February 14, 2020 Edition

CHEAC Office Closed February 17

The CHEAC Office will be closed on Monday, February 17 in observance of the President’s Day Holiday. We will resume normal operations on Tuesday, February 18.

CHEAC State Legislative Member Education Day Expands

A number of CHEAC members recently descended upon the State Capitol to educate members of the Legislature and their staff on the role and value of local health departments in Sacramento. This year’s event was an expansion of CHEAC’s first Legislative Member Education Day held in 2019 with 29 members representing 19 local health departments, including a nice balance of large, medium, and small, who made 61 visits in the Capitol building last Wednesday.

CHEAC members focused their discussions with Legislators and their staff on several key issues to support local health department activities including supporting CHEAC’s budget request to provide $15 million in funding to address sexually transmitted disease reinfections, supporting Senator Hill’s SB 793 to ban flavored tobacco in California, requesting legislators advocate for dedicating a portion of the Governor’s proposed nicotine tax revenues to bolster the public health workforce and infrastructure, and also working to ensure public health departments have a role in the planning design and implementation of Medi-Cal Healthier California for All (formerly known as CalAIM).

CHEAC extends our appreciation to those CHEAC Members that participated and look forward to continuing to promote local health departments and their critical role in their jurisdictions to the Legislature.

Assembly Select Committee on Infectious Diseases Convenes Informational Hearing on HIV, HCV, and STDs

On Tuesday, the Assembly Select Committee on Infectious Diseases, chaired by Assembly Member Mike Gipson, convened an informational hearing focused on the HIV, HCV, and STD epidemics in California. The hearing featured three key panels, the first providing an overview of the diseases in California, the second highlighting challenges in addressing them, and the third offering key strategies to end the HIV, HCV, and STD epidemics in our state.

Dr. Marisa Ramos, Chief of the Office of AIDS at the California Department of Public Health (CDPH), provided the Committee with a brief overview and of recent funding streams provided in the 2019 Budget Act to address these issues. She also discussed ongoing challenges associated with the epidemics, including the nexus with homelessness and opioid use. Dr. Ramos highlighted the importance of linkages to care and integrating surveillance and monitoring activities in effectively addressing the widespread epidemics.

Dr. Karen Mark, Medical Director with the Department of Health Care Services (DHCS), discussed DHCS’ recently proposed Medi-Cal Healthier California for All (CalAIM) proposal and its role in addressing the HIV, HCV, and STD epidemics. The initiative aims to address beneficiaries’ social determinants of health and provide intensive services for critical populations. Dr. Mark also discussed DHCS’ ongoing collaborations with CDPH, particularly around coverage of medications without prior authorization, availability of PrEP and PEP medications, and expansion of Hepatitis C programs regardless of disease stage.

Heidi Bauer with the Department of Corrections and Rehabilitation (CDCR) further discussed CDCR’s infectious disease screening and treatment programs operated by the Department to inmates. Bauer discussed the vulnerability of inmates upon their entry into CDCR facilities, the importance of ensuring successful community transition and linkages to care, and CDCR partnerships with local health departments and other state agencies in ensuring connections and referrals to care through Whole Person Care (WPC).

The second panel featured local and community-based perspectives of the challenges in addressing HIV, HCV, and STD epidemics. Panelists included representatives from the Gender Health Center, TruEvolution, Fresno Barrios Unidos, TransLatin@ Coalition, and the Kern County Public Health Services Department. The panelists discussed their entities’ roles in providing services, coordinating care, and responding to the HIV, HCV, and STD epidemics, as well as resource and staffing challenges and limitations in delivering such services. Kimberly Hernandez with Kern County Public Health discussed local rates of syphilis and congenital syphilis and role of the health department in conducting surveillance and monitoring, screening and testing, and linkage to care services among individuals who are infected and/or exposed to the communicable diseases. Ms. Hernandez further discussed the factors exacerbating the increase in STDs, including homelessness and poverty.

