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Learn more about the island jurisdictions that are represented in ASTHO's membership, each of which has its own unique context, history, and needs.

The Benefits of Primary Prevention article

Improving a State’s Process for Disclosing Data for Public Health Purposes to Tribal Public Health Organizations

Designing a Public Health Informatics Job Classification Series: A How-To Guide How To Design a Public Health Informatics Job Series Public health agencies can use this actionable guide to develop data informatics jobs and fill critical gaps in their workforce. As part of state and territorial data modernization programs and data system improvement, many public health agencies are realizing that their existing job classifications don’t always reflect the specialized work of public health informatics professionals. While some positions may resemble traditional roles like epidemiologists, they require a distinct set of skills. Informatics professionals focus on integrating and managing data, building stronger data systems, and improving how information flows across programs and partners. They often use advanced tools such as SQL and Tableau, and they work with national data standards — like HL7, FHIR, LOINC, and USCDI — to ensure that health information systems can “speak the same language.” Existing classifications (such as epidemiologist or information technology specialist) rarely capture these technical and cross-disciplinary responsibilities. Creating a dedicated public health informatics job classification series helps agencies attract and retain experts with the right mix of data, technology, and public health skills. It also provides a clear structure for professional growth, defining duties and qualifications for entry-, mid-, senior-, and managerial-level positions. This clarity supports both staff development and long-term workforce planning. However, establishing a new job classification is not a simple task. It requires careful planning, collaboration across departments, and formal approval processes that can take time. This guide outlines the key decisions, documentation, and steps needed to determine whether a new classification is right for your agency and how to develop one effectively. Each health department’s structure and policies are unique, so the process described here should be adapted to fit local circumstances. Steps in the Process 1. Identifying the Need for a New Job Classification The first step is to determine whether your agency truly needs a new public health informatics job classification. Many health departments find that existing job titles — like epidemiologist or clinical application coordinator — don’t align well with the skills required for informatics work. A new classification may be warranted if current titles have different job requirements, pay structures, or barriers that make it difficult to attract and retain qualified candidates. Begin by asking key questions: Does your department already employ staff performing informatics functions? If so, what are their current classifications, and are they effective in recruitment and retention? How flexible are your civil service rules for posting positions with modified requirements or titles? If there’s sufficient flexibility, you may not need a new classification. Are you relying on temporary staff or contractors for informatics work? If so, analyze whether creating permanent positions could reduce long-term costs. If a new classification isn’t immediately feasible, what options exist to train, promote, or compensate staff doing informatics work within the current framework? 2. Understanding the Approval Process and Requirements Once a need is established, identify the steps and timeline required to create a new classification. This process varies widely by jurisdiction and can take several months, or even years, to complete. Start by determining who has decision-making authority and which offices must approve the proposal. This may include local HR departments, statewide HR or civil service offices, commissioners, or budget authorities such as the Office of Management and Budget. If your HR department has a moratorium on creating new classifications, consider negotiating or repurposing existing ones. Document the rationale thoroughly, highlighting recruitment challenges, misaligned duties, and how informatics roles support data modernization goals. Include evidence such as prolonged vacancies or the impact on program performance. Prepare necessary documentation, which may include: A list of required competencies. Subject matter expert reviews. A work study or position analysis. A “career ladder” illustrating differences between entry, mid, senior, and managerial roles (see example: Nebraska’s Informatics Series (PDF)). Comparisons with other job families, such as Nebraska’s Epidemiology Series (PDF). Additionally, determine whether other state agencies also require informatics roles, as cross-agency collaboration can strengthen the case for a new classification. When it comes to salary justification, find out who sets pay scales — some states use centralized systems, while others allow departmental flexibility. In unionized settings, salary changes may also require negotiation. For example, Minnesota uses the Hay methodology through Korn Ferry to determine compensation levels. 3. Gathering Job Descriptions, Competencies, and Key Skills Developing an accurate and competitive job description is crucial. Start by analyzing the knowledge, skills, abilities, and other characteristics required for informatics work. Assess whether existing staff possess these competencies and where skill gaps may exist. Collect and review comparable job descriptions and frameworks from trusted sources, such as: Public Health Informatics Institute and Council of State and Territorial Epidemiologists Region V Public Health Training Center O*Net Online Health Informatics Profile PublicHealthCareers.org Commonly required skills include: SQL R SAS Python Tableau Snowflake ETL processes Interoperability standards (HL7, FHIR, LOINC, USCDI) Project management tools (e.g., Agile and LEAN) Certifications such as HL7 CDA Specialist, FHIR Fundamentals, or Tableau Desktop Specialist may also be valuable. For competency alignment, reference the following professional frameworks: HIMSS Global Health Informatics Competency Frameworks Applied Public Health Informatics Competency Model (PDF) Council on Education for Public Health (PDF) Council of State and Territorial Epidemiologists Competencies Toolkit Public Health Accreditation Board Council on Linkages Core Competencies CDC Competencies for Public Health Professionals You can also consult the Lightcast workforce analytics reports for skills and salary trends and review the literature review repository for additional insights. 4. Conducting Salary Benchmarking Competitive compensation is essential to attracting informatics professionals. Begin by identifying your HR department’s comparison states or agencies and reviewing their pay plans. Compare rates with large local jurisdictions when possible. Showing cost savings from converting contractors to permanent employees can strengthen your justification. If union negotiations are part of your environment, plan early to align with contract timelines. Many agencies use external benchmarking tools aligned with the location of the job, such as Salary.com, Payscale, Glassdoor, or Indeed. Large-scale workforce datasets from Lightcast — a large-scale data vendor that includes data collected from millions of job descriptions — can be useful as well. Data from Lightcast queries include examples of competitor employers, top technical and soft skills, example job titles, and salary ranges for public health informatics positions. Searching and summarizing reference data like this is vital for establishing baseline job information that is in-line with successful public health informatics positions elsewhere, which can help build a case for why your new series is different than existing jobs and requires a specific pay range. For deeper insights into salary trends and disparities, review the following: Salary and Job Requirement Differences for Jobs in Local and State Health Departments Versus the Private Sector: Analysis of Large-Scale Job Postings Data demonstrates that public-sector informatics roles can pay up to 50% less than private-sector equivalents. Salary Disparities in Public Health Occupations: Analysis of Federal Data (2021–2022) shows that informatics jobs pay between 25-45% less in local or state government compared to all other sectors, a difference of up to $71,000 per year in wages. When Money Is Not Enough: Reimagining Public Health Requires Systematic Solutions to Hiring Barriers explores structural barriers beyond pay, such as slow hiring processes or outdated job descriptions, that cause barriers to hiring in health departments. Also review relevant salary surveys from professional associations: HIMSS Nursing Informatics Survey (2022) American Health Information Management Association Salary Survey Report (2019) (PDF) American Medical Informatics Association Salary Survey iMercer Healthcare Informatics and Technology Compensation Data Other Considerations Establishing a new public health informatics job classification requires more than paperwork — it requires persistence, partnerships, and long-term planning. Building relationships with key stakeholders, such as HR leaders, civil service administrators, union representatives, and department executives, is essential. Each may have unique perspectives and concerns about creating new classifications, so tailoring your approach can make a difference. Persistence is often key. If one strategy or argument isn’t successful, try another. For example, some departments have found success by framing informatics roles as critical to data modernization, interoperability, and cost efficiency, while others emphasize workforce development or public health impact. Having distinct classifications for public health informaticians and epidemiologists also supports workforce morale and clarity. It helps staff and partners understand who to contact for specific issues (e.g., analytical versus technical data

