Good morning and welcome.
Calling to order. Clark County
Board of Health, September 23rd,
2026. If you would join me in
standing for the Pledge of
Allegiance, if you're able. I
pledge allegiance to the flag
of the United States of America
and to the Republic for which
it stands one nation under God,
indivisible, with liberty and
justice for all. Thank you.
Let's go on to the roll call,
counselor young here, counselor.
>> Belkot is absent. Counselor
little. Present counselor
Fuentes is absent. And Chair
Marshall here. Thank you. We
have a quorum.
>> Thank you. Are there any
amendments to the agenda?
>> None today.
>> None today. Okay, then we'll
move quickly on to comments
from the public. Just reminding
folks this is the Board of
Health. I don't know if
anyone's signed up. No one
online. Okay. Nobody signed up.
No one signed up. Okay. No
comments from the public today.
Moving on to the consent agenda,
we have three sets of minutes
from August 19th, 2026, which
was a special meeting. Should
we do these each individually?
Okay. Is there a motion to
approve or any changes?
>> I'll move approval.
>> Thank you. Second moved and
seconded. All those in favor,
say aye. Aye aye aye. Motion
carries. And then the minutes
from August 26th, 2026. Are
there any changes? If not, I'll
entertain a motion.
>> So moved.
>> Thank you. Second moved and
seconded. All those in favor
say I.
>> I I.
>> I motion carries. And then
finally minutes from September
2nd, 2026, which was also a
special meeting. Any
corrections, if not entertain a
motion to approve. You guys can
take turns.
>> So moved.
>> Thank you. Moved and
seconded. All in favor say I. I
I okay, motion carries. Health
officer coverage is our next
item.
>> April for a third deputy
county manager will present
this one.
>> Okay. April.
>> Good morning, Madam Chair
and Board of Health. Can you
hear me?
>> Yes we can.
>> Perfect. April 1st, deputy
county manager and interim
director of public Health. And
I'm here this morning
requesting the Board of Health
to approve for the Director of
Public Health to authorize the
contract with qualified health
officers when necessary, to
cover for our Board of Health
appointed clerk, County health
officer. So Clark County has
historically maintained both
the health officer and a deputy
health officer to ensure
continuity of public health
leadership and adequate
coverage during times of
absence. With the recent
retirement of our health
officer and the appointment of
our interim health Officer, the
department has continued its
commitment to maintaining
stable and compliant public
health oversight. The interim
health officer has a planned
vacation, and additional
coverage is needed to ensure
uninterrupted fulfillment of
our statutory responsibilities,
timely decision making and
ongoing support to our public
health officer county wide
duties during her absence. And
just to make it clear, I'm
asking that the Director of
Public Health have delegation
from the Board of Health to
offer authorize the temporary
coverage of the Clark County
Health officer for this
particular request and for
future needs like this in the
future.
>> Okay. Thank you. Are there
any questions from the board?
>> Go ahead. Chair. Just a
question, April. What what
exactly does this work look
like when you have somebody
that is not typically in that
role? Obviously, we had an
interim come in and there's
been, you know, learning period
for that and kind of getting up
to date. But that institutional
knowledge of what's in general
happening was already there.
But when we contract with
somebody to come in for, say, a
week or two weeks or something
like that, what what does it
look like? I mean, do they
spend that entire time just
kind of learning the I don't
understand the role completely
well enough to know exactly
what that would look like.
>> Sure.
>> They have to be a certified
health officer. So not only do
they need to be a doctor, but
they need to have gone to
school to be able to do the
health officer duties most of
the time. And, and what I plan
on doing this is using a health
officer from a different
jurisdiction and contracting
with them to cover us. They
would only be covering our
needs while she was on vacation.
Urgent and emergency needs like
TB care, rabies, any measles
outbreaks, things like that.
But anyone who we would
contract with would be
certified health officer.
They'd have the experience.
They wouldn't have to learn the
whole thing.
>> Okay. And so with that, does
the contract look like, you
know, as needed basis or does
it look like we will have you
assigned for this time period?
And so you will be compensated
for that whole time period.
>> Assigned for the time period
and the, and the contract that
we would be going is by an
hourly basis. So they would not
be doing it. They they are
already a health officer
somewhere else, so they would
not be doing it for 40 hours a
week. So it would just be by
hour basis when needed.
>> Okay, great. Thank you.
>> Yeah. No problem.
>> I have a quick question. And
so this would just be for a
short period until we've hired
an interim health officer. Is
that correct?
>> Well, we have an interim
health officer. This is our
interim can go on vacation and
you the Board of Health has to
appoint a health officer. And
so that's why this staff report
is actually asking that you
give that delegation to the
Director of Public Health for
any time like this, for like a
vacation coverage or a short
term temporary coverage of your
appointed health officer.
>> What I meant to say is
deputy health officer, usually
we have a health officer and a
deputy health officer. That's
what I meant to say.
>> Yes, which is why we haven't
needed this.
>> Right.
>> Good. In 13 years.
>> Thank you. Any other
questions? If not, I'll
entertain a motion to approve.
>> So moved.
>> Thank you.
>> Second.
>> Moved and seconded. All
those in favor say I.
>> I I I.
>> Okay, thank you. April.
Public health in action. Access
to baby and child dentistry.
Please. Please go ahead.
>> In the community Health
Division.
>> To make sure that the mic is
on because people online can't
hear.
>> Nobody say that. I'm sorry,
do I repeat what I said or.
Repeat?
>> I think I need to.
>> Okay, briefly. From my name
and everything. Okay. Well good
morning again. My name is Santa
Cruz. I'm a community health
specialist for the Access to
Baby and Child Dentistry
program, known by families and
community organizations as the
A, B, C, D program. I'm here
today with a community partner
and collaborator, Deanna
Russell, health services
administrator with EOF. And I'm
hopeful to have Doctor Hsu, the
A B, C, d champion and owner of
Storybook Dental, join us
throughout the presentation via
Zoom. Slide two. Thank you. The
A, B, C, D program is part of
the Healthy Communities team in
the Community Health Division.
For your reference, the
organizational chart is shown
here. Slide three please. After
this presentation, you will
understand the importance for
children to access dental care
early in their lives. The work
being done by the A, B, C, D
program and ways you can
support oral health care in
Clark County. Slide four please.
Oral health is critical for
overall health and well-being.
Scheduling a visit by
scheduling a visit by age one
ensures children building
habits for life. Baby teeth are
very important and healthy baby
teeth support, nutrition,
speech development and guide
permanent teeth. When children
establish a dental home at a
young age, they are more likely
to associate dental visits as a
positive, welcoming and safe
experience. Unfortunately,
cavities are the most common
chronic disease of childhood in
the United States, but they are
preventable with healthy habits
and access to care. Slide five
please. Poor oral health.
>> Go ahead.
>> Okay. Poor oral health can
be devastating and bring
devastating effects on young
children and their families.
And treatment can be traumatic
in some cases. And costly
cavities can be painful and
interfere with a child's
ability to focus and learn in
school, eat, speak and even
play. Dental disease and
emergencies are often
preventable. Preventive,
preventative and for parents,
sometimes they are expensive to
treat. Prevention helps
everyone save money and time.
Slide six please. The data here
comes from the 2023 2024 smile
survey, representing over
2,702nd and third grader grade
children in 27 Clark County
Public Schools who received
dental screenings, dental
hygienists were hired to
examine children's teeth for
decay, sealants and treatment
needs. A few findings from the
survey show that 1 in 8 second
and third graders in Clark
County have untreated tooth
decay, representing more than
350 kids. Additionally, 370
kids were identified as needing
urgent dental care within the
following 2448 hours because of
pain or infection. Low income
children were much more likely
to have cavities and treated
and rampant decay. They were
also more than twice as likely
to need urgent treatment
compared to their peers.
Importantly, they were less
likely to have sealants on
their permanent permanent
molars, pointing to an equal
access to preventive services.
Slide seven please. The
importance of early access and
addressing oral health
disparities for children with
Apple Health were the reason
that A, B, C, D was developed.
