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ASTHO's State Health Policy and Federal Government Affairs teams examine trends and developments in public health law. These pieces, collectively called Health Policy Update, are a regular feature on ASTHO's blog.

Insight and Inspiration: Conversations for Public Health Leaders ASTHO is honored to present Insight and Inspiration, the premier webinar series designed to motivate public health leaders as they respond to new and ongoing public health challenges. The nation’s preeminent thought leaders, authors, and strategic thinkers offer attendees strategies to further develop their leadership skills as well as ground themselves and their teams even amid crisis. This series is open to governmental public health professionals at all stages of their careers. Check out upcoming opportunities and previous session recordings below to take your leadership to the next level. website

Past Event Recordings Explore our past event recordings below or take a look at our upcoming events and trainings. article

Speakers 2023 Health Equity Summit Speakers health equity, health equity summit, health equity conference, public health speakers, health equity speakers, public health experts, health equity experts Speakers at this year's Health Equity Summit are some of the biggest names in public health and health equity. Speakers at tthe 2023 Health Equity Summit are some of the biggest names in public health and health equity. Browse through the speakers below. article

Agenda <!-- All events will be virtual and are listed in ET. Please check back often, as the agenda is subject to change. --> The 2023 Health Equity Summit: A Movement for Justice is a national convening of state and island area health officials, federal and local partners, and stakeholders committed to advancing health and racial equity. This event is designed by and for public health professionals, health equity leaders, and their partners. Attendees will have conversations that inspire action to confront health inequities’ root causes and move towards justice. Objectives: Mobilize the public health workforce and stakeholders to prioritize implementing evidence-based practices and policies directed toward advancing the health and well-being of people who have experienced historical discrimination and oppression. Recommend equity practices that are sustainable within our public health system by working alongside community members to envision a nation that supports optimal health for all. Prioritize collaboration and information sharing among state and federal health officials, partners, and stakeholders across states and jurisdictions to advance equity. <!-- Access the Agenda --> website

Past Events Resources Center Welcome to the health equity summit past events resources center. Information about past health equity summits and related series, recordings, and additional resources are available below. website

Upcoming Events, Trainings, and Opportunities website

ASTHO's hub for public health learning, training, and development resources.

Whether you're a public health professional, policymaker, or member of the media, ASTHO’s communications are your trusted source for timely, expert-driven information.

ASTHO’s 2025 public health blog features articles on policy, innovation, and leadership to support state and territorial health agencies.

