1174: Medicaid Collaboration and Vector-Borne Disease Policy

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Tuesday, July 28, 2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials.

 

Strong public health systems depend on collaboration, like partnerships across agencies or coordinating responses to emerging health threats. Today, ASTHO Senior Analyst for State Health Policy Beth Giambrone discusses a recent ASTHO Health Policy Update that examines how states are approaching vector-borne disease policy through surveillance, reporting requirements, education, and cross-agency coordination.

 

Later, ASTHO Senior Analyst for Medicaid and Health Systems Partnerships Orobosa Idehen introduces a new Medicaid Oversight Governance map designed to help state agencies better understand their governance structures, strengthen relationships with Medicaid partners, and identify opportunities to improve population health.

 

Let's start with Beth Giambrone. So, Beth, states are working on a lot of vector-borne disease policies right now, from tick remediation and mosquito plans, what are the different approaches telling us about what states are doing?

 

BETH GIAMBRONE: 

What you see from these approaches is that states and territories, and how they define their roles and what they do is really dependent on a number of factors. One of the biggest ones is regional differences. So, if you look at states like, say, in the southeast that may have to focus more on mosquito-borne diseases, as opposed to the northern states where they may have to take more actions against tick-borne diseases, those regional differences really, really come into play. The other factor that we see a lot is what role the agency or the state in general has on vector-borne diseases to begin with. So, in some cases, in the blog, you'll see that legislation is defining the state's role in vector-borne disease controls. So, for example, establishing mosquito management programs or mosquito surveillance programs. On the other hand, you might see, and you see legislation that's more redefining the department's roles. So, for example, integrating remediation into existing management programs for mosquitoes or for ticks, sharing results for pathogen testing with other relevant agencies. So, it really just depends on the state and what their needs are.

 

SHEEHAN: 

Yep, and some states are expanding their reporting requirements for, for example, for something like Alpha Syndrome. That presents challenges as well as opportunities.

 

GIAMBRONE: 

It does. One of the things, and I will say, one of the reasons why we're starting to see more surveillance and reporting requirements is that we're now starting to see diseases here in the United States that weren't here 10 to 20 years ago. So that is a large reason for why we're starting to see obviously some more surveillance. There's definitely some advantages and challenges to both. For advantages, what we're seeing is that having more accurate data on the prevalence of a disease, any disease, whether it's Lyme disease, Alpha-gal, Rocky Mountain Spotted Fever, West Nile, the prevalence of it, seeing that in a particular state, can help impact everything in the state, from researching into disease and treating diseases. And even if right now there isn't a current treatment, that data can be used to help prevention programs. Now, the challenge is there are a lot of the challenges that we see in public health. You know, having limited resources, whether it's funding or whether it's staff to do these surveillance programs. You know, having added reporting requirements does add an administrative burden, especially if it's a new requirement, so you know there could be a situation where a state may be unable to fulfill the legislative requirement that was given to them, or might be fulfilling it at the expense of other public health programs.

 

SHEEHAN: 

Yep, and another theme that comes up in the Health Policy Update is cross agency or you know intra agency within a government collaboration. Why is that? Why is that important in maybe helping lessen that burden?

 

GIAMBRONE: 

So, I think one of the big reasons why it's so important is just getting to exactly what you're saying: lessening the burden because the burden is now being shared by multiple agencies. There are definitely situations you might see in a state where you're getting data that maybe another agency is already collecting. So, there's no reason to have two different agencies collecting the same data. So, having the ability to be able to collaborate between those between agencies for the information that they need is not only a time saver, it can be a fund finance saver because you know you're now able to take the money that you would have used for that data collection and put it to something else. And there's a lot of different ways that states can do that. There's no real one right way to do it. There are multiple effective ways. So, as you see in the blog, you know there's legislation that might require that or establish the coordination between those agencies. You can use the rulemaking process. You know sometimes a bill might say that you know the agencies need to coordinate, but they won't tell the agencies how to do that. So, they can then decide what the best way for coordination is. There are other states that can use and have used memorandums of understanding to establish that, and sometimes it's just as simple as one agency getting on the phone with another agency and asking them, "Hey, what do you have? Where is it that we can work together to get the best data that works for everybody?" Every state's needs are different, so you know, if a state is thinking about doing this type of coordination, it's really good for them to think about how coordination works now in their state, and you know, are they going to need formal language to do that? Because formal language, it's, as you can see from what I was talking about, isn't necessarily needed.

