Committee hears how Georgia public health is organized and funded — districts, grants, EMR rollout and budget pressures

State and local public‑health officials briefed a Georgia House study committee on how county health departments are organized and how DPH allocates state and federal funds, and they described operational differences between urban and rural counties.

Chris Ruston, interim district health director for Fulton County, and Will Bell, chief financial officer for the Georgia Department of Public Health, gave detailed descriptions of districts, staffing and DPH’s FY26 appropriation and county grant flows.

Structure and service delivery

Georgia’s public‑health system is a hybrid: oversight and technical assistance come from the state Department of Public Health while a county board of health in each of the state’s 159 counties sets local policy and approves local budgets. The state is organized into 18 public‑health districts; some districts are a single populous county (for example, Fulton) while others cover many rural counties.

District directors serve as the operational link between state and local boards: they are appointed by the DPH commissioner, vetted by county boards of health and act as chief executive for district governance. Local county health departments provide direct services — immunizations, WIC, family planning, STD/HIV testing and treatment, environmental health inspections, newborn and children’s screening programs — but the mix and frequency of services varies by county size and staff availability.

“District staff provide economies of scale — IT, HR and finance functions — so a 1‑county health department isn’t required to staff all of those functions,” Ruston said, summarizing how districts support smaller counties.

Funding flows and grant types

CFO Will Bell told the committee DPH’s FY26 appropriation totals approximately $922,500,000 across funding sources. Federal funds account for roughly half of that total ($464,800,000), with WIC alone representing about $250,000,000 of federal funding. Bell said the FY26 state general fund appropriation for DPH is about $402,700,000 and that roughly half of that state funding is distributed to county health departments as general grant‑in‑aid.

Bell explained two major categories of grant aid to counties:

- General grant and aid: state funds to support local public‑health infrastructure (personnel, basic operations). DPH allocates these funds annually via a formula last updated in 2011 that weights county population (40%), county population under poverty (40%) and county poverty rate (20%). The county “local match” requirement stems from the master agreement between DPH and county boards of health; the required base match across all counties was approximately $12,200,000 in FY24 though counties collectively provided more than that ($48,500,000 total county funding in FY24). Bell said three counties missed the match last year.

- Programmatic grant and aid: funds directed to specific programs (for example, HIV/Ryan White, maternal and child health, emergency preparedness). Bell said about 75% of programmatic grant aid originates with federal agencies.

Bell provided FY25 headcount figures showing roughly 4,245 staff working at county health departments statewide and about 1,079 employees at DPH’s state office. He also presented district‑level grant and aid spreads: general grant aid a median of roughly $11,000,000 per district and programmatic grant aid median about $11,000,000 per district (district totals vary widely by population and program).

EMR roll‑out, telehealth and lab capacity

Committee members pressed officials on data systems and billing. Ruston said the state selected an electronic medical record (EMR) vendor, Patagonia, and plans a phased rollout over roughly 24 months with rural and urban pilots; the stated goal is to move districts from disparate systems to a single platform to improve data flow, reporting and program oversight. DPH officials said the federal infrastructure grant will initially pay implementation costs, and the state will evaluate long‑term maintenance and possible cost‑sharing after stabilization.

Officials described telehealth and teledentistry pilots, expanded HIV telemedicine and regional specialty clinics that use telemedicine for pediatric genetics, neurology, and other services. Ruston described the Georgia Public Health Laboratory’s scope — a Decatur headquarters and a smaller Waycross facility — with more than 150 lab staff, about 115 assays available and nearly 360,000 newborn screening specimens processed in FY24 (more than 8 million tests and hundreds of thousands of QC runs across the lab’s work in FY24).

Questions from lawmakers focused on workforce, billing and local funding. Panelists said nursing, environmental health specialists and nutritionists are the hardest positions to recruit and retain; competition from private hospitals, remote‑work options and variable county funding levels all contribute to turnover. The committee heard that county pay and career ladders vary and that DPH and districts have increased targeted salary funding in recent years to help retention.

What lawmakers asked and next steps

Members asked whether the EMR could enable statewide billing agreements and collective contracting with insurers. Officials noted structural limits because local clinical staff are county board employees rather than state employees; any broad contracting approach would need statutory or governance changes to implement statewide billing or contracting arrangements.

Bell and Ruston told members they will provide county‑level breakout data on general grant aid and local match amounts on request. Committee members said follow‑up questions will focus on the master agreement, county contributions, EMR cost‑sharing and workforce career ladders.

Ending

Officials urged legislators to consider how state investments can shore up the core workforce and infrastructure as federal funding shifts. The committee will hold additional hearings and compile recommendations and a final report on funding and organizational options for Georgia public health.