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Learn how Nebraska's Division of Public Health restructured their grants monitoring process in this blog post.

Learn how peer-to-peer collaboration has helped health agencies develop their performance management and quality improvement efforts.

Learn about four Congressional hearings focused on challenges affecting older adults, including inflation and opioids.

States Amending Policies to Slow Congenital Syphilis Increases States Trying Policies that Increase Syphilis Testing Amelia Poulin State are exploring ways to slow the rapid increase of congenital syphilis cases by strengthening policies to require testing at key points during pregnancy. Syphilis among newborns, or congenital syphilis, is preventable. Yet the latest CDC data show that congenital syphilis cases have more than doubled (106%) from 2019-2023. In 2023 alone, there were nearly 4,000 cases of congenital syphilis resulting in 279 stillbirths and infant deaths. Timely testing and adequate treatment during pregnancy might have prevented up to 80% of these cases. Increases in congenital syphilis often mirror increases in syphilis among reproductive-aged women. From 2022 to 2023, the rate of syphilis (all stages) increased 6.8% among women aged 15–44 years; rates also increased in 39 states and Washington, D.C. CDC recommends testing pregnant women for syphilis at the first prenatal visit, as well as at 28 weeks gestation and delivery if they are at increased risk of infection. Syphilis testing recommendations extend to asymptomatic women who are at increased risk for infection as they may face additional barriers to health care. ASTHO’s policy-level interventions for states and territories suggest universal syphilis testing for pregnant women. Additionally, states have been taking action to increase access to syphilis testing for people, including those who are pregnant. The Syndemic Perspective A history of incarceration, sex work, drug use, and geography can all significantly increase risk for sexually transmitted infections (STIs), HIV, tuberculosis (TB), and more. Structural barriers, including housing instability, economic insecurity, stigma, and restricted health care access, create conditions that heighten vulnerability to multiple infections. These conditions do not occur in isolation but rather as part of a syndemic, where overlapping epidemics interact with and exacerbate one another. Health agencies may be positioned to address upstream and root cause issues recognizing and addressing the intersections of these disease areas and related structural and social issues (e.g., drug use and poverty). Health agencies carry a wealth of interdisciplinary expertise, with staff leading efforts around data collection and surveillance, policy, community mitigation, and more, all of which support capacity to identify root causes and design an evidence-based, multifaceted response. Policies that prioritize housing stability, harm reduction services, and access to comprehensive health care, including STI screening, can help mitigate these risks and improve health outcomes. Geography can also increase the chances of syphilis transmission. Some regions with limited health care infrastructure, provider shortages, and limited STI prevention program funding and capacity may have higher rates of infection. Rural areas and certain urban settings may lack accessible clinics or specialized services, creating significant barriers to timely testing and treatment. Rural areas and certain urban settings may lack accessible clinics or specialized services, creating significant barriers to timely testing and treatment. Social and economic differences across different geographic locations contribute to varying levels of disease burden. By adopting a syndemic framework, states can move beyond disease-specific interventions and implement comprehensive strategies that address upstream factors contributing to disease transmission. State Actions Several states have introduced or passed legislation to expand syphilis testing access, with a focus on increasing screening opportunities, mandating insurance coverage, and ensuring appropriate prenatal testing protocols. Syphilis Testing In 2024, Colorado enacted HB 24-1456, which gave the state’s Board of Health rulemaking authority over syphilis testing. This flexibility allows the state to adapt its public health response based on emerging epidemiological trends as new data on syphilis transmission and congenital infections become available. The 2025 legislative sessions have highlighted additional approaches to expanding access to syphilis testing. The New York legislature introduced S 2704, which would require health insurance coverage for certain approved STI home test kits. This policy would provide individuals who face barriers to in-person care a convenient and private way to get tested and stay healthy. Oregon is also addressing testing accessibility through HB 2943, which would require hospitals to test people for HIV and syphilis when they have blood tests done in the emergency department (ED). Since EDs often serve populations who do not routinely access preventive health care (e.g., people experiencing homelessness or struggling with substance use disorders), this legislation would strengthen the role of emergency settings in STI prevention and intervention. Perinatal Syphilis Testing Recognizing the importance of perinatal screening, several states have introduced legislation to add requirements for syphilis testing at key points in pregnancy. Tennessee recently enacted SB 1283, which requires that health care providers take a blood sample to screen for syphilis, hepatitis B, and hepatitis C at the first prenatal examination, ten days after the examination, and at delivery. This approach aligns with CDC recommendations and ensures infections are identified and treated in time to prevent congenital transmission. Similarly, Nebraska LB 41 would require testing for syphilis at the first examination, in the third trimester, and at birth (with the mother’s consent), reinforcing a multi-point screening strategy to detect and treat infections that may develop later in pregnancy. Missouri’s SB 178 would take a comprehensive approach to syphilis prevention during pregnancy by requiring an additional test at 28 weeks, a critical point for intervention. The legislation would also require treatment for mothers who test positive for an STI, reducing the risk of congenital infections. Additionally, it would expand Expedited Partner Therapy by allowing any health care professional authorized to prescribe medications to administer Expedited Partner Therapy as well as include other STIs in the treatment, enabling faster treatment for sexual partners who might otherwise go untreated and continue the cycle of transmission. Policy Considerations Expanding both syphilis and perinatal syphilis testing policies demonstrate a growing recognition of the need for proactive, evidence-based strategies to address the increasing rates of syphilis and congenital syphilis. However, the ability of policies to affect public health outcomes may depend on continued resource allocation, workforce training, and public awareness campaigns. State and territorial health agencies can consider additional measures, such as integrating syphilis screening into routine primary care visits and providing funding for community-based outreach. Conclusion These legislative actions represent various approaches states are taking to addressing syphilis. Implementing screening protocols aligned with current evidence may contribute to efforts to address syphilis and congenital syphilis. By leveraging legislative action and evidence-based interventions, states can improve health outcomes and reduce disparities in syphilis and other STIs. A comprehensive approach that includes additional testing, expanded health care access, and targeted interventions for populations at higher risk for infection or severe disease may ensure better health outcomes for parents and infants alike. ASTHO will continue to monitor and report on this important public health issue. article yes

