Health First Indiana: A Big Step in the Right Direction

Fellow Professional Highlight Blog Post

Tyler Warman (Class VII Fellow) is the Director of Intergovernmental Affairs in the Governor’s Office, working directly with local elected officials in all 92 counties. Tyler is a graduate of Hillsdale College with a degree in politics.

"While Indiana is firing on all cylinders economically, our state ranks poorly when it comes to health. If you were to think about all 50 states as a car out on the racetrack…we'd be in the 16th or 17th row," Governor Eric Holcomb said last January. 

Indiana is 45th in smoking and tobacco use, 46th in obesity, and 45th in public health funding. Not coincidentally, the majority of public health funding has historically been provided by local governments with limited revenues. County investments differed, ranging from $83 per Hoosier to as low as $1.25. The rest was a combination of grants and $7 million split between 92 counties each year. These troubling numbers illustrated the threat to the physical health of our state and shone a spotlight on the critical need for enhanced public health funding.

Governor Holcomb recognized this need and, in 2021, established the Governor’s Public Health Commission which included the Indiana Department of Health, local elected officials and health officers, and various public and rural health organizations. This commission met regularly throughout the year, hosting public meetings and extensive listening tours across the state. 

Following the commission’s report, Governor Holcomb made public health a major tenet of his 2023 legislative agenda, advocating for a historic amount of funding with the goal of giving every Hoosier access to core public health services. 

When first introduced, the legislation had a tough road ahead. Skepticism ran deep, whether it was the amount of funding needed or the number of interested counties. The team gathered feedback and recommendations from countless stakeholders, improving the legislation at every step and building support among local elected officials and legislators. Transparency and communication were key, answering every question and addressing every concern. 

The final product became Health First Indiana (HFI), a voluntary program in which counties vote whether to participate, provide a match to the new funding, and agree to provide core public health services. With this new program, $225 million over the biennium, a historic level of funding and a 1,500% increase, was committed to be distributed to participating counties. What began with a statewide task force focused on taking a comprehensive look at our public health landscape ended with the largest increase in state funding for public health in our state’s history.

Once the bipartisan legislation passed overwhelmingly, the hard work continued. Crisscrossing the state, the goal was to illustrate how Hoosiers would benefit from their county opting in to this program. Key to this effort was providing local elected officials and local health departments the data, tools, and flexibility to improve their county’s health in innovative ways according to their own needs and priorities. 

In HFI’s first year, 86 counties made the jump, each with a unique and tailored approach to the funding. Ripley County is funding their mobile integrated health program with EMS. Madison County is outfitting a mobile unit to provide services to distant parts of their county. Kosciusko County is partnering with Lutheran Hospital to provide vouchers for early pregnancy care and transportation to prenatal visits. These are just a few examples of the impact this historic funding is making. 

In May 2024, all 92 counties opted into the Health First Indiana program. Indiana is now leading by example in public health with other states looking to us for inspiration and best practices. Our health care professionals and local health departments can spend more time preventing illness than treating it. We can benefit as a state from the strong link between public health and economic prosperity, with increased productivity and lower health care costs over the long-term. 

While 92 counties opting in is a critical milestone, the work is not over. As the next biennial budget approaches, I encourage the General Assembly to continue this popular and transformational investment into the public health of our state, county by county.