January 10, 2020 Edition

Governor Newsom Releases 2020-21 Budget Proposal

This morning in a nearly three-hour press conference, Governor Gavin Newsom unveiled his FY 2020-21 budget proposal.

CHEAC produced a summary of the Governor’s 2020-21 budget proposal available here. Additional budget resources will be posted on our CHEAC Budget Page throughout the year.

Over the coming weeks, the Legislature will begin hearing proposed budget items and stakeholder proposals, and CHEAC will continue to keep its members apprised of budget-related developments.

Legislature Returns to Sacramento, Kicks off New Year

California’s Legislature reconvened the second year of their two-year session on Monday with relatively brief floor sessions. Both Senate President Pro Tempore Toni Atkins and Assembly Speaker Anthony Rendon warmly welcomed their members back to their respective chambers. Pro Tem Atkins acknowledged 2020 would be a very busy year with the Senate first tackling the mountain of two-year bills that need to be dispensed with this month. She also outlined three major issues of concern for the Senate this year including addressing the homelessness crisis, preparing California to respond to wildfires and to review processes for power safety shutoff events, and finally ensuring the 2020 Census, California Primary, and General Election proceed accordingly. Speaker Rendon, in his remarks, referenced the work ahead this year and welcomed two new Assembly staffers – Chief Clerk of the Assembly, Sue Parker and Chief Sergeant at Arms Alisa Buckley. Both were officially sworn into their new roles during Thursday’s floor session.

This month, both houses will have to contend with more than 1,100 legislative proposals that were introduced in 2019 and made into two-year bills. The deadline to move these bills through their house of origin is January 31. One of the hottest topics to be discussed this month includes Senator Scott Wiener’s SB 50, which makes significant changes to local zoning laws allowing for more high-density housing near mass transit hubs. SB 50 has been highly contentious, particularly among local governments, and was shelved by the Senate Appropriations Committee last year. Senator Wiener has made some changes to the bill to address concerns, but it remains to be seen if it has garnered enough support yet to make it out of the Senate.

Expect another hot topic this year to include some fixes to Assembly Member Lorena Gonzalez’s AB 5 from last year, which added limitations to the way independent contractors (such as Uber or Door Dash) are employed. Assembly Member Gonzalez has received heavy criticism from various freelance workers impacted by the law (which went into effect January 1st), but has been vocal in her desire to address concerns in clean-up legislation.

Another big proposal was unveiled in the Assembly this week to create a California-specific Green New Deal modeled upon the national plan proposed by New York Congresswoman Alexandria Ocasio-Cortez. AB 1839, authored by Assembly Members Rob Bonta, David Chiu, Ash Kalra, Eloise Gomez Reyes, Shirley Weber, and eight additional Democratic co-authors, is still in spot-bill form, but would seek to reduce homelessness, further cut greenhouse gas emissions, and improve living standards in California’s poor communities over the next 10 years. Assembly Member Bonta indicated that details would be fleshed out during the legislative process and acknowledged the bill would be “expensive but necessary.”

There are a few key changes in the memberships of both houses since last Fall worth noting. On the Senate side, Senator Jeff Stone resigned late last Fall to join the Trump Administration in the US Department of Labor; his seat remains vacant until his replacement is elected during the March primary/special election. In the Assembly, the chamber welcomed new member Megan Dahle, who replaced her husband, Senator Brian Dahle, in a special election held in November 2019.

With 2020 also being an election year, all seats in the Assembly will be up during the March primary and November general election compared to only the odd seats in the Senate. As a final aside, term limits will hit six Senators this year (Jim Beall, Cathleen Galgiani, Jerry Hill, Hannah-Beth Jackson, Bill Monning, and Mike Morrell). In the Assembly, no member is termed out this year; however, eight members have declared their candidacies for various other offices or official retirements (Susan Eggman, Kansen Chu, Jay Obernolte, Monique Limon, Christy Smith, Ian Calderon, Melissa Melendez, and Todd Gloria).

Please see our CHEAC Weekly Bill Chart for specific information on bills of interest to CHEAC.


AB 315 (C. Garcia)  – OPPOSE

AB 315, a two-year bill, places restrictions on the use of revenues derived from local agencies by local government associations (such as CHEAC) for lobbying the Legislature or Congress or for educational activities. The measure would add new reporting requirements on local government associations. The bill was originally set to be heard in the Assembly Local Government Committee next week; however, has since been pulled. Assembly Member Garcia has since indicated her intent to introduce legislation to allow the State Auditor to conduct audits on local government associations receiving taxpayer dollars.