Puerto Rico Program Supports Vulnerable Populations ASTHO Island Support Learn how Puerto Rico addresses social determinants of health and promotes equity among vulnerable populations. The Puerto Rico Department of Health’s Health Equity Program implemented an innovative initiative to support diverse institutions, with the goal of addressing social determinants of health and promoting health equity among vulnerable populations. This provided opportunities for a wide range of sectors including private non-profit organizations, universities, and hospitals. The project evolved throughout its duration, demonstrating the power of local funding and the importance of flexibility in program administration. Project Kickoff Grant Awarding and Training Process During the second request for proposal, 30 organizations expressed interest in submitting applications. However, given the detailed and rigorous rubric, six applied, of which four grants were awarded. The team scored the proposals based on the rubric, and allocated funds to support vulnerable populations such as individuals living in rural areas, people with disabilities, pregnant women, and older adults. Implementation and Best Practices Once the Health Equity Program awarded grants, they designed a detailed work plan, including key indicators for monitoring and tracking the progress of beneficiary organizations. They implemented a SharePoint-based system for the submission of reports and documentation. In addition, they held monthly meetings to ensure cohesion and effective communication among all stakeholders. This collaborative approach enabled efficient and transparent monitoring processes. “It was a collaborative process since the institutions know their populations best. We just wanted to ensure a systematic and consistent plan because these matters are crucial for project progress and monitoring.” — Miguel Cruz, PhD, Co-Principal Investigator Project Evolution The program initially funded one institution and due to its positive impact, additional opportunities emerged to provide funding for up to four additional institutions. The main topic revolved around health literacy as a strategy to reach health equity among people living in rural areas, older adults, people experiencing homelessness, individuals with functional diversity, and those experiencing a mental health challenge. These four new institutions covered the west, central, and other rural areas broadening coverage within traditionally underserved communities. Administrative Flexibility and Communication Strategies Administratively, the program had to be flexible during pre-award and award processes, ensuring compliance with state and federal regulations. This included revising announcements and creating plans. Additionally, the program created documentation, like templates, and provided technical assistance to clarify compliance guidelines to ensure transparency and proper use of funds. The program implemented effective communication strategies to inform institutions about funding opportunities, including announcements via mass media and the Department of Health’s official social media platforms. They also created an external technical committee as an official communication channel to evaluate proposals. For this purpose, the creation of a detailed rubric facilitated its proper, unbiased, and timely assessment. Technological Challenges and Solutions One key challenge throughout the project was the use of technology to receive, process, and manage documentation. To mitigate obstacles, a SharePoint webpage facilitated electronic documentation acquisition between each subgrantee and the program. Additionally, the program provided clear instructions and developed a Q&A guide based on the needs that various institutions identified. In case of new inquiries, the Health Equity Program also shared responses collectively to ensure all organizations received consistent information, enabling them to complete the process smoothly and with equal opportunity. Lessons Learned A final evaluation of the process revealed that anticipating challenges was key to the project’s success. However, there are still areas for improvement: One of these is the optimization of financial processes by the organizations. It is critical to submit evidence of fund use in a timely manner and ensure accuracy in reconciling invoices within the allocated period. Organizations should also align internal processes with the parameters set when they receive funds. Adhering to these parameters can streamline the process on the Department of Health's side. Although beneficiaries get an assigned accounting professional, the documentation must still go through the Fiscal Office for review. Another challenge faced by institutions was retaining participants in the training sessions provided as part of the grant. Therefore, mechanisms need to be in place to ensure active and continuous participation in future interventions. The Health Equity Program also identified the opportunity to standardize the evaluation processes for organizations. While each institution worked on diverse projects, evaluations were based on their respective work plans and progress reports. However, a standardized evaluation process could improve efficiency in future interventions. Sustainability and Recommendations Many institutions that received funds have used them as a starting point to develop larger initiatives while others have used them to develop internal resources (i.e., digital libraries, trainings). “Organizations used this funding as seed money for projects that are now receiving greater financial support. Others have developed internal resources that allow them to continue addressing key health issues. For instance, they have optimized the use of digital libraries, expanded training reach, and replicated projects funded by this grant in other municipalities.” — Miguel Cruz, PhD, Co-Principal Investigator For other agencies looking to implement similar programs, the recommendation is clear: Streamline efforts to maintain consistency and coherence. Additionally, explore other agency or office supports for fostering an organizational culture that prioritizes continuous monitoring and process improvement, emphasized Cruz, PhD. Conclusion Clear, transparent communication and flexible administration with a focus on health equity generate a positive impact on vulnerable populations — as evidenced by increased knowledge, improved participant skills, attitude changes, inclusion in services, greater technology use among older adults, and enhanced equity skills among workers. This project demonstrates how health departments can collaborate with other sectors to address social determinants and ensure equitable access to resources. article yes

