1111: How Flexible Funding Is Reshaping Public Health

JOHN SHEEHAN:

This is Public Health Review Morning Edition for Wednesday, April 22, 2026 I’m John Sheehan with news from the Association of State and Territorial Health Officials.  Today: How Flexible Funding Is Reshaping Public Health.  We talk with ASTHO Senior Analyst for Chronic Disease & Health Improvement, Corinne Gillenwater.  She’ll unpack the limitations of traditional, siloed funding models and describe a more adaptive approach of flexible funding.  It’s the topic of the upcoming ASTHO webinar, “Driving Impact with Flexible Funding.” 

Corinne Gillenwater, welcome to the show.

CORINNE GILLENWATER:

Thanks so much for having me, great to be here.

SHEEHAN:

So Corinne, what issues or what problems is the webinar set up to handle? What is the problem with traditional public health funding models?

GILLENWATER:

So the webinar is going to take a look at traditional versus flexible funding strategies. And when we think about traditional funding, we think about just the really complex and diverse mix of funding streams that public health gets. So federal, state, local, foundation, even private funding sources that public health agencies use to help sustain their services and address emerging health challenges. So the reason that traditional public health can sometimes have some gaps is that

It can be rigid and restrictive, only allowing for certain work to be done and that leads to missing natural points of connection. So for example, let's say if you have funding earmarked for diabetes work, then it sometimes isn't able to be used for related issues like hypertension or obesity or heart disease, even though those are very closely linked and share many of the same risk factors. So over time, that kind of categorical funding can lead to working inside

instead of working on broader chronic disease prevention efforts. And so sometimes the funding streams don't match up with the way that health happens in the real world. Health issues and the community factors that impact them, of course, overlap, intersect, compound. So if the funding stays very rigid, this can sometimes stifle the collaboration and efforts that would be required to apply those funding streams to health issues more holistically. So that's where flexible funding

can sometimes step in is help to address those gaps by bringing together multiple streams towards common goals to allow for more comprehensive and adaptable programming.

SHEEHAN:

And that makes a lot of sense. The example you cited of diabetes care makes complete sense. It would be frustrating if something is categorized a certain way and therefore restricts funding so you can't apply it towards something that's very much in the same realm as diabetes care. So what does that shift away from funding silos in the traditional funding method, away from that into flexible funding? What does that look like?

GILLENWATER:

Exactly.

So at ASDA we've been really lucky to have had conversations with flexible funding experts at state health agencies across the US and what we're seeing from them is usage of three main methods. So those are braiding, blending and layering. Braiding seems to be the most commonly used flexible funding strategy that we're seeing and it really involves taking multiple complex funding sources and really using them towards a shared goal while still being able

to track them separately and have separate accountability for each funding source. So that seems to be the most popular. And then blending takes this a step further by taking a bunch of different funds and combining them into one single stream. Now that one is a little bit tricky because you need to make sure that program goals, eligibility, and reporting requirements very, very closely aligned because again, you're making that one stream. And then layering is probably the second most popular after braiding.

and that is taking multiple funding sources for the same initiative and making sure each stream maintains its own budgeting and reporting requirements, but otherwise using them towards a common goal in same initiative.

SHEEHAN:

I see. And how are states handling this? Like what are some strategies that states are using to advance this?

GILLENWATER:

Yeah, we've had a lot of great examples that we've learned from to most specifically from our report that the webinar is going to touch on. We're experts in California and Colorado sharing some of their experiences. So for instance, in California, their nutrition and physical activity division were able to braid and layer some funding streams related to nutrition, specifically the USDA's farm to school program. And they were able to leverage that with

other funding streams related to physical activity, tobacco cessation, and behavioral health. So like we mentioned before, being able to use a bunch of different streams to tackle a lot of interrelated problems. And then in Colorado, health agency staff were able to grade the CDC state physical activity and nutrition or SPAN grant with a diabetes grant fund that they also had to help improve food access through nonprofit partnerships.

looked like was taking a lot of different funding streams and focusing in on the problem of food access as a crucial community driver of health and then working hand-in-hand to provide funding to a nonprofit called the Food Bank of the Rockies which helped to offer direct services to communities to help reduce food insecurity. So there's a lot of great examples out there of states being able to use different federal funds like Preventive Health and Health Services or PHHS.

as block grants, as well as the Public Health Infrastructure Grant, or FIG, with some state general funds and special state funds related to tax and fee programs and private or philanthropy donations. so states are getting really innovative about bringing all these different streams together and being able to tackle these interrelated problems.

SHEEHAN:

Yeah, those sounds like some very creative solutions.

GILLENWATER:

Exactly.

SHEEHAN:

So the webinar breaks down into opportunities, challenges, and lessons revolving flex funding. What are some common challenges that some states run into?

