February 19, 2021 Edition
This week, Governor Gavin Newsom, Senate President pro Tempore Toni Atkins, and Assembly Speaker Anthony Rendon announced an agreement on a package of immediate actions to provide relief to residents, families, and businesses experiencing hardship during the COVID-19 pandemic. The agreement reflects a compromise on initiatives proposed in the Governor’s January Budget to provide cash relief to low-income residents, provide fee waivers for certain businesses, and provide additional support for childcare and other critical activities.
Below, a brief summary of the items included in the immediate action package is provided:
- Golden State Stimulus: Under the agreement, $600 one-time payments will be made to households that received the California Earned Income Tax Credit (EITC) for 2020. Additionally, the agreement will provide $600 one-time payments to taxpayers with Individual Tax Identification Numbers (ITINs) who were precluded from receiving federal economic impact payments. A $600 one-time grant to households enrolled in the CalWORKs Program and recipients of SSI/SSP and Cash Assistance Program for Immigrants (CAPI). Combined, the total agreement represents a total of 5.7 million payments to low-income residents.
- Small Business Relief: The agreement quadruples the amount of small business grants from $500 million to $2 billion, which will provide grants up to $25,000 to small businesses impacted by the pandemic. $50 million is also allocated to support cultural institutions. The agreement additionally conforms California tax law to new federal tax treatment for loans provided through the federal Paycheck Protection Program.
- Business Fee Waivers: The agreement provides two years of fee relief for approximately 59,000 restaurants and bars licensed by the Department of Alcoholic Beverage Control (ABC). Fee relief for nearly 600,000 barbering and cosmetology licensees under the Department of Consumer Affairs will also be provided.
- Childcare Support: $400 million in new federal funds to provide stipends of $525 per enrolled child for all state-subsidized childcare and preschool providers serving approximately 400,000 children statewide will be provided under the agreement. Federal resources will extend care for children of essential workers through June 2022.
- Aid to Individuals and Families: $24 million will be allocated to the Housing for Harvest program to provide financial assistance and services to agricultural workers in the state who have had to quarantine due to COVID-19. A combined $35 million will also be allocated for food banks and diapers.
- Community College Student Support: The agreement provides an additional $100 million in emergency financial aid for qualifying low-income students enrolled in California community colleges. $20 million will also be provided to reengage students who left community college studies during the pandemic or to engage students at-risk of leaving their studies.
- CalFresh Student Outreach: $6 million to support outreach and application assistance to the University of California, California State University, and California Community College students made newly eligible for CalFresh is included in the agreement. $12 million in state funds to support associated county administrative workload will also be included.
- Restoration of Reductions: The agreement also restores previously enacted reductions, effective July 1, for the University of California, California State University, the Judicial Branch, Child Support Services, and for moderate-income housing.
The Senate Budget & Fiscal Review Committee met on Thursday to hear budget measures associated with the above investments. The Assembly Budget Committee is set to convene a hearing on Monday to similarly consider the investments. The Legislature is anticipated to take up the measures for action early next week. An announcement on the agreement reached by the Governor and legislative leaders is available here.
Today, Governor Gavin Newsom announced two significant COVID-19 developments related to vaccine prioritization for education workers and the release of updated youth sports guidance.
Education Personnel to be Prioritized for Vaccine
Under the Governor’s announcements today, staff working in-person in public schools or childcare settings must be prioritized for vaccines statewide beginning March 1, 2021. Working in person include those currently working in-person or those that will be working in-person in the coming weeks, as confirmed by school employers. 10 percent of first doses statewide will be prioritized for education personnel, and the state’s third-party administrator (TPA) will prioritize a set amount of appointments for school staff and childcare providers through MyTurn in partnership with school districts, county offices of education, childcare providers, and labor organizations.
The move by the Newsom Administration follows the Thursday introduction of companion measures AB 86 and SB 86 by Assembly and Senate Budget Committees related to the safe reopening of schools, including vaccine prioritization for education personnel. On Thursday evening, Governor Newsom released a statement on the Legislature’s proposal, highlighting the actions of his Administration to safely reopen schools to date. Notably, Governor Newsom in his statement indicated the legislative proposal “doesn’t go far enough or fast enough” in reopening schools and expressed concern that the legislature’s plan would delay school reopenings statewide.
Updated Youth and Adult Sports Guidance Takes Effect Feb. 26
The Newsom Administration additionally issued updated youth sports guidance that will become effective on Friday, February 26. The guidance applies to all organized youth and adult sports, including school and community-sponsored programs, and privately organized clubs and leagues. Under the updated guidance, outdoor high- and moderate-risk sport competitions may resume in Red (Substantial) tier and Purple (Widespread) tier, with modifications, including testing requirements for certain outdoor high contact sports.
Under the updated guidance, outdoor high-contact sports can be played in counties in the Purple or Red tier with a case rate at or below 14 per 100,000. Weekly testing will be required for football, rugby, and water polo participants age 13 and over in counties with a case rate between seven and 14 per 100,000. Weekly testing is required for all participants and coaches in these sports. Sporting competitions must additionally adhere to various other requirements related to informed consent, face coverings, and physical distancing.