State and territorial health officials gathered on Capitol Hill to meet with lawmakers and discuss public health priorities—learn more about Hill Day in this blog post.

Good news and bad news on tobacco use: smoking rates are down but e-cigarette use continuing rapid rise among youth. Read how states are combating the problem.

Cases of sepsis and septic shock can be prevented with strong health policies as shown in New York. Several states have taken action to enact mandatory early detection and treatment protocols.

Learn how the Maryland Department of Health leveled up their strategic planning process to improve their critical public health work in this blog post.

Read ASTHO's latest on how appropriations bills and budget cuts could affect the Debt Ceiling and the U.S. economy.

The VDH Internship Academy, funded by PHIG, is a key pipeline for public health careers with paid, growth-focused internships.

Learn about chairs of key committees in the 119th Congress, their priorities, and what may be in store for public health funding in this federal health policy update.

Explore how states are enacting legislation to help justice-involved people avoid overdose illness and death and foster a smooth transition after release.

2026 Blog Posts article

Learn how Michigan has applied lessons learned a year later from a radiological exercise in this blog post.

Learn about the importance of immunization information systems to public health in this Health Policy Update.

Exercise Excellence: Michigan Reflects on a National Level Exercise Exercise Excellence: Michigan Reflects on a National Level Exercise Adrianna Evans Learn how Michigan's health department collaborated with state and federal partners for a radiation preparedness exercise. In March 2025, the Department of Energy hosted a national level exercise designed to promote radiation readiness. This exercise, called Cobalt Magnet 25, brought together a wide variety of interdisciplinary partners from federal, state, local, and international governments, among other partners. Michigan hosted the exercise. ASTHO’s Director of Preparedness, Adrianna (Annie) Evans, sat down with representatives from the Michigan Department of Health and Human Services (MDHHS) to learn about their experiences with Cobalt Magnet 25, how they’ve applied lessons learned one year later, and how those lessons might be applied to different threats. This blog post will be the first in a series “Exercise Excellence” that shares insights and perspectives from emergency preparedness exercises. This first blog post will share insights from Michigan on Cobalt Magnet 25 overall preparation, planning, collaboration, and more. Tell us about your experience with Cobalt Magnet 25. Jason Smith, Emergency Management Coordinator: While Michigan State Police, our state’s emergency management agency, took a key role with the U.S. Department of Energy on lead exercise planning, MDHHS served as lead exercise planner, player, and co-chaired a public health and environment working group alongside partners from Ontario and the Michigan Department of Environment, Great Lakes, and Energy. MDHHS leveraged this opportunity to initiate internal play and engage local public health and health care partners across the region. This included representation from two health care coalitions, five local health departments, and four major health care systems — many of which were outside the directly affected communities for this scenario. MDHHS activated our emergency coordination center. Overall, the Cobalt Magnet 25 Full Scale Exercise featured over a thousand injects emphasizing field sampling, decontamination, and reception centers. Our participation spanned preparedness, laboratory, environmental health, behavior health, disability health, and communications, including our public information officers. This experience strengthened cross-jurisdictional coordination and enhanced MDHHS's operational readiness for radiological incidents. Terra Riddle, Director, Division of Emergency Preparedness and Response: From my perspective, Cobalt Magnet 25 was impressive. Each player jurisdiction had the opportunity to make the exercise meaningful. It was really great to see all the partners come together and how each jurisdiction worked through these scenarios. It was unique in the communications world due to the depth, richness, and realness of the exercise play. Jay Fiedler, Director, Bureau of Emergency Preparedness, EMS, and Systems of Care: I participated when the larger group convened as part of the planning process. I hadn't seen something like this before in an exercise of this caliber. One of those activities was a briefing held for departmental leadership of state and federal agencies leading into the full exercise. I also served in