Commissioners move forward with hospital tax proposal; hear updates on sewer billing, other county matters

Highland County commissioners Terry Britton and David Daniels voted to implement a new tax assessment on the county’s two hospitals, opening the opportunity for those facilities to recoup funds with no revenue impact on the county, during their Wednesday, July 2 meeting.

Commission president Brad Roades was absent.

Commissioners voted 2-0 to “establish a Hospital Tax Assessment to fund the Non-Federal share of the Rural Ohio Hospital Tax Pilot Program Pursuant to AM. SUB. H.B. NO. 96.” Also approved were two separate intergovernmental agreements/memorandums of understanding with the Ohio Department of Medicaid for the Rural Ohio Hospital Tax Pilot/State Directed Payment Program, with one for Highland District Hospital and one for Adena Greenfield Medical Center.

As discussed in June, House Bill 96 — the legislation for 2026-27 appropriations — includes a section to create the Rural Ohio Hospital Pilot Program, through which counties can “set the annual rate” for a new assessment on hospitals. The assessment will be used to “cover … the nonfederal share of Medicaid patients that benefit hospitals in the county” and “administrative expenses” and cannot exceed $150,000, the bill says.

Commissioners made the approval at the earliest possible opportunity, as their vote came roughly 24 hours after Ohio Governor Mike DeWine signed the state operating budget bill into law. 

Colleen Ernst, executive vice president of health care consulting firm Adelanto Healthcare Ventures (AHCV), attended the meeting Wednesday, along with Adena President & Chief Executive Officer Jeff Graham, Highland District Hospital President & Chief Executive Officer Tim Parry and Highland District Hospital Vice President of Finance & Chief Financial Officer Meghann Ackley. 

Ernst gave the initial presentation to commissioners last month. For more background, see: https://highlandcountypress.com/news/hospital-tax-pilot-program-proposa….
 
“We are very happy to give the update that since we last spoke, the governor has signed the budget, and that included the language authorizing certain counties to adopt new tax rates so that their hospitals would pay a tax to the county,” Ernst said.

Britton reminded the community that this provision does not mean there will be a “tax increase for any individual” consumer of health care services in the county, to which Ernst agreed.

“In fact, in the resolution that is before you today, there is a provision specifically stating that there cannot be a patient surcharge passed along by the hospitals to the patients,” Ernst said. “The only two who will get a bill, if you adopt this resolution today, are the two facilities represented here, Highland District Hospital and Adena.”

Daniels asked if Ernst had an estimate of how much of a reimbursement the hospitals could see through this program.

“The local government entity or the state imposing the tax can't be in a position of making any guarantees about specific outcomes, so we do try to avoid representing any things that the county is acting in reliance on any specific return,” Ernst said. “If the hospitals are contributing through a provider tax, which this is, their dollars are the state share, and the state share pulls in federal match, and the federal match minimum is one-to-one. 

“This is a program running through multiple counties, and each of the different jurisdictions has their own rate, but the pool of dollars that comes from these counties does qualify for that federal match, and then the dollars follow the patient.”

Britton also asked Highland County Auditor Alex Butler if he had any questions before moving forward on the proposal.

“We have had multiple conversations and emails, and we're up to speed,” Butler said. “If you guys so choose, we’ll be happy to assist in facilitating this.”

Commissioners then voted to pass the resolution and related agreements.  

“I think this is definitely a plus for both of our hospitals in Highland County,” Britton said.

The remainder of the meeting involved an update on various county matters.

First, commissioners met with Kristie Alexander, who shared statistics and information on Rocky Fork Lake sewer system billing.

Alexander was hired last May (taking office in June 2024) for the new position of sewer billing clerk, with a goal to tackle delinquency rates and to facilitate the monthly billing.

Some of the statistics shared by Alexander included the following: 

– Revenues collected: $740,122.64 in 2023; $883,722.43 in 2024; and $448,290.62 through June 2025, for a projected total of $896,581.24 this year.

“This doesn't show a huge growth from 2024, but there are several things to consider,” Alexander said. “We did reduce the penalties on lake sewer bills, so that was taken down from $4.35 to $4 because we're no longer penalizing the debt service portion of the sewer bill.”

Alexander and Daniels both also noted that due to the change to monthly billing, “customers aren't paying ahead on their bills the way that they were” under the previous system.

“From January to June of 2024, there was a total of $82,642.59 collected in credit memos,” Alexander said. “What credit memos are is when people pay ahead on their sewer bill gets placed to the credit memo fund, and then it gets allocated to their bill as new bills are ran. This year, from January into June, we only collected $65,335.61.

“People are still paying their bills. They’re just doing it monthly, rather than in larger chunks.”

– New connections: $3,333.84 in 2023; $155,100 in 2024; and $49,607.45 through June 2025, for a projected total of $99,214.90 this year.

