February 25, 2022 Edition
CHEAC recently welcomed Damitra “Dimi” Hawkins to the CHEAC Staff as a Fiscal Analyst. Dimi joins CHEAC from the California Department of Health Care Services (DHCS) where she most recently served as Chief of the County and Tribal-Based Medi-Cal Administrative Activities Unit in the Local Governmental Financing Division. Dimi served in various capacities at DHCS over the past 10 years.
Dimi will be involved in CHEAC budget advocacy efforts, as well as local health department financing and budgeting issues. Dimi’s email address is email@example.com. Please join us in welcoming Dimi to the CHEAC Staff!
The CHEAC Legislative Committee today convened its first daylong bill review meeting to assess the first batch of new legislative bills introduced in the second year of the 2021-22 Legislative Session. The Legislative Committee reviewed nearly 30 measures of potential interest to California local health departments and public health services in the state. The CHEAC Legislative Committee will convene again in two weeks to review the second batch of new bills introduced this year.
In other legislative news this week, the California State Assembly on Wednesday swore in a new member. Assembly Member Mike Fong was victorious in the recent special election for the 49th Assembly District in Los Angeles County. The seat was previously held by Assembly Member Ed Chau who resigned in late 2021 after being appointed by Governor Gavin Newsom to the Los Angeles County Superior Court. Assembly Member Fong served on the Los Angeles Community College Board of Trustees since 2015. He was previously a candidate in a special election for an Assembly seat in 2017.
For a full update, including new bills identified today by the CHEAC Legislative Committee, the latest edition of the CHEAC Weekly Bill Chart is available here.
Budget Subcommittees of both the California State Senate and Assembly this week maintained busy schedules, considering a series of investment proposals from the Newsom Administration in areas of health care, health care workforce, food insecurity, and other notable areas. Below, we highlight relevant hearings.
Senate Sub. 3 Considers Investments for DHCS
On Thursday, the Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services convened a hearing to consider proposed investments included in the Governor’s January Budget related to health care coverage and affordability. Specifically, the subcommittee reviewed expenditures under the authority of the Department of Health Care Services (DHCS), including the implementation of California Advancing and Innovating Medi-Cal (CalAIM) and significant behavioral health-related investments and programs.
Of note to CHEAC Members, the Subcommittee considered the Newsom Administration’s proposal to expand full-scope Medi-Cal coverage to all income-eligible adults regardless of immigration status. The Subcommittee expressed support for the proposal but raised questions around the proposed implementation timeline of the expansion, currently no sooner than January 1, 2024.
The Subcommittee additionally considered the Administration’s proposal to sunset the Child Health and Disability Prevention (CHDP) Program. CHEAC submitted a letter to the Subcommittee outlining concerns with the proposal relative to potential impacts on child populations and local health department operations of the program. Last, the Subcommittee also considered the Administration’s proposal to include coverage of the HPV vaccine within the Family PACT Program.
All items were held open for action at a later date. The full agenda is available here. A video recording of the hearing is available here.
Assembly Sub. 4 Reviews Administration’s Health Care Workforce Proposals
The Assembly Budget Subcommittee No. 4 on State Administration convened a hearing on Tuesday to review a series of employment-related investment proposals from the Newsom Administration. Specifically, the Subcommittee received a presentation from the Administration on its $1.7 billion in health care workforce proposals to recruit, train, hire, and advance an ethnically and culturally inclusive health and human services workforce statewide.
Proposals considered as part of the health care workforce investments included High Road Training Partnerships for Health and Human Services, the Health Care Workforce Advancement Program, and targeted emergency medical technician training.
The California Can’t Wait Coalition, led by CHEAC, submitted a letter and provided public comment to the Subcommittee elevating additional needs for the state’s public health workforce. The Coalition urged the Legislature to consider supporting workforce training and pipeline investments included in the Coalition’s Public Health Equity and Readiness Opportunity (HERO) Initiative. The HERO Initiative seeks one-time investments totaling nearly $190 million to provide recruitment and retention stipends, waive public health nurse certification fees, and bolster a number of existing fellowship and training programs.
The health care workforce item was held open by the Subcommittee on Tuesday. The Subcommittee notes that given the crossover of the items with other Budget Subcommittees, a joint subcommittee hearing may be convened to consider all health and human services workforce investment proposals from the Newsom Administration.
The Subcommittee No. 4 hearing agenda is available here. A video recording of the hearing is available here.
Assembly Sub. 1 Assesses Food Insecurity Proposals
On Wednesday, the Assembly Budget Subcommittee No. 1 on Health and Human Services convened a hearing to assess the Governor’s January Budget proposals related to antipoverty and safety net programs. The majority of budget proposals considered by the Subcommittee fell within the California Department of Social Services (CDSS), including those related to food assistance and housing and homelessness.
