1107: Public Health Leaders Push for Funding, Flexibility, and Rural Transformation

John Sheehan (0:00): This is Public Health Review Morning Edition for Wednesday, 04/15/2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials. Today, we hear about some of the big storylines and takeaways from this year's Spring Leadership Forum held in Washington, D. C, where public health officials convene for a week of strategy, training, and direct engagement with federal leaders. Our guest is Kathryn Jones, ASSO Government Affairs Senior Analyst, here to discuss what happened and where things are going with public health and the federal government.

Catherine Jones (0:33): What really stood out this year was both the scale and urgency of the moment. Having more than 40 health officials participate in ASTHO's Spring Leadership Forum created a lot of positive energy and a truly unified voice. Beyond the numbers, the conversations were really action oriented. During the week, the combination of leadership training, federal agency engagement, and congressional meetings on the hill promoted ASTHO's vision, which is optimal health for all.

John Sheehan (1:05): So a big storyline this year has been the public health infrastructure grant or FIG. And there was an emphasis on advocating for a billion dollars for the grant in fiscal year twenty seven. How has FIG already been making a big impact for states and and local municipalities?

Catherine Jones (1:24): Yeah. You're absolutely right. ASTHO members who engaged in congressional meetings were very clear that the FIG program has been transformative in their states. ASTHO's FY twenty seven appropriations focuses on $1,000,000,000 for FIG funding to address public health workforce shortages, data modernization needs, and general public health capacity and infrastructure. Importantly to note, FIG is flexible, which allows jurisdictions to tailor investments to their specific needs, whether that's hiring and training workforce, improving surveillance systems and interoperability, expanding lab capacity or foundational capacity such as emergency preparedness and communications.

Catherine Jones (2:11): The consistent message to Congress was that this program is working incredibly well, but adequate funding needs to be sustained and predictable.

John Sheehan (2:23): Yeah. And listeners to this podcast will find that message pretty familiar. In addition, a big storyline has been the rural health transformation program. What were some key takeaways from this year's Hill Day?

Catherine Jones (2:36): Well, states are very excited about the Rural Health Transformation Program. They plan to use the program in numerous ways to improve both health care and public health. Dollars are slated to expand telehealth, improve access to behavioral health services, improve maternal and child health, address substance use disorder and opioid use disorder, workforce training, access to transportation, and the list goes on and on. But the challenges are also significant, especially workforce shortages in rural areas, hospital closures, and the limited administrative capacity in rural areas to actually manage this fund. Another key theme was sustainability.

Catherine Jones (3:21): Officials are concerned about all of these improvements without long term investments to sustain them.

John Sheehan (3:28): And another big issue, certainly very, very important for our colleagues and partners in the territories and the freely associated states, has been Medicaid funding and statutory caps. What exactly is what message did those health officials want Congress to take away? And what do we need to understand about what they're facing?

Catherine Jones (3:54): We had a great delegation from The US territories and pretty associated states. The US territory's main concern is Medicaid funding, which is different from funding in the states. Medicaid in the states automatically adjusts based on needs, with the federal government matching state spending through federal medical assistance percentages, also called FMAPs. Now in the states, the FMAP is set by a formula based largely on state per capita income. For example, a 60% FMAP means that the federal government pays 60¢ of every Medicaid dollar and the state pays 40¢.

Catherine Jones (4:40): Poorer states receive a higher federal match up to 83%. Unlike the territories, states also have no Medicaid caps. So looking at the territories, Medicaid in the territories operates under fixed federal funding caps, number one, and lower or time limited FMAPs, which are determined by statute rather than the standard per capita income formula. This means that once federal funding is exhausted, territories must use local funds or reduce their services, benefits, and enrollment. Does that make sense?

John Sheehan (5:26): It does make sense. Lastly, Katherine, another challenge facing access to care. There have been some things promoted like telehealth expansion. Does anything seem like it's going to to work or that's actionable?

Catherine Jones (5:45): Veterans access to care remains a top priority in the freely associated states and US territories, with leaders urging faster VA implementation so veterans can receive care locally and not have to travel for care, which is very expensive and very disruptive for families. Some improvements that are needed on all the islands, especially in the freely associated states, are expanding telehealth services and broadband access, mail order pharmacy options, travel reimbursement programs, access to mental health services, and improving on island hospitals and clinics.

John Sheehan (6:26): Well, Katherine, thanks a lot for this update.

(5:45): Veterans access to care remains a top priority in the freely associated states and US territories, with leaders urging faster VA (6:29): Thank you.

John Sheehan (6:30): Katherine Jones is a senior analyst of government affairs for ASTHO. For more than eighty years, ASTHO has championed public health and supported the work of state and territorial health agencies across the nation. Stay ahead of the curve on emerging health policy trends and legislative developments at both the state and federal levels. Subscribe to ASTHO's legislative alerts and get timely updates delivered directly to your inbox. The link is in the show notes.

John Sheehan (6:58): Adaptive leadership requires balancing complex decision making, competing priorities, and leading diverse teams. For the fifth and final session of the Leadership Power Hour, The Mastering Clarity, Resilience, and High Impact Teams, on April 28, participants will learn critical skills that foster trust, promote accountability, and enable collaborative team dynamics under pressure. Leave with renewed clarity, actionable tools, and the confidence to inspire trust and drive meaningful outcomes, even in times of uncertainty. Find a link to register in the show notes. This has been Public Health Review Morning Edition.

John Sheehan (7:35): I'm John Sheehan for the Association of State and Territorial Health Officials.