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This toolkit is designed to support public health leaders in leveraging the policy development process to achieve health equity in their jurisdiction.

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

Federal, State, and Stakeholder Perspectives on the Rural Health Transformation Fund Perspectives on the Rural Health Transformation Fund Catherine Jones Explore federal, state, and stakeholder perspectives on the Rural Health Transformation Fund, shared at a discussion hosted by ASTHO and Cornerstore Government Affairs teams. In early July, ahead of final votes on the One Big Beautiful Bill Act (full text H.R.1), Senate Majority Leader John Thune (R-SD), joined by Senators Susan Collins (R-ME) and Lisa Murkowski (R-AK), secured a $50 billion funding line for a new Rural Health Transformation Program (RHTP). This five-year mandatory fund is designed with two primary goals: To stabilize vulnerable rural hospitals, health centers, clinics, and their workforces. To improve access, affordability, modernization, and health outcomes for rural residents, who on average experience higher rates of chronic disease, shorter lifespans, and lower earning power compared to urban populations. To help states better understand how to apply and utilize RHTP dollars, ASTHO partnered with Cornerstone Government Affairs to host a discussion on Sept. 4 featuring two expert panels. Participants included representatives from Centers for Medicare & Medicaid Services (CMS) and HRSA, congressional staff, state health departments, and experts from the National Rural Health Association and National Association of Medicaid Directors. Lively discussions provided valuable insights into the application process, how states might deploy funds to build and sustain rural health programs, and the realities of delivering care on the ground. Panel One: Federal Perspectives Application Tips The first order of business was to provide potential applicants with essential information they need to apply. CMS is working quickly to release the Notice of Funding Opportunity in early September. Applications will be due in November, with funding decisions finalized by Dec. 31. This is a one-time application for the five-year mandatory fund, with dollars allocated evenly across FY26 to FY30 ($10 billion per year). Importantly, the RHTP fund is separate from — and unaffected by — FY26 Labor Health and Human Services, and Education discretionary appropriations outlined by the Senate and House, and any continuing resolutions. The $50 billion program will be divided into two parts. $25 billion will be distributed evenly among states that apply and have successful applications. The remaining $25 billion will be allocated at CMS’s discretion based on factors such as a state’s rural population, the number of rural health care facilities, and state policies and policy commitments. States will not be required to provide matching funds. In anticipation of the application deadline, many state health departments have been mobilizing over the past weeks. Health officials are convening task forces, launching working groups and public hearings, and issuing Requests for Information and surveys to shape projects and spending plans. These efforts are focused on aligning with CMS’s strategic goals, including making rural America healthy again, providing sustainable access to care, workforce development, innovative care delivery, and technology modernization. Program Insights Panelists also highlighted how RHTP differs from existing rural health programs. The Federal Office of Rural Health Policy, for example, funds initiatives focused on quality improvement, hospital technical assistance programs for operational challenges, and targeted pilot programs to test the feasibility of ideas related to community needs. By contrast, RHTP will provide states with a large, flexible infusion of funds to augment existing and novel rural health care efforts. States will also be permitted to use RHTP dollars for one-time investments (e.g., electronic health record systems, diagnostic equipment, and network-building initiatives). Panelists emphasized the importance of tailoring approaches to state and community needs, noting that Tribal communities face especially severe challenges, requiring intentional engagement. The first session concluded with a focus on Alaska, where 73.7% of hospitals are in rural areas — a key driver of Senator Murkowski’s strong advocacy for the fund. Her legislative director noted the state’s persistent struggles with connectivity, limited primary care access, workforce shortages, and low patient volume. Previous funding formulas, which relied heavily on hospital bed counts or numbers of health care facilities, often