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Policy Options to Improve Data Sharing Between State and Local Health Departments Organizational policies on data sharing between state and local public health agencies. This report explores organizational policies related to data sharing between state and local public health departments. ASTHO, in collaboration with the National Association of County and City Health Officials and the Network for Public Health Law developed this report, which aims to serve as a guide for state and local public health leaders as they consider organizational policy options to improve state and local data-sharing efforts. Get the Report (PDF) website yes

Moving from Design to Implementation: Lessons on Expanding Contraception Access in New Jersey Liz Gipson, Jahira Sterling, Lauren Moran, Brittany Lee, Sophia Durant Lessons on expanding contraception access in New Jersey. Public sector health leaders play a critical role in influencing reproductive health policy design and program implementation. As the key authorities on state programs, public sector leaders foster necessary collaboration between community partners and other state agencies. In New Jersey, state officials are implementing two contraception access bills, S 413 and S 275, enacted in 2022 and 2023 respectively. This report details lessons learned from New Jersey’s cross-sector and interagency collaboration, which can guide public sector leaders in other states working to expand access to reproductive health services. Get the Report (PDF) website yes

The OD2A Health Equity Needs Assessment is designed to assess the support, technical assistance, and training that state, local, and territorial health agencies need to move health equity forward within their OD2A programs.

Learn about public health strategies for preventing chronic disease that intersect with themes in MAHA report including nutrition and physical activity.

Colleen Arceneaux and Jantz Malbrue from the Louisiana Department of Health to discuss why forgoing community health worker certification was the right course of action for their state.

ASTHO conducted focus groups to examine overdose-related issues and identify potential engagement opportunities for public health and public safety around overdose prevention. This brief outlines key takeaways and is designed to serve as a guide for public health building and strengthening relationships with public safety.

Pharmacies have long been instrumental partners in providing lifesaving vaccines nationwide. As state and territorial health officials evaluate their COVID-19 response, planners must include input from the pharmacy community when identifying areas for improvement, as well as best vaccination practices in advance of future public health emergencies.

Each year, ASTHO tracks and analyzes key legislation that impacts public health, and highlights the emerging trends for our members. While the bulk of the tracked legislation arises in state legislatures, ASTHO also follows legislation from the territories and Freely Associated States, jurisdictions collectively referred to as the insular areas. The insular areas often face different challenges than the states, while also sharing many common concerns. This post contains a brief look at some of the public health related legislation introduced in the insular areas during their current legislative sessions.

The Special Supplemental Nutrition Program for Women, Infants, and Children is a targeted public health nutrition program designed to support nutrition and health behaviors that reach low-income families. The program is funded through discretionary funds to the United States Department of Agriculture and administered by each state’s health or public health department. The department then contracts with county health departments, local health centers, hospitals, federally qualified health centers, and private nonprofits to deliver community-based clinic services.

May is Mental Health Awareness Month and the importance of continued mental health promotion and suicide prevention efforts during the COVID-19 pandemic. As we address the physical effects of COVID-19 through social distancing, mask wearing, and vaccination, we still need to prioritize mental health and well-being during and after the pandemic. A recent Morbidity and Mortality Weekly Report found increases in adults reporting symptoms of anxiety or depression (36.4% to 41.5%) and unmet mental health care need (9.2% to 11.7%) between Aug. 2020 to Feb. 2021.

Guest post by Jennifer Orme-Zavaleta, PhD. Last month, I had the pleasure of joining ASTHO’s Vice President for Health Security, Meredith Allen, EPA Administrator Michael Regan, and the president of the Environmental Council of States (ECOS) Patrick McDonnell at the ECOS Spring Meeting. The event marked the start of a strong state-federal relationship under the new EPA leadership, highlighted by the extension of a formal Memorandum of Agreement (MOA) reaffirming a partnership between our three organizations to advance cooperative initiatives in pursuit of environmental health.

