1050: Leading Through Uncertainty: State Strategies for a Changing Public Health Funding Landscape

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Monday, January 12, 2026. I'm John Sheehan, with news from the Association of State and Territorial Health Officials today.

What happens when the federal government steps back and states are asked to lead? Continuing our Legislative Prospectus Series, which examines the public health policy trends set to shape 2026, ASTHO President and Connecticut Commissioner of Public Health, Dr. Manisha Juthani, joins us to discuss the creation of a new public health emergency funding safety net and the difficult decisions leaders face when planning amid constant uncertainty. Later on, ASTHO's Senior Director of Public Health Infrastructure, Brian Lentes, will break down key federal funding streams, governance models, and practical steps states can take to stabilize infrastructure, modernize data systems, and support the public health workforce. But first, let's start with Dr. Manisha Juthani. I asked her to explain Connecticut's new public health safeguard account and what it was intended to do.

MANISHA JUTHANI: 

In this last legislative session, it was clear that we were entering a new era in public health in the country, and potentially for the state of Connecticut, because as a state public health department, we are 80% funded by the federal government. This is true for many agencies around the country, and what the legislature decided to do was establish this account which could assist in public health emergencies to ensure our ability to meet the state's public health needs. So, the goal of this account was really to be a safety net. Should there be changes that came from the federal government? Should there be an emergency where we needed to be able to access funds in a fast fashion? The legislature and the governor's office supported this particular bill, which gave us the ability to do so.

SHEEHAN: 

Did you work with the legislature to help craft the- the account?

JUTHANI: 

So, we have a very good relationship with the leadership of the Public Health Committee in the legislature, who certainly recognize the importance of public health funding. Although we didn't directly work with them on the establishment of this account, items that were in the budget are generally negotiated between the governor and the governor's office and the General Assembly, and we also were in direct communication with the public health chairs about the rescission of COVID funds. So, when the $11 billion in COVID grant funding was cut in March, that was in the middle of our legislative session, it was clear that there may be a loss that Connecticut experiences. We were one of the states that did sue, and so, we were able to retain those funds and have been using them, but they certainly were informed and well-appraised of the challenges that we were facing as a public health department.

SHEEHAN: 

You describe this, the fund, as a safety net? Does that mean that there won't be any lapses in funding pending, sort of, unforeseen changes?

JUTHANI: 

So, at this point, we have had those funds cut from COVID funds, but that we were able to have reinstated. We have other grants where it has been unclear whether they were going to be funded or not. There have been numerous threats. But again, we have had many that looked like we're going to be cut, maybe not cut. We have other grants which look like maybe cut, but have not been cut yet. And so, I think the challenge that we've had is that we don't have specific cuts that these funds have needed to be tapped to fill the gap of. However, what is available is that should something else come down the road, and it is a critical public health service that we think currently is funded by the federal government, but will be a major lapse in our governmental public health abilities, we could go to the governor's office and say that this really requires tapping into those funds which had been allocated, really for a public health emergency.

SHEEHAN: 

Gotcha. It's really concerning to, sort of, hear the hoops and the hurdles that you've got to go through in order to deal with this uncertainty. What does a plan look like going forward?

JUTHANI: 

Every plan we make gets adapted day by day, it honestly feels like, and so, what our plan going forward looks like is planning for the best case scenario and the worst case scenario and every option in-between, and being agile to be able to change in real-time as we actually see what's executed upon and what changes are coming down for us. So, it is a lot of uncertainty. It is challenging to plan for uncertainty, but what we have tried to do is try to be clear on what type of work is really a must for us to do. What do we need to do statutorily? What do we next need to do because we think it's best in the interest of public health and the residents of Connecticut? And then lastly is the bucket, unfortunately, of items that we would love to do, but are going to be lower on our priority list because there just are other things that are higher on the list. And so again, even with this emergency fund, being thoughtful about recognizing what is actually a true emergency versus what is something that we were doing that we had funding for, and maybe that funding is running out? Would it truly be an emergency to not do that work? We had to think very carefully about that. We have not had to make that exact decision just yet. I do think in '26, and potentially in '27, we may be faced with such decisions. We just haven't quite gotten there yet, and so, knowing that we do have these funds as something that we could at least talk about and get the agreement from the governor's office to say that this is an emergency that really needs funding, we just have to be thoughtful about that, because there are plenty of other potential emergencies we've imagined going forward, and we don't really want to use funds on work that we think is important, but maybe not an emergency, per se.