How New Laws Support Telehealth and Access to Health Care How New Laws Support Telehealth and Access to Health Care Ashley Cram Learn how federal and state policies are improving access to health care by supporting telehealth. Telehealth strengthens the health system by reducing barriers to access to health care and extending services to underserved communities. Federal and state policies — many born out of the COVID-19 pandemic — have increased the use of telehealth by patients and providers. This includes expanded reimbursement to allow more providers to deliver telehealth services in more locations and through more modalities. This Health Policy Update summarizes recent federal and state laws and policies that impact telehealth delivery and access to care. Federal Laws and Policies Rural Health Transformation Program Enacted as part of the One Big Beautiful Bill Act in July 2025, the Rural Health Transformation Program appropriates $10 billion per fiscal year for the Centers for Medicare & Medicaid Services (CMS) to award to eligible states looking to improve rural health care. CMS encouraged state applicants to focus on select strategies, including investment in technology platforms that enhance care delivery. This includes tools and resources that support telehealth overall and remote patient monitoring (RPM), which is a way for providers to monitor and support patients through the use of devices that support data collection and transmission. Applicants that participate in interstate licensure compacts are also incentivized throughout the five-year program period by being awarded additional points for participation, which may lead to states pursuing compact legislation in the coming years. Medicare Telehealth Flexibilities Set to Expire During the COVID-19 pandemic, CMS issued numerous flexibilities that authorized broader telehealth use to expand access to care. Flexibilities included expansion of certain audio-only services, geographic areas and patient locations, and additional provider types eligible to deliver telehealth services. Current policy authorizes these pandemic-related telehealth flexibilities through January 30, 2026. Without permanent extension of these flexibilities, Medicare coverage for telehealth services beyond January 30, 2026, telehealth will again be limited to patients living in rural areas and to certain services, providers, and facilities. Physician Fee Schedule Changes CMS establishes the annual Medicare Physician Fee Schedule (PFS), which sets payment policy for health care services provided by physicians and other professionals to Medicare beneficiaries. The 2026 PFS includes new codes for RPM that allow providers to tailor monitoring frequency and engagement levels to meet patient needs. These codes, and the expansion of RPM, allow providers to effectively monitor health indicators such as weight, blood pressure, blood glucose, and respiratory flow rates, to manage health issues. By regularly monitoring a patient’s health status, a provider can reduce the risk of adverse health outcomes and emergency department visits. Additionally, the PFS streamlined the process for adding eligible telehealth services for reimbursement by removing distinction between permanent and provisional services and focusing review on whether services can be delivered via telehealth. State Legislation Impacting Telehealth Delivery States are also developing policy solutions to enable broader access to telehealth services, including expansion of audio-only and RPM services. Audio-only telehealth services are the use of communications technology, without a visual component, to deliver synchronous health care services. This modality can ensure continuity of and access to care for patients who live in areas with limited broadband and/or those who lack access to a video-enabled device. In 2025, at least four states enacted laws related to audio-only telehealth services. This includes at least three states that extended coverage that would have otherwise expired. In Hawaii, SB 1281 extended the expiration of the state’s coverage of certain audio-only behavioral health services through 2027, while Minnesota (HF 2) took a similar approach to audio-only telehealth services, including certain behavioral health and substance use disorder services, through July 1, 2027. Similarly, Maryland (SB 372/HB 869) removed the sunset date for coverage of audio-only telehealth services. And more broadly, Missouri (SB 79) clarified the state’s telehealth definition to include audio-only technologies. RPM uses digital devices to monitor a patient’s health by collecting and sharing health information with providers. RPM is particularly effective for management of chronic conditions, allowing providers to engage in shared decision making with patients and prevent adverse health outcomes through more regular monitoring. In recent years, several states enacted legislation to expand access to RPM including two bills in Louisiana. Enacted in 2024, HB 896 established the Louisiana RPM program for Medicaid patients with chronic conditions and a history of high-cost services, with the goal of improved care coordination and reduced costs. Then in 2025, SB 70 expanded these criteria to include pregnant and postpartum women and infants following discharge from the NICU. In Maryland, HB 553 specifies that the Medicaid program must cover the equipment and provider oversight of blood pressure monitoring for eligible recipients, including pregnant and postpartum individuals and those with chronic health conditions. Lastly, Virginia enacted SB 843 which directs the state Medicaid agency to develop a plan and cost estimate for expanding Medicaid eligibility for RPM for patients with chronic conditions. State and territorial health agencies can encourage public health programs to incorporate telehealth and propose policy solutions that enable broader utilization of telehealth modalities across the entire jurisdiction. States that are interested in expanding access to telehealth can visit ASTHO’s Telehealth Project Initiation and Scoping Assessment to conduct a review and identify opportunities to expand access to telehealth, particularly related to policy, infrastructure, and funding. UD3OA22890-13-00 article yes

