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Centralizing Administrative Functions, with Lessons Learned from Guam Megan Drake-Pereyra Centralizing administrative functions, such as procurement or grants management, is a strategy many organizations utilize. Having administrative functions concentrated with a specific team rather than dispersed or managed within separate teams can work well. There is potential for standardized processes and procedures, increased efficiency and quality, more control and accountability, and consistent data collection and monitoring. This brief details how health departments can utilize existing, evidence-based frameworks to centralize administrative functions and build off lessons learned from others, such as the Guam Department of Public Health and Social Services (Guam DPHSS). Getting Started Considerations When transitioning from a decentralized structure to a centralized structure, it is important to clearly outline the what, why, how, and benefits. Consider the following components to kickstart success: Leadership vision: Start with the leader’s visionary perspective. When the leader allocates sufficient time and consistently reinforces the vision, it allows for the necessary decisions, trust, and support to be established during the transition. Data-driven design: Use data and existing information, such as current standard operating procedures or process diagrams, to understand the decentralized process differences/similarities, and guide effective centralized processes and procedures. Role clarity: Clearly outline and define the new centralized infrastructure, purpose, roles, responsibilities, expectations, and procedures. This helps everyone understand and follow the new processes more consistently, with better results. Performance measures: Establish and use performance measures from the outset (e.g., team knowledge, skills, competency, process time and quality, outcomes, impact, etc.), for insight into the value, or return on investment, of the centralized model. This will help indicate the quantity, quality, and impact of programs/processes. Documentation: Capture and share decisions, vision, goals, structure, standard operating procedures, and relevant details in writing for new team members and users of the centralized functions. Communication: Transparently share plans, timelines, and additional knowledge to maximize utilization and value. Additionally, anticipate and proactively address resistance to change to help everyone embrace and adhere to the new, centralized approach. The Plan-Do-Study-Act Method Change management, quality planning, and process improvement models can also support organizational and process change. For example, the quality improvement methodology, Plan-Do-Study-Act (PDSA), offers an effective framework for centralizing administrative functions and complements many of the aforementioned considerations: Step one, plan, relies on leaders to decide the vision, scope, structure, roles/responsibilities, goals, and purpose of the centralized team. Here leaders establish and reinforce the leadership vision, using existing data to guide the design of the new centralized team. Step two, do, is dedicated to onboarding centralized team members, defining their work processes and procedures, and ensuring effective communication with all stakeholders. This requires thorough documentation and strong communications plans. Step three, study—an often overlooked but crucial building step—is for testing the processes, procedures, roles, and responsibilities, to confirm and build confidence that this centralized structure will yield the desired results. Performance measures provide clarity into what is working well and what is not. Step four, act, is for launching and rolling out the structure, ongoing monitoring of performance, and continuing to educate and coach for successful, sustainable improvements. Lessons Learned from Guam Guam DPHSS, a joint health and social services agency, is working to centralize its administrative functions to reduce inefficiencies and redundancies as well as improve quality and consistency. This has been a big change for Guam DPHSS, but leadership vision, documentation, role clarity, and communication have proven to be key throughout the process. In 2021, Guam DPHSS established a centralized Office of Grants Management (OGM). In its early stages, programmatic teams saw OGM as a regulatory body that would audit and direct their work, while OGM’s true objective was to provide support and ease administrative burden, allowing program staff to focus on accomplishing their goals and deliverables. By clarifying and documenting the vision, roles, and responsibilities as well as focusing on communication, the OGM built trust, addressed specific concerns, and established a shared vision of their role as supportive and helpful. In 2023, Guam DPHSS began the process of establishing a centralized Procurement Management Office (PMO). While Guam DPHSS reorganized and co-located staff into the new, centralized PMO, Guam was undergoing a governmentwide business process improvement (BPI) project focused on procurement—presenting an opportunity for Guam DPHSS to involve new PMO staff and other key DPHSS team members in improving its functions and centralizing the procurement process. Through the BPI project, which utilized PDSA, DPHSS clarified roles and responsibilities, defined work processes and procedures, and developed training and communications plans that supported process improvement and centralization of procurement functions. Guam DPHSS has learned many lessons throughout their journey to create a centralized OGM and PMO, including that change of this magnitude is hard—more specifically, balancing change management while ensuring maintenance of key operations. Ultimately, they found that the aforementioned considerations and methods for getting started were critical in supporting the change to centralized administrative functions. Establishing the Ideal Structure for Administrative Functions Determining if and how centralized administrative functions will work for an organization is multifaceted. An organization’s culture, size, infrastructure (including technology and systems), and workforce and skills all play crucial roles in shaping the ideal structure. The methods and considerations noted previously can help health departments determine and support the best path forward for each unique organization. ASTHO has several additional resources and tools that can support administrative change and improvement. Visit the ASTHO STAR Center to learn more. website yes

ASTHO Innovation Advisory Council fosters partnerships between state health agencies and industry leaders to drive public health innovation and data modernization.

