The Carroll County Board of Health is more than a week into its new fiscal year and has yet to adopt a 2009 budget, a fact that has many on the board wringing their hands.

“We’re operating illegally, essentially,” said board Chairman Dr. Jack Birge. “We don’t have a budget, and we’re already operating in the fiscal year, and that’s not good.”

The reason for the delay in approving a budget, Birge said, is delays within the state Department of Health’s own budgetary planning commission. Originally cutting millions from mental healthcare, the state has also shifted funds from general healthcare, and the last-minute appropriations on the state level have had a domino effect on counties hoping to approve a budget before July 1.

“There’ been a lot of shifting of funds,” Birge said. “It’s been like trying to get a budget through quicksand. We’re greatly concerned about all these unknowns.”

Birge’s concern is rooted in the lack of communication between the Department of Health with the Department of Human Resources and the local health board. Under the existing system, counties are under the authority of a regional director who has the last say in public health matters. To illustrate that point, Birge warned of a potential outbreak of a pandemic flu strain in which the regional director would have the ultimate authority about how to combat the outbreak despite being relatively unfamiliar with the county.

As applied to budgetary matters, it is the state’s responsibility to allocate certain funds, but such allocations are not necessarily based on county needs. The county then pays a large portion of its own budget without having ultimate say in how that money is spent.

While not having an official budget, the board did hear a tentative budget from Lyneil Charity of the Board of Health finance committee. To the dismay of several of the board members, the presentation was marred by statistical inaccuracies and further uncertainty about when an ’09 budget might become reality.

Board member Bill Chappell, who is chairman of the Carroll County Board of Commissioners, cited a supposed $600,000 surplus from the previous year, an amount that would have alleviated concern about the health board potentially incurring a deficit for 2008-2009. He was told the surplus was essentially a “keying error,” and the sheet that contained it was more of an “internal worksheet” than an official financial statement. The actual surplus for the previous fiscal year was slightly more than $30,000.

Members of the board also voiced concerns about revenue reports from April and June of this year. According to documents that were guaranteed “factually correct,” the budgeted revenue for June dropped $29,000 from the month before, a lapse that would never occur in a properly budgeted revenue report, Chappell said.

“You don’t have a budget dropping $29,000 in a single fiscal year,” he said. “It’s difficult for me to have confidence in any of these numbers.”

Despite the possible accounting errors, the budgetary proposal did outline revenues and expenditures for the following year.

Expenditures for the following year were estimated at $2.07 million with expenditures of $2.15 million, creating a deficit of approximately $106,000. Proposals to reduce the deficit included holding the line on employee wages, accepting private insurance and the implementation of a dental clinic.

Of these, Birge said he believed the health board would be able to make up the deficit by relying on the payments of third-party insurance companies -- assuming the state accepts some responsibility in paying money later audited from the county by HMOs, Birge said.

“The Carroll County Board of Health is personally responsible for any money that the government disallows,” Birge said. “That means we pay Medicaid but if they audit us and tell us that we shouldn’t have been paid, we have to give the money back. We’re very vulnerable because we have all the responsibility and no authority.”

At this point, the county health board has little option but to ask the state Legislature to force DHR into taking on increased responsibility for local boards.

“I may not see it in my lifetime,” Birge said. “Politically, we’re going to have to do it. Obviously it’s going to have to come out from the Legislature because the region is comfortable in their little pink blanket, and they don’t want to change.”