The Vashon Health Care District laid out its proposed 2025 budget and strategic plan during a special meeting on Wednesday, Nov. 13.

The $1.96 million 2025 budget sets aside a little more than half a million for the district’s urgent care contract with DispatchHealth, around $750,000 for behavioral health and vulnerable adult programming, and roughly $400,000 in operating expenses, including payroll, rent and accounting expenses.

Based on its current needs and programs, the district doesn’t anticipate needing to raise its levy for several years, superintendent Tim Johnson said at the meeting. The district plans to levy around $1.95 million in tax revenue in 2025, the same amount as it did this year.

“We are at a levy amount that we can probably hold steady … into 2028 or 2029 before needing to look at revising it,” Johnson said. “That may change in the future, but we can only look so far ahead.”

The board will next discuss the 2025 budget and may take action on it during their 7 p.m. meeting on Nov. 25 at the Vashon Presbyterian Church (17708 Vashon Hwy SW). Look for a link to join by Zoom on vashonhealthcare.org.

Past, present and future

VHCD is a hospital district under county code, but as Vashon has no hospitals, it does business under the Health Care district name.

Voters established the district in November 2019 with the primary goal of creating a body which could sustain primary care on the island. The district did so in 2021 and 2022 by subsidizing the care of island provider Sea Mar. The district also acquired a piece of property, next to Kathy’s Corner and near Vashon Town, that could seat a new island healthcare clinic.

But in late 2022, Sea Mar and VHCD split, and Sea Mar now operates independently at its clinic on Sunrise Ridge. Sea Mar plans to build and operate its own new clinic in Vashon Town at the site of the Spinnaker building. Should Sea Mar depart, the district will have the option to purchase their future clinic.

After that split, VHCD spent 2023 re-evaluating its goals, and came up with three priorities: Maintaining a rainy day fund for primary care in the unforseen event that Sea Mar departs Vashon; funding behavioral health services; and bringing urgent care to Vashon.

This summer, VHCD began funding behavioral care services — including a social worker and counselor positions — across various island service providers and the school district. It also signed a deal to bring mobile urgent care provider DispatchHealth to the island. DispatchHealth began providing care on Vashon in October.

Now, the district has identified a fourth priority: Care for vulnerable adults, especially those who need help affording healthcare. VHCD has given $20,000 to subsidize VYFS’ medical voucher program under this plank; is considering funding a social worker at the senior center; has set aside $250,000 to possibly work with VIFR on developing its Mobile Integrated Health program; and plans to build a “compassionate care” fund that will help uninsured islanders access DispatchHealth.

The 2025 budget includes all those programs, plus the maintenance of the property near the Vashon Town core, which continues to lie fallow.

DispatchHealth and urgent care beyond

The Health Care District (VHCD) has committed to subsidizing DispatchHealth’s (DH) operations on Vashon at a cost of roughly $1.2 million in property tax revenue for the next two years, i.e. through fall 2026.

The contract specifies a go/no decision point 18 months in (which will be around spring 2026) for VHCD to decide whether to keep the urgent care provider on for longer.

The first year runs the district and taxpayers $560,000, with a 3% increase assumed for the second year. But that increase will be waived if DispatchHealth sees more than 1,800 patients in its first 12 months on Vashon.

DispatchHealth saw 69 patients in October, or a little more than two patients per day on average. It would need to start seeing more than double that amount to reach the 1,800 number.

The rate of patients served will continue to grow as the service becomes better-known on the island, Johnson said, and he said the odds are a little better than a coinflip that the service will reach that 1,800 number by a year in.

“I hate to predict where it’s going to level out at,” he said in an interview. “But in their history, they generally start to see six to eight patients a day pretty routinely once an area is fully implemented, in a few months.”

Past the two-year contract, and built into VHCD’s budget, is funding for urgent care into 2026 and 2027, estimated at roughly the same cost (between $550,00 and $600,000 per year) as the district now pays for DispatchHealth. That’s because the district plans to continue funding urgent care efforts on the island in some capacity, whether that be through DispatchHealth, funding VIFR’s MIH program, or some other solution, Johnson and boardmembers said.

“Whether we would continue to work with DispatchHealth or find another solution … we would need to allocate resources for that,” Johnson said at the meeting. “So I have (budgeted for) that at the level of DispatchHealth, because that’s the best estimate I can come up with. … It’s a sustainability estimate to make sure we can continue to fund (urgent care).”

The money isn’t committed to that purpose; it’s part of the budgeted plans the district is setting for its future, he said.

“One of the key components of our strategic planning is to make sure that we do not take on functional long term commitments and then have to back away from them,” Johnson said. “We do not know, in two years, whether we will re-contract DispatchHealth, but we do anticipate, unless something major changes, that we will still be ensuring that there’s urgent care on the island.”