It is a very unique program
that is supported by both
public and private partnerships
to ensure all children in
Washington can access early
dental care. The program
started in the 1990s in Spokane,
and Clark County, was an early
adopter of the program. The A,
B, C, D program is now
implemented across Washington
state. Slide number eight,
please. The A, B, c D program
is based on partnerships at all
levels. The key statewide
partners include the University
of Washington School of
Dentistry, Washington
Department of Health,
Washington Health Care
Authority, Washington State
Dental Association, the Arcola
Foundation, and at the local
level, A, B, C, d dentist
champions and local
partnerships. We also work with
early learning programs,
community based organizations
and pediatricians to increase
access to care. Slide nine
please. The main goal of the A,
B, C, D program is to connect
Apple Health, ensure children
to a dentist for early care and
education on how to take good
care of their child's teeth.
This helps children build
healthy habits for life. The A,
B, C, D program focuses on
children ages 0 to 6 and
children 6 to 12 who have a
Medicaid Developmental
Disability designation. There
are three main strategies to
increase dental care with these
populations. Number one
recruiting and enrolling dental
providers in the program. Once
enrolled, dentists receive
specialized training and
certification to provide care
to young children. This dentist
can be general or pediatric
dentist doctor Zhu or local A,
B, C, d champion plays a very
important role in providing
that training and support.
Number two, participating
dentists receive enhanced fees
for caring for eligible Apple
Health insured clients to help
make reimbursement more
comparable to private insurance.
Currently in Clark County, we
have 48 A, B, C, d dentists
serving our children. Number
three, education and promotion
to families through community
partnerships. The A, B, C, D
program works with community
partners to provide oral health
education and address barriers
to care. Despite these efforts,
about 16,000 Apple Health
insured children ages 1 to 13
have not access dental care in
our county. Partners like
Educational Opportunities for
Children and families, EOF
helps us reach those children
and connect them to care. Slide
number ten, please. In addition
to coordinating dental
trainings to on board new A, B,
c, d dentist, the a, B, C, d
program works to develop and
maintain strategic partnerships
to promote the program to Clark
County families. We work to
equip partners to implement
ways to promote oral health,
education and dental access
within their settings. To
support these efforts, we have
developed educational materials
and brochures for local
families in different languages
languages that are related to
our communities in Clark County.
We have also heard from
families and partners about
barriers in addressing and
access, accessing care for
children and youth with special
health care needs. To address
these concerns, we developed
sensory kits and educational
materials for clinics to
improve the dental visits for
both the patients and the
providers. The kits included a
weighted stuffed animal fidgets,
spectrum glasses and other
items to bring comfort and ease
for children. For a more
successful visit. Many of the
barriers experienced by
children and youth with special
health care needs are system
issues, and we have recently
helped initiate a statewide
group to address these
challenges together. By
connecting with statewide
partners, we are working to
improve dental care access and
quality for all kids in
Washington state. Slide 11
please. I would now like to
introduce Diana Russell to
share about her experience
working with the A, B, C, D
program. Thank you.
>> Good morning.
>> Board your microphone.
>> Good morning. Thank you for
having us. My name is Diana
Russell. I'm the director of
health services for Educational
Opportunities for Children and
Families, also known as EOF. We
are grant holders for Early
Head Start, Head Start and Icap
early learning programs here in
Clark County for the last 60
years. We currently serve about
1200 kids per year age 0 to 6,
including expectant moms. And
through my time here at EOF
when I started 25 years ago,
there was one dentist in Clark
County that saw children age
three and older. We have a
standard in Head Start that all
of our kiddos have a dental
within the first 90 days. So
when I started my job, I was
fast looking for a way to
succeed in that, and I
collaborated with Clark County
Public Health. The oral health
person at that time was Melody
Scheer, the Oral Health
Coalition of Clark County
through Clark County Public
Health. We ended up with a
dental champion named Doctor
Yosan, and together we created
a steering committee to apply
for and get the A, B, C, D
program here to Clark County. I
can tell you for our kids at
EOCF all of our kids are at or
below poverty level, and we
currently have a 19% disability
rate of kids with special
health and developmental needs.
Our kiddos do have on site
screening with dentists that
we've collaborated with through
A, B, C, D, but I can tell you
some of our most challenging
kiddos come to us by way of
withdrawal behaviors, not
eating all these different
challenges in the classroom.
And when we get to those oral
screenings, we often find that
those kids with the most
difficult problems in class
have rampant decay. I'd like to
tell you a short little story
here about a child we had in
our program. He came to us. We
with health, mental health,
nutrition, and developmental
disabilities. He. He had.
Failure to thrive was at the
zero percentile for weight for
height had been removed from
other early learning programs.
He had a full individual
education plan for
developmental delays and speech
delays. He was described as
withdrawn, angry, unpredictable
and wouldn't eat well. His gum
lines were black. I'm not, to
this day, can't figure out how
a speech therapist was working
with him, not noticing that.
And, you know, I felt like
saying bingo, bingo. So we were
able to collaborate with A, B,
C, D programs and get this
child sedation dentistry. He
had to have O.R. time. He had
rampant decay. He had multiple
abscesses, which could cause a
life threatening condition or
death. And he got that. He got
that treatment need through the
A, B, C, D program where it
wasn't there before. That child
gained 12 pounds in three
months. That child was not an
unhappy, unpredictable, angry
child. That child began to
thrive and had very good
outcomes. Had we not addressed
those issues, the trajectory of
his life would have been
completely different. He would
have remained in that deficit.
And I can imagine you could see
what his education would have
maybe been like or not been
like at all. And we have many,
many other stories like that.
One story that comes to mind
was during Covid, we had a
family who had been turned into
child protective services for
rampant decay that couldn't be
addressed because of abscesses,
and it was a lack of ability
for that mom to get her
insurance to get her in. It
wasn't a lack of not wanting to.
I was able to collaborate with
Anna Cruz here with A, B, C, D,
and one of our providers at D
Luna Dental was able to help
this child thrive. I can
probably provide you those
stories all day long, but the
collaboration goes far beyond
that. It's not just the eating
or the speech, it just can also
affect brain development. It
affects behaviors. It affects
the way the child succeeds in
school. And without a, B, C, D,
I am not sure how these 0 to 6
year olds would be served. It
is a very unique clientele.
Dentists have to get a little
tricky and that's where the
champion comes in. Teaching
other dentists how to better
work with pediatric patients.
Any questions for me?
>> Okay. Thank you. Are there
any questions?
>> But I think are you.
>> Thank you. Deanna.
>> I'm looking at Councilor
Little first looking over.
>> Okay.
>> Sure. Thank you. Oh, sorry.
I didn't realize he had. Go
ahead.
>> Doesn't matter to me. Are
you done with the presentation?
>> No.
>> Okay, I'll hold my questions.
>> Okay.
>> Thank you. Diana, I see that
Doctor Hsu or a BCD champion,
owner of Storybook Dental has
joined the call and I would
like to give him time so he can
talk about increasing access to
Clark County children and also,
you know, different or
important steps needed to
ensure that we have early and
positive foundation for oral
health. Go ahead, doctor Hsu.
>> Hello. Good morning. Thank
you very much for having me.
Everybody hear me okay.
>> Yes yes we can.
>> Okay. Thank you. So I
stepped into this role about
four years ago when Doctor Remy
Yosan retired. And since then I
have partnered closely with
Miss Anna Cruz and provided
training to dentists who want
to become a, B, C, d certified.
And in those, training usually
lasts somewhere between 90 to
120 minutes. We discussed the
history of the program, how how
the dentist can can more easily
interact with families with
very young children. And over
the over the past, about 3 or 4
years, I think we we certified
probably somewhere between 12
and 15 dentists, maybe. Anna,
you can check me on that.
>> Yes, probably more.
>> Which is actually quite
remarkable considering that,
you know, this is essentially a
money losing program for any
dentist who sign up. What I
mean by that is, you know,
being being a state Medicaid
provider, the fees, although
much better than regular state
Medicaid fees. I want to, I
want to I don't want to
sugarcoat it because the state
Medicaid standard state
Medicaid fees essentially has
returned to what they used to
pay in the late 90s when when
minimum wage was around six
bucks. So so there's tremendous
headwind for, for Anna and I to,
to try to get people interested
and excited to join this
program. But we still have, you
know, good warm hearted
dentists in the community who,
who are willing and who are
stepping up Clark County just a
little bit over half of all our
children under 18 are are
enrollees of the state Medicaid
program. And for those of us
who do enroll in A, B, C, D and
provide care, many of us would
see children beyond the age of
six, which is when A, B, C, D
program actually phases out.
