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Cascade County health officials flag grant, billing and budget concerns including $915,000 expense shortfall
Summary
Health department staff reported complications with state grant requirements, billing cleanup and a $915,000 budget gap after using reserves; staff said the universally offered home visiting grant likely cannot move forward because required insurance exceeds a statutory liability cap.
Cascade County Health Department leaders told the Cascade County Board of Health they are actively reviewing grant requirements and cleaning up multi-year billing and accounts receivable issues that have produced a notable budget strain and program uncertainty.
Abigail (Health Department staff member) said the department has been working with finance and its medical-billing contractor to reconcile electronic health record data and how it posts into the county accounting system. Trista (health department billing specialist) said the department recently wrote off bad debt for the first time in four years and has identified process and policy gaps that contributed to inflated accounts receivable and gross charges.
"We think the AR is currently inflated," Trista said. She added that entries made to get claims out the door have artificially raised gross charges and that contractual adjustments and write-offs must be posted consistently to reflect true revenue.
Staff said the department has been operating some programs in expectation of grant awards and that one grant in particular, the universally offered home visiting (UOHV) grant, may not proceed. Abigail said the Montana Department of Public Health and Human Services(DPHHS) requires higher liability and cyber-insurance limits for that grant than the county can obtain because counties are subject to a statutory liability cap. "This requires us to get more insurance than we can get because of that liability cap," Abigail said. Several other counties reportedly have struggled to meet the grant's insurance requirements.
Finance staff reported the health department is currently budgeted for approximately $915,000 in additional expense this year tied to programs and reserves. Staff said they will recommend not continuing programs that should be fully grant-funded if the funding is not secured: "We certainly aren't going to be in a place where we can supplement programs that are supposed to be fully grant funded," Trista said.
Board members and staff said they need 30 to 60 days to complete assessments and present clearer budget options to the board of county commissioners. Staff asked for time to reconcile grant accounting, identify which programs will require county general fund support and recommend adjustments ahead of the county budget process.
Abigail also flagged federal developments: staff briefly discussed a recent executive order that paused new federal grant actions before it was rescinded, and cautioned the county is still monitoring federal grant policy changes that could affect passthrough funding.
No formal vote was recorded on funding changes during the meeting; staff described proposed contingency planning and indicated they will return with recommendations for the board of commissioners and the Board of Health.
