The Honorable Ronald J. Mariano, Speaker of the House
The Honorable Aaron M. Michlewitz, Chair, House Ways & Means Committee
The Honorable Denise C. Garlick, Chair, House Committee on Bills in Third Reading
The Honorable Marjorie C. Decker, House Chair, Joint Committee on Public Health
The Honorable John J. Lawn Jr., House Chair, Joint Committee on Health Care Financing
The Honorable Hannah Kane, Ranking House Member, Joint Committee on Public Health
State House, Boston

(Delivered electronically)

Dear Speaker Mariano, Chair Michlewitz, Chair Garlick, Chair Decker, Chair Lawn, and Representative Kane,

On behalf of cities and towns across the Commonwealth, the MMA again wishes to express deep appreciation to you for the powerful partnership that you and the Legislature have embraced to support and assist local health departments throughout the COVID-19 pandemic. Your swift action to provide resources to address the public health emergency has made Massachusetts a national leader in responding to the crisis.

As the House considers next steps in advancing the capacity of state and local public health departments, we ask you to ensure that H. 5104, An Act Relative to Accelerating Improvements to the Local and Regional Public Health System to Address Disparities in the Delivery of Public Health Services would not create a sweeping new unfunded mandate and place a huge financial burden on all municipalities.

While we appreciate and support the intent of the legislation, which is to strengthen capacity, collaboration, and investment in local and regional public health departments, we are deeply concerned that the measure has the potential to impose a new and unaffordable annual unfunded mandate of at least $140 million on municipalities. We are aware that the legislation calls on the Department of Public Health to provide funding to boards of health to implement and comply with the new proposed minimum standards, and the intent would be to support this transformation of public health through future investments. However, as written, H. 5104 does not mandate that the state meet its obligation to financially support the outlined goals. Instead, the state’s responsibilities would be subject to appropriation, while municipalities would not have that flexibility, and would be forced to fund the new costs imposed by the Department of Public Health.

Under the bill, cities and towns would be mandated to meet new “foundational” spending standards for public health, creating a major financial challenge for municipalities, which must work within the revenue limits of Proposition 2½. Municipalities would have to cut other essential municipal services to meet the new requirements, triggering widespread disruption in their capacity to fund other critical programs, including those that support the most needy and vulnerable residents of our communities.

Also, there is no comprehensive fiscal analysis of the proposal to fully understand the magnitude of the financial impact this would have on cities and towns. The $140 million preliminary cost estimate was developed by the Legislature’s Special Commission on Local and Regional Public Health in its June 2019 report.

When the Special Commission issued its report, entitled “Blueprint for Public Health Excellence: Recommendations for Improved Effectiveness and Efficiency of Local Public Health Protections” (“Blueprint”), one of their key findings was that most local boards of health were unable to keep up with a growing list of duties. Of course, this finding was pre-pandemic. The duties and importance have now grown exponentially. In an era of global pandemics, we understand the desirability of local public health performance standards more than ever. However, with no updated understanding of the costs associated with such mandated minimum performance standards, and no identified dedicated state-funding source, the responsibility to support these mandates would be a new burden placed on cities and towns as a significant new unfunded mandate.

The Blueprint contemplated a realistic two-step process to improve the local public health system (page 30). The first step was to transition local boards of health into compliance with existing statutes and regulations. The second was to help local boards of health build capacity in readiness to meet a minimum set of standards known as the Foundational Public Health Services. H. 5104 is now seeking to fast-track the transformation of local boards of health, by mandating that they meet a minimum set of performance standards now. The Blueprint warned that, “[t]o push them to upgrade to Foundational Public Health Services (FPHS) – without first developing the readiness and capacity to do so — will just intensify the crisis for these struggling cities and towns — and widen the gap between them and the small number of well-funded and supported health departments that will be able to implement the new standards” (page 71).

We welcome the opportunity to engage on this topic of improving local and regional public health departments, and the funding mechanisms required to do so.

In the interim, we ask that this legislation be amended to make it clear that the bill would not impose an unfunded mandate, by inserting (in subsection (d)(i) on line 52) the same “subject to appropriation” standard for cities and towns and boards of health that is used for state agencies.

Thanks to your leadership, the partnership between state and municipal leaders has been stronger than ever during this public health emergency, and remains critical as we take steps to improve the delivery of services. Thank you for your attention to this important matter. If you have any questions, please do not hesitate to have your office contact me or MMA Senior Executive and Legislative Director Dave Koffman at or 617-426-7272, ext. 122, at any time.

Thank you very much.


Geoffrey C. Beckwith
MMA Executive Director & CEO