December 6, 2019 Edition

Stanislaus County Awarded PHAB Accreditation – PHAB Names new President and CEO

We are pleased to announce that the Stanislaus County Health Services Agency was awarded accreditation status by the Public Health Accreditation Board (PHAB) this week. Stanislaus County becomes the 17th local health department awarded PHAB recognition in California, in addition to the California Department of Public Health (CDPH).

Please join us in congratulating all of the hard work of our colleagues in Stanislaus County. PHAB’s announcement is available here.

In other Accreditation news, earlier this week PHAB’s Board of Directors appointed Paul Kuehnert, DNP, RN, FAAN, as the organization’s new President and CEO. Mr. Kuehnert previously served as associate vice president – program for the Robert Wood Johnson Foundation overseeing the foundations work related to leadership and transforming health and health care systems. Prior to joining RWJF, Kuehnert was the county health officer and executive director for health in Kane County, Illinois, a metro-Chicago county from 2006 until 2012. Current PHAB President and CEO Kaye Bender retires at the end of December.

DHCS & California Surgeon General Launch ACEs Aware Initiative

California Surgeon General Dr. Nadine Burke Harris and Department of Health Care Services (DHCS) Medical Director Dr. Karen Mark on Wednesday unveiled the first phase of the ACEs Aware initiative, the statewide effort for California healthcare providers to screen patients for adverse childhood experiences (ACEs). California is now offering a two-hour provider training to screen pediatric and adult patients for ten categories of ACEs, including abuse neglect, and household dysfunction, that increase the likelihood of ACE-associated health conditions due to toxic stress.

Beginning January 1, 2020, Medi-Cal providers can be reimbursed for ACEs screenings for Medi-Cal patients. Recall, the 2019-20 Budget Act included $45 million ($22.5 million state funds and $22.5 million federal funds) in provider reimbursements for such screenings. The broader ACEs Aware initiative seeks to provide training, clinical protocols, additional resources, and payment for screening adults and children for ACEs. Detecting ACEs early and connecting patients to interventions, resources, and other support can significantly improve the health and wellbeing of individuals and families.

In addition, DHCS and the Office of the Surgeon General are convening the Trauma-Informed Care Implementation Advisory Committee’s Provider Education and Engagement Subcommittee via webinar on December 13, 2019, from 12 p.m. to 1 p.m.. The webinar will discuss a draft Request for Proposal (RFP) for external organizations to apply for grants to support provider training and provider engagement activities, communication and outreach to providers, and meetings to train providers and encourage the development of linkages and referral network.

The webinar will include an opportunity to provide public comment. Public comments can also be submitted via this survey by Monday, December 16, at 5 p.m. PST.

The newly unveiled ACEs Aware website is available here.

Registration for the webinar is available here .

Newsom Opens Applications for Emergency Homelessness Aid, Appoints Doherty as Advisor on Homelessness

Governor Gavin Newsom on Wednesday announced that California counties and cities can now begin applying for $650 million in emergency homelessness aid provided through the 2019-20 State Budget Act. Newsom noted that California has been unable to secure the 2019 point-in-time (PIT) count data from the federal government; instead, the Newsom Administration has created an interim solution in which preliminary, estimated PIT data that has been submitted to the federal government by local jurisdictions will be used. Nearly $500 million of the full $650 million will be available in the interim, and the remaining 25 percent of funds will be allocated to counties and cities once the federal government releases the finalized PIT data.

Also, on Wednesday, Governor Newsom appointed Matthew Doherty as an expert advisor on homelessness to the Governor’s Office and Agencies. Doherty has over 25 years of leadership experience in both the private and public sectors, focusing on ending homelessness and the creation and integration of housing, services programs, and economic opportunities.

Notably, Doherty served as the executive director of the United State Interagency Council on Homelessness, the federal agency charged with coordinating the federal response to homelessness and with creating national public-private partnerships to end homelessness. Doherty served under both Presidents Obama and Trump. According to Governor Newsom, Doherty will work with the Newsom Administration to craft a federal advocacy agenda related to homelessness and bring national best practices for solving homelessness to local jurisdictions throughout the state.

