By Casey Smith
Indiana Capital Chronicle

INDIANA — Local health officials across Indiana are gearing up to receive their share of a historic wave of state funding meant to increase disease prevention efforts and improve Hoosiers’ overall well-being.

The vast majority of Indiana’s counties opted to participate in a statewide program designed to revamp the state’s public health investment — which until now has averaged $55 per resident, far below the national average of $91 per capita.

Each county had until Sept. 1 to finalize their decision. Ultimately, 86 of the 92 counties joined. In all, 6.5 million Hoosiers, equal to 96% of the state’s population, are covered by a county that has opted in to the new public health initiative.

“This funding … has brought together communities, including state and local elected officials, health care leaders, schools, businesses, community organizations and citizens to evaluate their local needs and then brainstorm solutions,” said Dr. Lindsay Weaver, the state health commissioner, last week at the State Budget Committee.

“This is a first-of-its-kind investment in public health, and we are putting health first, and moving into the space of prevention,” she continued.”

The new state funds will be disbursed to counties on or after Jan. 1.

The six counties that didn’t opt in — Whitley, Wells, Fountain, Johnson, Crawford and Harrison — will receive their legacy funding of $387,000 for the 2024 fiscal year, Weaver said.

The funding that they did not receive will be redistributed to the other counties that did, Weaver said. Those counties can still participate in the 2025 cohort, however.

Prior to the program, called Health First Indiana, the state’s public health investment was around $6.9 million, compared to the 2024 commitment of $75 million followed by $150 million in 2025.

What’s happening in Indiana’s counties

Counties qualify for a range of funding, depending on whether they meet specific goals and their county matching amount.

Weaver said the dollars are expected to largely be used for tobacco prevention and cessation, chronic disease prevention, trauma and injury prevention, referrals to clinical care, and maternal and child health.

“These are new spaces for our locals to be digging into recognizing where their specific needs are and identifying opportunities for improvement,” she told the budget committee on Friday.

Counties are required to submit an annual financial report before funding is dispersed each year. Local health departments will additionally need to submit an annual report to the state health department and detail how the dollars were spent.

Weaver said state health officials have reviewed all of the budgets submitted by participating counties and ensured that they are meeting the statutory requirements. No more than 10% of a local department’s budget can be spent on capital expenses, and no more than 40% of the funding should be earmarked for regulatory costs. Although there was a waiver to allow counties to go over that threshold, if needed, none were submitted.

Weaver indicated that 78% of the new public health funding is going towards prevention and health outcome core services. Only 22% of the state dollars are going to be used for regulatory expenses, she said.

She added, too, that 68 Indiana counties are partnering with community agencies in the first year to provide core public health services. That includes off-site and mobile clinics, as well as partnerships with hospitals and community-based programs.

Weaver said some counties are providing fitness and nutrition services through a YMCA or Purdue Extension, while others are using new local connections to purchase AEDs for schools and provide car seats to those in the community.

Specifically, St. Joseph will use some of its funding to invest in chronic diseases prevention and maternal and child health, Weaver said. Clark County is working with two Federally Qualified Health Centers “to assist in bridging the gap in pregnancy care.” And Floyd County is also partnering with family health services to provide maternal child health needs and substance use disorder treatment.

A separate semi-annual report also has to be completed at the local level and will provide updates on key performance indicators.

The key performance indicators, or KPIs, measure a county’s progress toward implementing various health initiatives and goals set forth by the state health department.

Counties must develop their own local key performance indicators by 2024.

At the state level, the first batch of key performance indicators “are about identifying leading causes,” Weaver said. With new funding, counties are tasked with putting in place specific programs to address the leading cause of trauma and injury, for example.

“Our approach this first year is to acknowledge that we’re starting at the bottom and we have nowhere to go but up. We hope to quickly move from key performance indicators into very specific metric key performance indicators,” Weaver said. “But this is new work. Just having the counties take that scale back and look and see what really is a leading cause of trauma and injury in their community, and then implementing a program, is novel for many of our communities.”

Already, the state has  developed an Indiana County Health Scorecard to track seven health metrics, including life expectancy, infant mortality, smoking rate and obesity.

The Indiana Department of Health is also working on creating a centralized website for public health-related job postings at the state and local levels.

A first step, with more to come

Still, Weaver emphasized that one round of state funding towards public health won’t be enough to produce major or long-lasting results.

She told state budget regulators that the General Assembly should be prepared to make continued, significant investments in the state’s public health program for at least the next four to five budget cycles.

“This is going to take time. This truly is an investment in our future. We are confident we’ll be able to show improvement in local outcomes as soon as the end of next year, and that we’ll be able to start to see those micro improvements,” Weaver said. “But when you’re talking about changing big metrics, big numbers, that will take some time, but we take the steps.”

The state health commissioner said that for now, the plan is to define what metrics Indiana wants to improve most.

She reiterated that root causes for different health issues vary from county to county, and that some time will be needed just to identify which solutions work best at each local level. New funding and community partnerships will help make that happen, Weaver said.

But while metrics at the local level will improve sooner, moving the marker on a broader scale could take more than a decade.

“If we’re looking to improve national rankings and metrics, that takes time — that’s the five or 10 years,” Weaver said. “But I do think we’ll be able to see that incremental improvement over time and know that this investment is for our kids’ future and our grandchildren’s future.”

Committee chairman Rep. Jeff Thompson, R-Lizton, insinuated his support for long-term funding, given the overall cost savings to the state.

“Medicaid is the fastest growing part of our state budget, and at the rate it is currently going, it’s not good,” Thompson said. “And so we’ve got to change the health of our public at large, because the cost is growing and growing.”