When children on their sixth
year birthday. The the, you
know, the children obviously
continue their their married
lives with with no change. But
from a provider practitioner
side, the fees return to the
standard Medicaid rates, which
as I mentioned before, is
basically essentially the same
rate that they used to pay in
the late 90s. And, you know, as
everybody knows, 2026, nothing
costs the same as 1999. And so
this, this is this, this
presents a very real and very,
very tough challenge for all of
us. In spite of that, we I
think of all the Medicaid
eligible children who are
enrolled, who I believe we have
a 56 ish percent success rate
in getting them to the dentist,
recognizing that there are just
families who, who, who are
unable for whatever, you know,
work schedule reasons,
transportation reasons that
cannot get the kids to the
dentist. We, we actually do
have a couple of community
dentists and dental programs
that are now trying to take the
care into the schools. There
are at least two, if not three,
services who are quietly
engaging elementary schools all
around the county and try to
bring dental personnel and
portable equipments to
elementary schools to, you know,
at least do some screening. If
not, but provide services.
There are there is a local
dentist, doctor Reyna Strong,
who is able to do more than
just screening. I mean, she can
actually provide dental care
like restorative services and
things like that on site in
schools, should those children
need it, and should the parents
permit that to happen? So. I
would say that the the future
of the program is, is good. I
think both the state Asera
University of Washington, Me,
we are committed to continue to
champion this program and try
to get more dentists enrolled
in it to service the kids. But
the headwind is real. If if we,
you know, if the if the state
does not provide the adequate
budget, adequate budget to
support to, to support a fee
increase on the on the on the
Medicaid fee schedule. At some
point, all of us will be priced
out of it, and we won't be able
to continue our work without
without some outside help. So.
That is my report. Happy to
answer any questions.
>> Thank you very much. So
let's turn to Counselor Little.
Or did you have more to.
>> I just.
>> Want to.
>> Okay, I have a wrap up note.
Thank you. So we believe every
child deserves access to oral
health care and other important
roles and your roles as
counselors. We ask that you
consider families when
reviewing and adopting new
policies and programs. Many
families, many families are
experiencing stress and
hardships. We need to work
together to reduce economic,
transportation and workplace
stressors. In addition, when
opportunities arise to support
access to care, especially
dental care and especially care
for Apple Health, ensure
children. We need to work
together to ensure all kids in
Clark County stay healthy, and
I think together we can achieve
this goal. Thank you.
>> Great. Thank you very much.
Go ahead. Okay. Thank you.
>> This is great information.
My kids love Storybook Dental,
by the way. I'm just trying to
get a sense of how we can help.
It sounds like we need to
advocate to the state for more
funding, but I want to go to
slide number six and get a
little bit more of an
understanding of the second
data point there. So it says
that the number of second and
third graders needing
restorative dental care has
grown from in 2015, it was 2%.
And then in 2024, it was 14%.
Is it still increasing? What
was happening in the in-between
years? Is it was it
consistently getting worse? And
what year did the A, B, C, D
program start? Just wondering
what impact the program has had
toward a number like that.
>> Well, so the I'll provide
some quick answers. The A, B, C,
D program came into being
actually back in 1995, and a
lot of good has been done, and
there was a steady increase in
children being seen by A, B, C,
d certified dentists from 95
all the way to honestly about
2015 or so. Right, right there
on that data point. Somewhere
around 2015, though, however,
the it kind of plateaued. What
I mean by that is the
percentage of children being
seen. Now, the population of
Clark County have continuously
grown. So. So even though the
percentage stayed the same,
more kids had were being seen.
But the the percent of children
since about 2015 has kind of
essentially plateaued out at
about that 55, 56%. And then
with, you know, during Covid
time and the subsequent months
after that, there was a sharp
decline. And so, you know, when
they did this survey back in
2024, I believe some of what we
saw there, the big jump there
was attributed to, you know,
Covid. And in fact, among the
pediatric dental community,
they talked about Kolke, Kolke,
cavities, Covid, Covid or
whatever. You know, when kids
are at home doing Zoom classes
and have essentially unfettered
access to snack foods
throughout the day. So with
that, that increase does not
necessarily represent like a
failure of the program, but it
does represent, you know, a, I
guess, a failure of or I guess
it's a proof in point that so
much of what happens in the
home affects cavities rather
than what happens in, say, my
office in, in when I do my
training, I do emphasize to the,
to the dentists that that are
being trained that this, the,
the home care thing needs to be
so, so heavily emphasized
snacking habits, cleaning
habits, all of these needs to
be talked about. And councilor,
you mentioned that what can
County do? Well, it's the same
stuff that I kind of been
asking our our state lawmakers,
you know, as you might know,
Senator Cleveland is actually
the chair of the Senate side,
health and Long-Term Care
Committee, chair of that
committee. And and
Representative Paul Harris has
been when he was on the House
side, was in the health
committee for for many, many
years. In fact, I'm scheduled
to meet with both of them next
month to, to talk about this
issue. And what I've proposed
to them is that knowing that
state budgets is unlikely to
allow additional funding to the
Medicaid program to increase
fees, what can we what might we
do? What can, what might we be
able to do to reduce cost on
our side? And one of the things
I'm asking them for is, you
know, could they create some
kind of a. An employment
assistance program to help us
subsidize some of our employee
costs, hiring costs, going to
see if they can help us. You
know, for those of us who who
sees, you know, who has like a
thousand or more Medicaid
clients in our, in our
practices, can we get some kind
of a reduction in excise tax?
You know, so, so in essence, if
we cannot add to the pot, can
we reduce the burden? And if
that's a possibility at the
county level as well, that'd be
fantastic that, you know,
somehow help us with, with our
cost burdens to, to, to make
the math work high.
>> Yeah. I'd also just like to
jump in quickly. My name is
Daniel Lopez. I'm an
epidemiologist at Clark County
Public Health, and I was
involved in the analysis of the
Smile survey data. And yeah,
I'd like to point out, like the
doctor mentioned, some of the
pandemic related effects
definitely played a role here.
And seeing this increase from
2015 to 2024. But another one
is there were some
methodological differences
between the earlier survey and
the later one. The earlier
survey only used white light to
detect decay, while the more
recent survey used white and
black light, which increased
the sensitivity and our ability
to detect decay. So that's why
we also see this jump of 2% to
14%. By going back to some of
the pandemic related effects,
we also saw a sharp increase in
the number of children needing
early and urgent dental care.
And we attribute that to some
of the pandemic effects.
>> Okay. Thank you for all this
information. And and if I'd
like to learn a little bit more
about your ideas on reducing
costs and whatever that is, if
you could send it to us in
writing, we could consider
advocating for that with our
state legislators. We do that
each year. So I just want to
get a I. It sounds like
education is really key. Home
care is key to just give us a
more of a sense of the
disincentive of costs for you.
I'd like to know what the
enhanced fees are and. Right
now and how I. I know you're
trying to compare it to 90s and
today, but can you give us
specific examples of what kind
of costs, what kind of headwind
do you have? Even with the
enhanced fees? So we can try to
figure out or understand the
gap that we're dealing with?
>> Sure. So when the A, B, C, D
program was first constructed,
not it's not like there's
enhanced fees for every dental
code. They were very, very
strategic in picking and
choosing which codes gets a
little bit of extra in enhanced
reimbursement. For example,
first patient new visits. That
exam has a better code, a
better rate of routine, six
months recall visit that that
code has a better rate. But you
might be surprised to hear that
the cleaning we provide does
not have an enhanced rate. So a
typical cleaning might be
$8,590 at the Non-enhanced.
Reimbursement rates the state
pays is 32 and and. A say a new
patient exam could be $100. The
non-enhanced rate is about 40.
The enhanced rate is about 50.
And so at the. In the enhanced
rate, as I mentioned earlier,
expires the day the child turns
six years old. And so even with
the enhanced rates, which right
now for most dental offices
comes out to be about break
even, or maybe you make, you
know, somewhere between 2 to 5
to $8, depending on, you know,
how, how much your lease is,
how, how efficient your office
is running. At the enhanced
rate level. You. I think the
math can work. The issue
becomes when the child turns
six years old and it reverts to
the regular dental rates and we
can certainly. Counselor, email
the fee schedule to you so that
you can. You can look at it,
but the A, B, C, D program
enhancement is very, very
limited. Like I said, the the
exam rates have the two exams,
the regular exam, the routine
exam and the new patient intake
has enhanced rates. Emergency
exams does not cleaning does
not fluoride application is
enhanced and and fillings and
steel crowns and the composite
crowns in the front teeth.
