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Policy Trends Shaping Public Health Funding and Administration in 2026 Policy Trends Shaping Public Health Funding in 2026 Learn about policy trends shaping public health funding and administration in 2026, including increased funding for behavioral health and other areas. Decades of underinvestment in the nation’s public health system have impacted agencies’ ability to respond to health challenges. The COVID-19 pandemic revealed the fragility of a chronically under-resourced sector tasked with responding to a global emergency. While public health has received influxes of funding through the CARES Act and American Rescue Plan Act over the last five years, both were temporary injections of funding in response to COVID-19. There have been efforts to provide longer term funding for public health improvements through the Public Health Infrastructure Grant and the Prevention and Public Health Fund, but this funding faces an uncertain future: There have been multiple reductions in federal funding to the Prevention and Public Health Fund since its creation in 2010. Moreover, state public health agencies are preparing for the possibility of federal funding being reduced or cancelled. This, coupled with balanced budget requirements, is driving states to explore ways to improve their public health investments while bolstering infrastructure — focusing on health departments’ core services, and ensuring access to quality public health programs at the state and local levels. Increased Funding for Public Health In 2025, 47 states enacted or will enact budget bills. While overall nationwide funding for public health in FY26 was roughly equivalent to FY25, at least half of the state health departments had some form of increased funding (e.g., Medicaid, provider reimbursement rates, and specific public health initiatives and programs). For example: Behavioral Health: Colorado SB 25-206 included a $1.6 million increase in funding to provide behavioral health services in primary care settings. Certification: Illinois SB 2510 includes a $6 million increase to support licensing, inspecting, and certifying health care facilities for compliance with state and federal regulations. Maternal and Child Health: Georgia HB 68 provided a nearly $3 million increase in funding to expand a pilot program that provides home visits in at-risk and underserved communities during pregnancy and early childhood. Rural Health: Arizona’s budget bills include $4 million to expand access to health care through the development of rural medical residency programs. School-Based Health Centers: Delaware HB 225 appropriates funding to develop school-based health centers in elementary schools with more than 90% of students classified as low-income, multilingual learners, or underrepresented minorities. Leg Prospectus-2026 - Funding - Rural Health Improved Public Health Administration Several states passed legislation restructuring their public health systems. Nevada enacted SB 494, dividing the previous Department of Health and Human Services into two separate agencies. The bill gives the new health agency, called the Nevada Health Authority, the authority to oversee health programs (e.g., Medicaid and the Children's Health Insurance Program), manage health care compliance and consumer health services, and develop policy that improves health care access and cost efficiency. Hawaii’s HB 1120 formally gives the Department of Health the authority to prevent, address, and abate any issues that pose a threat to public health and/or environmental health, such as toxic materials, vector-borne diseases, and climate change. More than half of U.S. state health agencies are decentralized or largely decentralized, meaning many public health services are provided by city, county, or regional health departments that are separate from the state health agency. In 2025, at least two states enacted legislation enhancing local health departments’ abilities to provide core public health services: Utah SB 172 requires the Department of Environmental Quality to enter into cooperative agreements with local health departments to prevent and respond to potential health and safety threats from the environment. It also establishes a governance committee of state and local health department personnel to evaluate proposed policy changes affecting local health departments and ensure allocated resources meet the minimum performance standard. Washington HB 1946 modifies the membership requirements for local health boards, allowing federally recognized tribes with reservation or trust lands in the board’s jurisdiction to have members on the board. It also allows urban Indian organizations recognized by the Indian Health Service that provide services within that jurisdiction to have members. Looking Ahead ASTHO anticipates states and territories will continue considering and adopting legislation to provide state funding for public health and improve public health infrastructure, including those that: Create contingency plans or rainy-day funds in the event of reduced federal funding. Establish partnerships with neighboring states to share health data. Promote sharing services and resources within local health departments. Leverage regionalization as a tool to consolidate and share scarce public health resources. Adapt the funding and management of public health grants to ensure efficiency. Improve public health data systems to promote greater efficiency. OE22-2203 PHIG article yes

State and federal actions to expand the doula workforce and improve maternal health.

The COVID-19 pandemic has impacted both the physical and mental health well-being of youth. Disruptions in both their home and school life have put youth at risk for poor mental health outcomes that include increased anxiety, depression, and risk of suicide. This Mental Health Month we examine state and territorial legislation that addresses youth mental health.

Adopting a public health approach to substance use by implementing harm reduction policies across all levels of government can help communities address the overdose crisis. This post analyzes e

In an effort to help meet demand, some states and territories have joined interjurisdictional licensing compacts that allow a mental health care provider licensed in one state to provide care in another state—without needing to gain licensure in multiple states. These agreements also offer guidance on patient privacy for services rendered remotely or from out-of-state.

The COVID-19 pandemic has negatively impacted youth mental health, particularly as a result of school closures, social isolation, family economic hardship, fear of family loss or illness, and reduced access to healthcare. However, states have many strategies to choose from to improve youth mental health and reduce suicide.

Continuing ASTHO’s Legislative Prospectus series—which highlights the top 10 public health policy issues for 2022—we are focusing this week on mental and behavioral health as well as supporting the public health workforce.

