December 16, 2016 Edition

Affordable Care Act Update and Analyses

Plans to repeal and replace the Affordable Care Act (ACA) continue to be a focus for Republican Congressional members. Last week, United States Senate Majority Leader Mitch McConnell announced that upon Congress returning on January 3, there would be efforts to move a resolution to repeal the ACA, noting that this would be the first item up in the new year. Congressional Republicans have said they will vote on repealing and replacing the ACA quickly, but may keep the provisions in place for up to four years.

Republicans continue to discuss the details of what a repeal and replacement of the ACA would consist of. Republican members of the United States House Committee on Ways and Means met on Capitol Hill this past Thursday to discuss plans to repeal of the ACA. While no specific details were offered, Committee Chairman Kevin Brady told reporters that there would be an adequate transition period after the ACA is repealed. House Republicans are also focused on ensuring “universal access” to health care – meaning everyone can buy or find coverage if they choose – versus ensuring everyone has coverage.

While details are still outstanding, we do know that a repeal of the ACA would drastically impact people across the nation. The Center on Budget and Policy Priorities released state-by-state fact sheets on the impact of repealing the ACA without replacing it. In every state, tens of thousands of people would lose health coverage, including roughly 4.9 million people in California.

Yesterday, the UC Berkeley Labor Center issued a data brief looking at the number of Californians that received coverage either though Medi-Cal expansion or through subsidized plans through Covered California. Since the ACA, roughly 5 million individuals were enrolled in Medi-Cal. Of those, roughly 3.7 million adults became newly eligible for Medi-Cal through the expansion. The data brief also notes, roughly 1.2 million Californians have subsidized coverage through Covered California.

Despite plans to repeal the ACA, open enrollment is underway and in California, over 196,000 have signed up for coverage through Covered California.  The open enrollment deadline for California has been extended to midnight Monday, December 19 to begin coverage on January 1, 2017. This also aligns with the Federal deadlines.

NACCHO’s Recommendations to the Federal Government

The National Association of County and City Health Officials (NACCHO) shared recommendations to the incoming Trump Administration and the 115th U.S. Congress to protect and improve health and well-being in the nation’s communities. These recommendations provide Congress and the Administration with a list of essential, short-term priorities to improve local infrastructure as well as promote the longer-term success of healthy and thriving communities by strengthening national capacities in disease prevention and public health.

NACCHO’s four overarching goals with respect to national health policy are the following:

  1. Strengthen and modernize the governmental public health system, so that federal public health agencies and state and local governmental public health departments work effectively together.
  1. Prepare and quickly respond to ever-present public health emergencies and threats by ensuring robust and sustained funding for public health emergency preparedness activities as well as surge funding to support an immediate response.
  1. Transition the health care system to focus on population health improvement that results in optimal health for all residents and moves the United States towards being the healthiest nation.
  1. Improve health for all Americans by recognizing and acting on the knowledge that many of the factors that influence health status are outside the traditional health care system.

NACCHO’s recommendations can be found here.

21st Century CURES Act

Earlier this week, President Obama signed into law the 21st Century Cures Act, a sprawling piece of legislation that provides increased funding for medical research, overhauls federal mental health care policy, and speeds up the development and approval of experimental drug treatments.

Overall, the Cures Act provides $6.3 billion to various programs and federal agencies over ten years; however, it should be noted almost all of the funding provided in the Act is subject to the annual federal budget appropriations process.  Furthermore, the Act cuts $3.5 billion (roughly 30%) over ten years from the Prevention and Public Health Fund (PPHF) to offset the costs of the Act’s provisions.

