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The coronavirus pandemic has thrust what was once a seldom-discussed subject — local public health agencies — into the public consciousness, and the interest locally doesn’t seem to be fading away. About 2,500 people watched or called into a virtual town hall meeting where leaders took questions about how Arapahoe County is working to create its own health department amid the breakup of Tri-County Health, according to the county.

Public health agencies play a different role in the public’s lives than doctors treating illnesses, Arapahoe County Commissioner Nancy Sharpe explained.

“Public health, on the other hand, wants to keep you from getting sick in the first place,” Sharpe said during the town hall.

Adams and Arapahoe counties are still members of Tri-County Health, but Douglas County has already exited and formed its own health department.

Douglas County’s leaders have long clashed with Tri-County Health during the coronavirus pandemic, announcing plans in July 2020 to begin the process of withdrawing from the health agency after its decision to require mask wearing in public.

Some of Adams County’s leaders had felt frustration with Tri-County’s policymaking, too, but Adams’ message wasn’t against mask orders. Arapahoe has appeared reluctant to cut ties with the health agency, with officials in that county maintaining they had no choice but to move toward going solo after Douglas withdrew and after Adams announced it would also pull out.

Adams and Arapahoe counties are set to withdraw from Tri-County Health by the end of 2022, leaving the counties several months to navigate the task of creating their own health departments.

Arapahoe County’s future board of health — the policy-making body for the county’s upcoming health department — will be empaneled, or created, by this summer to help get the department started, according to the town hall’s presentation.

Local officials have floated the idea that Tri-County Health could live on in some form and continue to provide public health services to one or more counties after December 2022, but it’s unclear whether that will happen.

If nothing else, many of Tri-County Health’s employees may find jobs in the new county health departments.

“This whole situation of Tri-County Health and Douglas County leaving, then Adams County and us forming our own health (departments), has been weighing heavily on the minds of the Tri-County Health employees,” Arapahoe County Commissioner Jeff Baker said during the March 30 town hall.

Baker added: “We hope that Tri-County employees will consider bringing their expertise to us, to the Arapahoe County health department.”

Going solo

Aside from the headline-grabbing public health orders — such as mask mandates — that the health agency has issued during the pandemic, Tri-County Health has also provided no-cost cancer screenings, overdose prevention, free nurse visits, restaurant and child care facility inspections, and other services to its residents, according to an Arapahoe news release.

The creation of new public health departments appears likely to result in Adams, Arapahoe and Douglas counties all having the independence to make their own decisions on public health orders and how to provide health services for residents.

An Arapahoe County spokesperson in early September said a separation by Arapahoe wouldn’t be driven by any policy disagreement with the health agency. Douglas County’s exit of Tri-County Health would potentially create financial or budgetary problems for the other two counties, the spokesperson, Luc Hatlestad, added.

And despite all three counties moving to leave Tri-County, one or more of them may continue receiving health services from Tri-County, even after 2022 — though it’s unclear how likely that result may be.

Arapahoe was the last of the three counties to provide notice that it will separate from Tri-County. The Arapahoe County Board of Commissioners — the county’s elected leaders — voted to take the action in a Dec. 14 resolution.

The text of Arapahoe County’s resolution says: “One of the options being considered includes continuing the Tri-County Health Department as a legal entity in some form other than a multi-county district public health agency … so that it may continue to exist and continue to provide public health services to one or more counties after December 31, 2022.”

Asked whether Tri-County Health is considering whether to continue to exist in a different form, such as a nonprofit or other type of entity, to contract with any of the three counties for health services, Mindy Tappan, a spokesperson for Tri-County Health, said: “Not at this point, although we continue to explore various options moving forward.”

Hatlestad, the Arapahoe County spokesperson, said: “We’re open to contracting with any service provider that we determine can offer public health services effectively and affordably.”

Transition won’t come cheap

To start their own public health agencies, Adams and Arapahoe could run into costs up to millions of dollars each, according to a report from a consulting firm that has studied the benefits and drawbacks of the counties’ decisions to handle public health services alone.

One part of the report points to “additional needed” revenue of $3.6 million in Arapahoe and $2.6 million in additional need in Adams.

For context, Adams County’s contribution to Tri-County Health’s 2021 budget was $3.8 million, Arapahoe County’s contribution was $4.8 million and Douglas County’s contribution was $2.6 million, according to Tri-County.

Asked whether raising taxes or budget cuts will be necessary to support a single-county health department, Arapahoe County Commissioner Nancy Jackson said in December that costs were unclear at the moment.

The transition to a new health department “will, of course, affect the county’s budget, but we’re still determining the specifics about that,” Hatlestad said in early April.

It’s “important to differentiate one-time costs from ongoing/operating expenses,” the county’s presentation said.

County leaders are looking at using “ARPA and fund balance” for one-time needs, the presentation said, appearing to refer to the federal American Rescue Plan Act. That’s the economic stimulus bill signed into law in March 2021 with a goal to support the economic and public health recovery from the COVID-19 pandemic. “Fund balance,” generally, is a term for money a government has saved up over the years.

“In the short term, separate, single county public health agencies would have access to less public health revenue, and perhaps services, and would incur transition costs for start-up and (the) dissolution of TCHD,” the Oct. 12 report by the Otowi Group says. That’s the consulting firm that has studied the benefits and drawbacks.

How expensive the transition could be depends in part on what a court has to say about an alleged $50 million fee Tri-County Health and the counties may owe to another government body if counties continue to pull out.

At issue is a payment that the health agency may eventually owe to the Colorado Public Employees’ Retirement Association, or PERA, which provides retirement and other benefits to employees of government agencies and public entities in Colorado.

A lawsuit by the retirement association was recently filed in Adams County District Court regarding the alleged payment owed.