Government Shutdown Effects on Public Health: Lessons from the 2025 and 2018-2019 Closures Catherine Jones Learn about the government shutdown effects on public health, with insights from the 2025 and 2018-2019 closures. When the federal government shuts down, it exposes vulnerabilities in our public health ecosystem. It also brings to light the critical role state and territorial health departments play to protect the health of their jurisdictions. While the political dynamics behind each shutdown may vary, the consequences are unfailingly disruptive. Some federal agencies and programs continue under mandatory or advance appropriations, but the day-to-day machinery that keeps the federal public health system functioning — workforce, oversight, and technical assistance — is impacted. Federal employees from shuttered agencies are either furloughed or required to work without pay if their roles are deemed essential to public safety, as with certain functions of HHS and FDA, among others. The effects of a shutdown can be temporary or long-lasting. In the past, Congress enacted guardrails to reduce the harm of future funding lapses, but the unpredictable nature of each shutdown ensures that disruption, loss, and hardship follow. A comparison of the 2025 and 2018-2019 shutdowns displays this impact — with the 2025 impasse becoming the longest shutdown in U.S. history, surpassing the 35-day record set during the December 2018 to January 2019 closure. Key Differences Between the Shutdowns The 2018-2019 shutdown, which was sparked over a funding fight for the U.S-Mexico border wall, spared HHS because the FY2019 Labor-HHS-Education Appropriations Act had already been enacted before the funding lapse. As a result, core public-health agencies — including CMS, CDC, HRSA, and SAMHSA — continued operating. However, the programs funded through the Agriculture-FDA appropriations bill (e.g., SNAP, WIC, and FDA) were impacted, but the disruptions were somewhat contained: FDA paused some food and drug inspections, while SNAP and WIC administrators worked to stretch timing buffers to sustain benefits. The 2025 shutdown, by contrast, impacted HHS. Disputes over the Continuing Appropriations and Extensions Act, 2026, (H.R. 5371), also known as a continuing resolution (CR) — compounded by an acrimonious stalemate over extending the Affordable Care Act premium tax credits (analyses show premiums could more than double in 2026 without extensions) and reversing Medicaid cuts in the One Big Beautiful Bill — placed health care directly in the shutdown’s epicenter. After 14 failed attempts to move the CR in the Senate, the measure was revised to extend federal funding through Jan. 30, 2026, and to reverse the Reductions in Force (RIFs) enacted during the lapse in appropriations. This CR was combined with three additional minibus appropriations packages, which included the Agriculture-FDA bill that funds SNAP and WIC through FY2026. On Nov. 10, the Senate narrowly mustered the 60 votes needed for passage, with eight Democratic senators joining in support. The bill then cleared the House on Nov. 12 with a 222-209 vote, and President Trump signed it the same day. The result of the 43-day shutdown was a deeper and more systemic breakdown. Furloughs and RIFs swept across agencies. Staffing gaps impacted CDC, SAMHSA, and CMS operations, while lawsuits proliferated over withheld pay, suspended contracts, and SNAP payment distribution. As of now, ACA subsidies remain unresolved, and the full repercussions of the 2025 shutdown continue to emerge. A Closer Look at the Shutdown Impacts Furloughs In 2025, the HHS contingency plan anticipated furloughing roughly 41% of its workforce, with CDC and NIH hit hardest — about 64% and 75% of staff, respectively. During the 2018-2019 shutdown, about 48% of HHS staff were furloughed, with CDC at 61% and NIH at 76%. After the 2018-2019 shutdown, Congress enacted the Government Employee Fair Treatment Act of 2019, ensuring that all furloughed federal employees receive retroactive back pay once operations resume. The current CR provides a provision requiring the payment of federal employees who are furloughed or excepted during the lapse. Government contractors, unlike direct federal employees, are not guaranteed back pay after shutdowns. RIFs During the 2025 shutdown, CDC issued more than a thousand layoff notices, some later rescinded, while SAMHSA reported significant workforce