Cascade County health department warns of shrinking budget, staff cuts and program changes

Cascade County public-health leaders told the Board of Health this week that flat or reduced grant funding, rising payroll and the end of some federal programs have forced the department to eliminate positions and consider further cuts.

Health Officer Abigail Ellis said the department received "level funding" from some federal grants but noted that "expenses increase over time," leaving the health department with a structural shortfall. She said salaries alone for environmental health staff next year are projected at $533,000 while the program brings in roughly $150,000 in revenue.

"Level is a win, but it doesn't take into the fact that your expenses increase year to year with inflation," Ellis said, explaining the budget pressure. She said several grants are moving toward reimbursement-based payments or performance-based metrics, increasing the risk of reduced revenues if service targets are not met.

Ellis said three employees for a provider-based program were laid off and several additional positions have been eliminated through vacancies, reducing the department from about 50 positions to approximately 42. "In total, including those 3 that I mentioned, it's almost 10 individuals that we've reduced over the last year," she said.

Why it matters: Officials said mandated services must be preserved while discretionary or nonmandated programs are at risk. County leaders noted that without new funding, reserves will not sustain current service levels next year and more reductions are likely.

Planned steps and options: Ellis said staff are reviewing fee schedules, exploring partnerships to house certain grant programs (for example, cancer screening), and looking for ways to combine positions or coordinate with city partners. "One opportunity for increased revenue is immunizations," she said, and the department intends to continue prioritizing services that can generate sustainable revenue.

Board members urged prioritization of mandated services and noted that some long-running grants may be a better fit in other community organizations that already provide related clinical services. County Commissioner Briggs said the county will need to "right size" services to match ongoing revenues and reserves.

Personnel and leadership updates: The board heard that Dr. Amthor is being considered as medical director beginning July 1, pending contract finalization. The department also acknowledged the departure of provider Pauline Conway and her team; Ellis praised their patient care and said some of Conway's clients will have the option to follow her into other care settings.

Ending: Officials said they'll return with more specific proposals and fee-schedule changes; in the meantime, staff will continue to prioritize mandated services and seek partnerships to preserve community programs.