SHEEHAN: 

Yeah, in addition to, sort of, the clear-eyed accounting that you've had to do in this process, have you- have there been other lessons, other takeaways, things that might help other states?

JUTHANI: 

We all know that relationships and communication are at the heart of all of this type of work. Having good relationships with the governor's office, with the legislature, having key champions in the legislature of public health who trust the Public Health Department, who know that they can rely on us for good information, to help them inform things that they want to advocate for, and to be able to be good partners. So, as to say that they know we've got the best interest of the residents in Connecticut at our hearts, and that we are really trying to be good stewards of money that is given to us, so that we aren't going to be just asking for money with an endless rope where we want to support all the programs that we have, But that we too, can work with them to understand that we need to prioritize and understand that there are other priorities the state has to have, and we have to understand that. And I think that when we can be honest partners, when we can be true to what we're trying to accomplish, but understand that there are other priorities too, then I think it gives a lot of credibility to us when we say we really need something because then people know that you've been true partners in the situation.

SHEEHAN: 

And how do you view Connecticut's role, and really the role of states in, sort of, the broader nationwide public health system?

JUTHANI: 

What we've seen from the federal government is a pullback from the traditional role that it has played in public health. What that is leaving with states to do is to lead on our own, and one of the ways that we've all been doing that is to learn from each other and work together and identify best practices from each other. There are certainly certain things that only the federal government can do, and the reality is, for example, we all collect data as states. We then send that data to the federal government, and the federal government is the only one that has eyes and can put all that data together for us to be able to see what is one state doing versus another. So, we still rely on that to be able to say, let's say we're in the middle of the respiratory viral disease season, what is flu looking like around the country? But that data is coming from the states. We are the ones providing that. What we're going to do with that data is largely driven by policies at the state level, whether it be things like flu response or whether it be on other topics. Really, this is a moment where states are leading the way. The federal government has, quite frankly, asked us to do that. They've asked us to lead on a number of things. They've asked to step back from some of the traditional responsibilities they have previously led on. And so, I think when I look at being ASTHO president, being Connecticut, is, what can we do to lead our state to be as healthy as possible? And what can I learn from other states that are leading in other ways? And can all of us be models for each other in how we can collectively lead better, so that we each can work better as a unit, as a country, but at the same time, since so many public health responsibilities and authorities actually lie at the state level and not at the federal level, that we can actually use that authority to the best that we can to lead our residents in a best path forward as it relates to public health.

SHEEHAN: 

Dr. Manisha Juthani is ASTHO president and the Connecticut commissioner of public health.

Now, let's hear from ASTHO's Senior Director of Public Health Infrastructure, Brian Lentes. I asked Brian to give us some details about two grants: the Prevention and Public Health Fund and the Public Health Infrastructure Grant.

BRIAN LENTES: 

So, the Prevention and Public Health Fund, PPHF, provides sustainable federal funding for national public health initiatives like immunizations, disease surveillance, community health programs, and aims to improve public health outcomes. It's more prevention-focused and targeting improvement of the health and slowing of healthcare cost growth, where Public Health Infrastructure Grant, or PHIG, is more recent initiative using ARPA funds that focuses on strengthening state and local health departments, workforce services, to stand up essential public health services and modernized data health systems for state, territorial, and large local and city health departments. They all receive those funds. The key differences are that PPHF is a broad, long-standing funding stream for various prevention programs, when PHIG is a specific, flexible grant program designed to rebuild and modernize the foundation of public health systems.

SHEEHAN: 

And with changes expected in federal funding, are there things that states can do to, sort of, manage funds, or the way that existing funds are used?

LENTES: 

Yeah. So, there are several practices that could assist, aligning existing appropriations with cross-cutting priorities. Examples of these areas could be data modernization, workforce preparedness, updating statutes or budget language to maybe allow greater flexibility in how funds are used, are possible, considering enabling the blending or braiding of funds sustained foundational public health capabilities, and also investing baseline state dollars in core infrastructure to reduce the reliance on fluctuating federal funds, and also legislatures can strengthen oversight and performance measures to ensure efficient use of current funds. Communication is key: How we share the impacts made in the community and on the health of the populations.

