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Health department details finances, warns of grant uncertainty and reserve drawdown
Summary
Cascade County Public Health staff reviewed monthly finances, saying collection from billed services is about 58.4%, vaccine purchases drive supply costs, reserves are being drawn down and federal grant uncertainty may force program prioritization; county will not proceed with one home-visiting contract.
Abigail, a prevention-services staff member, and Trista Vessic, the county chief financial officer, briefed the Cascade County City-County Board of Health on the department’s monthly finances and long-term funding risks.
Vessic explained the county’s recurring local support: the City of Great Falls contributes up to $250,000 annually toward operations and the county matches that amount; additional revenue comes from a per-capita rural mill levy and a permissive medical levy applied to non–grant-funded FTE. “That’s the tax mill component and the contributions that come from the city and county,” she said.
Abigail summarized program income and collection performance: the department’s billing company returns about 58.4% of billed charges on average. Staff said they have been cleaning up old receivables (including COVID-era vaccine billing) and are drawing down a cash reserve this fiscal year. “Total expenses for this fiscal year have increased by about $84,000 compared to last year,” she said, and the department has begun to use parts of its immunization reserve.
Vaccine purchases are the health department’s largest supply cost; operating costs excluding vaccines generally run about 10–15% of the budget, staff said. In that context, the department described a conservative approach to hiring and program expansion given potential federal funding reductions. Abigail told the board the health department is preparing for “increases in cost and potential decreases in funding” and is looking at billing options for some communicable-disease services to diversify revenue.
On grants and contracts, a staff speaker (identified as Miguel in the meeting) said the county is not proceeding with the universal home visiting contract associated with that grant. “Generally speaking, the county is not proceeding forward with that contract on that grant,” Miguel said; staff offered to discuss details after the meeting.
Board members asked for clearer lists of mandated services versus discretionary programs. Abigail and Vessic reviewed mandated areas (communicable-disease reporting and certain environmental health inspections) and noted many prevention services—immunizations, WIC, home visiting—are historically provided by health departments but are not universally mandated and may depend on grants.
Members asked staff to continue monthly financial reporting and to return with any recommended priority changes should grant funding decrease.
