January 14, 2022 Edition

Governor Unveils 2022-23 Budget Proposal, Includes $300M for Public Health Infrastructure

On Monday, California Governor Gavin Newsom unveiled his Administration’s proposed 2022-23 state budget. Notably, the Governor’s budget includes $300 million ongoing General Fund for public health infrastructure beginning in 2022-23, consistent with the agreement reached last year between the California Can’t Wait Coalition, the Legislature, and the Newsom Administration.

CHEAC produced a memo detailing proposed investments of most interest to California local health departments. The memo is available here.

Following the presentation of his budget proposal, Governor Newsom spent the week promoting several topline investments included in his Administration’s “California Blueprint.” Governor Newsom visited a COVID-19 testing site in Los Angeles County on Wednesday and highlighted his proposed $2.7 billion COVID-19 emergency response package, which includes a $1.4 billion early action budget request. The package includes investments for testing, vaccinations, health care worker staffing, state operations, and contacting tracing activities. The Newsom Administration touted the praise of the pandemic emergency response package received by public health, health, and state and local leaders, including CHEAC Executive Director Michelle Gibbons.

On Tuesday, Governor Newsom traveled to the Central Valley to highlight his Administration’s proposal to expand full-scope Medi-Cal eligibility to all income-eligible residents, regardless of immigration status. Governor Newsom spent Wednesday in San Diego County, visiting a homeless encampment and highlighting partnerships between state, local, and community-based partners to assist residents experiencing homelessness. The Governor promoted his Administration’s proposed $2 billion investment to support new housing units and treatment slots which builds upon a significant, multiyear investment included in the 2021 Budget Act.

The Administration is anticipated to continue highlighting its investment proposals as the Legislature begins its budget work in earnest over the coming weeks. The Senate Budget and Fiscal Review Committee will convene an informational hearing on the Governor’s budget on Wednesday, January 19. The Assembly Budget Committee will convene a similar hearing on Wednesday, January 26.

CHEAC will continue to keep Member jurisdictions apprised of the latest budget developments, including on public health infrastructure and workforce. CHEAC’s budget advocacy page is accessible here.

Budget Analyses Released by LAO and Legislature for 2022-23

Yesterday, California’s Legislative Analyst’s Office (LAO) issued their summary of the Governor’s 2022-23 budget that is released to assist the Legislature as they begin their budget deliberations. In their analysis, the LAO noted the following top issues about next year’s proposed budget:

  • They believe the budget’s multiyear revenue projections are reasonable, but the Governor’s new spending proposals exceed the state’s estimates of the budget’s capacity;
  • The Administration is urged to strongly consider building more general purpose reserves;
  • Consideration of the State Appropriations Limit (SAL or Gann Limit) remains an important concern and will constrain the Legislature’s choices during the upcoming budget process;
  • The Legislature should ensure the success of recent initiatives before committing to additional funding or creating additional new programs;
  • Encourages the Legislature to consider longer-term COVID-19 planning for potential program flexibilities or funding that may be necessary as COVID-19 remains a continuing public health and economic challenge in the future.

Earlier this week, the Senate Budget and Fiscal Review Committee released their overview of the Governor’s proposed 2022-23 budget and the Assembly Budget Committee also released their budget highlights document

CDPH Temporarily Waives COVID-19 Testing Requirement for Health Care Workers

The California Department of Public Health (CDPH) on Saturday issued updated guidance for health care workers and emergency medical services personnel to help address staffing shortages in care delivery systems.

Under the new guidance, health care works and emergency medical services personnel who test positive for COVID-19 and are asymptomatic may return to work immediately without isolation and without testing. Those who have been exposed and are asymptomatic may return to work immediately without quarantine and without testing. These personnel are required to wear an N95 respirator for source control. These waivers are in place from January 8, 2022, through February 1, 2022.

CDPH updated the following guidance consistent with these changes: CDPH Isolation & Quarantine Guidance; All Facilities Letter 21-08.7; and Notice to EMS Providers.

Newsom Issues Executive Order to Prevent COVID Test Price Gouging

On Saturday, Governor Gavin Newsom issued Executive Order N-2-22 establishing consumer protections against price gouging on at-home COVID-19 tests. The order comes as the state and nation continues to grapple with significant surges in COVID-19 cases, largely due to the omicron variant.

The order prohibits sellers from increases prices on COVID-19 home test kits by more than 10 percent. The order also provides additional tools to the California Department of Justice and the Attorney General’s Office, District Attorneys, and other local law enforcement to take action against price gouges.

Additional information from the Governor’s Office is available here.

