The County Role in Public Health
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Counties play a critical role in promoting and protecting the health of people and the communities in which they live, learn, work and play. As administrators and operators of the local health safety net, county agencies employ a wide range of public health services that protect resident health and well-being through the prevention of illness, injury and other adverse health outcomes.
A robust public health system centers equity and actively promotes policies, systems and overall community conditions that drive optimal health.1
Public health is an intersectional field that works to address the underlying causes of health outcomes. This work requires both intergovernmental collaboration between federal, state and local governments, as well as multisectoral partnership across local government agencies.
This brief provides an overview of how counties provide integral public health services for all Americans, describes their public health authority, their role in preparedness and response efforts, and local public health efforts to address social determinants of health (SDOH) in our communities. The brief will also outline key federal policy recommendations for our federal partners to safeguard funding and authority for local public health services and programs.
House passes SUPPORT Act reauthorization
On June 4, the U.S. House of Representatives passed the SUPPORT for Patients and Communities Reauthorization Act of 2025 (H.R. 2483) by a strong bipartisan vote of 366–57. The bill, which reauthorizes billions of dollars for critical programs that target overdose prevention, now heads to the Senate Committee on Health, Education, Labor and Pensions, where a version of the bill was overwhelmingly advanced with bipartisan support in the 118th Congress.
CMS increases oversight on states’ use of Medicaid funds for undocumented immigrants
On May 27, the Centers for Medicare & Medicaid Services (CMS) announced it is increasing federal oversight of state Medicaid programs to ensure compliance with federal law regarding the use of Medicaid funds for undocumented immigrants.
Measles on the rise: What county officials need to know
Vaccination is the most effective defense against measles, and county leaders can use their voices to encourage uptake of the MMR vaccine.
NACo offers new Medicaid resources as Congress advances Budget Resolutions with major Medicaid reform implications
On April 10, the U.S. House of Representatives voted to adopt a Senate-passed budget resolution, marking the next step in the budget reconciliation process. The proposed funding levels therein represent significant potential cost shifts to counties, particularly in the area of Medicaid financing. To help county leaders understand what’s at stake, NACo has developed two new resources.
County Countdown – April 21, 2025
Every other week, NACo's County Countdown reviews top federal policy advocacy items with an eye towards counties and the intergovernmental partnership. This week features the ARPA reporting deadline, a budget reconciliation update and more
U.S. House reintroduces legislation to address the Medicaid Inmate Exclusion Policy
Two bipartisan bills aimed at addressing the Medicaid Inmate Exclusion Policy (MIEP) were recently reintroduced in the U.S. House of Representatives.
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