losses. There were no RIFs during the 2018-2019 shutdown. In AFGE v. Donald J. Trump, federal-worker unions challenged the administration’s issuance of mass layoff notices during the 2025 shutdown, arguing that RIFs during a funding lapse violate the Antideficiency Act and are “arbitrary and capricious.” A federal judge issued a preliminary injunction blocking further RIFs for hundreds of employees. This case is currently ongoing. To note, as part of the revised aforementioned CR, RIFs issued during this shutdown were reversed, returning to status quo workforce levels prior to the lapse of appropriations. WIC WIC entered October 2025 with funds from Section 32, providing $300 million as a bridge. Nationally, on average, WIC (a discretionary program) needs about $150 million per week to serve approximately 7 million women, infants, and children. To support access, several states tapped emergency funds and reallocated resources to food banks. In early November, the Trump Administration transferred $450 million from unused customs revenue to fund WIC. During the 2018-2019 shutdown, WIC continued to operate without gaps using prior-year funds. SNAP Roughly 42 million Americans currently rely on SNAP benefits. SNAP is considered mandatory spending, which allows payments to continue temporarily during a shutdown, but when a lapse exceeds 30 days, disruption risk escalates. During the 2025 shutdown, EBT payment delays triggered widespread litigation. In Coalition of States v. U.S. Department of Agriculture, over 25 states sued USDA for suspending benefits despite available contingency funds, citing violations of the Food and Nutrition Act and the Administrative Procedure Act. Federal courts issued temporary restraining orders protecting millions of beneficiaries. The administration appealed to the Supreme Court to halt payments, and the Court granted the request. During the 2018-2019 shutdown, SNAP participants received benefits in December 2018 and January 2019. February benefits were also distributed in late January to avoid disruptions; these were not additional benefits. Tribal Health In 2025, the Indian Health Service remained open due to FY2026 enacted advance appropriations. This funding was in part a reaction to the dire consequences of the 2018-2019 shutdown in which the Tribal and Urban health programs reported having to limit health care services and resources, due to Indian Health Service employees having to work without pay or being furloughed. Unique Implications of the 2025 Shutdown As previously noted, because Congress fully funded HHS in 2018-2019 there was minimal impact on public health programs. However, the length and scope of the 2025 shutdown did impact HHS directly. For example: Mental health: Mental and behavioral health access contracted sharply as SAMHSA’s state-support network lost nearly two-thirds of its staff, due to shutdown RIFs as well as earlier rounds of layoffs and retirements. At-home care and telehealth: During the 2025 government shutdown, hospitals nationwide faced delayed Medicare reimbursements and the temporary suspension of hospital-at-home programs, which had become vital for managing capacity during workforce shortages. Telehealth expansion and remote monitoring efforts were also paused, causing many patients to pay out of pocket. U.S. territories: The pause on SNAP and the Nutrition Assistance Program (NAP) funding in November had disproportionate impacts on the U.S. territories, as higher percentages of their populations depend on SNAP and NAP (20%-40%). In three territories, legislatures passed bills to fund partial or full SNAP and NAP benefits for November. Implications for the Future of Public Health The 2025 shutdown underscored that lapses in government funding disrupt the public health ecosystem. A fully functioning system relies on steady collaboration from federal, state, local, and tribal health departments. The depth of the 2025 crisis has ignited bipartisan discussion about structural fixes to prevent governing by brinkmanship. Proposed congressional legislation includes bills to stabilize federal pay with automatic funding, contain congressional travel and adjournment until appropriations are complete, guarantee pay for federal workers and contractors, prevent disruption to SNAP and WIC programs, and ensure reimbursement to states. Padding Block - Large Related Contnet - Blog - Government Shutdown Effects on Public Health article yes