Those are enhanced. But like
extraction, for example, I
don't I don't think that is.
And so so it is not a. Not not
Imagings are either. So so
X-rays and things like that.
Those are not enhanced. So. The
overall picture is that. With.
Without. Cost of living
adjustments, sort of. Those
fees will eventually even the
enhanced fees will eventually
fall behind inflation and have
the math not work out. And the
enhancements are not built in
in any way. If, for example, in
Washington state, the minimum
wage increases are built into
law. So every year that's going
to go up. But but the dental
dental fee schedule is not
there's no automatic
adjustments to account for that.
So every year this program goes
forward, the, the, the monetary
number is, you know, staying
the same. And therefore the,
the proportionality of it is,
is reduced, meaning that the,
the losses begins to pile up
year after year. I've been I've
been in Clark County since 2006.
This is my you know, I'm
wrapping up my 20th year here.
And what was adequate and
equitable back in 2006, you
know, is now very, very
difficult to manage as far as
making the math work. So.
>> Okay. Thank you for, for
that. And thanks for what you
do. I'm gonna let other
counselors ask some questions.
>> I saw counselor Belkot. Had
her hand up.
>> Yes. Thanks, chair. I was
having some technical
difficulties initially. Have
you done any outreach to the
school districts on some of the
availability of dental care?
Because I know for me
personally, I was just asking
my own dentist about this a few
months ago, and his
administrative office gal let
me know that there are some
programs in Vancouver for low
income or no income people,
where they can set things up on
a sliding scale. And of those
is the school. Are you doing
any outreach with the schools
to let them know about that? I
had no idea.
>> So. So there are two main
kind of quote unquote free
clinic or sliding fee clinics
in, in, in our area, you have
the free clinic of southwest
Washington in Plasmodium, which
actually does, I mean, their,
their dental, their dental arms
seem to be diminishing or have
been diminished over the last
20 years. I don't know why. It
seems like when I was first
here in 2006, they do more
dental and they they do a lot
less. Now. The one place that
have actually done a lot of
dental and is doing more and
more is the battleground health
clinic. But the battleground
health care that free clinic in
the in the Gardner Center, they
do a lot of dental and and and
that is available. I as far as
outreaching to schools. That's
a great question. Back in 2017,
2018, I, I did training
programs with all the area
school nurses on dental trauma,
first aid and management and,
and so the four major school
districts plus ESD. 112 all the
nurses at that time had have
received training from me and
know about resources, but I
don't I don't necessarily know
if every school knows like
there are dentists they can
refer to. So that might be
something that the county can
help because Ana did have we do
have a brochure of A, B, C, d
certified dentists in the
county, both specialty
pediatric dentists and general
dental clinics that that can
service A, B, C, D clients,
Medicaid clients. And so that's
that brochure can easily be
distributed to all the schools.
If if that could be helpful.
>> Yeah.
>> I think yeah.
>> Go ahead.
>> If I can add to that, we
update the A, B, C, D brochure
twice a year. It includes a
list of 25 dental clinics
accepting Medicaid, private
insurance as well. And it is
shared with Vancouver School
District, evergreen and other
districts in our county. I
connect with family, community
resource coordinators and
community partners to pass the
voice that those dental clinics
are available for the families
and their children. Okay, yeah.
>> I can add to that as well.
In the share food bags that go
out for kids who need food
security over the weekends, I
think that's about 2700 food
bags a week through the share
program, through every school
district in Clark County, they
do put A, B, C, D fliers in
there. And we also collaborate
at community events, fairs, all.
I don't think there's been an
event I have been at in Clark
County that that A, B, C, D
hasn't been present. And we
work with all of our families,
has 15 school districts and
three counties, and our
collaborations with their
family resource coordinators.
We share those resources.
They're very familiar with A, B,
C, D and dental link to try and
get those kids to the dentist.
>> Yes.
>> I, I think that's great.
That's very helpful. I almost
think because I know that the
schools send out newsletters
with the districts and then
also the PTA groups too,
because they share the
information with. I mean,
that's what PTA Parents and
Teachers Association. So that
might be something. But I, I
literally just recently heard
about a couple of these
different programs, doctor,
that you mentioned, because I
actually, I would say for the
most part, even if you have
dental insurance, it's always
not great for the reimbursement
rates are not great. And the
reason why I was kind of
rooting around and asking about
this is I have a couple of
friends that are, that have
jobs that don't have the most
robust insurance plans. And
they were wondering like how to
go about dental, how to get
those services. And so I asked
my dentist, so they mentioned
the not the battleground clinic
that you mentioned, but the
other one. And I literally, I,
because I had no idea. And I
was like, well, this is great
information. I wish, you know,
more people knew about that.
And I have been getting
newsletters from my ten year
old school. And I haven't I
haven't noticed it. I'm like,
you know, that would be really
something helpful. Or maybe
like I mentioned, maybe the,
the PTA avenue, although I
don't know if that's something
they would be interested. But
anyway, just some food for
thought. Thank you.
>> So yeah, no problem. So
couple couple challenges though.
A lot of these so, so these
free clinics, the, the services
they could provide is somewhat
limited. For example, they
won't be able to do root canals
say. And for children they may
be able to do some simple
fillings. They may not be able
to. They are definitely not
well equipped to handle, you
know, super anxious children
who may not be able to
cooperate. And so, so the
expertise that may be required
could easily exceed these
clinics. And, and at the same
time, you know, we try to we
try to offer help. We try to be
part of the the safety net as
we can. And hopefully,
hopefully, you know, we'll
everybody together can make
this work a little better. And
I must apologize. I've got
patients waiting for me already,
so I'll kind of put myself on
mute and video off, but I'll
try to listen in as much as I
can.
>> Thank you. Thank you very
much.
>> Thank you, Doctor Hsu.
>> Okay. Councilor young.
>> So thank you. This has been
extremely informative. And you
know I caught on to the same
thing. That 2% to 14% is pretty
alarming. And I was wondering
if there are other things that
we've talked about several
issues. But you know, what is
leading to that? You know, all
the different factors. If you
could help us identify those
factors in any ways that we can
work to reduce those. So
because, you know, one of the
things that was mentioned is
people or kids aren't getting
getting their ceilings, right.
But also there are choices.
There are actions that take
place in the household that
even if they aren't getting
ceilings, will lead towards
more healthy, you know, dental
situation. So those kinds of
things I would be interested in,
in understanding what really.
And we also thank you for
chiming in the fact that we
measure things differently
probably also elevated that
number somewhat. But I think
whatever it is that's trending
and leading towards these, we
need to try to see if we can
address the root cause, you
know, no pun intended there.
Yeah. So one of the things that
I was wondering, and I, and I
don't think it was touched on,
and I know that Doctor Hsu is
busy, but what I'm curious
about is I know when we say
that there are 25 clinics that
will that accept Medicaid
patients. What does that look
like? Does that look like
somebody calling one, saying,
sorry, we do, but we're full.
We don't accept any more
Medicaid patients. Does it look
like, yes, we'll take you, but
you're three months away from
being able to see us. What what
does that look like?
>> That is more work that needs
to be done. Of course,
increasing the fee will be
attracting more dentists. So
they are not on the loss, but
on the even pay and
reimbursement. Families are not
going to dental visits
sometimes because of financial
stress. The current
circumstances is one. Parents
both work trying to make ends
meet. The hours of the clinics
are basically 9 to 5. Some
dental clinics are not open on
Fridays. Ideally, you know, it
should be more availability
after hours or even a Saturday
morning clinic. I think all of
us are working to increase the
number of dentists in the
brochure. And that means
reaching out to clinics in
Clark County, sending
information about the program
and the impactful difference
that these clinics can make in
the lives of our children in
Clark County. Coordinating
timely trainings with Doctor
Hsu in addressing the trainings.
Right. Instead of like later,
later. So yeah, it's just
education and information to
all the community partners
working with families and
children in our community.
>> So there, in other words,
there are still not enough.
>> No, no. We need more. Yes,
more. So. And for children with
special health care needs that
are so much more limitations,
sometimes they have to drive to
OHSU for care or Seattle for
Washington School of Dentistry
because we cannot address their
needs here in Clark County. And
if they already have challenges
and stress, right, just with
their conditions, just getting
in a car and driving two, three
hours, that is just extra
stress. So your support is
really important.
