Legislative Committee Proposes Systemic Changes Amid Funding Crisis
A Georgia legislative committee has released five comprehensive recommendations to restructure the state’s public health system, addressing decades of chronic underfunding and administrative challenges. The proposals emerge from extensive hearings across Georgia, highlighting critical gaps in a hybrid system where 159 county health departments share control with state-level agencies.
The committee’s formation stemmed from alarming statistics: less than $1 of every $10 spent on Georgia’s three health agencies reaches the Department of Public Health (DPH). This agency bears responsibility for disaster preparedness, outbreak response, air and water quality monitoring, disease prevention, and population health initiatives. The remaining funding flows to the Department of Community Health, which administers Medicaid, and the Department of Behavioral Health and Developmental Disabilities.
Understanding Georgia’s Public Health Funding Crisis
The Current Financial Landscape
Georgia’s public health infrastructure operates under significant financial constraints that limit service delivery statewide. County health departments collectively received $187.8 million from DPH in fiscal year 2025 for general operations, while counties contributed only $48.5 million in fiscal 2024—far exceeding their required $12.2 million contribution under an outdated formula.
Scott Thorpe, executive director of the Southern Alliance for Public Health Leadership, emphasized the fundamental challenge: “The ultimate answer is that local health departments will — at some point — need more money or will need to cut programs and services. It’s that simple.”
Representative Darlene Taylor, the Thomasville Republican who chaired the committee, acknowledged that increased funding for public health will come eventually, but not during the current legislative session. She cited federal budget uncertainty and a strategic approach to reform the system “piece by piece.”
Five Key Recommendations for System Reform
1. Modernizing County Funding Formulas
The committee recommends updating the county match requirement for local health department contributions. Currently, the formula relies on population and tax digest data predating 1972, creating significant inequities across Georgia’s diverse counties.
Leah Chan, director of health justice at the Georgia Budget and Policy Institute, praised the modernization effort: “This is a really important step toward strengthening our public health infrastructure and being able to keep Georgia’s community safe and healthy.”
However, counties express concern about increased financial burdens, particularly with proposed property tax reductions on the horizon. Todd Edwards, director of government affairs for the Association of County Commissioners of Georgia (ACCG), noted: “We’re not looking to increase additional expenses on counties when our revenue is about to be decreased.”
Jack Bernard, chairman of the Fayette County Board of Health, criticized the approach given Georgia’s $14.6 billion budget surplus: “The state should have put more money into this and not dump it on the county. Our state is wealthy.”
2. Protecting Employee Benefits During Transitions
The committee proposes allowing local board of health staff to retain accrued leave when transitioning to state appointments. Under Georgia’s hybrid system, county workers lose their leave benefits when moving to district or state positions—a significant disincentive for career advancement.
Representative Taylor introduced legislation to address this barrier, which unanimously passed the House Public and Community Health committee. The bill aims to create “a sustainable career ladder that will help in improving employee retention in public health.”
3. Establishing Clear Accountability Standards
Streamlining the public health system to create transparent lines of authority, consistent service standards, and accountability measures represents a critical reform priority. Currently, only four entities in Georgia hold accreditation from the Public Health Accreditation Board: the state DPH, Cobb & Douglas Public Health, Gwinnett-Newton-Rockdale Public Health, and District 4 Public Health.
Bernard advocates for mandatory accreditation statewide: “The public health certification process takes it away from theory and puts it into practice that you’ve got to set down your goals and objectives.”
4. Consolidating County Boards into District Boards
Transitioning from 159 individual county health boards to 18 district boards would consolidate administrative burden and improve resource allocation. The recommendation addresses rural counties’ inability to leverage economies of scale with limited resources.
Chris Scoggins, a public health professor at Middle Georgia State University, supports regionalization while emphasizing local representation: “Doing so in a way that preserves the voice, values, and lived experience of our rural residents is critical.”
5. Granting DPH Authority for District Reconfiguration
Allowing DPH to update health district composition without unanimous local consent would enable the state to align districts with current demographics and community needs. This flexibility could prove essential as Georgia’s population patterns shift.
Balancing State Control and Local Input
The recommendations reveal tensions between centralized efficiency and local autonomy. Bernard highlighted this contradiction: “These recommendations are sort of contrary. Number one, it says we want counties to contribute more. And then it basically says, ‘Oh, by the way, we’re going to do away with any coordination with your local county officials.'”
County health boards provide crucial benefits beyond governance, mobilizing local leaders including county commissioners, school district representatives, physicians, and city officials to advocate for public health resources and support.
The Path Forward for Georgia Public Health
Georgia’s public health system stands at a crossroads. With nearly 6,000 workers employed across state and local health departments, workforce challenges compound funding shortages. Chan noted that “below market average salaries” and impending retirements threaten system stability.
The legislative committee’s recommendations represent initial steps toward comprehensive reform. However, sustainable transformation requires addressing the fundamental funding gap that has plagued Georgia’s public health infrastructure for decades. As these proposals move through the legislative process, stakeholders must balance fiscal responsibility, local control, and the critical mission of protecting population health across Georgia’s diverse communities.
