July 1, 2021 Edition

Final Budget Act Heads to Governor, Commitment Secured for Public Health Funding

After two weeks of extended negotiations between legislative leaders and the Newsom Administration, the California State Senate and Assembly on Monday took action on the state’s FY 2021-22 Budget. Recall, the Legislature earlier in June passed its own version of the state budget to meet the June 15 constitutional deadline while negotiations with the Administration continued. That bill, AB 128, notably included significant investments for public health, including the California Can’t Wait Coalition’s request for $200 million ongoing for local health department infrastructure and workforce.

Late last week, with little time remaining before the start of the new fiscal year, the Legislature put into print the “Budget Bill Jr.” (SB 129), representing the spending plan agreement reached between legislative leaders and the Newsom Administration. No “official announcement” has been released by either party acknowledging a budget deal, and negotiations on a few high-profile subjects, including childcare, drought, and homelessness, remain outstanding.

SB 129 includes no funding in FY 2021-22 for local health department infrastructure and workforce. However, the Newsom Administration has committed to a minimum of $300 million annually beginning in FY 2022-23 to address preventable death and disease, reduce health disparities, and support an agile public health workforce statewide.

This amount is intended to include ongoing funding to local health departments as requested by the California Can’t Wait Coalition. A statement from the California Can’t Wait Coalition on the $300 million budget commitment is available here.

The Senate and Assembly on Monday heard and voted on SB 129, as well as the first round of budget trailer bills that include additional funding and implementation details on various investments. The budget measures were advanced to the desk of Governor Gavin Newsom, and SB 129 currently awaits the Governor’s signature, which is anticipated to occur within the coming days.

CHEAC has issued a memo summarizing key investments included in the state’s FY 2021-22 budget agreement, available here.

While Governor Newsom has already acted upon a handful of budget measures, including an extension of the state’s eviction moratorium, the Legislature and Newsom Administration are anticipated to continue work on budget trailer bills over the coming weeks. CHEAC will continue to keep its Members apprised of relevant budget developments, including on funding for local health department infrastructure and workforce.

Two Weeks Remain Before Legislative Summer Recess, Aragón Confirmed by Senate

The California State Senate and Assembly continue their steady pace of policy committee hearings with two weeks remaining before the Legislature’s month-long summer recess. Just before adjourning for their recess, lawmakers face a July 14 deadline to convene policy committees to meet and report bills. As such, bills continue to be negotiated, amended, and advanced along the legislative process.

Of note this week, the Senate on Monday unanimously confirmed Dr. Tomás Aragón as the Director of the California Department of Public Health (CDPH) and State Public Health Officer. Recall, just last week, the Senate Rules Committee convened a confirmation hearing to review Dr. Aragon’s appointment and unanimously advanced his appointment to the full Senate floor.

Below, we highlight bills of interest to CHEAC Members. For a full update, the latest edition of the CHEAC Weekly Bill Chart is available here.

Build Environment & Climate Change

AB 585 (L. Rivas) as amended June 30, 2021 – SUPPORT

Assembly Member Luz Rivas’s AB 585 establishes, upon an appropriation by the Legislature, the Extreme Heat and Community Resilience Program within the Office of Planning and Research (OPR) to coordinate state efforts and support local and regional efforts to mitigate the impacts of and reduce the public health risks of extreme heat. OPR would establish criteria and guidelines for grants and give priority to applicants serving disadvantaged communities and vulnerable populations. AB 585 was heard this week in the Senate Natural Resources and Water Committee and passed on a 9-0 vote and now moves to Senate Environmental Quality Committee.

Communicable Disease Control

AB 789 (Low) as amended June 28, 2021 – SUPPORT      

AB 789 authored by Assembly Member Evan Low was heard in the Senate Judiciary Committee this week. The measure would require an adult patient receiving primary care services in a facility, clinic, unlicensed clinic, center, officer, or other setting, to be offered screening test for Hepatitis B and C if their insurance covers the cost. Follow-up care must be provided or referral to a health care provider to those who opt to be tested and either test positive for Hepatitis B or Hepatitis C. AB 789 was advanced from the Senate Judiciary Committee on a 11-0 vote and next moves to the Senate Appropriations Committee.

