Montgomery County Board of Health Biannual Session - June 30, 2026

Introduction and Opening Business

• Presiding Officer: Natalie Fanny Gonzalez, Council President.
• Date of Session: June 30, 2026.
• Introductory Remarks: Council President Gonzalez opened with a moment of silence for victims of the tragic earthquake in Caracas, Venezuela. She noted that while her family is safe, thousands have died, including a Little League baseball team of children aged $10$ to $11$. She emphasized the need to maintain humanity in civic work.
• Council Attendance: Council members Balcom and Sales attended the meeting virtually.
• Approval of Minutes: The following minutes were approved without objection:
  • May 12 and 13, 2026: Council Sessions.
  • May 14, 2026: Bi-County Budget Session.
  • May 14, 15, 21, and June 9, 2026: Council Sessions.

Administrative Overview of the Board of Health Update

• Legal Requirement: Under Maryland State Law, the County Council must sit as the Board of Health twice a year.
• Scheduling: While recommended for May and October, the primary session is typically moved to June due to the intensity of the May budget cycle; a second meeting is held in October.
• Leadership Team: Dr. Kesha Davis (Health Officer) provided the briefing with coordination from Dr. Runners, Sean O’Donnell, and Ben Stevenson II.

Epidemiological Trends and Demographic Changes

• Population Statistics: Montgomery County has surpassed $1.08$ million residents.
• Demographic Shifts (2020–2024):
  • Non-Hispanic white residents: Decreased by $5.8\%$.
  • Hispanic residents: Increased by $1.7\%$.
  • The overall population increase is primarily driven by the growth of the Hispanic community.
• Aging Population: Residents aged $65$ and older now comprise $18\%$ of the population, a historic record.
• Geographic Growth Centers:
  • Greatest Growth: Zip codes $20842$ (Dickerson) and $20871$ (Clarksburg).
  • Greatest Decrease: Zip codes $20879$ (Gaithersburg) and $20868$ (Spencerville).

Leading Causes of Mortality

• Data Timeline: Current epidemiological data covers up to the year $2023$.
• Primary Causes of Death (2021–2023): As the acute impact of COVID-19 recedes (metaphorically described as a "receding tide"), chronic diseases have returned to the forefront. The leading causes are:
  • Heart Disease.
  • Cancer.
  • Cerebrovascular Disease (Stroke).
  • Diabetes.
  • Chronic Respiratory Disease.

Food Insecurity and Nutritional Support Programs

• Insecurity Rates:
  • 2019: $8.6\%$.
  • 2023: $12\%$.
  • Comparison (2023): Maryland at $13\%$, United States at $14\%$.
• Office of Food Systems Resilience (OFSR) Initiatives:
  • Food as Medicine Grant: Awarded to six organizations to provide fresh produce to food-insecure patients in health clinics and hospitals, prioritizing cultural dignity (client choice vs. standard boxes).
  • Nutrition Benefits Outreach: Collaborating with schools and providers for SNAP, WIC, and SunBucks enrollment.
  • MC Groceries Program: Supports $500$ households in the "self-sufficiency gap." These are families earning too much for SNAP but struggling to afford the cost of living in Montgomery County. Households receive a monthly grocery stipend of $\$100$ to $\$400$ for healthy groceries via Instacart.

Healthy Montgomery and the Community Health Improvement Plan (CHIP)

• Definition: Healthy Montgomery is the county's Local Health Improvement Coalition (LHIC). It is a public-private partnership co-chaired by the County Health Officer and a community representative (currently Kimberly McBride of Trinity Health/Holy Cross).
• Structure and Governance:
  • Required Members: County agencies, hospital systems, core community initiatives.
  • Term Members: Participants serving defined periods to provide fresh perspectives.
• Strategic Integration: For the first time, the Department of Health and Human Services (DHHS) and local hospital systems are producing a joint CHIP ($2025\text{--}2028$). This aligns strategies to avoid duplication and maximize impact.
• Priority Action Areas:
  1. Access to Care: Focuses on closing clinical gaps in behavioral health, specialty care, and culturally responsive services.
  2. Upstream Prevention: Creating conditions for health beyond treating existing illness.
  3. Social Determinants of Health: Addressing housing, food access, transportation, and system navigation.