Tobacco Control

SB 793 (Hill) – SUPPORT

Senator Jerry Hill introduced on Monday a revitalized effort to ban sales of all flavored tobacco products statewide, including mint and menthol tobacco products. Recall, Senator Hill carried a similar measure last year (SB 38) which sought to ban all flavored tobacco products; however, Senator Hill ultimately shelved the measure on the Senate Inactive File after receiving hostile amendments which would have exempted certain tobacco products. SB 793 is proposed to go farther than the recently finalized federal rule by the U.S. Food and Drug Administration (FDA) which will prohibit certain flavored cartridge-based electronic cigarettes (except tobacco or menthol flavors).

In rolling out SB 793 this week, Senator Hill unveiled 29 coauthors from both the Senate and Assembly representing both the Democratic and Republican parties. Lieutenant Governor Eleni Kounalakis also joined in support of measure, which is sponsored by the American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, the Campaign for Tobacco-Free Kids, and Common Sense. CHEAC continues to work closely with the sponsorship coalition in support of the measure to reduce access to all flavored tobacco products and protect Californians from lifelong tobacco-related illnesses and death. We strongly encourage local health departments to support SB 793 and express their support via social media.

Newsom Issues Executive Order to Address Homelessness

On Wednesday, Governor Gavin Newsom issued a press release announcing his Executive Order N-23-20 to reduce street homelessness, reduce barriers for homeless individuals to access health care and other services, and increase housing options for those experiencing homelessness. The executive order, effective immediately, requires:

  • All state agencies named in the Executive Order to develop metrics for state agencies and local partners by February 28, 2020 to assess the use of state resources below and the impact.
  • The Department of Finance to establish a new fund, the California Access to Housing and Services Fund, within the Department of Social Services (DSS) to receive future state appropriations, as well as donations from philanthropy and the private sector, for affordable housing, rental and operating subsidies and stabilizing board and care homes.
  • State agencies to conduct the following actions by January 31, 2020, for the purpose of identifying property that can be used by local partners for providing shelter for homeless individuals on a short-term basis:
    • The Department of General Services (DGS) to identify properties from the inventory of excess state land and state facilities;
    • The Department of Transportation (Caltrans) to develop and share a model lease template to allow counties and cities to use Caltrans property adjacent to highways or state roads;
    • The Office of Statewide Health Planning and Development to work with local jurisdictions, tribal communities and private entities to assess vacant and decommissioned hospitals and health care facilities; and
    • The Department of Food and Agriculture, in consultation with the DGS, the Department of Housing and Community Development, DSS, and the Office of Emergency Services, to conduct an initial assessment of fairgrounds in or near jurisdictions where a shelter crisis is in effect.
  • DGS to supply 100 travel trailers from state fleet and the Emergency Medical Services Authority to supply complementary modular tent structures to provide temporary emergency housing and health and social services across the state immediately through September 30, 2020.
  • A multi-agency strike team with the Business, Consumer Services and Housing Agency, Government Operations Agency, Health and Human Services Agency, Labor and Workforce Development Agency, and the Transportation Agency, to provide technical assistance and targeted direct support to counties, cities and public transit agencies looking to get homeless individuals indoors and connect them to health and social services.

In addition to the Executive Order, Governor Newsom previewed elements of his 2020-21 budget proposal, including providing seed funding for the California Access to Housing and Services fund created by the Executive Order and funding for the Administration’s Medi-Cal transformation proposals, now called Medi-Cal Healthier California for all (formerly known as CalAIM). Additional budget details can be found in the CHEAC Budget Memo.

The press release can be viewed here.

Newsom Administration Renames CalAIM Initiative

The California Department of Health Care Services (DHCS) on Wednesday announced that is has renamed the multi-year reform initiative aimed at improving the health outcomes and quality of life for California’s population in Medi-Cal. Recall, DHCS released its formal proposal to incorporate several state innovations that have been successfully tested through California’s federal 1115 waivers at the end of October 2019, referred to as “California Advancing and Innovating Medi-Cal” or “CalAIM.”

The broad-based effort to transform the Medi-Cal delivery system, program, and payment structure will now be known as “Medi-Cal Healthier California for All.” According to DHCS, the change reflects the initiative’s alignment with Governor Gavin Newsom’s platform to build a “California for All,” as well as the long history and public familiarity with the Medi-Cal name.

Online references to the initiative on DHCS’ website have been updated to reflect the new name and existing bookmarks and webpages that include the old terminology will be automatically redirected to the updated pages. Additional information on the initiative is available here.

