Background: Billing for clinical services is perceived to be increasingly important for local health departments (LHDs). Yet very little evidence exists regarding the frequency and relative financial importance of clinical billing revenues.

Purpose: The purpose of this study is to report on trends in the frequency and financial scope of clinical billing by LHDs from 2008 to 2013.

Methods: The study used data from the 2008, 2010, and 2013 National Association of City and County Health Officials Profile report surveys. Per capita revenues from clinical billing and percent of total LHD revenues from clinical billing were calculated.

Results: Clinical billing became significantly more common between 2008 and 2013, with approximately three quarters of LHDs receiving revenues as of 2013. The mean amount received also significantly increased. The net increase in clinical billing revenues per capita ($2.82) was greater than the overall increase in total revenues per capita from 2008 to 2013.

Implications: Clinical billing revenues provided a backfill against erosion in funding for LHDs. While certain regions (e.g., Northeast) have consistently seen smaller clinical billing revenues and other regions (e.g., Southeast) have consistently seen large clinical billing revenues, other regions (e.g., West) are increasingly billing as well. While increasing reliance on clinical billing revenues may present longer-term challenges, these revenues represent a tremendously important source of financial stability during the Great Recession. Current trends indicate that in spite of declines in individually-focused services, revenues from clinical billing are increasing.