Assembly Budget Subcommittee No. 1 Discusses Title XIX Funding, WIC EBT, Home Visiting, Hepatitis A, STDs, and Valley Fever

This week, the Assembly Budget Subcommittee No. 1 on Health and Human Services continued to hear budget issues related to public health. Highlights from the discussion are provided below:

Maternal, Child, and Adolescent Health (MCAH). Connie Mitchell, Deputy Director of the California Department of Public Health, the Center for Family Health (the Center) provided members with an overview of the program, including touching on both federal Title V and Title XIX funding.  She noted that Title V must be used equally for case management for children with special needs, child adolescent services and maternal health services. Assembly Member Arambula demonstrated an interest in maximizing federal funding for the state and inquired about whether California could draw down more federal funding with an additional investment of state funds.

Women Infants & Children (WIC). Christine Nelson, Chief of the WIC Division provided members with an overview of program activities. She noted trends of participation declining both in California and nationally, though California’s participation rate remains the highest of all. According to CDPH, they have focused their efforts into three groups: 1) retaining active participants – those that are certified and utilize their benefits; 2) re-engaging certified families that are no longer coming back for checks; and 3) recruiting new eligible families.

CDPH also provided an update on the EBT system for WIC and was pleased to announce that they are on track to launch EBT system ahead of scheduled implementation in 2020. The Department will need to replace the 23-year old IT system used at state and local agencies and will be announcing the new vendor within the next few weeks. The selected vendor will use an existing system used in other states, modified for California. According to CDPH, in 2018 they will focus on building the infrastructure for the transition by training WIC and local agency staff. In summer 2019, CDPH will pilot the new system and start services in Solano County. The Department intends to do a tiered rollout throughout the state, which will be staggered for better flow and evaluation of lessons learned. They anticipate the transition to be completed by Spring 2020.

Infant and Early Childhood Home Visiting Program. CDPH provided the Subcommittee with an update of the Infant and Early Childhood Visiting Program, which currently operates in 23 counties in California.  Members expressed concern for ensuring the CalWORKS Home Visiting program, which was included in the Governor’s January Budget Proposal would not duplicate efforts that currently exist under the home visiting program overseen by CDPH. CDPH indicated the CalWORKS Home Visiting Program would fall under the oversight of the California Department of Social Services (CDSS), and that there is regular discussion between the two state agencies.

Members were also interested in adverse childhood experiences (ACEs) and touted home visiting as a key tool to address ACEs. Assembly Member Arambula referenced the recent Oprah Interview on 60 Minutes and declared his passion around addressing ACEs.

Hepatitis A. Dr. Gil Chavez, Deputy Director for the CDPH Center for Infectious Disease, recapped activities undertaken to address the hepatitis A outbreak highlighted key lessons learned. He noted a lack of sanitation related to homelessness made the transmission of Hepatitis A more difficult to contain. He further noted that the homeless population is harder to reach and that the delivery of preventive services is difficult and costly. He highlighted local health department efforts that ensured the vaccination was taken into homeless encampments.

STDs. Dr. Karen Smith, Director of CDPH, provided the overview on the departments STD control efforts. She noted rapidly increasing cases of STDs and noted some contributing factors included: increase in substance use disorders, increased occurrences of sex in exchange for money or resources, and meet-ups arranged through online forums.

Dr. Smith noted that despite the one-time increased funding dedicated to STD control, that local jurisdictions do not have sufficient funding to maintain a workforce level that can address the growing trends in STD cases.

Valley Fever. Assembly Member Rudy Salas presented his proposal for $3 million one-time General Fund in 2018-19 to fund research for a vaccine and cure for valley fever through the University of California and $1 million for a statewide public outreach and awareness campaign about symptoms, diagnosis, and treatment of valley fever. He was accompanied by a Representative from Kern Medical Center, who stated valley fever was the most significant disease facing their county, even beyond the flu. A representative from Valley Children’s Hospital spoke to the increasing cases of children with valley fever presenting at their hospitals. He noted that in addition to receiving patients from the Kern, Kings, and Tulare counties, Valley Fever cases were also from the San Joaquin and coastal counties as well.

Assembly Member Vince Fong also came before the Subcommittee to present his proposal for $3 million for a research grant within the California Department of Public Health to fund Valley Fever treatment research and outreach at the Valley Fever Institute at Kern Medical Center. The Institute is the only academic institution that is specifically dedicated to Valley Fever. It provides several treatment options that are not available in other locations throughout the world and the funding would allow the Institute support a Valley Fever repository of samples for research and create education programs to support provider education.

All items were held open by the Subcommittee. For your reference, we are providing a link to the agenda and recording of the hearing.