disadvantaged Alaska and similar states. RHTP, structured as a cooperative agreement, gives states both predictability and flexibility: dollars they can count on, combined with broad authority to design solutions in partnership with CMS protocols and assistance. CMS has existing protocols for grant management, and Congress will likely ask for clear reporting requirements as they monitor the successful implementation of the fund. Panel Two: State and Stakeholder Perspectives Rural Health Challenges To align visions with on-the-ground realities, health department leaders from Pennsylvania and Mississippi described their extensive efforts underway to gather input and identify priorities that are both sustainable and impactful, underscoring the importance of community engagement in shaping state strategies. Panelists noted that states are working through a broad list of rural health challenges, including: Maternal and child health. Behavioral health. Substance use disorder. Emergency medical services. Transportation barriers. Aging populations. Specialist shortages. Data modernization (including cybersecurity, AI, broadband, training, and administrative support). Telehealth. Workforce shortages. Hospital, clinic and federally qualified health care center closures. Payment models (public and private). Improving health information exchanges and electronic heath records were also mentioned as universal goals. RHTP is designed with flexibility to tackle these issues and to craft solutions (some of them can be shelf-ready, such as technology or prevention kits) to respond to the diverse needs of rural communities. Aligning Programs Panelists were asked how they are working with partners to achieve alignment for their programs. All concurred that strategic planning is essential, with an emphasis on local partnerships and regional collaborations. It was stressed that rural health care should ideally be delivered as close to the community level as possible, supported by a robust ecosystem. Speakers agreed that the financial health of rural areas is inseparable from the health of their hospitals and clinics. It was underscored that local residents are deeply invested in their communities and want to see them thrive. Transforming rural health care systems will require large-scale collaborations at a local level, which are built on trust, a shared vision, and a clear understanding of the long-term goals. The challenges of chronic disease, which occurs and leads to death at significantly higher rates in rural areas, surfaced. Panelists agreed that tackling this issue requires major investments in ancillary professions — such as nutritionists, physical therapists, and community health workers — alongside a renewed emphasis on primary care services and alleviating the acute shortage of primary care physicians. According to the American Medical Association, roughly 65% of rural areas face a shortage of primary care providers, and only 4%-5% of incoming medical students now come from rural backgrounds. Some solutions noted by the panelists were extending medical student rotations in rural settings from a few weeks to 12 or more, coupled with financial and professional incentives. Encouragingly, research shows that students from rural areas are far more likely to return home as practicing physicians. Final Words Panelists overwhelmingly agreed that RHTP represents an unprecedented opportunity for states — though, notably, not for U.S. territories or Washington, D.C. — to expand access, raise the quality of rural health care, and ultimately improve both quality of life and life expectancy for their rural residents. The $50 billion fund is not only a lifeline but also a testing ground, and if implemented successfully, it could serve as a model to pave the way for future federal investments of this magnitude in rural health. For more information on RHTP, please email MAHARural@cms.hhs.gov. Participants Part One: Federal Senator Lisa Murkowski and Angela Ramponi, MPH, Legislative Director Emily Chen, MBA, Senior Advisor, Office of the Administrator, Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services Tom Morris, MPA, Associate Administrator for Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services Moderated by Carlos Jackson, Principal, Cornerstone Government Affairs Part Two: State and Stakeholder Daniel Edney, MD, FACP, FASAM, State Health Officer, Mississippi State Department of Health Debra Bogen, MD, FAAP, Secretary of Health, Pennsylvania Department of Health Zil Joyce Dixon Romero, State Government Affairs Manager, National Rural Health Association Lindsey Browning, Deputy Executive Director of Programs, National Association of Medicaid Directors Moderated by Susan Kansagra, MD, MBA, Chief Medical Officer, ASTHO article yes

