Local Health Departments Face Cuts To Services If State Continues To Withhold Funds

Throughout the COVID-19 pandemic, Local Health Departments (LHDs) have been the tip of the spear in the local response. They have been on the front lines, leading testing, tracing and quarantine operations that help identify new cases and stop the spread of the virus, and leading the inspection of gyms, restaurants and other business that help our economy reopen safely.

These functions, while critical to New York's success in slowing the spread of the virus and safely reopening businesses are just a few of the many essential services that LHDs provide to promote health and wellness, prevent disease, disability, and injury in communities.

These services are increasingly at risk of as New York State withholds critical funding to local governments, including funding known as Article 6 funding, which supports LHDs in their core functions.

Sarah Ravenhall, Executive Director of the NYS Association of County Health Officials, recently NYSAC's County Conversations podcast where she spoke with NYSAC Executive Director Stephen Acquario about the core work of local health departments and the tremendous negative impacts local health departments are facing from the withholding of state aid. 

Below is an excerpt from the episode The Tip of the Spear: Local Health Departments' Role in the Fight Against COVID-19, which you can find at www.nysac.org/podcast.

Acquario: Article 6 of the Public Health Law requires the counties to deliver core public health services and establishes a program for the state to reimburse the county Health department for the expenses they incur. Can you explain what these core public health functions are and how the state typically reimburses the counties?

Ravenhall: Core or basic services are just that, they're foundational services that public health provides to promote health and wellness and prevent disease and disability and injury in communities. While many services involve interaction with individuals, Public Health core services are designed to address population health, which is where they differ from clinical health care. So, the core public health services are prevention focused rather than treatment focused.

Acquario: It sounds like when you're describing these core public health services, you're talking about communicable diseases, we're talking about emergency preparedness and response, and we're talking about environmental health. All of those are front and center right now, during this pandemic, it just seems counter intuitive to be withholding federal or state funds. Let's talk about withholding, or reimbursement that's not making its way into the community right now.

In recent weeks, we've seen the state respond by withholding 20% or more of the funding owed to counties in virtually every category. However, Article 6 reimbursement follows a different approval process. the way that counties submit for reimbursement, they have to do a state approved plan and a voucher process, are these vouchers being approved at the full amount that's owed back to the county?
   
Ravenhall: Not at this time. They are not being reimbursed at 100%.
 
Acquario: How will the state aid withholdings affect local health services and the ability for the LHD to respond during the pandemic? 

Ravenhall: This will have a significant impact for local public health services and pandemic response. We recently surveyed the local health departments earlier in the summer about the potential impact of a 20% withholding on core services and on pandemic response. 
In terms of key core areas for public health emergency response, 64% of local health departments responded indicating that they would need to reduce services. Either targeted, or across the board. Even 5% said that they would no longer be able to provide most of or all of the required services.

It's really devastating to the public health landscape. Communicable disease – 61% of local health departments indicated that they would need to reduce services. Family health – even greater numbers – 74% of local health departments indicated that they would need to reduce services. 10% even stated that they would no longer be able to provide those services. 

We're talking about things like maternal child health services, home visiting – eliminating those services altogether. That would be pretty disastrous. The list goes on – chronic disease, community health assessments - both in the 80th percentile of having to reduce services. Environmental health services, so lead inspections, restaurant inspections, 67% of local health departments would need to reduce services. 
We're talking about really important core public health services. Community outreach, education in schools, lead poisoning prevention education – all areas that would need to be reduced if these withholdings are not reimbursed by the state. These are areas that we, as a state, cannot afford to see eliminated or reduced in any capacity. 

For the full conversation listen to the County Conversations Podcast episode, The Tip of the Spear: Local Health Departments' Role in the Fight Against COVID-19, which you can find at www.nysac.org/podcast.