Sustaining DMI: Medicaid Advanced Planning Document Process How state Medicaid agencies can request enhanced federal funding for Medicaid Enterprise Systems and related activities. Why is the Advanced Planning Document process important? Based on information from the Government Accountability Office (GAO), the Centers for Medicare & Medicaid Services (CMS), and the Federal Register, the Advanced Planning Document (APD) process is a procedure through which states develop a plan of action for their Medicaid information technology (Medicaid IT) projects. These plans are for designing, implementing, or operating Medicaid Enterprise Systems (MES) projects. State Medicaid agencies (SMAs) submit completed APDs to CMS—specifically a designated state officer in the Center for Medicaid and Children’s Health Insurance Program (CHIP) Services (CMCS) Data and Systems Group (DSG)—to request federal financial participation for their activities. The state officer reviews APDs to assess whether states’ requests for federal financial participation for designing, developing, implementing, or maintaining MES activities contribute to the economic and efficient operation of Medicaid and meet specific technical and operational criteria defined in statute, regulation, or sub-regulatory guidance. A state that receives federal financial participation can see increased access to stable federal funding to support MES activities. In addition, APDs are used to monitor a state’s project performance and outcomes. What are the three types of APDs? There are three types of APDs: Planning, Implementation, and Operational (Table 1). Table - Resource - Sustaining DMI: Medicaid Advanced Planning Document Process What are the major steps for states in the APD process? To request enhanced federal funding for MES, SMAs must complete the APD template that aligns with where they are in the development of their project (for example, design or maintenance) and submit it to the designated CMCS DSG state officer. The APD process contains five major steps and can take many months to complete: Meet with key state contacts and decision-makers. Based on information from the Public Health Informatics Institute’s information and tip sheets, before developing the APD, the SMA should identify and engage key state contacts and decision makers to solicit their input about the proposed project and secure their and their staff’s collaboration to complete and submit the APD to the CMCS DSG state officer. The state health agency (SHA) should work closely with the SMA during this process to ensure that they provide needed support to the SMA. For example, the SHA may gather information for the SMA to include in the APD or advise on how to complete particular sections of the APD. During this process, the SMA and SHA should consult with their respective agency leadership to discuss the type of technological solutions Public Health maintains, Public Health’s relationship with the state Medicaid program, and the opportunity to align systems to reduce overall state costs and improve state efficiency through the APD process. The SMA and SHA should also engage the MES lead, who can offer critical information about current MES components and component certification needed to complete the APD. In addition, GAO recommends states involve their chief information official in overseeing Medicaid IT projects because they can play a critical role in decision making related to IT budgets, management, and oversight. Next, the SMA and SHA should engage the CMCS DSG state officer to develop a strong understanding of how the APD can support the Medicaid program and serve a public health interest. Coordinating with the state project management office can help integrate the diverse parties and processes needed to develop and submit the APD for approval. It can also help ensure that states develop a comprehensive and flexible timeline for the APD process, stay aware of approaching deadlines, and meet ad hoc requirements. Develop the appropriate APD. Next, based on 45 C.F.R. § 95.610(c), the SMA and SHA should identify which of the three types of APDs to submit to the CMCS DSG state officer. Planning APDs are recommended for large and complex projects, such as statewide projects. However, if a state can identify a clear and easy pathway to integrate a public health information technology system with a current MES procurement or development phase, it can forgo developing a Planning APD and directly develop or update an existing Implementation APD. For example, if a state is looking to integrate its counties’ public health data into its MES at once, it should develop a Planning APD as the project is large and affects all counties in the state. However, if a state already has most of its counties’ public health data in its MES but is looking to add a single county’s data to its MES using the same process it previously and successfully used to add the other counties’ data, it may not need to submit a Planning APD. If a state has already successfully integrated its counties’ public health data into its MES and is looking to make major technology upgrades and improvements, it should submit an Operational APD. Regardless of the type of APD the state submits, the SMA and SHA should work together to ensure the request meets the Conditions for Enhanced Funding (see separate document Conditions for Enhanced Funding: The Basics). Submit the APD for approval and be available for revisions. Based on information from CMS, GAO, and the Office of Child Support and Enforcement, the state should then submit the APD to the designated CMCS DSG state officer. The SMA and SHA should plan to receive questions and revision requests from the CMCS DSG state officer and ensure that the state has staff capacity to answer questions and revise and resubmit. Approval conditions can be found at 45 C.F.R. § 307.15, but approval criteria might vary by Medicaid IT project and other factors. If approved, implement the plan. Next, the state can carry out the plan described in its Planning and Implementation APDs. After the Medicaid IT project has been operating for at least six months, states can request system certification from CMS. According to CMS, certification is required to receive the enhanced 75 percent federal financial participation for operations. The certification process includes states submitting to CMS an intake form, a certification request letter, and supplemental materials with information on its system. CMS may then start its review to assess whether the state’s system meets certification requirements. If approved, monitor and report progress and submit other APDs as needed. Based on 45 C.F.R. § 95.610(c) and 45 C.F.R. § Part 95 Subpart F and information from CMS, CMCS, Office of Child Support and Enforcement, as the state continues with its Medicaid IT project, it should adhere to monitoring and reporting requirements for enhanced federal funding. It also should submit annual APDs as required. If the state wants to make any major changes to the Medicaid IT project in concept, scope, cost allocation approach, timeline, and other key areas, it must develop and submit an as-needed APD. An as-needed APD is due no later than 60 days after the occurrence of the change. State examples: Medicaid Enterprise System projects Based on information from Alvarez & Marsel, state MES projects will vary based on factors such as the maturity of a state’s technology infrastructure, its specific data needs, and its available resources. As such, projects to design, implement, or operate MES can range in size, complexity, and timeline. For example, the Alabama MES Modernization Program, the Wyoming Integrated Next Generation System Project, and the Florida Health Care Connections project all seek to transform their singular Medicaid Management Information Systems (MMIS) into modular, multi-vendor MES, but differ in approach. In addition, Arizonia and Hawaii are collaborating to modernize their shared MES. For more information on state MES projects, see the Medicaid Enterprise System Solution/Module Contract Status Report. This webpage lists states’ MMIS and Eligibility and Enrollment contract information for their MES projects. It also lists contact information for state officers to reach out to learn more about states’ MES projects. website yes

