Buncombe County Board of Health adopts FY26 fee schedule; director authorized to make midyear changes and Helene fee relief included

The Buncombe County Board of Health voted to adopt the health department's Fiscal Year 2026 billing guide and fee schedule at its April meeting, approving year-over-year rate updates and adding language enabling the health director to implement midyear adjustments.

Paul Watson, operations manager for the health department, presented the annual billing guide and fee schedule. He told board members the package is required to be adopted annually by both the Board of Health and the Board of County Commissioners and that the 2026 schedule reflects minor changes: 47 listed items had price changes (many tied to increases in vaccine and family-planning reimbursement rates), sliding-fee updates to align with federal poverty guidelines, and a billing-frequency change for accounts with outstanding balances.

Key clarifications given during the presentation: accounts with balances of $25 or more will be billed every other month (to reduce administrative costs); accounts under $25 continue to be billed quarterly. Watson said the department spends about $8,000 annually on billing activities and that most rate-setting follows Medicaid and commercial reimbursement schedules and a market review of surrounding counties. Environmental health fees and septic/well permitting were included in the fee schedule; environmental health staff reported no changes to their fees this year.

Board discussion addressed how fee changes affect access. The health department noted it does not turn away clients; several programs remain free (sexually transmitted infection clinic, breast and cervical cancer program), sliding fees are based on federal poverty level, payment plans are offered and unpaid balances may be handled via debt set-off processes.

Hurricane Helene relief: board members asked that the schedule incorporate fee relief for residents whose structures were damaged by Tropical Storm Helene. The motion adopted by the board included a provision approving any recommended fee reductions for residential structures damaged by Helene through Dec. 31, 2025. The health director is authorized to implement midyear fee changes as needed; the board and staff noted that county-commissioner action on a May 6 resolution could inform the specifics of any reduction but would not be required for the director to act under the board's existing authorization.

Vote and procedure: the motion to adopt the FY26 fee schedule as presented and to approve recommended fee reductions for Helene-damaged residential structures was made by a board member, seconded by Jennifer Horton, and passed by voice/hand vote. The meeting record shows the motion carried but does not provide a numerical roll-call tally; one board member who had to leave early provided assent before departing.

What changes and programs this affects: the staff identified family planning and immunizations as the programs most affected by fee changes; vaccine procurement pathways and patient-assistance programs reduce costs for uninsured patients. The billing guide also authorizes the health director to update rates midyear to align with changing Medicaid and insurer reimbursement rates.

Next steps: the health department will implement the adopted fee schedule, communicate changes to staff and clients, and, if county commissioners approve specific Helene-fee relief, will apply reductions as authorized.