The Senate released its version of the FY25 LHHS appropriation bill on August 1, 2024, with significant changes in proposed public health funding than the House's proposed bill.

Summary of FY24 House Appropriations Bill astho, association of state and territorial health officials, global health, ending the hiv epidemic, fy24 lhhs appropriation bill, substance abuse and mental health services administration, firearm injury and mortality prevention research, center for forecasting and analytics, agency for healthcare research and quality, public health data modernization, climate and health, public health infrastructure and capacity, government affairs, tobacco prevention and control, house labor health and human services and education, health resources and services administration, fy24 house appropriations bill, reducing new hiv infections, center for forecasting, funding opportunity, research and quality ahrq, health and human services, department of health, healthcare research and quality, agency for healthcare research, hiv aids, human services hhs, impacts of climate, gun violence, university of michigan, national institutes of health, ehe initiative, epidemic in the united, hiv prevention and treatment, real time, health effects, health impacts ASTHO | Learn about cuts to public health funding in the House Labor Health and Human Services and Education subcommittee's FY24 appropriations bill. On July 13, the House Labor Health and Human Services and Education (LHHS) appropriations subcommittee released its version of the FY24 LHHS appropriation bill and will mark up the legislation on July 14. The proposed funding levels included within the bill are subject to change as both chambers of Congress are expected to engage in negotiations before the expiration of the current fiscal year on September 30, 2023. It is important to note that the subcommittee has not released the report text, therefore ASTHO cannot complete a detailed analysis. The summary below was provided by the committee.  Outlook: This bill is considered to be the low water mark for funding, compared to what the Senate is expected to propose. The Senate has yet to formally begin its work on the FY24 appropriations bills, but we expect that to occur in the coming weeks. As a reminder, any appropriations legislation must be approved on a bipartisan basis. The funding levels included in this bill are NOT final but rather are an indication of the priorities for the majority in the House. Given what is expected to be a contentious funding season, the likelihood of Congress approving a continuing resolution with a 1% across-the-board cut is extremely high and a government shutdown in October cannot be ruled out. The ASTHO government affairs team will continue to advocate on behalf of state and territorial public health departments, encouraging Congress to increase funding for state and territorial public health. The subcommittee draft text and summary are available for review. Excerpts from Subcommittee Funding Summary Centers for Disease Control and Prevention (CDC): The bill includes a total of $7.6 billion for CDC, a cut of $1.6 billion below the enacted level.  The bill eliminates funding for Firearm Injury and Mortality Prevention Research, a cut of $12.5 million below the enacted level. The bill eliminates funding for Tobacco Prevention and Control, a cut of $247 million below the enacted level. The bill eliminates funding for the Ending the HIV Epidemic initiative, a cut of $220 million below the enacted level. The bill includes $100 million for Public Health Infrastructure and Capacity, a cut of $250 million below the enacted level. The bill includes $75 million for Public Health Data Modernization, a cut of $100 million below the enacted level. The bill includes $371 million for Global Health, a cut of $322 million below the enacted level. The bill eliminates funding for the Climate and Health program, a cut of $10 million below the enacted level. The bill eliminates funding for the Center for Forecasting and Analytics, a cut of $50 million below the enacted level. Substance Abuse and Mental Health Services Administration (SAMHSA): The bill funds SAMHSA at $7.1 billion, a cut of $234 million below the enacted level.   Health Resources and Services Administration (HRSA): The bill includes $7.3 billion for HRSA, a cut of more than $700 million below the enacted level. (The comparison does not include Community Project Funding included in the FY 2023 enacted bill.)  The bill eliminates funding for Title X Family Planning, a cut of $286 million below the enacted level. The bill includes $781 million for the Maternal and Child Health Block Grant, a cut of $35 million below the enacted level. The bill eliminates funding for Healthy Start, a cut of $145 million below the enacted level. The bill eliminates funding for the Ending HIV Epidemic Initiative, a cut of $220 million below the enacted level. The bill eliminates funding for multiple programs to support diversity in the health care workforce, including: Health Careers Opportunity Program ($16 million) Centers of Excellence ($28 million) Nursing Workforce Diversity ($24 million) Agency for Health Care Research and Quality (AHRQ): The bill eliminates funding for AHRQ, a cut of $374 million below the enacted level. Office of the Secretary—General Departmental Management (GDM): The bill includes $344 million for GDM, a cut of $258 million below the enacted level. The bill eliminates funding for the Teen Pregnancy Prevention Program, a cut of $108 million below the enacted level. The bill includes $26 million for the Office of Minority Health, a cut of $49 million below the enacted level. The bill includes $28 million for the Minority HIV/AIDS Initiative, a cut of $24 million below the enacted level. The bill includes $20 million for the Office on Women’s Health, a cut of $49 million below the enacted level.  article yes