The full announcement from the Governor’s Office is available here.

PPIC Report Explores Potential Impacts to California’s Safety Net Programs in Economic Recession

The Public Policy Institute of California (PPIC) released a report this week exploring potential impacts on several key programs within California’s social safety net, despite the state currently experiencing an “unusually bright” economic picture. PPIC looks back at previous economic downturns and considers how California balanced the state budget, as required by the state constitution, while maintaining support for residents through Medi-Cal, CalWORKs, SSI/SSP, and the relatively new California Earned Income Tax Credit (CalEITC).

During the Great Recession a decade ago, the share of Californians who were poor grew from 12.2 percent to 16.6 percent. Three large state safety net programs registered $1.9 billion in cuts annually from 2008 to 2012, representing 15 percent of all cuts in state General Fund spending. In looking ahead, PPIC forecasts what may lie ahead for California’s safety net:

  • Using past experiences to project trends in the next economic recession, 500,000 to 1.2 million Californians could fall into poverty during a mild or moderate recession.
  • Poverty rates remained elevated for several years after state revenues began to recover, underscoring the necessity of planning for the entire economic cycle.
  • Medi-Cal has expanded dramatically in recent years and now provides health coverage for millions of low-income families and individuals. Ensuring It continues to play this critical role while maintaining increasing health care costs will be a challenge.

In a moderate-to-severe recession, PPIC notes that program cuts will be inevitable. PPIC recommends two principles to frame spending decisions: 1) prioritize protecting the most vulnerable Californians – those who are harmed most in economic downturns and depend on multiple safety net programs for basic necessities; and 2) recognize the staggered timing of recessions, revenue shortfalls, and poverty, and aim to restore cuts when revenue is recovering but poverty is still high.

California’s more than $20 billion in reserves is expected to provide a cushion in a budget crisis, but an important unknown is the role of the federal government in the next recession. In previous recessions, federal support protected California from more severe safety net spending cuts; given the current federal political climate, PPIC notes, it remains unclear what amount of assistance California will receive when the economy slows next.

The full PPIC report is available here.

CDPH CHC to Hold Peer Learning Collaborative Session on December 11

The California Department of Public Health (CDPH) Center for Healthy Communities (CHC) will be launching its Peer-to-Peer Learning Collaborative sessions in partnership with local health departments throughout the state.

The first session will be held on Wednesday, December 11 from 10:00 am to 11:00 am and will feature the Alameda County Public Health Department. The session is titled, “Advancing Health Equity: Fostering Community Partnerships to Build Power,” and will detail how Alameda County launched its housing equity work, developed partnerships with grassroots community organizations, government agencies, nonprofits, and others, and expanded a public health practice to impact housing policies and systems. 

Sessions are intended for local and state public health leadership, administrative, and programmatic staff. Registration for the December 11 session is available here.

Future sessions will be held on February 26, 2020, featuring the San Diego County Health & Human Services Agency and on May 27, 2020, featuring San Joaquin County Public Health Services. Additional details for the future sessions will be provided at a later date.

12/09/2019 Update: CDPH has cancelled this event; the event will be rescheduled at a later date.

New Study Finds Drop in U.S. Life Expectancy Among All Races and Geographies, Largely Driven by Midlife Deaths

A new study published in the Journal of the American Medical Association (JAMA) has found that increased death rates among U.S. residents have extended to all racial and ethnic groups, as well as all geographies – rural, suburban, and urban. The most recent report strengthens recent analyses from the U.S. Centers for Disease Control and Prevention (CDC) that have shown downward trends in U.S. life expectancy, representing a U.S. health disadvantage compared to other high-income nations despite the United States having the highest per capita health care spending in the world.

The newest study examined life expectancy data between 1959 and 2016, as well as cause-specific mortality rates between 1999 and 2017. Between 1959 and 2016, life expectancy increased from 69.9 years to 78.9 years but declined for the three consecutive years after 2014. Notably, an increase in death rates of individuals aged 25 to 64 has occurred across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and an extensive list of organ system diseases. The largest relative increases in midlife mortality rates occurred in New England and Ohio Valley states, including Ohio, Pennsylvania, Kentucky, and Indiana.

