Future of Public Health:
Finance and Investment Planning Guide

Strengthening the Financial Foundations of Public Health in California

The California Department of Public Health's (CDPH) Office of Policy and Planning is committed to strengthening the financial sustainability of local health jurisdictions (LHJs) to build a stronger public health system statewide. As part of the Future of Public Health initiative, this guide offers stable and flexible funding strategies to meet evolving public health needs as well as unique needs depending on LHJ capacity. CDPH contracted with Health Management Associates, Inc. (HMA) to develop the Finance and Investing Planning Guide and provide training for state and local health department leadership.

The Finance and Investing Planning Guide provides a focused understanding of the current state of public health financing in California. It also outlines a detailed analysis of revenue maximization opportunities for LHJs and CDPH to consider. The revenue maximization opportunities range from activities that LHJs can implement under existing programming, as well as new programming to explore. Additionally, the guide highlights opportunities to better align public health and healthcare systems through coordinated planning, shared funding strategies, and collaborative system design.

The Finance and Investing Planning Guide serves as a roadmap for California's 61 LHJs and CDPH to:

Understand the current public health financing model and existing gaps
Explore opportunities to optimize and expand revenue sources
Align local public health priorities with Medi-Cal and CalAIM initiatives
Advance workforce development, health equity, and systems integration

This guide was informed by input from dozens of stakeholders, including public health leaders, local officials, and statewide associations. It supports data-driven, strategic investment decisions to ensure Californians have access to foundational public health services.

Why This Work Matters

The COVID-19 pandemic exposed longstanding challenges in public health capacity—from outdated infrastructure to insufficient funding streams. In response, California launched the Future of Public Health initiative in 2022 and has invested nearly $300 million annually since then to transform and modernize the system. This guide helps make the most of those investments by:

Estimating actual staffing and infrastructure needs across LHJs
Providing models for sustainable funding and resource alignment
Offering training and technical assistance on implementation strategies

Key Features of the Finance and Investing Planning Guide

Local Infrastructure Assessment

Includes a model to help LHJs estimate their foundational staffing and resource needs based on population size, geography, and mandates.

Revenue Maximization Opportunities

Outlines current and emerging opportunities for LHJs to leverage Medi-Cal and federal funding, including:

Targeted Case Management (TCM)
County-Based Medi-Cal Administrative Activities (CMAA)
Maternal, Child, and Adolescent Health Federal Financial Participation
Community Health Workers and Doulas under CalAIM

Training and Technical Support

CDPH and HMA offered some training on how to use the guide for local planning, infrastructure development, and funding alignment. Opportunities for future trainings are pending.