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In New York, funds for essential public health services flow from the state to local health departments through an unassuming statutory mechanism. This budget season, that mechanism — Article 6 of the Public Health Law — has drawn attention in Albany.
Through Article 6, local health departments receive state reimbursement for core public health services like communicable disease control and chronic disease prevention. Historically, every municipality has been reimbursed at the same rate. But in 2019, Gov. Andrew Cuomo cut the reimbursement rate — only for New York City.
In the years since, that’s meant a loss of up to $90 million annually for the New York City Department of Health and Mental Hygiene, limiting its tuberculosis control work and hindering the expansion of its programs, leaders say.
Successive city health commissioners have unsuccessfully advocated for the restoration of those funds. This year might prove different.
As potentially deep cuts to federal funding by President Donald Trump loom over the city and state, some Democratic state lawmakers are mounting an effort to restore New York City’s Article 6 funding, backed by local leaders and health advocates. With mounting concerns about bird flu, and rising rates of sexually transmitted infections and TB cases, they want to see the state make deeper investments in the city’s public health infrastructure.
In Albany, a bill sponsored by Assembly Member Jessica González-Rojas, a Queens Democrat, would restore equal reimbursement rates for local health departments. And while Gov. Kathy Hochul didn’t include restored Article 6 funding for the city in her $233 billion executive budget, proponents hope to see it in budget proposals from the Assembly and the Senate expected next month.
“Given the threats that Trump is hanging over our city and state, I think it’s urgent and imperative to get this done this year,” González-Rojas said.
Cuomo’s cut targeted New York City
Local health departments across New York provide a range of essential health services, including immunizations, STI testing and treatment, infectious disease surveillance, perinatal programs and public health emergency preparedness.
Through Article 6, localities fund much of that work — and the state picks up the rest of the tab. The state provides each municipality that delivers core public health services with a base grant of $750,000, or $1.30 per capita for larger municipalities like New York City. Beyond the grant, the state reimburses localities for 36% of the cost of core public health services.
As a result of the 2019 cut, New York City is only reimbursed for 20% of those services. That means that the city has to cover 80% of their cost, not 64%. Advocates say that the cut is especially punitive for a city with a large, diverse population that bears a disproportionate burden of the state’s public health challenges.
Six years ago, the Cuomo administration justified the cut with the argument that New York City receives some funding directly from the federal government. But some advocates believe that the move reflected the strained relationship between former Gov. Cuomo and former Mayor Bill de Blasio.
“This was specifically a hit at New York City, deliberately done by then-Governor Cuomo, knowing that the city would have to reach into its own coffers to make up at least some of the cut, if not make up more than the cut,” said Charles King, CEO of Housing Works, a nonprofit that serves New Yorkers living with HIV/AIDS, which opposed the 2019 cut.
To Sen. Gustavo Rivera, a Bronx Democrat and chair of the Senate Committee on Health, it was “Governor Cuomo at his petty best trying to just slap Bill de Blasio in the face.”
Rich Azzopardi, a Cuomo spokesperson, said in a statement: “Any budget is the product of negotiations between the executive and legislators — most of which live in New York City — and this program adjustment was reflective of the state’s finite resources and the fact that New York City is treated as a separate entity in the eyes of many federal agencies, which gives it direct access to other federal funds that no other county has.”
In the years since the cut, Azzopardi added, “If there had been an issue at any point, there was ample time to address it — but let’s be real, that’s not what this is really about.”
In response to a question about Hochul’s position on restoring the city’s Article 6 funding, a spokesperson said she has “made the largest investments in safeguarding public health and enhancing our health care system of any governor in the history of New York State” and is working with Attorney General Letitia James to fight federal spending cuts.
But Dr. James McDonald, the state health commissioner, voiced his own reservations about the unequal distribution of Article 6 aid during a health budget briefing in Albany earlier this month.
“I wasn’t here when what was done was done, and I can’t imagine why it was done that way, but it is odd,” he told state lawmakers.
He added: “It’s really the very definition of the word ‘disparity,’ isn’t it?”