Medicaid Updates and Health Resource Reforms (HR1)

• Crucial Deadlines:
  • October 1, 2026: Asylees and refugees will lose eligibility for Medicaid (except for pregnant women and children).
  • January 1, 2027: New rules resulting from HR1 take effect, including a requirement for Medicaid recipients to re-apply every $6$ months and a work requirement of $80$ hours per month.
• Uninsured Population Statistics:
  • County Average: $6.9\%$ (better than $7.4\%$ in $2022$, but worse than the state average of $6.3\%$.)
  • Hispanic Uninsured Rate: $18.8\%$.
• The Safety Net Gap: Montgomery Cares and Care for Kids programs serve approximately $34,000$ uninsured residents ($45\%$ of the total). An estimated $40,000$ residents will remain without coverage, a number expected to rise following HR1 implementation.
• Administrative Burden: Moving from annual to semi-annual re-verifications effectively doubles the workload of eligibility staff. The county requested seven additional eligibility workers, but the positions were not funded in the current budget.

Behavioral Health and Substance Use Data

• Overdose Trends (2025–2026):
  • Total Fatal Overdoses: $30$ recorded so far in the current period, a $3\%$ decrease from the previous year.
  • Demographics: Males account for $72\%$ of fatalities.
  • Substances: Fentanyl was involved in $17$ of the $30$ cases. Other concerns include alcohol, cocaine, and poly-substance use.
  • Age Group: The $25\text{--}34$ age range is currently most heavily impacted.
• Harm Reduction Initiatives:
  • Narcan Kiosks: Four kiosks are currently in circulation, having dispensed $816$ boxes of Narcan.
  • Vending Machines: Strategic deployment of harm reduction vending machines is planned for high-risk zip codes.
• Strategic Plan Pillars:
  • Prevention/Harm Reduction: School-based life skills programs, Narcan saturation (goal: $1,000$ residents trained annually).
  • Treatment/Recovery: Expanding Medically Assisted Treatment (MAT) and specialty housing for transitional age youth.
  • Public Safety: Increasing frequency of drug take-back days; targeted re-entry services for formerly incarcerated individuals exiting with substance use disorders (goal: $75\%$ direct placement rate).

Suicide Mortality and Prevention

• Rates (2025):
  • Montgomery County: $9.9$ per $100,000$ residents (an increase from 2024).
  • Maryland: $9.6$ per $100,000$.
  • National Average: $13.3$ per $100,000$.
• Racial and Ethnic Disparities:
  • The Hispanic mortality rate jumped from suppressed levels to $8.9$ per $100,000$ in $2025$.
  • The number of documented Hispanic suicides more than doubled year-over-year to a total of $21$ individuals, mostly males aged $25\text{--}64$.
  • Non-Hispanic Black residents sustain a rate of $10.5$ per $100,000$, surpassing the Maryland average for that demographic.
• Youth Trends (Ages 10–21): ER visits for suicide attempts among Hispanic youth increased by $56\%$ between $2020$ and $2025$. Non-Hispanic White youth attempts increased by $22\%$, and Non-Hispanic Black youth by $13\%$.
• Suicide Fatality Review Teams Act: Effective October 2026 (HB 1012), this authorizes the creation of multi-agency teams to perform post-mortem analysis of suicides to identify systematic intervention points.

Intimate Partner Violence (IPV)

• ER Visit Data: For the first time since $2019$, Montgomery County ER visit rates for IPV fell below the state average in $2025$.
• Note on Underreporting: Health officials cautioned against interpreting the ER data as a true decline in prevalence. ER data only captures severe injuries; DHHS Trauma Services actually saw an increase, serving over $1,700$ survivors in FY25 (an increase of $39$ from FY24).

