BOONE — Creating a financially stable plan for AppHealthCare as well as researching capital improvement plans for county sanitation operations were two major priorities identified by the Watauga County Board of Commissioners on Feb. 13.
The board met for the first day of its two-day budget retreat to discuss the 2020-21 fiscal year budget and met with various agencies that receive county funding. It was during the discussion with Jennifer Greene, the health director for AppHealthCare (serving Watauga, Ashe and Alleghany counties), that the commissioners became concerned.
The county started a three-year recovery plan in 2018-19 for AppHealthCare — formally known as the Appalachian District Health Department — to help the organization reduce the amount it’s using from its fund balance. This included an increase of $66,215 each year, for a total of $680,705 in 2018-19 and $746,920 in 2019-20. The county is suggesting allocating $813,135 to AppHealthCare for 2020-21.
However, even with the increase in funding from Watauga, the agency is still having to use money from its fund balance to cover expenses. Greene said AppHealthCare is operating with a fund balance of 29 percent of annual expenditures, and if the agency drops below 8 percent, the state’s Local Government Commission will begin to investigate.
AppHealthCare does receive funding from the other two counties it serves, but not as much as it does from Watauga. Alleghany County allocated $212,706 for 2019-20 — the highest amount it has awarded to the agency in the last 15 years, according to materials from AppHealthCare. Ashe County allocated $544,358 in 2019-20 — also the highest it has allocated in that timeframe.
Greene noted that the current funding plan with all three counties includes Alleghany and Ashe counties funding the agency at the level to which they originally committed.
"I believe both Alleghany and Ashe counties have sincere interest in supporting their public health agency, too," Greene said. "We came to state the fact that we have a lot of ground to make up and we were looking for support to explore an equitable way to address our funding challenges together with a plan."
An AppHealthCare chart depicted the patient count, nurse visits and provider visits for all three counties that it served in 2018-19. Ashe County had a total of 2,205 individual patients, 990 nurse visits and 4,943 provider visits. Greene noted that Ashe County has a greater need for primary care as AppHealthCare is one of the only doctor’s offices in the county. The chart also showed that Alleghany County had 1,706 individual patients, 757 nurse visits and 3,914 provider visits.
In the same year, Watauga had 1,881 individual patients, 1,546 nurse visits and 1,262 provider visits.
However, clinical visits are only a part of what the health department offers. Greene said AppHealthCare also offers children’s dental services in local schools without county funding and promotes community health and surveillance to obtain broader grant opportunities to support public health needs that complement county funding.
Additionally, Greene said the agency provides more environmental health services in Watauga County since the county has a greater number of establishments — such as food, lodging, child care centers, public swimming pools and tattoo businesses. She added that Watauga County also served more students in the past year than the other two counties and that communicable disease response efforts are more focused in Watauga because of the population size.
County Manager Deron Geouque said there had been previous meetings with county managers of the other two counties served by AppHealthCare to discuss funding. He said that the managers at the time said that their counties don’t have the same tax base as Watauga, and therefore shouldn’t have to provide as much funding.
AppHealthCare officials stated that the agency already has minimum staffing, and even is under-staffed in some areas. The agency also stated that it has identified about a $1,165,166 gap in funding that it needs to be sustainable.
“We’re not the only district health department that’s in this boat,” Greene said. “I think we’re the only one that’s sounding the alarm. The reason for that is because public health costs money. It costs money that unfortunately isn’t state subsidized; it’s on the backs of the counties.”
Ideas floated among the commissioners of potentially separating from the other two counties if they don’t provide more funding and other consequences of what may happen if additional funding is not provided. The discussion ended with Greene and Geouque agreeing to try to meet with the county managers from Ashe and Alleghany to create a funding plan for the agency.
The board also met with county Sanitation Operations Services Director Rex Buck as well as Randall Baker with Baker Advisors and Mark Cathey with McGill Associates.
Baker outlined options to the commissioners for the county to potentially begin compost operations. Currently, the county is able to take brush and turn it into a single-ground mulch. The commissioners discussed options for double-grounded materials and the potential for composting. The county planned to research its options — such as whether to front costs to perform the composting in the county or transport the material elsewhere for profit.
Cathey presented plans for upgrades to county sanitation facilities on Landfill Road. He presented compliance and liability issues that he said needed to be addressed soon; the most critical being the pond located on the property. Cathey said the pond is not lined and doesn’t have a proper outlet structure. He added that if the pond were to fail, it would send debris downstream.
The trailer parking area also had a notice of violation and needed attention, but Cathey said it would be a relatively straightforward fix.
In terms of congestion, safety and efficiency issues, Cathey identified problems with crossing traffic patterns, the location of the Convenience Center being too close together to other options, confusion with transfer station traffic patterns and poor sight distance for tractor-trailers at the Landfill Road and U.S. 421 intersection.
Cathey offered a few different options for renovations to the area for safety and ease for users. The commissioners asked for the planners to provide more detail and cost estimates for the upgrades to the area at a future meeting.
Continuing a conversation from its Jan. 21 meeting, the commissioners met with staff from Watauga County Parks and Recreation to discuss the draft fees for the new recreation center. Information was presented that compared the fees to seven other recreation-type facilities in the state, and the commissioners agreed that the proposed Watauga rec center fees were competitive fees. Keron Poteat reiterated that financial assistance could be available to community members based on the federal poverty guidelines.
The Watauga County Board of Education also joined the meeting to discuss the 2020-21 budget for Watauga County Schools. Superintendent Scott Elliott listed the following as the school system’s current expense and capital needs going into the next fiscal year: the fourth year of non-certified positions salary study (including funding for teacher assistants), planning for the new Valle Crucis School, continuation of phase one of system-wide renovation plans, replacement of the athletic turf at Watauga High School and ongoing replacements of activity buses and service vehicles.
Elliott noted that the bigger ticket items will be included in the phase one renovation plans — such as electrical work at three of the schools and HVAC in several buildings. He also mentioned that some work at the schools had been stalled by the lack of a state budget passed by the N.C. legislature.
WCS Director of Finance Ly Marze said she attended a meeting earlier that day with other finance directors and Raleigh representatives who indicated that a budget may not be possible in the coming year unless changes are made in the coming short session in April.
The commissioners were scheduled to continue the second day of their retreat on Feb. 14 to discuss the Pritzker Children’s Initiative, the Guy Ford Paddle Access, the Middle Fork Greenway, the upcoming Census, updates on broadband, Watauga Medics funding and other matters.