Learn how health agencies can strengthen their overdose prevention programs through business improvement.

Olmsted County Pilots a Regional Population Health Data Hub to Improve Data Accessibility Gelila Tamrat, Sara Black, Reema Mistry, Christina Severin Olmsted County, Minnesota, pilots a regional population health data hub to improve data accessibility, which supports improved decision-making and interventions. Historically, Olmsted County and other local counties in southeast Minnesota have faced barriers to accessing timely and actionable public health data, including limited data analytics workforce capacity, lack of data-sharing agreements (DSAs), and misaligned data suppression standards. To address these challenges, Olmsted County Public Health Services (OCPHS) piloted a regional population data hub, in partnership with the Minnesota Department of Health (MDH) and 10 local health departments (LHDs). OCPHS procured resources to develop a regional data-sharing platform, expanded their epidemiology team, and pursued DSAs. As a result, they gained access to critical data that supports informed decision-making and tailored interventions at the local level. Tina Jordahl - Brief - Olmsted County MN DMI Hub Developing a Regional Population Health Data Hub With financial support from the Minnesota legislature in 2021, OCPHS collaborated with MDH and its regional counterparts to develop a regional population health data hub for smaller LHDs to access community-level public health data. OCPHS maintains the hub by managing data from the state, regional partners, and 10 LHDs, and creating data dashboards to support southeast Minnesota counties’ population health data needs. This effort involved building and expanding relationships with MDH unit-specific epidemiologists, working closely with public health system consultants at MDH, and raising awareness of the need for sustained data analytics workforce support. Following the initiative’s success, OCPHS plans to engage with state and local leaders to identify funding sources that can sustain the hub beyond the pilot funding cycle. Promoting Data Accessibility through Strategic Partnerships and Agreements MDH’s Center for Public Health Practice supports public health system consultants, who offer technical assistance and consultation services to strengthen public health infrastructure across Minnesota. The consultant for the southeast region of the state was crucial in linking state and local staff to advance the development of the regional population health data hub. They helped triage and expedite requests from OCPHS by identifying the right points of contact for datasets and legal counsel within MDH. The collaboration of MDH, OCPHS, and participating LHDs facilitated the development of DSAs, which allowed for proper data flow and enabled OCPHS to request data from MDH on behalf of participating counties, reducing the need for each county to request data. It also helped OCPHS to become the first county in the state to adopt CDC’s ESSENCE tool to monitor hospital visits for syndromic surveillance across Minnesota and neighboring states, better enabling LHDs to address the needs of communities residing along state borders. Hiring Strategies for the Data Analytics Workforce OCPHS focused on hiring staff to support the regional population health data hub with data expertise, strong communication skills, and a particular interest in population health and social determinants of health. OCPHS created two permanent epidemiologist positions to promote sustainability for that position in the future. To expand their hiring pool, OCPHS relied on Olmsted County’s updated remote work policies following the COVID-19 pandemic when many shifted to remote or hybrid work. They also invited leaders from partner counties to help vet candidates who could support other LHDs’ needs. Meaghan Sherden - Brief - Olmsted County MN DMI Hub Advancing Equity Through Data Accessibility Due to data suppression rules, counties in southeast Minnesota had limited access to county-level data for certain statewide datasets. OCPHS worked with MDH to identify appropriate data suppression standards that supported access to community-level public health data and preserved privacy and security, and collaborated with the county IT department to develop the regional data hub with public-facing and internal dashboards, aligned with the required privacy and security standards. The public-facing dashboards show aggregate data with appropriate suppression standards at county, regional, and state levels. The internal dashboards provide complete data summaries and are protected with appropriate permissions and multi-factor authentication for LHD staff to perform population-level analysis. Providing timely, granular data to participating counties allows LHD staff to develop tailored strategies to address emerging health issues promptly, bridging health equity gaps. OCPHS also integrates standard demographic data on race, sex, gender, and age into its dashboards, enabling regional LHDs to gain deeper insights into their communities and fine-tune equity-centered public health initiatives and interventions. Jenny Passer - Brief - Olmsted County MN DMI Hub Implementation Considerations Foster collaborative relationships across state and local health departments to identify opportunities to share resources when advancing data-sharing efforts. Models in which larger LHDs support key data infrastructure needs on behalf of smaller LHDs may bolster data analytics/epidemiology capacity across multiple LHDs and streamline coordination with key partners at the state health department. Consider how state health department consultant or liaison roles charged with providing technical assistance to state or local partners may help facilitate key connections between state and local health department staff pursuing cross-jurisdictional data-sharing efforts. Invest in data analytics/epidemiology workforce strategies that help address specific needs related to population health and relationship building, along with technical skills. Cross-jurisdictional data-sharing efforts require staff with strong data analytics and communication skills, as they work with multidisciplinary leaders and across jurisdictions to inform community-based interventions. Collaborate proactively with legal and IT departments to identify data governance solutions and technical approaches to adhere to required privacy and security standards. Establishing DSAs is important, as it allows sharing of data within required legal guardrails. Similarly, IT leaders can identify technological solutions that support effective access to data. OT18-1802 website yes