Notable provisions do the following:

  • Authorizes $1 billion, over two years, for state grants to supplement opioid abuse prevention and treatment activities.
  • Provides $4.8 billion, over ten years, to the National Institutes of Health (NIH) for various medical research initiatives, including the Administration’s Cancer Moonshot initiative.
  • Shortens the FDA approval process for the development of new drugs and medical devices.
  • Reauthorizes the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA) that supports local efforts to decrease mental illness in jails.
  • Reauthorizes the Community Mental Health Services (CMHS) and Substance Abuse Prevention and Treatment (SAPT) block grants, which allow counties to deliver direct behavioral health services to those with mental health conditions and substance abuse disorders.
  • Institutes several requirements on the CDC regarding antimicrobial resistance monitoring and education.
  • Requires HHS to take various actions regarding the development of medical countermeasure innovations, including the development of promising technologies that address unmet public health needs.
  • Requires the HHS Secretary to issue a report on ways to promote innovation in the development of vaccines that minimize the burden of infectious disease

If you’re interested in more information, the House has issued brief summary and Kaiser Health News issued a report describing most sections of the bill.

DHCS Medi-Cal Waiver Update

The Department of Health Care Services (DHCS) announced changes to the Special Terms and Conditions of California’s Section 1115 ‘Medi-Cal 2020’ Waiver.

The Centers for Medicare & Medicaid Services (CMS) approved two amendments requested by DHCS. The first, authorizes DHCS to include Federally Recognized Tribes and Tribal Health Programs as lead entities for the Whole Person Care (WPC) pilots. The second, allows DHCS to modify the payment methodology for Domain 1 of the Dental Transformation Initiative (DTI), which targets increases in preventive dental services for California children. The amendments are effective as of December 8, 2016.

The approved amendments will be posted to the Medi-Cal 2020 website. Additional information is available on the WPC webpage and the DTI webpage.

DHCS also submitted an amendment to add the Medi-Cal Access Program (MCAP) population to the Medi-Cal Managed Care delivery system. MCAP – a program DHCS inherited from the Managed Risk Medical Insurance Board – provides low-cost health insurance coverage to uninsured pregnant women with incomes at 213%-322% of the Federal Poverty Level. If approved, all new MCAP enrollees would be enrolled starting July 1, 2017 into a Medi-Cal managed care plan operating in their county of residence. To minimize care disruption, women enrolled into MCAP prior to July 1, 2017 will continue to receive care under the Medi-Cal Fee-for-Service delivery system.

Additional information related to MCAP is available on the MCAP website Questions or comments can be directed to:

Emerging Leaders in Public Health Application for 2017

The Kresge Foundation is partnering with the University of North Carolina Gillings School of Global Public Health to recruit and select 20 teams for Emerging Leaders in Public Health (ELPH). Public health leaders who represent diverse backgrounds and serve populations experiencing health disparities are encouraged to apply.

ELPH is a leadership development initiative aimed at helping current and future local public health leaders advance innovative models which improve their organizations and position them for new opportunities to meet the changing health needs of their communities. Teams of two co-leaders will embark on an 18-month, action-oriented experience. They will focus on the development and implementation of a “transformative concept” that shifts or expands the capacity of their local health department.

Participating leadership teams will receive coaching, education, and up to $125,000 from The Kresge Foundation to apply their leadership skills and competencies in the development and implementation of their concept.

Applications will be accepted from January 4, 2017 through February 20, 2017. An informational Webinar will be held on January 18, 2017.

More information about the selection criteria, application process, and stories of previous participants can be found at: For questions, please send an email to:

Digital Bridge Initiative

The Digital Bridge initiative aims to bring public health and health care together to collaborate on ways to effectively share information and improve public health surveillance. The initiative is seeking applications for sites interested in establishing a unified, multi-jurisdictional approach to electronic case reporting (eCR).

Each site will be represented by one health care delivery system, that system’s health data provider (e.g., EHR vendor, HIE) and a state, territorial, local or tribal public health agency.

The Digital Bridge project management office will host a site application question and answer session on December 16, 2016 at 10:00 a.m. PST. Interested parties should register here. The deadline to apply is January 13, 2017. Additional information is available at