“This fluctuates so much on people building out there, which we have absolutely no control over, but I think it shows that people are building out at the lake,” Alexander said.

– Delinquencies: August 2024, 309 accounts totaling $89,613.33; and June 2025, 286 accounts, $77,975.44.

“Of that amount, $6,483.90 is from a single account, which then they're currently in the middle of civil litigation trying to get that taken care of,” Alexander said. “I also had another report that I did to show where sewer delinquencies are on the decline, compared to the number of notices that we're sending out versus the number of disconnect work orders that we're doing.”

– Disconnection notices: 2023, 706 notices, 467 disconnects; 2024, 412 notices, 209 disconnects; and 2025 thus far, 167 notices, 76 disconnects.

“If someone's three months behind on their sewer bill, they get a notice saying that they're about to be disconnected,” Alexander said. “If they don't pay within seven days, then after the seven-day period, we send the workers out to disconnect them.”

Daniels asked if Alexander could share data in the future as well that doesn’t include the “abandoned properties” that cause “long-term” delinquencies at the lake as opposed to new ones. 

“Our delinquency rate looks a lot different when you take those abandoned properties out of there, who's not paying their bill and who's actually using the system,” Daniels said.

On a related note, Alexander told commissioners that she is working with the treatment plant on a report listing all such properties, which she intends to give to the land bank.

“I know they're not going to be able to take care of all of it, but any property that starts paying taxes again, starts paying their sewer bill again, is going to be beneficial for the county as a whole, rather than just sitting there and rotting, essentially,” she said. 

Alexander also spoke about a new program started in 2024 for shutoffs at residences with a shared grinder, which she said “has resulted in $6,906.25 of delinquent bills being taken care of.

“They're sent a notice in the mail, and they're given a certain amount of time to pay, usually at least a month,” Alexander said. “If they don't have their account paid in full by the date given in their certified mailing, then we have Unger Construction come in and install a cleanout. It's not fair to the people who are paying their bill to be shut off, and it's also not fair to the people who are paying their bill that they're paying for them and their neighbors, essentially. 

“So far, we've targeted 10 properties, and of those 10 properties that we've targeted, only three of them had to have the construction completed, and of those three, two of them have been making payments toward getting that debt taken care of, and they are also responsible for the construction fee.”

Commissioners thanked Alexander for the update and for her efforts thus far, with both telling her she is doing a “good job addressing” the billing issues.

“Keep up the good work,” Britton said.

Commission clerk Mary Remsing provided several updates as well, including discussing the Rolling Acres sewer project, dog pound, cybersecurity and courtroom repairs.

As previously reported, the county was awarded a $416,000 Critical Infrastructure grant for the Rolling Acres system in New Market Township, which Daniels said is a system the county “inherited as a result of a deal commissioners made a number of years ago” and which “probably haven’t had much upgrades probably since they were built in the ’60s and ’70s.”

Both Remsing and county ARPA funding coordinator Nicole Oberrecht said the project “to replace collection system piping, manholes, shutoff valves and reconnection of laterals and restoration work” is making good progress.

“That is near completion,” Remsing said. “They got in there really quick with the weather, and then we got hit with some rain, so they just have finished up some restoration work. I think there's one piece of the restoration that needs completed, but that project will be done way before the deadline.”

Oberrecht added that the new shutoff valves will allow the county the option to “become aggressive” with delinquent customers, much like they are doing with the Rocky Fork Lake system.

For dog pound updates, at Remsing’s recommendation, commissioners voted 2-0 to accept the resignation of dog warden Josh Shiveley, effective June 12. Remsing said that Taylor Brown is continuing to serve as chef dog warden, while Kayla Lindsey was hired June 5 as kennel attendant. 

“We also will — sometime in the future, probably near — need to get that dog warden position filled,” Remsing said.

Daniels thanked the Sheriff’s Office for their assistance, as both an HCSO deputy and Remsing had to help on a day when the dog pound was understaffed. Britton said they should work on a backup plan in case a “situation” like that arises in the future.

Remsing also spoke to commissioners about the need to ensure county departments are trained in cybersecurity matters. She and Oberrecht suggested working with the Ohio Cyber Range Institute through the University of Cincinnati, which offers free in-person and virtual training, and said she had a sample memorandum of understanding in the event commissioners wanted to work with them.

“I'm currently following House Bill 283, which will require political subdivisions to adopt a cybersecurity program,” Remsing said. “Nicole and I the other day sat through a webinar, or a little Zoom call, with Ohio Cyber Range Institute. They offer training for employees, education on cyber mindfulness.”

She told commissioners that there are “different programs” that can be used, including general two-hour training for all employees.

