City, county discussing health department funding
During their April 1 meeting, the city-county health board discussed the city’s response to their request for additional funding toward health department operations.
Cascade County’s City-County Health Department is a joint city-county operation providing public health services, including, but not limited to, vaccinations, restaurant inspections, rabies investigations, septic reviews, communicable disease prevention and family services.
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It’s governed by a joint city-county board, but CCHD employees are county employees, and operates under a 1975 management agreement with the city, much of which is outdated or unenforced.
The city and county disagreed about the makeup of a governing body established by the Legislature in 2021 as a reaction to COVID and operated under a temporary updated management agreement that has since expired. The two local governments have made no progress on negotiating a new agreement.
The cost sharing of joint operations has caused tension over at least the last decade, as the city shoulders more of the cost burden for the Great Falls Public Library and the 911 dispatch center, but the county funds the bulk of the health department and the countywide emergency notification system.
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For the current budget year, total projected CCHD revenues are $1,649,424 and total expenses are $2,257,383, with a projected $607,959 deficit, according to Trista Besich, county finance officer.
The city contributed $250,000 toward operations, with the county contributing $478,306 through rural mills, general funds, entitlement revenue and permissive medical funds. CCHD also receives state and federal grants and generates revenues for services such as inspections, licenses and immunization fees.
The city’s contribution has remained the same since at least 2015, county officials said, while the county contribution has made up the balance depending on revenues and expenses annually.
On Feb. 5, the health board sent a letter to the City Commission and City Manager Greg Doyon, “requesting an increase in the annual budget allocation from the city.”
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CCHD functions “contribute to critical public health infrastructure necessary for economic growth in Great Falls and Cascade County. The Health Department is facing rising costs despite measures to contain these costs as much as possible, while still providing those services mandated by law,” the board wrote.
All seven health board members, including City Commissioner Shannon Wilson, signed the letter.
On March 13, Doyon responded to the health board, writing, “We recognize the importance of public health services and appreciate the statutory responsibilities carried out by the Board of Health. Before the city can meaningfully evaluate the request, additional clarity is needed regarding the scope, basis, and long-term implications of the proposed increase.”
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Doyon asked whether the board’s request was a one-time adjustment, a temporary measure or an ongoing increase.
He wrote that the current annual contribution of $250,000 “predates current city staff and elected officials, we’re not sure how that was determined or what methodology was used. To assist the city in evaluating any additional funding request, please provide the current and proposed funding methodology or rationale used by the county for future contributions. We’re curious about whether the amount is tied to service levels, population, assessed valuation, statutory obligations, or another factor; and whether that methodology has been formally reviewed or updated by the Board of Health/County Commissioners.”
Doyon has been Great Falls’ city manager since 2008.
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In his email, Doyon writes that the city would like to better understand the underlying causes of the budget shortfall for the current fiscal year and whether the county considers it a one-time condition or a structural imbalance; and “what internal corrective actions or cost-containment measures has the county considered or implemented.”
Doyon wrote that interlocal agreements with the county and cost-sharing discussions have been a “sore topic” and asked the county to clarify whether the county’s request for CCHD funding is “related to changes in county funding levels or levy decisions; intended to rebalance contributions between the city and county; or connected to any existing or anticipated interlocal agreements or understandings.”
Doyon wrote that the city was interested in whether the health board and county were open “to exploring longer-term structural options, including alternative funding models authorized under Montana law, to address ongoing fiscal sustainability. The city does not believe that incremental funding adjustments, absent a shared long-term framework, will fully resolve the underlying issues.”
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Doyon does not specify those alternative funding models or details as to what a long-term framework might look like.
“The city looks forward to continued collaboration with the Board of Health and Cascade County. Once the requested information is provided, city staff will be prepared to brief the City Commission and discuss potential next steps in an informed manner,” Doyon wrote.
For roughly the last year, Cascade County officials have been discussing and cutting the CCHD budget, which The Electric reported in November 2025.
That restructuring has looked at limiting the use of unsustainable grants, reducing services that aren’t mandated by state statute and eliminating positions.
Last year, CCHD cut about $1 million from its budget and 14 positions through a reduction-in-force process and about another five through attrition.
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In health board meetings this year, there has been continued discussion of expenses outpacing revenues, potential additional cuts and changes to grant programs.
During the April 1 health board meeting, Commissioner Joe Briggs asked for their feedback.
“This is nothing new,” Briggs said, and that they’d attempted discussions previously, but the last time we tried to talk, “they took us to court.”
Besich, the county finance officer, said that she didn’t have extensive knowledge on how the city’s contribution was determined.
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Briggs said that the agreement between the city and county for operation of the health department called for joint budgeting and cost sharing.
“I can’t tell you when that agreement quit being followed,” Briggs said, and he’d been at the county for 21 years, taking office in 2005.
He said the city’s contribution to CCHD was “unilaterally” set by the city manager before Doyon’s tenure, and it was increased a time to two to the current $250,000 level.
“The county has had to make up every other dime of the cost,” Briggs said.
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Internally, Briggs said they’d discussed calculating the per capita cost of services, similar to how 911 dispatch center funding is determined by call volume.
He said the county pays 25 percent of dispatch operations, but the city charges for administrative costs such as legal and human resources.
Briggs said that the county, through the Cascade County Sheriff’s Office and rural fire departments, has no input on dispatch center operations.
Briggs said that the city is legally required to either be part of a joint health department or operate its own, and it would cost the city more than $250,000 to operate its own health department.
He said the county has previously considered whether it should “simply disband the city county health department,” but since city residents are also county constituents, ” we have been loath to do that.”
Besich said she would gather financial data to further address Doyon’s questions and asked if the board wanted to focus on mandated services or include the additional administrative costs.
Briggs said county officials have been reticent to include administrative costs in the discussion, even though the city bills the county for those costs at the dispatch center.
Rachel Amthor, a physician and health board member, said they should incorporate administrative costs since healthcare is getting more expensive and complicated.
“The city contribution needs to grow with time,” she said, and was “shocked” by the city’s annual contribution.
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Up until a few years ago, rural mills made up the bulk of the CCHD budget, but Briggs said they shifted that funding to the county general fund and used the city’s per capita formula to determine the amount of rural mills to allocate to CCHD.
“There’s a limited amount of money that we have to continue to pump into that,” Briggs said.
For the Feb. 4 health board meeting, county staff gathered historical data for environmental health and communicable disease activities to compare those within the city limits versus the remainder of the county.
That information was included with the board’s letter to the city.
Environmental health data from 2015 through 2025 included primarily inspections required by law for restaurants, hotels, tattoo shops and other facilities.
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For those years, the services provided within the city limits totaled 9,329, of a countywide total of 10,918, or 85.77 percent, according to the county.
Within the communicable disease division, staff reviewed data from 2021 through 2025, identifying Great Falls versus county for communicable disease investigation, tracking and reporting.
Of the total 31,910 activities, 29,857, or 93.3 percent, were within the city, and the remaining 2,053 were in the county areas outside the Great Falls city boundary.
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During the Jan. 28 city commission retreat, Doyon briefly mentioned CCHD funding and that it was on a bit of a “crash course” with the county’s seemingly reluctance to name a representative for the city’s new TIF review board after city commissioners opted not to appoint Briggs to the seat.
“I wish we had a better relationship with the county,” Doyon said.
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The city ultimately did not appoint Briggs to the TIF board, instead appointing a former county commissioner that the county doesn’t recognize as its representative.
