Funding uncertainty has MCHD in 'dangerous financial straits'
They're well-educated guesses – estimates, if you prefer the term.
You look at what you expect to get, weigh that against what you expect to spend – and hope nothing happens along the way that negatively skews either number beyond reconciliation.
But what if you have no real way of knowing what to expect?
That's where leadership with the Monongalia County Health Department often is finding itself.
MCHD Executive Director Anthony DeFelice has estimated that up to 40% of the health department's budget originates from federal sources.
As with most sectors dependent on federal dollars, there's considerable uncertainty in public health.
The MCHD launched into an unprecedented budgeting process knowing some of those dollars are secure, some have already been eliminated and some are complete unknowns.
'The IAP Grant is the immunization grant. It's just been a given every year that you're getting that. We've had no indication. They stopped the IAP grant and terminated it,' county Health Officer Dr. Brian Huggins said. 'We don't know if the Vaccines for Children (Program) is going to exist next year. Those are significant funding sources that help pay for some of our nursing staff. With this budget, we didn't include them. If we get them, great. But we just don't know.'
And that, DeFelice explained, is how MCHD is approaching this budgeting process. If leadership is confident the funds are secure, they're included. If there's any uncertainty, the dollars aren't being budgeted.
DeFelice described the process as 'very thorough' and 'very conservative.'
Chief Financial Officer Devan Smith explained that the health department's program managers and executive team have gone meticulously through each line item in an effort to determine where reductions can be made.
Smith said budgeting in public health is already both art and science in that it often requires as much intuition as accounting.
'When you add in deep uncertainty about whether core functions of the organization will continue to be funded, it not only makes providing estimates difficult, but also means that you have to question what services will be kept or lost under different scenarios,' he said. 'What made this budget year so hard for us was not the mechanical process of performing calculations or reviewing expenses. It was weighing the people element –- potential reductions in the services we are able to provide to families in our community or impacts to employees we have worked with for years that may no longer have a job.'
Among the measures under consideration are fee increases. An initial example is a 10% bump in fees for the health department's dental program. A review of if, where and when MCHD can continue to offer free and reduced-cost services is under consideration. The health department also plans to keep all vacant positions unfilled.
Further, some programming considered 'enhanced' offerings – meaning beyond the core functions of environmental health, communicable disease, immunization, threat preparedness and community health promotion – are being scaled back as only core, or basic, functions are eligible for state and county support.
Huggins offered an example.
'The biggest thing that is changing is that our family planning clinic is going to go from five days a week down to a single day a week. The biggest reason for that is loss of funding streams that were supporting our basic services. Family planning is an enhanced service by state code. Family planning, unfortunately, loses money. It just does,' he said, explaining the program lost somewhere around $150,000 in the 2025 fiscal year.
'There is potential with family planning that we may have to discontinue services completely if the funding stream stops. According to the DHHS budget that's been proposed by the administration, family planning is on the list of services that is to be eliminated – not moved to a different service, eliminated from funding. If that occurs, we'll look at everything we can because we realize, for a lot of people, this is a critical service.'
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