On a related note, Remsing said the County Risk Sharing Authority, their liability insurance, has notified its members that “it's imperative that procedures are in place” to avoid altering any “vendor, financial institution or employee’s contact information or banking information without independent verification.

“I discussed this with Alex,” Remsing said. “He does have a policy in place for any kind of ACH [direct deposit] payments. I don't know if this needs to be discussed further with, like, say, human resources from an employee level, but I think it's just important that we put it out there, because if we are negligent, then we're not going to get coverage through our insurance company.

“Countywide, we all need to be very aware and cognizant of what's going on, as far as a cybersecurity standpoint, and we need to put measures in place that safeguards us as a whole. I know we've had neighboring counties that have had lots of problems, and I think we just need to try to safeguard and put us in a good position.”

Britton agreed that “all the departments need to get somebody in on this” training and to work on consistent policies.

“This is becoming a huge, huge problem throughout the state — well, throughout the country,” Britton said. “The sooner that we can get something in place, the better. I think the training on this really needs to be done on a regular basis and go over policies and make sure that everybody's aware. I know it’s redundancy once you get started, but we’ve got to keep reminding everybody that these guys are professionals. They know how to get in and try to get your money.”

Britton suggested that they “set up a team” to work on policies, and Daniels said that once completed, “every county employee needs to sit through a session” on cybersecurity. Remsing said the Ohio Cyber Range Institute’s “training that they provide would be beneficial for everybody” to assist with developing county plans.     

Finally, Remsing reported that Highland County Common Pleas Court Judge Rocky Coss had called the commissioners’ office Wednesday morning to inform them of “a piece of the ceiling in the courtroom” had fallen.

“He doesn't think it's a leak from the roof,” Remsing said. “He thinks that the plaster, I don't know if it's layering, it's just starting to peel away. 

“He does think that it probably needs a quick fix, sooner rather than later, so I wanted to bring that to your attention.”    

Daniels asked the commission clerks to have a contractor from Cincinnati Commercial Contracting look at the courtroom and see if someone on their crew could “make a patch.”

In other discussion:

• Commissioners approved two contracts with the Prosecutor and Job and Family Services, with one for Title IV-E services and one amending an existing IV-D contract.

“Title IV-E pertains to our child welfare services that we provide, so that's a result of our state monitoring,” Highland County JFS Director Jeremy Ratcliff said. “They recommended that we more formalize our agreement with the Prosecutor’s Office and Anneka [Collins, county prosecutor] and staff providing child welfare services. This contract allows us to bring in additional federal dollars for each program to reimburse the county.”

For the amendment to the IV-D contract, Ratcliff said they have “found out there’s potentially some local dollars being used that we could now include in the formula that changes the unit rate,” which can lead to higher reimbursements.

• Commissioners voted to approve a training contract for the Sheriff’s Office for training through Jawless Hog Tactical.

“It is tactical training for entries into buildings and different ways of doing entries into buildings,” Highland County Sheriff Randy Sanders said. “It's a two-day class. 

“It costs us $5,000. We got that out of our law enforcement trust to handle that. It’s basically, it's an early, small step into tactical trading for our officers.”

Britton asked how many officers would complete the training. Sanders said “up to 10” can attend, but that the HCSO is also offering to “sponsor” officers from Hillsboro and Greenfield’s police departments as part of that group. 

• Commissioners approved a resolution to declare that a real and present emergency exists and to authorize repairs to the Hi-TEC Building pursuant to Ohio Rev. Code 307.86(A)(2), as urgent roof repairs are needed. Oberrecht said that Doug Karnes of McCarty Associates has already submitted permits to the city of Hillsboro.

In other construction updates, Oberrecht said WDC Group “plans to get a lift rented sometime this month” to “thoroughly examine the exterior of the courthouse” to determine its repairs, while bids for the new county engineer truck barn will be due Aug. 13.

• After their regular session, commissioners held an executive session to discuss employment.

Commissioners also made the following approvals, each by a 2-0 vote:

• A contract extension among commissioners, Ohio Public Works Commission and the Highland County Engineer for New Market/Prospect Road reconstruction and resurfacing. 

• A request from the Sheriff for an additional appropriation from unanticipated revenue within the (1000) County General Fund in the amount of $4,299.36.

• A request from the Sheriff for an additional appropriation from unappropriated funds within the (2230) Concealed Carry Fund in the amount of $20,411.56.

• A request from the Sheriff for an additional appropriation from unappropriated funds within the (2230) Concealed Carry Fund in the amount of $30,000.

• An additional appropriation from unanticipated revenue within the (2280) Records Preservation Fund in the amount of $2,025.

• A budget modification within the (1000) County General fund in the amount of $62,511.54.

• Commissioners voted 2-0 to authorize the commission president to execute a Placement Agent Engagement Letter with Baird.

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