Learn about the importance of exploring intermediaries that work alongside existing data platforms in addressing ongoing public health challenges.

Partnering with Birthing Hospitals to Protect Babies Against RSV Partnering to Protect Babies Against RSV Susan Kansagra, Michelle Fiscus, Kim Martin Learn how immunization programs partnered with birthing hospitals to expand participation in Vaccines for Children and better protect babies against RSV. In 2023, the Advisory Committee on Immunization Practices (ACIP) recommended the use of monoclonal antibodies (mAbs) to prevent respiratory syncytial virus (RSV) in infants, a major milestone in newborn immunization. Unlike vaccines, which stimulate the body’s immune system to produce its own protection over time, mAbs work right away by giving the body ready-made protection against infection. This is especially important for newborns who do not have the protection of maternal RSV vaccination, which causes them to face a higher risk of severe RSV illness and need protection as early as possible. In response to the 2023 ACIP recommendation, state and territorial immunization programs acted quickly to ensure these new protections reached the babies who needed them most. One of the most effective strategies was partnering with birthing hospitals to expand participation in the Vaccines for Children (VFC) program, a federally funded initiative that provides vaccines to children at no cost to their families who might otherwise be unable to afford them. This program enabled the delivery of RSV mAbs — such as nirsevimab and now clesrovimab — to VFC-eligible newborns without any financial burden on their families. High Stakes, Strong Results The stakes were high, as RSV is the leading cause of infant hospitalizations in the United States. It was previously responsible for an estimated 58,000 to 80,000 hospitalizations and up to 300 deaths in children under age five each year. Data on RSV mAbs showed significant results, reducing RSV-related emergency department visits by 63% and hospitalizations by as much as 80%. Administering RSV mAbs in the first few days after birth, during RSV season, ensures that infants are protected before their first exposure — a critical step in reducing illness and health care burden. Strategies for Success Health departments played a leading role in bringing birthing hospitals into the VFC program. Many hospitals were not previously enrolled, often due to limited awareness, logistical barriers, or concerns about administrative burdens. Immunization programs responded by 1) launching targeted outreach, 2) offering tailored technical assistance, 3) simplifying enrollment processes, and 4) providing guidance on proper storage, eligibility screening, and documentation. The Impact of Stronger Partnerships These efforts have generated measurable results: The number of birthing hospitals enrolled in the VFC program increased from 292 in the 2023 season to 1,012 in 2025, boosting coverage from 10% to 36% of all U.S. birthing hospitals. This clearly demonstrates that these partnerships are effective and make a real difference in protecting infants’ health. State data further highlights this success and shows that collaboration across states, hospitals, and public health partners is crucial for achieving measurable impact: Virginia nearly doubled the number of birthing hospitals enrolled in the VFC program, increasing from six to 11 within one year. The state’s immunization program implemented an innovative Replacement Model to simplify requirements and collaborate closely with hospital teams to overcome barriers. Similarly, California provided resources, developed an enrollment checklist, and communicated the benefits of enrollment to birthing hospitals. Finally, across six states, 33 hospitals, and 400 clinics over two RSV seasons, Intermountain Health coordinated a system-wide approach that developed educational tools, enrolled hospitals in VFC, and addressed supply shortages. It also piloted a Replacement Model where mAb product was purchased by the hospital and doses administered to VFC-eligible babies were replaced with VFC-funded stock. These efforts also strengthened relationships between public health programs and birthing institutions. Trust and communication improved, and hospitals became more engaged in broader immunization goals (e.g., access to other birth-dose vaccines like hepatitis B). This expanded partnership not only protected newborns during RSV season but reinforced the capacity of immunization programs to mobilize quickly, implement new recommendations, and ultimately improve health outcomes. Compared to prior seasons, RSV-associated hospitalization rates were 28%-43% lower in 2024-2025, which was the first season with widespread availability of mAbs and maternal RSV vaccine. Future Opportunities Health departments have used a number of strategies to increase VFC enrollment by hospitals and mAbs coverage as a whole, including: Using birth volume data to prioritize outreach to additional hospitals for enrollment in the VFC program. Ensuring linkage to Immunization Information Systems to determine maternal RSV vaccination status and quickly identify eligible infants. Working with health systems on standing orders and protocols to help providers administer mAbs rapidly to eligible infants. Bringing hospitals and payers together to provide financial models that support universal coverage. While bundled payments for labor and delivery stays have been a barrier for private payer coverage, the high ROI for preventing future RSV-related health care utilization may provide additional opportunities for payers to consider alternative coverage models. Sharing promising practices through a Learning Collaborative webinar series developed by the Association of Immunization Managers, in coordination with CDC. The rapid rollout of RSV mAbs through the VFC program is a model of success. It shows that when public health agencies and health care partners work together, we can deliver lifesaving interventions, even in complex, high-volume settings like birthing hospitals. As new immunization tools emerge in the years ahead, the infrastructure, lessons and relationships built through this effort will continue to support the goal of protecting all children from the very start. article yes