>> I think we, we often talk
about lack of resources. And I
think one of the things that we
often forget about, and you
touched on it a little bit, is
one of the resources that we
have is time and energy, quite
frankly, and capacity as
parents. And I think that is a
big struggle for people when,
you know, you touched on it,
the 9 to 5, when you have both
parents working full time, they
come home, they're exhausted,
you know, and then they have
these little kiddos running
around causing havoc. And it's
stressful. And, you know, you
get stuck in this daily grind
as parents and then, you know,
your, your, your capacity is
diminished. And so thinking
about getting an appointment
scheduled, getting it in the
calendar and remembering it,
you know, taking time off of
work and figuring that out if
it's even possible. I mean, all
those things lead to a real
struggle for many people. And
so I love the idea of bringing
the dental to schools. That
would be huge, I think, because
that would relieve so much
stress from the parents. So I
would love to see, and we've
already spoken about it before,
but anything that we can do in
terms of, of lobbying the state
legislature to make changes.
But I would also like our
public health or I imagine it's
public health that would do
this to take a look at the fee
structure that we have for our
dental offices in the county
and see if there's maybe the
possibility to do like some
shifting, you know, towards,
you know, lowering or
minimizing those fees for the
folks that do choose to
participate. And of course, we
would need to make sure that
there would be some level of
accountability there, ensuring
that people are making a
difference to those fees. I
don't know whether it's
possible, whether we can do
that, but I certainly would
like to look at any, any kind
of financial incentive that the
county could provide for those
folks that are willing to
contribute towards that service.
So thank you so much. I think
we it seems very evident that
we care about this and we want
to make a difference. So please
give us all the recommendations
that you can think of that we
can make a difference on.
>> Thank you, thank you.
>> Okay. I have a few questions.
I think that doctor had
mentioned there was a certain
percentage of children that are
on Medicaid in Clark County.
What percentage was that of
children? 5454 that's what I
thought I heard. And then I was.
>> It's 98%.
>> For OSF. It's 98%.
>> Okay. I was just wondering
about the overall in the in.
>> The.
>> 54.
>> I think, Andrea, if you
could just come up to a mic and
say that number, I can't read
your lips.
>> Sorry, is this one on?
>> You can turn it on. There
you go. Yes.
>> In terms of.
>> And could you just introduce
yourself for the record?
>> Good morning. For the record,
my name is Andrea Pruitt and
I'm the community health
director at Clark County Public
Health. And so the percentage
of residents in Clark County
that have Apple Health health
insurance coverage vary year to
year, but it's a little less
than 50% of our population
across all age groups and
categories have Medicaid
insurance. And so that's going
to look slightly different for
Eocs enrolled population than
it will for the broader general
population. So it's a it's
about 40%, 43%. It varies from
year to year.
>> So 40% of all children. Of
Clark County.
>> Yes. Okay. Have Medicaid.
>> And so we can get you that
exact percentage.
>> I just wanted to understand
because I think that represents
a very vulnerable population
that I wasn't a aware it was so
high.
>> I just heard the number half
of kids under 18 in Clark
County are enrolled in Medicare,
Medicaid. So that roughly half.
Okay, okay.
>> All right. Thanks for that.
And then the other another
thing that came up that was of
concern to me is getting access
is Apple Care and Medicaid. Is
that basically the same thing?
Is it very difficult to get on
to those programs?
>> I don't know if I'm on or
off.
>> Is this on? Okay. So so yes
and no. It depends on what your
how how prepared the parent is.
Do they have the documents
needed to apply? If you have
the documents needed to apply
and you have access to internet
and computer and you're savvy,
you could apply and qualify and
get that email in 20 to 30
minutes. I've helped families
do that. I've also had families
who don't have that
documentation and have to work
very hard to find that
information and don't have
access to computer, don't have
access to internet. English is
not their first language, and
it's taken maybe 17 hours and 4
or 5 tries, and they work with
an in person assistant or
patient navigator. So and then
you have to.
>> Provide that navigator.
>> It's a state health care
authority of Washington has the
is the owner of that. But each
county has an agency that
oversees it. And in Clark
County, see, my is the people
who house them. They they don't
work for the C ma medical
clinic, but they do have their
offices in C Ma locations. They
are bilingual and help families
with Medicaid application
process.
>> Great. Thank you. Because
the example you gave, I think
that was one of the problems
that they had difficulty
accessing Medicaid.
>> Or dentists.
>> Or, or, or, and dentists.
Okay. So I think providing
wherever there that seems like
a key component is providing
assistance to those people who
are having that, that
difficulty to gain that access
and Are sealants. Is that a
something that gets extra a
little extra reimbursement or
do we know?
>> I believe sealants are
covered under the enhanced
reimbursement.
>> Great, great. Okay. Oh, and
then the cut off is at six
years. And so for those
children that are older than
six, is the assumption that
good practices have been in
stilled. And what does their
dental health look at? 6 to 18.
And I would just say those
teenage years. Oh, a lot can
happen.
>> So the A, B, C, D program is
0 to 6 and then 6 to 13 with
the the developmental
designator. And we have seen
teenagers with not optimal oral
health. So it's like a drop.
>> So there's not a similar
program for the older age. No I.
>> Think it jumps to adulthood
like 18. Like now they're
covered with Medicaid as adults.
>> Okay. Okay.
>> So it's just to address the
gap in there too.
>> Okay. Let's see, what else
did I have going on here? I
think that's all my questions.
Just it has been really very
informative and, and whatever
policies at the state level or
the federal level that you can
identify that we could weigh in
on. Please bring that to the
the Board of Health and the
Council. And we can, if three
of us agree, we can advocate
for these programs.
>> Sure. Yes.
>> Do you think we could get
this on a future agenda for
action items just so we don't.
So it doesn't disappear?
>> I think the the health
department. Will you all
monitor what's going on at the
legislature, I imagine, and can
work with with us and with
Jordan as issues arise. So I
think, you know, once we get
into looking at what our
priorities are, everyone here
has heard that this is likely
to be a priority.
>> Okay. So we'll get it on a
future agenda. All right.
Awesome. Thank you.
>> Yes.
>> Go ahead.
>> The one idea, though, of
taking a look at our local fees
is a little bit different. And
I just wanted to see if there
was interest of the council of
having that brought forward to
us as well.
>> I'm I'm interested in seeing
what the fees are. Anything
that we can do on our end to
reduce the cost burden, since
it's unlikely that the enhanced
fees will be increased or, or
broadened.
>> What what fees do we have
related to dental? I don't know
that we provide dental care.
>> We don't. The fees that
Doctor Hsu is referencing are
set by the state, by the health
care authority. So those
enhanced rates and then right
the enhanced rates are are set
at the state level. So those
are updated or they're static.
And those are available through
the Health Care Authority. And
we can share those with you in
terms of anything that happens
at the local level and
additional reimbursements that
dentists or healthcare
providers receive for
individuals with private health
care insurance. Those
reimbursement rates may be
different than what the health
Care authority reimburses for
Apple Health members. And so
those we do not have access to,
and that is considered
proprietary and private. So we
don't have the authority to
adjust rates at the local level.
>> Yeah, that was not my
suggestion. My suggestion was
looking at what what if any,
fees the county charges the
business itself.
>> Oh, okay.
>> To see if we could do some
shifting there to provide an
incentive.
>> I gotcha. Okay.
>> Thank you.
>> Okay. Thanks for clarifying
that. I wasn't clear on that.
>> Go ahead.
>> And just to add to that, any
other creative ways we can do
to reduce their cost burdens?
>> Okay. Anything else from any
council members?
>> Yes. If I could just clarify
because I know Councilor Little
ended with putting it on a
future agenda. I think I heard
the council say put it on the
agenda when we're talking about
legislative priorities. Correct.
Just including in that
discussion, not a separate that.
>> That was my suggestion. But
Councilor Little did you have a
you want to bring it back to
the Board of Health?
>> I just don't know what it is.
We're asking for information.
And I guess based on that
information, I guess it will
show up in our inbox and then
we can put it on an agenda. But
I do want to save space for a
discussion beyond us just
asking the state to do their
part. I want to see what our
part could be.
>> I agree to I think I would
like to actually have a touch
at the dais on this, and not
just have it blend into the
legislative process, and then
also the fees from the county,
I think would be totally
separate from that. I mean,
that's not our legislative
agenda. That's something here
we handle locally.
