Indiana State Health Commissioner Lindsay Weaver discussed the advantages of flexible public health funding. She is pictured at a state budget hearing on Dec. 16, 2024. (Whitney Downard/Indiana Capital Chronicle)
In a tight budget year when state-funded entities have been told that a flat appropriation is a win, Health First Indiana came off relatively well with only a modest $25 million cut over the next two-year budget cycle.
Health First Indiana, a statewide effort to increase public health funding, launched in 2023 and earmarked $75 million in state funds the first year followed by $150 million in the next year. The current version of the budget sets funding at $100 million each year.
But earlier this month, a handful of senators flagged concerns about the program and whether it was too flexible, openly musing about whether to introduce constraints on the funds. One questioned how long it would take to see results.
Supporters of the program point to the flexibility as an advantage, allowing communities to spend their funds in whatever way meets six core public health services.
“Those big metrics move in five, maybe ten years in some instances. But at the same time, I recognize that people want to see (if) what’s happening is making a difference,” said Public Health Commissioner Lindsay Weaver. “And it is.”
She noted that every county had key performance indicators to meet, whether it was reducing their tobacco rate or reducing fall-related emergency visits for senior citizens.
“I know there was a concern about oversight but there’s lots of layers of oversight,” Weaver said. “Us sitting in Indianapolis and saying, ‘Everybody in the state do the same thing’ has not been successful. But I do truly believe we are already seeing results at the local level and these locally driven initiatives will make the biggest difference.”
House lawmakers
Specific rumors about questionable spending on undocumented immigrants hadn’t yet crossed the building from the Senate into the House, where House Speaker Todd Huston said on Thursday that he hadn’t heard “any concerns” from his members other than the funding level.
Rep. Matt Hostettler, R-Patoka, said the issue of money was why he voted against the proposal in 2023.
“When I voted against the public health spending, it was because it was one time money and we didn’t know if it could continue,” said Hostettler. “I don’t mean to be prophetic, but here we sit and there’s less and less money.”
He pointed to an amendment he filed, but ultimately didn’t call for a vote, that would have sunsetted the bill after two years, ensuring the program was a one-time appropriation. While he hasn’t personally heard about whether undocumented immigrants had accessed the program, he said that it needed to be addressed if it was hindering access for Hoosiers.
“When this money was originally allocated, it was to support more healthy communities. And how do we measure that?” Hostettler asked. “If there are people that are not Hoosiers that are taking advantage of it — and that’s keeping Hoosiers from taking advantage of it — that’s an issue.”
An Indiana Capital Chronicle review of all 95 public health department expense reports didn’t find any explicit public health funding for immigrants — undocumented or not — though the City of Fishers partnered with Hamilton County Immigration Welcome Center. However, 25 other local public health departments reported using their dollars to contract with translation services.
Hostettler did flag one expense he found to be questionable: a $600 condom purchase in LaPorte County to prevent the spread of infectious diseases.
“Is that what we need to be doing? Was that the best expense of those $600 for that community? Maybe it was,” Hostettler said. “When the expenditures range from that to possibly translation services — what do we really want to do?”
Rep. Robin Shackleford, who serves as the ranking minority member on the House Public Health Committee alongside Hostettler, urged lawmakers with questions or concerns to visit the program’s website. Each county’s health goals and expenditures are publicly available for scrutiny.
“I think we have legislators that are so afraid that we’re using any type of public assistance to go towards someone that is not from Indiana or not from this country … that it is fogging their vision,” said Shackleford, D-Indianapolis. “What we really should be focusing on is the health of our state. And that is what I think these health departments are trying to focus on.”
Progress so far
Though dollars were allotted in 2023, funds didn’t start getting out in communities until January 2024, with 86 counties opting into the public health funding in the first year. Since then all have joined.
As the new budget cycle approached quickly, the state reached out to the Richard M. Fairbanks School of Public Health at Indiana University’s Indianapolis campus in late 2024 to estimate the return on investment so far. With just eight months of data, from January to August, researchers estimated that the less than $75 million distributed so far had reaped $95 million in benefits, according to a December 2024 report.