Navigating Public Health Planning with Precision and Purpose Discover examples and best practices for developing strategic plans that enhance community health outcomes. Embarking on the journey of public health planning demands more than good intentions. It requires a meticulous blueprint that encompasses budgetary considerations and strategic timelines, and effectively leverages external support. Across a landscape in which every decision has the potential to uplift entire communities, there are a world of opportunities and details to explore. Included among them are the critical components of crafting a robust plan, the value of engaging contractors, and strategies for optimizing resources. Mining Existing Plans for Insight and Inspiration Organizational strategic plans, Community Health Assessments (CHAs), and Community Health Improvement Plans (CHIPs) can supply guidance and inspiration for comprehensive public health planning. These documents offer both valuable insights into public health initiatives and tangible examples of effective planning frameworks. There are multiple examples of existing plans within health agencies across jurisdictions; when seeking them out, consider various criteria (e.g., population characteristics, geographic location, and specific health priorities). By examining plans tailored to communities with similar demographics or facing comparable health challenges, planners can apply approaches that resonate in their own context. Additionally, understanding the distinctions between strategic plans, CHAs, and CHIPs is essential, particularly for agencies aspiring towards PHAB Pathways Recognition Program or PHAB Accreditation. These plans are separate entities within the PHAB framework, each playing a vital role in shaping public health strategies and fostering community well-being. Strategic Plans Strategic plans outline organizational goals, plans to achieve them, and how to measure success. They drive resource allocation, decision-making, and other priorities organization wide. Examples U.S. Virgin Islands Hawaii Forest County Potawatomi* El Paso County, CO* San Joaquin County, CA* Community Health Assessments Community health assessments offer a complete view of risks, resources, and factors influencing outcomes. Supported by diverse environmental and socio-economic data, CHAs inform health policy, staff protocols, partnerships, program development, funding, resource allocation, and health improvement planning. Examples U.S. Virgin Islands Oneida Nation* Forest County Potawatomi* El Paso County, CO* San Joaquin County, CA* Pierce County, WA* Community Health Improvement Plans Community Health Improvement Plans are strategic, collaborative roadmaps derived from CHAs. They outline how health agencies, partners, and communities will unite to enhance overall health. They guide priorities, resource allocation, and steer project, program, and policy implementation. Examples U.S. Virgin Islands Hawaii Oneida Nation* Forest County Potawatomi* El Paso County, CO* San Joaquin County, CA* Pierce County, WA* *PHAB Accredited Health Department Plan Components, Timeline, and Budget Agencies considering planning processes and examples from other jurisdictions should recognize the diversity in approaches across different agencies and jurisdictions. There truly isn’t a singular “right” way to undertake public health planning. Instead, it’s about tailoring the process to suit the jurisdiction’s unique needs and circumstances. Examples to Guide Plan Development The Kansas Institute of Health’s Strategic Planning in the Public Health Sector Handbook offers a comprehensive breakdown of planning elements and timeframes based on a six-month plan development calendar. Explore Minnesota Department of Health’s Community Health Assessment and Planning Toolkit, a rich resource for navigating the CHA-CHIP process and timeline. Their template includes a detailed approach that considers capacity to accomplish each step within a desired timeline. Given the variation in the depth and breadth of jurisdiction planning processes, it is challenging to pinpoint a specific dollar amount to cover a planning endeavor. NACCHO’s MAPP Budget Template (part of their downloadable MAPP 2.0 process) can help systematically think through the resources necessary for planning processes. Outsourcing Key Support External support—in the form of facilitators, contractors, or other specialized professionals—can play a pivotal role in enhancing public health planning by offering fresh insights, innovative strategies, and diverse perspectives. Such support also allows for full, active organizational participation in the planning process. Moreover, they can provide valuable technical assistance, helping to navigate complex challenges and identify best practices from other contexts. By harnessing external support, organizations can optimize their decision-making processes, foster collaboration, and enhance the delivery of services to communities, thereby promoting better health outcomes for all. Conducting a SWOT Analysis: Contractors can assist in facilitating a thorough analysis of the organization's strengths, weaknesses, opportunities, and threats (SWOT). This structured assessment helps identify internal factors that impact the organization's ability to achieve its objectives and external factors that may affect its operations. Proposing Strategic Priorities: Based on the SWOT analysis and input from stakeholders, contractors can help planning teams crystallize priorities aligned with the organization's mission and vision. These priorities serve as the foundation for developing the plan. Facilitating Steering Committee Meetings: Steering committee meetings are crucial for decision-making and guiding the strategic planning process. External facilitators can lead these meetings, ensuring productive discussions, consensus-building, and alignment with organizational goals. Developing Components of the Strategic Plan: Contractors can support in drafting or reviewing various components of the plan, including vision and mission statements, goals, objectives, and action plans. They may ensure these components are clear, concise, and aligned with the overarching strategic direction. Developing a Draft Implementation Plan: An implementation plan outlines how to achieve strategic goals, including timelines, responsible parties, and resource allocation. Contractors can support an organization to develop a draft implementation plan that outlines actionable steps to translate the strategic plan into reality. Developing Quality Improvement Metrics: Contractors can assist in guiding the development of metrics to measure the effectiveness of the strategic plan. These metrics should be specific, measurable, achievable, relevant, and time-bound (SMART), providing a framework for monitoring progress and making data-driven decisions. Conducting Training Among Organization Staff: To ensure buy-in and understanding of the strategic plan and process itself, contractors can help develop and co-facilitate training sessions for staff members. These sessions may cover strategic objectives, action plans, and their roles in achieving organizational goals. Developing a Communication Plan: Effective communication is an essential key for keeping any strategic plan off the shelf. Contractors can support an organization in developing a comprehensive communication plan that outlines key messages, target audiences, communication channels, and timelines to ensure consistent and transparent communication throughout the organization and with partners. Developing Process Logs, Templates, and Meeting Notes: Contractors can create documentation tools such as process logs, templates for strategic planning documents, and detailed meeting notes. These resources streamline the planning process, capture important discussions and decisions, and serve as valuable references when considering sustainability. In summary, external support brings valuable expertise and resources to public health planning processes, enabling organizations to navigate complexities, engage partners effectively, and develop actionable strategic plans that drive positive health outcomes for communities. OE22-2203 PHIG website yes