>> Okay. So what I think I'm
hearing is bringing this back
to a Board of Health meeting,
and that we would have you all
go back. And if you want to
come forward with any other
specific recommendations for us,
advice that that would be that
would be welcome. Okay, great.
All right. All right. Thank you.
>> Thank you so much for your
time consideration.
>> Thank you.
>> Okay. Health officer update
Doctor DeSilva. Welcome.
>> Good morning. I am Brienna
D'Silva Bhatia, the interim
health officer. For the record.
And before I get started with
the health officer update, I
wanted to extend a thank you to
the A, B, C, D program. And for
the interest from all of you as
somebody who struggled with
pediatric dental care. I really
appreciate and value programs
like this being available. So
thank you. All right. So this
month will be talking about
respiratory viral season
vaccine recommendations. This
month, major medical societies
and the Washington State
Department of Health released
their vaccination
recommendations for Covid, flu
and RSV. In general, these
illnesses continue to cause
substantial illness,
hospitalization, and death in
the United States with the
greatest risk of severe disease
concentrated among older adults,
infants, pregnant people and
people with underlying health
conditions. This morning, we
will go over those
recommendations, and at the
next Board of Health, I plan to
share more information about
how and why these
recommendations were developed,
and provide more details on
local response, as well as a
general county situational
update. I'll start with Covid.
Since initial approval, Covid
19 vaccine formulations have
changed annually to better
match circulating variants and
to approve improve their
effectiveness. This is commonly
referred to as getting the
updated vaccine. This season,
we have four FDA approved Covid
19 vaccines available. They all
target the same variant. We
have Moderna, Spikevax,
Moderna's Em next spike,
Pfizer-BioNTech, Comirnaty and
Novavax Sanofi's, Nuvaxovid.
They're all approved for
different age groups.
Washington state is following
the guidance of national
organizations, including the
American Academy of Pediatrics
and the American Academy of
Family Physicians. Everyone
over the age of six months can
have access to Covid 19
vaccines. Clark County Public
Health and Washington
Department of Health encourage
everyone over the age of six
months to receive an updated
Covid 19 vaccine. People at the
highest risk for complications
from Covid will have the
highest benefit from
vaccination, and this includes
children six months to 23
months. People with any risk
factors or underlying
conditions that make them more
susceptible to severe disease,
and adults over 65 to be
considered up to date. People
between the age of 19 to 64
need one one dose of the
updated Covid vaccine this year
or this season, rather, and
adults above age 65 need one
dose and then a booster about
six months later. Adults that
are significantly
immunocompromised need more
doses. For kids, 1 to 2 doses
is needed depending on their
age and similarly to adults. If
they are immunocompromised,
they will need more doses to be
considered up to date. Outside
of age, medical societies and
public health have no formal
preference over any one
manufacturer. They are all
equally safe and effective. The
state Department of Health has
renewed a statewide Covid 19
standing order so that anyone
six months and above who wants
to be vaccinated can do so. The
standing order serves as a
prescription before the
standing order was created last
season, some people who wanted
to receive a Covid 19 vaccine
could not get one at a pharmacy
without a prescription. I think
this season most pharmacies are
indeed aware of the standing
order and that it has been
renewed. But if community
members want to bring a copy of
the standing order with them to
serve as their prescription,
they can access this online on
the Washington Department of
Health website, which is
doh.w.gov. On the upper right
hand side of the web page is a
search bar, and you can type in
standing orders, and it will
show a list of the various
standing orders available for
the state. I'll pause there if
you have any thoughts or
questions.
>> Chair.
>> Go ahead.
>> Thank you as always for the
complete information and
recommendations. So you're
saying that anybody at any age
should probably this fall or
winter, get a flu and Covid
shot? And are they their
separate shots? There isn't a
combined one. And then the
other question is, I was at the
doctor yesterday and they
didn't have those yet available.
Are they? When will they likely
be widely available at Costco
and at your doctor's office?
>> I'll touch on influenza in
just a moment. These are
separate vaccinations,
different shots, different
packaged differently. You can
get a Covid and a flu shot at
the same time. They need to be
in a different location. So
commonly one in the left arm,
one in the right arm,
commercial or private privately
purchased Covid 19 vaccines are
rolling out now. I've heard
several locations just this
week have started allowing
appointments and scheduling for
folks who are getting publicly
funded, publicly purchased
immunizations, specifically
Covid. There is a delay, and I
do have some updates that that
I was planning to talk a little
bit more about at the end.
After we kind of get through
influenza and RSV. So I will I
will circle back to that. Thank
you. Everyone. Six months and
above is eligible for Covid 19
vaccine.
>> I would just personal
experience. They're available
at Safeway and I've gotten my
flu and Covid update the
standing orders that just the
state is a state standing order.
Okay. Thank you. Go ahead.
>> I, I'm wondering, you know,
we have not really discussed
Covid in depth for quite some
time. And, and I'm, I'm
wondering. Like, I have not
seen. So just anecdotally, it
has been a very long time since
I've heard of somebody getting
really sick from Covid. There
was a time when people were
getting horribly sick from it.
I just don't I haven't
experienced that within my
circle of people that I
associate with. What I'm
wondering is, you know, you say
that people are eligible, but
what is our actual
recommendation and what is that
recommendation based on? Are
there still people getting
severely ill? What percentage
of people in our, you know,
hospitals are Covid patients?
Can you just elaborate a little
bit on that?
>> Absolutely. I plan to bring
more information about this in
far more detail. Next board of
Health. But Washington state is
following a National Medical
Society recommendations,
meaning anyone six months and
above should consider getting a
Covid 19 vaccine. People will.
People who are more at risk or
prone to have more severe
disease will have a higher
benefit from the vaccines. It
is absolutely true that we are
not seeing the severe and
terrible disease that we saw
previously during the height of
the pandemic, and some of that
could be related to folks
having maybe multiple illnesses,
as well as multiple doses of
vaccine that have primed their
immune system to just handle
future encounters more
effectively. There's also some
data to suggest that the
variants have just been less
severe. That's a little bit of
a ticking time bomb, because we
can't predict how the virus
will mutate. We fortunately
have seen mutations that have
seemed to convey less severe
disease, but we don't know when,
when or if that will change in
the future. Regarding Covid
numbers, I'll agree with you.
We haven't been seeing again
that the terrible disease that
that we saw in 2020, 2021 with
different waves, but there are
still folks, particularly
infants, immunocompromised
people and people over the age
of 65 who are still indeed
getting more severe illness.
Most of the Covid is not
seasonal. People get Covid all
year with a winter and
respiratory viruses and the
cold weather. We have seen
peaks during that time, but
there have been peaks during
warmer months. Most of the
Covid data for the state is
bundled with respiratory virus
season, so we don't have a lot
of updated numbers right now.
Clark County Public Health does
put out a respiratory virus
update where we post data on
influenza locally. And so as we
kind of enter into this season,
we will see more state and
local resources available where
I can provide you with like
very, very solid direct numbers.
Regarding last year, I don't
know the numbers off the top of
my head, but we do have reports
coming in now of disease burden,
as well as the vaccine
effectiveness of the last, you
know, last year's updated
booster.
>> Yeah, I look forward to that
discussion. I mean, as we know,
there's a lot of distrust
around this issue. And there
has been I'm sure it continues,
although we don't just we just
don't hear about it as much. So
when we do provide a
recommendation, I think it is
important. It sounds like we're
going to get that some real
data behind our recommendation,
not just that a specific
organization says that we
should recommend that just to
help help develop that, that
trust in the recommendation
coming out of public health. So
thank you. Look forward to that.
>> Okay. I will continue with
influenza. In brief, the
influenza vaccine is updated
yearly. Global and U.S.
surveillance tracks the
different flu strains that are
circulating. And this informs
the annual updates. We know
that seasonal influenza
vaccination reduces severe
disease, hospitalization, and
death. Washington State
Department of Health are
following again the
recommendations from national
medical societies such as the
American Academy of Pediatrics,
American Academy of Family
Practice or Family Physicians,
and the American College of
Obstetricians and Gynecologists.
And we are recommending an
annual flu shot for everyone
aged six months and above. This
year, we have five
manufacturers and lots of
options. There are special
considerations for certain age
groups. Some children between
age six months and eight years
need two doses. If this is the
first, the first time they're
getting vaccinated for
influenza within people age 65
and above, it is preferred to
have an enhanced flu shot over
the standard standard dose. So
right now we have four enhanced
flu shots available, which are
preferred again for people over
age 65. These are fluzone,
flublok, Fluad and M flu severe.