Arizona Department of Health Services Pursues Policies to Advance Data Sharing with Tribal Nations Erik Skinner, Christina Severin, Reema Mistry The Arizona Department of Health Services is pursuing policies to advance data sharing with tribal nations, centered around partnerships, education, and more. With leadership support and funding to modernize its public health infrastructure, the Arizona Department of Health Services (ADHS) is pursuing policies to advance data sharing with tribal nations. This includes investing in partnerships with tribal leaders, educating the public health workforce about tribal governments and tribal health care, and working to improve data identification processes to support effective data sharing between the state and tribal nations. Data sovereignty is an important consideration for ADHS, as there are 22 federally recognized tribal nations in Arizona. ADHS recognizes the inherent right of tribal nations to access their citizens’ public health data and is developing a tribal data sovereignty policy that both acknowledges their unique data needs and aligns with state requirements around tribal engagement. Leadership Support and Effective Tribal Engagement ADHS leadership understands the importance of making strong connections with tribal nations and recognizing each nation’s public health priorities while meeting its statutory requirement to develop tribal consultation policies. To that end, ADHS developed the tribal liaison position to serve as a resource, advocate, and communication link between ADHS and Arizona’s Native American health care community partners, including tribal community leaders, health and epidemiology directors, Indian Health Service (IHS), and Tribal Epidemiology Centers (TECs). Understanding cultural norms is essential to building trust with tribal partners; the tribal liaison role has been vital to ADHS engagement with tribal nations on data sovereignty topics. People and processes are important to establishing data sharing policies, and a well-informed workforce is essential for effective collaboration with sovereign tribal nations. ADHS is working with the Native Nation Institute to provide training on tribal sovereignty and cultural humility for staff. It has also developed a tribal handbook for public health staff on sovereignty, cultural trauma, and the roles of IHS and TECs. Identifying Tribal Affiliation within Datasets and Tribal Public Health Priorities ADHS conducted a data assessment to identify instances in which data sharing was active and ongoing between ADHS and tribal nations, and instances in which it had expired. A notable technical challenge was identifying tribal members within existing datasets, as many public health datasets are incomplete (e.g., do not include tribal affiliation) or rely on IT systems that are unable to aggregate data appropriately—making it difficult to ensure tribal authorities receive relevant, comprehensive public health data for their communities. In addition, because each tribal nation’s public health priority areas and data needs could differ from the data that state health information systems collect, sharing relevant data with tribal nations can be challenging. ADHS is working with each nation to identify tribal public health priority areas, find solutions to identify tribal data within state collected datasets, and share it with the respective nations. Ken Komatsu - Brief - AZ DHS Pursues Policies to Advance Data Sharing with Tribal Nations Honoring Sovereignty in Data Sharing Relationships Data sharing agreements with public health agencies often establish that the state agency controls the disposition and use of the data, and that each party benefits. Acknowledging that tribal partners are entitled to their citizens’ data without conditions differs from how ADHS has historically approached data-sharing relationships with others. ADHS plans to formally establish a non-transactional data sharing policy with tribal public health partners, and establish data sharing agreements that align with this approach going forward. Implementation Considerations Considerations for state health agencies in fostering strong relationships and effective engagement with tribal partners around data-sharing efforts include: Center tribal sovereignty when framing data sharing agreements with tribal nations. Engage tribal liaisons in data-sharing efforts with tribal nations. They maintain close relationships with tribes and can help develop mutual cultural understanding, which is essential to engaging tribal partners. Assess datasets to determine data completeness with regards to tribal affiliation and identify opportunities to improve comprehensive data sharing with tribal authorities. Invest in state health agency staff training on tribal sovereignty and cultural humility, so staff can be well-prepared when engaging in data sharing conversations with tribal partners. Gerilene Haskon - Brief - AZ DHS Pursues Policies to Advance Data Sharing with Tribal Nations OT18-1802 website yes

Explore key actions, indicators, and supports to enhance workforce recruitment and hiring in governmental public health.