The updated guidance is available here.
This week, the Biden-Harris Administration detailed a series of actions intended to improve COVID-19 testing, support global COVID-19 vaccination efforts, and provide relief to impacted Americans. Below, these actions are summarized:
- Increased Weekly Supply: The Biden-Harris Administration announced it is increasing the weekly, minimum supply level of COVID-19 vaccines delivered to states, territories, and tribes to 13.5 million doses. This increase represents a 57 percent increase from when the Biden-Harris Administration took office. The Administration additionally announced it will be increasing its allotment of vaccine supply to pharmacies participating in the federal retail pharmacy program from one million doses to two million doses.
- Testing for Schools and Underserved Populations: The Department of Health and Human Services (HHS), in partnership with the Department of Defense (DoD), will make a $650 million investment to expand COVID-19 testing availability for K-8 schools and underserved congregate settings, including homeless shelters. HHS will establish regional coordinating centers to organize the distribution of COVID-19 testing supplies and partner with laboratories across the country to process test specimens.
- Increasing Manufacturing of Testing Supplies: HHS and DoD will invest $815 million to increase domestic manufacturing of testing supplies and raw materials that have created shortage issues.
- Increasing Virus Genome Sequencing: The U.S. Centers for Disease Control and Prevention (CDC) will invest nearly $200 million to identify, track, and mitigate emerging strains of SARS-CoV-2 through genome sequencing. This initial investment will increase CDC’s sequencing more than threefold from about 7,000 samples per week to approximately 25,000. The Administration notes the American Rescue Plan, as proposed by President Biden, would invest $50 billion to expand and support testing and invest in U.S. testing capacity to allow public health officials to track the virus in real time.
- COVAX Financing: The Biden-Harris Administration announced an initial contribution of $2 billion to Gavi, the Vaccine Alliance for the COVAX Advance Market Commitment, a World Health Organization (WHO) initiative to support the access of safe and effective COVID-19 vaccines to 92 low- and middle-income countries. The U.S. will release an additional $2 billion for COVAX between 2021 and 2022 with the first $500 million being made available when existing donor pledges are fulfilled and initial doses of vaccines are delivered to specified countries. The Administration further calls on international governments to support COVAX and target urgent vaccine manufacturing, supply, and delivery needs of low- and middle-income countries.
- Housing Relief: In light of ongoing pandemic-related economic hardships, the Biden-Harris Administration announced it is extending the foreclosure moratorium for homeowners through June 30, 2021, extend the mortgage payment forbearance window until June 30, 2021, for borrowers who wish to request forbearance, and provide up to six months of additional mortgage payment forbearance for borrowers who entered forbearance on or before June 30, 2020. The Administration has also established a centralized resource for homeowners and renters to access housing assistance.
Additional information on this week’s announcements can be accessed here, here, and here.
Today, President Joseph R. Biden announced his nomination of Chiquita Brooks-LaSure as the Administrator of the U.S. Centers for Medicare and Medicaid Services (CMS). Brooks-LaSure is currently the Managing Director at Manatt. She is a former policy official who played a key role in the development and implementation of the Affordable Care Act (ACA) and has more than 20 years of experience in health policy. She was previously the deputy director for policy at the Center for Consumer Information and Insurance Oversight within CMS and the director of coverage policy at the Department of Health and Human Services.
The full nomination announcement is available here.
The Senate Budget & Fiscal Review Subcommittee No. 3 on Health and Human Services today convened a hearing to examine proposed budget investments under the jurisdiction of the California Department of Health Care Services (DHCS). Today’s hearing included presentations from DHCS Director Will Lightbourne and State Medicaid Director Jacey Cooper, representatives from the Department of Finance (DOF), and the Legislative Analyst’s Office (LAO).
Subcommittee members reviewed a number of issues, including COVID-19 impacts on the Medi-Cal program, Medi-Cal telehealth policy changes and remote patient monitoring, and delay or repeal of program and benefit suspensions. Notably, the subcommittee examined the Newsom Administration’s California Advancing and Innovating Medi-Cal (CalAIM) proposal, including the requested expenditure authority of $1.1 billion for local assistance costs. Subcommittee members discussed the sweeping changes proposed under the CalAIM initiative, including enhanced care management services, in lieu of services, and the role of managed care plans in coordinating and delivering services to beneficiaries. The subcommittee additionally discussed at length DHCS’ proposed investments related to behavioral health services.
All items were held open for action at a later date. The hearing agenda is available here.
This week, the California Legislative Analyst’s Office (LAO) released an analysis on the state’s Medi-Cal budget for 2020-21 and 2021-22, as well as an analysis of California Advancing and Innovating Medi-Cal (CalAIM) financing issues. Brief summaries of these reports are provided below:
Medi-Cal Budget Analysis
The LAO’s analysis assesses major adjustments to the Medi-Cal budget in 2020-21 and 2021-22 and summarizes major discretionary proposals that contribute to increased spending in the program for 2021-22. The LAO intends to release additional publications analyzing major Medi-Cal budget investments over the coming weeks and months.