Learn about the work of ASTHO's learning community to prevent ACEs through partnership, data, and messaging.

Read about deference to ACIP vaccine recommendations in state and territorial vaccine policy, following recent changes to the committee.

Learn about health legislative priorities through the end of 2025, related to Medicaid and Medicare, the Affordable Care Act, site-neutral payments, and more.

Learn about the Vermont Department of Health's efforts to prioritize data modernization initiatives through its Data Modernization Advisory Committee.

Downstream Effects of CDC Adopting ACIP Recommendations for COVID-19 and MMRV Vaccines Downstream Effects of CDC Adopting ACIP Recommendations Susan Kansagra, Andy Baker-White, Meredith Allen, Kimberly Martin, Ericka McGowan Learn about the downstream effects of CDC adopting ACIP recommendations for COVID-19 and MMRV vaccines, as states examine how their policies and laws intersect. On Oct. 6, CDC adopted the recommendations that the Advisory Committee on Immunization Practices (ACIP) made in September — specifically, individual-based decision-making for COVID-19 vaccine and separate measles, mumps, and rubella vaccine, and the varicella vaccine in toddlers. The adoption of these recommendations now sets in motion a cascade of other processes that influence access to vaccines. In addition, several states have begun to examine how their state level policy and laws intersect with ACIP recommendations given the delay in adoption and the uncertainty of the process going forward. COVID-19 Vaccine Recommendation CDC adopted the recommendation for shared clinical decision-making for the COVID-19 vaccine for those six months and older. The adoption of this ACIP recommendation has a ripple effect on coverage and access: It enables states to begin ordering COVID-19 vaccine under the Vaccines for Children program. It allows state Medicaid programs that link coverage to ACIP recommendations to cover the cost of the vaccine. It enables pharmacists to provide the COVID-19 vaccine under the federal PREP act declaration — as opposed to or in addition to state law, which varies by state. Many state health departments issued standing orders and executive orders to enable pharmacists to administer in the meantime. It requires health insurers to cover the cost of the vaccine, as the Affordable Care Act ties insurance coverage requirements to ACIP recommendations. Though, prior to the meeting, health insurers indicated they would do so anyway this year. MMRV Recommendation The CDC also adopted the recommendation for separate varicella (V) and measles, mumps, rubella (MMR) vaccines rather than the MMRV vaccine (combined measles, mumps, rubella, varicella) for children under four years. As background, current guidance allows either MMRV or MMR + V to be administered to children 12-47 months. However, because of a small but higher risk of febrile seizures for dose one, they are recommended to be administered separately (MMR + V), unless families express a preference for MMRV. Only about 15% of children currently receive MMRV for the first dose, and the general consensus is that this decision will result in some changes but not significantly impact access to vaccines: The adoption of this recommendation means that VFC will no longer cover MMRV for children under four, but it continues to cover separate MMR and V vaccines. Since many state Medicaid plans tie vaccine coverage to ACIP recommendations, coverage of MMRV by state Medicaid will vary depending on this language, though separate MMR and V vaccines would continue to be covered. Private insurers can choose to cover MMRV and will likely continue to in the short term but are not required to. They are required to cover separate MMR and V vaccines. How States Are Preparing for the Future As it stands now, ACIP recommendations, particularly for respiratory viral season, are not that different than prior years – with influenza, RSV, and the COVID-19 vaccine recommended (the latter with shared clinical decision making). However, the delayed and unpredictable process has led many states to examine how closely they are tied to ACIP in law, regulation, or practice. Over 600 statutes across U.S. states and territories reference ACIP — whether for pharmacist vaccine authority, school entry, health care worker or other requirements. States have considered a variety of actions to ensure they maintain access to vaccinations for their jurisdictions including: Passing or introducing legislation that allows the state health department to use ACIP guidance from previous years or recommendations from other bodies (e.g., medical provider organizations) in state law, as it relates to school entry, pharmacist authority, and others. Issuing standing orders and executive orders to enable pharmacists to administer vaccines in the absence of ACIP recommendations. Examining Medicaid state plan language to determine how to interpret requirements when ACIP is referenced and considering updates to that language (e.g., North Carolina). Issuing state requirements for insurers on vaccine coverage (e.g., Oregon, California, Hawaii). Examining use of state funds to purchase vaccines. Supplemental Resources Tracking State Actions on Vaccine Policy and Access by KFF Vaccine Resources by the Common Health Coalition States Take Action to “Immunize” Vaccine Access by Mandy Cohen, Julian Polaris, and Liz Dervan Vaccine Integrity Project — Fall Immunization Information by the Center for Infectious Disease Research and Policy Special Thanks - Blog - Downstream Effects of CDC Adopting ACIP Recommendations Padding Block - Large Related Content - Blog - Downstream Effects of CDC Adopting ACIP Recommendations article yes

