is 11:45 on
May 19th, 2026. We resume the normally scheduled board of county commission meeting. Moving down the agenda, this brings us to county attorney matters. Item 14A, Bureates MSTU Advisory Committee,
vacancies, appointments. Good morning, General Council Scheler. >> Thank you. Um, this item that I'm bringing to you, uh, quite a while back, many years ago, the board uh, formed an MSTU in the Vero Lake Estates area and,
um, the property owners there pay $50 a year that is that goes into drainage and roadway improvements. When that ordinance was set up, it was set up with the with language that there would be a committee from property owners within
that community who could provide recommendations to the board on um on projects. And at this point that that committee had gone dormant. The last time that they made recommendations to the board, which the board adopted, was
2013. those projects that I sent you a list of them yesterday h have all been done and right now there's a pretty much a $2.5 million fund balance in that um account. So the Vero Lake Estates Property Owners
Association approached us to kind of revitalize the committee um and so what we we've advertised it for quite a while. We have there's seven members on the advisory committee per the ordinance. There are 12 applicants that
have uh presented their names for consideration. We've included all that information in your packet. So I um at this point we need a appointment to of seven members to this advisory committee.
>> Great. Thank you. Um, obviously this is in Commissioner Adams district and I'm guessing that she is more obviously intimately involved not only with the uh property owners association but as well
as with some of the applicants. I will defer to commissioner. >> Sure. So um having gone through the list I think the goal is to make sure we have a good representation of VLE overall both in involvement
um in age and in you know location around VLE where some of the applicants come from. Um there are uh several members of the POA on this list. There's also a member that has served um on the committee in the
past who has expressed interest in in being back on the committee. So um my and this is purely my recommendation but my recommendation would be um D. Maslin, Lisa Counz,
William Davies, Dale Group, Sue Valenza, Chad Sharpetta, Richard Clipstein,
and then I would also suggest that we have an alternate just in case, and that would be Mark Hayek. Okay. I've reviewed them as well and and it's a I think a similar list. Uh one thing that I did keep in mind as someone
that hadn't lived there for over a year, I kind of dqed them just for knowledge and recency. Um commissioners, any comments on Commissioner Adams recommendations? No, I'm I'm fine with that. And I think
it's good to keep uh people with current experience, people from the POA, so I I had them on my list as well. And also the person who was uh previously appointed in 2015. And I'm sorry, did your list include the um the sheriff's
deputies? It did. Okay. Because I Yeah, I had I had him on my list as well. So yeah, I'm I agree. >> Thank you, Mr. Adams. Is that >> That would be a motion. >> A second. >> We have a motion. We have a second. Uh,
Commissioner Flesher, >> it's got his thumb up. >> Thumb up. >> Let the record reflect, clerk. It's a thumb up. >> Any further discussion? >> She's laughing. >> Hearing none. All in favor? I. And congratulations to our new seven plus
the alter. And um I assume that staff will be reaching out to coordinate the first meeting. >> Yes, we um public works staff is going to be taking the lead on that, but our office is certainly willing to assist. >> Fantastic. Thank you.
>> Thank you, commissioners. Moving along to item 15, Commissioner Matters. And again, Commissioner Susan Adams update. >> Thank you. I just wanted to give you guys an update on happenings in district 1 since there's been some legislative things we've been working on. Um the
Felsmere Water Control District uh statute, I'm sorry, that change is still awaiting the governor's signature. However, uh we do have a signed interlocal agreement with the current
Bell's Mayor Water Control District and the county that will handle this transition period. I think we've just we discussed at a last um update kind of going ahead and getting that done. What that ILA covers, it protects um the
assets. It also calls for any any expense, any expense that's not budgeted uh for this next six months will have to be agreed upon by the county and will have to be approved at a public uh water
control district meeting. Uh they did just have their land owners meeting where they voted to keep the assessment the same going into next year. So we will inherit that assessment um which
will be basically a static budget. Um they also one of the uh superintendent's term was up uh Steve's term was up. They replaced him with uh Karen Leadford as as a representative of the property
owners. So that ILA will be on next uh our next agenda for ratification. Um but the attorney's office has been in involved in drafting that um ensuring that the language was what the commissioners wanted to see and had that
strength and enforcability and it has been as of 10:15 today it's been signed um by all parties at the water control district. So we are good to go there. The other thing I wanted to kind of give you guys an update on which is in line with legislation is the city of Felsmere
called together a property t kind of a what they're calling a property tax working group. Um it's comprised of one staff member uh from each city. Typically it's been their city manager
and then one city um council member. they reached out to John and Kathy and then myself to attend these meetings as well. Uh Kathy's got a lot of that institutional legislative knowledge on
what's going on in Tallahassee and they asked me to attend based on my involvement with FAC and Nico. Um we've had a lot of discussions on what's going on with property taxes. Uh the group did put together a letter that will if and
when something happens with property taxes, the idea was to use that as a uh communitywide coordinated effort to kind of have our voices heard in Tallahassee. That's on hold um before it would be
signed or sent. Of course, it will come here for input. I don't think it's uh gone to any of the cities yet. It's just something that the staffs have been working on a collaborative language that we can all kind of combine our voices for a stronger voice on that. Um since
that is kind of on hold right now. Interestingly, that group has morphed a little bit into looking at um larger legislative trends either in the state but also on the national level and trying to kind of collaborate on
appropriations. So whatever appropriations each is asking for kind of builds on that overall plan of of the county. So it's been a good group to combine our voices and make sure we're not working at odds on each with each
other legislatively but also um just to coordinate and and bounce off ideas. It's it is an ad hoc committee that's you know hosted by the city of Felsmere. the meetings have been in Felsmere, but we've had a couple and I just wanted to give you guys an update uh so you knew
that was going on, but also what those conversations have been. And if anything changes there, um we'll certainly I'll be happy to bring that back in in an update. >> We thank you and we thank you for championing that. Any questions for Commissioner Adams?