Formal partnerships between health agencies and private companies can lead to resource sharing, expertise exchange, and improved health services delivery. The strategies outlined in this resource provide a comprehensive approach to enhancing health equity through public-private collaboration.

Healthy People Coordinator Description Template This template was designed to help health agencies craft job descriptions for staff that can effectively incorporate Healthy People 2030 frameworks into public health initiatives. Healthy People is a national framework that fosters a shared vision of public health across the United States. It establishes national priorities every 10 years to guide jurisdiction planning and data collection, which is supported by the HHS Office of Disease Prevention and Health Promotion (ODPHP). The goal of this template is to create a description for the role of Healthy People Coordinator that is adaptable and flexible to meet the needs of health departments and help them identify candidates. This template was designed with the reality in mind that this is an unfunded position, and for many jurisdictions the position itself may be embedded within another position within the department/division or bureau. This description details the knowledge, skills, and abilities for a successful candidate that can be used on their own or added and adapted to fit into an existing and aligned role. The Healthy People Coordinator role has historically had connections to funding for block grants, performance improvement, or other public health infrastructure related projects. How ODPHP Defines HP Coordinators: “The Healthy People State and Territorial Coordinators make Healthy People happen every single day across the United States. Each state or territory has a Healthy People Coordinator who serves as a liaison with the Office of Disease Prevention and Health Promotion (ODPHP). ODPHP works with Coordinators to identify areas of alignment in their work and the Healthy People 2030 goals and objectives. They also collaborate with the HHS Office of the Assistant Secretary for Health (OASH) Regional Offices.” Suggested Position Description and Overview This position will ensure adequate oversight, management, and efficient and effective implementation and integration of the Healthy People framework within jurisdiction-wide, programmatic-specific, and organizational planning efforts. It will also provide support to state block grant programming and accreditation efforts. Suggested Position Duties Support both program managers and division heads in vision and strategy to align their work with the Healthy People 2030 framework. Help to assess and align planning efforts (CHA/SHA, CHIP/SHIP, Strategic Planning) and programmatic work with Healthy People 2030 objectives. Promote the adoption of data-driven and evidence-based interventions and strategies while working to adapt them to jurisdictional needs. Foster collaborative approaches through increased communication and engagement across programs, departments, and local jurisdictions. Engage leadership, community-based and non-governmental organizations, trusted leaders, and the community across multiple sectors to initiate action and educate key stakeholders around the current public health evidence base to inform policies in alignment with the Healthy People 2030 framework. Serve as the liaison to local/regional/state health departments to better align local level planning efforts with state/territory/freely associated state planning efforts. Participate in Healthy People opportunities offered by ODPHP. Suggested Qualifications for Employment Knowledge, Skills, and Abilities Knowledge of national frameworks like Healthy People 2030, as well as social determinants of health, health literacy, and health equity. Skills in performance and quality improvement and planning. Familiarity with use of evidence-based interventions and practices. Ability to manage multiple timelines and projects. Insight, general understanding, and knowledge in strategies to advance equitable health outcomes. Suggested Requirements for Education, Experience, and Competencies Master’s Degree or higher in Public Health or a closely allied field, preferred but not required. Qualifying experience (demonstrated by certificate, course work, or practical experience) in performance and quality improvement frameworks, evaluation, and data interpretation. Extensive written and oral communication skills coupled with demonstrated experience communicating complex topics or issues both verbally and in writing to diverse internal and external audiences across a broad spectrum of managerial, administrative, and professional staff, especially executive-level leaders. Demonstrated experience in the following subject areas: Organizational development. Working with diverse groups, interacting with the community or community partners. Strategic planning. Facilitation and decision-making. Coaching preferred but not required. Demonstrated competencies in the following areas: Self-awareness, self-management, and continual growth and learning. Decision making—the ability to identify issues; develop analyses of alternative positions and impacts; make data-driven, defensible recommendations; take calculated risks based on logical ratio decision-making processes; make timely/responsive decisions; assume responsibility for decisions made; and involve others appropriately in decision-making processes. Working openly and transparently with colleagues and partners, fostering trust and serving as a resource in challenging work environments. Utilizing quality improvement tools and processes in accomplishing work activities and in support of the agency’s mission and goals; this includes seeking opportunities to participate in process improvement activities and initiating efficiencies in how work is accomplished. Showing a commitment to inclusivity, encompassing cultural, racial, ethnic, and gender sensitivity and competency. Organizational and political awareness. Ability to inspire. Practicing ethics and integrity. Utilizing tools for effectively collaborating with a multigenerational workforce. Suggested Preferred/Desired Education, Experience, and Competencies Understanding, skill, and experience in data interpretation/visualization. Proficiency in co-creating organizational strategies and building shared commitments with executive-level leaders and partners. Certification(s) in facilitation, leadership development, change management, quality improvement, or other related topics. Experience working in a public health-related or governmental organization. website yes

