A leaked draft bill proposes to do away with municipal health departments and combine them into county districts, effectively regionalizing towns and cities in all matters related to public health.
The legislation would form county health districts and force suburban and rural towns into cost-sharing with cities. The draft plan requires each municipality to contribute 1.5 percent of their budget in order to receive state health funding and grants.
Currently, there are 73 different local health agencies, according to the Connecticut Department of Public Health, and some towns have voluntarily combined into districts. For example, the Torrington Area Health District includes 18 municipalities. Creating a health district for all of Litchfield County would increase that number to 29 different towns.
However, many other towns and cities have their own health departments, separate from their neighbors. Although the city of Hartford has its own health department, under this new bill the district would include the 28 different towns and cities in Hartford County.
Funding for the new health districts would be based on the population of each district and the operating budget of each municipality in that district. Each district will receive $1.85 per person in the district, provided each municipality in the district contributes 1.5 percent of their previous year’s operating budget. Funding would remain contingent on the commissioner of public health approving the program and budget of each district.
Current funding for municipal and district health departments is slightly different. Municipalities with a population more than 50,000 must contribute at least $1 per person and receive DPH budget approval in order to receive $1.18 per person from the state, plus any federal grant money. Health districts have the same requirements but receive $1.85 per person.
The Department of Public Health budgeted $4,083,916 in aid for local and district health departments in the 2017 budget.
For many towns and cities, the change from a $1 per person contribution to 1.5% of the operating budget would be a big change. The Torrington Area Health District, for example, contains 137,000 people across 18 towns. The district has a 26 member board which meets and determines how much each town needs to contribute per person in order to finance the TAHD. The current rate is $5.48 per capita.
The TAHD has revenue of $1.7 million, which consists of $451,356 from the DPH and $738,735 from the towns. The rest is comprised on licensing/permit fees and “other revenue,” such as federal grant money given by the state.
Under the proposed change however, the TAHD district would expand to 29 towns and Torrington alone would have to contribute $1.9 million to make TAHD eligible for DPH funding and grants. Other towns in the TAHD such as Litchfield or Plymouth would have to contribute $455,517 and $396,477 respectively.
Manchester, with a population of 58,000, operates a health department specific only to Manchester with a budget of $779,377. The DPH contributes $68,781, based on $1.18 per resident contribution. Under the proposed guidelines, the Manchester health department would be disbanded and the town would become part of the Hartford County health district. Manchester would have to contribute $3.3 million for the county district to receive state aid.
With a population of 898,272, a Hartford County health district would be eligible for $1.6 million from the state, plus any potential federal grant money.
Hartford’s health department has a budget of more than $14 million, which accounts for 2.6 percent of the city’s budget. Hartford received $2.1 million from DPH in 2015.
Municipalities would not decide whether to seek state funding. Instead a governing board of the county health district would. On the board, larger cities and towns would have more votes than smaller ones.
According to the document, the Commissioner of the Department of Public Health would appoint a “director of health” for each of the eight counties in Connecticut who “shall be responsible for leading the transition to the county district health department model.”
The director of health would oversee formation of a governing board for each county. The governing body of each town can appoint one person to the governing board. However, cities with a population of more than 50,000 will be able to appoint two members. The governing board will be responsible for modifying or adopting “reasonable rules and regulations for the promotion of general health within the district.”
The governing board will also have the ability to acquire property, file lawsuits and “provide for the financing of the programs, projects or other functions of the district.”
The governing board, which will meet annually, will then appoint an “executive board” which will consist of medical professionals as well as public members.
Word of this bill comes as some cities like Hartford are pushing the idea of regionalizing their services with surrounding towns. These health districts would share in the costs of adopting and implementing both state and local health policies.
Maura Downes, spokeswoman for the Department of Public Health, said DPH is “still in a very preliminary stage with legislative proposals,” and notes the agency has met with local health directors and districts to “get their input on legislative changes that DPH might propose.”
Local health agencies monitor public health issues such as inspecting restaurants and day care centers, investigation of garbage or pollution complaints, as well as monitoring drinking water and sewage issues.
Although, these departments of public health enforce state and federal regulations they are also responsible for enforcing local regulations as well.
“This concept needs to go through a thorough vetting process,” Downes said. “We need to have several additional conversations with local health directors, legislators, and other stakeholders before anything concrete is announced.”