Hearing none. Uh that brings us to our special districts and boards. The solid waste district disposal. I see Meta here with annual CPI adjustment or the solid waste agreements. Welcome.
>> Good morning. Commissioners Shimea, managing director of the solid waste disposal district. Um we have multiple contracts uh under solid waste and they all have a built-in CPI clause and so um usually we wait a little bit later in
the year because some of the agreements have uh time frames that uh year-to-year changes that that are a little later but uh with budget preparations and then so on and so forth, we wanted to get this item in in front of you today. Um so we have uh basically our yard wastist
operations is with Atlas Organics. Um we we have that agreement that has a CPI index. It's June to June for for them. They have a max cap of 3% per year. Uh we have Indian River Sustainability Center. That's the H Heartland Evaporator System that also has a cap of
3% annual uh waste management. Uh that's both for universal waste collection and the recycling collection. Uh that has a max of 5%. Uh and then Republic Services for uh the landfill and the convenience centers that uh also has a 5% cap. And
then finally, bulk express. They transport the recyclables from Indian County to St. Lucy County and that has a uh 3% cap. So reviewing uh you know each of these uh companies basically submits their annual adjustment request to us.
We've reviewed them uh and and today presenting the individual request. Uh Atlas has requested a 1.38% increase. Indian River Sustainability Center has requested a 1.42%. Uh waste management uh Republic Services
and Bulk Express again they they tie in January to January change. It's it was a 1.22% to 2% increase. Um, and so, uh, we're here today to kind of get get the authorizations for these CPI adjustment approvals. Uh, they will be factored
into our our budget request and then, um, accordingly will get factored in, uh, to any adjustments in in rates. Um, so, uh, overall I did want to just mention to you when we look at all of these contracts and we look at solid
waste, uh, and I think it's, uh, it's on the second page of the agenda item of the budgetary impact, we're we're looking at total of like 32.5 million. So when we look at SWID funding and and what we're doing, these contractual services that run the gambit of our
operations from collection to disposal to processing, recycling, and so on and so forth, yard waste processing, leech evaporation. Um it's a it's a big big part of of our overall SWID budget. Uh and all of these have uh per per board
approval contracts that have an annual adjustment covers fuel prices, labor increases, and so on and so forth. Just so with that, I'm I'm uh recommending approval and happy to answer any questions you may have. >> Commissioners, any questions for director?
Um I mean I was just curious um why it's a different percentages the CPI the increase it >> it's uh >> I mean they're close but >> right some of the agreements are older like the Atlas agreement is much older than than uh than we have now. And so um
that they they have a a different monthto month. So I mentioned Atlas is June to June versus like Waste Management Republic or January to January comparison. So every month an index comes out, the consumer price index comes out and it's being compared
to year prior and so you're looking at the difference over yeartoear. Uh and then we usually in some of these have like a 75% of that CPI change and so that is what's contributing to the differences. Um overall what what uh
previous commissioners and whatnot what we've done is as we get into new agreements and working with the county attorney's office we have tried to uh modify those agreements so that they they all line up to more of a January to January time frame that allows us to get the timely request in and bring bring
them to your to the board for approval so that we can factor them into our budget. Uh and and so that's that's our goal and that's what we did recently with the waste management and republic is to line them up so that they're more January to January than later.
>> Okay. Thank you for the clarification. >> Thank you commissioners. What's your pleasure to have a motion by Commissioner Herman, a second by Commissioner Adams. Any further discussion? Hearing none. All in favor? I >> Commissioner Flesher?
>> No, he's one thumbs up. Thumbs up madam clerk. Motion passes unan. And finally the public comment non-aggenda related matters. Anyone has any comments whatsoever? >> Hearing none. Seeing none this meeting
is adjourned. Thank you.