Sustaining DMI: A State Health Official’s Guide to Enhanced Funding Sustainable financing strategies for state health officials to support data modernization and Medicaid. What is the relationship between a state’s Medicaid program and its public health data system? Although state implementation of the Medicaid program (Title XIX of the Social Security Act) varies, each state’s program has enrollment and claims data on Medicaid participants, including demographic data on race and ethnicity, age, and service utilization, such as vaccines received. At the same time, a state’s public health system needs to collect, analyze, and report diverse data from public health initiatives and related programs to support its goals to protect and improve the health of individuals and communities by promoting healthy lifestyles, researching and encouraging disease and injury prevention, and detecting, preventing, and responding to infectious diseases. A state’s Medicaid program and public health agency can collaborate to implement a sustained data modernization initiative (DMI) that combines Medicaid and public health data and integrates these data into the state’s health-related data ecosystem. A sustained DMI can yield various improvements to a state’s health-related data ecosystem, such as improved data quality, public health reporting, data storage and resiliency, and analytics to respond to pandemics. It can also set the stage for data sharing with additional data system partners, which can further improve the state’s health-related data ecosystem. Why is sustainable funding necessary to continue DMIs? Sustainable funding to support personnel, processes, and technology is imperative to the continued success of a DMI. Stable funding can increase state Medicaid and public health agencies’ likelihood of recruiting and retaining personnel with advanced degrees, such as biostatisticians and epidemiologists, by enabling the agencies to offer compensation packages that are competitive with job market rates. Stable funding also enables the agencies to maintain and refine new and existing data-sharing processes, and it ensures that technology is maintained and upgraded appropriately to meet evolving needs. Medicaid funding is a potentially large and stable funding stream that can support the personnel, processes, and technology in a DMI that focuses on integrating Medicaid and public health. However, public health funding has historically been an unstable patchwork of federal, state, local, and private funding streams and mechanisms, largely because of changing economic and political priorities and the perceived risk level and severity of major public health threats. What sustainable financing strategies can support the personnel, processes, and technology needed to continue DMIs? State health officials can use the following three strategies when pursuing Medicaid funding to sustain a DMI: Blend and braid funding sources. Optimize existing and potential funding streams by blending or braiding administrative approaches to grow and maintain programs. To blend funding sources, program officials combine funding into a single stream, which results in a loss of award-specific requirements and thus requires statutory authority. In contrast, braiding funds allows program officers to direct funds toward a single strategy or initiative while preserving funding requirements (Box 1). Callout 1 - Resource - Sustaining DMI: A S/THOs Guide to Enhanced Funding Support personnel by using cost allocation through the Advance Planning Document (APD) process or the Administrative Cost Allocation Plan. A DMI team often has people with specialized skills, such as clinical and technical experts, compliance or legal officers, and financial experts. The salary for these people may be cost-allocated via the APD process or the Administrative Cost Allocation Plan described in Social Security Act Section 1903(a)(7) (Box 2). To illustrate, the Administrative Cost Allocation Plan provides 50 percent match for costs that meet a series of requirements to cover personnel costs. In addition to this strategy, state health officials can cover salary costs through blending and braiding approaches. Callout 2 - Resource - Sustaining DMI: A S/THOs Guide to Enhanced Funding Align public health functions with Medicaid business and technical functions. To explore whether a state Medicaid agency could access enhanced federal funding to support public health, a state public health agency must approach the state’s Medicaid program collaboratively and design and implement a DMI that does the following: Meets the Conditions for Enhanced Funding and couples any technical system improvements with measurable outcomes that improve public health and the Medicaid program. Investigates the extent to which the public health technical functions (for example, health care provider enrollment) align with similar Medicaid business functions. Confirms the extent to which the public health functions and Medicaid Enterprise Systems share or could share (that is, reuse) core technical components to support common business functions. Callout 3 - Resource - Sustaining DMI: A S/THOs Guide to Enhanced Funding After this investigation is complete, the state Medicaid agency should explore cost allocation models that apportion costs with the benefits received (Box 3). Box 4 provides examples of public health use cases that successfully acquired enhanced Medicaid funding. Callout 4 - Resource - Sustaining DMI: A S/THOs Guide to Enhanced Funding website yes

Overdose Spike Preparedness Exercise Tabletop in a Box Overdose Spike Preparedness Exercise Tabletop in a Box Check out these resources for actionable steps to conduct overdose spike preparedness exercises. The Overdose Spike Tabletop in a Box resource is intended to assist state and local jurisdictions to plan and prepare for overdose spikes through the implementation of an overdose spike preparedness exercise. An overdose spike is broadly defined as when the total number of suspected overdoses for a defined geographic area exceeds a pre-determined threshold for a specified time. Overdose spikes are emergency events that require a coordinated response among many agencies and partners. The purpose of the exercise is to practice response scenarios with all partners who may be called upon to respond during a real-life overdose spike. The objectives of the exercise are to: Discuss the necessity and urgency of preparing for overdose spikes. Enhance cross-sectoral partnerships to respond to overdose spikes. Practice response scenarios to support developing or enhancing overdose spike response protocols. Resources The tabletop in a box includes six resources to help plan for and conduct an overdose spike preparedness exercise. Partner List (automatic Word download): The exercise partner list includes a suggested list of key response partners who might participate in the spike response preparedness exercise. The response team may use this document to brainstorm key response partners and track contact information and invitation status for the exercise. Mock Scenario and Inject Inventory (PDF): This document serves as a menu of options for exercise facilitators to select from when determining what scenarios and injects, or example scenario changes, to include in their overdose spike preparedness exercise. Agenda (automatic Word download): This document includes two template agendas to accompany the exercises. Exercise Slide Deck (automatic PowerPoint download): These slides serve as a template for response teams to adapt and use to structure the exercise. Action Plan Template (automatic Word download): This template can be used to identify and organize key activities that strengthen your jurisdiction’s spike response protocol. Resource List: This list outlines key resources on overdose spike preparedness and response strategies that may assist exercise facilitators and participants before, during, and after an exercise. Tips for Facilitating an Overdose Spike Preparedness Exercise It is important to note that each jurisdiction has unique resources, assets, and challenges. This resource is intended to be modified by the exercise facilitators to fit the local context and priorities. Some general tips for facilitators are outlined below. We encourage facilitators to share ongoing feedback on the utility of these materials by contacting opioidpreparedness@astho.org. Planning Exercise facilitators and their roles in the community will vary by jurisdiction. Facilitators should generally have detailed knowledge of the overdose prevention and response landscape in their jurisdiction and feel comfortable with leading discussions among partners. Facilitators may enlist others to help organize and prepare for the exercise. It is recommended that facilitators, as well as any others involved in exercise planning, begin the planning process by completing the Partner List resource. This list will help outline partners who should be invited to participate in the exercise. Following this step, facilitators should choose the scenario and inject that will yield the most fruitful discussion during the exercise. Once these first two steps are complete, facilitators and planners should invite participants and schedule the exercise. The general recommendation is to schedule the exercise at least six weeks after the day the invitations are sent to maximize availability. Structure The Overdose Spike Preparedness Exercise outlined in this resource is designed to take approximately four hours to complete, including breaks, and can be conducted virtually or in person. The exercise can be split into two sessions that take place no longer than one week apart. The benefit of splitting the exercise into two sessions is the ability to adjust and invite additional partners if gaps are identified during the first session. If the sessions are split, facilitators are encouraged to enlist timekeepers and to use their discretion in choosing when to close the first session and where to pick up for the second. Protocol Development and Enhancement The Overdose Spike Preparedness Exercise outlined in this resource can be used by state and local jurisdictions at any stage of spike response development, whether they have a plan or protocol in place or not. If the jurisdiction has a plan or protocol in place, it should be shared with all participants beforehand so that the plan can be appropriately tested through the exercise. If a plan or protocol has not yet been developed, exercise facilitators should give special attention to what information they would need to elicit through the exercise discussion to begin formulating a plan. Whether or not a protocol exists, the facilitators should plan to task someone with taking extensive notes during the exercise. Action Planning It is critical to summarize the next steps and key priorities when closing each session of the exercise, as well as identifying the person responsible for ensuring that the next steps take place and a timeline. Specific goals and objectives may vary by jurisdiction, but some potential next steps may include formalizing roles and responsibilities, drafting/modifying a response protocol, and connecting with new partners. Resource List Accordion - Resource - Overdose Spike Preparedness Exercise Tabletop in a Box article yes