SB 742 (Pan) as amended March 4, 2021 – SUPPORT

Senator Richard Pan’s SB 742 was heard in the Assembly Public Safety Committee this week. The measure would prohibit a person from engaging in physical obstruction, intimidation, or picketing targeted at a vaccination site during the site’s operational hours. SB 742 was advanced out of Assembly Public Safety Committee on a 6-2 vote and is now in the Assembly Appropriations Committee.

Health Equity

AB 1407 (Burke) as amended June 21, 2021 – SUPPORT

Assembly Member Autumn Burke’s AB 1407 would require schools of nursing and nursing programs to include direct participation in one hour of implicit bias training as a requirement for graduation. The measure would require, beginning January 2023, nurse licensees within the first two years of holding their license to complete one hour of direct participation in an implicit bias course. Hospitals would also be required to implement an evidence-based implicit bias program as part of its new graduate training program that hires and trains new nursing graduates. AB 1407 was passed out of the Senate Business, Professions and Economic Development Committee on a 12-1 vote with one member not voting and now moves onto the Senate Health Committee.

SB 17 (Pan) as amended May 20, 2021 – SUPPORT

SB 17, authored by Senator Richard Pan, was advanced this week from the Assembly Accountability and Administrative Review Committee on a 5-0 vote with two members not voting and now moves to Assembly Appropriations Committee. This measure would establish a statewide Office of Racial Equity to be governed by a Racial Equity Advisory and Accountability Council to coordinate, analyze, develop, evaluate, and recommend strategies for advancing racial equity across state agencies, departments, and the Office of the Governor. CHEAC is joined by the California Association of Public Hospitals and Health Systems (CAPH), the County Welfare Directors Association of California (CWDA), and the County Behavioral Health Directors Association of California (CBHDA).

CDPH Holds Final “Vax for the Win” Incentive Drawing

Today, the California Department of Public Health (CDPH) hosted a Dream Vacations Giveaway as the final drawing in the state’s “Vax for the Win” Incentive Program to encourage more state residents to receive a vaccine against COVID-19. According to CDPH, the incentive program continues to have a positive impact on the rate of vaccinations since its launch in late May, increasing the number of doses administered in the state’s lowest resourced communities for consecutive weeks.

During the incentive program’s peak, California realized a 33 percent increase in vaccinations (5/27-6/02 vs. 6/03-6/09) at the time making California one of the only states in the country to achieve a week-over-week increase in the vaccination rate. Outside of this peak, CDPH indicates the program has shown promising results in slowing down the rate of decline in first doses administered that California and the rest of the country is experiencing.

Today’s drawing offered all residents aged 18 and older who are at least partially vaccinated a chance to win one of six vacation getaways to destination cities, including Anaheim, Los Angeles, Palm Springs, San Diego, and San Francisco. Today’s winners live in the following counties: Alameda, Contra Costa, Orange, San Francisco, San Mateo, and Santa Cruz.

$50 “You Call the Shot” gift cards remain available for any residents beginning their vaccination series, while supplies last. A limited supply of free Six Flags theme parks passes remain available at select clinics in the Bay Area and Los Angeles area.

Additional information from CDPH is available here.

DHCS Submits CalAIM Waiver Applications to CMS

On Wednesday, the California Department of Health Care Services (DHCS) submitted the California Advancing and Innovating Medi-Cal (CalAIM) Section 1115 Demonstration and CalAIM Section 1915(b) Waiver to the U.S. Centers for Medicare & Medicaid Services (CMS) for review and approval.

By submitting the applications, DHCS is seeking federal approval to implement key components of the CalAIM Initiative, which seeks to establish broad, multiyear system, program, and payment reforms to deliver population health, person-centered approaches to improving health outcomes among Medi-Cal beneficiaries and other low-income populations in California.

The CalAIM Section 1115 Demonstration Application seeks to amend and renew the existing Medi-Cal 2020 Section 1115 Demonstration, approved through December 31, 2021. DHCS is requesting approval by December 2021 to enable implementation beginning in January 2022. A 30-day public comment period will be held by the federal government on DHCS’ demonstration application. The comment period is anticipated to begin this month and more information will be made available when the comment period begins.