 

SHEEHAN: 

And in an example going the other way, New York State recently vetoed their tick-borne illness reporting requirement, which just shows you know there are real logistical challenges to this kind of this kind of reporting.

 

GIAMBRONE: 

Yes, there are definitely a lot of logistical challenges. So, the reason why it was vetoed by the governor was because there was a lack of appropriated funding for the program, and unfunded mandates continue to be a challenge in public health. And you know, things like these reporting requirements, you know, if there's no funding behind it, can be a real challenge because coordinating the surveillance, coordinating that reporting, that can take resources, and not having that funding makes it really, really difficult, almost impossible, to fulfill that goal that the legislature wants. So, you know, this is why it's very important for states to be able to adequately fund public health and public health programs,

 

SHEEHAN: 

100%. And so many of the education-focused proposals involving public awareness campaigns and provider training screenings, all this stuff cost money. How do policymakers think about balancing those investments versus the actual surveillance and vector control programs?

 

GIAMBRONE: 

This, for policymakers, that's the primary challenge because there really is there's always a need to be to do both. So, you know, if you think about it from the, you know, medical education standpoint, you know healthcare providers need to be trained to recognize symptoms of disease, so of new diseases or you know current diseases like Lyme disease. They need to be able to know what the proper treatment protocols are. You know, resident estates need to know how to prevent those diseases in the first place from spreading or happening to them. And conversely, agencies need to know, like where the disease is. Is it located in their state? How prevalent is it? You know, is it concentrated in a one area? So, then that way they can concentrate those resources in that particular area. I think what I've seen over just doing this research and working on this, a lot of these, a lot of this legislation rather, they've legislatures are looking at what they already have in place and what the specific needs of their jurisdiction, their state, their territory are, and then making those decisions on what needs to be done. So, you might have a situation where a state already has a very, very strong surveillance program, but now they're realizing they need to start putting more, you know, putting additional effort into education or into training, giving medical training to medical professionals. It's always going to be different for every jurisdiction, and I think that's for when you're looking at this, that can be sometimes difficult for someone to see because there really isn't a silver bullet, and it really is dependent on what the state needs, as opposed to something that is a one-size-fits-all solution to the problem.

 

SHEEHAN: 

Beth Giambrone is ASTHO's senior analyst for State Health Policy. Now let's hear from Orobosa Idehen, ASTHO's senior analyst for Medicaid and Health Systems Partnerships, about a new Medicaid Oversight Governance map designed to help state agencies better understand their governance structures, strengthen relationships with Medicaid partners, and identify opportunities to improve population health. So, before we get started into what this map is, what problem was the Medicaid Oversight Governance map designed to fix?

 

OROBOSA IDEHEN: 

Yeah, I don't think it was necessarily trying to solve a problem, but more so build a case with our Medicaid and Health Systems Partnership portfolio. We try to work with states to go through this, of building partnerships with their Medicaid counterparts, and so the first unspoken part of this framework is understanding your governance, and then we work to establish priority alignment, and then from there we encourage states to go through this audit of cross-agency relationships, and then finally work through mechanisms, whether that's policy mechanisms, data mechanisms, to push the needle on those priority areas, so this map is really that first step of this unspoken framework that our team uses as we work with states.

 

SHEEHAN: 

Gotcha. And so, what is this thing?

 

IDEHEN: 

This is a visual tool that we're hoping provides public health leaders with a baseline understanding of Medicaid and public health program structure and oversight. And so, it's not a tool that you just necessarily look at, and you throw it away. But we're hoping that there's some interaction here with state health agencies, where states are able to understand their own governance, and then also look at other governance structures across the country, see how they fare with other states in terms of their governance structure, the opportunity for relationship development, and from there, just how to move their priorities along the line of this framework that I shared with you before.