Valerie Yeager, the interim director of the university’s Center for Health Policy, said that number was a “conservative underestimate” that primarily focused on three key activities: blood pressure screenings, prenatal care and fall prevention services.
At eight months, or two-thirds of the way through the first year, the departments received roughly $50 million in public health funding, Yeager observed.
“There’s already a $95 million return. So that’s (almost) a 200% return on the investment for just three of the activities that they’ve been doing,” Yeager told the Indiana Capital Chronicle.
But payoffs may not be quick or even easy to measure. Reducing the number of falls in a community — one of the top reasons why an elderly Hoosier might enter long-term care — helps reduce community health care costs long-term by keeping a senior citizen in their home and out of a nursing home.
Prenatal care, on the other hand, can be a quicker turnaround. Getting a pregnant mother connected with those health care services, which can include screenings for gestational diabetes or vitamin access, can result in a baby with a higher birth weight. A heavier baby is more likely to be born at full-term and spends less time in an intensive care unit.
“We take all of those potential … dollars saved as a result of avoided health care services,” said Yeager. “What we will also begin to see are things like reductions in maternal deaths and reductions in infant deaths if we can increase the number of women in Indiana who also receive prenatal care early in their pregnancy.”
Nearly one-quarter of pregnant Hoosiers don’t receive prenatal care in the first trimester while another seven percent never get any care at all, Yeager said. The report further expands on this statistic by citing research estimating $4,113 in savings for each birth when women access prenatal care.
In the eight months analyzed, public health funding was used to provide or refer 11,918 women to prenatal services, generating an estimated $49,000 in savings.
“It’s a really comprehensive and very basic — but essential — service that we need to make sure is provided,” Yeager said. “Previously, public health agencies were working at such a deficit that … the Health First Indiana dollars are strategic investment for Hoosiers because it creates opportunities for the agencies to add essential services that they weren’t previously able to provide.”
Much of the efforts include partnerships with outside organizations, such as pregnancy resource centers to connect women to prenatal care. Other connections include school health services to target youth vaping and teaching local Amish communities how to Stop The Bleed, a life-saving emergency skill.
“I think of it as the foundation of our house was broken and it needs to be repaired. The Health First Indiana dollars are lifting the house back up to have a stable foundation. It’s not building a massive new addition or making a mega mansion, it’s fixing the foundation so that public health is resourced to do the crucial work necessary to reduce health care needs and health care spending by keeping people healthy,” said Yeager.
“It costs far less to keep people healthy than it does to make them well again,” she continued.
Major program supporters
And while a few senators, albeit influential ones, have questions about the program, the public funding has an “excited” supporter in Senate Majority Leader Rodric Bray.
“I’ve heard and talked to a number of local health departments. They’re enthused about the money and things that they’re able to do with it. They’re talking about hitting on some things that really matter to the health of Hoosiers and they’re excited about that. Frankly, I’m excited about that,” Bray, R-Martinsville, told reporters on Thursday.
He pointed to the possibility of improved health rankings but acknowledged funding difficulties in this budget cycle. Many local public health departments have used the dollars to hire nurses dedicated to maternal and infant health or to limiting the spread of infectious diseases.
“I’m not trying to argue that we’ll give it more money than we did in 2023 but there’s value in, at least, giving as much money. Because those folks have invested their time and people are there working,” Bray said. “They want to make sure that those jobs are going to continue to be there and continuing to have funding for that is important. At least to me.”
Weaver also noted that the program had the support of Gov. Mike Braun himself, whose budget first included that $100 million annual appropriation for public health funding. On the campaign trail, Braun identified public health as “a good place” for investing state funds.
“Frankly, in Indiana, we can’t afford not to invest in public health and those prevention programs. We’ve had poor health outcomes, including infant mortality and maternal mortality, for some time. We need to do something different and we need to make a difference,” Weaver said.