The last panel of the hearing included representatives from the California HIV/AIDS Policy Research Centers, the Transitions Clinic Network, the Los Angeles County Department of Public Health, Family Health Centers of San Diego, and Essential Access Health. Representatives of the panel examined key strategies to end the HIV, HCV, and STD epidemics throughout the state, including the need for intensive services for individuals exiting incarceration, well-coordinated linkages and transitions to care for vulnerable populations, expanded screening and testing activities, and adequate resources for staffing. Mario Pérez with the Los Angeles Department of Public Health Division of HIV and STD Programs further highlighted the health department’s role in responding to the epidemics and its close work with community-based organizations in reaching specific populations. Mr. Pérez discussed the need for state policy to routinize screening and testing and navigator staff to ensure access to treatment services. Mr. Pérez, among other panelists, urged the Legislature to bolster public health capacity and infrastructure to adequately address, respond, and prevent epidemics such as the HIV, HCV, and STD epidemics experienced statewide.

Members of the Select Committee inquired about the startling rates of infectious diseases, factors exacerbating disease conditions, barriers experienced by individuals, local agencies, and community-based organizations in addressing the epidemics, and strategies available to the Legislature and state to end the epidemics. Public comment featured a number of local governments, public health, and community-based entities discussing the need to broaden approaches to addressing the epidemics to consider social needs and cooccurring conditions, increasing investments in public health and health services, and expanding screening, navigation, and treatment services.

A video recording of the hearing is available here.

Senate Health Committee Holds Informational Hearing on Rise in Vaping

On Wednesday, the Senate Health Committee convened an overview hearing to examine the rapid rise in vaping electronic cigarettes, health impacts, and strategies available to reduce vaping utilization. The hearing featured three panels detailing current vaping rates and recent trends, statewide efforts to address vaping products and emerging health effects, and local government policies to decrease access to vaping products.

The first panel featured Dr. Michael Ong of the University of California, Los Angeles (UCLA) and Chair of the Tobacco Education and Research Oversight Committee (TEROC). Dr. Ong discussed the unprecedented increase of the use of vaping products, particularly among youth and young adults, over the past several years. Dr. Ong’s presentation included the latest data available detailing California youth utilization of vaping products, as well as research finding that youth who use tobacco products first began with flavored tobacco products.

The second panel of the hearing featured California Department of Public Health (CDPH) Director and State Health Officer Sonia Angell who provided information on the health impacts of vaping and nicotine use, particularly on young and developing brains. Dr. Angell provided a status update on the ongoing E-Cigarette or Vaping Product-Use Associated Lung Injury (EVALI) cases in California and detailed the role of CDPH and local health departments in investigating and responding to cases. Approximately three to five EVALI cases per week continue to be identified by CDPH, and CDPH is working to standardize monitoring and reporting activities statewide. Dr. Angell also discussed the Newsom Administration’s public awareness campaign and proposed budget investments to discourage vaping use throughout California.

The third panel featured representatives of the Contra Costa County Public Health Department, including Director Dan Peddycord and Health Officer Chris Farnitano. Contra Costa County provided Senators a presentation on its recently enacted county ordinance banning the sale of flavored tobacco products in the county’s unincorporated areas. Dan Peddycord discussed the health department’s role in limiting tobacco product access, particularly among youth and young adults, and its work with cities within the county to enact similar restrictions. Both Mr. Peddycord and Dr. Farnitano urged the committee to enact a statewide ban on flavored tobacco products to comprehensively and uniformly limit access to the products.

Members of the Senate Health Committee raised questions of the panelists around what has driven the significant increase in youth uptake of vaping products and vaping products’ impact on youth health. Senator Jerry Hill, who attended the hearing as an interested party, inquired about the role of flavored products in reversing the previously declining trend of tobacco use among youth and young adults. Senator Hill has introduced SB 793 to ban the sale of flavored tobacco products statewide; all panelists during Wednesday’s hearing expressed support for the measure and CHEAC is an active member of the coalition supporting the proposed ban.

Senate Health Committee Chair Richard Pan in his closing remarks expressed significant concern with the most recent data of youth tobacco use and discussed the proposed flavored tobacco ban as a mechanism to “stop the bleeding” of high rates of youth tobacco use and uptake.

A video recording of Wednesday’s hearing is available here. The hearing’s background paper is available here.

LAO Issues Reports on Governor’s Proposed Investments in Homelessness, Climate Change

This week, the Legislative Analyst’s Office (LAO) issued two reports related to Governor Gavin Newsom’s proposed investments included in the 2020-21 proposed budget. The reports play a key role as the Legislature begins holding budget committee hearings over the coming weeks and months to examine proposed investments across various program areas and topics. The LAO’s reports this week assess the Governor’s proposed investments in homelessness and climate change.

