MMA offers suggested changes to bill intended to advance capacity of state and local public health departments

The Honorable Marjorie C. Decker, House Chair
The Honorable Julian Cyr, Senate Chair
Joint Committee on Public Health
State House, Boston

Delivered electronically

Dear Chair Decker, Chair Cyr, and Distinguished Members of the Committee,

On behalf of cities and towns across the Commonwealth, the MMA again wishes to express our deep appreciation for the powerful partnership that you and the Legislature embraced to support and assist local health departments throughout the COVID-19 pandemic. Your swift action to provide resources to address the public health emergency has made Massachusetts a national leader.

We appreciate the opportunity to offer testimony as the Committee considers next steps in advancing the capacity of state and local public health departments through An Act Relative to Accelerating Improvements to the Local and Regional Public Health System to Address Disparities in the Delivery of Public Health Services, H. 2204 and S.1334. We deeply appreciate and applaud Rep. Kane, Rep. Garlick, and Sen. Comerford for leading this important work in the Legislature, and for advocating for a program to address disparities in local health department capacity. The MMA is very supportive of the intent of the bill, but would like to offer some suggestions to ensure the bill is affordable for cities and towns and complies with Proposition 2½’s ban on new unfunded mandates.

Technical Addition to §27D(d)(i)
When the Special Commission issued its report, “Blueprint for Public Health Excellence: Recommendations for Improved Effectiveness and Efficiency of Local Public Health Protections” (“Blueprint”), one of their key findings was that most local boards of health were unable to keep up with a growing list of duties. Of course, this finding was pre-pandemic. Their duties and importance have now grown exponentially. In an era of global pandemics, we understand the desire to raise local public health performance standards. However, given the impact of inflation and changes to the labor market since the 2019 Blueprint, we expect the $140 million preliminary cost estimate to be much higher in the upcoming years. We are supportive and greatly appreciative of the additional “subject to appropriation” language that has been added in §27D(d)(i) of the bill. But to clarify the Legislature’s intent for it to be the Commonwealth’s commitment to fund these new requirements, we suggest the bill be amended to read “Subject to appropriation by the Commonwealth under subsection (f), boards of health…” as a technical clarification. Adding “Commonwealth” importantly distinguishes that the state will fund this portion, rather than other potential entities such as cities and towns, while referencing “subsection (f)” narrows the state’s commitment to that specific subsection, rather than broader board of health needs.

Clarification to §27D(f)(2)(iii)
We appreciate the intent behind the language in §27D(f)(2)(iii) clarifying that funding “shall supplement and shall not replace existing state, local, private or federal funding to boards of health…”, however we have concerns that, as written, this language would trigger an unfunded mandate by requiring municipalities to maintain local funding levels. As written, language compelling municipalities to sustain a local maintenance of effort would trigger an unfunded mandate under Proposition 2½ — potentially threatening the intent of the bill to provide uniform standards in every zip code of the Commonwealth. While competitive grants can require such a funding commitment, non-competitive grants can’t require them without running afoul of this law. We suggest removing the term “local” from this sentence and adding clarifying language for the exception of existing expiring funding sources to help clarify this concern. This would allow for a seamless transition from existing one-time sources of funding while communities continue to build toward foundational standards, wherever they exist.

We also suggest adding language to better inform the Department of Public Health, and in turn municipalities, of the costs necessary to fund these commitments as well as the cost disparities between communities. This will help create a more comprehensive picture of the costs, which can better inform the budgetary needs in future years. By understanding and accounting for the true costs necessary to comply with the standards, communities can also be held accountable for their own funding commitments.

Therefore, we suggest §27D(f)(2)(iii) should read:
“(B) confirms that funding provided pursuant to this clause shall supplement and shall not replace existing state, private or federal funding to boards of health and regional health districts, other than expiring state, private or federal grants used to implement foundational public health services; provided further, reports shall include the additional funding under subsection (f)(1) necessary to comply with the standards in future fiscal years;

We welcome the opportunity to engage on this topic of improving local and regional public health departments, and are supportive of the intent of this important legislation.

Thanks to your leadership, the partnership between state and municipal leaders has been stronger than ever during the COVID crisis and remains critical as we take steps to improve the delivery of services. If you have any questions, please do not hesitate to have your office contact me, MMA Senior Executive and Legislative Director Dave Koffman at dkoffman@mma.org, or MMA Legislative Analyst Ali DiMatteo at adimatteo@mma.org, at any time.

Thank you very much for your consideration and support of local government.

Sincerely,

Geoffrey C. Beckwith
MMA Executive Director & CEO