Cascade County leaders spent much of Wednesday’s Board of Health meeting examining the department’s finances and weighing potential changes to programs.
The discussion followed a detailed financial presentation from Cascade County Chief Financial Officer Trista Besich, who outlined how revenues, expenses, and cash reserves have shifted since the pandemic and what that means for the Health Department’s operations.
Aneesa Coomer reports - watch the video here:
Besich told the board that while the department brings in revenue through immunizations, environmental health licenses, and several grants, those sources are not keeping pace with rising expenses.
According to the presentation, total expenses have increased 54% since before COVID, growing from $1.4 million to $2.15 million, while revenues have dropped back toward pre-pandemic levels after several years of COVID-related boosts.
The department’s operating budget is built from several streams: rural mills, county general fund dollars, a $250,000 contribution from the City of Great Falls, environmental health permit fees, immunization and vaccine charges, interest income, and various grants.
Besich noted that during the pandemic, federal COVID grants temporarily stabilized the budget, most notably a $260,300 infusion in 2023, allowing the county to maintain programs. But as those funds expired, the department’s cash reserves began shrinking.
The presentation also showed fluctuations in fund balance and noted that some programs are currently operating at a loss.
Besich pointed to year-to-date figures indicating that several grants provide less revenue than the cost of staff time, administrative requirements, and clinical components required to fulfill them.
Cascade County Commissioner Joe Briggs, who chairs the Board of Health, says the deeper financial breakdown was necessary to understand the scope of the challenge.
“One of the members of the Board of Health really wanted to get a better foundation on where we were,” Briggs says. “They see bits and pieces every month, but not the full picture. And the reality is, we’re in some fiscal straits right now.”
Briggs says the financial review underscored concerns about specific programs. He explains, “We have to determine which grant-funded services we’re willing to subsidize with other funds and which ones we just can’t afford. Our core mission is communicable-disease control. We do a lot of other programs that are nice to have, but they are not required services.”
He also points to programs the department cannot fully support due to clinical requirements. Briggs says, “We don’t have a clinician, so we have difficulty meeting the conditions of those grants where somebody like Indian Health Services or Alluvion Health has the clinicians necessary that they could, if they wanted to, appropriate those services. They’d be a good fit for them.”
Briggs said one set of grants has already been transferred to another provider, and additional programs are still under review. He added, “The hope is the services won’t go away, they just won’t be provided by the county.”
Besich said the department will continue providing monthly budget updates, including fiscal-year-to-date tracking, projected shortfalls, and any required supplemental appropriations.
Briggs added that transparency is essential as the Board of Health determines which programs to maintain, which to transfer, and how to align spending with available revenue going forward.
