February 18, 2022 Edition

Legislature Reaches Bill Introduction Deadline, CHEAC Legislative Committee to Meet Next Week

The California State Senate and Assembly today reached the deadline to introduce new bills for the second half of the 2021-22 Legislative Session. Legislators this week introduced hundreds of bills on a wide range of topics, and the Senate and Assembly desks are anticipated to finalize processing of all new bill introductions through the weekend.

The CHEAC Legislative Committee will meet next week to review and determine positions on the first batch of new bills of potential interest and/or impact to California local health departments and public health. The Committee will convene again in mid-March to review the second batch of new bills. As the Legislative Committee identifies and takes positions on new bills of interest, bills will begin to appear on our CHEAC Weekly Bill Chart. As a friendly reminder, our CHEAC Weekly Bill Chart is published at the end of each week and accessible on CHEAC’s Legislative Advocacy Page.

Of note this week, Senate President pro Tempore Toni Atkins on Thursday announced a hearing has been set for SCR 5 (Melendez) on March 15 in the Senate Governmental Organization Committee. SCR 5 would declare an end to the Governor’s state of emergency proclaimed on March 4, 2020, due to the COVID-19 pandemic. In her statement, pro Tempore Atkins indicated:

“The Committee will debate the merits of the resolution and the implications it will have on California’s ability to respond to the COVID emergency. I understand we are all tired of living life in an emergency, but ending the emergency must be done responsibly to ensure there are no unintended consequences so we can continue to meet the need of our state’s residents in an unpredictable future.”

In other legislative news, the full Senate today voted 33-0 to confirm Dr. Rohan Radhakrishna as the Deputy Director of the California Department of Public Health (CDPH) Office of Health Equity (OHE). Recall, Dr. Radhakrishna’s appointment was considered by the Senate Rules Committee last week and unanimously advanced to the full Senate.

For a full update on CHEAC-tracked legislative measures, the latest edition of the CHEAC Weekly Bill Chart is available here.

Senate, Assembly Consider CDPH and Health Care Access Investments

This week, the Senate Budget & Fiscal Review Subcommittee No. 3 and Assembly Budget Subcommittee No. 1 considered key public health- and health-related investments proposed by the Newsom Administration. Below, we detail these hearings:

Senate Sub. 3 Considers CDPH Investments, Including for Public Health Infrastructure and Workforce

Today, the Senate Budget & Fiscal Review Subcommittee No. 3 on Health and Human Services convened a hearing to assess budget investment proposals under the jurisdiction of the California Department of Public Health (CDPH), including the Governor’s January Budget proposal to provide $300 million ongoing to state and local health departments.

A considerable portion of today’s hearing was dedicated to the “Foundation for the Future of Public Health,” which featured a background on the historic underinvestment of public health in California and persistent public health staffing challenges statewide. CDPH Director and State Public Health Officer Dr. Tomás Aragón and other CDPH representatives presented the Newsom Administration’s proposal to provide $200 million to local health jurisdictions and $100 million for CDPH for critical public health workforce and infrastructure.

The state’s portion of the $300 million investment is anticipated to support over 400 positions at the state level across workforce development, emergency preparedness and response, information technology and data science, communications and public education, community partnerships, and community health improvement efforts.

The agenda item featured a stakeholder response panel, consisting of CHEAC Executive Director Michelle Gibbons and SEIU California Government Relations Advocate Matt Lege, as well as representatives from the California Pan-Ethnic Health Network (CPHEN) and the Public Health Institute. Ms. Gibbons, during her remarks to the subcommittee, expressed CHEAC’s support for the Governor’s $300 million proposal for state and local public health. She highlighted the importance of the investment to enable state and local health departments to begin to rebuild the decimated public health workforce in protecting and promoting the health of California communities. Ms. Gibbons also called attention to the California Can’t Wait Coalition’s budget requests for one-time investments in critical public health training and workforce pipeline investments.

Following the panel’s comments, Subcommittee No. 3 Chair Senator Susan Talamantes Eggman underscored the importance of investing in public health infrastructure and workforce. Senator Richard Pan similarly discussed the historic underinvestment of public health in California, the traumatic impact of the COVID-19 pandemic on public health professionals, and workforce development opportunities and supports for existing public health workers. Dr. Pan also raised the potential of leveraging lessons learned from the 2020 Census in public health-related community-based messaging and partnerships.

Additional items considered by Subcommittee No. 3 included investment proposals for climate and health surveillance, public health regional climate planning, the Alzheimer’s Healthy Brain Initiative, opioid public awareness and surveillance, home visiting expansion, and Black Infant Health (BIH) program expansion, among others. CHEAC provided comments and expressed support for numerous investment proposals covered by the Subcommittee during today’s hearing.

All items were held open by the Subcommittee for action at a later date. The agenda from today’s hearing is available here. A video recording of the hearing is available here.