You can think of the enhanced
shots as being stronger or more
potent, and they elicit a
stronger and more effective
immune response in folks in
that age group who
traditionally their immune
system needs a little bit extra
help in just producing
antibodies among the boosted or
enhanced vaccines, none is
preferred over the other. I'll
pause there if you have any
thoughts or questions.
>> I think we're good.
>> Okay. RSV or respiratory
syncytial virus. This typically
starts as a more mild upper
respiratory tract infection. So
cough, flu, runny nose, really
hard to differentiate from
something else, but it can
quickly move down into the
lungs and cause a very severe
illness called bronchiolitis.
Bronchiolitis is a reason that
infants may simply stop
breathing and experience apnea
if they become ill with RSV.
Washington state is again
following the guidance of
national organizations like
American Academy of Pediatrics
for the use of monoclonal
antibodies in infants.
Monoclonal antibodies are human
made proteins or antibodies,
and we give them to children
via an injection to protect
them from RSV. It's a little
bit different from a vaccine,
but may be referred to as a
vaccine product in that their
immune system does not have to
make the antibodies. We just
give them antibodies, and that
provides protection throughout
their first or even second RSV
season, depending on how many
doses they get and when they
get it. This can be very
special and very tailored to
each individual child. So folks
should absolutely speak with
their pediatricians about when
they should, when their child
should get it, and if they need
a second dose. We also have an
RSV vaccine, and this is a one
time dose for pregnant people
between 32 and 36 weeks. And
it's also recommended that all
adults over age 75 and some
adults with risk factors for
severe disease or
immunocompromising conditions
receive one dose between 50 and
age 74. Currently, the evidence
supports this as a one time one
you know, one time in your life
dose. This is an area where we
may see changing evidence in
the future about booster doses,
but right now it is one time
dose to last for life. I wanted
to just end on a little note
about vaccines for children,
which is a federal program
designed to eliminate cost as a
barrier for immunizations. This
program purchases vaccines from
manufacturers at a special
discounted federal rate, and
then provides them for free to
enrolled health care providers
to then use in children anytime
before their 19th birthday.
Washington operates this
program under the title of
Childhood Vaccine program, and
we also operate in adult
vaccine program, which is
funded through different grants.
And so this allows healthcare
providers to give specific
vaccines to people free of
charge. Under this program, RSV
products Ability to Order
opened in August by the. When
you order within about a week,
the product is delivered.
Influenza ordering opened on
September 1st. However, the
federal program has not
authorized access to Covid 19
vaccines. It is unknown when
ordering or shipments will
become available. This means
that about half of U.S.
children who. I'll back up a
moment. About half of U.S.
children are eligible for this
vaccines for children program.
The fact that the Covid 19
vaccines are not yet available
for ordering or administration
similarly means about half of
U.S. children currently do not
have access to the Covid 19
vaccine. We anticipate that the
we'll hear very soon, and that
this program will will open up
and start allowing people to
order these vaccines. But we're
hearing a lot of concerns from
health care providers in the
community that they still don't
have these vaccines on hand.
This creates a little bit of a
dilemma in that Covid vaccines
may become available later in
the season, or it may timing
wise, folks may not be able to
get one later if they're here
now for an appointment and
they're anticipating getting a
Covid 19 vaccine, parents may
not be able to bring their
children back, you know, in a
week or two weeks or a month.
This also pushes health care
providers to consider ordering
these vaccines on the private
market, which is potentially
very, you know, quite costly.
I'll end with just some
resources for parents and
families. If anyone would like
to learn more. Some very good
and reliable and comprehensive
websites include vaccine
information.org and
healthychildren.org. For folks
that might want more detail and
to look at literature and
studies. Another really great
website is Spread the facts.org.
This links to the American
Medical Association, which has
consolidated recommendations.
And lastly, immunize.org also
has a YouTube channel and they
have really wonderful videos
there, 1 to 3 minute snippets,
and they have a lot of detailed
information. These are
primarily geared towards
healthcare providers, but for
folks who want a more in-depth
and comprehensive review,
that's also those are all
really great options. Thank you.
>> Okay. Is there any does
anyone know why there's a delay
in making those vaccines
available?
>> The federal program has just
not released, has not opened
ordering. And I, I don't think
we've had any recent updates on
when that will become available.
>> And in previous years, it's
been a you would have expected
it to be available. Now.
>> Last year there was a
similar delay, although I don't
on the off the top of my head
have the exact date that
ordering opened, but there was
a similar delay last year.
Prior to this. I do not believe
there were delays in ordering
and receiving Covid 19 vaccines.
>> Okay. Thank you. Any other
questions? Okay. Thank you very
much, doctor.
>> Thank you.
>> Okay, then. Moving on.
Maternity system of care update.
Andrea.
>> Good morning.
>> Good morning Council. Andrea
Pruitt community health
director. For the record, Clark
County Public Health wants
residents with Apple health,
health care insurance that is
Medicaid, to have the same
access to first trimester
prenatal care and sustained
high quality maternity care
services as their privately
insured peers. In 2025 to
Reground, the board, Clark
County Public Health worked to
consolidate and distribute a an
issue brief regarding
deficiencies in access to
prenatal and maternity care
services for Apple Health
residents living in Clark
County. As part of this work,
we have been convening with our
Washington State Department of
Health, the Health Care
Authority, health care
providers offering obstetric
and prenatal care services in
Clark County, as well as our
community partners representing.
Individuals that have Medicaid
health insurance, as well as
those accessing safety net
services. If you may recall, we
came to you several times in
2025, in February, April, May,
June, August and September of
last year with updates
regarding our conversations and
outcomes of policy summit
meetings with elected officials,
health care providers and
community members
disproportionately impacted by
this lack of access to discuss
the primary barriers and
drivers of these system issues
that result in this lack of
access to care. It's been just
over a year since the Clark
County Board of Health passed a
resolution on September 9th of
2025 relating to the importance
of access to high quality
pregnancy related health care,
effectively formalizing our
collective commitment to
addressing the root causes of
these critical access gaps for
Medicaid or Apple Health
beneficiaries and residents
trying to access this care in
Clark County. Over the past 12
months, Clark County Public
Health has been working on a
series of several initiatives
with our state agency partners
and our local health care
system partners to identify and
implement strategic solutions
to address these barriers,
primarily, our workforce
capacity issues. Network
adequacy constraints and issues
with payment reform. Some of
these issues were also
discussed as part of the Oral
Health and Dental presentation.
These primary drivers
contribute to limited access
for obstetric care and result
in the increased risk for poor
maternal child health outcomes
for residents with Medicaid or
Apple health insurance. So
notably, in 2024, 59% of Clark
County residents with Apple
health insurance access
prenatal care in the first
trimester, compared to 77% of
their privately insured peers.
In 2025, we observed additional
declines in access to first
trimester prenatal care, with
54.3% of Medicaid beneficiaries
receiving first trimester care.
As of yet, the 2025 access to
care for individuals with
private insurance is still
pending release. That said,
over the past 12 months, the
most notable work that we've
been doing locally, that was
also referenced in a memo that
the council or I'm sorry, the
Board of Health, received in
June regarding our progress
update, has been with our
executive and clinical health
systems leadership of
PeaceHealth, Southwest Legacy,
Salmon Creek and Vancouver
Clinic. We've been meeting
monthly to discuss local
options, to be able to to
address the lack and shortage
of health care providers, as
well as issues with network
adequacy. Earlier this spring,
our health system partners
elected to prioritize focusing
on reestablishing our local
model of care, which includes
working with Seema, our local
fqhc, to reestablish their
provider network. That
beginning in 2023, they started
sunsetting some of their
service provider groups,
including their midwifery
practice and also their
physicians, who historically
have provided labor and
delivery services as part of a
broader system of call coverage
and network at Legacy Salmon
Creek Hospital. As a result,
we've convened two additional
larger partner meetings this
year. One meeting took place in
June. The other one took place
just two weeks ago. These large
system meetings have convened
different sections of our state
and local health care providers
and government oversight
agencies, with the goal of
determining how and what
solutions we can access in
terms of right, and adding
additional providers to our
local network in order to be
able to meet the the service
needs of our residents who live
here. This Friday, PeaceHealth
Southwest and Legacy Salmon
Creek anticipate receiving an
updated draft, written
agreement or proposal from Cmaa.