Homelessness Investments

In issuing its report, the LAO indicated its intent to provide the Legislature context for the state’s homelessness crisis, an update on recent state efforts to address homelessness, an assessment of the Governor’s 2020-21 homelessness plan, and a proposed framework to assist the Legislature in developing its own plan and funding allocations as an alternative to the Governor’s proposal.

The LAO discusses the state’s current homelessness crisis and estimates 151,000 people are currently experiencing homelessness, more than any other state in the nation. Despite significant investments from state and local governments, California saw a 16 percent increase in its homeless population from 2018 to 2019. The LAO discusses the important role of local governments in providing services to individuals experiencing homelessness and provides a historical context around how funds have been spent by state and local governments to address the issue.

As proposed in the Governor’s 2020-21 budget, $750 million is slated to establish the California Access to Housing Services Fund (CAAHS) within the Department of Social Services and $695 million is slated to reform the Medi-Cal system through the Medi-Cal Healthier California for All (CalAIM) initiative. In assessing the Governor’s proposed investments, the LAO finds that the Governor’s proposals fall short of articulating a clear strategy for curbing homelessness in California and raise significant questions for the Legislature to consider during the budget process. Furthermore, the LAO urges the Legislature to develop a comprehensive strategy for addressing homelessness through a framework that identifies goals, identifies solutions that align with goals, sets clear state and local responsibilities, identifies a state governance structure, establishes a funding strategy, and develops rigorous oversight mechanisms. The LAO contends that this framework, established by the Legislature, would ensure the state’s resources are used in a way that results in meaningful reductions in homelessness.

The LAO sets forth a series of recommended one-time actions if the Legislature is unable to develop over the next few months a clear and comprehensive strategic plan to address homelessness. These alternative efforts largely focus on supporting local initiatives to address homelessness, including providing grants to local governments, while the Legislature has time to develop its homelessness plan.

The full LAO report on proposed homelessness investments is available here.

Climate Change Investments

The LAO also issued a report examining the Governor’s proposed investments related to climate change. The four main proposals evaluated by the LAO include a $965 million cap-and-trade expenditure plan, $25 million for expanded climate adaptation research and technical assistance, $250 million for a new climate catalyst loan fund, and a $4.8 billion climate bond. The report issued by the LAO sets forth a series of key issues for the Legislature to consider, including thinking broadly about its climate change-related priorities, General Fund commitments, Greenhouse Gas Reduction Fund dollars, and the use of nonfinancial tools and regulations to achieve its climate goals.

The full LAO report on proposed climate change investments is available here.

QR Code Cannabis Regulations Approved

Last month, the California Bureau of Cannabis Control (BCC) released emergency cannabis regulations making it mandatory for cannabis businesses to post their unique Quick Response Code (QR code) certificate in their storefront windows and carry it with them when making cannabis deliveries. Yesterday, the Office of Administrative Law (OAL) approved the emergency regulations, which went into effect immediately. For more information on cannabis regulations, including the new emergency regulations, click here. 

Trump Releases Federal FY 2021 Budget Blueprint

This week, the Trump Administration released their federal fiscal year 2021 budget blueprint, which outlines the President’s policy priorities for the next budget year beginning on October 1, 2020. These documents define the Administration’s plans for the federal government, but also serve as the opening gambit to negotiations with Congress.

In a record-breaking $4.8 trillion budget plan, the Trump Administration delineates five key priorities for the coming fiscal year including new or renegotiated trade deals, rebuilding the nation’s military, addressing the opioid crisis, regulatory reform, and achieving American energy independence. However, the spending plan also outlines almost $2 trillion in domestic spending cuts particularly to safety net programs. Reductions would include new work requirements for Medicaid, federal housing assistance and food stamp recipients, which would reduce spending in these programs by nearly $300 billion.

Democrats in Congress were less than enthusiastic about the President’s 2021 Budget vision with House Speaker Nancy Pelosi noting “year after year, President Trump’s budgets have sought to inflict devastating cuts to critical lifelines that millions of Americans rely on.”  The President was also criticized from more conservative outlets for the budget blueprint relying on “optimistic projections for economic growth and unlikely budget cuts to illustrate deficit reduction.”

Perhaps one of the more worrisome proposals are proposed cuts to Medicaid and the Affordable Care Act (ACA) over ten years, totaling $844 billion, including eliminating the enhanced federal match for the ACA’s Medicaid expansion to low-income adults. Furthermore, the Administration proposes to require all states to remove adult Medicaid enrollees who do not meet new work requirements.