Recipient Orientation Handbook for OD2A State and LOCAL Cooperative Agreements overdose prevention, substance use disorder, overdose crisis, opioid overdoses, principal investigators, project officer, grants management specialist, secure access management services, public health, mental health conditions, opioid use disorder, drug overdose deaths, opioid overdose deaths, medical condition, cooperative agreements, withdrawal symptoms, drugs or alcohol, prescription drugs, health care, overdose deaths involving prescription opioids, treatment for substance use disorders, deaths involved synthetic opioids, astho, association of state and territorial health officials ASTHO | This guide is for new recipient staff working on the CDC Division of Overdose Prevention cooperative agreements OD2A-S and OD2A-LOCAL. Overdose Data to Action (OD2A) supports jurisdictions in collecting high-quality, comprehensive, and timely data on nonfatal and fatal overdoses and in using those data to inform prevention and response efforts. OD2A focuses on understanding and tracking the complex, changing nature of the drug overdose epidemic and highlights the need for seamless integration of data into prevention strategies. The OD2A program page details funded jurisdictions, how this cooperative agreement contributes to CDC’s efforts to prevent opioid overdoses, and more. This orientation handbook serves as a resource for new recipient staff involved in the CDC DOP OD2A awards, in the hopes that it will assist them in managing their award. Get the Guide (PDF) website yes

Charter Template and Guide Creating a charter is a worthwhile exercise when forming a workgroup, advisory group, or committee or putting together a new project. A charter provides guidance, aligns the project or team goals, and helps make the business case for the effort. This charter is meant to be both a guide and template; it contains many common elements that can be customized. Consider what is important for your successful work together and include those key elements in your team’s charter. Putting together a charter may seem burdensome. In reality, it is an important source of truth for the team to reference throughout the project. That said, charters are working documents. As projects and teams evolve, it is important to revisit the charter and agree to updates together. Assembling the team and developing the charter together is a collaborative way to kick off the work the team will do together. The Commonwealth of the Northern Mariana Islands’ (CNMI) Commonwealth Healthcare Corporation (CHCC) recently used this charter guide, and here is what a CHCC DMI team member had to say: "We collaborated to draft a comprehensive team charter for our Data Management and Integration work. Subsequently, we refined this document in conjunction with our partners, ensuring alignment and clarity. As we prepare for our inaugural meeting, this finalized charter symbolizes the committee's steadfast dedication to executing the Advisory group plan with solidarity and purpose." Get the Resource (PDF) To more easily copy and paste, or fill out content, convert the PDF to a Word document using Adobe's PDF-to-Word Converter. OE22-2203 PHIG website yes

ASTHO legislative alert, Dec. 20, 2022: End-of-Year Funding and Policy Package Summary

On March 28, 2022, the White House released President Biden’s FY23 proposed budget. The budget outlines the Administration’s funding priorities for the upcoming fiscal year. Congress has the authority to approve, reject, or modify the budget’s recommendations.

On April 4, 2022, the U.S. Senate indicated that they have reached an agreement on a $10 billion bipartisan emergency supplemental funding bill for the federal COVID-19 response.

ASTHO CEO Michael Fraser's Testimony in Regards to the U.S. Department of Health and Human Services for the Committee on Appropriations, United States Senate