the response coordinator role in our Community Health Emergency Coordination Center during the exercise itself. What was the preparation and planning process like for this exercise? Fiedler: This was roughly a yearlong planning process facilitated by a federal contractor, but it required extensive engagement with our state and federal partners. Jason worked in regular planning meetings and activities throughout that year. Some ways that the players were pulled together in meetings leading up to the exercise were really valuable for creating partnerships. Our partners from Ontario joined us. We don’t always get to work with them. That helped facilitate enthusiasm for the exercise itself and enhanced coordination between all the players involved. Smith: In addition to the exercise planning itself, the beauty of Michigan hosting Cobalt Magnet 25 was the opportunity to capitalize on existing trainings, whether it be through Counter Terrorism Operations Support, general radiological emergency preparedness training, and programs through CDC — primarily their public health decision-making course for radiological emergencies. There was a lot of training going on behind the scenes to build up awareness and capacity over the year. I thought the education opportunities made the exercise itself a success. Riddle: I'm glad you mentioned that, Jason, because it brought up another thought about the in-depth training led by the federal partners in the communications world. They invited our partners at the state and local levels to participate in radiological and communications training that was pretty niche. Our partners appreciated that this training prepared them for the exercise and it has spurred lot of conversation since about where we go next. This type of scenario requires a lot of collaboration with government agencies across levels of government, different fields, and even other countries. How did you manage that collaboration and what lessons did you learn? Riddle: The big takeaway is that trust built before a crisis sustains coordination during a crisis. This exercise required management across local, state, federal, and international partners with clear roles, consistent communication channels, and shared objectives early on. Fiedler: The pre-meetings were a unique aspect of this exercise and the connections built were really valuable. I hadn't seen that until an exercise of this scope and scale, but will be helpful going forward as we think about how we work and plan exercises as a whole. Smith: One lesson learned was that there is a bigger appetite for training, both in our department and local partners. Michigan has three nuclear power plants. That prevailing threat does build some desire for general awareness throughout the state, particularly among our 45 health departments. We also realized we need to work a little bit more collaboratively with our environmental partners, our agricultural partners, and have a more unified response effort. Riddle: If I can add, there's always an appetite for training and for support for our local partners, but Cobalt Magnet 25 brought visibility into different types of training. Jason explored radiological training. We explored communications training. Now I wonder all the time if there is a partner that could offer new trainings that we haven’t done before. What’s next for MI? Does MI have any other upcoming exercises — radiological/nuclear or otherwise — that you’re looking forward to? Smith: We’re focusing on a comprehensive overhaul of our response plans — not only our radiological nuclear hazards, but also for other functional and hazard specific annexes. In February 2026, we worked with our emergency management agency, local health departments, and health care coalition partners on a severe weather functional exercise. We also have a few workshops and tabletops scheduled for spring 2026 on volunteer management and vector-borne diseases. Additionally, we're prioritizing One Health coordination and formal agreements with agriculture and environmental agencies to strengthen collaboration across the quality-of-life sector. Lastly, we have a climate change tabletop exercise planned in partnership with environmental health teams within MDHHS. These initiatives reflect our commitment to building resilience across multiple hazards while continuing to advance radiological preparedness. Riddle: The depth of relationships continue to be a leading priority. Regardless of the emergency, our teams working together will be our strength. We're all interconnected and that plays into different activities. For example, our patient movement work, which inherently has many partners and requires close coordination like we saw with Cobalt Magnet 25. Exercise Excellence - Radiation Resources article yes