Newsom Issues Executive Order to Support In-Person Learning During COVID-19 Surge

Governor Gavin Newsom on Tuesday issued Executive Order N-3-22 to provide staffing flexibility for schools to support continued safe, in-person instruction for students. The Governor’s order addresses barriers that delay the hiring of qualified short-term substitute teachers, permit substitute teachers to have their assignments extended, and provide additional flexibility to support retired teachers who have returned to the classroom.

Flexibilities detailed in the order expire on March 31, 2022, and are only available to schools that make findings that the flexibilities will support in-person services for students despite staffing shortages caused by COVID-19. The order additionally expands previous executive orders (N-12-21 and N-25-20) that addressed barriers for retired teachers and staff to return to the classroom.

Additional information is available here.

Biden-Harris Administration Expands COVID-19 Testing Support for Schools

This week, amid record spikes in COVID-19 cases nationwide, the Biden-Harris Administration announced a series of actions to support full-time in-person instruction in K-12 schools. These actions include:

  • Sending Five Million No-Cost Point-of-Care Tests Per Month to Schools – The Biden-Harris Administration will distribute five million free, rapid tests to schools each month to help schools stay open and to implement and sustain screening testing and test-to-stay programs. The new allocation builds upon the CDC Epidemiology and Laboratory Capacity (ELC) program, and CDC will work with states who can submit request to receive additional tests for high-need school districts. The first shipments of tests are anticipated to be delivered later this month.
  • Providing Five Million PCR Tests for Free to Schools Per Month – The Administration is making available additional laboratory capacity to support a five million PCT tests per month for schools to perform individual and pooled testing in classrooms nationwide. The additional testing will be delivered through the Department of Health and Human Services (HHS) Operation Expanded Testing (ET) Program, funded by the American Rescue Plan Act (ARPA). Three federally funded regional providers will offer materials, supplies, and lab results and reporting at no direct cost to recipients through four regional hubs.
  • Deploying Federal Surge Testing Units – HHS and FEMA are working with state, territorial, and tribal partners to address testing needs in communities and stand up federal testing sites. Sites are focused on ensuring hardest hit and highest-risk communities have equitable access to free and convenient testing. As federal agencies review COVID-19-related resource requests, agencies will consider how federal test sites can support the safe operation of K-12 schools.
  • Connecting Schools with COVID-19 Testing Providers – ARPA, enacted by Congress in 2021, includes $130 billion in Elementary and Secondary School Emergency Relief Funds to safely reopen schools which can be used to support school-based COVID-19 testing. The Department of Education and the CDC will work with states and outside organizations to make connections to testing providers in their state.
  • New Training, Resources, and Materials for Implementing Test-to-Stay – The CDC last month implemented a “test-to-stay” approach for K-12 schools, allowing students to remain safely in the classroom during their quarantine period as long as they wear masks and test at least two times in the seven days following an exposure. CDC will release additional materials for schools on how to implement test-to-stay programs, including a school checklist and FAQs.

Additional information on these activities is available here.

Biden-Harris Administration Requires Insurers to Cover OTC COVID-19 Tests

The Biden-Harris Administration announced this week that it is requiring health insurance companies and group health plans to cover the cost of over-the-counter (OTC), at-home COVID-19 tests, enabling individuals with private health insurance coverage to obtain tests for free beginning January 15, 2022. The new coverage requirement will allow beneficiaries to purchase tests online or in a store and have it paid for up front by the health plan or allows individuals to be reimbursed for the cost by submitting a claim to their plan.

Insurance companies and health plans are required to cover eight free OTC at-home tests per covered individual per month. For a family of four all on the same plan, the family would be able to get up to 32 tests covered by their health plan per month. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment.

OTC test purchases will be covered in the commercial market without the need for a health care provider’s order or individualized clinical assessment and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements.

As part of the requirement, The Administration is incentivizing insurers and health plans to set up programs that allow people to procure OTC tests directly through preferred pharmacies, retailers, or other entities with no out-of-pocket costs. Insurers and plans would cover the costs upfront, eliminating the need for consumers to submit a reimbursement claim. Even with preferred pharmacies or retailers, insurers and health plans are required to reimburse tests purchased by consumers out of network at a rate of up to $12 per individual test.

State Medicaid and Children’s Health Insurance Program (CHIP) programs are currently required to cover FDA-authorized at-home COVID-19 tests without cost-sharing.

Additional information is available here.