SHEEHAN: 

Is there a difference, or what is the difference, between a public health agency or system that's centralized versus decentralized, and how does that play into how funding is managed?

LENTES: 

Yeah, so a centralized state health department consists of local health departments that are directly governed by the state health agency. The state controls the local staffing, budgeting, and program decisions, and public health authority. On the other hand, a decentralized model for where the health departments are governed by local governments, such as a county or city. Local authorities control staffing, budgeting, program decisions, with the state providing guidance, some oversight, and some standards. So, there can be autonomy, but there can be administrative burden due to funds management requirements being distributed across many local health authorities, potentially increasing variability and administrative complexity. On the funding impact side, in a centralized model, federal funds typically flow to the state, which then distribute, and manages funds for all jurisdictions. Whereas in a decentralized model, the funds may flow from the state to local health departments. The centralized departments may allow for more standardized implementation or streamlined reporting and consistent performance across regions. Some federal grants assume strong state level coordination, while decentralized states may need additional coordination structures to ensure consistent reporting and compliance.

SHEEHAN: 

So, Brian, given- given a little bit of uncertainty nationally right now, what are some things that states can prioritize in terms of their their infrastructure?

LENTES: 

Yeah, a few things can be a focus within the governance and financing areas of the health departments, including creating state governance frameworks with roles and dedicated decision rights and escalation paths that connect state, local, and territorial partners. You can stabilize base funding, so, establishing or increasing state baseline appropriations for core public health functions is an option, and enabling flexible funding, so, removing restrictive line items, allowing braiding and layering of program funds can be beneficial, and potentially even using multi-year budgets to safeguard against federal funding swings in the workforce in organizational capacity areas, departments can invest in workforce development pipelines such as internships, loan retainer programs and career ladders to retain staff. They can also consider creating shared service models for functions such as human resources or procurement or even IT. This helps, frees up staff for program work. Departments really should have a focus on data, IT, and interoperability. They may need to prioritize statewide data modernization by adopting interoperable standards and new governance models and application program interfaces that support secure data exchange. Standard metrics and reporting processes to reduce duplicative data collection will be important moving forward. And finally, when you're thinking about areas such as preparedness or supply chain and facilities, they also have opportunities to invest in things such as modern lab capacity and regional lab networks, and also strengthen continuity of operations planning by involving multiple sister agencies wherever possible. We anticipate that states and territories will continue advancing legislation that strengthens their public health systems and reduces reliance on fluctuating federal funding. Together, these actions can propose states and territories to build a more resilient and responsive public health infrastructure.

SHEEHAN: 

Brian Lentes is ASTHO senior director of public health infrastructure.

Earlier, we heard from Dr. Manisha Juthani, ASTHO president and the Connecticut commissioner of public health. They spoke with us as part of ASTHO's Legislative Prospectus Series, which highlights the policy trends set to shape public health in 2026.

Public health data is evolving, and interoperability is the next frontier. Join us, Thursday, January 22, for a webinar titled, 'The Next Frontier of Public Health Interoperability: TEFCA, HDUs, and What Comes next.' Experts from state and local public health, health information exchanges, and data networks will explore how intermediaries like HIEs and health data utilities are making real-world data exchange possible and what it means for public health action.

Join Dr. Manisha Juthani, commissioner of the Connecticut Department of Public Health, and ASTHO president, and John Auerbach, senior vice president for public health, ICF, for an Insight and Inspiration webinar that examines how clear, purposeful leadership strengthens both internal and external trust through discussion and reflection. We will examine how leaders embody steadiness amid uncertainty, set a sustainable pace and provide calm direction that builds trust and drives performance. This conversation aims to inspire participants to recognize their composure and capacity, not as a personal indulgence, but as a fundamental leadership function that shapes the overall tone, focus, and confidence of their organizations. Join us for this 'Steady Hands, Steady Teams: Leading with Confidence and Composure' session happening February 11 at 4 p.m. Eastern. The link to register is in the show notes.

This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.