Hill Day Advocacy at ASTHO’s 2026 Spring Leadership Forum

March 16, 2026 | Catherine Jones

While spring brings many familiar rites of passage, ASTHO’s Spring Leadership Forum stands out as a defining moment each year. For one week, ASTHO Board Members convene with health officials from states and the U.S. territories and freely associated states (FAS) in Washington, D.C., to examine pressing public health policy issues, participate in leadership and policy training, and align cross-jurisdictional priorities.

This year’s forum saw a record number of more than 40 health officials. It included discussions with federal agency experts, meetings with congressional offices during Hill Day, and specialized sessions (e.g., Rural Health Academy and public health communications in the AI Era).

Federal Agency Meetings

ASTHO’s Board of Directors met with leadership from HHS, including representatives from the Office of the Assistant Secretary for Health, CMS, Administration for Strategic Preparedness and Response, SAMHSA, and HRSA. Discussions focused on:

• Strategic priorities for each agency.
• How to strengthen federal-state collaboration.
• Sustaining public health infrastructure.
• Addressing emerging health priorities.

Hill Day Meetings About Public Health Funding

ASTHO organized meetings with members of Congress and their staff to highlight the importance of sustained, stable, and robust public health funding — specifically, the Public Health Infrastructure Grant (PHIG) and Rural Health Transformation Program (RHTP).

PHIG

A central priority was advocating for a $1 billion allocation for PHIG in FY27 to strengthen the public health workforce, data systems, and foundational capabilities health departments rely on. Officials noted the impactful use of PHIG dollars in their states, how this funding directly supports local health departments, and emphasized that public health funding has historically followed a boom-and-bust cycle tied to emergencies — leaving federal agencies and state and local health departments to respond to major crises without consistent infrastructure and workforce support between events.

RHTP

Conversations also addressed the Rural Health Transformation Program and the challenges of deploying large federal investments quickly and effectively. Participants discussed an innovative pilot that allows Medicare reimbursement for emergency medical services responding to calls that do not result in hospital transport. Additional topics included:

• Clinical workforce shortages.
• Measles outbreaks.
• Vaccine access and insurance coverage.
• Emergency preparedness (i.e., the Strategic National Stockpile).
• Adequate lab capacity.
• Impacts of delays in federal grant funding.
• Workforce.
• Broader efforts to redesign health care systems to prioritize prevention and keep patients out of emergency rooms.

Hill Day Discussions with U.S. Territories and Freely Associated States

Meetings with congressional committees focused on issues facing the U.S. territories and FAS, such as those surrounding Medicaid funding and access to care for veterans.

Medicaid Funding

Territorial health leaders emphasized the critical role Medicaid plays in sustaining island healthcare systems, where the program serves as a backbone of coverage for many residents. Congressional action has helped stabilize territorial Medicaid funding by establishing a permanent 83 percent Federal Medical Assistance Percentage (FMAP) for the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa, and a temporary 76 percent FMAP for Puerto Rico. However, leaders stressed that Medicaid funding remains vulnerable to statutory caps that are too low and future policy changes. They also emphasized Puerto Rico’s current FMAP will expire in 2027.

Access to Care for Veterans

Representatives from FAS (the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau) raised concerns about access to health care and mental health services for veterans. While veterans from these nations are eligible for certain benefits through the Department of Veterans Affairs, many must travel long distances to receive care in Guam or U.S. states — creating significant financial and logistical barriers. Leaders emphasized solutions to improve access, including:

• Expanding telehealth services.
• Mail-order pharmacy options.
• Beneficiary travel programs.
• Leveraging existing on-island hospitals and clinics.

Ensuring veterans can receive care and age in place in their home communities supports their health, strengthens local health systems, and reinforces longstanding partnerships between U.S. states and critical Pacific Island allies.

Looking Ahead

ASTHO extends its sincere appreciation to the members of Congress, congressional staff, committee staff, and federal agency leaders who met with state and island delegations and engaged in thoughtful dialogue on strengthening public health systems. In the months ahead, ASTHO’s Government Affairs team will continue working closely with congressional offices to provide timely data and perspectives, and to advocate for sustained federal investment in public health programs and territorial and FAS health care issues.

ASTHO remains committed to advancing solutions to ensure health agencies have the resources and flexibility needed to address today’s public health challenges and prepare for those ahead.

Reviewed by Carolyn Mullen, Senior Vice President, Government Affairs and Public Relations.