 

SHEEHAN: 

Okay, and one of the one of the details it highlights is things like if Medicaid and public health sit in the same agency, and who has oversight of them. Why is that important to highlight?

 

IDEHEN: 

Yeah, our team really believes that a large part of the governance conversation can lead into the conversation around partnerships between Medicaid and public health agencies, and so understanding your governance gives you understanding of whether the partnerships are established through the structures, or if you might need to get a bit more innovative in partnering with your Medicaid sister agencies. And so, we're hoping that the public health and Medicaid workforce can see who they should be partnering with through this map. See if they have if shows have oversight of Medicaid, what influence they have there around Medicaid policies, and just see just a visual tool on what those partnerships can look like and what they currently stand as.

 

SHEEHAN: 

Okay, and as you mentioned, it is a tool. It's not just for reference. So, how are you hoping that state agencies can use it?

 

IDEHEN: 

Yeah, beyond what I've already said, we actually, funny enough, got a request today from a state health official who just wanted to see what other state structures look like, and so there's a way that you can look at your own state's governance structure, which you probably know. There's a lot of turnover in our state health agencies, so there's an opportunity to just check in on your state. But there's also a chance to glance at other state governance structures, see how many shows have oversight of Medicaid, maybe even tap into those shows and see what they're doing with that oversight governance structure that they have, how they leverage that to partner with Medicaid and improve population health outcomes. So, we're hoping that you're not just looking and seeing who folks are, but maybe even reach over to the state across and see how their governance structure impacts partnerships.

 

SHEEHAN: 

Yeah, and how you can examine your own governance structure and partnerships, where the gaps might be, how you can align with other organizations.

 

IDEHEN: 

Exactly, exactly.

 

SHEEHAN: 

And so, with that in mind, say it were your first time looking at the map, what would be your way in to sort of explore it?

 

 IDEHEN: 

I think the first thing that you want to do is understand ultimately understand what your governance structure is. We've kind of broken it down to umbrella agencies where you might be public health might be in the same agency as Medicaid. We have a specific description for shows who have oversight of Medicaid, and then we have freestanding, which shows that your public health agency is separate from your Medicaid agency. And so, the first thing you want to do is see what that governance structure is, and from there start thinking about how that governance structure impacts your opportunity for partnerships. I think a lot of people think that once you have that embedded internal super agency structure, then partnerships are given. But that's not always the case. You want to start taking an audit. Okay, if we sit in the same agency, what do partnerships look like? Are there advisory committees? Are there spaces where we can collaborate? Since these structures are already there, and then for states that don't have that structural support for partnerships, you have the opportunity to get a bit more innovative. Okay, we don't sit in the same agency, so that might mean that I need to know a person who knows a person at Medicaid and start creating those relationships there, and be a lot more, like I said, innovative about what it looks like to establish data sharing structures, advisory committees to push the needle on policies or any priority that might be shared between Medicaid and public health.

 

SHEEHAN: 

Orobosa Idehen is ASTHO's senior analyst for Medicaid and health systems partnerships.

 

Earlier, we heard from Beth Giambrone, ASTHO's senior analyst for State Health Policy.

 

In spring 2026, ASTHO completed a needs assessment to better understand the strengths, gaps, and opportunities for communication about sexually transmitted infections (STIs) from state and territorial health departments. Results highlight the important role that health department leadership plays in ensuring the success of STI and other public health programs through internal communication policies and culture. Find more about improving public health communication for effective STI programs at the link in the show notes.

 

ASTHO welcomes new member Tesha Quail, interim director of the Division of Public Health for the Delaware Department of Health and Social Services. Dr. Quayle joined the Division of Public Health in 2013 and most recently served as associate deputy director, overseeing the Birth to Three programs and community health promotion. She is also an adjunct professor at Wilmington University in the College of Health Professions and Natural Sciences. Learn more about Dr. Quail through the link 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.