February 12, 2021 Edition

Legislature Examines State Rollout of COVID-19 Vaccines, Considers Public Health Infrastructure Funding

This week, the California State Senate and Assembly convened several hearings to examine the state’s rollout and administration of COVID-19 vaccines, as well as consider investments for the state’s public health infrastructure. Below, we detail each of the hearings.

Assembly Sub. 1 Assesses Vaccine Administration, Hears CHEAC Budget Requests

On Monday, the Assembly Budget Subcommittee No. 1 on Health and Human Services (HHS) convened its first subcommittee hearing of the year to examine proposed early action investments in the areas of the Emergency Medical Services Authority (EMSA), the Office of Statewide Health Planning and Development (OSHPD), the California Department of Public Health (CDPH), and the Department of Health Care Services (DHCS).

Notably, the subcommittee received an overview of the CDPH budget and reviewed CDPH’s pandemic response, including investments related to workplace outbreak reporting, infectious disease modeling, and personal protective equipment (PPE) funding. Numerous representatives from CDPH, including Director and State Public Health Officer Tomás Aragón, Chief Deputy Director Susan Fanelli, and State Epidemiologist Dr. Erica Pan, discussed the department’s role and performance in coordinating and responding to the ongoing COVID-19 pandemic. Among the topics covered by CDPH representatives were state industry guidance, COVID-19 vaccine allocation and administration, hospital surge activities, impacts on populations disproportionately affected by COVID-19, and epidemiological surveillance.

Madera County Public Health Director Sara Bosse presented to the subcommittee to share a local perspective on pandemic emergency response activities, including case investigation and contact tracing efforts, partnerships with health providers and community-based organizations, and vaccine administration. Director Bosse highlighted ongoing challenges being experienced by local health departments statewide in responding to the pandemic, such as data quality and access, public health workforce availability, and vaccine supply and administration efforts, among others.

Director Bosse and CHEAC Executive Director Michelle Gibbons, among others, presented budget requests for two public health infrastructure investments. The requests, sponsored by CHEAC, CSAC, UCC, RCRC, HOAC, and SEIU California, seek $200 million ongoing General Fund for public health infrastructure and workforce and $3.45 million one-time General Fund for a statewide public health infrastructure study. Director Bosse highlighted the urgent need for ongoing and sustainable funding for public health infrastructure to ensure a trained and adequate workforce and ensure the continuity of non-pandemic-related local health department programs and services.

Subcommittee members had the opportunity to ask questions of presenters, which largely focused around COVID-19 vaccine allocation and distribution, vaccine eligibility, the forthcoming third-party administrator (TPA) framework, vaccine equity and attempts to reach underserved populations, and ongoing challenges with data and state data systems. All items were held open for action at a later date.

The subcommittee agenda is available here. A video recording of the hearing is available here.

Joint Assembly Committees Hear Local and State Perspectives on COVID-19 Distribution

On Wednesday, the Assembly Accountability and Administrative Review Committee (A&AR) and the Assembly Emergency Management Committee (EM) convened a joint oversight hearing to examine California’s COVID-19 vaccine distribution. The chairs of each committee, Assembly Member Cottie Petrie-Norris (A&AR) and Freddie Rodriguez (EM), both emphasized at the start of the hearing their goal was to understand California’s vaccine rollout strategy and how recent changes will impact existing local vaccine operations.

The first panel was comprised of Yolo County Health Officer Dr. Amy Sisson and Los Angeles County Department of Public Health’s Chief Science Officer, Dr. Paul Simon. Dr. Sisson discussed how vaccines are allocated and distributed at the local level by health departments. She illustrated the problems with state vaccine data and recommended that if the state moves to a third-party administrator (TPA), data quality needs to be improved and local health departments (LHD) must be engaged in decisions on how to distribute vaccine to vulnerable communities. Dr. Simon emphasized the biggest issue to date is the scarcity of vaccine supply. He also recommended that as the state moves to the third-party administrator, LHDs must be allowed to identify provider networks within their communities to ensure the equitable distribution of vaccine, that additional state and federal revenues are necessary to support local efforts to slow the spread of the virus, to allow LHDs to have ongoing and timely access to accurate data to assist local planning and evaluation, and to provide consistent and coordinated messaging from the state to help manage the public’s expectations and to maintain public trust.

