The Public Health Nursing Act would amend the Public Health Service Act to create a dedicated Public Health Nursing Workforce program. It authorizes grants to state, local, and territorial public health departments to establish, expand, and sustain a public health nursing workforce, with a focus on underserved areas and maternal and infant health outcomes.
The bill also defines what constitutes a public health nurse and sets aside a long-term funding stream to build capacity across public health systems. This is a targeted investment in core public health infrastructure, aiming to improve preventive care, disease management, and maternal health services in communities that need it most.
At a Glance
What It Does
The Secretary would establish a grant program (Subpart 4) to fund public health nursing workforces at state/local/territorial public health departments, including specifying permissible uses of funds for recruitment, training, and operations.
Who It Affects
State, local, and territorial health departments, public health facilities (including mobile clinics and rural hospitals), and licensed registered nurses serving as public health nurses.
Why It Matters
By building a scalable PHN workforce in high-need areas, the bill seeks to reduce chronic disease burden, infant mortality, and maternal morbidity while expanding access to preventative services and public health programs.
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What This Bill Actually Does
The bill creates a new Subpart 4 under Part E of Title VII of the Public Health Service Act, establishing the Public Health Nursing Workforce program (Section 780). It authorizes the Secretary to carry out activities to establish, expand, and sustain the PHN workforce and to provide grants to state, local, and territorial public health departments.
Eligible uses of grant funds include wages and benefits for recruiting, hiring, and training licensed registered nurses to serve as public health nurses in public health departments, especially in underserved areas, as well as the purchase of medical supplies and PPE and related administrative costs. Recipients may make subgrants to local health departments to support these activities.
Priority in grant awards goes to applicants serving communities with high chronic disease rates, infant mortality, maternal morbidity, and populations that are low-income or medically underserved, as well as areas defined as health professional shortage areas and maternity care target regions. Applicants are also expected to produce plans in appropriate languages and cultural contexts and must either have a collective bargaining agreement with labor organizations or a policy not to interfere with labor rights.
Recipients must maintain non-Federal expenditures at or above prior-year levels (maintenance of effort).Public health nurses are defined as nurses who provide preventive health services, nutrition guidance, infectious disease management, chronic disease management, and maternal care (prenatal and postpartum) to improve outcomes for mothers and infants. The bill authorizes $5 billion annually for each of fiscal years 2026 through 2035 to support these activities.
The Five Things You Need to Know
The bill creates a new Subpart 4 under Title VII to establish the Public Health Nursing Workforce program.
Grant funds may be used for recruiting, hiring, training, and supporting PHNs, including PPE and supplies.
Priority goes to areas with high disease burdens, maternal health challenges, and underserved populations, with language/cultural considerations and labor rights protections.
Non-Federal expenditures must be maintained at least at prior-year levels (maintenance of effort).
A long-term funding authorization of $5 billion per year runs from 2026 to 2035.
Section-by-Section Breakdown
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Public Health Nursing Workforce program
Adds Subpart 4 to Part E of Title VII of the Public Health Service Act to authorize a dedicated program for establishing, expanding, and sustaining a public health nursing workforce. It sets up the framework for grant-making to state, local, and territorial public health departments and defines the structure for how funds are to be used and how award priorities will be set.
In General—Secretary to carry out activities
The Secretary is directed to carry out activities relating to establishing, expanding, and sustaining the PHN workforce, including the authority to make grants to state, local, and territorial public health departments. This creates the administrative backbone for the program and identifies the federal role in funding and oversight.
Use of funds
Grant funds may be used for recruiting, hiring, and training licensed registered nurses as PHNs, with emphasis on serving medically underserved areas. Funds cover wages and benefits, PPE, and necessary medical supplies, plus administrative costs associated with grant administration.
Subgrants
Grantees may make subgrants to local health departments to support the described activities, enabling local adaptation and capacity building across jurisdictions.
Priority for recipients
Award selection prioritizes applicants serving high-need areas and populations, including those with high chronic disease rates, infant mortality or maternal morbidity, low-income communities, and health professional shortage areas. Provisions require language- and culturally appropriate service delivery and adherence to labor rights protections.
Maintenance of Effort
Recipients must maintain non-Federal expenditures for PHN activities at least at the level of the prior fiscal year, ensuring continuity of public investment in the workforce.
Public Health Nurse defined
Defines a Public Health Nurse as a professional providing preventive health services, nutrition guidance, infectious disease management, chronic disease management, and maternal/prenatal and postpartum care to improve maternal and infant health outcomes.
Authorization of appropriations
Authorizes $5,000,000,000 to the Secretary to carry out this section for each fiscal year from 2026 through 2035, establishing a long-term funding baseline for the PHN workforce program.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- State public health departments gain ongoing grant funding to build capacity and hire PHNs, enabling broader public health reach.
- Local health departments in medically underserved areas gain subgrants to implement PHN programs and improve service delivery close to communities.
- Licensed registered nurses pursuing or already serving as PHNs receive job opportunities, training, and support that enhance workforce stability.
- Medically underserved populations, including residents in high-chronic-disease areas and areas with high maternal morbidity, gain improved access to preventive and maternal health services.
- Rural and maternity care-focused communities benefit from PHN presence and targeted public health interventions.
Who Bears the Cost
- State, local, and territorial governments must maintain non-Federal expenditures at prior-year levels, creating a financial obligation that can influence budgeting decisions.
- Grant administration imposes staffing and reporting requirements on public health departments, incurring administrative costs.
- Labor-related obligations (collective bargaining or policies protecting NLRA rights) may involve costs or adjustments for employers and public agencies implementing the program.
- Operational costs for PPE, training, and supplies are borne by grant funds, with ongoing need to ensure adequate procurement and supply chains.
- Some communities or Departments may face competition for limited grant funds, influencing local prioritization and project choices.
Key Issues
The Core Tension
The central dilemma is balancing ambitious nationwide workforce expansion with finite state and local budgets and the practical realities of nurse supply, credentialing, and labor governance. The bill aims for broad reach and durable capacity, but achieving that without compromising ongoing public health funding or educational pipelines presents a nontrivial policy trade-off.
The bill ambitiously scales up a public health nursing workforce through a centralized grant program, but several tensions could affect implementation. The most direct constraint is funding predictability: while $5 billion per year is authorized, annual appropriations determine actual flow, and gaps could undermine long-term workforce planning and retention.
Administrative overhead and the complexity of meeting grant reporting requirements may also divert time from service delivery. Implementers must navigate a suite of conditions—priority criteria, language and cultural considerations, and labor rights protections—that could affect applicant eligibility and onboarding speed, especially for smaller jurisdictions.
A second tension centers on the maintenance-of-effort requirement. Requiring non-Federal expenditures to match or exceed prior levels can strain state and local budgets during fiscal downturns, potentially limiting the reach or depth of hiring in hard-hit communities.
Lastly, the definition of a “public health nurse” and its scope—while broad—raises questions about credentialing pipelines, supply of qualified nurses, and the ability of mobile clinics or home-visit programs to scale quickly to meet demand. These tensions are central to whether the program can sustain a robust, culturally competent PHN workforce over time.
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