GILLENWATER:

Yeah, and that's so true because flexible funding has so many benefits and advantages, but of course nothing is without its headaches. So something we're hearing a lot from states is the administrative burden that comes alongside flexible funding. So of course when you're bringing together so many different funding streams and each one has their own particular requirements and runs on their own particular grant cycle, you're going to have some issues with tracking and making sure you have the right infrastructure, have things go

going along different timelines. So a lot of work goes into making sure that you have the right system in place to be able to do flexible funding. And so a lot of states are coming up with the issue of just not having the right tracking tools or the right financial management software or not having enough time to train their staff to build their own capacity to help alleviate some of this burden. And so sometimes when you think of this administrative burden, some leadership,

in agencies might not be willing to buy into this. They might not think that it's worth the headache that it causes. And so being able to get that leadership buy-in as well as community buy-in, so talking to the community members that these public health programs aim to serve, that takes time, that takes trust, and that kind of relationship building does not happen overnight. And so what would be really helpful there would be able to show those stakeholder groups the return on investment, but even that can get difficult.

because we don't have a lot of evaluation methods just yet or tracking models to show how effective and efficient flexible funding is. And so our advice, I think, to state health agencies from what we've heard from experts is to really try to name and identify these implementation challenges early and often so that you can try to work on and devise solutions with your leadership and with your community and try to figure out the solutions that

best for your jurisdiction.

SHEEHAN:

And you kind of have alluded to this already, the notion of the administrative burden and having to sort of account for different ways that funding streams have to be accounted for and categorized. And these are specifically kind of governmental quandaries, things that come up when you're dealing with government requirements.

Can you talk a little bit more about sort of the unique constraints and things you have to consider when working through government settings like this?

GILLENWATER:

Absolutely.

And one of the suggestions we had was around financial management software. I think governmental agencies would benefit from really taking the time and money and effort to really investing in the right infrastructure there. So just taking the time to shop around, compare and determine those tracking tools and that software licensure that fits best for your jurisdiction's needs. And then another thing that governmental agencies might want to consider is making sure

the right training opportunities, making sure to have the right workforce development opportunities for their staff to increase their capacity for tracking and reporting on these multiple funding streams. I think having that training in place as well as having that financial infrastructure foundation would really help to reduce that administrative burden in the long run. And then another helpful tidbit would be for agencies to make sure that they have a plan around

storing and maintaining all of the documentation. As we mentioned, because of the number of funding streams that you'll be braiding, layering and blending, this is a lot of documents. This is a lot of data, making sure that there's some user-friendly guides around where to store it, how to make sure all team members have access to it. Those are really critical to have in place before starting or expanding your flexible funding models. And this will help you too in the long run because then you'll have the ability to track data,

and conduct analyses as well as produce some of those impact reports that will help you make that return on investment case when the time comes. So in terms of that as well, again, like we said before, what's one of the most pivotal things is having a collaborative environment, making sure to break down those silos and encourage that cross agency collaboration so that different teams can know what each is working on and maybe how can we share resources

GILLENWATER:

How can we pull together time, resources towards these similar public health goals? And so keeping informed of what's going on at your agency across different teams might help to allow for those natural points of connection where you can say, okay, actually these streams might be able to be braided together because we're working towards a common goal. So having those natural points early and often is definitely critical there.

I think similarly with that collaboration and that collaborative environment, it will be important to get leadership on board early as well as community members. So thinking through different meaningful engagement opportunities, whether it be a needs assessment or a survey or a town hall, just really getting their input in on how to co-create these solutions and these flexible funding strategies I think will be super important to getting and sustaining that buy-in. 

And then lastly, think just getting creative with programming, developing pilot programs, using phased or staggered implementation methods, and testing new flexible funding models where possible and appropriate, you know, where there's space to learn by trial and error. I think that that's an extremely helpful way to do it and making sure to document the successes, but equally as important, documenting the failures so that we learn through all these best practices about how to scale and

sustain the different effective flexible funding strategies used by health agencies across the nation.

SHEEHAN:

Thank you. Corinne Gillenwater, thanks so much.

GILLENWATER:

Thank you.

SHEEHAN:

Corinne Gillenwater is a senior analyst for Chronic Disease & Health Improvement at ASTHO.  The ASTHO webinar, “Driving Impact with Flexible Funding” is April 28th.

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Today is Earth Day, and ASTHO supports state and territorial health agencies in their work to protect the public’s health by addressing environmental health, or the intersection of people’s health with the environments in which they live, work, and play. Environmental health encompasses foundational factors of health like food and water safety, air quality, healthy and safe housing, and preventing disease carried by vectors like ticks and mosquitoes. Find a link to more resources 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.