Scott Harris Testimony Regarding Sustainable and Predictable Public Health Funding Testimony Title Scott Harris 20250409 On behalf of the Association of State and Territorial Health Officials (ASTHO), I respectfully submit this testimony on FY26 appropriations for the U.S. Department of Health and Human Services (HHS). ASTHO is the national nonprofit representing state and territorial public health agencies. ASTHO's members — the chief public health officials of these agencies — are dedicated to formulating and influencing sound public health policy and assuring excellence in public health practice. We respectfully request that Congress provide sustained and predictable federal funding from the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), and the Administration for Strategic Preparedness and Response (ASPR) for state and territorial health departments. The funding requests mentioned below are illustrative of the ongoing needs of our jurisdictions; we acknowledge that these levels may not be achievable in the next fiscal year. I am sincerely grateful to Congress for providing resources in FY25 to support and maintain investments in public health, ensuring our nation’s preparedness for current and emerging health threats. As a former state health official once eloquently stated, “The U.S. public health system is not a singular entity but a decentralized, uneven patchwork of federal agencies and state, local, tribal, and territorial public health authorities. As a result, the collaborative endeavor for public health is only as strong as the weakest link.” State health department budgets are a mix of state and federal funding streams. For some states, up to 80% of all funding comes from federal sources, with CDC being the single largest funder. Any disruption or decrease in federal funding will result in a significant impact on the ability of state and territorial health departments to protect and promote the health and safety of our population. Public health officials remain deeply concerned that our country faces significant challenges, including, but not limited to, the ongoing opioid overdose epidemic, chronic disease, preventing the spread of infectious diseases, rising health debt, access to health care in rural areas, and mental health crises. Furthermore, the recent abrupt cancellation of grants totaling as much as $11 billion caught state and territorial health departments by surprise; unfortunately, these actions will significantly impact our public health preparedness and response activities. Although the majority of this funding had already been spent, it was appropriated by Congress and obligated to health departments with work plans, budgets, and timelines approved by federal agencies for ongoing activities. These funds were intended not only for pandemic response, but also for mitigating key health security vulnerabilities that became apparent during the pandemic as well as strengthening our preparedness and response framework for the future. With congressional and executive branch support, these funds were being used to modernize data systems, bolster laboratory capacity, improve electronic case reporting of time-sensitive infectious disease outbreaks, improve H5N1 avian influenza and measles testing, and enhance biomedical terrorism preparedness, to name just a few examples. To meet not only the next public health emergency threat but also address our current challenges, it is critical that Congress invest in a stronger public health system by providing sustained and flexible funding that meets the needs of state, territorial, and local public health departments. America’s state and territorial public health departments work in partnership with CDC toward this goal. CDC plays a vital role in supporting communities to expand the capacity of our nation’s frontline of public health defense: our country’s state, tribal, territorial, and local public health departments. Regardless of the politics in our individual jurisdictions, state and territorial health officials are united in our mission to protect the health of our country. As the committee and incoming administration consider modernizing the federal government infrastructure, we respectfully request the following: Congress must work to sustain investments to state and territorial health departments: As Congress grapples with reducing our nation’s debt and deficit, the savings or return on investment generated by investing in public health has long been documented. Moreover, our membership relies on federal funding to address a myriad of illnesses through targeted interventions with the shared goal of preventing injury and disease. For example, in the fall of 2023, the North Carolina Department of Health and Human Services identified apple cinnamon fruit puree as the likely source of elevated blood lead levels in children. Even low levels of lead exposure in children can have long-lasting health effects, including potential brain damage and permanent reduction of IQ. Following their assessment, FDA issued a safety alert advising parents not to buy or feed the identified brand of fruit puree. Consultation: As the boots on the ground who put federal policy into action on the front lines, it is vital to consult with state and territorial health leaders about the potential impacts of funding reductions and/or administrative changes. Pausing or preventing money from going to states and territories, especially when done with little or no notice, creates disruptions and further harms our ability to rebuild trust with the public. As the recipients of numerous grant programs, we have first-hand knowledge of administrative changes that may actually benefit the system and could help reduce redundancies in the federal government. Flexibility: Federal funding mechanisms are often focused on specific programs, such as lead poisoning or food safety, and cannot be used flexibly to accomplish broad programmatic goals. We are grateful for the subcommittee’s ongoing support for public health infrastructure and capacity by funding this line at $350 million and we respectfully request $1 billion for this program at CDC in FY26. This disease-agnostic, flexible, and sustainable funding will support efforts within agencies that build capacity to detect and respond to threats both domestic and global, while improving and supporting activities in core public health capabilities, including assessment, policy, preparedness and response, community partnership, communications, equity, accountability, and performance management. Moreover, this funding will build a highly trained workforce that can be rapidly scaled to meet local, regional, or national threats. We strongly encourage Congress to prioritize flexibility in programmatic funding wherever possible to ensure the needs of the population can be met. Along with partner organizations, ASTHO supports the Data: Elemental to Health Campaign. Previously, we called on Congress to provide the first-ever dedicated funding for public health data systems and build a 21st-century public health data superhighway. Thanks to the work of this Subcommittee, Congress answered the call and provided annual funding for CDC's Public Health Data Modernization Initiative (DMI). For FY26, we request $340 million for data modernization efforts at CDC, which includes funding for the Center for Forecasting and Outbreak Analytics and the Response Ready Enterprise Data Integration platform. DMI is necessary for building a world-class data workforce and data systems to ensure we can meet the next public health emergency at full capacity. Our state and territorial health departments need robust, sustained, yearly funding to complete the foundational investment in DMI and ensure we are providing resources for public health systems and infrastructure, including at state and local health departments, to keep pace with evolving technology. States use the Preventive Health and Health Services Block Grant (Prevent Block Grant) to offset funding gaps in programs that address leading causes of death and disability. In some cases, this grant serves as seed funding for crucial, innovative projects so a state or territorial health department can meet otherwise unfunded community health goals. ASTHO respectfully requests $175 million for this program. For more than 30 years, the Prevent Block Grant has served as an essential funding source for state and territorial health agencies. CDC’s Public Health Emergency Preparedness Cooperative Agreement (PHEP) provides vital support for public health preparedness and response. ASTHO requests $1 billion for PHEP to sustain and improve governmental public health programs. Established in the aftermath of the September 11 terrorist attacks, PHEP has been a core public health preparedness program that supports 62 state, local, and territorial public health departments. The pandemic response demonstrated the need to invest in these programs to rebuild and bolster the nation’s preparedness capabilities. CDC has refreshed its strategy with critical lessons learned from COVID-19 to support public health jurisdictions with an updated response framework that prioritizes essential areas for the public to prepare for, respond to, and recover from health threats in the next five-year funding cycle that begins in the current fiscal year. Under ASPR, ASTHO is requesting $500 million for Health Care Readiness and Recovery, which includes the Hospital Preparedness Program (HPP) Cooperative Agreement. This includes developing mechanisms for effective patient movement, communicating situational awareness, and providing resource sharing across disparate health care entities. HPP allows individual health care facilities and coalitions to access a truly national response network, enabling the system to save lives and protect Americans from 21st-century health security threats.

ASTHO legislative alert, analysis of reauthorization of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program.