Economic security and well-being, job stability, access to safe and affordable housing, access to healthy and nutritious foods, and access to resources to manage mental and physical health—all of these things impact individual, family, and community health. The COVID-19 pandemic has fundamentally impacted each of these social determinants of health for many Americans. Furthermore, some communities and industries have faced harder economic impacts than others, including households with low incomes, non-white households, and households with children. Human services and public health leaders can collaborate to make sure we are rebuilding systems and programs in a way that creates healthier, more resilient families and communities.

The adage “what gets measured, gets done” has had staying power for a reason. When we can accurately describe conditions, quantify impact, and elucidate connections, we have a better chance at taking collective (and effective) action to tackle even the most challenging problems facing our communities. The National Survey of Children’s Health is a powerful tool to provide this critical information to researchers, policymakers, and state-level decision makers.

In anticipation of the upcoming presidential election in November, the Republican and Democratic National Committees released their platforms. These platforms provide an overview of values, policies, positions, and principles on various domestic and foreign issues deemed most important to the two political parties. For the upcoming 2020 elections, delegates of the Republican National Committee approved a resolution that renewed support for the platform adopted in 2016 and the Democratic National Committee approved a 2020 platform. Although both platforms touch on a diverse list of issues, there are several that are of interest to health and public health.

The opioid crisis continues to claim the lives of thousands across the United States and has cost the economy billions in health care, mortality, and criminal justice costs. In 2018, it’s estimated that 67,367 people died of overdose, with opioids (prescription opioids, heroin, and other synthetic opioids other than methadone) made up almost 70% of overdose deaths. Provisional data for the twelve-month period ending December 2019 shows that there were 71,130 overdose deaths, with 50,178 overdose deaths attributed to opioids. The COVID-19 pandemic has also exacerbated the drug overdose crisis. Data shows that in the time of continued lockdowns and social distancing that overdose rates have increased, indicating a sustained need to support people with substance use disorder.

State and local jurisdictions are developing Ending the HOV Epidemic plans. The EHE initiative has largely focused on four key strategies: Diagnose, Treat, Prevent, and Respond to potential outbreaks. The EHE initiative set a goal to increase the estimated percentage of individuals with indications for PrEP who have been prescribed PrEP to 50 percent by 2025, as the national average as of 2018 is 18.2 percent. Several states have proposed and/or passed legislation to ensure insurance coverage of PrEP and/or to allow pharmacists to prescribe and dispense it. In addition to efforts addressing cost-related challenges, states can also employ innovative approaches—such as telehealth—to expand access to PrEP services to those in need.

On Dec. 3, the International Day of People with Disabilities commemorates disability rights and brings awareness to essential issues for those with disabilities by promoting the “well-being of persons with disabilities in all spheres of society.” While the ADA laid a critical foundation for disability rights, the work to ensure equitable access to services and needs continues, including access to state and local emergency preparedness and response activities like crisis communication, access to resources, allocation of vaccine and other medical countermeasures, and transportation.

In February 2023, ASTHO staff traveled to Koror, Palau for a four-day health equity summit and held workshops to identify, select, and prioritize measures for Palau’s health equity work.