Recent HHS Leadership Changes That Impact Public Health Recent HHS Leadership Changes Impacting Public Health Catherine Murphy Get a rundown of recent HHS leadership changes that impact public health, including to CDC director, ACIP, and the U.S. Surgeon General. Over the last 16 months, the Trump Administration has championed the Make America Healthy Again (MAHA) agenda within HHS — with Secretary Robert F. Kennedy, Jr., leading the department. He was confirmed by the Senate and sworn in on Feb. 13, 2025, and has since worked to implement sweeping changes in the department and MAHA priorities (e.g., addressing chronic disease and childhood allergies, removing specific food dyes, and increasing transparency within the agency). Significant changes within HHS over this period include the termination of 10,000+ employees via Reductions in Force and more departures via voluntary separation incentives. This has left many agencies and offices to adjust and impacted how state and territorial health departments collaborate with partners at HHS agencies like CDC. Alongside these major ongoing changes (and more proposed) to the department are the appointments and alterations to HHS leadership by President Trump. CDC Director CDC has seen a handful of changes during the first year of the Trump Administration. Its director leads the agency and directs public health priorities like disease prevention, outbreak control, and health threat defense. In July 2025, Susan Monarez was confirmed as CDC director but removed a month later due to disagreements with the Administration over vaccine policy. Soon after, she appeared before the Senate Health, Education, Labor & Pensions (HELP) Committee to testify about events around her termination. The lack of CDC leadership was a source of concern for the public health community, as leaders cited the importance of evidence-based decision-making from the agency and sound leadership to respond to ongoing health threats and emergencies. Following the departure of Monarez, Jim O’Neill, deputy secretary of HHS, was appointed acting director of CDC. In February 2026, however, he was removed from the role amid his departure from HHS to be nominated as the director of the National Science Foundation. Meanwhile, department restructuring elevated Chris Klomp to chief counselor, in charge of all HHS operations. While HHS searches for a new CDC director, Jay Bhattacharya, director of NIH, is performing delegable duties. Federal law dictates that Senate-confirmed positions, including CDC director, have acting replacements for a maximum of 210 days — a deadline that passed on March 25. The agency says that they are actively looking for a replacement. Advisory Committee on Immunization Practices CDC’s Advisory Committee on Immunization Practices (ACIP) is a group of up to 19 voting members — independent medical and public health experts — who make recommendations on vaccines, which become CDC policy once adopted by its director. Recommendations bear on immunization schedules, the Vaccines for Children program, and clinical decision-making, and have downstream effects on whether insurance providers cover vaccines and the context in which they can be administered (i.e., pharmacy vs. office visit). ACIP has also seen considerable change under this Administration: In June 2025, HHS removed all 17, Biden-appointed members of ACIP. In a press release, the department noted the goal to “reestablish public confidence in vaccine science.” This move garnered bipartisan response from Congressional leaders, especially those on the Senate HELP Committee, who specifically questioned Secretary Kennedy on his potential revisions to CDC’s vaccine recommendations during his confirmation hearing. In January 2026, HHS announced an overhaul of the childhood vaccine schedule outside of the ACIP recommendation process. The announcement included changes to recommendations for hepatitis A, rotavirus, influenza vaccines, and more. In March 2026, a federal judge placed a stay on all of Secretary Kennedy’s appointments to ACIP, the panel's recommendations, and the 2026 schedule change. Surgeon General Finally, the U.S. Surgeon General role, which advises the public on health and leads the Commissioned Corps of the U.S. Public Health Service, has been marked by ongoing shifts. In May 2025, after withdrawing his nomination for Janet Nesheiwat, President Trump announced Casey Means, MD, as his new nominee for the position. Means is a doctor and wellness influencer who advocates for MAHA priorities, including finding ways to reduce rates of chronic disease. Several members of the Senate HELP Committee have stalled her confirmation, citing concerns around Means’ statements on vaccine safety. Means appeared before the committee in February 2026. Public Health Impacts The flux within HHS — a side effect of the administration’s desired changes within the department — has had ongoing impacts on the process for issuing public health guidance, approving and altering vaccine recommendations, and more. Congress remains interested in understanding the impact of reforms occurring within HHS, including in hearings centered around agencies and nominees. ASTHO will continue to track changes within HHS as well as responses from legislators, and work to be a resource to Congress on best practices for public health. article yes