Analysis: President Biden’s FY24 Budget Proposal On March 9, the White House released President Biden’s FY24 budget proposal, which outlines the Administration’s funding priorities for the upcoming fiscal year. As a reminder, Congress has the authority to approve, reject, or modify the Administration’s budget recommendations. ASTHO issued a statement in response to the FY24 President’s budget proposal and a legislative alert outlining a snapshot of the new initiatives and policies proposed by President Biden. State and territorial health officials should view the HHS budget in brief for details and additional information about these programs included in the Congressional justifications hyperlinked below. Centers for Disease Control and Prevention (CDC) Health Resources and Services Administration (HRSA) Substance Abuse and Mental Health Services Administration (SAMHSA) Assistant Secretary for Preparedness and Response (ASPR) Food and Drug Administration (FDA) Department of Interior (DOI) HRSA The request proposes $15.9 billion for HRSA, an increase of $1.5 billion above FY23. Highlights include: $290 million, an increase of $125 million, to end the HIV epidemic. $512 million, an increase of $225.5 million, for the Title X Family Planning program to improve access to reproductive and preventive health services. $937.3 million, an increase of $121.6 million, for the Title V Maternal and Child Health Block Grant. This includes $333.7 million for Special Projects of Regional and National Significance funding and $145 million to support investments to improve maternal health and address disparities in maternal mortality and morbidity. $415.9 million, an increase of $63.4 million, to expand access and improve health care in rural communities. This includes $165 million, an increase of $20 million, for the rural communities opioid response program. $2.7 billion, an increase of $892.5 million, for HRSA workforce programs. This includes: $965.6 million, an increase of $547.7 million, for the National Health Service Corps. $387.4 million to train mental health and substance use disorder providers. $27.5 million to support new approaches to recruiting, supporting, and training new health care providers. $25 million to support the mental health and well-being of health care providers. $110.2 million to expand the diversity of the health profession workforce. $7.1 billion, an increase of $1.3 billion, for health centers. This includes $1.9 billion in discretionary funding and $5.2 billion in new proposed mandatory funding, considering the expiration of the current authorization at the end of FY23. $415.9 million, an increase of $63.4 million, for rural health related activities. $130 million for a new program to support patients diagnosed with Long COVID. $276 million, an increase of $119.4 million, to improve maternal health. CDC The request proposes $11.58 billion for CDC, an increase of $2.4 billion above FY23. Highlights include: $600 million, an increase of $250 million, to support public health infrastructure and capacity. $340 million, an increase of $165 million, for public health data modernization. $100 million, an increase of $92 million, for social determinants of health. $160 million, level funding, for the preventive health and health services block grant. $100 million, an increase of $50 million, for the Center for Forecasting and Outbreak Analytics. $1.26 billion, an increase of $336.6 million, for Immunization and Respiratory Diseases. This includes $999 million, an increase of $317 million, for the Section 317 immunization program and $251 million for the influenza program. $764.8 million, an increase of $72 million, for global health programs. $106 million, an increase of $35 million, for Public Health Workforce and Career Development. $35 million for the Infectious Disease Rapid Response Reserve Fund. $1.54 billion, an increase of $153 million, for HIV/AIDS, Vital Hepatitis, STI, and Tuberculosis prevention. This includes $310 million for the Ending HIV Epidemic Initiative, an increase of $90 million. $1.4 billion, an increase of $590.3 million, for injury prevention and control. This includes: $713.7 million, an increase of $207.8 million, for opioid abuse and overdose prevention and surveillance. $15 million, an increase of $6 million, for addressing adverse childhood experiences. $35 million, an increase of $22.5 million, for firearm injury and mortality prevention research. $268.1 million, an increase of $250 million, for youth and community violence prevention. $420.8 million, an increase of $174 million, for environmental health programs. $362.8 million for occupational safety and health. $1.8 billion, an increase of $388.2 million, for chronic disease prevention and health promotion. $943.2 million, an increase of $38.1 million, for public health preparedness and response. $845.8 million, an increase of $95 million, for emerging and zoonotic infectious diseases. $86 million, an increase of $1 million, for the Agency for Toxic Substances and Disease Registry. The proposal also includes the following realignments that will help CDC increase accountability, reduce administrative burden, and provide programmatic flexibility: Realign $26 million for Lyme Disease to be included as a non-add under the Vector-Borne Diseases program, project, or activity (PPA). Consolidate the Public Health Emergency Preparedness Cooperative Agreement, Academic Center for Public Health Preparedness, and all other CDC Preparedness programs into a single PPA labeled “Domestic Preparedness” to provide CDC with greater flexibility to respond to public health emergencies. Consolidate all other Environmental Health, Climate and Health, and Safe Water PPAs into a single PPA labeled “Environmental Health Capacity” under the Environmental Health Activities budget activity. SAMHSA The request includes $10.8 billion for SAMHSA, an increase of $3.3 billion above FY23. Highlights include: $4.9 billion, an increase of $2.1 billion, for SAMHSA’s mental health activities. This includes $1.65 billion for the Community Mental Health Block Grant. $836 million, an increase of $334.4 million, to the 9-8-8 and Behavioral Health Crisis Services program. $5.5 billion, an increase of $1.3 billion, for substance use services that include harm reduction, treatment, and recovery services. This includes: $2 billion, an increase of $425 million, for state opioid response grants. $2.7 billion, an increase of $425 million, for the Substance Use Prevention, Treatment, and Recovery Services Block Grant. $183.8 million, a decrease of $151.1 million, for Health Surveillance and Program Support. $245.7 million, an increase of $8.9 million, for substance use prevention. ASPR The request proposes $4.3 billion for ASPR, an increase of $642.2 million above FY23. Highlights include: $995 million, an increase of $30 million, for the strategic national stockpile. $312.1 million, an increase of $7 million, for the Health Care Readiness and Recovery (formerly the Hospital Preparedness) program. Within this total, $240 million is provided for formula-based cooperative agreements to states, territories, and freely associated states, Washington, D.C., and three high-risk political subdivisions. FDA $780.0 million for the tobacco program. With these resources, FDA will continue to invest in product review and evaluation, research, compliance and enforcement, public education campaigns, and policy development. The budget also requests an additional $100 million in user fees and requests authority to include manufacturers and importers of all deemed products among the tobacco product classes for which FDA assesses tobacco user fees. To ensure that resources keep up with new tobacco products, the proposal would also index future collections to inflation. This proposal would ensure FDA has the resources to address all regulated tobacco products, including e-cigarettes, which currently have high rates of youth use, as well as future novel products. $1.7 billion for food safety, nutrition, and cosmetics, an increase of $210.6 million above FY23, to support efforts and commitment to strengthen FDA’s food safety and nutrition capacity. DOI The Administration supports funding the renewal of our Compacts of Free Association relationships with the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. The Administration intends on seeking $6.5 billion in economic assistance over 20 years to be provided through a mandatory appropriation at the Department of State, and language calling for continued implementation of the Compacts at the Department of the Interior. Overall, the United States remains committed to its long-standing partnerships with the governments and people of the freely associated states. website yes

On June 30, 2022, the House Committee on Appropriations held its markup of the FY23 Labor, Health and Human Services, Education and Related Agencies appropriations bill.