ASTHO and NAMD Letter Urging Congress to Fully Fund Medicaid and CHIP in U.S. Territories Dear Chair Wyden, Chair Rodgers, Ranking Member Crapo, and Ranking Member Pallone: Strong, sustainably funded Medicaid and Children's Health Insurance Programs (CHIP) are crucial to addressing health care challenges in the U.S. territories. On behalf of the Association of State and Territorial Health Officials (ASTHO) and the National Association of Medicaid Directors (NAMD), we urge Congress to ensure the fiscal stability of the territories’ Medicaid programs by lifting the annual Section 1108(g) allotment cap for all territories and authorizing a permanent 83% Federal Medical Assistance Percentage (FMAP) for Puerto Rico. Robust Medicaid and CHIP are critical components of strong and resilient territorial health systems. The five U.S. territories—American Samoa, Guam, the Commonwealth of the Northern Mariana Islands (CNMI), Puerto Rico, and the U.S. Virgin Islands (USVI)—vary dramatically in population, health care system capacity, and Medicaid program structure. Despite these differences, they share common challenges, including significantly higher rates of poverty (ranging from 16.8 percent in Guam to 54.6 percent in American Samoa in 2019, compared to 10.5 percent in the United States), higher rates of chronic health conditions, and a lack of health care infrastructure. Medicaid and CHIP programs are crucial to addressing these challenges. Chronic underfunding has impaired territories’ capacity to serve their residents, who are U.S. citizens or U.S. nationals. Historically, the territories have faced two statutory funding challenges: 1) A low, fixed FMAP rate that is not tied to per capita income (as is the case in the states), and 2) Annual funding caps. Prior to FY 2023, Congress supplemented low annual funding amounts with short-term additional investments. The short-term nature of this funding limited territories’ ability to plan, undertake large investments, and efficiently deliver services. In the Consolidated Appropriations Act of 2023, Congress permanently increased the FMAP for American Samoa, Guam, USVI, and CNMI to 83% and authorized a 76% FMAP for Puerto Rico through 2027. NAMD and ASTHO applaud and fully support this structural means of addressing longstanding needs. Congress should continue to build on this foundation by extending the permanent 83% FMAP to Puerto Rico to ensure all U.S. territories have access to sustainable Medicaid and CHIP funding. Over and above this FMAP adjustment, Congress must also address the constraints caused by the allotment cap on the territories’ Medicaid and CHIP funding, established by Section 1108(g) of the Social Security Act. When a territory reaches this cap, they are responsible for funding their Medicaid agency solely with local dollars. Due to challenges generating sufficient local funds, many territories have been forced to cut services after reaching these allotment caps, drastically limiting their ability to offer services and destabilizing local health care providers. For example, CNMI expects to hit its FY 2024 cap by July, leaving the CNMI government with more than two months of unmatched Medicaid costs. Congress should eliminate the annual Section 1108(g) allotment cap to ensure sustained access to high-quality public health and health care services in the U.S. territories. Sustainable, equitable funding will allow territorial programs to make long-term, cost-effective investments that support high-quality and innovative Medicaid programs. The Consolidated Appropriations Act of 2023 directed American Samoa, Guam, CNMI, and USVI to develop four-year strategic plans focused on workforce, program integrity, systems development, and financing. The four territories developed comprehensive plans with ambitious goals, including developing electronic eligibility and enrollment, MMIS, and T-MSIS systems, launching initiatives to expand local provider workforces and territory administrative capacity, and strengthening program integrity processes. These plans are evidence of the momentum and energy that territory leaders bring to their reform agendas. Technical assistance from CMS and other agencies will remain a critical resource for capacity-building efforts in the territories. In addition to lifting the statutory allotment cap and providing Puerto Rico with a permanent 83% FMAP, Congress should also consider providing the territories with targeted, project-specific enhancements to their administrative match rates to facilitate necessary technical assistance and change management. These structural improvements will strengthen the impact of Medicaid dollars allotted to the territories. Thank you for your previous support of the Medicaid programs in the U.S. territories and your ongoing attention to this important issue. If you have any questions or require additional information, please reach out to Jeffrey Ekoma (senior director of government affairs at ASTHO, jekoma@astho.org) and Jack Rollins (director of federal policy at NAMD, Jack.Rollins@MedicaidDirectors.org). Sincerely, Joseph Kanter, MD, MPH Chief Executive Officer, ASTHO Kate McEvoy, Esq. Executive Director, NAMD website yes

