Harder for Us, Easier for Them: How Wisconsin Is Reducing Administrative Burden on Local Health Departments

June 16, 2026 | Melissa Touma

Public health funding is meant to translate resources into action, supporting people, systems, and services that protect and improve community health. Yet over time, reporting requirements, approvals, and compliance checks have accumulated into administrative structures that slow progress instead of accelerating it. For local and tribal health departments, this administrative weight often pulls staff away from community‑focused work and toward managing paperwork, processes, and workarounds.

As a flexible and recipient-driven funding model that aims to improve the public health system, the Public Health Infrastructure Grant (PHIG) offers a unique opportunity for state recipients to reimagine how they support local and tribal health departments to enhance system-wide efficiency and effectiveness. PHIG does not prescribe how states must reduce burden, but asks recipients to demonstrate how they are reducing administrative requirements and reporting burden put on local health departments and subrecipients.

The Wisconsin Department of Health Services has approached this challenge deliberately, reshaping how grants are designed, managed, and experienced by local and tribal partners. Grounded in a “customer service” mindset, Wisconsin is implementing practical and replicable strategies that are reducing administrative burden, maintaining compliance, and strengthening relationships along the way.

Starting With Structure and Putting Relationships at the Center

Wisconsin’s effort began with a simple but transformative principle: the state should absorb complexity so local and tribal partners don’t have to. Internally, this mantra, “harder for us, easier for them”, became a guide for every PHIG management decision.

A key enabler was where PHIG lived in the department. Instead of placing the grant program in a compliance‑ or finance‑focused unit, Wisconsin housed it within its Office of Policy and Practice Alignment (OPPA) whose core mission is maintaining strong relationships with local health departments, tribes, and statewide partners. This structural decision ensured that customer service and partnership guided implementation choices. Within OPPA, regional directors serve as direct liaisons, maintaining close, interpersonal relationships with the state’s 84 local and 11 tribal health departments. This relationship‑based model allows the state to test ideas, refine communications, and gather real-time feedback before decisions are finalized, improving the way that policies and processes are informed by the lived experience of those implementing the work. This consistent, trusted presence has strengthened communication and created a feedback loop that supports both accountability and efficiency.

Equally important to Wisconsin’s transformative principle was timing. The team managing the grant was new and able to approach the workplan without the weight of legacy grant management practices. Without assumptions about “how grants are always done,” staff questioned each requirement from the outset, leaning into the flexibility PHIG offered. This allowed Wisconsin to challenge the status quo and design processes around current needs rather than precedent.

“We start with the bare minimum, what we know is absolutely necessary, and we make sure we have a really strong justification for anything else we’re going to require.”

Engaging the Public Health Workforce to Set Funding Priorities

To inform how it would invest a portion of PHIG funds, Wisconsin implemented a participatory budgeting process in 2025 that invited ideas directly from the field. The state surveyed all governmental public health staff — including state, local, and tribal partners — asking for broad, creative ideas to strengthen public health infrastructure. The OPPA team cataloged, reviewed, and refined more than 100 ideas through multiple rounds of screening, scoring, and discussion with state leadership, local health officers, and system partners. Rather than funding individual ideas, the Wisconsin Department of Health Services used the results to identify shared priorities and translate them into larger, collaborative investments — such as regional service and resource‑sharing grants and statewide communications initiatives — ensuring that field input meaningfully shaped funding decisions.

Innovating Through Contracting: Paying Tools and Services Directly

One of Wisconsin’s most impactful burden reduction strategies involves rethinking how common costs and services are procured and paid for on behalf of local and tribal health departments. Traditionally, covering expenses such as accreditation fees would have required amending dozens of individual pass‑through agreements, a heavy administrative burden for both the state and local health departments. Instead, Wisconsin asked a different question: Is there a way to achieve the same outcome without requiring local departments to manage the transaction at all?

Based on feedback from a focus group of local health department leaders, Wisconsin secured a sole‑source contract with the Public Health Accreditation Board, allowing the state to pay accreditation fees directly on behalf of local and tribal health departments. This approach removed the need for invoices, reimbursements, and local procurement processes while still delivering the full benefit of accreditation support. With the direct contractual relationship established, Wisconsin is also able to pay for Public Health Accreditation Board staff to provide direct technical assistance to Wisconsin local and tribal health departments.