State Policy Trends in Cybersecurity and Public Health Preparedness Maggie Nilz Learn how states are including cybersecurity in their emergency preparedness work in this Health Policy Update. Cybersecurity is an increasingly important component of public health preparedness as state cybersecurity policy intersects with public health agency responsibilities. Public health agencies rely on interconnected digital systems and critical infrastructure for disease surveillance, laboratory reporting, emergency communications, and health data management, making cybersecurity critical to maintaining these functions. Beyond compromising sensitive data and potentially harming patients, cyber incidents can disrupt essential public health services, including emergency response operations. Health care data breaches have steadily increased over the last 15 years, highlighting growing risks for government and health systems. A recent report showed that more than 7,000 health care data breaches were reported to the Department of Health and Human Services since 2009, and reported HIPAA data breaches in 2023 were nearly double the number recorded in 2018. Meanwhile, preparedness capacity has lagged: as of 2022, only 13% of local health departments reported being prepared for cyber-related disruptions, and recent scans show cybersecurity is rarely included in emergency preparedness planning. In response at the federal level, HHS recently announced it is undoing a 2024 reorganization by returning department-wide technology responsibilities to the Office of the Chief Information Officer while refocusing the Office of the National Coordinator for Health Information Technology on improving nationwide health IT interoperability and data sharing. In recent years, state and territorial legislatures have begun to address these gaps by incorporating cybersecurity into preparedness, health care oversight, and statewide governance structures. These legislative trends signal a need to integrate cybersecurity into emergency operations plans, strengthen cross-sector coordination, and safeguard the continuity of public health services. Some of the most recent policies considered and enacted by legislatures treat cyber incidents as emergencies, expand reporting requirements, and strengthen cyber governance. Cyber Incidents Are Being Built into Emergency Preparedness Frameworks In response to these growing threats, jurisdictions have begun incorporating cyber response into emergency plans and strategies, reinforcing cybersecurity as essential to preparedness. These developments highlight growing awareness that cyber incidents can disrupt critical services, much like natural disasters. In 2025, New York enacted S 7672, which requires municipal entities and public authorities report cybersecurity incidents and demands for ransom to the state Division of Homeland Security and Emergency Services. In addition, it directs the Director of the Office of Information Services to establish cybersecurity training and protection standards for state systems as well as require cybersecurity training for state and local government employees. Virginia is currently considering HB 83, which would establish a volunteer Cyber Civilian Corps within the state IT agency to provide rapid assistance during cybersecurity incidents affecting municipalities, nonprofits, education, and critical infrastructure. Preparedness efforts also extend beyond legislation to executive action. In February 2026, Minnesota Governor Tim Walz authorized $1.2 million in state disaster assistance to support response efforts and restore critical systems in response to a cyber incident that disrupted digital services in Saint Paul on July 29, 2025. Additionally, the National Governors Association has included cybersecurity as a primary consideration for planning and preparedness in their latest edition of the Public Health Emergency Playbook. Health care and Public Health Critical Sectors Are Facing New Cyber Requirements Beyond emergency response frameworks, jurisdictions are also adopting cybersecurity reporting and planning requirements for health care