Due to lower than anticipated caseload growth in the Medi-Cal program, the Governor’s budget reflects a $1.2 billion decrease from the 2020-21 Budget Act. The LAO indicates the Governor’s budget additionally recognizes a savings in 2020-21 of around $230 million General Fund related to declines in routine health care utilization due to the COVID-19 pandemic. For the upcoming budget year, the LAO indicates the Governor’s budget anticipates an unprecedented nearly $6 billion increase due to technical adjustments and discretionary spending proposals.
The LAO further details the Newsom Administration’s Medi-Cal proposals and provides an assessment of several aspects of the Medi-Cal program’s expenditures. Of note, the LAO provides commentary on the end of the COVID-19 public health emergency and Proposition 56 provider payments and implications from the state’s flavored tobacco referendum, among other considerations.
The full LAO Medi-Cal Budget Analysis is available here.
CalAIM Financing Analysis
The LAO additionally published an analysis of financing issues related to the Newsom Administration’s ambitious CalAIM initiative. The LAO report provides background and history of the CalAIM proposal and details major policy reforms as part of the initiative. Notably, the LAO determines that many, if not most, of CalAIM reforms have significant potential to result in new costs and/or savings in Medi-Cal.
The LAO identifies anticipated major impacts of the CalAIM proposal, including improved coordination and new services for high-risk and high-need populations, transforming and streamlining managed care, and modifying behavioral health service delivery and financing. The LAO finds that using state General Fund resources for a series of CalAIM proposed investments is a reasonable approach and determines that expanded federal Medicaid funding would become available to the state through CalAIM services. The LAO identifies possible changes the Legislature may wish to explore, including improving managed care plan fiscal incentives to deliver more cost-effective care. Many programmatic details of the Administration’s CalAIM proposal remain elusive, limiting the ability of the LAO to provide a full analysis of the proposed delivery and financing changes.
The full LAO CalAIM Financing Issues Analysis is available here.
California Health Policy Strategies (CHPS) recently issued a policy brief providing an overview of the California Department of Health Care Services’ (DHCS) California Advancing and Innovating Medi-Cal (CalAIM) implications for reentry and justice-involved populations. CHPS details the background of the Newsom Administration’s CalAIM proposal and discusses potential changes in health services delivery and financing for justice-involved populations, namely through pre-release planning, behavioral health-facilitated referral and linkage, enhanced care management, and in lieu of services.
CHPS identifies a series of overarching issues with the CalAIM proposal as it relates to justice-involved populations, including engagement with the California Department of Corrections and Rehabilitation (CDCR) and Department of State Hospitals (DSH), deployment of community health workers, access to housing, and a continuum of community-based interventions.
The full CHPS policy brief is available here.
This week, the California Department of Health Care Services (DHCS) announced it is delaying the planned go-live implementation date of April 1, 2021, for Medi-Cal Rx due to the need to review new conflict avoidance protocols submitted by the project’s contracted vendor, Magellan Health. Recall, the Medi-Cal Rx initiative seeks to transition all Medi-Cal pharmacy services from managed care to fee-for-service.
Centene Corporation in January 2021 announced its plans to acquire Magellan Health. Centene, through subsidiaries, operates managed care plans and pharmacies that participate in Medi-Cal. According to DHCS, the Centene acquisition of Magellan was unexpected and requires additional time to explore conflict avoidance protocols to ensure a division between corporate entities to protect pharmacy claims data of Medi-Cal beneficiaries and other proprietary information. Medi-Cal Rx remains a priority of the Newsom Administration, and additional information on the initiative is anticipated in May 2021.
On Thursday, Governor Gavin Newsom announced the appointment of Rohan Radhakrishna, MD, MPH as the Deputy Director of the Office of Health Equity at the California Department of Public Health (CDPH). Radhakrishna has served as the co-chair of the Health Equity Committee of the California Conference of Local Health Officers (CCLHO) since 2019 and the Deputy Health Officer at Contra Costa County Health Services since 2018. Radhakrishna was previously the chair of the Family and Adult Medicine at Contra Costa County Health Services from 2015 to 2019 and held other international and global public health positions. The position requires Senate confirmation.
The appointment announcement is available here.
Recently, the California Budget & Policy Center issued its report, “Confronting Racism: Overcoming COVID-19 and Advancing Health Equity.” The report assesses the inequities unveiled during the COVID-19 pandemic, including racism’s impact on the health of children, families, and individuals, the COVID-19’s disproportionate impact on communities of color, and pandemic-induced economic hardship. The report calls on state policymakers to declare racism a public health crisis and provides an overview of how health inequities are a direct consequence of historic and ongoing racism. The report points to historic racist policies and practices in housing, environment, employment, health care, justice system, and education in barring communities the opportunity to be healthy and thrive.
The full California Budget & Policy Center report is available here.