Oregon Health Authority Public Health Director Naomi Adlin Biggs told the Joint Interim Subcommittee on Human Services on April 21 that the state’s public health modernization program faces a roughly $262.1 million shortfall to fully implement the foundational programs and capabilities set out under Oregon’s modernization framework.

The gap means that while recent biennial investments have funded hundreds of local positions and new programs for tribes and community-based organizations, state officials say more sustained and targeted funding will be required to realize the statutory model enacted in 2015 and the goals in the public health accountability metrics.

Biggs opened the agency’s informational presentation by identifying herself: “For the record, my name is Naomi Adlin Biggs and I’m the Public Health Director at Oregon Health Authority.” She summarized the public health modernization framework as a statewide approach to ensure core governmental public health functions across four foundational program areas and related capabilities, and said, “Public health modernization is not a single program. It’s a comprehensive approach to public health that uses programs and capabilities to bring together governmental and non‑governmental resources and partners.”

Key figures provided in the briefing

- State general fund investment: $112,200,000 for the 2023–25 biennium (OHA figure reported in the hearing).
- Local public health authority (LPHA) allocations in the current biennium: $50,350,000.
- Funding to federally recognized tribes and the urban Indian health program in 2023–25: $9,700,000 (eight of nine tribes and the urban Indian program opted in).
- OHA retained approximately $20,300,000 of the modernization funds for statewide functions.
- The 2024 capacity and cost assessment (CCA) reported current estimated annual spending of $602,200,000 on foundational programs and capabilities and identified a resource gap of about $262,100,000 to fully implement those statutory requirements. For additional, non‑mandatory programs, current spending was estimated at $233,500,000 with a gap of roughly $42,000,000.

Biggs said the 2016 costing estimate of an additional $210 million per biennium to implement core modernization functions was an underestimate; the 2024 CCA produced larger gap figures after accounting for pandemic lessons and expanded definitions of equity and organizational capacity.

How funds have been used

Biggs described how state modernization dollars have been allocated and what they have funded. The current investments have supported more than 300 local public health positions, including roughly 80 positions focused on communicable disease, about 30 on environmental health, and additional positions that support multiple foundational capabilities. OHA reported hiring specialized statewide staff with modernization funds, including a climate‑related epidemiologist, a senior toxicologist, and four regional epidemiologists to provide outbreak response and surge capacity.

The presentation noted that LPHAs must complete climate resilience plans by June 30 and later demonstrate implementation; LPHAs are also implementing interventions to improve immunization access and updating all‑hazard emergency preparedness plans.

Tribes and community‑based organizations

OHA reported that eight of nine federally recognized tribes and the urban Indian health program opted into modernization funding for 2023–25. Those funds—about $9.7 million for the biennium—were described as supporting tribal public health action plans, data access improvements, workforce training and emergency preparedness work. Committee members asked OHA to follow up in writing on why the one tribe did not opt in; Co‑chairs requested that follow‑up during the hearing.

OHA’s public health equity grant program currently funds 196 community‑based organizations (CBOs) across eight program areas. The agency said 133 CBOs receive funding in at least one modernization‑funded program area; about 40% of funded CBOs receive funding in more than one area. OHA reported that funded CBOs provide services in an average of four counties and that six funded CBOs operate statewide. The agency also reported grant‑funded work is delivered in about 50 non‑English languages.

Accountability metrics and incentives

OHA described the statutory requirement that the Public Health Advisory Board establish and update an accountability metrics framework. Under the current formula, 1% of available funds is reserved for incentive payments tied to performance on process metrics; 5% of available funds is allocated to a matching component if a 5% funding increase threshold is met. Biggs said the advisory board updates the funding formula every two years and that the base funding component currently provides approximately $400,000 per LPHA (about two positions) plus demographic adjustments such as rurality and poverty indicators.

Workforce and capacity findings

The 2024 CCA—completed by 30 of 33 LPHAs and OHA’s public health division—used a national assessment tool adapted for Oregon. OHA presented self‑assessed capacity and expertise heat maps showing higher implementation levels in communicable disease control, environmental health and access to clinical preventive services, and lower implementation in prevention and health promotion, policy and planning, and organizational competencies. OHA attributed some lower health equity capability scores to a higher standard of what constitutes meaningful health equity work since 2016.

Policy package and next steps

Biggs described a policy option package that would add $2,000,000 to public health modernization funding to address immunization inequities and to offset reductions in one‑time federal COVID‑19 response funding. The agency said that additional funding, if approved, would be distributed via special payments to LPHAs, tribes and CBOs.

Committee questions and remarks

Members asked about tracking CBO performance and metrics; Biggs said the forthcoming statewide health equity plan and a statewide workforce plan—expected by the end of the biennium—will better define CBO roles and inform data collection for impact measurement. Members also raised concerns about measles risk and local pockets of low immunization; Biggs said OHA is working with local partners and neighboring states on early detection and response and noted Oregon had a recent measles outbreak the previous summer.

The informational hearing closed with no formal action on HB 5025. Co‑chairs asked for follow‑up in writing on the tribe that did not opt in to modernization funding.