Of interest, the Subcommittee assessed budget proposals for the CalFresh program, as well as the proposed $50 million one-time investment for food banks to mitigate increases in demand among food-insecure populations and expansion of the California Food Assistance Program (CFAP) for all California residents 55 and older regardless of immigration status.
The Subcommittee held open all items for action at a later date. The Subcommittee No. 1 hearing agenda is available here. A video recording of the hearing is available here.
The Legislative Analyst’s Office (LAO) this week published a brief assessing various January Budget proposals from the Newsom Administration related to improving health care access and affordability in California. The LAO details opportunities for the Legislature to improve affordability of health plans purchased through Covered California, as well as key access and affordability challenges that remain.
Notably, the LAO covers the following significant health access and affordability items:
- Full-Scope Medi-Cal Coverage to Remaining Income-Eligible Undocumented Populations – The LAO determines the Newsom Administration’s proposal is consistent with past legislative efforts to expand Medi-Cal coverage to younger and older undocumented residents. The proposal would substantially reduce the number of residents who do not have access to comprehensive health insurance, and the LAO encourages the Legislature to closely assess the Administration’s caseload and cost estimates. The LAO suggests legislators explore an accelerated implementation timeline, including by incrementally expanding coverage.
- Reduce Medi-Cal Premiums to Zero Cost – The Governor’s proposal to reduce all Medi-Cal premiums to $0 beginning July 2022 would help improve affordability and access to health coverage for certain populations, according to the LAO. The LAO encourages legislators to seek additional information on how past-due premiums would be handled but agrees with the policy basis for the proposal.
- Establish the Office of Health Care Affordability – The LAO details the context of health care costs in California, as well as previous attempts to establish a similar office in the state. The Governor’s proposal would establish the office through budget-related legislation and reappropriate $30 million General Fund to establish the office that was included in the 2021-22 Budget. Overall, the LAO determines creating the office is a reasonable yet ambitious step toward controlling health care costs and urges legislators to ensure continued monitoring of implementation. The LAO further outlines several issues for further consideration by legislators, including ensuring legislative oversight of the office.
- Reduce the Cost of Insulin – The Newsom Administration has announced a forthcoming potential partnership to manufacture insulin in California. The LAO determines insulin could be an appropriate focus for a partnership but looming uncertainties around the proposal leads the LAO to recommend holding off on approving the proposal. Specifically, the LAO recommends an evaluation of legal, market, policy, and regulatory factors that could impact the partner, as well as whether the state would be able to produce insulin at a price that results in savings and improves patient access to affordable medication.
The LAO further identifies options to improve affordability of health plans purchased through Covered California, including eliminating deductibles for certain beneficiary populations. The LAO rounds out its report on health access and affordability by detailing outstanding issues for consideration by legislators.
The full LAO report is available here.
Late last week, President Joseph R. Biden, Jr. extended the national emergency declaration related to the COVID-19 pandemic beyond March 1, 2022. The national emergency was initially declared on March 13, 2020, and was set to expire on March 1 without an extension.
The extension issued by the Biden Administration allows for the continuation of pandemic-related flexibilities across numerous program and policy areas, including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and Health Insurance Portability and Accountability Act (HIPAA) coverage requirements, including waivers for telehealth services.
The notice from the White House is available here.
Today, the U.S. Centers for Disease Control and Prevention (CDC) unveiled “COVID-19 Community Levels,” a new tool to help communities determine what COVID-19 prevention strategies to take based on the latest available data. Levels can be “low,” “medium,” or “high” based on a combination of three metrics.
The metrics utilized by the CDC include new COVID-19 hospital admissions per 100,000 population in the past seven days, the percent of staffed inpatient beds occupied by COVID-19 patients, and total new COVID-19 cases per 100,000 population in the past seven days. New COVID-19 admissions and the percent of staffed inpatient beds occupied represent the potential for strain on the health care delivery system. Data on new cases acts as an early warning indicator of potential increases in health care delivery system strain in the event of a COVID-19 surge.
The COVID-19 community level is determined by the higher of the new admissions and inpatient beds metrics, based on the current level of new cases per 100,000 population in the past seven days. The CDC, based on the COVID-19 Community Level, details individual-, household-, and community-level prevention strategies against COVID-19. Recommendations offered by the CDC include a range of vaccines, testing, and nonpharmaceutical interventions.
