County health board returned over half of state funds last year. Will this year be different? (2024)

Now that the state has entered a new fiscal year, the Cowlitz County Board of Health and Board of Commissioners will have to decide how to spend state health funding that went largely unused last year.

Local health departments do not have to apply for the funding; it is allocated automatically, and any funding that is not used is returned to the system to either be reallocated or returned to the Legislature.

In the July 2023-June 2024 fiscal year, Cowlitz County was allocated $1,439,000 in state funding and returned $954,014, about two thirds of the available funding.

Some jurisdictions may end up being unable to spend all their funding for the year, but it is very rare for funding to be purposefully returned, said Jaime Bodden, managing director of the Washington State Association of Local Public Health Officials.

“Most counties are grateful to have dedicated funding to support government mandates they have been solely responsible for covering,” Bodden said.

What is the funding process?

First, the state Legislature allocates part of the budget to the fundamental services funding. In the 2023-24 operating budget, those services received $324 million, or $162 million per year, Bodden said.

A steering committee with representatives from the Washington State Department of Health, the state board of health, local health jurisdictions and tribes then decides what programs and services should receive the funding and how much they will get.

Once funding has been assigned to Cowlitz County Health and Human Services, the county commissioners must approve the contract to accept all or part of the money as part of the health and human services budget. The board of commissioners makes this decision based on recommendations from the county board of health, board member and County Commissioner Dennis Weber said.

Recently, the amount of funding available has greatly increased, from $58,739 to $1,439,000 annually, Cowlitz County Health and Human Services Communications Manager Kristin Young said.

Why was the funding returned?

The county commissioners were ultimately unable to make a decision about how to use the funding, and only assigned enough to maintain ongoing programs and make cost of living adjustments, Weber said.

The county accepted $154,643 for communicable disease prevention and control and $330,343 not assigned to a specific purpose, according to information from the county health and human services. It did not accept any funding for data collection and analysis or Lifecourse, a category that includes maternal and family health, medical and oral health, behavioral health, chronic disease and injury and violence prevention.

Weber said part of the issue was that the county board of health did not provide any recommendations. In the past, the county commissioners and the board of health had a more streamlined decision-making process because they consisted of the same three members, but a state law passed in 2022 added four nonelected members to the board of health who are unable to make final decisions about budget issues.

Weber encouraged the board of health to approve funding to hire an epidemiologist or other professional to conduct a community survey and find out what public health issues the county should focus its efforts on. Data collection is one area the health department could have used the state’s foundational services funding, according to information put out by health and human services.

“If we’re going to be spending tax dollars, we need to be data driven,” Weber said.

Along a similar line, Cowlitz County Board of Health member Mary Jane Melink requested health and human services compile a list of priorities so the board could make a more informed decision about how to assign the state funding. The list was created, but the board of health was not able to make a decision in time to take advantage of the 2023-24 funding.

The four main priorities health and human services identified were substance-use prevention and education, increasing treatment for sexually transmitted diseases, chronic disease prevention through promoting healthy lifestyles and environmental health such as water testing for arsenic.

“I think there’s some real opportunities to do a lot of good in the community using those dollars,” Melink said.

What about next year?

The county received the same amount of funding for the 2024-25 fiscal year, but has not yet made any decisions about how much will be accepted or how it will be spent, said Young with health and human services.

“I’m very, very hopeful that this year, when they receive those funds, the commissioners will allow the health department to use those dollars for the priorities they’ve identified,” Melink said.

One option county commissioners are interested in is possibly remodeling part of the county’s juvenile detention center for use as a residential treatment center for youth behavioral health and substance use issues.

The detention center has capacity for over 50 residents but rarely meets it, so the space is not being used efficiently, Weber said. Meanwhile, those who are assigned treatment currently have trouble finding local options.

Other potential areas of concern include sexually transmitted disease, opioid use and behavioral health issues, especially among the homeless population.