The Supreme Court decision on the Mandanas-Garcia petition regarding the internal revenue allocation given to local government units is a significant ruling in strengthening the concept of decentralized governance and delivery of services. While the ruling grants local government greater resources and financial support, the immediate implication is the full devolution of services defined in the Local Government Code, including health services. The urgent concern is how much the Mandanas Ruling will affect local health systems. This paper presents some existing and foreseeable issues surrounding the implementation of the Mandanas Ruling in relation to the current devolved healthcare system. In particular, challenges in implementing the ruling in relation to health devolution, the local health system process, and the Universal Health Care Act are discussed. Some concrete action points for addressing these issues are also posited for policy-makers and implementors to consider in order to ensure not just the smooth and efficient implementation of the ruling but also the continuity of care for Filipinos.