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.

Public Comment

Information will be updated here as the Board conducts rulemaking, including opportunities to provide informal and formal public comment.

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!

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.

Tribal Reservations and Trust Lands

Below you will see a placeholder of a map actively under development (September 2025) of Tribal Reservations and Tribal Trust Lands by county. The map is not currently keyboard or screen-reader accessible. The map will be a visual tool, useful for educational purposes, and not suited for legal guidance.