Our Fqhc as to what the future
of that collective model of
care will look like. This is
critical because right now we
do not have enough providers
who are serving our Apple
Health or Medicaid
beneficiaries in order for
everyone to have access to high
quality, timely prenatal care.
It's resulting on the strain
for both hospital systems and
the existing workforce. And
it's creating poor health
outcomes, delayed care, and and
in some circumstances, no
access to care. So in addition
to what we anticipate for the
health systems to receive those
draft model agreements from
Cmaa this Friday, we're also
going to plan to reconvene in
November. That same group,
clinical and executive
leadership from our hospital
systems and executive
leadership from Cmaa to figure
out what the future plan will
be in terms of making sure that
we can meet the needs
specifically for prenatal care
and labor and delivery pending
on the outcome of that November
meeting. We will then have
additional information to
figure out what next steps need
to be taken, if any, and what
avenues we can draw down on in
partnership with the Health
Care Authority and the
Washington Department of Health,
in order to establish, like an
interim plan to bring in
temporary providers or. And in
addition to having longer term
conversations with the health
care Authority about payment
reform, which is the
reimbursement fee for service
structure and an alternative
and innovative ways in order to
be able to have enough
providers to provide prenatal
care and, and labor and
delivery services. And so that
I'll stop there and see what
additional questions you have.
But just a reminder, you do
have that progress report
update that we sent over in
writing, excuse me, in June,
and we can continue to update
that. So you have a good
understanding about all of the
different ways we're working
with our partners to try to
open up that access to care.
>> Thank you Andrea, really
appreciate your leadership on
this issue. When you're trying
to address things in a systemic
way, it takes time. It takes
all of the players coming
together. So you've you've done
a really good job. Any
questions from council? Yes.
>> Go ahead.
>> Yeah. Just wondering,
similar to our previous
discussion, whether we had ever
looked at county charged fees
for these businesses, is it
possible way to incentivize
more people or more businesses
for being willing to accept
patients?
>> Yes. And I, we are having
those conversations. There may
be some opportunities for the
county council and Board of
Health to incentivize or create
revenue streams through tax
initiatives to support or
offset or encourage the
additional provision of health
care to specific populations
and our pregnant and parenting
populations. Moreover, I think
the conversations that we're
really focusing on right now
are ensuring that the systems
that already exist function
well. And so it's really
critical that we pay close
attention to what our health
care systems and our partners
and our fqhcs are designed,
right, in theory, to do and how
they function in practice. And
so what we're really seeing is
a need for our fqhc to fully
meet their compliance issued
mandates that are set at a
federal level. And so in the
absence of their ability to
right maintain for a number of
reasons their workforce, that
has implications on all of us.
And so we want to be really
careful before we ask for
additional support locally from
our taxpayers and our residents
that live here, that we are
being excellent stewards of the,
you know, the, the, the taxes
we already pay. And so there's
a lot of quality assurance and
compliance issues that are tied
to this. And everyone has a
very specific role, ensuring
that everyone knows whose role
is what and how those things
function is something that
we're working really hard to
clarify. The, the, the federal
federal pass through landscape
and how Hrsa funds are
distributed locally for
federally qualified health
services. It's different.
There's no state agency that
really has a singular oversight
function for how these programs
work in theory and in practice.
>> Okay. Yeah. Thank you. And
just kind of back to the idea
of the county charge fees. Like
I have no idea, like what fees
are levied against like a
dental office or provider
prenatal care. I don't know if
it's in the hundreds and it's
kind of meaningless and won't
make a difference or if it's in
the thousands, I don't know. I
mean, I imagine they have like,
you know, fire inspection fees
and probably, I mean, health
inspection fees to some degree.
And I don't know, all those
other fees and whether it would
be enough to make a meaningful
difference. So but would be
interested in hearing that for
sure.
>> I think that question is a
great one, and I would be very
interested in offering that
opportunity. In your question
to our health systems
leadership, I feel like that
could be a conversation in a
work session, and I will
absolutely share that message.
And then we get a comprehensive
list from their perspective
about what they feel would be
meaning making.
>> Okay. Thank you.
>> Yeah.
>> Great. And then I would just
add, if there are any
legislative fixes that you
identify. Yes, please, please
bring those forward as well.
>> Yes. And I've started having
some of those conversations
with some of our physician
groups and our local healthcare
leadership. Once those groups
have established what their
priorities are, we will be sure
to connect the leaders
representing those policy
priorities to Jordan and the
Board of Health. We want to
make sure that we stay kind of
correctly in our scope and our
space, but they're working on
them. They don't have them yet.
I did ask, and so there may be
some very specific things that
will help to address workforce
capacity, you know, malpractice
insurance premiums and some of
those things, as well as
payment reform. So we will keep
in touch.
>> Great.
>> Yeah.
>> Thank you very much. Great
work.
>> Thanks.
>> Okay. Moving on. Public
Health Advisory Council report.
And Emily, thank you for being
here.
>> I am. I'm Emily Estes. I'm
the vice chair of the Public
Health Advisory Council. The
Phac voted last night to move
our meetings to the second
Thursday of the month to
increase the communication and
give us time between Board of
Health meetings and facts, so
we can kind of do a little bit
of a better job of priority
setting relating to the ongoing
discussions with the board
about increasing our
communication, we would like to
and have heard from our
membership the desire to
continue discussions with the
board on fulfilling our our
statutory advisement role. In
addition, yesterday Phac
entered executive Session under
the qualifying section G of the
Opma and there was no after
action. I often use these times
to share the concerns and
experiences of individual Phac
members with specific
professional capacities or
skills that were shared during
our meeting and in this case,
as the consumer or a consumer
on the board. These are mine.
So my family and myself have
personally been affected by the
lack of prenatal care access
for Medicaid recipients in
Southwest Washington. When this
information was brought to you
back in 2024, I, I was a data
point on that inadequate access.
I've also seen my kids be
susceptible to inadequate care
because of the delay in access
to vaccination and because
pharmacies can't provide them
to Medicaid recipient children,
they need to access a clinic.
And regarding the A, B, C, D
program, I've seen that outcome
really clearly. And, you know,
circling back to what I think
was a really consequential part
of this meeting today, I have
very few barriers to care
except for public insurance.
And I have extensive
professional experience signing
families up for Medicaid and
accessing care. And but for the
work of Clark County and that
program, I myself would not
have been able to find a
Medicaid eligible dentist for
my children. Molina. Apple
health lists, dental providers,
their online and many dentists
on that list actually don't
take children or they are not
in practice, or they are not
currently involved in the A, B,
C, D program. Calling around
does not work very well. Other
people and myself have been
hung up on. When asked if a
dentist receives Medicaid or
takes Medicaid. I've also seen
the success of the program in
our family dentist who was
identified by the A, B, C, D
program to work with my
daughter who has Medicaid
designated developmental
disability and special health
care needs, which made the
point of care actually
accessible for her. So all of
that to say, while there are
organizational changes and
transitions recently, I just
really want to recognize the
really tangible value of the
work of Clark County Public
Health and that program in my
own life. And having heard from
the fact yesterday on these
topics, their conversations
we'd like to keep participating
in as you move forward on them
as well.
>> Great. Thank you very much.
Any questions? Comments from.
>> The.
>> Chair board? Yep.
>> Thank you for those
recommendations. I've said this
before, but I just this is my
opinion. I think it's weird
that we're the Board of Health.
I think it's kind of
inappropriate that the
legislature thought we should
be the Board of Health. I
understand that we're the ones
that allocate resources and
such, but we're not experts.
And you are and I my model of
how this should work is that
you, the experts, should debate
issues, public health issues,
and come up with
recommendations, very specific
recommendations of what we
should do, of what you would do
if you're the Board of Health
and ask us to implement those.
That's how I think it should
work. And so if you could bring
back to the group, I know we're
trying to increase
communications and get more
recommendations, but that's
just how I think of how it
should work. And I'm really
open to a lot of your ideas and
want to get more, more of them,
very specific things that we
can act on. So I'm looking
forward to that. And yeah,
thank you.
>> Thank you. Other comments?
Seeing none. Thank you very
much. And we'll keep the lines
of communication open. Okay.
Any comments from the board. I
don't see or hear any. So we've
completed our agenda. And
without objection, the Board of
Health is adjourned.