Following the local perspective panel, several representatives spoke on behalf of the state’s vaccine rollout efforts. Panelists included CDPH Director, Dr. Tomás Aragón, Government Operations Secretary, Yolanda Richardson, TPA Project Coordinator, Marta Green, CalOES representatives, Tina Curry and Lori Nezhura, and Civic Engagement and Strategic Partnerships Director, Maricela Rodriguez. Dr. Aragón discussed the state’s approach to vaccination efforts across the state and delved into vaccine prioritization categories. Secretary Richardson talked about the rationale for creating a single statewide network for vaccine distribution through the TPA as well as the creation of the MyTurn vaccine eligibility and appointment system. Other panelists discussed the TPA, state supports for vaccination clinics including PPE and staff, and the state’s vaccine community engagement and education plan.

Members of both committees expressed concerns with the TPA, vaccine prioritization categories, and vaccine allocations. Assembly Member Petrie-Norris concluded the hearing with three recommendations to the state including setting clear and achievable goals for the public and partners, asking that state plans or criteria not be changed as it creates confusion, and requesting improved communications with counties and statewide/local partners.

The hearing agenda is available here. A video recording of the hearing is available here.

Senate Sub. 3 Examines COVID-19 Response, CDPH Budget Items

Today, the Senate Budget & Fiscal Review Subcommittee No. 3 on Health and Human Services (HHS) convened a hearing to examine proposed investments in the California Department of Public Health (CDPH), as well as to receive an update on the state’s ongoing public health response to the COVID-19 pandemic. The subcommittee considered various investments proposed by CDPH, including infectious disease modeling, COVID-19 workplace outbreak reporting, personal protective equipment (PPE) availability, and books for low-income children.

The subcommittee received updates from CDPH on the current status of COVID-19 in California, prevention and response activities associated with the pandemic, COVID-19 testing capacities, the state’s vaccine distribution processes and systems, case identification and contact tracing supports, pandemic preparedness efforts, and funding implications for the pandemic response. The hearing additionally featured a panel of representatives to provide an overview of local- and sector-specific pandemic response activities. CHEAC Executive Director Michelle Gibbons and HOAC Executive Director Kat DeBurgh discussed local health departments’ activities in responding to the pandemic, resource needs associated with the continued pandemic response, and gaps in readiness and resources for a future pandemic. Other witnesses representing hospitals, clinics, and skilled nursing facilities discussed the pandemic’s impacts on their operations, and the California Pan-Ethnic Health Network (CPEHN) and SEIU California additionally discussed impacts on their consumers and communities.

The hearing agenda is available here.

JLBC Approves $1.2 Billion in Funding for Continued LHD COVID-19 Response

On Tuesday, the Joint Legislative Budget Committee (JLBC) notified the California Department of Finance (DOF) of its approval of the Newsom Administration’s proposal to allocate nearly $1.2 billion in unanticipated federal funds to local health departments to support ongoing response activities to the COVID-19 pandemic. Recall, approximately $1.7 billion in Epidemiology and Laboratory Capacity (ELC) funds were allocated to California by the most recent federal COVID-19 relief measure that was passed by Congress and signed into law in late December 2020.

The expanded funding will support local health department efforts in responding to the pandemic emergency, including through testing, contact tracing, vaccination, surveillance, containment, and mitigation. Funds were allocated through an equitable formula developed by the California Department of Public Health (CDPH) in consultation with CHEAC and CCLHO that is based on population, poverty rates, and race/ethnicity.

The approval letter from the JLBC is available here.

Biden-Harris Administration Announces Additional Vaccine Supply, FQHC Vaccine Program

This week, the Biden-Harris Administration announced several key developments in the federal government’s response efforts related to the COVID-19 pandemic. Below, we highlight these activities:

  • Purchase of Additional Vaccines: On Thursday, the U.S. Department of Health and Human Services (HHS) and the Department of Defense (DoD) purchased an additional 100 million doses each of COVID-19 vaccines from Pfizer, Inc. and Moderna, Inc. to help meet demand for COVID-19 vaccines in the U.S. The orders placed this week increase the total amount of vaccines purchased from the two companies to 600 million doses. Each company is delivering 300 million doses in regular increments through the end of July 2021.  
  • FQHC Vaccine Program: The Biden-Harris Administration announced that beginning next week, federally qualified health centers (FQHCs) throughout the country will begin directly receiving COVID-19 vaccine supply. The program will be incrementally implemented and will complement existing jurisdictional efforts to provide COVID-19 vaccines. An initial 250 Health Resources & Services Administration (HRSA)-funded FQHCs will receive vaccine supply next week. Initial health centers chosen for the first phase of this program serve a large volume of disproportionately impacted populations, including individuals experiencing homelessness, public housing residents, migrant and seasonal agricultural workers, and patients with limited English proficiency. The program is anticipated to expand to the more than 1,400 HRSA-funded health centers with over 13,000 sites as vaccine supply increases. Additional information on the program from HRSA is available here.
  • Increased Weekly Vaccine Supply: Building on announcements from previous weeks, the Biden-Harris Administration will increase overall, weekly vaccine supply to states, tribes, and territories to 11 million doses nationwide. This increase represents a 28 percent increase since the Biden-Harris took office on January 20. The Administration is committing to maintaining the 11 million weekly doses as the minimum supply level for the next three weeks.
  • Equity Task Force: President Biden and Vice President Kamala Harris this week announced membership of its COVID-19 Health Equity Task Force that is tasked with providing recommendations for addressing health inequities caused by the COVID-19 pandemic and for preventing such inequities in the future. The task force is chaired by Dr. Marcella Nunez-Smith and will involve 12 task force members representing a wide array of backgrounds and expertise, racial and ethnic groups, and other important populations. Notably, Mayra Alvarez, President of The Children’s Partnership, a California advocacy organization working to advance child health equity, and Andrew Imparato, Executive Director of Disability Rights California, were named to the task force. Additional information, including a listing of task force members, is available here.

LAO Issues Overview Report on CalAIM Proposal

This week, the California Legislative Analyst’s Office (LAO) published a report providing an overview of the state’s California Advancing and Innovating Medi-Cal (CalAIM) proposal, a sweeping set of reforms to expand, transform, and streamline Medi-Cal service delivery and financing. This week’s report from the LAO is the first in a series addressing different components of the Newsom Administration’s proposal and details key changes from last year’s withdrawn proposal, analyzes overarching issues as part of the proposal, and provides key points for the Legislature’s consideration.

The LAO provides a high-level overview of the Medi-Cal program in California, including details on the various systems through which beneficiaries access services, and identifies key changes and clarifications the Administration has made in its new CalAIM proposal. One of the key changes identified by the LAO is the addition of a new In-Lieu of Service (ILOS) benefit for asthma remediation services, a benefit advocated for by CHEAC during the state’s CalAIM stakeholder process. The LAO discusses the state’s proposed CalAIM financing plan, determining the funding plan is substantially similar to last year’s proposal.

In assessing the Administration’s broader CalAIM proposal, the LAO finds the proposal could potentially reduce health disparities and improve service delivery among Medi-Cal beneficiaries and strengthen managed care plans’ capacities and incentives to coordinate care for patients. However, the LAO identifies a number of overarching outstanding questions with the Administration’s proposal, including whether managed care plans are well positioned for a significant expansion of responsibilities, whether new benefits would expand the supply of already limited services, and whether the CalAIM proposal would create new complexities. The LAO recommends the Legislature use its budget and policy processes to resolve key outstanding questions and provide legislative input. Additionally, the LAO recommends the Legislature explore potential delays in implementation, consider establishing a process for legislative oversight of implementation activities, and require a comprehensive and independent evaluation.

The full LAO report on the CalAIM overview is available here.

CDA to Host March 3 Webinar on Equity in Aging

The California Department of Aging (CDA) will again host a webinar as part of its multi-part series on “Equity in Aging.” The next webinar will occur on Wednesday, March 3 from 10:00 am to 11:00 am and is entitled, “Culturally Informed Policy & Programs: With and For Asian & Pacific Islander Older Adults.” The webinar will feature the National Asian Pacific Center on Aging (NAPCA) and SSG Silver and will include a discussion on how to build community, provide culturally responsive services and supports, and create opportunities with and for Asian and Pacific Islander older adults in California.

Registration for the webinar is available here.