Public Health Funding Needs Clarity and Predictability

As Maryland rethinks how it supports public health, counties are calling for clarity, consistency, and a stronger state-local partnership. Counties’ feedback urges a modern approach to funding, one that reflects today’s public health realities and helps local governments plan responsibly.

Medicaid As previously covered by MACo, Maryland’s Commission on Public Health released a draft slate of over 60 recommendations to strengthen and modernize the state’s public health system. Following the draft’s release and the 30-day public comment period, MACo submitted formal feedback highlighting county priorities, especially regarding funding formulas, state-local coordination, and support for modern public health governance.

MACo weighed in with feedback on the draft recommendations:

The Maryland Association of Counties (MACo), representing the state’s 24 jurisdictions, appreciates the opportunity to provide input and offers support for the Commission’s draft recommendation to revisit and modernize the core funding formula for local health departments.

Local health department funding is a shared responsibility between the State and county governments. Local health departments provide essential services tailored to the unique needs of their communities, which have become increasingly complex in recent years. The core funding formula, which serves as the foundational support for these services, has not been meaningfully updated in decades. While counties broadly support a review and potential modernization of the full funding framework, MACo’s most pressing concern relates specifically to the lack of transparency and predictability in how local matching contributions are calculated and applied.

In 2024, several counties faced unexpected and unbudgeted increases in their required local match contributions for state health funding, some of which were communicated after local budgets had been finalized. These increases, tied to state employee salary adjustments outside the core formula, created confusion and financial strain for local governments and ultimately resulted in a waiver, which is not a sustainable long-term solution.

The current funding model is unclear, outdated, and misaligned with modern public health practices. While the methodology includes adjustments for inflation and population growth, it fails to account for evolving public health challenges, new mandates, or unexpected cost increases.

MACo urges the Commission to give special attention to clarifying how local contributions are determined and communicated. Local governments must be able to rely on a predictable, understandable system when crafting their annual budgets, especially when matching requirements can have significant fiscal impacts at the county level. A modernized formula would strengthen the state-county partnership and better position Maryland to respond to the health needs of its residents.

Thank you for your consideration and for your work on this important issue.

As the Commission finalizes its recommendations and the State considers next steps, counties will remain active participants in the conversation. MACo will continue to advocate for a fair and functional funding model that reflects local realities and supports long-term public health success.

Stay tuned to Conduit Street for more information.

At the 2025 MACo Summer Conference general session, “Leading Through Limits: Protecting Public Health,” panelists will explore how LHDs are managing limited budgets, setting priorities, and making the case for modernizing Maryland’s local health funding formula to support long-term stability and outcomes.

The 2025 MACo Summer Conference will be held at the Roland Powell Convention Center in Ocean City, MD, from August 13-16. This year’s theme is “Funding the Future: The Evolving Role of Local Government.” More information can be found on our conference website.