DHCS Publishes Informational Charts on Managed Care Models

The California Department of Health Care Services (DHCS) recently posted an informational chart with managed care model type definitions and requirements. The purpose of the chart is to aid counties, plans, and other stakeholders in understanding the different managed care model types and the associated requirements. The informational chart can be found on DHCS’ website here.

State Auditor Releases Report on Medi-Cal Childhood Lead Level Testing

On Tuesday, California State Auditor Elaine Howle released a report entitled, “Childhood Lead Levels: Millions of Children in Medi-Cal Have Not Received Required Testing for Lead Poisoning.” The audit was conducted on the Department of Health Care Services (DHCS) and the California Department of Public Health (CDPH) and found that from fiscal years 2009-10 through 2017-18, more than 1.4 million of the 2.9 million one- and two-year old children enrolled in Medi-Cal did not receive any of the required lead level tests and another 740,000 children missed one of the two tests.

State law generally requires that children enrolled in Medi-Cal receive tests for elevated lead levels at the ages of one and two years. According to DHCS’ data, the rate of eligible children receiving all required tests was less than 27 percent. Many of these children, according to the State Auditor’s office, live in areas of the state with high occurrences of elevated lead levels. The Auditor determined that DHCS has not effectively overseen Medi-Cal managed care plans to ensure that children are receiving the required lead tests.

DHCS has only recently begun developing a performance standard for measuring whether managed care plans are ensuring that children receive such tests. While DHCS is developing an incentive program to increase payments to healthcare providers for each lead test they report administering, the State Auditor is concerned by how long it may take these programs to influence lead testing rates. The State Auditor further concluded that DHCS could take more immediate action to increase the number of children receiving the tests, such as requiring health plans to identify children who have not received lead tests and reminding their healthcare providers of the need to provide the tests.

Related to CDPH, which is charged with the prevention and management of lead poisoning cases, the State Auditor determined that it has failed to focus on addressing lead hazards before children are exposed to them and has failed to meet legislative requirements concerning lead poisoning. State law requires CDPH to identify geographic areas at high risk for childhood lead exposure and publish an analysis of such areas each year beginning in March 2019; CDPH had not done so as of October 2019. It also failed to meet a statutory requirement to post on its website a list of certain census tracts in which children have tested positive for specified lead levels. The State Auditor conducted a similar analysis and found that from fiscal years 2013-14 through 2017-18, half of children with elevated lead levels were located in just 15 percent of the state’s census tracts.

Moreover, the State Auditor found that CDPH’s efforts do not appear to align with preventing future instances of lead poisoning in geographic areas in which children are at the greatest risk, given that CDPH contracts with childhood lead poisoning prevention programs at local agencies and only requires local programs to monitor abatement in homes of children who already have lead poisoning. The State Auditor also determined that CDPH could not demonstrate the effectiveness of local prevention program outreach activities in reducing lead exposure in high-risk areas. Also included in the State Auditor’s report is an examination of the CDPH Childhood Lead Poisoning Prevention Program, which was found to allocate funding to local prevention programs based on a funding formula that uses outdated information on the number of children with lead poisoning in each jurisdiction, leading to significant differences in the services that local programs have been able to provide.

The State Auditor detailed a series of recommendations for the Legislature, DHCS, and CDPH:

  • The Legislature should:
    • Amend state law to require laboratories to report contact information and unique identifiers with children’s lead test results.
  • DHCS should:
    • Prioritize its effort to adopt a performance standard for lead tests and ensure that this standard is specifically designed to monitor its success in meeting the State’s requirements for lead testing of one- and two-year old children.
    • Incorporate into its contracts with managed care plans a requirement that plans identify each month all children without records of required lead tests and remind the responsible healthcare providers of the need to test those children.
  • CDPH should:
    • Immediately complete and publicize an analysis of high-risk areas throughout the state.
    • Either require local prevention programs to demonstrate the effectiveness of their outreach or analyze the cost-effectiveness of approaches such as proactive abatement and require the local prevention programs to replace or augment their outreach to the extent resources allow.
    • Prioritize meeting legislative requirements, including updating the factors healthcare providers use to determine whether children are at risk of lead exposure.
    • Update its allocation formula to take into account the most recent data for the number of children with lead poisoning in each jurisdiction.

DHCS, in responding to the Auditor’s report, agreed with the recommendations and has prepared corrective action plans to implement them. CDPH also agreed or partially agreed with the Auditor’s findings. The State Auditor found that both DHCS and CDPH’s approaches for implementing certain recommendations do not fully address the related findings and concerns.

The full State Auditor report is available here.