In conjunction with the COVID-19 Community Levels, the CDC announced it is also relaxing its masking guidance for communities where the COVID-19 community level is low or medium. CDC is dropping its recommendation for universal school masking and will instead recommend masking in communities at a high level of COVID-19. Notably, the CDC emphasized the ability for people to choose to mask at any time. The CDC additionally indicated that people with symptoms, a positive test, or exposure to someone with COVID-19 should wear a mask regardless of community level.
Additional information from the CDC is available here.
Governor Gavin Newsom today announced the continued phased rollback of executive orders issued in response to the COVID-19 pandemic. Specifically, the Governor took action to “lift all but 5 percent of COVID-19 related executive order provisions” while maintaining critical measures to support the state’s ongoing response and recovery efforts. According to the Newsom Administration, the remaining 17 executive actions include maintaining the state’s testing and vaccination programs and protecting hospital and health facility capacity.
- COVID-19 Testing – Four provisions provide flexibility necessary to support the state’s COVID-19 testing program. Under the SMARTER Plan, the state will need the flexibility to process at least 500,000 tests per day.
- Vaccination and Boosters – Two provisions provide flexibility to support the state’s vaccination and booster efforts. This includes waiving licensing requirements temporarily to enable pharmacists and pharmacist technicians to administer COVID-19 vaccines and waiving requirements to allow the state to offer mobile vaccine clinics.
- Hospital Capacity and Vulnerable Populations – 11 provisions remain necessary to protect capacity in the health care delivery system and vulnerable populations, particularly during COVID-19 surges. This includes provisions allowing health workers from out of state and enabling certain agencies to provide remote and expanded nonresidential services for more clients.
The Administration notes that prior to today’s action, only 15 percent of COVID-19-related executive orders remained in effect. 19 remaining provisions were terminated immediately today, with an additional 18 provisions to expire on March 31, 2022, and 15 provision to expire on June 30, 2022. The Governor notes as part of the state’s COVID-19 SMARTER Plan, additional provisions will be lifted as they are no longer needed to support the ongoing pandemic response.
The Governor additionally issued a proclamation terminating 12 open states of emergency related to various fires, heat waves, and other incidents dating back to 2015.
The order rolling back additional COVID-19-related executive actions is available here. Additional information from the Newsom Administration is available here.
This week, the California Department of Public Health (CDPH) updated three State Public Health Officer Orders allowing receipt of a COVID-19 booster to be deferred for up to 90 days for infections that occurred after the primary vaccine series.
The updated orders apply to covered workers detailed in the three State Public Health Officer Orders on Health Care Workers, Health Care Workers in Correctional Settings, and Adult and Direct Care Workers.
The California Department of Public Health (CDPH) and the Labor and Workforce Development Agency (LWDA) on Thursday announced the continuation of community engagement efforts by awarding more than $27 million in contracts to 153 community-based organizations statewide. Awarded organizations will continue to encourage COVID-19 vaccination, including boosters, especially among communities hardest hit by the pandemic.
According to CDPH, the partnerships with CBOs are part of the state’s extensive work to address health inequities exposed by the COVID-19 pandemic. In total, the state has invested over $50 million in partnerships with more than 200 CBOs to help Californians get vaccinated through direct and peer-to-peer outreach, including appointment assistance, canvassing, phone banking, and text message campaigns.
Organizations received awards ranging from $50,000 to $300,000 for regional or statewide outreach efforts to communities disproportionately impacted by the pandemic. The two projects consist of the California COVID Community Health Project and the California COVID Workplace Outreach Project.
Additional information from CDPH is available here and information from LWDA is available here.
The U.S. Centers for Disease Control and Prevention (CDC) recently updated its guidance related to COVID-19 vaccines to recommend an eight-week period between the first and second doses of an mRNA vaccine for some people ages 12 and older, particularly males ages 12-39 due to an increased risk of myocarditis.
The CDC maintains its recommendation for a three-week interval for individuals 65 and older, immunocompromised individuals, and others who need rapid protection due to increased risk of community transmission or severe disease.
Additional information is available here.
A survey from the University of California, Berkeley Institute of Governmental Studies examined a range of issues related to how K-12 schools are handling the ongoing COVID-19 pandemic. The poll was administered online in early February among 8,937 California registered voters.
The poll’s primary findings include:
- Overwhelming support among the state’s voters for adding COVID-19 to the list of required vaccinations for K-12 students and requiring students, teachers, and staff to wear masks while in school this year. However, there are large partisan and ideological differences in vies about both policies. Greater than eight in 10 of the state’s liberal voters are supportive while only about one in four approve of the policies among the state’s conservative voters.
