Commissioners of the five northern counties deny PHD budget

By Soncirey Mitchell
Reader Staff

Commissioners from the five northern counties met with Panhandle Health District May 20 to vote on the Fiscal Year 2027 budget, which includes an ambitious expansion and restructuring of clinical services. The group voted 4-1 to deny the budget, citing issues with PHD’s environmental regulatory side and with a proposed 2% cost-of-living adjustment for employees.

According to Idaho Code, the counties must pass PHD’s budget by Monday, June 1. Counties are required by law to pay into the health district; however, ongoing negotiation will determine how money is allocated to PHD’s various services. As yet, there are no plans to reduce current service offerings, but without support from the counties, PHD will likely be unable to move forward with planned clinical program expansions intended to broaden services and attract more regional users.

PHD requested $2,216,903 from Benewah, Bonner, Boundary, Kootenai and Shoshone counties, which is the same sum as last year. PHD set the overall proposed FY ’27 budget at $12,299,702 — funds that would come from a mix of permits, licenses and health services. PHD further planned to use $443,630 from its reserves.

The amount each county contributes depends on its population and valuation, meaning that had the budget passed, Kootenai County would have paid the lion’s share, totaling $1,479,299. Bonner County would have paid the second-highest amount, at $470,211. For every county except Kootenai, those numbers reflected a reduction of $1,000-$2,000 in contributions from previous years.

The FY ’27 budget was structured around changes to clinical services to attempt to tackle the “chronic disease epidemic” by hiring additional staff — including a social worker, two medical assistants, a nurse practitioner and a public information officer — and incorporating naturopathic medicine. PHD also planned to provide more clinic days in each county. According to the Centers for Disease Control and Prevention, three in four adults in the U.S. have at least one chronic condition. Chronic diseases such as heart disease, cancer and diabetes are the leading causes of death and disability in the nation.

According to PHD Medical Director Gregory Pennock, those changes would help to increase community use of the clinics, which would in turn fund the operations through insurance payouts and patient fees, making for “more budget neutrality.”

Still, at the outset of the May 20 meeting, Boundary County District 2 Commissioner Tim Bertling made the motion to deny the budget, which Bonner County Dist. 1 Commissioner Brian Domke seconded. Bertling argued that the proposed budget did not benefit his county, which uses Boundary Community Clinics in partnership with Kootenai Health, and that the district needed to “go back to doing what PHD does well,” by which he meant environmental services.

The proposed budget did not cut any funding from PHD’s environmental programs, and in fact increased septic permit fees to completely cover the cost of processing applications and testing sites.

Shoshone District 3 County Commissioner Jeff Zimmerman agreed, stating that his county frequently struggled with illegal sewage dumping and required additional assistance from PHD.

“It was my understanding … that we were functioning as expected,” said Board of Health Chair Thomas Fletcher. “So, that we are functioning subpar is new to my thoughts.”

He added that the commissioners had never brought up those issues during PHD’s many meetings during the budgeting process. Environmental and Health Protection Division Administrator Jason Peppin agreed, adding that his department handled all such issues, and that all the affected parties need do is file a report, and PHD staff would work with landowners to get into compliance, whether through septic or wastewater disposal systems or other means.

“We’re staffed appropriately in all the five counties, including Shoshone County, and the budget was crafted to be budget neutral in the septic program,” added Peppin.

According to Domke, the BOCC’s issue with the budget was the inclusion of a 2% cost-of-living adjustment for all PHD employees.

“The issue is, however, that if I were to vote to approve a COLA for the PHD staff, and then we are ultimately unable to match or do something similar for our own county staff, then I would be creating an inequity,” said Domke. “And so it’s a challenging situation and I don’t have a great solution, but I’m unwilling to create that potential inequity.”

Domke clarified that the issue stems from Idaho Code. Though PHD must pass a budget by the first Monday in June, Bonner County’s fiscal year begins Oct. 1, meaning its budget usually gets passed in late August. Therefore, PHD must pass its budget — with or without a COLA — well before Bonner County can determine if it has the budget to pass one for its employees.

Other commissioners agreed, adding that their respective boards worried that, with the additional employees and clinic changes, PHD would need to ask for more money from the counties in FY ’28.

“So, in our view of what the clinical budget looks like, we’re hiring nurse practitioners, physicians [and] clinical people to generate revenue,” said Pennock, arguing that each hire will likely bring in three times their salary in revenue because of expanded capacity to meet the demand for services.

“So in the private sector … we look at clinical people as revenue generators, not as expenses,” he added.

The counties voted 4-1 to deny the budget, with Kootenai County Dist. 2 Commissioner Bruce Mattare dissenting. The PHD board of health will present a new proposal on or before Monday, June 1, with different options for counties to opt out of clinical services. Doing so will not reduce a county’s overall contribution to the health district, which is set by state statute. As of the May 20 meeting, only Boundary County commissioners had indicated a desire to eliminate clinical services in their jurisdiction.

“Unwittingly, this would make for a much more efficient clinic,” said Fletcher. “If you think about it, for us to provide a once or twice a month service, 100 miles away, is an expensive proposition, whereas [Kootenai’s] patient population is just right here. It … just from a straight business perspective, is more efficient.”

Panhandle Health District meetings are open to the public and take place at the district’s headquarters (8500 North Atlas Way, in Hayden). Stream them online on PHD’s YouTube page or via Microsoft Teams by visiting panhandlehealthdistrict.org.