The CalAIM Section 1915(b) Waiver Application seeks to amend and renew the existing Specialty Mental Health Services (SMHS) Section 1915(b) Waiver and consolidate Medi-Cal managed care, dental managed care, SMHS, and the Drug Medi-Cal Organized Delivery System (DMC-ODS) under a single 1915(b) waiver. The existing SMHS Section 1915(b) will expire on December 31, 2021. DHCS is requesting approval by December 2021 to enable implementation in January 2022. There is no federal public comment period for the CalAIM Section 1915(b) Waiver.

Additional information on the applications, as well as the submitted materials, is available here.

Federal Resources Acquired to Support Lava Fire Response

On Tuesday, Governor Newsom traveled to Siskiyou County to be briefed by fire and emergency management officials responding to Lava Fire in Siskiyou County. Governor Newsom announced that California has secured a Fire Management Assistance Grant (FMAG) from the Federal Emergency Management Agency (FEMA) to support the response to the fire. The FMAG assists local, state, and tribal agencies responding to the fire for a 75 percent reimbursement of their eligible fire suppression costs.

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

CDC Reports Sharp Declines in Breast and Cervical Cancer Screening

The U.S. Centers for Disease Control and Prevention (CDC) this week released a report finding that tests received by women through CDC’s National Breast and Cervical Cancer Early Detection Program declined by 87 percent for breast cancer and 84 percent for cervical cancer during April 2020 as compared with previous five-year averages for that month.

According to the CDC, prolonged delays in screening related to the COVID-19 pandemic may lead to delayed diagnoses, poor health consequences, and an increase in cancer disparities among women already experiencing health inequities. Screening declines observed in CDC data coincided with the rapid increase of COVID-19 cases in spring 2020. Factors that may have contributed to the declines during this time include screening site closures and the temporary suspension of certain health services due to the pandemic.

The CDC additionally details health equity implications for this recent study:

  • Declines in breast cancer screening varied from 84 percent among Hispanic women to 98 percent among American Indian/Alaskan Native women.
  • Declines in cervical cancer screening varied from 82 percent among Black women to 92 percent among Asian Pacific Island women.
  • In April, the number of screening tests of breast cancer declined in metro (86 percent), urban (88 percent), and rural (89 percent) areas compared to the respective five-year averages. The decline for cervical cancer screening tests was 85 percent and 82 percent for metro and rural areas and 77 percent for urban areas.
  • Screening volumes had begun to recover in all groups by June 2020 (the end of observation period).

Additional information from the CDC is available here.

White House Issues COVID-19 Global Response and Recovery Framework

Today, the Biden-Harris Administration issued the U.S. COVID-19 Global Response and Recovery Framework to establish a set of objectives and delineate activities of U.S. departments in responding to the global pandemic. The U.S. Government will pursue five objectives within the framework related to vaccinations, health systems, acute social needs, economic systems, and international health security.

Additional information is available here. The full framework is available here.

Child Development Screenings Increased Over Past Decade, Per UCLA Study

A new policy brief issued this week by the UCLA Center for Health Policy Research (CHPR) found that developmental screenings for young children ages one through five increased from 2007 to 2018. Whether health care providers asked parents about developmental concerns also increased over the same timer period.

The study, funded by First 5 California, used data from the UCLA CHPR’s California Health Interview Survey and found that 72 percent of California parents reported that their child was assessed for developmental delays in 2018 compared to 29.5 percent in 2007. 64.3 percent of parents stated that a doctor or other professional asked if they had concerns about their child’s learning, development, or behavior in 2018 compared to 47.2 percent in 2007.

The brief assesses the prevalence of screenings across demographic characteristics and found differences by household income, insurance type, parental education, and race and ethnicity. Among those findings:

  • Parents were more likely to report that their children received developmental screenings and were asked about developmental concerns if they had higher household incomes, employment-based insurance, a usual source of medical care, higher education levels, spoke only English at home, and identified race/ethnicity as non-Hispanic White.
  • By contrast, low rates of screening were found for families with Medi-Cal insurance, without a usual source of medical care, with incomes less than 300 percent of federal poverty level, educational attainment of high school diploma or less, reported race/ethnicity of Hispanic or African American, and dual language learner children in the home. Parents identifying as Asian also reported less frequently being asked about developmental concerns.

UCLA CHPR cites support for universal developmental surveillance and screening as recommended by the American Academy of Pediatrics and for future research to help identify more barriers to assessment.

The full policy brief is available here.