November 2025 Federal Funding and Government Shutdown Update November 2025 Government Shutdown/Funding Update Learn about the Continuing Appropriations Act, 2026, that the Senate agreed to vote on to end the current government shutdown. On Nov. 9, 2025, the Senate agreed to vote on the Continuing Appropriations Act, 2026, to end the current government shutdown and fund portions of the federal government through a continuing resolution (CR) that would expire Jan. 30, 2026. The CR keeps current federal funding levels and applies to agencies such as CDC, HRSA, SAMHSA, and EPA. The rest of the federal government, including programs within the Department of Agriculture, FDA, the Department of Veterans Affairs, and the operations of Congress would be funded through full fiscal year appropriations bills expiring on Sept. 30, 2026. The bill also specifies a number of requirements related to federal workforce, state reimbursement, and spending which are detailed in the sections that follow. Outlook Considering the bipartisan support for this deal to end the government shutdown, the ASTHO Government Affairs team is tentatively optimistic that the Continuing Appropriations Act, 2026, will eventually become law. However, the current political environment is volatile and if anything changes, we will issue another legislative alert. After the Senate votes on the bill, which may be delayed due to negotiations on some agriculture provisions, the House will need to approve it by a simple majority vote. If the House fails to garner enough support, then the government shutdown will continue. Here is the full text of the bill, the text of various extenders, and a section-by-section summary of all sections by the Senate majority. Federal Workforce and State Finances Requires the return of all federal workforce levels prior to the current lapse of appropriations on Oct. 1, 2025. Requires that funds be apportioned to agencies at a rate that would prevent the furlough of any employee during the duration of the CR. Prevents agencies from overspending funds for grant programs during the CR period, unless funds are required to be spent for the programs during such period. It preserves the funding level for most grant programs, subject to Congress’s decision in the full-year appropriations acts. Explicitly states that agencies should spend money in the most limited way possible during the duration of the CR. Directs that funds provided by the CR are available to pay federal employees who were furloughed or excepted during the lapse. Requires reimbursement to states that carried out federal programs, to prevent a reduction in service, during the lapse. Prevents statutory PAYGO sequestration cuts to Medicare, agriculture, and other programs. Agriculture and FDA Specifically, Senators agreed to advance a three-bill package that includes FY26 funding for the Department of Agriculture and the Food and Drug Administration (Ag-FDA), the Department of Veterans Affairs, and the Legislative Branch. The Ag-FDA bill provides: A hemp products ban, which prevents the unregulated sale of intoxicating hemp-based or hemp-derived products, including Delta-8, from being sold online, in gas stations, and corner stores, while preserving non-intoxicating CBD and industrial hemp products. $8.2 billion for the Special Supplemental Nutrition Program for WIC. $460 million for the Commodity Supplemental Food Program to assist low-income seniors. $37.8 billion in mandatory funding for child nutrition programs, as requested by the Administration. $107 billion in mandatory funding for SNAP, as requested by the Administration. Reimbursement for both the SNAP and WIC contingency reserves to account for expenditures during the government shutdown. $7 billion (budget authority and user fees), a decrease of $70 million below FY25 enacted levels, for FDA. $1.2 billion for the Food Safety and Inspection Service. $4.1 billion to support rural development across the country including $1.4 billion to prioritize aging water and wastewater infrastructure. Public Health Provisions Other public health provisions in the bill include extending several programs through Jan. 30, 2026, including: Community health centers. National Health Service Corps and teaching health centers that operate general medical education programs. The Special Diabetes Program. Some of the authorities of the Pandemic and All Hazards Preparedness Act. Unfortunately, this bill did not include provisions to reauthorize HPP, PHEP, or other public health programs, which will need to be reauthorized in the new year. Extends Medicare telehealth flexibilities that were extended in the Consolidated Appropriations Act, 2023. The Sexual Risk Avoidance Education Program. The Personal Responsibility Education Program. Family-to-Family Health Information Centers. website yes