Improving Grants Management in the U.S. Virgin Islands: Q&A with Tatia Monell-Hewitt Improving Grants Management in the U.S. Virgin Islands Anya Groner Learn about how the U.S. Virgin Islands Department of Health streamlined grants management, as explained by its Chief Finance Officer Tatia Monell-Hewitt. Public health agencies have an important role in piecing together federal and local funding to support a comprehensive, cohesive array of programs and services for their communities. Optimal management of these funds ensures communities maintain access to these crucial initiatives. In the U.S. Virgin Islands (USVI), decentralized and inefficient processing coupled with high staff turnover caused delays in grant procurement that, at times, caused funds to go unspent. In the aftermath of Hurricanes Irma and Maria, Category 5 storms that devastated the islands in 2017, USVI Governor Albert Bryan Jr. sought assistance to manage and spend the federal funds available for the massive recovery process. In collaboration with ASTHO and the Department of the Interior, the territorial government began a three-year business process improvement initiative to streamline grants management. Nine agencies, including the governor’s office, came together to establish official grant and financial management systems, ensuring that federal funding could be accessed faster once approved. By maintaining a long-term vision, consistency of effort, and steadfast support from leadership and staff, USVI has been highly successful in streamlining the grants management process. Since the new system launched in 2023, initial sample data showed a range of 25-64% reductions across agencies in the time to set up federal grants, which enables the health agency to begin work sooner – highlighting what is possible with continual improvement. Furthermore, communication channels established through the business process improvement initiative have enabled interagency collaboration. This initiative built the foundations for improving grants management in USVI, and the Department of the Interior awarded additional funds to continue interagency communication, collaboration, and improvement to sustain the gains. In this interview, the USVI Department of Health’s Chief Finance Officer Tatia Monell-Hewitt discusses how changes to USVI’s grants management process and increased interagency collaboration impact public health. What prompted the update to USVI's grants management process? Was there a particular event or series of events? The update was prompted by the USVI’s Department of Health’s successful Business Process Improvement initiative in 2019-2021, along with a broader recognition of inefficiencies and inconsistencies in how federal grants were being managed across government agencies. An analysis of several grants conducted by ASTHO throughout government agencies revealed that, in some cases, the setup process from the receipt of a Notice of Award (NOA) to having the budget available online, could take up to 255 days or the better part of a year. These delays significantly hindered program execution and the timely drawdown of funds. The findings highlighted the urgent need for a streamlined and standardized grants management process. What were some of the biggest changes that you made to the grant process, and why are they so valuable? The most impactful changes include adoption of a standardized federal grant planning and setup process across the nine agencies defined as receiving the NOA to having an approved budget online. We moved from paper to an electronic process to improve transparency, speed, and accountability, and agreed to/established defined time frames for each step. Lastly, the creation of the Federal grant community of practice allowed for ongoing training, problem identification and resolution, and building process consistency across and within agencies. These improvements reduce delays, increase first-time accuracy, and enhance compliance, ultimately allowing agencies to deliver services to the community more quickly and effectively. The grants management process is often invisible to the public. Have USVI residents noticed the quicker turnaround? Yes! A more efficient grants management process has strengthened community trust in the U.S. Virgin Islands public health system. Improved customer satisfaction, faster service delivery, increased outreach participation, and more responsive agency communication have made a real difference. The community sees that the department is being a responsible steward of federal funds, which builds confidence in our ability to serve and protect. How did the improvements to the grants management process impact health agencies in particular? The Department of Health benefits from clearer roles and responsibilities in grant execution. That translates to quicker access to funding. A key example is the Epidemiology and Laboratory Capacity grant. The budget was approved and online within 30 days of the NOA. This enabled a swift response to the dengue outbreak that began in December 2024 on St. Thomas and St. John. Using real-time surveillance from the dengue dashboard, the epidemiology team targeted mosquito control efforts in hotspot communities. Supported by case mapping and proactive prevention strategies, the combined efforts — surveillance, lab testing, provider education and resource deployment — helped contain the outbreak and safeguard public health. How have partnerships strengthened health access and preparedness? Has that culture of collaboration and communication across government agencies continued in other projects? Absolutely. Agencies such as the Department of Health, Department of Human Services, Department of Finance, Department of Justice, and the Office of Management and Budget now coordinate processes, resolve issues collaboratively, and share training initiatives. Strong partnerships ensure that the Department of Health can align financial resources quickly to support health programs and improve access to care and emergency preparedness. Shared accountability has enabled timely and effective service delivery for the community. Have other improvements to grants management and agency coordination resulted from the business process improvement initiative? Definitely. The process has led to a uniform process across departments. Shared expectations include ongoing performance measures, a focus on timelines, a standard operating procedure checklist, and shared tools such as Adobe Acrobat Sign. Regular communication and updates shared in the community of practice meetings have made the grants management process more efficient, trainable, and adaptable to new challenges. What does the Department of Health’s grants management data collection show, and how does it use this data for continued improvement? The Department of Health uses a scorecard to track critical metrics such as milestone completion times, low spending rates, slow drawdowns, and the number of corrections needed. This data driven approach has helped us identify bottlenecks, guide training, and informed standard operating procedures. It has also highlighted programs that consistently manage their grants well. How do you see this work continuing over the long term? This work is built for long term sustainability. We’ve set up continuous education using the-train-the-trainer model, ongoing performance reviews and interagency meetings, and accountability by the community of practice and the cross-agency leadership team. We have a shared vision of efficiency and citizen-focused service delivery. What about this work are you most proud of? I am most proud of how multiple agencies came together to build a unified, efficient system. We've significantly shortened the time between the NOA and getting the budget online. We’ve established timeframes for each step of the grant procurement process — two days to receive the NOA, 10 days to adjust the spending plan, three days to obtain financial codes, seven days to submit the budget, and three days to get the budget online. That’s 25 days total for the entire grant turnaround. That alone has enabled us to serve our community much faster, which is what matters most. CDC-HHS - $1,000,000 article yes