Environmental Health and Water Contamination

• PFAS (Perfluoroalkyl and Polyfluoroalkyl Substances):
  • Location: Elevated levels found near the Great Seneca Highway and the former Public Safety Training Academy.
  • Source: Legacy use of firefighting foam containing PFOA/PFOS.
  • Safety: Drinking water monitored by WSSC and DC Water remains safe. The threat is to surface water ingestion and private wells.
  • Response: Free well testing for residents within a $1$ mile radius of the contamination site (fewer than $10$ wells identified).
• Piscataway Interceptor Pipe Breach:
  • Incident: An estimated $243$ million gallons of untreated wastewater entered the Potomac River on January 19 (repaired by March 14).
  • Current Status: Water advisories are lifted, but a sediment advisory remains in effect for specific river zones due to high bacteria levels detected in DNA testing.

Germantown Emergency Room Closure and Reinvestment

• Closure Date: June 30, 2026 (last day of operation).
• Replacement: The new Adventist tower at Shady Grove opens July 1, 2026.
• $2 Million Reinvestment Fund: Savings from the closure are being redirected via the Health Services Cost Review Commission (HSCRC) into Germantown community health. Pillars include:
  1. Primary Care Expansion: Support for Montgomery Cares clinics to handle urgent care and same-day triage.
  2. After-Hours Nurse Triage: Operating 4 p.m. to 9 a.m. to guide Montgomery Cares clients away from ERs to appropriate primary or urgent care.
  3. Urgent Care Access: For the first time, Montgomery Cares will cover urgent care visit costs for enrolled clients.
  4. EMS Innovation: Mobile integrated health networks to assist 911 dispatching.

Infectious Disease and Global Health Updates

• Lyme Disease and Tick-Borne Illness:
  • Maryland cases increased from approx. $1,000$ in $2021$ to over $3,000$ in $2024$.
  • Warning for Bullseye rashes and use of insect repellent.
  • Alpha-gal Syndrome: Transmitted by the Lone Star tick, causing an allergy to red meat and dairy.
• Ebola Virus Outbreak (Sudan/Bundibugyo variants):
  • Ongoing in DRC and Uganda.
  • CDC is tracking all returning U.S. citizens from affected regions. Montgomery County has monitored approx. $90$ travelers; no cases have been detected locally.

Mobile Health Clinic Operations

• Capacity: The clinic provides medical, dental, and behavioral health screens. Demand consistently outpaces capacity.
• Patient Data:
  • $30\%$ of clients receive more than one service per visit.
  • Average throughput: $8$ dental patients, $7$ mental health patients, and $8\text{--}16$ medical patients per day.
• FY27 Strategy: Targeting East County and historically Black communities through pop-ups at libraries and parks.

Questions and Discussion

• State of Black Health Survey: Council Member Sales and President Gonzalez inquired about the timeline. The survey closes in July with reports expected by the end of $2026$. Focus groups will occur through the fall with specific attention to continental African and Caribbean communities.
• Medicaid Eligibility Barriers: Council Member Mink discussed a recent lawsuit involving Maryland and 24 other states against federal rules restricting the definition of "medical frailty," which could exempt people with chronic conditions from work requirements.
• Suicide/Mental Health in Zip Code 20906: Council Member Evans expressed concern over the high prevalence of youth suicide and attempts in her residential zip code and requested deeper data on causal factors like housing stress and social isolation among Latino men.
• MCOT (Mobile Crisis Outreach Teams): Dr. Martin clarified that in FY27, Montgomery County will have eight teams available during peak hours ($7\text{--}11\text{ p.m.}$). They are currently dispatching from Germantown, Silver Spring, Tacoma Park, and Rockville. A 911/988 CAD (Computer-Aided Dispatch) integration is in development.
• Closing Motion: The Consent Agenda was approved on a motion by Council Member Jawando, seconded by Council Member Sales.