Assembly Sub. 1 Assesses Health Care Access Budget Investments

On Monday, the Assembly Budget Subcommittee No. 1 on Health and Human Services convened a hearing to consider a series of investments related to health care access. The bulk of the items considered by the Subcommittee fell under the jurisdiction of the Department of Health Care Services (DHCS).

The Subcommittee received presentations on the considered budget items from representatives of DHCS, including DHCS Director Michelle Baass and State Medicaid Director Jacey Cooper. Of note, the Subcommittee considered the Newsom Administration’s proposal to expand full-scope Medi-Cal to all income-eligible adults ages 26-49 years old regardless of immigration status, as well as a proposal to add HPV vaccine coverage in the Family PACT Program.

DHCS also presented its proposal to sunset the Child Health and Disability Prevention (CHDP) Program. During the hearing, Subcommittee Chair Assembly Member Joaquin Arambula raised a series of questions of the Department regarding how its proposal would impact children, as well as local operations of the program. CHEAC, in its letter submitted to the Subcommittee last week, expressed opposition to the Administration’s proposal out of concerns for potential impacts on vulnerable children and local health department program operations.

All items during the hearing were held open for action at a later date. The full agenda from the Subcommittee No. 1 hearing is available here. A video recording of the hearing is available here.

LAO Publishes Assessment of Public Health Infrastructure and Workforce Spending Plan

The Legislative Analyst’s Office (LAO) this week issued its assessment of the Newsom Administration’s proposal for public health foundational support, namely the Governor’s January Budget proposal to provide $300 million ongoing to state and local public health.

The LAO provides historical context and background of state funding into the California Department of Public Health (CDPH), as well as the series of needs exposed during the COVID-19 pandemic. The LAO report details the Governor’s proposed funding to state and local public health departments and the six-point plan to bolster the state’s public health infrastructure through staff recruitment and training, emergency response, information technology, communications, community partnerships, and community health.

In its assessment of the Newsom Administration’s proposal, the LAO finds the Administration’s spending plan has many merits, including increasing real-time disease surveillance, coordinating regional epidemiological and communications activities, and improving strategic planning. However, the LAO identifies gaps in the Administration’s plan relative to creating a workforce pipeline, strengthening its statewide public health laboratory network, and laying out an overarching information technology strategy.

Further, the LAO identifies opportunities for the Legislature to strengthen oversight of local health departments. The Administration’s proposal, as written, does not include minimum requirements or goals for local health departments, and the LAO notes that tying local plans directly to community health needs assessments (CHAs) and community health improvement plans (CHIPs) may not be the best substitute “for a more deliberate and consistent type of local plan” across local health departments.

The LAO in its report outlines a series of recommendations for consideration by legislators:

  • Asking for more information from the Newsom Administration, particularly around omitted objectives in the spending plan that the LAO identifies
  • Incorporating better oversight of local health departments, including by requiring more CDPH management of local plan development and oversight of local health departments’ use of funds
  • Developing reporting requirements, such as regular reports to the Legislature on CDPH and local health department efforts
  • Implementing the Administration’s plan through trailer bill language instead of the currently proposed budget bill

The full LAO assessment on the Administration’s public health infrastructure and workforce spending plan is available here.

Governor Unveils COVID-19 SMARTER Plan

Governor Gavin Newsom on Thursday unveiled his Administration’s approach to the next phase of the state’s COVID-19 pandemic response. According to the Newsom Administration, the SMARTER Plan builds on lessons learned over the past two years and the state’s ongoing commitment to equity. The Plan will “ensure California can maintain its focus on communities that continue to be disproportionately impacted and stay prepared to swiftly and effectively respond to emerging COVID-19 variants and changing conditions.”

The SMARTER Plan’s pillars and preparedness components focus on public health measures and strategies the state has used successfully to slow the spread and protect residents. The Plan consists of:

  • Shots – Under the Administration’s plan, California will maintain capacity to administer at least 200,000 vaccines per day on top of existing pharmacy and provider infrastructure.
  • Masks – The Administration acknowledges the continued importance of masks to slow the spread of COVID-19 and other respiratory viruses. The state will maintain a stockpile of 75 million high quality masks and the capability to distribute them as needed.
  • Awareness – The Administration’s plan will continue to stay aware of how COVID-19 is spreading and evolving variants, communicate clearly how people can protect themselves, and coordinate our state and local government response. California will maintain capability to promote vaccination, masking, and other mitigation measures in all 58 counties and support engagement with at least 150 community-based organizations.
  • Readiness – The state will maintain resources and supplies to allow quick response to protect public health and keep the health care delivery system well prepared. The state will also maintain wastewater surveillance in all regions and enhance respiratory surveillance in the health care system while continuing to sequence at least 10 percent of positive COVID-19 test specimens. The state will also maintain the ability to add 3,000 clinical staff within 2-3 weeks of need across various health care facility types.
  • Testing – Testing will continue to minimize the spread of COVID-19. California will maintain a commercial and local public health capacity statewide to perform at least 500,000 tests per day, a combination of both PCR and antigen tests.
  • Education – California will continue to keep schools open and children safely in classrooms for in-person instruction. The state will expand school-based vaccination sites supported by the state by 25 percent to increase vaccination as vaccine eligibility expands.
  • Rx – The state will maximize orders for the most clinically effective therapeutic available through federal partnerships, ensuring allocations of effective therapeutics are ordered within 48 hours.

