On March 11, 2021, the American Rescue Plan Act of 2021 was signed into law, including the appropriation of more than $130 billion to the Coronavirus Local Fiscal Recovery Fund, for making payments to metropolitan cities, counties, and other units of local government to mitigate the fiscal effects stemming from the public health emergency. Hennepin County expects to receive direct payments from the U.S. Treasury totaling more than $220 million and received the first-half payment of $122.9 million in May of 2021.

The American Rescue Plan Act provides that money from the Coronavirus Local Fiscal Recovery Fund may only be used to cover certain costs incurred by December 31, 2024, including costs to respond to the public health emergency with respect to the Coronavirus Disease 2019 (COVID–19) or its negative economic impacts. Under the available guidance from the U.S. Treasury, this category of eligible costs can include expenditures for the mitigation and prevention of COVID-19, including expenses related to COVID-19 vaccination program and sites; costs of providing COVID-19 testing and monitoring, contact tracing, and monitoring of case trends and genomic sequencing for variants; expenses for communication related to COVID-19 vaccination programs; expenses for technical assistance to local authorities or other entities on mitigation of COVID-19-related threats to public health and safety; expenses related to establishing or enhancing public health data systems; and payroll and covered benefit expenses for public health staff, to the extent that the employee’s time is spent mitigating or responding to the COVID-19 public health emergency. 

The American Rescue Plan Act also provides that money may be used for the provision of government services to the extent of the reduction in revenue due to the pandemic. Under the available guidance from the U.S. Treasury, this category of eligible costs can include maintenance of infrastructure or pay-go spending for building new infrastructure, including roads; modernization of cybersecurity, including hardware, software, and protection of critical infrastructure; health services; environmental remediation; school or educational services; and the provision of police, fire, and other public safety services.

COVID’s large-scale emergency response has placed unsustainable burdens on an already stretched public health system. In addition to continuing to fight COVID, Hennepin County Public Health (HCPH) must provide the routine, but vital, public health services the residents of Hennepin County depend on. These vital services include population-based data assessment capacity to focus on health equity and address disparities; community-initiated solutions that are inclusive and improve outcomes in health; infectious disease and population-based prevention programming; and public health infrastructure for planning, delivering, and evaluating public health programs and services.

There are longstanding, race-based, health disparities in Hennepin County. The COVID-19 pandemic has brought these disparities into sharp focus, as the pandemic has directly, and indirectly, contributed to unacceptable health outcomes for residents. For example, in the past 18 months, childhood immunizations in the county have plunged; the need for a coordinated, prevention-focused approach to mental wellbeing has grown; and public health expertise, like infection control and mitigation, has shown itself to be a matter of life or death in congregate care settings.

The pandemic has reinforced the value of public health staff, and the expertise and skills they provide to keep Hennepin County residents healthy and safe. The Local Public Health Act (Minn. Stat. 145A) defines six foundational areas of public health responsibility which all community health boards in Minnesota must prioritize and implement activities. The first, and arguably most important area of responsibility is to “[a]ssure an adequate local public health infrastructure.”

This BAR requests resources to bolster population-based, prevention programming and strengthen public health capacity in Hennepin County to meet the current and future challenges of COVID-19, specifically to address foundational areas of public health responsibility.

Prevent the Spread of Communicable Diseases: Bolster Infectious Disease Response and Coordinate Immunization Outreach and Delivery

The pandemic contributed to significant declines in childhood immunization rates. Funds from ARP would be used to enhance and expand existing public health programs, which are charged with monitoring and improving childhood vaccination rates.

The pandemic emphasized the consequences of inadequate infection control and mitigation in congregate living facilities. Funds from ARP would be used to sustain and expand the infection prevention pilot project in congregate living facilities.

The pandemic and a succession of other recent infectious disease outbreaks such as measles, tuberculosis, hepatitis A and HIV that have heavily impacted communities of color, has illustrated the need for HCPH to create a Community Based Infectious Disease Response Team. This team will conduct testing, vaccination, medication administration, and care coordination for people in the communities in which they live.

Prepare and Respond to Emergencies: Strengthen Public Health Emergency Response

The pandemic illustrated the need for a more robust public health emergency preparedness program. ARP funds will be used to increase and enhance HCPH’s capacity to respond to public health emergencies.  

Promote Healthy Communities and Healthy Behavior: Address Chronic Diseases Due To COVID

The pandemic had widespread impacts on society leading to “secondary health effects of COVID-19,” including worsening chronic disease, mental health, and family health. ARP funds will be used to strengthen health promotion programming to mitigate the impacts of COVID in the community.

Promote Healthy Communities and Healthy Behavior: Coordinate Early Childhood Development Strategies

The pandemic has had negative impacts on families with young children, including lack of access and connection to services that support healthy growth and development. Building on current work with community providers, the county will increase staffing capacity to improve access to early childhood services for families. ARP funds will be used to hire an Early Childhood Coordinator to implement this work.

Assure an Adequate Local Public Health Infrastructure: Expand Assessment Capabilities and Increase Project Management Capacity

The pandemic illuminated the hazards of inadequate public health infrastructure investment, especially around assessment, like the SHAPE survey, and overall public health project management capacity.  

ARP funds will be used to enhance assessment capabilities in HCPH, especially the SHAPE field work and data collection, which in 2022 will focus on the direct and indirect impacts of COVID-19 in the community. ARP funds will also be used to increase project management and operational capacity within HCPH to respond to the strategic initiatives highlighted by COVID.

A strong and effective public health infrastructure is needed to plan, deliver, communicate, and evaluate public health interventions. It is essential, to not only respond to crises such as the COVID-19 pandemic, but to address both longstanding and newly emerging public health challenges.

Current Request:

The current request is to authorize federal funding in the amount of up to $10,000,000 to hire up to 30 full time equivalent positions to support critical population-based public health activities, and to contract for data management and community initiated solutions to improve health outcomes; and delegate authority to the County Administrator to negotiate agreements for services.