U.S. Supreme Court Issues Split Rulings on Vaccine Mandates

After hearing oral arguments on the cases last week, the U.S. Supreme Court on Thursday issued two decisions on COVID-19 vaccine mandates for specified occupational groups set forth by the Biden-Harris Administration. Below, we highlight these decisions:

Vaccine Mandate for Large Employers

The Supreme Court struck down the vaccine-or-test mandate for employers with 100 or more employees issued by the U.S. Department of Labor (DOL) Occupational Safety and Health Administration (OSHA). Justices ruled on the OSHA case on a 6-3 vote with Justices Stephen Breyer, Sonia Sotomayor, and Elena Kagan dissenting. The majority opinion of the court maintained that OSHA exceeded its authority in issuing the requirement.

The unsigned majority opinion notes, “Although Congress has indisputably given OSHA the power to regulate occupational dangers, it has not given that agency the power to regulate public health more broadly. Requiring the vaccination of 84 million Americans, selected simply because they work for employers with more than 100 employees, certainly falls in the latter category.”

The dissenting Justices, in their written opinion, argues that the court’s conservative majority “seriously misapplies the applicable legal standards” and “stymies the Federal Government’s ability to counter the unparalleled threat that COVID-19 poses to our Nation’s workers.”

Following the ruling, President Joseph R. Biden, Jr. issued a statement expressing his disappointment that the Supreme Court blocked the “common-sense life-saving requirements for employees at large businesses that were grounded squarely in both science and the law.” In light of the ruling, the Biden-Harris Administration is calling on businesses and industries to institute vaccination requirements to protect their workers, customers, and communities.

The full ruling from the court is available here.

Vaccine Mandate for Health Care Workers

In contrast to the Supreme Court’s OSHA ruling, the court upheld the vaccination requirements for Medicare and Medicaid providers issued by the Centers for Medicare and Medicaid Services (CMS). Justices voted on 5-4 ruling with Chief Justice John Roberts and Justice Brett Kavanaugh joining Justices Breyer, Sotomayor, and Kagan. The court’s majority opinion notes that the CMS rule “fits neatly within the language of the statute” and upholds the fundamental principle for the medical profession of “first, do no harm.”

The four dissenting Justices issued two separate opinions authored by Justices Thomas and Alito. Justice Thomas notes, “These cases are not about the efficacy or importance of COVID-19 vaccines. They are only about whether CMS has the statutory authority to force healthcare workers, by coercing their employers, to undergo a medical procedure they do not want and cannot undo.”

The full ruling from the court is available here.

CDC Study Finds Flu Vaccination Prevents Severe Illness in Children

The U.S. Centers for Disease Control and Prevention (CDC) recently published a study in the journal Clinical Infectious Diseases (CID) showing that influenza vaccination protected children against serious flu illness even when they were infected with a flu virus that was antigenically different from the vaccine virus. According to the CDC, this reinforces the benefit of flu vaccination, even when circulating flu viruses have drifted and are different from the virus used in vaccine production.

The CDC study reports that flu vaccination reduced the risk of severe flu in children by 78 percent against similar flu A viruses and 47 percent against flu A viruses that had drifted from the vaccine virus. Further, the vaccine was 76 percent effective at preventing life-threatening influenza, which included invasive mechanical ventilation, CPR, or other severe complications including death. The study adds evidence indicating that some people who are vaccinated still get sick, but the vaccination can decrease illness severity.

Additional information from the CDC is available here.

HRSA Updates ACA Preventive Care Guidelines to Improve Care for Women and Children

The U.S. Department of Health and Human Services (HHS) announced that the Health Resources and Services Administration (HRSA) has updated comprehensive preventive care and screening guidelines for women and for infant, children, and adolescents. Under the Affordable Care Act (ACA), certain group health plans and insurers must provide coverage with no out-of-pocket costs for preventive health services within HRSA-supported comprehensive guidelines.

Among the updates, for the first time the guidelines will require insurers and plans to provide coverage without a copay or deductible for double electric breast pumps. Other updates to women’s health services include well-woman preventive care visits, access to contraceptives and contraceptive counseling, screening for HIV, and counseling for STIs. HHS also approved a new guideline aiming to prevent and reduce obesity in midlife women through counseling.

For infants, children, and adolescents, updates include adding universal suicide screening risk for individuals ages 12 to 21 and new guidance for behavioral, social, and emotional screening. HRSA additionally accepted new guidelines for assess risks for cardiac arrest or death for individuals ages 11 to 21 and assessing risks for hepatitis B virus in newborn to 21-year-olds

Insurers and health plans subject to the requirements will be required to provide coverage without cost-sharing of new and updated services beginning in 2023.

Relatedly, the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) recently issued a report highlighting how the ACA has increased access to preventive care for millions of Americans, including vaccinations, contraception, and cancer screening. The ASPE report estimates that more than 150 million with private insurance, including 58 million women and 37 million children, are receiving preventive services with no cost-sharing, as required by the ACA.

Additional information from HHS is available here.