How Health First Indiana funding has helped counties

In a few short weeks, $150 million will be distributed to local public health departments in Indiana’s 92 counties in a second wave of funding from the Indiana Department of Health’s Health First Indiana program.

For James Vest, who oversees the Howard County Health Department, the funding allowed the agency to expand its operating hours and hire a public health nurse with a focus on child and maternal health.

“That money has allowed us to get staff to increase our hours and have additional employees. It makes it easier for people,” Vest said. “The longer this goes on, I think the better it’s going to be for the state of Indiana.”

The next cohort will include every county for the first time after six holdout counties opted into funding last month. Monies are distributed during the fiscal year, rather than the calendar year, meaning the $150 million will be distributed starting July 1. The 86 counties that participated last year qualified for a combined $75 million, divvied up according to population and health metrics.

But future funding depends on the whims of the General Assembly, which meets in a few short months to set the 2025-2026 budget.

State Health Commissioner Lindsay Weaver highlighted the flexibility of Indiana’s program that delivered dollars directly to counties to individualize priorities based on their own metrics.

“Counties can make data driven decisions on where it is most needed to invest in evidence-based initiatives that will improve health outcomes. As I travel across the state, hospital, law enforcement, school, and business leaders are all coming to share what this funding has meant to their community,” Weaver said in a statement.

“It will take time to move the needle on Indiana’s health outcomes, but the many new partnerships, programs, and initiatives underway are already being felt across the state. I’m excited that all 92 counties have opted into the program for 2025 and look forward to supporting state and local partners as they continue Health First Indiana implementation.”

Projects funded by Health First

Beyond increasing hours for the public — making it easier for Howard County residents to get vaccines and other health services — having a dedicated nurse for child and maternal health will help improve birth outcomes, Vest said.

“That program is just being developed,” he said. “We budgeted for things like sleep sacks, car seats, diapers, wipes, etc. … it’s a new one and going to be growing quite a bit to help improve our birth outcomes in our county.”

Indiana’s infant mortality rate has consistently ranked higher than the national average, meaning more Hoosier babies die of often preventable causes. The Health First site reports that the statewide infant mortality rate sits at 6.8 deaths per 1,000 live births, a five-year rate calculated by dividing the number of infant deaths by the number of live births for the years 2017-2021.

Howard County’s ranking is slightly below the state average, at 6.4 deaths per 1,000 live births. But counties vary widely, from a low of 3.2 deaths per 1,000 live births in Wabash County to 12.8 deaths per 1,000 live births in Pulaski County.

Other areas highlighted in county breakdowns include life expectancy, smoking rates, suicide rates and vaccination rates.

Smoking cessation efforts are also a popular target for Health First dollars, especially anti-vaping efforts that rely on partnerships with local schools.

An estimated 21% of Hoosiers smoke, nearly double the national rate of 11.5%. In counties like Ohio and Switzerland, those numbers tick up to 30.8% compared to just 10.5% in Hamilton County.

For Huntington County, where nearly one in four Hoosiers use tobacco, one of the priorities was partnering with the Tobacco Free Huntington Coalition. Using the Health First dollars, Huntington County purchased 5,000 units of nicotine cessation products at a cost of $5,000.

“We don’t have a high fetal or infant mortality rate, so that’s not our focus as much as we know we have a very high tobacco use in our county,” said Matt Pflieger, the county’s public health officer.

Future initiatives include collaborating with the local Boys and Girls Club to provide vaping prevention programs.

Each county must account for its spending in a budget breakdown submitted to the state health department and uploaded to Health First’s website. Huntington’s budget, for example, details its salary and benefits for a public health nurse but also includes a $100,000 memorandum of understanding with Huntington Area Transportation, which provides medical transit services to residents.

Under the program guidelines, counties must continue to fund departments at the same level but Pflieger said the state investment moved the agency beyond a “piecemeal” approach and streamlined finances. One priority has been to identify and award grants to programs already operating, rather than trying to hire additional personnel to do the work.

“Being a smaller county, some of our resources are less than other larger counties,” Pflieger said.

“We’ve said, we’re not going to just grow our health department into a larger size. Let’s find people who are already doing really good work in our community and help them do even better work. So we’ve set up some partnerships with local organizations to expand some of those services out into our county.”

Sharing their work

Indiana’s health departments already have several responsibilities spelled out in state statute, such as inspecting and permitting tattoo parlors, identifying health problems during restaurant surveys and mitigating environmental health hazards.

But local public health departments can offer so much more, said Amanda Organist, the director of nursing for Bartholomew County. Traditionally, Organist said the agency encountered residents during vaccine appointments, which offers an opportunity to connect people to local food pantries or tobacco cessation services.

Public health clinic supplies were the largest single line item expense for Bartholomew County, a category that included informational packets on the the above alongside:

  • Blood sugar screening supplies
  • Bike helmets
  • Gun locks
  • Life Jackets
  • Blood pressure monitors to loan to pregnant mothers with hypertension
  • First aid supplies for schools
  • Seat belt incentives
  • Immunization supplies
  • Condoms

“Having the extra funding and the limelight of the health department has brought more awareness of the different services we can provide. Some people just think ‘oh just go there for your shots’ or ‘go there for x, y and z’ but we’re really much more than that,” Organist said.

Vest, with Howard County, agrees. One little known service his department offers is mosquito control, which can mitigate the deadly diseases spread by the pests.

“Going forward, we’ll be able to increase other services, like with lead risk assessments. We’re looking to be able to pay for those environment assessments or lead inspections on homes,” Vest said. “We’ll increase our advertising and educational materials so folks will know who we are and what we do here.”

But doing that takes money, Vest said, even just to purchase ad space to spread the word. Such projects will require continued, stable funding for health departments.

“Hopefully it continues to be available for years to come,” said Organist.

To see county-specific budgets breaking down how public health dollars are spent, visit the Health First Indiana website and select a county.

Public health funding then and now

Bartholomew County:

Legacy Funding: $84,058.61

2024 Funding: $928,011.11

2025 Funding: $1,788,024

Howard County:

Legacy Funding: $84,503.08

2024 Funding: $944,379.54

2025 Funding: $1,819,561.50

Huntington County:

Legacy Funding: $54,377.18

2024 Funding: $371,048.43

2025 Funding: $714,909

By Whitney Downard – The Indiana Capital Chronicle is an independent, not-for-profit news organization that covers state government, policy and elections. Staffer Mia Hilkowitz contributed to this report.