March 2024 Federal Funding Update wic program, environmental protection agency, appropriation bills, food and drug administration, government affairs, government shutdown, synthetic nicotine, fiscal year, federal government, public health, house and senate, food and drug administration fda, tobacco free nicotine, synthetic nicotine products, spending levels, white house, government agency, spending bill, regulate tobacco products, astho, association of state and territorial health officials ASTHO | Congress must approve legislation to provide FY24 funding for a portion of the federal government. This week, Congress must approve legislation to provide FY24 funding for a portion of the federal government. Currently, the federal government is operating on a two-tiered continuing resolution. Funding for discretionary programs in the Agriculture Appropriation bill—Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and FDA—expires on March 8. On March 3, Congress released the legislative text of the Consolidated Appropriations Act, 2024, which proposes FY24 funding for six of the 12 appropriation bills. This package includes funding for EPA, the WIC program, the Supplemental Nutrition Assistance Program (SNAP), and FDA, among other critical programs. Importantly, this legislation includes full funding for the WIC program, a priority for ASTHO and other public health organizations. Funding for HHS discretionary programs (NIH, CDC, HRSA, SAMHSA) expires on March 22. Legislative text proposing funding for these programs has not been released. Outlook Given bipartisan negotiations, ASTHO’s government affairs team believes this bill will be signed into law, avoiding a partial government shutdown on March 8. Additionally, text for the remaining six appropriation bills, including funding for HHS, is expected to be released later this week, with approval needed before March 22. According to media reports, this specific package of legislation will face a very difficult road to approval by Congress. Resources Bill Text Legislative summaries (Majority and Minority) Joint Explanatory Statement—Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriation Act, 2024 Joint Explanatory Statement—Energy and Water Development and Related Agencies Appropriations Act, 2024 Joint Explanatory Statement—Interior, Environment, and Related Agencies Appropriations Act, 2024 Key Public Health Funding Highlights Agriculture Appropriation Bill $7.03 billion for the WIC program, an increase of $1.3 billion over FY23. This ensures the program is fully funded, and it increases funding for fruits and vegetables in the WIC Food Package to meet the President’s request. $122.4 billion ($3 billion to remain available through Sept. 30, 2026, for a contingency reserve) for SNAP, a decrease of $31.5 billion from FY23. $6.7 billion, level funding, for FDA. In addition, FDA is required to address drug and device shortages, among other critical priorities. Urges FDA’s Center for Tobacco Products to immediately remove any product containing synthetic nicotine from the market, regardless of whether such product is subject to the Premarket Tobacco Product Application process. Rescinds unspent COVID resources at FDA. Environmental Protection Agency This bill includes $9.2 billion for EPA, a reduction of $232 million. $4.4 billion for State and Tribal Assistance Grants. Within this amount, the bill includes $2.8 billion for Clean Water and Drinking Water State Revolving Funds and $1.4 billion in Community Project Funding. Compact of Free Association Pages 960-1048 of the bill text include a section amending Compacts of Free Association, which is important for territorial ASTHO members. The government affairs team will review this provision and provide additional analysis to our territorial members in the upcoming weeks. Other Public Health Programs Extends funding for the following programs through December 31, 2024: Community Health Centers National Health Service Corps Teaching Health Centers that Operate graduate medical education programs  Special Diabetes Program Authority for states and tribes to request temporary reassignment for federally funded personnel.  website yes

ASTHO letter to the White House Requesting Funding For a National Monkeypox Response

On Oct. 4, 2023, ASTHO responded to a Request for Information from the U.S. House of Representatives' Ways and Means Committee on the subject of improving access to healthcare and rural and underserved areas, including the island jurisdictions.

