(TNS) — Some local health departments in Missouri are still waiting on federal aid to fight the COVID-19 pandemic, more than five months after millions of dollars were sent to counties to distribute.

As Missouri approaches 160,000 cases, testing continues to present challenges. The virus has encroached into rural areas that once believed they would not be affected. And the state's positive test rate sits at an alarming 21.1 percent, twice the 10 percent threshold for the red zone under White House Coronavirus Task Force metrics.

Meanwhile, many county health departments burdened by the unprecedented crisis have not received the help they need from their county leaders. Local health officials said they do not have the staff to keep up with contact tracing. Others looking ahead to the vaccine haven't been able to take the necessary steps to prepare for its distribution.

One county health department, Newton, was denied funds for extra cleaning supplies. "Wake me up from this nightmare," said Cheryl Eversole, administrator of the Dallas County Health Department, just north of Springfield, Missouri. Dallas County has received a small portion, not all, of its requested funding. In March, President Donald Trump approved the CARES Act, a $2.2 trillion stimulus package intended to soften the blow from the pandemic's devastation. Missouri received $2.4 billion.

Gov. Mike Parson's office said on May 4 that the state would begin distributing about $527 million to local governments.

As of mid-October, local public health agencies have received about 4 percent of the funds sent to the counties, according to the Missouri Department of Health and Senior Services.

Other entities that have received funding include private businesses, schools, court houses, and sheriff's offices.

The Star contacted every local health agency in Missouri, of which there are more than 100. Fifty responded, with most reporting they have received the federal dollars they need.

But at least four county health departments have not seen any of the money. Others said the amount they have received was far below what they need.

"It's unconscionable," said Bert Malone, a board member of the Missouri Public Health Association. "This is a disease control effort and the local public health agencies frankly should be first in line."

Malone said some county commissions have withheld funds because they blame public health agencies for advocating for shutdowns and mask mandates.

"This is not a blame game," he said. "This is life and death."

Platte County Coronavirus Aid

The Platte County Commission has not disbursed CARES Act money to its county health department or the Kansas City Health Department.

It's been more than a month since the commission sent the health department a draft to release funds, said Mary Jo Vernon, director of the Platte County Health Department. She has not received the final document.

"We're trying to just wait patiently," Vernon said.

The county has recorded 921 cases and 12 deaths. The positive test rate has climbed to 18.67 percent.

Vernon said the health agency is spending about $24,000 every month on testing. The public is requesting more testing services because testing at commercial sites is booked, she said.

The health department isn't able to keep up with its contact tracing volume, a process that can become extensive when cases balloon or close contacts cannot be easily located.

"We really need to hire additional people," Vernon said. "But it's kind of concerning to do that from a fiscal standpoint if you don't know if you're going to get additional money back."

Vernon said the health department and the commission disagree on how to deal with the pandemic.

"It just makes it difficult to get to that solution-based point," she said. "I just want to work with people. You can expend your energy fighting or you can expend your energy for a common goal. And to me, our common goal should be protecting the health of the community."

Kansas City is eligible for CARES Act funds through Jackson, Clay and Platte counties.

It received $11.6 million from Clay County in June and $18.8 million from Jackson County in August, according to the city's finance committee. It has not received any aid from Platte County.

Mayor Quinton Lucas said his office has been working with the county governments since March.

"As of this date, Kansas City has not received the CARES Act funding requested from Platte County to help with our pandemic response, particularly to support the health of our police, fire, and health employees doing hard work in the Platte County portion of our city each day," he said in a statement Tuesday.

The Kansas City Health Department said its efforts to rein in the virus have been hampered by the delay in Platte County.

"Our ability to provide the essential COVID-19 services to save lives and promote economic recovery in Platte County is severely impaired due to not receiving any funding to support disease investigations, contact tracing, testing, and education to prevent the spread of disease and inform residents on what activities are reasonably safe so that they can support economic recovery," the department said in a statement.