- Parents of school-aged children display broad support for allowing in-person instruction to proceed at their child’s own school with 79 percent in favor. Yes, a significant portion of parents (37 percent) report that they are not confident that their child is safe from the virus in school with Latino and Black parents expressing less confidence than white and Asian parents.
- When parents are asked about the importance of having their own school-aged child vaccinated against COVID-19, 64 percent feel this is essential or important but 26 percent do not. Asian parents are more likely than others to feel that it is essential to have their child vaccinated.
- Among the overall electorate, strong bipartisan agreement exists that COVID-19 has had a negative impact on the educational quality of public schools in their own area. Nearly three in four voters statewide hold this view.
- Voters, by a greater than two-to-one margin, believe schools should be given the flexibility to decide when to continue in-person instruction rather than adopting a policy of requiring that in-person instruction be cancelled when COVID-19 cases rise above a certain threshold.
According to the Berkeley IGS, the survey results indicate that widespread concerns remain about the impact of the COVID-19 pandemic on K-12 education but significant partisan differences exist when voters are asked about how schools should respond to the pandemic.
The full survey results are available here.
The U.S. Centers for Disease Control and Prevention (CDC) recently released two new reports in its Morbidity and Mortality Weekly Report (MMWR) that provide important insights on the health and wellbeing of children and adolescents during the COVID-19 pandemic.
The first report assessed pediatric emergency department visits, finding that overall pediatric emergency department visits decreased in 2020, 2021, and January 2022 compared to visits in 2019. COVID-19-related emergency department visits increased across all pandemic years and among pediatric age groups. There were additionally increases in the weekly number and proportion of emergency department visits for certain types of injuries, some chronic diseases, and visits related to behavioral health concerns. Factors affecting caregivers during the pandemic, including unavailable or unpredictable childcare, illness, financial hardship, and mental health concerns, were found to possible increase a child’s vulnerability.
The second report examined changes in pediatric emergency department visits for mental health conditions and found that adolescent girls (12-17 years old) accounted for the largest increases in the number and proportion of emergency department visits for mental health conditions in 2020, 2021, and in January 2022 compared to 2019. Weekly visits for eating and tic disorders increased for females, particularly adolescent females, over the same period. According to the CDC, the highly complex nature of individual experiences makes it difficult to identify a single reason for changes in mental health conditions during the pandemic.
Additional information on the recent reports is available here.
The National Institutes of Health (NIH) National Institute on Minority Health and Health Disparities (NIMHD) recently published a study exploring the prevalence of COVID-19-related discrimination in all major racial and ethnic groups in the United States. COVID-19-related discrimination includes experiences of being threatened or harassed based on someone’s perception of another having COVID-19.
Data was collected from the COVID-19 Unequal Racial Burden (CURB) survey. The survey inquired whether individuals from racial and ethnic groups had experienced COVID-19-related discriminatory behaviors, such as being called names or insulted, being threatened or harassed, or hearing racist comments. The survey also asked whether participants felt that others acted afraid of them because they belonged to a racial or ethnic group misconceived to get COVID-19 more often.
Results determined that 22.1 percent of participants have experienced discriminatory behaviors, and 42.7 percent of participants reported that people acted afraid of them. When compared to white adults, people from all racial and ethnic minority groups were more likely to have experienced COVID-19-related discrimination. Researchers additionally analyzed the impact of other social and demographic factors on COVID-19-related discrimination. People from groups that have been marginalized, such as those who speak little to no English and those with lower levels of education, were found to face more discrimination due to the pandemic.
The results from the study suggest that the COVID-19 pandemic has worsened existing resentment toward racial and ethnic minorities and other minority populations in the U.S. The study suggests the need for careful and responsible public health messaging during public health crises to help prevent and address discrimination against groups that have been marginalized.
Additional information on the study is available here.
The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is making more than $560 million in Provider Relief Fund (PRF) payments to more than 4,100 providers throughout the U.S.
With this week’s announcement, nearly $11.5 billion in PRF payments have been distributed to more than 78,000 providers in all 50 states, Washington, D.C., and five territories. This amount is in addition to HRSA’s distribution of American Rescue Plan Act (ARPA) Rural payments totaling nearly $7.5 billion in funding to more than 44,000 providers since November 2021.
According to HHS, the PRF payments have been instrumental in assisting health care providers prevent, prepare for, and respond to the COVID-19 pandemic. Providers have used funds to remain in operation and continue supporting patient care. Health organizations facing workforce shortages and staff burnout are also able to use the funds to support recruitment and retention efforts.
Approximately 86 percent of PRF Phase 4 funding applications have been processed. Remaining applications will continue to be processed throughout early 2022.
Additional information is available here.