and public health organizations. Companion bills in Tennessee (HB 511/SB 555) would require health care providers and facilities to notify their contracted health insurers of cybersecurity incidents. In Maine, LD 2103 would require hospitals to adopt cybersecurity plans to protect patient data and maintain operations, and must include cybersecurity training for employees and board members. New Jersey is looking to adopt and implement a more comprehensive cybersecurity plan across all sectors. This session, legislators have introduced at least two cyber security bills: A 3231 would require “sensitive businesses” (defined as those engaged in financial, essential infrastructure, or health care industries) to report cybersecurity incidents to the New Jersey Cybersecurity and Communications Integration Cell (NJCCIC) when they are aware of their occurrence and would require NJCCIC to conduct a cybersecurity audit within 30 days of notification. A 3283 would require the same “sensitive businesses” to implement cybersecurity programs in accordance with standards adopted by NJCCIC and certify compliance annually. As states expand reporting and cybersecurity requirements, these obligations may intersect with public health reporting and continuity planning. States Are Strengthening Government Cyber Governance and Coordination In addition to sector-specific requirements, jurisdictions are also strengthening the governance structures responsible for coordinating cybersecurity, improving their ability to respond to large-scale incidents affecting public systems. Legislation enacted recently in Texas and California aim to improve coordination among state government by establishing a state agency centralizing cybersecurity incident prevention and response (Texas HB 150) and mandating the development of a cybersecurity playbook to strengthen information sharing (California AB 979). A 2024 bill enacted in Puerto Rico (PC 1530) requires commonwealth agencies to develop and implement a cybersecurity program, which must include a yearly risk assessment as well as vulnerability assessment. At least three jurisdictions are currently considering bills strengthening established cybersecurity programs, with two states recently passing legislation. Utah recently enacted a bill authorizing the Utah Cyber Center to conduct voluntary cybersecurity risk assessments for critical infrastructure and coordinate with government entities on infrastructure safety (HB 165). Utah also enacted legislation creating a specific funding stream for the Center to use for various activities, including implementing a statewide cybersecurity plan and conducting assessments for governmental entities (SB 123). Kansas enacted HB 2574, which would require chief information security officers for the executive, legislative, and judicial branches to adopt cybersecurity programs based on a nationally recognized standard for governmental entities. Finally, Florida recently passed SB 7024, which would expand the state’s public record exemption to include risk assessments, information related to cybersecurity breaches, and information related to data protection, ensuring the confidentiality of sensitive cybersecurity information held by state agencies; the bill is with the governor for final consideration. Key Takeaways for Preparedness Leaders Cybersecurity is critical for preparedness across multiple policy areas, and requires new planning, coordination, and oversight responsibilities. By including cyber incidents into disaster frameworks, standards for health care organizations, and governance, preparedness leaders may find themselves more directly engaged in integrating cybersecurity into emergency operations, exercises, and cross-sector partnerships. For state and territorial health agencies beginning to incorporate cybersecurity into their preparedness plans, agencies such as the Cybersecurity and Infrastructure Security Agency provide jurisdictional support and resources to guide this work. article yes

Learn about Pima County's journey to advance data modernization efforts through an elevated partnership with County IT.