The three members of the Platte County Commission -- Ron Schieber, Dagmar Wood and John Elliott -- did not respond to requests for comment.

The County Commissioners Association of Missouri also did not respond.

Other Missouri Counties

Missouri's decision to allocate CARES Act aid to county commissions has created a patchwork of responses to the pandemic across the state's 114 counties.

The health department in St. Louis County received $53 million -- more than 30 percent of the county's $173 million in CARES Act funds.

In Ripley County in the Ozarks, public health center director Janice Morrow said she feels lucky the commissioners have approved $53,372 in reimbursements and a $250,000 request for salaries and supplies to get through the end of the year.

"Not everyone has a good relationship with the political powers," she said.

Still, the process "has been a nightmare to accomplish with all the cases we are working as well. The political powers in Jefferson City should have through this process through," Morrow said.

In Newton County, which has recorded 1,890 cases including 17 deaths, health department administrator Larry Bergner requested $250,285. The department has gotten $3,395.

"I'm really pretty disappointed in how slowly this process has been," he said.

The health department still owes $27,000 to a local clinic for onsite testing that took place in June. A funding request for extra cleaning supplies was denied as was money to set up a drive thru vaccine clinic that would have been used for both flu shots and the COVID-19 vaccine once it becomes available.

The situation isn't much better in Shelby County, where $7,000 has been distributed to the health department.

According to minutes from a September CARES Act meeting, the county approved several expenses at the county court house as well as $19,006 for the sheriff's office to purchase equipment to improve radio communications

Health department administrator Audrey Gough said many of the items "are not COVID related in my opinion."

She said the county has used the federal dollars "to fulfill wish lists."

Health department officials in Grundy, Monroe and Putnam counties said they have not received any CARES Act funds yet.

Putnam County Health Department administrator Joetta Hunt said the health department hasn't received funds because the county's application deadline isn't until Nov. 1.

She and other health officials have expressed concern because the federal dollars have to be allocated, distributed and spent by the end of the year.

"That's kind of crunch time," she said.

'We Will Take a Leap of Faith'

In August, the Missouri State Treasurer's Office sent a memorandum of understanding to county governments encouraging them to commit 15 percent of the CARES Act funds to the health department.

Twelve have signed on so far and two more are in the process, said Alex Tuttle, director of governmental policy and legislation with the Department of Health and Senior Services.

"We continue to work with county commissioners to sign the MOU to ensure that these resources are distributed appropriately where needed," Tuttle said.

In Cooper County, health department administrator Melanie Hutton said she applied for $39,000 in funds and has received $17,600 for repayment of expenses.

The health department wanted the MOU to be signed, but the commission declined, she said.

They went ahead with hiring a nurse who could conduct testing in the county, which doesn't have a hospital.

"We will take a leap of faith that we'll get reimbursed at the end of the year," Hutton said. "We don't know that for a fact."

The Mercer County Commission has sent $10,533 to the health department for antibody testing and other supplies. But some of the health department's requests for reimbursement for staff time, education materials and PPE for schools was turned down. The MOU was denied, said health department administrator Gina Finney.

Eversole, in Dallas County, said they have agreed to the MOU, but so far the department has only received $17,919 of the $297,000 it is supposed to get.

Buchanan County received more than $10 million from the CARES Act.

The City of St. Joseph Health Department asked the county commission to enter the MOU for $300,000, which was less than 15 percent.

"They opted not to enter the MOU but to earmark up to $150,000 for public health," said Debra Bradley, director of the City of St. Joseph Health Department.

In other cases, health departments have rejected the MOU.

"I don't think that would be in our best interest to accept 15 percent," said Grundy County Health Department administrator Elizabeth Gibson.

As of Tuesday, Missouri has recorded 159,625 cases including 2,615 deaths, according to state data.

(c)2020 The Kansas City Star (Kansas City, Mo.) Distributed by Tribune Content Agency, LLC.