The U.S. Centers for Disease Control and Prevention (CDC) recently issued a grant opportunity forecast for $3 billion in American Rescue Plan Act (ARPA) funds to improve critical public health infrastructure needs. The investment, according to the CDC, will help ensure that U.S. public health systems are ready to respond to public health emergencies like COVID-19 and meet the evolving and complex needs of communities and populations they serve.
The funding program will help to address the historic underinvestment in the county’s public health system and in communities that are economically or socially marginalized, rural communities, and communities with people from racial and ethnic minority groups. The funding will provide cross-cutting support to public health agencies for critical infrastructure needs related to workforce, foundational capabilities, data modernization, and physical infrastructure. Investments in these areas are anticipated to have lasting effects on public health capacity and systems across the country and will help public health agencies transform to meet the evolving and complex needs of the U.S. population.
The grant submission period is estimated to open on April 14, 2022, and close June 13, 2022. The award floor is currently proposed at $2.5 million with a maximum of $150 million.
Additional information from the CDC is available here.
The STOP! Partner Group, a collaboration between the Johns Hopkins Bloomberg School of Public Health and over 16 multidisciplinary partners representing public health, law enforcement, and government, recently announced a campaign to better support, protect, and assure the safety of the country’s public health workforce. The STOP! Campaigns aims to address ongoing workplace violence, harassment, and threats against public health agencies and professionals.
The campaign comes as a recent survey of local health departments (LHDs) in the U.S. identified at least 1,500 incidents of harassment and violence against public health workers in health departments nationwide between March 2020 and January 2021. The STOP! Partner Group urges the federal government to establish a national reporting system for incidents of violence against the public health workforce and provide legal protections for public health workers facing harassment and violence.
Various resources and information have been made available by the campaign. Additional information is available here.
On Thursday, Governor Gavin Newsom announced the award of $50 million in grants to 19 local governments throughout the state to provide shelter or housing for more than 1,400 individuals currently experiencing homelessness in encampments.
Among awardees announced this week include Santa Barbara, San Bernardino, Santa Cruz, Orange, and Marin counties. The Newsom Administration additionally announced the state is on course to clear 1,000 homeless encampments statewide by the end of 2022.
Additional information is available here.
The California Budget & Policy Center this week released a brief on the demographics of homelessness in California. The report highlights the various and complex reasons individuals experience homelessness, as well as the importance of tailoring interventions to different types and scales to support unhoused residents statewide.
The report’s primary findings include:
- Homelessness in California is temporary for most who experience it, but some face long-term, chronic homelessness
- Unhoused Californians are primarily single adults, with a smaller share of families with children and unaccompanied youth
- Racial disparities are stark within California’s homeless population, with Black, American Indian or Alaska Native, and Pacific Islander residents disproportionately comprising the state’s homeless population
- Californians experience homelessness in every county throughout the state, with the most residing in Los Angeles County
- California’s unhoused population is aging and increasingly composed of older adults
The report calls a series of actions to address homelessness in California, including interventions focused on overrepresented Californians, including people of color and single adults who comprise the majority of the homeless population.
The full California Budget & Policy Center report is available here.
The National Association of County and City Health Officials (NACCHO), with support from the U.S. Centers for Disease Control and Prevention (CDC) and the National Center for Injury Control and Prevention (NCIPC), recently announced a funding opportunity for local health departments. The opportunity will award up to five counties or cities to implement interventions to assess and respond to substance use-related stigma within their communities.
Awardees will work with NACCHO, CDC, and subject matter experts to deploy a substance use-related stigma assessment, analyze collected data, and implement a communication, education, or training campaign. Applicants may request up to $220,000.
An information webinar on the opportunity will be held on Thursday, March 3, 2022, from 11:00 am to 12:00 pm PT. Registration is available here.
Applications are due on March 21, 2022. Additional information on the funding opportunity is available here.
A new report from the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) found that since the implementation of the Affordable Care Act (ACA) coverage provisions beginning in 2010, the uninsured rate among Black Americans under age 65 decreased from 20 percent in 2011 (approximately 7.1 million people) to 12 percent in 2019 (approximately 4.4 million people), a decline of 40 percent.
The report shows that states that have not expanded Medicaid have the highest percentage of uninsured adults and children who are Black. If the remaining 12 non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming) were to expand Medicaid, an estimated 957,000 Black Americans without insurance coverage would be eligible for Medicaid coverage.
The report additionally highlights various legislative and administrative actions by the Biden-Harris Administration to expand affordable coverage options through American Rescue Plan Act (ARPA) subsidies, a Marketplace Special Enrollment Period (SEP), and enhanced outreach to Black Americans.
The full HHS report is available here.