Health Department budget pitch highlights doula program shift, lab upgrades, lead work and opioid‑settlement planning

Milwaukee — The Milwaukee Health Department presented its proposed 2026 budget to the Finance & Personnel Committee on Oct. 8, outlining a proposed increase in levy‑supported spending, program reorganizations and investments in modernization while flagging uncertainty tied to grant litigation and federal actions.

Sarah Osborne of the city budget office told the committee “the health department's proposed budget is almost 8% higher than their adopted 2025 budget,” while the department’s leaders described program changes, new operating arrangements and capital needs for clinics and the laboratory.

Why it matters: the Health Department manages mandated functions (disease control, inspections and clinical services) and strategic investments (lead hazard reduction, maternal and child health, neighborhood nursing). The department said it is balancing city funding, grants, ARPA and special funds while preparing for possible federal funding disruptions.

Key items and figures

Overall funding and staffing: City documents and department staff said the Health Department’s levy‑supported budget proposal is about $23.4 million with roughly $17.9 million in non‑levy funding (including grants and special funds). The department plans to draw down remaining ARPA allocations and carries an anticipated mix of grants and opioid settlement funds; the department reported an aggregate ratio near $1 in grant/other dollars for every $1 of city levy support. The department will reduce funded positions by about 8 FTEs (a 2.6% decline) in the proposed 2026 budget, and it reported administrative overhead dropped from 22.2% to 10.9% in 2025.

Doula program: Commissioner Mike Todoraitis said the department will transition its doula program from eight internally funded positions to contracting with community‑based doulas. Todoraitis said the department currently serves “a little over a 100 live births every year through our program and we're seeking to double that,” and that other cities (New York City was cited) use an outcome‑based contracting approach. The department said the shift aims to expand access, reduce staff recruiting churn and pay for outcomes rather than full‑time staffing.

Electronic health records and lab modernization: The department said it has moved to a new electronic health record (an Epic product called OCHIN/MyChart) and transitioned its laboratory information system to a modern LIMS (Clinisys), steps officials said will improve clinical data exchange, allow patients to access results, and ultimately improve billing and cost recovery at city clinics.

Lead abatement and environmental health: The department continues lead case management for children and strategic hazard reduction programs. Staff said they investigate roughly 1,200 children per year with elevated blood lead levels (the department reports data for children at and above 5 μg/dL while the state statutory enforcement threshold is 15 μg/dL); staff also described active abatement contracts, efforts to batch project work to improve contractor throughput, and a lead registry that currently lists 22 properties. Committee members asked why orders and abatements varied year to year; staff said they are working with the City Attorney’s Office to streamline order writing and to clear old or inactive orders.

Neighborhood nursing, WIC and preparedness

Neighborhood nursing pilot: The department is piloting neighborhood nursing within its clinical branch and has hired an initial nurse for outreach, with further hires expected once recruitment completes. Deputy Commissioner Jeff Lynn Brown described neighborhood nursing as a targeted public‑health outreach to collect neighborhood‑level data and connect residents to services.

WIC and federal funding risks: Department leaders said WIC funding at the state level can cover about 30 days of operations if federal funds are interrupted; they are monitoring the federal government shutdown and said they are coordinating with state partners to maintain services.

Opioid settlement funds: Department and budget staff said the city has received initial opioid settlement appropriations (including amounts in prior budgets such as $810,000 and later a $1.5 million appropriation) and expects multi‑year settlement flows totaling tens of millions of dollars over many years (staff cited roughly $33 million anticipated across a long settlement term). Department leaders said they are developing a five‑year spending plan and emphasized the need to program funds for street outreach, prevention and recovery services, and to coordinate program evaluation and academic partnerships before committing large sums.

Performance management and community health assessment

Staff described progress on dashboards, data modernization, public‑health accreditation work, and a community health assessment due for release in November; leaders said better real‑time dashboards will help managers track program outcomes and that the department wants to expand external facing dashboards for residents.

Committee feedback and next steps

Committee members pressed for clarifications on how many dwellings are abated, how much lead work focuses on rental properties, and whether the shift to contracted doulas could reduce the depth of postpartum supports. Members asked for a written follow‑up on opioid settlement spending plans and neighborhood nursing staffing timelines. The committee held the mayor’s budget communication (file 2501) to the call of the chair; the Health Department will return with requested details as the budget process continues.

Ending note

Department leaders said they will continue to pursue grants and philanthropy, complete EHR and lab installations, pilot neighborhood nursing and finalize an opioid settlement spending plan. The Health Department cautioned that litigation over federal grants and the federal budget environment could change revenue and program plans.