City health services were impacted
In New York City, the annual loss of $90 million in state dollars has hindered the Health Department’s work, Dr. Michelle Morse, the city’s acting health commissioner, told Healthbeat.
The agency is behind on hiring TB case managers and contact tracers, Morse said, a particular concern as the city faces an increase in cases. In 2023, the Health Department reported 684 confirmed cases of TB, a 28% increase from 2022 and the highest number in a decade.
“If we had those dollars, we probably would have had a bit more of a reserve and been able to respond more quickly to the uptick in TB cases we’ve seen in the most recent data,” Morse said.
King, of Housing Works, described the city’s TB program as “very leanly staffed.” In fiscal year 2024, agency positions budgeted for TB prevention and treatment had a 16% vacancy rate, a small improvement on the 20% vacancy rate the prior year, Crain’s reported last year.
Earlier this month, seven employees of the Centers for Disease Control and Prevention who worked at the Health Department were terminated amid mass layoffs at the federal agency. Their work included data collection, outreach and surveillance for latent TB infections, as well as case management for people with TB, Health Department spokesperson Chantal Gomez said in a statement.
During his time leading the agency, Dr. Ashwin Vasan, Morse’s predecessor, was a vocal advocate for the restoration of the city’s Article 6 funds. Vasan, a primary care physician at Columbia University and fellow at the Harvard T.H. Chan School of Public Health, said the funding loss made the city’s TB control work even more difficult.
“With TB rates rising, we fought long and hard to get TB program vacancies and services refunded with city dollars,” Vasan said in a statement. “These could have been Article 6 eligible, which would have really helped speed this process up, which is essential when we’re talking about controlling infectious diseases.”
If the city’s Article 6 funds were restored, Morse hopes to see the Health Department expand its programming, including opening more sexual health clinics and making deeper investments in its services for new and expectant parents, like the New Family Home Visits Initiative and the citywide Doula Initiative, which are in high demand.
But with looming federal cuts, it’s also possible that those funds could become a crucial stopgap for the agency, which receives about $600 million per year from the federal government, she said. Full Article 6 funding could function as a form of “harm reduction from federal cuts,” she said.
“That maybe doesn’t sound as exciting, but it’s actually super important to be able to plug those holes if, and when, frankly, that federal funding is cut back,” she said.
Public health threats persist
While New York City has experienced particularly deep losses to its Article 6 funds, advocates say that across New York, state support for core public health services hasn’t kept pace with rising disease threats.
Aside from a base grant increase in 2022, Article 6 funding has remained largely stagnant. Between 2015 and 2020, the number of full-time employees at local health departments delivering Article 6 core services fell 7%, according to the New York State Association of County Health Officials. Those staff reductions hindered agencies’ abilities to respond to local public health issues — as well as to confront greater challenges, like the Covid-19 pandemic.
“It’s fair to say that the state has completely underfunded Article 6,” said King, of Housing Works.
In King’s view, Article 6 funding should be restored for New York City — and increased for all local health departments. He worries about the state’s ability to respond to the ongoing overdose epidemic, rising STI rates and increased cases of TB, as well as its vulnerability to measles, with recent outbreaks in Texas and nearby New Jersey.
“There are just any number of public health threats out there, and we need to be robust in our ability to anticipate them and to respond to them when outbreaks occur,” he said.
Patrick Orecki, director of state studies at the Citizens Budget Commission, a nonpartisan watchdog organization that opposed the 2019 cut, said it makes sense to apply a uniform reimbursement rate for Article 6 state aid. But whether New York City sees its funding restored this year will come down to what the Hochul administration is willing to invest in, he said.
“The state has a bit of a challenging fiscal situation with some pretty big gaps going forward in its budget, and the specter of federal cuts hanging over everything,” he said. “The state would have to choose it as a priority within the budget.”
For Sarah Ravenhall, NYSACHO’s executive director, those looming cuts cast the issue in sharp relief.
“There’s a lot of uncertainty in what will happen with federal funding,” she said. “Now is the time for the state to take a strong stance and put the resources that our infrastructure needs and deserves, and that our communities really deserve, into public health.”
Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.