Building on the success of this approach, Wisconsin pursued an additional sole‑source waiver with the Wisconsin Association of Local Health Departments and Boards (WALHDAB), the state’s association of county and city health officials. The WALHDAB waiver was intentionally written to allow for broader fiscal agent responsibilities which let the state pilot other burden reducing approaches, including the bulk purchase of Academy of Science memberships on behalf of local health departments. Rather than issuing small grants or reimbursements, WALHDAB purchased the memberships centrally, allowing participating departments to access the platform directly without managing invoices, contracts, or payments themselves.

Both sole‑source approaches required thoughtful change management. Internally, teams had to move past the assumption that funding must always “flow through” locals to have local impact. Externally, clear communication was essential to ensure health departments understood that while they would not receive funds directly, the state designed the model to reduce burden, increase efficiency, and maximize value.

Moving Resources Faster Through Regional Granting

Wisconsin also redesigned how funding moved out the door by creating a regional service and resource sharing grant program, intentionally structured to reduce administrative friction and accelerate impact. Instead of issuing a competitive request for applications, the state used a minimal selection process to identify subrecipients within each region of local health departments, which allowed the state to move quickly without sacrificing transparency or collaboration.

Under this model, Wisconsin asked local health departments in each of its five regions to self-select a fiscal host by voting via survey regions to self-select a fiscal host, drawing on existing relationships and trusted partnerships. Once selected, fiscal hosts worked collaboratively with other health departments in their region to develop shared work plans focused on identified opportunities within the Foundational Public Health Services framework. By avoiding competition and emphasizing collaboration, the approach encouraged coordination and collective problem-solving rather than duplication of effort.

This structure allowed funds to be available in roughly half the time of a traditional request for application, with agreements finalized in approximately 10 weeks. To further reduce burden, Wisconsin intentionally sequenced requirements so that detailed work plans were not due until after agreements were signed and funds were accessible. This gave regions the flexibility and breathing room to organize, convene partners, and prioritize activities without the pressure to fully pre-design projects before resources were in hand.

The regional model also functioned as a pilot for broader system design questions, testing how shared services, regional staffing, and collaborative infrastructure investments might be supported in more efficient and scalable ways. Early implementation has shown that when states align funding mechanisms with how local systems already collaborate, they can move resources faster while strengthening partnerships and reducing administrative burden for all involved.

Maintaining Oversight Without Over Managing

Despite significantly reducing reporting and administrative requirements, Wisconsin’s approach held under state audit scrutiny, an outcome that reflected a deliberate balance between flexibility and accountability.

Rather than relying on prescriptive reporting from local and tribal health departments, Wisconsin focused on strengthening its own internal practices. The state developed clear procedures for handling unallowable costs when they arose, including defined steps for correction, documentation, and follow-up. Wisconsin provided staff guidance to apply allowability rules consistently, reducing uncertainty while avoiding unnecessary pre-approval requirements.

Communication was critical to overseeing these processes. Wisconsin invested heavily in transparent guidance, accessible staff, and clear allowability resources, including centralized information hubs, monthly newsletters, and regular outreach. The team viewed frequent questions or follow-up needs not as compliance failures, but as signals to improve tools, clarify expectations, or adjust guidance, turning oversight into a quality improvement process rather than an enforcement exercise.

When state auditors questioned how appropriate use of funds could be ensured without intensive reporting or pre-approval, Wisconsin pointed to its strong communication infrastructure, real-time accessibility to grant staff, and clear documentation practices. In some cases, the state explicitly referenced federal grant language requiring recipients to minimize administrative burden, using the NOFO itself to justify why it didn’t implement additional controls without clear need.

Lessons for Other States

How funding systems are designed shapes how public health work gets done. Wisconsin’s experience demonstrates that reducing administrative burden is not about doing less, it’s about doing things differently. Ultimately, Wisconsin shows that reducing administrative burden is a deliberate practice. By designing state systems around the needs of local and tribal partners, states can strengthen accountability, improve relationships, and free up capacity for what matters most: protecting and improving community health.

This blog was informed by a key informant interview with Amy Perkins, PHIG Manager at the Wisconsin Department of Health Services, and reflects her firsthand insights into Wisconsin’s approach to reducing administrative burden on local and tribal health departments. Hear Amy share Wisconsin’s story in her own words in the PHIG Impact Report.

Reviewed by Lindsey Myers, MPH, Vice President, Public Health Workforce & Infrastructure.