Sept. 27, 2022, ASTHO Legislative Alert: analysis of Continuing Appropriations and Ukraine Supplemental Appropriations Act, 2023 (H.R. 6833).

The bill provides $27.1 million to address shortfalls in Medicaid funding in the Northern Mariana Islands and extends critical autism-related programs.

December: Federal Funding Update December 2024: Federal Funding Update On Dec. 20, 2024, the House of Representatives and Senate approved, by bipartisan vote, a short-term continuing resolution funding the federal government through Mar. 14, 2025. President Biden subsequently signed the bill into law. The full text of the bill can be reviewed here. Other public health provisions in the bill include extending of a number of programs through Mar. 31, 2025, including: Community health centers National Health Service Corps and teaching health centers that operate general medical education (GME) programs Special diabetes program Some of the authorities of the Pandemic and All Hazards Preparedness Act (PAHPA) Unfortunately, this bill did not include provisions to reauthorize HPP, PHEP or other public health programs, which will need to be reauthorized in the new Congress. Some telehealth flexibilities Sexual risk avoidance education program Personal responsibility education programFunding for family-to-family information centers through Apr. 1, 2025 website yes

HHS Budget Hearings Chart New Direction for Public Health Budget Hearings Chart New Direction for Public Health Catherine Jones Learn about the key policy/funding themes that emerged from HHS Secretary Robert F. Kennedy’s testimony during the May 2025 budget hearings. In May 2025, HHS Secretary Robert F. Kennedy Jr. appeared before the House and Senate Appropriations Committees as well as the Senate Health, Education, Labor, and Pensions (HELP) Committee to discuss the Trump Administration's proposed FY26 HHS budget. On May 2, President Trump released his “Skinny Budget,” which formed the basis of much of the questioning Sec. Kennedy received from members of both parties. These hearings illuminated a sweeping reorganization of HHS and other federal agencies, signaling a dramatic shift in public health priorities and funding. Seven key themes emerged from the testimony, highlighting how these priorities are being advanced through the Make America Healthy Again (MAHA) initiative and the newly proposed Administration for a Healthy America (AHA). The President’s Budget Appendix, released in late May, reaffirms these policy and funding proposals. Reorganizing HHS and CDC The blueprint for HHS calls for consolidating various agencies under the new AHA, including HRSA, SAMHSA, and parts of CDC. In the hearings, Republicans broadly supported MAHA and AHA initiatives, mentioning the need to disrupt bureaucratic inefficiencies, reduce regulatory hurdles, and improve health care delivery. Democrats expressed concerns about program disruptions, layoffs, and FY25 appropriated funds that remain undisbursed. A handful of Democrats pressed Sec. Kennedy on whether he would spend FY26 funds, as appropriated by Congress; he responded affirmatively. When asked who authorized the staff layoffs, Sec. Kennedy gave inconsistent responses claiming ownership in one hearing and later attributing decisions to the Department of Government Efficiency. Public Health Preparedness and Prevention Preparedness and prevention were central topics, especially in the HELP Committee hearing. The proposed elimination of the Hospital Preparedness Program and cuts to the Public Health Emergency Preparedness Program would result in a net loss of hundreds of millions of dollars in federal support. HELP Committee Chair Sen. Bill Cassidy (R-LA) voiced concerns about the implications for under-resourced and rural states. Sec. Kennedy emphasized CDC’s legal responsibility for national pandemic response and called for reauthorization of the Pandemic and All-Hazards Preparedness Act. In the House hearing, he also addressed topics such as supply chain independence from China for critical medicines, and adequate funding for the Strategic National Stockpile and Biomedical Advanced Research and Development Authority. Vaccines Sec. Kennedy's past vaccine skepticism drew bipartisan scrutiny. Lawmakers pressed him to affirm support for routine immunizations, particularly amid a measles resurgence. When asked about pediatric vaccinations in the House hearing, Sec. Kennedy demurred wanting to refrain from giving medical advice. In the HELP hearing, he confirmed that funding appropriated for vaccines would be used accordingly and stated that vaccine recommendations would continue to be made by CDC’s Advisory Committee on Immunization Practices (ACIP). However, on May 27, he contradicted that assurance by directing CDC