The 2020 holiday season is coinciding with a nationwide surge of COVID-19 cases. With great concern that holiday travel to see loved ones may exacerbate community spread of the virus, many states are increasing public health measures before the winter holiday season. As of November 16, 2020, 13 states and D.C. had a quarantine requirement for out-of-state travelers. The U.S. territories also have instituted travel restrictions to limit the spread of COVID-19.

State Legislatures Moving to Increase Rural Health Care Access How States Are Incentivizing Health Care Providers to Practice in Rural Areas Lana McKinney Hospital closures and fewer care options in rural areas cause worse health outcomes for Americans in those areas. Read about state policies aimed at bringing providers to back to rural America. People living in rural areas face greater health risks than those living in urban areas. Rural populations not only experience increased poverty and higher rates of chronic disease; they are also older and have less access to both health care providers and health insurance. States are exploring several strategies to improve health care access for rural residents, including recognizing a new hospital type, exploring alternative methods or sources of health services, and offering financial support for health care facilities and the rural health workforce. Access to Care Among many factors contributing rural areas accessing health care, hospital closures are a major one. Almost 200 rural hospitals have closed since 2005. When rural hospitals close, people living in those communities must travel farther for care. Rural areas may also experience shortages of and less access to health care professionals, including specialty care, as compared to urban areas. To reduce the number of hospital closures and provide support for existing hospitals in rural areas, the Consolidated Appropriations Act of 2021 created a new Medicare provider type known as the Rural Emergency Hospital (REH). These facilities offer a more limited scope of services than acute care or critical access hospitals and have their own conditions of participation and Medicare reimbursement structure. There have been 36 REH conversions in 16 states since 2023. Jurisdictions continue to explore legislation to formally recognize REHs under state law, State recognition of REHs is crucial for establishing licensure, defining service scope, and enabling participation in state health care programs like Medicaid, ensuring these facilities can legally operate and provide necessary care. with Florida (SB 644) enacting legislation in 2024, and Hawaii (HB 1179) considering legislation so far in 2025. A number of other jurisdictions have recently received approval to amend their Medicaid State Plans and define the payment methodology for REHs serving Medicaid recipients, including Iowa, Kentucky, Nebraska, Nevada, New Mexico. States are also exploring other policies to financially support rural hospitals during the 2025 legislative session. Alabama (HB 86) is considering a rural hospital investment program that would create tax credits to incentivize donations to those hospitals that could support service delivery. And bills to establish grant programs to support rural hospitals are before the legislatures in both Oklahoma (HB 2754) and Indiana (HB 1274). States are also exploring the role of technology, and community needs and resources, to support rural access to care. In 2024, Colorado enacted at least two bills with a rural population focus, including SB 24-168 to invest in remote patient monitoring to support rural health facilities and requires reimbursement. SB 24-055 creates an agricultural and rural community behavioral health program to understand the relevant issues and improve access to care. So far in 2025, at least two states are exploring ways to better serve people in rural communities. Hawaii (SB 1004) is considering legislation that would establish a pilot program to utilize community health workers in rural areas, while North Dakota (HB 1567) is proposing a legislative management study focused on improving access to oral health care, and would require review of telehealth options for reaching rural areas and workforce incentives for dental providers. Rural Health Care Workforce Jurisdictions are also using financial supports—including scholarships, tax incentives, and loan cancelation programs—to increase the number of health care providers in rural areas. At least three states modified financial support programs for practitioners working in rural and underserved areas in 2024. Mississippi’s S 2729 expanded the scope and responsibilities of its rural physician and dentist scholarship programs and their respective governing commissions. And Georgia (HB 872) amended its cancelable loan program to include dental students. California (SB 909) amended the requirements for its physician corps program, which provides financial assistance to those who practice in underserved areas, removes the limit on the amount of loan repayment available, and reduces the duration of service obligation from three to two years. Jurisdictions have also pursued tax policy changes aimed at supporting rural health care providers, including state tax credits for individual practitioners working in rural areas. In 2024, Georgia (HB 82) amended its rural physician tax credit to include dentists living and working in rural areas. In 2025, at least two states are considering expansion of tax credits for providers serving rural communities. In New Mexico, HB 52 would expand the state’s rural health care practitioner tax credit to include additional provider types, including speech language pathologists and occupational therapists. And Oregon is considering several bills to expand existing rural provider income tax credits, including HB 2549 to add pharmacists and HB 2204 to add podiatrists. Finally, legislatures are continuing to consider other policy initiatives to bolster the rural health care workforce in 2025. Acknowledging a shortage of nurses in rural communities and barriers for rural nursing students, Washington SB 5335 would establish a rural nursing education program in the state health department with a goal of improving nursing care in rural areas of the state. And in Nebraska, LB 119 would formally enact the state’s rural health opportunity program, which provides tuition waivers for students from rural areas pursuing health care careers, into law. ASTHO will continue to monitor this issue and provide any necessary updates. article yes

In 2020 and early 2021, state policymakers took action to raise awareness of the impacts of racism on health outcomes, to reverse the damage of racist polices, and to implement policy changes to ensure that future policies are enacted with a racial equity lens. In the past two years, many states introduced and adopted resolutions declaring racism a public health crisis. In the early weeks of 2022, there is notably less legislation that has been introduced as compared to the same time last year.