Health First Indiana funding to invigorate, expand county health department

MUNCIE, Ind. − The Delaware County Health Department is on track to get bigger and wealthier due to the state's Health First Indiana program.

County Health Department Administrator Jammie Bane discussed preparation for changes coming to the department in 2024 and 2025 do to an influx of state money − $1.3 million in 2024 and $2.6 million in 2025. It is expected Health First will maintain state funding past 2025.

County commissioners recently opted into the program. The state funding requires match by the county that amounts to the average of the past three local budget amounts for the department, Bane said, which amounts to $840,862.

Council member Matt Kantz said the county won't be required to exceed the county health department's existing budget to receive the money.

Bane said the department will ask for the $840,862 in local funding as its budget for 2025 and 2025. The minimum match in 2025 would be 20% of funding or about $300,000 less but Bane said county should maintain the larger amount in 2025 because it will be unknown how much funding the department would get from the state in 2026. He said the county could go to the lowest matching amount beyond 2026 if state funding continues to be strong.

But the administrator said the state has suggested the department continue to receive the $840,862 for its budget from the county due to the historic low funding for health in Delaware County.

Public vs. local spending on health care

According to figures compiled by Bane, the U.S. average for public health spending is $91 per capita. Local spending for Delaware County public health through the department amounts to $7.66 this year. Next year, with the state money, it would rise $11.61 and in 2025 with money state money, the per capita spending would reach 23.23.

"You're looking at keeping us well below where we need to be," Bane said of public health funding through his department even after millions in state revenue is added to the department budget.

He told council members that the local match concept by the state for the funding is meant to show a commitment to public health.

"We're quiet, we're off in a corner so we don't get prioritized," Bane said the the health department and county funding. "We're looking to change that."

He said the Health First program was: "The first step in the state of Indiana making an attempt to change that and bring us up to where we need to be."

He said the state program was looking to equalize public health services across the so people in large, wealthier counties and those in smaller counties can expect much the same public health services.

"It's a long road to get there but I think that's the intent," Bane said.

Council member: Difference in public vs. local spending 'disheartening'

Council member Ryan Webb said the imbalance between what Indiana spends for public health and what the country as a whole pays was "disheartening."

He said the county has health issues that must be dealt with by the community.

In paperwork provided to the council, Bane said the Indiana Department of Health ranked Delaware County 84th out of 92 counties for life expectancy, 84th out of 92 counties for adult obesity and 82nd out of 92 counties for infant mortality.

But Webb said that he has heard concerns in the community that with addition of state funding will come more state control and less autonomy to address local health needs as the local department sees fit.

The fear is, "we would be under the thumb" of state and federal officials, he said.

Specifically, Webb said that the local department handled the COVID pandemic well but there are rumblings that the virus might start spreading against this fall in large number, and a mask mandates or vaccine mandates could return on orders from the state or federal government.

"All I can tell them is, for me personally, I'm never going back there," Webb said.

Bane said that state officials have consistently said that the Health First Indiana program is not an attempt to take overt local health departments and that they have no interest in doing that. And he said that the resolution passed by the county commissioners to opt in state that the commissioners maintain oversight of the department.

Bane went on to say that if the state attempted to force the county department to take action local officials did not wish to take, the county could always opt out and accept no further money.

Local departments 'best situated' to make public health decisions

After the meeting Webb told The Star Press that he did not want the state to dictate to Delaware County best practices and procedures regarding public health.

"We learned our lesson from the national and state COVID protocols that we as a local health department are best situated to make the decisions in Delaware County relating to community health and we don't need the state meddling in our local decisions," he said.

Kantz said that local officials will be vigilant regarding any demands from the state would threaten personal liberty.

"Right now, it appears that it would be foolish not to take it and beef up the health department as it stands today," he said of the state money.

Bane is now looking to add to health department staff to address "key performance indicators" regarding the county's health with implementation of local health initiatives in the second half of 2024, according to paperwork provided the council.

Kantz said he expects it will be a challenge to fill positions needed.

"We're going to be competing against 92 other counties, plus the state, who are all increasing their pay," he said.

Bane said the local department and its board will get to pick the key performance indicators that health officials will focus on as the program gets rolling in Delaware County and provide a way to measurement of success for the department.

Council member Williams Hughes said there will also be some accountability regarding the program with the addition of a county council member to the local health department board on Jan. 1.

Webb noted that in spite of the community being a regional healthcare center, the health challenges here remain large.

"To be 82 out of 92 in infant mortality blows my mind," Webb said.

This article originally appeared on Muncie Star Press: Millions from state to invigorate, expand county health department