County health departments struggle, adapt as they wait to receive federal aid from state

The State of Montana had disbursed just 12% of the federal aid received so far through the American Rescue Plan Act, or $96.7 million out of $826.5 million, according to a budget and program planning report dated Nov. 3. All told, nearly $1.6 billion is appropriated to Montana.

Recently, at least a couple of county health departments in Montana have slashed staff and are using less effective approaches to address COVID-19 because the federal aid they thought they would receive from the state hasn’t arrived — or has been a fraction of what was expected.

In late August, Missoula County Commissioners sent a letter to Gov. Greg Gianforte pleading for resources to address spiking infections, and in particular, for money to do contact tracing. 

Last week, D’Shane Barnett, head of the Missoula City-County Health Department, said the county revamped its approach to contact tracing because it hasn’t received adequate funds, money he said the federal government intended to help address the public health emergency.

“It’s not as effective, but it works within the resources we have,” Barnett said. “And it’s unfortunate. It didn’t have to be that way.”

RiverStone Health in Yellowstone County had requested $800,000 for public health workforce, a case investigation manager, investigators, contact tracing, and data entry, according to the health department. RiverStone noted it received $70,000 from the state instead.

“If we had funding, we would have the ability to hire more personnel and would not have to be looking for a volunteer pool,” said Shawn Hinz, deputy health officer for Yellowstone County, via a communications coordinator.

Some public health officials point to information provided on the state of Montana’s American Rescue Plan Act website, called “One Stop ARPA Resources,” as evidence in part that they should have received more money. In particular, the One Stop page lists $143.4 million for testing and contact tracing, as does the appropriation in House Bill 632, which implemented the federal act in Montana.

However, Rep. Mary Caferro, part of the Health Advisory Commission that recommends how funds are allocated to the state health department, said the problem goes beyond federal dollars for contact tracing. For example, the Nov. 3 ARPA program report from the state notes the state Department of Public Health and Human Services had dispersed none of the $7.3 million for “public health workforce capacity enhancement.”

“A general theme is the administration is doing the bare minimum to get this money out,” said Caferro, D-Helena. “They’re doing the bare minimum.”

As an example, Caferro said the commission considered a proposal over the summer to spend $30.2 million to help with contact tracing, and it ended up recommending $17.7 million. The money was supposed to help schools reopen, and a survey of schools showed a high need, with 80 percent of schools responding, she said. Yet Caferro said just $2.5 million of the $17.7 million has been paid even though the school year is in full swing.

The Nov. 3 report noted that just $500,000 of the $13.6 million for “vaccine distribution, confidence and supply chain” had been paid, but Friday, the Department of Public Health and Human Services noted roughly $7 million had been obligated. It wasn’t immediately clear if more had been paid since Nov. 3 as well.

In response to the characterization that his administration is doing the bare minimum to get money to intended recipients, Gov. Greg Gianforte’s office directed questions to the state Health Department. Caferro said the administration’s rationale in the case of the $17.7 million is that few schools have applied for funds, but she said that’s a problem as well.

“The distribution is full of red tape and hoops,” she said. “And it ends up that inherently less money gets out into the community where it’s needed.”

In recent weeks, the state of Montana has been a hot spot for new COVID-19 infections and slow with vaccinations. Friday, daily case numbers were on their way down, 38 percent compared to two weeks ago, and hospitalization rates had dropped. But Barnett said the upcoming holidays will bring people together indoors and mean travel to places in crisis, such as Colorado, and he anticipates another wave of sickness is around the corner.

“We’re fully expecting spikes for COVID,” Barnett said.

In an email about the delay in Missoula County, Department of Public Health and Human Services spokesperson Jon Ebelt said the county did receive funds, if not from the pot of money in question. He did not respond to the characterization the state isn’t working hard enough to get the federal money to intended recipients, but he shared the status of grant approvals.

“The DPHHS Public Health and Safety Division has received and is distributing funding through ARPA CDC grants ($63,229,482 to date and $56,994,995 has been approved by the Health Advisory Commission) to support COVID-19 testing, vaccination, and mitigation strategies in specific settings such as county and tribal health departments, K-12 schools, prisons, etc.,” Ebelt wrote in an email. “These funds are being used to support testing through our state public health and our partner laboratories, rapid testing for local health departments, health care settings, K-12 schools and universities, prisons, nursing homes and other settings, and funding to support prevention and mitigation efforts in nursing homes and assisted living facilities.”

He also noted that DPHHS has released funds for $5 million in contracts with county and tribal health departments to support COVID-19 vaccine related efforts: “DPHHS is also providing over $4 million in funding to support local and tribal health departments hire additional workforce capacity to support their COVID-19 response and needs, including contact tracing.”

Since the vaccine has been available, people have been “throwing caution to the wind,” and social interactions are up, Barnett said. That means that when a person tests positive, that person might have 100 or so people who can be considered close contacts, representing thousands of calls when infection rates are high.

In the past, the county had contact tracers calling to help slow the spread, but not since at least the last six months, when Barnett took the helm, has such a program been running in full force. He said with adequate funding unavailable, the county shifted to an automated system instead of relying on limited contact tracing.

“It’s more effective as what we had before, but not as effective as if we had contact tracing funded in full force. Absolutely not.”

And since the county had to pivot, it needs to continue to use the system it has set up, Barnett said. So he said the time has passed for the county to be able to use money for person-to-person contact tracing: “Now, even if they did give it to us, it would be too little too late.”

In the meantime, though, the expenses are costly, and the lift is heavy.

RiverStone noted it has received a $1.5 million allotment from the state for vaccinations, but the money cannot be used on testing, contacting tracing, or investigations.

Hinz said RiverStone spent $60,000 in August alone on unreimbursed expenses related to COVID-19.

“A year ago at this time, we had 51 part-time case investigators,” Hinz said in the email. “Now we have one case investigation manager and nine case investigators working part-time to full-time plus (overtime) with youth investigations (people age 19 and younger who have tested positive for COVID-19). RiverStone Health is prioritizing youth cases and working with Yellowstone County schools to keep schools safe and open. We are closing cases, sending isolation letters, and manning the phones to answer many COVID-19 informational requests daily.”