Dorchester County health officer outlines $18 million budget, service gaps and PCP shortage

Dr. Casey Scott, Dorchester County health officer, told the county council Oct. 21 that the health department's fiscal-year budget was just over $18 million and that funding is largely split between state core funding and federal pass-through grants.

Scott said the department uses collections and insurance billing to sustain fee-for-service programs and that several programs'positions are supported by a mix of county match, state core, and grant funds. She said the county funds a registered nurse in all 11 county schools and that the department's collection efforts are important because grant dollars fluctuate.

Why it matters: County health rankings from the Robert Wood Johnson Foundation show Dorchester County near the bottom among Maryland counties for health outcomes, Scott said. She identified contributing factors including an aging population, higher rates of disability, smoking, inactivity and child poverty. Scott said the county has one primary care physician (PCP) for every 3,270 residents compared with about 1,160 residents per PCP statewide.

Services and partnerships: In fiscal year 2025 the department conducted 25 mobile clinics, immunized more than 1,400 residents, served more than 200 residents with disabilities, and coordinated more than 18,000 ambulatory transports. As of September 2025, about 13,000 residents (roughly 40% of the county) were enrolled in Medicaid, Scott said. The health department established a telepsychiatry partnership with the University of Maryland for the detention center and expanded outpatient telehealth capabilities.

Workforce and recruitment: Scott said recruiting social workers, nurses and nurse practitioners is difficult in a state personnel system because pay scales are structured. The county is pursuing rural workforce strategies such as the Rural Maryland Scholars program and said state rural-health transformation dollars and workforce promotion are under consideration.

Environmental health and operations: Scott reported that environmental health issued more than 250 temporary food permits, completed over 720 property status requests, approved 245 building permits, conducted three rabies clinics and vaccinated 269 pets. She said the department expects to be fully staffed in environmental health by mid-November for the first time in a long time.

Council Q&A: Council members asked whether PCP counts include midlevel providers; Scott said data sources vary and that typical PCP definitions often include family medicine, internal medicine and pediatrics depending on the source. Scott emphasized workforce development and collaboration with state programs.

Speakers quoted or paraphrased in this article are limited to those named in the meeting record.