With half of public health departments near bankruptcy in a state that ranks among the worst in overall well-being, Kentucky health officials are looking to lawmakers to overhaul how the agencies are funded in order to continue vital services.
A pension crisis and non-equitable funding model have led many departments to cut services to prevent closing their doors. The five counties served by Pennyrile District Health Department have not been immune to the crisis, but the outlook in Caldwell, Lyon, Trigg, Crittenden and Livingston counties is better than in many across the commonwealth.
For a few years, staffing vacancies created by attrition have been left unfilled across the five local health departments. The availability of an array of services has been reduced for some time. And starting this month, the doors on three of the facilities have been closed at least one day a week to make ends meet.
"We've not only cut to the bone, we're into the bone," said Jim Tolley, director of Pennyrile District Health Departments.
Staffing with the department is about half what it was when Tolley retired in late 2012. Last year, he accepted an invitation to come out of retirement and manage the health department amid a crisis that could see pension obligations jump from just under 50% of payroll to 93% beginning July 1.
That would not likely cause the district's five health departments to close like what could happen in other areas of the state, but many of the services currently offered could be cut altogether.
"That's going to hurt," Tolley said. "We will have to consider all options."
Even though Kentucky moved up two spots in this year's America's Health Rankings, at 43rd, it remains one of the 10 unhealthiest states. Shuttering health departments and eliminating vital services would ensure public health in the Bluegrass State continues to languish near the bottom of the rankings.
One of the services at threat locally is family planning, one of the larger programs offered by local health departments. Last year, it served 600 different individuals with an array of reproductive services for young women that includes contraceptives and sexual education following mandatory counseling.
Tolley is hopeful lawmakers see the urgency for public health and address needed changes in two key bills already being considered in Frankfort.
House Bill 171 would move health departments away from the current percentage of payroll formula for pension contributions and into a system that see them pay only what they owe divided evenly over the next 27 years.
Meantime, HB 129 would change the way public health departments are funded and prioritize resources. Known as the Public Health Transformation Bill, it would make funding to health departments more equitable, based upon the resources already available to the facilities rather than the current one-size-fits-all formula.
For Pennyrile District Health Department, that would offer a gain in annual funding of more than $332,000 spread across the five counties, reducing the need for local health boards to ask for a tax increase to provide funding necessary to continue services.
"That's not a drop-dead number, but it's a positive for all five counties," Tolley said of the estimate windfall, adding that HB 129 does not offer more funding, it just redistributes the money.
That means 14 of the state's 61 county and district health departments would get less state funding. Many of those are in more affluent areas of the state like central and northern Kentucky.
Tolley said the impact of HB 129 could allow all five health departments in the Pennyrile District to return to being open five days each week.
Health department cuts
Funding woes for public health departments across Kentucky have led to a reduction in services, including for the five county facilities of Pennyrile District Health Department. Starting Feb. 1, three of the local health departments saw their doors close at least one day a week to help makes end meet. The following shows how each county was affected:
• Caldwell: No cuts; remains open each weekday.
• Trigg: No cuts; remains open each weekday.
• Lyon: Thursday closed; open four days.
• Crittenden: Thursday closed; open four days.
• Livingston: Monday and Wednesday closed; open three days.