Methods The National Association of County and City Health Officials

budgets, is driving change in the public health system. This time of transformation presents both new challenges and growing opportunities for local health departments (LHDs) as they look to adapt to these changes. Some LHDs are exploring ways to develop revenue to sustain essential public health services, including billing third-party payers (public insurance providers, such as Medicare and Medicaid, and private insurers) for services provided in LHD clinics.1 This research brief describes the extent to which LHDs are billing for clinical services, what third-party payers LHDs are billing, approaches they are using to bill third-party payers, and whether LHDs are engaged in efforts to increase the extent to which they bill for services