While similar recent research has pointed to “deaths of despair” – drug overdoses, alcoholism, and suicide, particularly among rural, white populations – the JAMA study has found that a number of chronic diseases including heart disease, strokes, and chronic obstructive pulmonary disease have also played an outsized role among all populations in all areas. In the study, researchers note the strong nexus between social and economic hardship and premature death and, given the public health and economic implications of such deaths, make a further call to better understand underlying causes.

The full JAMA study is available here.

Trump Administration Finalizes Rule Tightening Work Requirements for SNAP Benefits, Up to 750,000 Expected to be Impacted

On Wednesday, the Trump Administration issued a final rule tightening Supplemental Nutrition Assistance Program (SNAP) processes in which states can waive a requirement that able-bodied adults without children work at least 20 hours per week. Under current law, able-bodied adults without dependents (ABAWD) are individuals 18 to 49 who are not elderly, women who are pregnant, or someone with a disability. ABAWDs are required to work at least 20 hours per week or be in a job training program if they receive SNAP benefits for more than three months in a three-year period. Current regulations allow states to waive this requirement for up to two years in areas with specified high unemployment rates.

Recall, the Trump Administration announced its intent last year to require additional work requirements to receive SNAP benefits. The U.S. Department of Agriculture (USDA) conducted a public comment period earlier this year and more than 140,000 comments were submitted, with the overwhelmingly majority of them in opposition to the proposed rule.

According to a USDA Fact Sheet on the final rule, the Administration’s actions will apply “a common-sense approach to promoting work” by setting clear expectations about program participation, recognizing dynamic on-the-ground employment conditions, and strengthening and standardizing criteria for waiver approval.

In announcing the final rule, U.S. Agriculture Secretary Sonny Perdue remarked, “Government can be a powerful force for good, but government dependency has never been the American Dream. We need to encourage people by giving them a helping hand but now allowing it to become an indefinitely giving hand.” The USDA contends that the economy has improved under the Trump Administration and assistance to unemployed, able-bodied adults is no longer necessary in such a strong job market.

Economic experts have forecasted that the final rule may disqualify up to 750,000 U.S. residents from receiving SNAP benefits. Anti-poverty advocates widely denounced the Trump Administration’s final rule, noting that the rule would cause serious harm to individuals and working families, particularly those who are low-income and unable to find steady work. Many members of Congress also denounced the final rule, noting that Republicans and Democrats overwhelming rejected such a proposal in the U.S. Farm Bill that was passed and signed into law in December 2018.

Wednesday’s final rule is part of a broader suite of regulatory efforts to attempt to scale back nutrition assistance programs. The Trump Administration has also proposed rules to close a loophole that allows families with incomes up to 200 percent of the federal poverty level (FPL) to receive SNAP benefits, prevent households with more than $2,250 in assets or $3,500 in households with a disabled adult from receiving SNAP benefits, and cut $4.5 billion from SNAP over five years by modifying eligibility formulas. All combined, studies have suggested the proposed rules would impact up to four million U.S. residents receiving nutrition assistance and nearly one million school children receiving free or reduced price school meals.

Wednesday’s SNAP ABAWD final rule is available here.

TFAH to Hold State of Obesity Webinar on January 29

The Trust for America’s Health (TFAH) announced it will hold a webinar featuring findings of TFAH’s 2019 State of Obesity report, as well as a discussion amongst public health leaders on the national obesity crisis, its health impacts, and how advocates are working at national, state, and local levels to address the ongoing epidemic.

TFAH’s report found that about one in three Americans of all ages are obese. The epidemic is estimated to increase national healthcare spending by $149 billion annual, about half of which is paid for by Medicare and Medicaid. The rates of U.S. obesity continue to climb, and racial, ethnic, income, and geographic disparities persist.

Webinar speakers will detail the latest national and state obesity rates and trends, highlight promising approaches localities have undertaken to ensure healthy communities, and offer national policy recommendations that incorporate innovative approaches that prioritize helping all Americans lead healthier lives.

The webinar will be held on Wednesday, January 29, 2020, from 11:30 am to 1:00 pm. Registration is available here.