Compassionate care

Separately, the district is also building a “compassionate care” fund that will allow uninsured islanders to receive care from DispatchHealth.

“The goal here is 100% coverage,” Johnson said at the meeting. “I’m not sure we’ll ever get to 100% but we are a far sight down the road to that.”

Two draft agreements are in the works.

One draft agreement with DispatchHealth designates VHCD as having the right to choose who gets uninsured care, and to pay a fee for that service.

VHCD has set aside $97,500 in its budget to cover the cost for people without insurance. That reflects an average of five uninsured visits per week, with each visit costing the district DispatchHealth’s self-pay rate of $375. (That rate is the cost of healthcare service for a patient who pays out of pocket and doesn’t use insurance.)

That total is a high estimate, Johnson said, and the cost will probably be lower.

“This is primarily targeted to our undocumented population,” Johnson said at the meeting. “In our latest tabling events … we had several Latino members of our population come up and ask, ‘I don’t have insurance. I can’t get insurance. Can I use urgent care?’ So we are working rapidly, as we had anticipated, to do that.”

Johnson said the few people not covered are mostly those using small exchange-based insurances or some people who are self-insured.

The other agreement, with Vashon Youth and Family Services (VYFS), would allow VYFS to help people who don’t have insurance get a visit from DispatchHealth — and to subsequently get signed up for insurance so they can keep getting care, Johnson said.

Building up reserves

The district maintains several reserves, including a pool of cash that serves as a “break in case of emergency” fund for primary care.

Sea Mar and VHCD maintain a cordial and productive relationship, Johnson has said. Keeping the primary reserve funds well-stocked just means that if worst came to worst, Vashon wouldn’t be left floundering for primary care, he said.

In its 2025 budget, the district laid out the following plans for its cash reserves:

• The main primary care reserve (used to recruit and subsidize a primary care provider if needed) currently sitting at $750,000, will gain $450,000 next year to reach a maximum of $1.2 million.

• The capital reserve fund, currently at $500,000, established to provide a down payment on the new Sea Mar clinic in Vashon Town if needed, will grow by $250,000 every year, up to a maximum of $3 million. (This is in addition to the $3 million that would be credited back to the district if it acquired the clinic, as per an earlier agreement with Sea Mar.)

• The administrative reserve fund will sit at $25,000.

• The district’s unobligated cash balance, siting at $1 million for 2025, will slowly be drawn down over the next few years but will reach a minimum of $500,000.

Add all those balances up, and the district’s total amount of non-reserved cash and reserves will sit around $3 million in 2025 and going forward.

By the numbers

VHCD plans to bring in $1.95 million in tax revenue and about $98,900 in investment interest in 2025, with a sum of roughly $2.1 million in total income. The budget sets aside about $1.5 million in the following rough amounts for programming:

• $564,000: DispatchHealth urgent care program.

• $354,000: Care for vulnerable adults, include vouchers and the possibility of a social worker or contracting with MIH

• $293,000: Youth behavioral health work and an adult behavioral health study

• $100,000: For unplanned needs, including pilot projects or unsolicited and one-time funding opportunities.

• $97,500: To cover compassionate care for DispatchHealth at an estimated five uninsured visits per week.

• $87,000: For potential adult behavioral health programming — separate from the adult behavioral health study above.

• $23,000: For outreach, including a contract with Voice of Vashon and events including a health fair.

For about $400,000 in operating expenses, the budget includes:

• $93,000 for the superintendent’s salary (a raise from $87,000 this year.)

• $81,000 for rent and utilities at Sunrise Ridge. This exact amount is compensated to the district by Sea Mar, who subleases from VHCD — so the district breaks even on this cost. The district’s lease at Sunrise Ridge (and sublease to Sea Mar) runs out in October 2025, after which, should Sea Mar still be operating at the facility, it will likely lease it directly from Sunrise Ridge, Johnson said.

• $55,000 for consulting and staff and board development.

• $43,000 for administrative staff. (12 hours per week for the district’s admin assistant, who makes $32 per hour; and 15 hours per week for the district’s new communications coordinator, who makes $30 per hour.)

• $32,000 for office rent.

• $29,000 for accounting, insurance and legal services

• $25,000 for taxes and insurance benefits

• $21,000 for an upcoming state audit. (With the district’s budget crossing $2 million, it now will face financial audits, Johnson said — which means the district must budget more for the audit process.)

• $19,000 for advertising and promotion.

• $16,500 for repairs and maintenance.

• $13,000 for website and software dues and subscriptions.

• $7,000 for water utilities and other water fees at the district’s unimproved property.