Policy Approaches to Improve State and Local Data Sharing Health officials can pursue organizational policies across key priority areas to advance state and local data sharing. Learn about these policy approaches. Several factors impact effective data sharing between state and local health departments—which is vital to public health decision-making—such as legislation and regulations, limited funding, IT and workforce resources, departmental processes, leadership buy-in, and data governance. Health officials can pursue organizational policies across these key priority areas to advance data sharing practices. Get the Infographic (PDF) website yes

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.

Read a detailed summary of the FY26 Senate Appropriations Bill, which was released on July 31.

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.

In-depth analysis on state health policy surrounding the public health workforce. This is part of ASTHO's annual legislative prospectus series.

ASTHO Legislative Prospectus | Previewing 2025 state legislative actions on data modernization and privacy.

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

ASTHO Legislative Prospectus | Previewing 2023 state legislative actions to build public health infrastructure.

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

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

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San Diego Academic Health Partnership Strengthens Service During COVID-19 and Beyond San Diego Academic Health Partnership Strengthens Service Mayela Arana Learn how the Academic Health and Human Services Department in San Diego strengthens service, research, workforce development, and more in the region. In San Diego County, the connection between academia and public service continues to grow stronger, shaping the future of health and human services. With over 8,200 employees serving a diverse population of 3.3 million residents, the County of San Diego Health & Human Services Agency (HHSA) plays a crucial role in advancing health, housing, and social services across the region. Recognizing the immense value of bridging education with real-world public service, HHSA and San Diego State University (SDSU) formed an Academic Health and Human Services Department (AHHSD): the Live Well Center for Innovation & Leadership (LWCIL), a first-of-its-kind initiative in San Diego County. This partnership is more than just a collaboration; it’s a transformative effort to strengthen education, research, workforce development, and service in the region, inspired by collaborative successes during COVID-19. A Vision Years in the Making Even before the COVID-19 pandemic, leaders at HHSA, SDSU, and SDSU’s College of Health and Human Services (CHHS) recognized the opportunity to deepen their relationship through an Academic Health Department (AHD) partnership. Many of those contributing to HHSA’s success began their journey at SDSU, with over half of the agency’s leadership team and a significant portion of its workforce having graduated from SDSU, particularly from CHHS. With a long history of partnering to provide real-world experiences for students, collaborating on research, and developing practice-informed curriculum, formalizing the partnership to integrate academia and health and human services practice was a natural next step. An Academic-Public Health Partnership in Action HHSA and SDSU’s longstanding relationship initially focused on student field experiences, research collaboration, and workforce development across select schools and decentralized departments but went on to have a major impact on the ground — most notably, enhancing HHSA’s COVID-19 response. Mobilizing Promotoras for Outreach and Support SDSU and HHSA worked together on recruitment, training, and community outreach. They successfully recruited 40 community health workers for a Promotoras program, which initially helped with contact tracing within the highest-risk communities. The Promotoras also identified where people needed assistance (e.g., food, services). SDSU provided support by organizing food pantries in high-risk areas, while the Promotoras took food to those in need. As vaccines became available, HHSA trained the Promotoras on messaging and communications to dispel misinformation and to encourage vaccine uptake. The Promotoras also helped those in the highest-risk communities get appointments at the county vaccination sites. Expanding Public Health Capacity with Nursing Students In addition, SDSU and HHSA worked together to train and deploy nursing faculty, students, and recent graduates in county vaccination efforts. From January through March of 2021, the SDSU School of Nursing partnered with Champions for Health, the local nonprofit arm of the San Diego Medical Society, to train 200 vaccinators. Once trained on the proper storage and administration of the COVID-19 vaccine, faculty-led groups of undergraduate nursing students administered vaccines at community sites in primarily underserved areas of the county — many organized by the San Diego Black Nurses Association. In addition to providing surge capacity staffing to support community and public health efforts, the partnership allowed students to complete clinical hours required for graduation during the pandemic when students were restricted from other clinical sites. Many of the students and graduates who served as temporary contact tracers and case investigators transitioned into full-time positions within HHSA as the COVID-19 response scaled back. Formalizing Collaboration for Lasting Impact Given the tangible value of their collaboration demonstrated