COQUILLE - Coos County Public Health likely will remain the charge of county wellness - not the state - but the myriad services it provides will be trimmed and the neediest clients will be paying fees for services that were once free.

That was the consensus Wednesday as the Coos County Board of Commissioners backed a recommendation from Commissioner Kevin Stufflebean suggesting the county not relinquish its public health authority to the Oregon Department of Human Services - a radical move the commissioners threatened earlier this year.

“My strong recommendation is that we retain public health authority and that we utilize this budget for the next fiscal year,” Stufflebean said. “It is based on the anticipation of zero general funds from the county.”

No deal has been finalized between the state and county, and a number of sticking points remain.

While the prospect of limping along with diminished funding frustrates Coos County Public Health Director Frances Smith, she was grateful to at least have a program.

That wasn't known at the start of Wednesday's meeting.

“Are we going to have a health department?” Smith asked the commissioners as she sat down, kicking off a nearly hour-long meeting.

That question came to the forefront earlier this year, after Congress failed to pass a 6-year-old federal timber payments law that shuttled about $6.8 million annually - or about 45 percent of the county's discretionary budget - to county coffers. As a result, the county has laid off nearly 80 employees and is looking for new ways to save money. When they learned Oregon law states public health is the duty of the state, not counties, county officials considered shedding the role the county has played since 1922.

Over the last 85 years, nearly all of Oregon's 36 counties have established their own local health departments. At one time, county and state government paid more for public health, however both revenue sources have dropped off considerably.

Last year, Coos County spent about 10 times as much on local public health compared to the state, despite the state's mandated duties. Still, the county's share of the overall bill for public health was around 13 percent, far below the 50 percent contribution it made back in 1994. The bulk of public health's $2.8 million budget is propped up by federal monies.

On average, over the last few years, the county has put around $250,000 into public health's budget, Smith said. The local dollars are used to match crucial state and federal grants.

That's going to stop July 1. Instead of giving cash to public health next year, the commissioners intend to leverage matching grants with in-kind contributions, including cost estimates for work carried out on public health's behalf by the commissioners, human resources staff, the county's legal counsel office, the information technology department and janitorial duties.

The drop in support means public health no longer will provide free family planning services to its clients who will be charged for exams and medications for such ailments as sexually transmitted diseases.

“So teenagers, women who have very little income will be charged for those services,” Smith said.

Furthermore, if the state chooses not to provide medications, Smith said her clients would be forced to get prescriptions filled at local pharmacies and make more emergency room visits to see if they have communicable diseases such as gonorrhea and chlamydia.

Whether the state will agree to the revisions in its annual contract is unknown. Board Chairman John Griffith was not optimistic and neither was Commissioner Nikki Whitty, but all three county officials pressed for changes in the next legislative session.

“(Counties) have been complaining about (state support of) assessment and taxation, public health, mental health far longer than any of us have been commissioners,” Whitty said. “Until we say enough is enough, they are not going to do anything about it. They are going to create new programs with all that money instead of backfilling programs that provide the service.”

Stufflebean, a former DHS employee who's spearheaded the negotiations, was more optimistic.

“I think the state realizes that it's either us providing something or nothing,” Stufflebean said. “They made it pretty clear that they would just as soon not have public health back at the state level.”

Even if the state OKs the deal, another obstacle lies in public health's path.

Coos County Public Health Business Manager Sherill Lorenzo said a proposed federal rule change requires “verifiable, dedicated locally taxed revenues” to be used as matching funds. If the change is OK'd, which state officials don't think will happen, it will upend how health organizations nationwide tackle Medicaid billing issues. In the past, Medicaid experts allowed county public health departments to match some grants with non-federal monies, but not all. Lorenzo said, Coos County Public Health never felt at ease taking that approach, since a misinterpretation on the county's part could prove costly.

“We always took the conservative approach,” Lorenzo said. “Now that we are faced with new challenges, we want to push the envelope as far as we legally can push it.”

With that uncertainty, Lorenzo is awaiting a response from the state that the financial tactic is legal.

If the state says no, Lorenzo said, public health no longer would bill for case management, which funds its home-visiting programs and WIC, a federal assistance program that promotes the healthcare and nutrition of low-income mothers and children under the age of 5.

Smith also made a last-ditch effort for the commissioners to consider funding public health with at least as much money as the state - around $36,000. Otherwise, she said it would be awkward to solicit support from the community when the county commissioners don't support their own department.

“We do!” Griffith shot back before Smith could finish her sentence.

“I don't know how you can say we don't,” Whitty said at the same time. “Would you like to go pay rent somewhere? There's no way you could continue if you were doing that.

“It's state responsibility,” Griffith said. “The fact that we are willing to do it at all is tremendous support.”

“I just want to put that on the table for you,” Smith said.