Data-Sharing Strategies to Support Access to Care Interventions Anna Bartels, Chikamso Chukwu Learn how primary care offices improve community access to health care in this Health Policy Update. Every state public health agency houses a Primary Care Office (PCO), which monitors the effectiveness of that jurisdiction’s health system. HRSA funds PCOs to identify communities with health professional shortages, and PCOs may also administer workforce programs to place providers in those communities. To identify which communities are experiencing shortages, PCOs collect state-level data on where health care providers work, what services they offer, and how many hours they spend on patient care. PCOs also track data on community needs, such as household income levels and community transportation options, to create a holistic picture of whether health care is truly accessible. PCOs across the country have explored different policy pathways to access reliable, accurate data, including laws that support PCO access to certain data sets, cross-sectoral relationships, and data-sharing agreements. According to ASTHO’s national PCO workforce assessment, over 85% of PCOs are part of a formal data-sharing arrangement, with licensing boards and Medicaid agencies serving as two of the most common data sources. This health policy update describes several types of actions jurisdictions have taken to support PCO data access. New Hampshire Law Allows the PCO to Survey Providers During License Renewals The New Hampshire PCO’s Health Professions Data Center administers a survey tied to health care providers’ medical license renewals that gathers self-reported provider and practice data, such as where providers work, how many hours per week are spent delivering direct patient care, and anticipated changes in capacity over the next five years. New Hampshire law outlines the scope of the survey and authorizes the PCO to collect, store, analyze, and report on health care workforce supply and capacity through surveying during license renewal. Although survey responses are the primary source of data on the health care workforce, data from the state’s all payer claims database housed within the Medicaid division provides supplemental information. Given the type of data involved, legal agreements are required between the PCO, licensing agencies, and relevant parties to maintain privacy for providers. These data are critical for the PCO to evaluate current and future capacity — especially in regions with limited providers — and proactively focus recruitment efforts on those communities. Colorado Braids Data Collection Strategies Across Multiple Sources While the Colorado PCO has relied on a similar law that authorizes collecting licensure data for more than 10 years, its data collection efforts have since expanded. The state now collects and integrates data across 16 different sources, each requiring a different procurement strategy. While some data sources are simple to access because they are public use files (e.g., Medicare provider data), other sources — namely state agencies — require the PCO to submit an application or enter into a memorandum of understanding or contract for access. Pursuing multiple data sources in this way takes significant effort and staff time, necessitating the health department to supplement HRSA’s PCO cooperative agreement funding with other sources, including state appropriations and private funding. A commitment to collaboration and investment and a willingness to build new relationships and processes from scratch support the Colorado PCO’s wide-ranging data collection strategy. Iowa Builds on Existing Relationships to Access Provider Data Iowa’s PCO has a long-standing relationship with the University of Iowa and a joint interest in health care workforce data. Currently, the PCO purchases provider phone survey information from the University of Iowa’s existing program and receives data on a biannual basis. The university’s data collection is part of its own research efforts and not collected on behalf of the PCO, so while the data are broader than what the PCO needs, it is still a valuable source of provider information. Because of this existing arrangement, the PCO could pursue a more expansive agreement (that would likely require additional funding) and expand the scope of the data, such as by adding data collection on provider residence or sliding fee scales. Other PCOs may consider approaching partners that have pieces of the data they need so there is an established relationship in place that may be expanded as new resources become available. PCOs Secure Access to Medicaid Claims Data State Medicaid agencies are another frequent data partner for PCOs, with at least 16 receiving provider data from their state Medicaid agency in various formats. In some states the Medicaid agency shares a point-in-time file with the PCO, who may manually recode the data before submission to HRSA. In other states, the PCO has direct access to the Medicaid claims processing system to independently extract the necessary data points. The nature of the partnership between the PCO and Medicaid agency may vary based on the state’s organizational structure (e.g., whether the PCO and Medicaid agency sit within the same department). However, a PCO seeking access to Medicaid claims data should be prepared to justify the need for the data, articulate how it can support the Medicaid agency, and develop the necessary relationships to support a workable solution for both parties. Conclusion Each PCO and state health agency has its own unique structure, and there is no “right” way to collect health care provider practice or access data. However, exploring how different jurisdictions approach these processes can help PCOs think strategically about new initiatives and relationships. ASTHO will continue tracking PCO success stories and remains available to facilitate connections among health agency staff. 2 UD3OA22890-13-00 article yes