LBOH Tribal Membership

Clarifying Tribal Representation and Timelines for Modifying Local Board of Health (LBOH) Membership

Summary

Engrossed Substitute House Bill (ESHB) 1946, effective July 27, 2025, requires the State Board of Health (Board) to clarify its local board of health (LBOH) composition rules and timelines for including Tribal representation on LBOHs (chapter 246-90 WAC). LBOHs must add appointed Tribal representatives within 60 days of receiving notice, while maintaining a balance between elected and non-elected members, as required by law. Tribal governments and Urban Indian organizations will now appoint their own representatives, instead of American Indian Health Commission, reinforcing Tribal sovereignty. The Board must update timelines and membership rules in Chapter 246-90 WAC by July 27, 2026.

For More Information

Statutory Authority: RCW 43.20.300
Board Contact: Ashley Bell, ashley.bell@sboh.wa.gov
Project Email: lbohcomposition@sboh.wa.gov

Interested Parties List: Join our interested parties list!

Share Your Input on Updates to the Local Board of Health Membership Rules  

The Board wants your feedback on proposed updates to chapter 246-90 WAC, Local Board of Health Membership. The purpose of these updates is to align existing rules with ESHB 1946 by clarifying Tribal appointment authority and setting a timeline for when a county legislative authority or board(s) of county commissioner(s), as applicable, must modify the membership of a LBOH in order to maintain the required balance of elected and non-elected members. This is your chance to share ideas, ask questions, and suggest changes before the rules hearing scheduled for Thursday, June 4, 2026, at 1:30 p.m.

The proposed updates to the rule are available in English.

LBOH Composition Rules Proposed Updates

To submit comments on the proposed rule, use one of the following methods:  

You may submit written comments through May 20, 2026, using the following options:

Fill out the Board’s formal comment period feedback form:  https://airtable.com/app4oL9BzOkuQNw2s/pag5OaobWSLIeSVWk/form 
Send comments to the Board’s public comment email address for this proposed rule: lbohcomposition@sboh.wa.gov   
Send comments via U.S. Mail to: 
Washington State Board of Health
PO Box 47990 
Olympia, WA 98504-7990

You may provide verbal comments during the rules hearing, which is open to the public, on June 4, 2026. The rules hearing begins at 1:30 p.m. 
You may give verbal comments in-person at the physical meeting location at: 
Historic Davenport Hotel, 
Early Bird Room 
10 S Post St  
Spokane, Washington, 99201

You may give verbal comments online by registering for the meeting via Zoom Webinar: https://us02web.zoom.us/webinar/register/WN_VMRRsyNtTLOO2WiatniCwA#/registration

Note: The Board will review and consider all written comments received as part of the official rulemaking file. All written comments received are public record and shared on the Board’s website. 

Important Information for the Rules Hearing:

You may attend the rules hearing in person at the above address or virtually via Zoom Webinar.
To give verbal comments on Zoom, you must access the meeting using your computer, laptop, or device. Your computer, laptop, or device must have speakers and a microphone.
The rules hearing will provide Spanish and ASL interpretation services via the Zoom platform.
If you need the meeting interpreted in a different language, please contact Board staff by May 28, 2026.

To request documents in an alternative format or a different language or to request meeting accommodations, please contact the State Board of Health at 360-236-4110 or by email at wsboh@sboh.wa.gov.

Additional Background

The State Board of Health (Board) is considering updates to chapter 246-90 WAC to implement Engrossed Substitute House Bill (ESHB) 1946 (Chapter 260, Laws of 2025). This law clarifies the requirements for Tribal representation on Local Boards of Health (LBOH). It also requires the Board to adopt rules to establish timelines for adjusting local board of health membership to keep a balanced mix of elected and non-elected members when Tribal representatives are added.

The previous law required the American Indian Health Commission (AIHC) to select Tribal representatives for LBOHs. The new law expands representation by allowing each Tribe and Urban Indian organization recognized by the Indian Health Service and registered as a 501(c)(3) within a jurisdiction to choose its representative for LBOHs or health district boards. It shifts the appointment authority from LBOHs to the Tribes and Organizations, respecting Tribal sovereignty and self-determination.

Under RCW 43.20.300, the Board has the authority to set rules for appointing non-elected members, including Tribal representatives, to LBOHs. ESHB 1946 goes into effect July 27, 2025. The law requires the Board to adopt rules for adjusting LBOH membership by July 27, 2026.

The Board filed a CR-101, Preproposal Statement of Inquiry, for chapter 246-90 WAC on September 10, 2025. The filing announces to the public that the Board is initiating rulemaking to consider updates to its rules, as required by ESHB 1946. The CR-101 also provides information on how to sign up to receive notices about the process and opportunities to participate in this work.

You can find this announcement under WSR 25-19-045.

The draft proposed rules and rules hearing were announced on April 20, 2026, and are listed under WSR 26-09-104 (CR-102).

Tribal Reservations and Trust Lands Map

The map below shows Tribal reservations and Tribal trust lands in Washington State as of October 2025. Tribal lands identified in this map may change. The map is intended to illustrate eligible Tribal lands and Tribal organizations that may appoint Tribal representatives to local boards of health under RCW 43.20.300 and was created for this rulemaking. This map is not a replacement for legal guidance. Local Boards of Health seeking clarity on how RCW 43.20.300 applies to them should contact their legal counsel. [SBOH Tribal Map Reference Information Sheet]

Map of tribal reservations and trust lands by county in Washington State