More than two months after the president approved a funding package to bolster local response to COVID-19 outbreaks, the Columbia/Boone County Public Health and Human Services department hasn’t received a penny. As confirmed COVID-19 cases continue to increase, according to health director Stephanie Browning the department has only been able to bring on two additional contact tracers - its retired former epidemiologist, and one of its former nurses: both on a part-time basis.
While the state health department has provided contact tracing support for some local health departments facing major outbreaks, Boone County health officials say they’ve been asking for help for months to no avail. Assistant Health Director Scott Clardy says it’s been a frustrating experience.
“We’ve been promised for months that they were going to be helping us with that, and we still don’t have anything yet,” Clardy said.
At a press briefing earlier this month, State Health Director Randall Williams said he wasn’t aware of any local health departments reaching out for help, other than Kansas City.
During that same briefing, Governor Mike Parson said the state would only play a support role in contact tracing, pointing instead to CARES Act funding counties have received.
“If they run out of that money, or it hasn’t been used, we’ll be there in that support role,” Parson said. “We’re not going to come in here and take over contact tracing.”
But health officials in Boone County and elsewhere have run into difficulty accessing federal aid money, due to a lack of guidance on how exactly localities are allowed to spend it. Boone County Commissioner Dan Atwill says he and his fellow commissioners are waiting on federal guidelines before setting up a computer system to process applications for the $21.7 million the county has received.
While Atwill says the fund will be able to provide reimbursements, Browning says her department’s costs are all coming out of their current budget. Atwill hopes to have the system in place to start receiving applications within the month, but he says it will depend on when federal guidelines come down.
In the meantime, Boone County has seen a steady increase in confirmed COVID-19 cases, with nearly 100 active cases as of Thursday evening. The county has also seen a sharp increase in its positivity rate, meaning a higher portion of those tested are testing positive. That rate has increased from 3.2 percent for the week of June 18, to 8.2 percent for the week of June 25.
The statewide struggle to access funding
Counties across the state have had difficulties spending CARES Act funding. The Missouri Information Corps contacted each of Missouri’s 114 counties to learn how they are spending the money. Most of the 26 counties that responded said they have not spent any of the money yet and are in the process of deciding what to do with it.
Missouri Treasurer Scott Fitzpatrick estimated about $1.5 billion in CARES Act funding remains unspent by the state. More than two dozen counties told the Missouri Information Corps they either don’t have a plan for spending the money — or, if they do have a plan, they haven’t written the checks.
Fitzpatrick said the state is being cautious when it comes to advising local governments. “We try to be very careful about giving very specific answers to difficult questions that are in a gray area,” he said. Fitzpatrick said the state government is forwarding questions to the U.S. Treasury.
On a recent call with Fitzpatrick and county leaders, U.S. Treasury counselor Daniel Kowalski emphasized local officials’ discretion in spending the funds. “You sort of know when you’re pushing the rules, right," Kowalski said. "Exercise good faith here and you’re probably in a good place.”
Asked directly about funding local health departments, Kowalski pointed to frontline workers, including police, fire and EMTs, but he also warned his advice wasn’t final.
“Whether an item of expenditure is permissible or impermissible will be determined by the inspector general at a later date. I did this to help you, not to bind me, ok?”
The difficulties local health departments have experienced accessing money have caught the attention of the National Association of County and City Health Officials, which flagged Missouri as a problem state. NACCHO chief of government and public affairs Adriane Casalotti says other states, such as Washington, have been more successful in coordinating between state and local health officials.
NACCHO has also raised the alarm about the long decline in funding for local health departments since 2008. In a report released Friday, NACCHO found a decline of 14 percent in spending on health departments the size of Boone County’s.
In Mid-April, Governor Parson created a working group to make recommendations on how to spend the federal money allocated to the state for coronavirus relief. The group, led by Fitzpatrick, is responsible for making sure money is spent according to federal guidelines.
Federal guidance remains unclear
The U.S. Treasury issued a four-page document with additional information about what is considered “necessary exidentures,” as well as FAQs for local governments to reference. The treasury released the first FAQ on May 4, followed by a longer, updated version on May 28.
Some of the information in the FAQs, however, seemed to contradict the original guidance, causing confusion and hesitation in the coronavirus working group, said Rep. Kip Kendrick, D-Columbia, a member of the working group.
“I think that we’re all kind of stuck on the guidance,” Kendrick said.
The initial four-page guidance prohibited funds from going to payroll expenses for employees whose work wasn’t “substantially dedicated” to fighting the pandemic. But the follow-up FAQ said it was okay to spend the money on expenses like payroll for teachers who had to adapt curriculum to an online setting.
Kendrick said the shifting federal guidance is making it hard to determine exactly how the funds can be used.
“I think that the state is somewhat hesitant at this point to earmark a lot of the funding until further guidance is provided,” he said. “And I think that at this point we are anticipating further guidance, which again will probably create additional confusion.”