5/21 Board of Health Meeting - The Budget Cut Edition

Public Health Updates:

The Budget Cuts:

In April PH did not have the bottom line because they were waiting to see exactly how the legislation would be implemented. PH statewide has taken a $21 million cut of FPHS funding. This was the base funding to make sure the capabilities were there for providing all the basic services and for being ready for disease tracking and prevention. WA has taken the lead in these foundational services funding, and PH was just adjusting to having a steady supply of money from the state. To have it now constricted when it was intended to be persistent creates a lot of whiplash. The cut will be distributed with $16 million being cut to PH departments, and the remaining $5 million in cuts will be to the State Dept of Health. The cuts begin at the start of the PH fiscal year, which is July 1. Jefferson County’s slice of these cuts will be $556,000, and that is added on top of the $300,000 that was asked for but not given by the county’s general fund. (27% was Jefferson County’s total cut percentage.)

PH employees have been working hard to figure out how to align themselves with these cuts. How do they keep their staff whole to continue the work that they need to do? They have open slots now and retirements coming up, and this will make doing the work more difficult. Some of the state contracts that help PH do their work are going away. For example, the contractor in charge of after-hour public health emergencies is being let go. This is the service state-wide that takes the call, does the triage, and contacts the local PH as needed. How will local PH jurisdictions do without this service? The state also provides red-cap software for HIPPA-compliant sharing of information regarding contract tracing and food-bourn illnesses. Data management for a system this big allows the state as an integrated unit when responding to outbreaks. Every epidemiologist in the state and PH staff have been trained on it, so if it goes away, each jurisdiction will refer back to whatever ad-hoc system they used before the software existed. For some, this will be pens and paper. There was a discussion of the Ebola outbreak and the impact of FA cuts to overseas aid programs--these cuts mean that communication is fragmented and any slowing of the response makes the outbreak worse. There are parallels to be drawn with the cuts to programs at the state.

Infectious Disease Update:

Foundational Public Health Services (FPHS) funding cuts are coming at a time of cuts in everything. All the grants also are disappearing at the same time, as many of these grants were federal associated. There’s not an easy solution where an easy chunk of money can be found and plugged in to fill the gap. All the extra has been cut, so now cuts are in places like the State Public Health Lab, which will result in delays of testing. When we don’t pay for the prevention, we pay more for the outcome. When it takes extra days for the results of a measles test, there will be a larger outbreak that will cost more in the end. Much of this tracks back to the cuts at the federal level. When the federal government reduced the share it paid for Medicaid, WA used its money to backfill the Medicaid cuts. So WA preserved the healthcare for the population, but this has left less money for maintaining programs.

Hantavirus and Ebola are the big stories in the news, and neither are likely to  have an impact in the Olympic Peninsula. There is no mild version of either, and both do not look or present like a cold (like covid and measles). Neither is known to have pre-symptomatic transmission. Everyone exposed to someone exposed on the cruise ship is in quarantine. Hantavirus is most commonly from cleaning a cabin or barn, inhaling the virus from the rodent droppings, and 40% of the cases are fatal. If you get Hantavirus on the peninsula, it is from rat droppings. If you have to clean the barn, spray droppings with diluted bleach, then mask. Ebola is not airborne. It is people taking care of sick people who get it. The loss of the testing infrastructure is part of the reason the spread has been greater than it should be. Ebola can be spread by dead bodies, which comes up against cultural practices.

Measles is the only outbreak now that we should worry about. There are 40+ cases in WA, and some are community spread, which means there are unreported cases moving around. If there is an outbreak in a space you are in, you will have to prove that you have been vaccinated. UT, SC, FL, TX have widespread outbreaks. Any children over six months can be vaccinated if they will be traveling to a state with a widespread outbreak.

Fee Schedule Update:

The Clinic Team, Fiscal Team, and PH Management reviewed the data and cost analysis and have set the fee schedule for 2027. They are creating the fee schedule and sliding scale schedule, and they have also created forms for patients to use to access the funds provided by Friends of Public Health. They will then edit the ordinance that governs the fees. There needs to be language on transparency added in to describe the process. Once they have the language, they will present it to the Board for approval.

There was a question on how FOPH money is accounted for that allowed PH to explain to the public exactly how the money we all have raised will be used: The money FOPH raises gets sent via check from the Jefferson Community Foundation to PH. When it arrives at PH, that money is added to a specific program code in the budget and finance documents. Staff has been trained on how and when to use this code when providing patient care to the community. There is a part of the form where people can note that they need support (sliding scale) or they need full coverage (FOPH pays for all). The billing department then sends it to management to approve. It was noted that people are using the funds.

Alternative Code Enforcement Program Update:

This is one of the programs that was fully funded by FPHS funding.

We all generate waste, and there is an infrastructure to handle that waste, but for people used to hauling their own waste who for some reason can no longer access the infrastructure, that is where the waste piles up and becomes a compliance issue. Staff training and staff resilience is crucial. Staff has to figure out why the situation has happened, and often times people feel judged and ashamed, which manifests as anger. The language used has so much impact on people, and effective language is part of the success.

The goal is to get the place cleaned up, and that requires a unique skill set. When you have physical health issues, are suffering abuse, or in a mental health situations, trash is not the focus of your life. But trash piles up, Environmental Health gets involved, and they prefer to fix the underlying issues simultaneously with the trash situation. Discovery Behavioral Health case managers are under contract and that has yielded significant success. They have voluntary compliance plans, and the case managers help break that down into smaller goals that make it easy to get momentum going. Case managers have different boundaries and having them involved allows the Code Enforcement staff to focus on their role in the process. Rarely is it just code violations.

They told the story of a person with cancer, and their garbage was not the most important thing, then went on to several others to show what has been possible. There was a lot of praise for the Association of local realtors that provide a lot of support for people who want to fix their problem, funding the loan of the dumpsters to get the process started. This is a pilot process -- there are no other counties doing what Jefferson is regarding getting at the root cases of these code compliance problems and get them fixed.

Thirteen people are enrolled in the Alternate Code Enforcement Program now. Two people were enrolled last year. One person has been kicked out. Three cases have been closed. Two enrollees passed away (being elderly is a risk factor for code compliance). There are twenty people who could be in the program if there were funding and staffing to do the intensive work that is needed. There was a discussion of a program between Kitsap Bank and the Main Street Programs for loans with very low interest rates. The interest paid has helped fund follow-on programs.

Community Health Improvement:

This briefing got cut short because of time, but it will be briefed at future PH meetings. At its core, CHI is a best practice to help determine what a community needs. It brings people together, builds relationships, and strengthens the networks that the community needs to thrive. CHI anchors the plans in community priorities. The Framework is MAPP 2.0 - Mobilizing Action Through Planning and Partnership. This is a widely used framework that helps build on previous cycles. The 2013-2016 cycle was PH-JH-City of PT joint effort and was data-driven. The 2018-2019 was a different structure that had a co-directorship with PH and JH. This cycle had a lot of community engagement and was broken into age bands.

Phase 1 of the new CHI effort is to Build the Foundation, which includes bringing in the people experiencing the inequities in healthcare to guide the planning. This phase takes time and intention but it makes the rest of the process flow out of the community. Health equity is the assurance of the conditions for optimal health for all people. Health equity is a goal but also a practice.

Jefferson County Strategic Plan:

PH has been working on contributions to the county strategic plan. This is a 5 year strategic plan. The last was published in 2024, and the implementation process is underway. There will be a mid-June report on the progress. The objectives are combinations of a lot of data collected, and sometimes the goals that come out of that process need to be tweaked over time. Conveying more about what PH does and how they do it are part of the process