Notable provisions of interest to local health departments include:

  • $1.6 billion, increased by $85 million from FY 2020, for State Opioid Response grants.
  • A proposal to move the Center for Tobacco Products out of the Food and Drug Administration (FDA) and create a new agency within Health and Human Services to focus on tobacco regulation.
  • $371 million, increased by $231 million from FY 2020, for the Ending the HIV Epidemic initiative, to support a ramp up of activities in 57 jurisdictions – 48 counties (in California, includes Alameda, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco counties), Washington DC, San Juan Puerto Rico, and 7 states with that have a substantial rural HIV burden (Alabama, Kentucky, Mississippi, Missouri, Oklahoma, Tennessee, and South Carolina).
  • $58 million, increase of $48 million from FY 2020, for the Infectious Diseases and the Opioid Epidemic program. Funding would be directed to “select jurisdictions nationwide” to target the infectious diseases associated with the opioid epidemic including HIV, viral hepatitis, and bacterial and fungal infections.
  • Eliminates $426 million from the CDC’s Chronic Disease Prevention and Health Promotion program area, including eliminating all program funding for tobacco; nutrition, physical activity and obesity; heart disease and stroke; diabetes; and oral health.
  • Eliminates all funding ($160 million) for the Preventive Health and Health Services Block Grant program.
  • Reduces funding for Emerging and Zoonotic Infectious Diseases by $85 million, including eliminating all funding for the Epi and Lab Capacity program and all funding for Healthcare-Associated Infections program.
  • $182 billion cut to SNAP over ten years, including adding work requirements for able-bodied adults ages 18 to 65.
  • Modifications to the Medicaid Institutions for Mental Diseases (IMDs) exclusion allowing for “targeted flexibility” to States to provide inpatient mental health services to Medicaid beneficiaries with serious mental illness.

The full FY 2021 budget proposal is available from the White House here. For a full list of proposed CDC appropriations including program cuts, click here.  

CDPH EPO Training Workshop Registration and Call for Abstracts Now Open

The California Department of Public Health (CDPH) Emergency Preparedness Office (EPO) 2020 Emergency Preparedness Training Workshop will be held June 15-17 at the Hyatt Regency Sacramento. The training workshop is designed for local public health emergency preparedness (PHEP), hospital preparedness program (HPP), and pandemic influenza (Pan Flu) grant funded programs to receive training on current grant requirements, enhance preparedness knowledge, and gather information on best practices and lessons learned that can be taken back to their local program. Registration for the workshop is now open.

Additionally, the 2020 Planning Committee invites interested parties to submit a proposal for the workshop, which is themed “Next Generation Preparedness.” All abstracts may include lessons learned from working together with at-risk and functional and access needs populations within communities. The deadline to submit a workshop proposal is Wednesday, March 11. A poster session opportunity is also available, and the deadline for submission is March 18. Additional information on the opportunities is available here.

TFAH Publishes 2020 Preparedness Report

The Trust for America’s Health (TFAH) recently published its report “Ready or Not 2020: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism,” which provides an annual assessment of states’ level of readiness to respond to public health emergencies and recommends policy actions to ensure the public’s health is protected during such events. The 2020 edition found overall preparedness improvement but identifies significant areas that still require attention.

Based on 10 performance indicators and public health funding, TFAH’s report ranks state preparedness into three performance tiers of high, middle, and low. 25 states and the District of Columbia were categorized into the high preparedness performance tier, representing an increase from 17 states last year. 12 states, including California, fell into the middle tier, and 13 states fell into the low tier.

Among the major findings of the report, TFAH determined a majority of states have plans in place to expand healthcare capacity in an emergency and most states are accredited in areas of public health and/or emergency management. TFAH further determined seasonal flu vaccinations remained too low, access to paid time off was limited resulting in the exacerbation of some infectious disease outbreaks, and hospital safety scores in a number of areas need improvement. TFAH set forth a series of recommendations to improve the nation’s ability to protect the public’s health during emergencies, including:

  • Providing stable and sufficient funding for domestic and global public health security
  • Preventing outbreaks and pandemics
  • Building resilient communities and promoting health equity in preparedness
  • Supporting the public health workforce and ensuring effective leadership and coordination
  • Accelerating development and distribution, including last mile distribution, of medical countermeasures

The full report from TFAH is available here.