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The Snohomish Health District was already seeking new revenue streams the same year COVID-19 hit.

The health district covers services that keep food, schools, and septic systems safe. It also responds to disasters and disease outbreaks.

The Snohomish Health Board was discussing ways to increase revenue, with board discussions in late 2019. Then COVID-19 demands sent the health district budget past its anticipated levels, from $17.5 million in 2020 to nearly $29 million.

In 2026, expenses are expected to slightly outpace revenues, said Ragina Gray, environmental health director for the district, in a presentation to Mill Creek's City Council. Plans are in the works, to prevent that from happening.

During the pandemic, "our normal work continued things like food safety inspections and annual inspections of schools and pools, these things were hampered, but not halted, by the pandemic," Gray said.

One added challenge to the COVID-era was the fluidity of rules and regulations. Shutdowns, phasing, and public funding created a need for guidance, so that businesses and other agencies could stay in compliance.

"The guidelines were ever-changing; COVID restrictions and the best practices were hard to gauge; and many restaurants struggled to interpret all the available information, while at the same time operating at limited capacity," Gray said. "We tried really hard to assist those facilities."

Of the cities and the county served by the health district, Mill Creek is one of five that declined a per capita status. Per capita cities pay a set amount per person, with a full payment based on population. That payment offsets the cost of services the health district offers within city limits.

Surrounding cities pay as follows: Bothell ($1.18), Mountlake Terrace ($1.02); Snohomish ($2.05); Lynnwood ($1); Edmonds (50 cents); and Mukilteo ($1.01) all contribute to public health funding. Snohomish County pays $1.97, for a contribution of $751,618 in 2020 and a little less than that is projected in 2021 due to a lesser population.

Cities are not required to contribute, and the funding is a relatively small part of the budget. Total per capita funding for the health district in 2021 is $1.1 million, so roughly 7% of the Snohomish Health District's revenue, Thomas said. In spite of the pandemic's impact on budgets, all cities are scheduled to pay the projected amounts, through 2021, Thomas said.

Per capita funding exists under the intergovernmental revenue umbrella within the budget. Intergovernmental funding as a whole is 60% of the budget.

Other funding comes from licenses and permits, charge for goods and services, and other miscellaneous revenue.

Public health activity in the city of Mill Creek both the COVID-related and non-COVID: one to three inspections per year for 58 food establishment permits, 64 routine food inspections, 78 child care consultations, 242 continuing education courses related to child care,14 vaccine clinics, 33 providers assisted, and virus-testing for more than 1,000 Mill Creek residents. A mass vaccination site opened at the Boeing Activity Center is about 11 miles away from the city's Town Center.

The city is aware of the invitation to contribute, but has no plans to do so yet.

The health district has "a standing request for per capita funding," said Mayor Brian Holtzclaw in a phone interview with The Beacon.

Planning ahead, the district is preparing to lease out space in its Rucker building and is in the process of creating a nonprofit agency, to access grant funding.

The Rucker building has one tenant, the IRS, which will bring in roughly $200,000 per year, Thomas said. That lease-revenue will go up, with more planning.

"We do have a leasing agent and are working with an architectural team to look at reconfiguring SHD spaces in the building to maximize leasable space," she said.

The nonprofit currently in formation is Sound Foundation for Public Health. A group of six initial board members were selected last fall and include chair, Maria Montalvo (Corvias Foundation); Vice Chair is Dr. Robin Fenn (Bastyr University); treasurer Joe Vessey (Community Health Center of Snohomish County); secretary Lika Smith (Pacific Islanders Health Board); Chris Cook (former Mukilteo city councilmember); and Lynn Sordel (City of Lynnwood).

"The bylaws provide up to 11 boardmembers so they will likely be adding more over time," Thomas said.

A filing with the Secretary of State is in the works, for the agency to become a nonprofit corporation. No funding projections were available on what the nonprofit may bring in, she said.

The health district is also slated to receive American Rescue Plan Act funding from the federal stimulus plan that will be distributed to cities, counties, and other agencies. The funds are planned as short-term gap funds, to help agencies endure the pandemic.

"We will receive ARPA funding, but we are waiting to see the language and allocation from the state legislature," Thomas said.

The district will be applying for all available funds, including ongoing monies in the state budget. At present, the House and Senate have drafted two proposed budgets, with finalization anticipated in late April.

The challenges of public health in Snohomish County are part of a bigger issue, statewide.

"$450 million per biennium is what is needed to fully fund foundational public health services across the state of Washington," Thomas said. "Until that gap is addressed, local health jurisdictions like the Snohomish Health District are unable to staff up and build programming to meet the needs for their communities. Essentially, we are in reactive and disease-response mode rather than more focus on prevention."

For now, the district continues to eye the road ahead while simultaneously addressing the continued urgency of the pandemic.

"We're working hard to contain the disease," Gray said.

The COVID response at present has not reduced in intensity with the vaccination effort underway. It includes "everything that we've been doing since Jan 2020 to support testing, tracing, isolation, vaccination and communication," Thomas said.

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