during the COVID-19 pandemic, HHSA and SDSU chose to use and adapt the national AHD model — gaining access to the growing, nationwide network of AHD partnerships that inform their goal of sustaining a high-impact academic-practice partnership. They formalized the partnership with a public signing of an overarching five-year memorandum of agreement (MOA) in October 2022 that launched the bold vision of creating San Diego County’s first and only AHHSD. They assigned an additional MOA specifically addressing joint research and data sharing in December 2024, and an addendum supporting agency-wide student field experiences is underway. With formal agreements across all key areas, the foundation will be in place for increased and accelerated collaboration by summer 2025. Building on the regional collective impact vision called Live Well San Diego, the AHD partnership adopted joint branding as LWCIL. An active Steering Committee, co-chaired by HHSA’s Deputy Chief Administrative Officer and CHHS’s Dean, meets quarterly and represents the highest-level leadership for each organization. Members include key leaders in HHSA operations, human resources, and strategy, and the directors from each of its eight service departments. On the academic side at SDSU, the Steering Committee includes representatives from the six schools and multiple institutes within CHHS. Setting Partnership Priorities LWCIL co-created and recently adopted a joint, multi-year Strategic Roadmap to guide the next three years of the partnership’s development and its contribution to a healthy, equitable, safe, and thriving San Diego region. It is organized around four high-impact priority areas: People Success: Build a diverse, competent, and engaged health and human services workforce​, including students and both partners’ workforces.​​ Research & Data Excellence: Inform and improve academia, policy, and practice with rigorous and relevant research. Service to Community: Integrate academia, practice, and community to advance equity and eliminate health disparities. Leadership & Sustainability: Create a nationally recognized academic-practice model with innovative leadership committed to improving academia, policy, and practice. Subcommittees for each priority area, co-chaired by leaders from both organizations, have launched and created action plans tied to advancing the Strategic Roadmap. In addition, emerging workgroups are aligning ​work plans​. Next steps include: Assessing what is already in place and integrating it into the partnership. Developing a standardized and streamlined process for students to complete internships at HHSA. Leveraging opportunities to bridge research and practice and, where appropriate, in collaboration with the community. Investing in capacity has been essential in moving the partnership forward and providing coordination. The director of LWCIL is a “boundary spanning” position, co-funded by SDSU and HHSA. Additional staff support has assisted the partnership, including two HHSA Management Fellows engaged in a year-long program. Advice for Others Seeking to Establish AHD Partnerships HHSA and SDSU offer the following tips to agencies looking to develop or expand AHD partnerships, based on their experiences: Secure leadership commitment: Ensure the highest-level leaders are committed to the partnership’s success and sustainability. LWCIL started with the support of the dean, deputy chief administrative officer, and directors within both organizations who continue to be actively involved as members of the Steering Committee and subcommittees. By doing so, they have helped set priorities, identified staff to participate, and continuously champion the partnership within their respective organizations. Start small: Build from what already exists between the partners, leverage willing internal resources, and celebrate early successes. LWCIL started with conversations focused on workforce development because of existing relationships and shared interests. Those conversations eventually evolved to include collaborating on rigorous equity-focused research and partnering to address needs identified by the community, such as housing stability for our older adult population and food insecurity. The subcommittee structure was created to support those shared priorities; however, it began with smaller, more narrowly focused conversations. Be strategic: Create a common agenda/plan that aligns with the goals of both organizations, making it easier for already-stretched organizations to commit to and benefit from the partnership. LWCIL's co-creation of a multi-year Strategic Roadmap allowed the partners to discuss the many opportunities for collaboration and integration, and to prioritize. It now guides where the partnership is going and helps keep everyone focused on what they collectively decided is important. Then, grow: By getting systems in place and understanding the benefits and challenges between two organizations (HHSA and SDSU), LWCIL is setting the stage for expansion to include other local universities. Take time to plan and set up structures: Creating the LWCIL ​Strategic ​Roadmap was a six-month process that engaged leadership from both organizations. This was critical for identifying priorities and direction, including what structures and systems needed to be organized so the work could move forward. Learn more about San Diego’s Live Well Center for Innovation & Leadership and AHD partnerships, or explore other workforce development resources from the Public Health Foundation. If your health agency wants more information about planning support, please submit a PHIG technical assistance request through PHIVE or contact