Digital transformation is critical to strengthening public health infrastructure, yet implementation across jurisdictions remains uneven. In the United States, state-level public health systems vary widely in their digital capabilities. Missouri’s Department of Health and Senior Services (DHSS) launched a digital modernization strategy to address these gaps. The objective of this work was to assess the digital maturity of Missouri’s public health system and examine how a validated digital maturity framework can inform strategic planning and investment. This was a cross-sectional, quantitative study using primary data collected from 59 public health teams across six DHSS divisions in 2024. The validated Digital Health Indicator (DHI) framework was applied via structured interviews to assess digital maturity across four dimensions: governance and workforce, interoperability, person-enabled health, and predictive analytics. Descriptive statistics and ANOVA were used to compare results across divisions, with forest plots used to visualize pairwise differences. The mean DHI score was 35.6/100, with substantial variation across
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