to remove COVID-19 as a recommended vaccine for pregnant women and children — reportedly without ACIP input. It should be noted that on June 9, a directive from Sec. Kennedy offered formal notice of the immediate termination of the current 17 ACIP voting board members. Injury and Violence Prevention Substance use, suicide, and overdose prevention were major topics around injury and violence. The FY26 budget proposes transferring CDC’s National Center for Injury Prevention and Control to AHA but still eliminates a majority of its programs. These programs have driven progress on opioid surveillance and community-based interventions, and reduced rates of overdose. When asked about preserving the SAMHSA State Opioid Response Grant, Sec. Kennedy said he supported harm reduction tools such as naloxone and community care programs but needed to review the specific grant. He acknowledged overdose as a public health crisis and stated that HHS will maintain 500 addiction treatment centers nationwide. He mentioned his commitment to addiction programs and the administration’s keen attention on preventing fentanyl from entering the United States. Additional questions were raised about high alcoholism rates on reservations, general funding for Indian Health Services, and elimination of LGBTQ+ services in the suicide prevention hotline; Sec. Kennedy promised to follow up on these topics. Chronic Disease, Cancer, and Food Safety Throughout the hearings, Sec. Kennedy underscored his steadfast commitment to reducing rates of heart disease, diabetes, cancers, Alzheimer’s and dementia, and other chronic conditions. He also wants to focus on the challenges of rural health care and rural hospital closures, as well as improved access to care for vulnerable populations, such as older Americans, veterans, and people with disabilities. In his testimony, Sec. Kennedy repeated his commitment to address nutrition and physical activity and to prioritize healthy eating in the Head Start program. He is working closely with FDA to phase out harmful dyes. FDA has fast-tracked approval for vegetable substitute dyes for the food industry. Sec. Kennedy is also focused on combating ultra-processed foods stating that “nutrition reform will address the root causes of diseases,” such as cancer. CDC’s Center for Chronic Disease Prevention is proposed for elimination in the budget, and the Diabetes Prevention Program Outcome Study is paused. Children’s and Women’s Health Lawmakers from both parties voiced concern over misinformation leading to declining vaccination rates and a growing measles threat. Youth mental health and social media harms were emphasized. Senators also raised bipartisan objections to the proposed elimination of CDC’s Childhood Lead Poisoning Prevention Program, which is being revisited. He expressed interest in researching environmental causes of autism and not solely focusing on genetics. In the House hearing, he acknowledged racial disparities in maternal care. Despite proposed cuts to programs like the National Breast and Cervical Cancer Early Detection Program, Sec. Kennedy voiced support for women’s health research. He also said he supports dental care, though he offered limited assurance on fluoride access. The budget proposes to close CDC’s Division of Oral Health. Tobacco Control In the House hearing, Ranking Member DeLauro (D-CT) criticized the proposed elimination of CDC’s Office on Smoking and Health. Senators in the HELP hearing emphasized tobacco’s status as the leading preventable cause of death and warned that staffing cuts would undermine decades of progress. Sec. Kennedy acknowledged the concerns but said he needed to review the specifics. He was also asked about FDA’s inaction on regulating illicit Chinese-made vapes targeting U.S. youth. While Sec. Kennedy presented the FY26 budget as a framework for streamlining government and cutting costs, critics argued that it undermines core public health capacities. As Congress enters markup season and prepares to negotiate final programs and funding levels, the outcome of this year’s budget debate will have long-term implications for the U.S. public health system. article yes

Federal funding that supports public healthy emergency preparedness is critical. Read the latest on PAHPA and more in the Health Policy Update.

A brief summary of all the significant public health legislation passed by U.S. Congress in the summer of 2022.

ASTHO Legislative Prospectus | Prevention 2025 state legislative action on infectious disease control and prevention.

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

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

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

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