The Newsom Administration indicates they will continue to focus on targeted investments and outreach to tackle COVID-19 health disparities in disproportionately impacted communities. The Plan includes new activities, including a new COVID-19 Assessment and Action Unit to monitor data and frontline conditions in real-time. The plan also builds upon a robust, regionally based wastewater surveillance and whole genome sequencing network to have early and rapid insights into the changing nature of the virus.

Additional information on the Administration’s SMARTER Plan is available here.

CDC Studies Underscore Safety and Effectiveness of COVID-19 Boosters

Data from recent studies from the U.S. Centers for Disease Control and Prevention (CDC) demonstrate that COVID-19 vaccine boosters remain safe and continue to be highly effective against severe disease over time.

The first CDC study reviewed data from two of its vaccine safety monitoring systems, V-Safe and the Vaccine Adverse Event Reporting System (VAERS). The study found that people 18 years and older who received the same mRNA vaccine brand for all their vaccinations received fewer adverse reactions following the booster dose than they did after their second dose of mRNA vaccine. 92 percent of reports to VAERS were not considered serious; headache, fever, and muscle pain were among the most commonly reported reactions. V-Safe data found medical care was rarely received after a booster dose.

A second CDC study reveals that a third dose of mRNA vaccine continues to offer high levels of protection against severe disease, even months after administration, underscoring the importance of staying up to date when eligible after receiving a primary series. CDC examined data on 93,000 hospitalizations and 241,000 emergency department and urgent care visits across 10 states during the Delta and Omicron waves. In the study, about 10 percent of people were boosted and over 50 percent of people hospitalized were over 65 years old. During Omicron, vaccine effectiveness against hospitalization was 91 percent during the first two months after a third dose and remained high, at 78 percent, four or more months after a third dose.

Additional information is available here.

Covered California Names Altman as New CEO

This week, Covered California’s Board of Directors announced the appointment of Jessica Altman as its new Chief Executive Officer (CEO). Altman currently serves as the insurance commissioner for the Pennsylvania Department of Insurance where she is charged with regulating Pennsylvania’s insurance marketplace, protecting consumers, and ensuring their health insurance needs are met.

Altman previously served in key roles in the Obama Administration during the early establishment and implementation of the Affordable Care Act (ACA), as well as the chair of the Pennsylvania Health Insurance Exchange Authority where she led the establishment of Pennsylvania’s state-based marketplace.

Altman’s appointment follows the announcement last fall that Peter Lee, Covered California’s first executive director, would be leaving after more than a decade of leading the marketplace. Altman is expected to begin in her new role in early March.

Additional information is available here.

Califf Narrowly Confirmed as FDA Commissioner

The U.S. Senate on Tuesday confirmed Dr. Robert Califf as Commissioner of the U.S. Food and Drug Administration (FDA). The Senate narrowly confirmed his appointment on a 50-46 vote with six Republicans supporting his appointment and five Democrats voting against his appointment. Califf was identified as a candidate by the Biden Administration last year.

Dr. Califf was sworn into his role on Thursday, taking over the helm from Dr. Janet Woodcock who served in the role on an interim basis during the past year. Dr. Califf served as FDA Commissioner in 2016-2017 after being confirmed by the Senate on a 89-4 vote with bipartisan support. Califf also served as FDA’s Deputy Commissioner for Medical Products and Tobacco from 2015-2016. Prior to rejoining the FDA, Califf was head of medical strategy at Alphabet, Inc. and a professor of medicine and vice chancellor for clinical and translational research at Duke University.

Additional information on Dr. Califf is available here.

HRSA Awards $55 Million to Enhance Telehealth at Community Health Centers

The U.S. Health Resources and Services Administration (HRSA) this week announced it has awarded nearly $55 million to 29 HRSA-funded health centers to increase health care access and quality for underserved populations through virtual care such as telehealth, remote patient monitoring, digital patient tools, and health information technology platforms. The funding builds on over $7.3 billion in American Rescue Plan Act (ARPA) funding invested in community health centers over the past year to mitigate COVID-19.

HHS notes the significant increase in virtual care delivered to patients during the COVID-19 pandemic, as well as continued demand for virtual visits. Funding awarded to health centers is anticipated to enable facilities to sustain an expanded level of virtual care and identify and implement new digital strategies.

