County health departments are requesting that Gov. Jay Nixon release the $3.3 million designated for public health projects and programs that he withheld from the state budget.
The local public health agencies (LPHA) had planned to receive $2.3 million plus another $1 million added by the legislature, but instead received nothing, said Kristi Campbell, director of the Cole County Health Department.
Multiple county departments - including Maries, Osage and Cole - sent letters to the governor's office requesting the funds be released. The Callaway County Health Department is planning to compose a letter but has not yet, said Director Sharon Lynch, who added the money was critical. Her office is still in the process of drafting its budget and the impact of the withholds is unknown.
Multiple county health department directors and administrators said the withholds will affect their ability to fund enforcement programs for food and lodging inspections, communicable disease and wastewater procedures, such as on-site sewage installation and inspection. Also that funding for local public health services was at $9.7 million in 2001 and is now at $2.3 million, representing a cut in 76 percent of funding.
The Cole County Health Department may not take as hard of a hit as others, because the funds for these programs comes from county taxes and the sewage-related costs are paid by permit fees, Campbell said.
Another fear is that some LPHAs will have to cut staff to deal with the loss of funding, and if the county department is already small or short-staffed then the loss of personnel will affect all programs that are provided through it, said Mahree Skala, executive director of Missouri Association of Local Public Health Agencies (MOALPHA).
The Columbia/Boone County Department of Public Health and Human Services support the request to release the funds, but has not sent a letter to the governor, said Andrea Waner, the department's public information officer.
Bruce Jenkins, administrator for the Miller County Health Department said he sent an email to the governor that echoes these sentiments. The money the government gives the health departments goes to enforcing statutes like food inspections and wastewater laws, and without the money the state may have to take over some of these responsibilities from the counties, he said.
The Osage County Health Department's letter requested for at least $2.3 million of the withholds be released, which is less than 0.3 percent of the more than $840 million in withholds. The appropriations for the health funds are designated for one year, so if action is not taken before the end of the fiscal year, June 2016, then the line item goes away and the funding is lost.
"It seems like the local public health agencies keep getting more and more tasks, but less funding," Campbell said. "People don't realize everything that the local public health department does. We can have the best colleges in the nation, but if people are dying from vaccine-preventable diseases it doesn't matter."
Many of the letters sent to the governor, including Campbell's, quote a 2012 study by the Trust for America's Health that placed Missouri second to last in the country for state funding to public health services. The state spends $6.08 per capita on health costs, compared to the national median of $27.40 and the only state Missouri beat, Nevada, at $3.28.
However, Missouri's decrease in government health spending is a part of a national trend, according to the study. From 2008 to 2012, states' annual per capita health spending decreased about $6.30.
MOALPHA along with the Missouri Public Health Association (MPHA) are the driving force behind the request letters that are being sent to the governor.
"We asked all of the local health agencies to write a letter," Skala said. "And I think many of them have. We have a 115 local public health agencies and I would say two-thirds are writing, so that would be around 70 places that have participated."
Skala also added that the withheld funding supports very basic functions of the LPHAs that many take for granted.
"Communicable disease control and public food safety services are more important than ever right now," Skala said. "I think the Ebola incident in Dallas reminds us of the importance of a good public health grounding to respond to emergencies like that ... and it takes some resources to do that."
The governor's office and the Department of Health and Senior Services did not respond to requests for comment.