Jill Schramm/MDN Holly Brekhus, executive director at First District Health Unit, speaks to the Ward County Commission Tuesday.

A loss of 149,788 in federal dollars is impacting First District Health Unit’s programs related to COVID-19, immunization, opioid response and family planning.

Grant dollars placed on hold amount to about 10% of the district’s federal allocation, according to information the health unit provided to the Ward County Commission Tuesday.

FDHU presented a preliminary budget of about $6.9 million for 2026, which includes a request for just over $1.56 million in property tax levy from its seven counties. The tax is an increase of about $35,000.

“The budget that I’ve submitted is very tentative,” said Holly Brekhus, FDHU executive director. “Our board decided not to approve our budget at our last meeting, just because of the uncertainty that is around the federal funding.

“What we don’t want to do is reduce programs when we don’t know what the funding is going to look like. So, we’re kind of hanging tight until we know where the federal government is going to land and what programs we’re going to have to discontinue doing,” she said.

Moving into 2026, the North Dakota Department of Environmental Quality will not be providing $4,000 in federal funds to support water pollution work, largely associated with septic systems. FDHU also is waiting to see whether federal funding will be cut in 2026 for family planning, substance abuse, emergency response and immunizations. Federal funds account for about 20% of the district’s overall budget, which is about $7.3 million for 2025.

This year, due to holds on federal dollars, FDHU lost $53,177 of its COVID funds, which go to provide information and test kits, when the federal grant was canceled last March. It left a budget deficit of $25,562 for 2025, according to FDHU information.

Brekhus said the health unit has been able to continue providing test kits from stock previously purchased.

A $250,000 grant to boost immunization rates also ended in March rather than continuing through June, leaving $57,868 that was not paid out. A State Opioid Response grant was reduced by 10% or $13,370. A $66,235 family planning grant was reduced by $52,988.

Brekhus said the loss of immunization funds was tied to COVID and affects off-site clinics. The loss of funds makes it difficult to cover the cost of traveling to provide off-site immunization clinics. To accommodate those clinics, FDHU had acquired a mobile unit, which Brekhus said will need to be used strategically in the future.

Statewide, the Women’s Way program, which provides breast and cervical cancer screenings to eligible individuals, has paused. Meanwhile, family planning funding and impacts to the immunization funding going forward are uncertain, FDHU reported.

“Once we get our final landing spot – when we’re going to know what federal programs are cut – we’re going to have to sit down and do an assessment. What programs can we keep? What programs can we maybe find other funding sources for? We’re always looking for grant opportunities,” Brekhus told the commission.

A grant is enabling the health unit to work with Minot Air Force Base and the Ward County Sheriff’s Department on alcohol prevention programs. It also is partnering with Ward County on the jail’s opioid use disorder program. FDHU is partnering with a kit manufacturer to offer colorectal cancer screening.

As FDHU looks to manage with available funding, there’s also the possibility that consumer fees for certain services, such as water testing, might need to be raised, Brekhus said.

“With the funds that we do receive, we want to make sure that we are focusing on what’s needed in the community. So, we’re doing a community health assessment to kind of figure out what it is in the community we should be working on,” she added.

FDHU has been reducing its staffing through attrition over the past two years as a cost saving measure, Brekhus said.

Based on estimated county valuations, FDHU is requesting 2.3 mills of the 5 mills it is allowed in state law to levy through its participating counties. It represents a decrease in taxes collected in each of the seven counties except for Ward County. Because Ward County’s overall property valuation has risen, the levy increases the dollars collected by 6%, Brekhus said.

FDHU’s budget request would be part of the 3% cap the state placed on increases in tax levies by political subdivisions. The health unit’s overall levy increase falls below 3%, but it would reflect as more than 3% in Ward County’s budget.

“If you take the total, it’s fine, but if you take us individually, we’re not fine,” Commissioner Ron Merritt said.

Brekhus responded legislators didn’t consider the situation of districts in developing legislation, but legislative action is required if the cap issue is to be fixed.