Additional information is available here.

CMS Seeks Information on Medicaid Access to Coverage and Care

The U.S. Centers for Medicare and Medicaid Services (CMS) recently announced it is seeking feedback on topics related to health care access, such as enrolling in and maintaining coverage, access health care services and supports, and ensuring adequate provider payment rates to encourage provider availability and quality. According to CMS, the request for information (RFI) is one of many actions CMS is taking to develop a more comprehensive access strategy in Medicaid and CHIP Programs.

Feedback obtained from CMS’ RFI will aid in CMS’ understanding of enrollees’ barriers to enrolling in and maintaining coverage and accessing needed services and support through Medicaid and CHIP. The information will help inform future policies, monitoring, and regulatory actions, helping ensure beneficiaries have equitable access to high-quality and appropriate care across payment and delivery systems, including fee-for-service, managed care, and alternative payment methods.

The RFI seeks feedback from a diverse set of stakeholders on a broad set of topics from ensuring adequate payment rates to encouraging provider availability and quality, to culturally and linguistically competent care and reducing gaps in health care coverage. The RFI is open for a 60-day public comment period beginning February 17, 2022.

Additional information is available here.

District Court Delays Effective Date of Cigarette Package Graphic Warnings

This week, the U.S. District Court for the Eastern District of Texas issued an order postponing the effective date of the “Required Warnings for Cigarettes Packages and Advertisements” final rule from the U.S. Food and Drug Administration (FDA). The district court delayed implementation of the rule for an additional three months, until April 9, 2023.

Recall, the FDA issued its final rule in March 2020, establishing new graphic warning labels for cigarettes and tobacco products. The FDA’s rule was set to take effect June 18, 2021. However, the implementation of the rule has been delayed by court orders seven times.

Additional information from the FDA is available here.

Newsom Administration Announces Additional Homelessness Funding Awards

The Newsom Administration within the past week announced a series of funding awards to address homelessness throughout California. We detail these announcements below:

$38 Million Announced to Combat Youth Homelessness

Governor Gavin Newsom late last week announced $38 million in new grant programs for community-based organizations statewide through the Homeless Youth Emergency Services and Housing Program. The grants are intended to allow local service providers to deliver temporary housing and supportive services for youth experiencing homelessness.

The grants are being distributed through the Office of Emergency Services (OES) to 12 community-based organizations. The funds aim to ensure safe shelter for teens and young adults experiencing short or long-term housing instability.

Additional information on the youth homelessness grants is available here.

$116.3 Million Awarded for Homekey Projects

Governor Newsom this week announced more than $116 million in funding for seven Homekey projects across the state. The projects are anticipated to provide nearly 400 units of housing for people experiencing or at risk of experiencing homelessness.

Funding awarded in the latest round of awards include grants to Ventura and Orange counties. According to the Newsom Administration, additional Homekey awards will be announced in the coming weeks. Completed applications will be accepted by the state on a rolling basis until funds are exhausted or May 2, 2022, whichever comes first.

Additional information on Homekey awards is available here.

Caltrans Active Transportation Program Funding Opportunity Opens Next Month

The California Transportation Commission (CTC), in partnership with the California Department of Transportation (Caltrans), will release the 2023 Active Transportation Program (ATP) Cycle 6 request for applications on March 16, 2022, to fund local infrastructure (e.g., bicycle paths and pedestrian facility construction) and non-infrastructure (e.g., education, encouragement) projects.

Applications will be due to Caltrans by June 15, 2022. The CTC anticipates in upward of $600 million in funding, combined with additional federal funds, for four fiscal years from 2023-24 through 2026-27.

Additional information from Caltrans is available here.

PPIC Issues Report on Impacts of Medi-Cal Expansion

The Public Policy Institute of California (PPIC) this week issued a report on the impacts of expanded eligibility of health insurance in California. PPIC, in light of Governor Newsom’s proposal to expand full-scope Medi-Cal eligibility to all income-eligible residents regardless of immigration status, explored longer-term impacts of the 2014 Medi-Cal expansion in California, with a focus on financial barriers to care.

PPIC finds that the expansion of Medi-Cal has reduced out-of-pocket health care costs, financial worries, and debt collections and bankruptcies among beneficiaries. PPIC additionally determined the expansion is also lowering financial barriers to necessary health services. In California counties with high uninsured rates in 2013 (places that stood to gain the most from Medi-Cal expansion), families have been less likely to delay needed care due to cost compared to those in other areas. Between 2014 and 2018, this translated to about a 25 percent reduction on average in delayed needed care. Importantly, this effect has grown over time.

PPIC discusses a series of recent proposals from the Newsom Administration to address health care coverage and affordability, including the state’s CalAIM Initiative and the recently established Office of Health Care Affordability.

The full PPIC report is available here.