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Six counties choose not to join first year of Indiana’s public health program. Here’s why one waited

By Abigail Ruhman

Posted December 24, 2024

The sign for the Johnson County Health Department and Coroner's Office on the side of a brick building, with the county's seal underneath.

The director for the Johnson County Health Department said it will use the funding for things like immunizations, fatality review, and trauma and injury prevention. (Abigail Ruhman/IPB News)

When Indiana overhauled its public health system in 2023, county health departments had to opt-in to the program. Six counties did not participate in the first year, but joined in year two. Johnson County was one of them.

Betsy Swearingen, director of the Johnson County Health Department, said the county commissioners wanted to see what happened with the first year of funding before they joined.

“At the beginning of 2024, we started having some serious conversations about why we didn't take the money,” Swearingen said. “Should we have taken the money? What would that look like if we did take the money?”

The Health First Indiana initiative was a result of 2023 legislation.

County elected officials were in charge of the decision to take Health First Indiana funding to provide additional core public health services. Before lawmakers expanded public health funding, counties shared about $7 million from the state annually

Crawford, Fountain, Harrison, Wells and Whitley counties will also be joining the initiative for the first time in 2025.

To receive the funding, counties must spend at least 60 percent of it on “core preventative services” such as immunizations, chronic disease prevention, and maternal and child health. The Indiana Department of Health said a key component of the initiative is to allow local health departments to determine how the funding is spent since they have insight on what their communities need.

Swearingen said part of the reason the county chose not to join the first year was because county officials and the county health department felt they were successful without the funding.

“We did kind of a self assessment of the core competencies and we thought that we were doing a pretty good job, that we were probably at about 90 percent of those — maybe somewhere in that ballpark or maybe a little higher,” Swearingen said. “And that there were some things that we could work on but that we pretty much were doing them without the funding.”

She said there was more of a benefit for smaller counties who didn’t have the same resources.

“These funds have allowed smaller health departments or health departments that may not have the financial means that we have here in Johnson County to hire new personnel and to expand their programming,” Swearingen said.

Ahead of the deadline for 2025 funding, Swearingen said the IDOH met with Johnson County officials and other stakeholders to discuss joining the program.

“They outlined what was working, what wasn't working, what the other counties were thinking about the [Health First Indiana] funds and what it would look like if we took them,” Swearingen said.

Swearingen said the county commissioners were concerned because it was a new program, and speaking with IDOH helped address some of their fears.

“The commissioners decided to try it,” Swearingen said. “We're always going to have to re-opt in every year, so we try it. We see if we like it in 2025 then and if it better serves our community.”

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The Johnson County Department of Health has a team that meets monthly with “subject matter experts” in the county to decide what to do with the funding come January. Swearingen said she wants to utilize those experts to decide the best way to utilize the funding.

“It's a lot of money,” Swearingen said. “I think that there's a lot of responsibility that comes with that, and I think that that will take a chunk of our time to make sure that we're being good stewards with these finances.”

Swearingen said Johnson County will use the funding for things like immunizations, fatality review, and trauma and injury prevention. She said Johnson County’s immunization rate is 63rd in the state.

“We hope to move up in that ranking so that we would be better and that our immunization rate of 57.7 percent would increase as well,” Swearingen said.

Swearingen said she hopes the funding helps strengthen already established relationships the county has with partners, like law enforcement, emergency response services and area health providers. She also said Johnson County will work with surrounding counties to help them where they can to better offer services.

Abigail is our health reporter. Contact them at aruhman@wboi.org.