The Navajo County Board of Supervisors held a regular meeting Tuesday, Sept. 23, during which the board heard from Public Health Director Janelle Linn regarding how the changes in federal funding sources will negatively impact the county.
“There are fundamental changes and continued uncertainty in public health,” she began. Linn provided a federal timeline to what lead to this monumental shift, explaining that these dates “mark the most significant disruption in our health district’s history.”
Beginning on Jan. 20, of this year, the U.S. withdrew from the World Health Organization and executive orders rescinded Biden-era policies on COVID-19 relief, preparedness and health equity, while a communication freeze was placed on the Department of Health and Human Services (HHS) and the Center for Disease Control (CDC). One month later in February, there were workforce reductions at CDC and National Institute of Health, which impacted over 5,000 employees.
“That filtered down to states and this ended with ADHS (Arizona Department of Health Services) having to let go of 57 infection disease investigators and laboratory employees,” Linn explained.
In March, stop-work orders terminated several COVID-19–related grants and reduction in force notices were issued. Linn noted, “Multiple federal grants received stop-work orders and those directly impacted us with the loss of our Health Disparities grant, our ELC (Epidemiology and Laboratory Capacity) Surveillance grant and five different immunization grants.” HHS also announced the elimination of 10,000 positions and the creation of the Administration for a Healthy America.
She explained that The Big Beautiful Bill, that was signed into law in July, cut nearly $1 trillion from Medicaid with significant implications for rural and public health. By August, oversight of federal grantmaking was tightened, making for easier cancellation of initiatives. CDC Director Susan Monarez was dismissed after 29 days in her position, “due to refusing to sign off on projects that had recommendations that were not rooted in science,” according to Linn.
Due to these events, major federal grants have been suspended or eliminated entirely. Linn reviewed the priorities that are under threat with these changes. She stated the Health Services District is 75% grant funded, and the cuts impacted 20 members of her staff, with seven positions being lost due to reduction in force, three of which were public health nurses. “That’s 14% of my department,” she added.
A total of $984,900 in grant funding has been eliminated, with additional cuts looming. Tribal services will be impacted by the US Department of Agriculture’s SNAP-Ed nutrition funding loss, “There will be impacts to nutritional programs on tribal lands effective Oct. 1.” Linn also explained that important grant funded positions are being held vacant due to unstable funding.
Services that are being eliminated included health disparities work, nutrition programs and work, chronic disease prevention, community outreach liaisons and mental health first aide. Services that are at risk for being further reduced are school immunization clinics and vaccination outreach, naloxone distribution, emergency mitigation and response, public health improvement and workforce development. This reduced outreach and services will result in increased community burden.
The cuts in Medicaid pose real threats to rural care access, with approximately 60% of Navajo County currently on Medicaid. “The Big Beautiful Bill cut Medicaid by $1 trillion dollars,” stated Linn, which will put up to 11 million people at risk for losing coverage, 12,274 of which reside within Navajo County. This cut will also result in further job loss, with 1,408 healthcare workers at risk for losing their employment in the county alone. This will cause further loss in specialty care services and increased risks of rural hospital closures.
Medicaid cuts will impact the county’s Community Heath Improvement Plan (CHIP) as well. Nutrition, housing, childcare, substance use, mental health, chronic disease and infectious diseases will all be negatively affected.
Loss of funding to nutrition, mental health and substance use will have rippling effects according to Linn. SNAP cuts will result in approximately 2,400 Arizona jobs being lost, with food insecurity projected to increase chronic school absenteeism by 5.4% in Arizona, with Linn noting, “Hungry children struggle to concentrate and focus on their schoolwork.” Poor nutrition will likely lead to an increase in chronic disease and healthcare costs and a decrease in learning and productivity.
Criminal justice will also suffer. Community-based public health has been proven to be more effective than incarceration, with funded inmate public health services reducing recidivism by 43%. Linn explained, “Every dollar spent on re-entry programs has a return of investment of $6.73.” Cuts to this funding is predicted to result in increased recidivism, causing increased tax-payer burden for incarceration costs and fewer individuals transitioning into the workforce successfully.
Negative effects will also be felt on the economy. Every dollar invested in public health and pandemic preparedness yields significant returns through reduced healthcare costs, improved productivity, health gains and gross domestic product growth. In rural areas like Navajo County, healthcare jobs are among the best-paying. Funding losses threaten residents’ ability to sustain a middle-class lifestyle and therefore make communities less attractive to families and businesses, directly undermining economic development and long-term viability.
Following this presentation, Linn made a call to action, for people to be a public health champion. “Sustaining and supporting our public health infrastructure is essential. It is foundational to building healthy, thriving communities. Without greater attention and advocacy, our public health system risks becoming increasingly unstable under its current trajectory.”
Linn asked for support in de-siloing public health funds and advocacy for programs including Public Health Emergency Preparedness, Women Infants and Children (WIC), Medicaid rural protections and rural health transformation funds. She encouraged people to follow key bills, SUD & MH Grant (HR 2483), FEMA Reform (HR 4669) and Senate appropriations for WIC funding. “My opinion is that, as a public health official with 23 years of experience, these changes are atrocities,” stated Linn, “You can stand with us as we fight to ensure public health policies and recommendations are made based on evidence and science, rather than swayed by political opinions.”
County Manager Bryan Layton followed up by stating that health determinants intersect with the justice system. This decline in public health and assistance will mean more work for law enforcement officers, justice courts, probation departments and so on. “So not only are we losing money to support our workers in the health department, but we’re also going to probably have increased costs on the criminal justice side.”
Following Linn, Workforce Innovation Opportunity Act (WIOA) Executive Director for Arizona@Work Adam Garrard provided updates on that organization’s funding and local workforce to the board. Local Workforce Development Areas (WIOA local areas) are responsible for a range of functions aimed at enhancing workforce development and employment opportunities including local plan development, labor market analysis, stakeholder and employer engagement, management of one-stop centers and other avenues that promote workforce development in northeastern Arizona.
WIOA funds youth work experiences, on-the-job training for adults, layoff assistance and retraining/support for dislocated workers. According to Garrard, funding has been reduced by 12%. “We are now down to $195,000 for three individuals to provide services.”
According to Garrard, these budget reductions have job coaches from six to three for three counties, limited school presence and has reduced access to training. One-stop operator funding and travel were also cut, weakening in-person oversight. Training costs, such as CDL programs, have outpaced funding, forcing lowered reimbursement caps that restrict participant access.
Job center costs are already minimized, but further cuts could close all three centers, eliminating in-person services. With only 2.5 administrative staff, Garrard stated the program is operating at bare minimum just to stay compliant.
While Senate Bill S.2587 keeps WIOA funding largely flat with a 1% reduction, the House Appropriations Act (H.R. 5304) makes severe cuts by reducing WIOA state grants by $1.7 billion, leaving only $1.3 billion nationwide. The act also completely eliminates WIOA Youth funding, which is $948 million, and a $713 million cut to Adult Job Training. “Without this funding, we are left with limited resources for economic growth,” explained Garrard.
Garrard noted that while WIOA is still law, it has expired and requires reauthorization. He encouraged people to advocate to federally elected officials to fund WIOA, and push for youth and adult funding. “We cannot lose this funding. It is very critical, especially in a rural area where we have limited resources already.”
