Background: Local health departments (LHDs) have repeatedly suffered job losses and program cuts after the 2008 economic recession, yet they serve as the backbone of the public health system in the United States.

Purpose: To assess if provision of clinical services by LHDs is declining in this post budget-cut, post Affordable Care Act era. To ascertain if LHDs’ budget reductions were associated with decline in number of clients receiving clinical services from LHDs.

Method: This research uses data from the 2015 Forces of Change Survey, administered to a nationally representative sample of LHDs by National Association of County and City Health Officials’ (NACCHO). The dependent variables included; three-level population strata, governance category, change in current budget compared to last year, anticipated change in next year’s budget, engagement with hospital on community health needs assessment (CHNA), workforce skills-interpreting data, workforce skills- addressing needs, collaborating with primary care-assessing availability, collaborating with primary care-implementing strategies and collaborating with primary care-referring patients. The data analysis was done using SPSS.

Result: A significant association existed (p < 0.05) between changes in patients served and the following independent variable: LHD governance category, reduction in current budget, expected reduction in next year’s budget, workforce skills-interpreting data, workforce skills- addressing needs, collaborating with primary care-assessing availability, collaborating with primary care-implementing strategies and collaborating with primary care-referring patients.

Conclusions: Our study has important evidence for initiatives aimed at an improvement in health care services at the local health department.