March 1, 2019 Edition
The 2019 CHEAC Annual Meeting will be held on October 9 – October 11 in Pasadena and will provide local health department leadership and staff throughout the state with networking and learning opportunities. This year’s conference theme is “Strengthening the Public Health Infrastructure” and will include keynote sessions with guest speakers and additional workshop opportunities to stimulate best practice sharing and discussion around significant issues impacting public health.
We are pleased to announce the opportunity for members and staff and key organizations to partner with us to strengthen the 2019 CHEAC Annual Meeting. We encourage CHEAC Members to circulate these opportunities to their networks as you deem appropriate.
This year’s conference will once again feature expanded workshops offered to attendees by collaborating with key partners to host innovative and exciting workshop sessions. Approximately 15 workshops will be hosted between 10:00 am and 4:00 pm on Wednesday, October 9 and Thursday, October 10.
Interested parties may submit workshop abstract proposals to CHEAC by COB on Friday, March 29. Additional information on workshop opportunities is available here.
CHEAC Annual Meeting sponsors are recognized for their valuable contribution and are welcome to network with local health department leadership and staff. Additional information on sponsorships is available here.
Further information about this year’s CHEAC Annual Meeting, including speakers, workshop, and registration details, will be provided in the coming months. Be sure to keep an eye out for additional details!
The California Legislature continues to ramp up its activities as policy and budget committee hearings are set for the coming weeks. Last Friday was the Legislature’s deadline to introduce new bills for the 2019 Legislative Session, and, in total, nearly 2,600 bills were introduced.
The CHEAC Legislative Committee met last week to review the first batch of bills introduced this year. The Legislative Committee will be meeting once again in March to review the second batch of new bills and take positions on measures that have a potential impact on public health and local health departments.
Senate Health Informational Hearing on Public Health Infrastructure
Next Wednesday, March 6 at 1:30 pm, the Senate Health Committee will convene an informational hearing on California’s public health infrastructure and capacity. The hearing will explore the role of local health departments, capacity to address ongoing and emerging public health issues, and challenges and possible solutions available to local health departments.
CHEAC has worked closely with the Senate Health Committee to assemble a robust hearing and, in partnership with HOAC, identified panel witnesses featuring many local health department experts, leaders, and staff.
Senate Select Committees Announced
Senate President pro Tempore Toni Atkins this week announced that the Senate Rules Committee finalized assignments to Senate Select Committees. While the Senate has fewer select committees than the Assembly, some committees of interest include:
- Select Committee on Social Determinants of Children’s Well-Being – Senator Holly Mitchell, Chair
- Select Committee on Status of Boys and Men of Color – Senator Steven Bradford, Chair
- Select Committee on Preparing California’s Future Workforce – Senator Anna Caballero, Chair
Our CHEAC Weekly Bill Chart is now available here and includes bills of interest that were identified by the Legislative Committee during our meeting last week. Below, we highlight some of those measures.
Access to Health Services
SB 66 (Atkins) as introduced on January 8, 2019 – SUPPORT
SB 66 by Senate President pro Tempore authorizes Medi-Cal reimbursement at federally qualified health centers (FQHCs) and rural health clinics (RHCs) for a maximum of two visits on the same day at a single location if the patient has a medical visit and a mental health visit or dental visit. Recall, pro Tempore Atkins last year carried SB 1125 which sought to do the same as SB 66, but the measure was vetoed by Governor Brown due to cost limitations.
Chronic Disease Prevention and Wellness Promotion
SB 347 (Monning) as introduced February 19, 2019 – SUPPORT
Senator Bill Monning’s SB 347 would require labels of sugar-sweetened beverages (SSBs) to bear the safety warning, “STATE OF CALIFORNIA SAFETY WARNING: Drinking beverages with added sugar(s) contributes to obesity, type 2 diabetes, and tooth decay.” The safety warnings would be required for vending machines, dispensing machines, and points of purchase for any unsealed SSBs. Recall, Senator Bill Monning carried this same measure in 2017 and Assembly Member Rob Bonta carried the measure in 2018; both previous attempts were unsuccessful.
Health Coverage/Health Care Reform
AB 4 (Arambula) and SB 29 (Durazo) as introduced on December 3, 2018 – SUPPORT
Both AB 4 by Assembly Member Joaquin Arambula and SB 29 by Senator Maria Elena Durazo seek to expand Medi-Cal eligibility to all adults with incomes at or below 138 percent of the federal poverty level (FPL) regardless of immigration status.
AB 414 (Bonta) as introduced on February 7, 2019, and SB 175 (Pan) as introduced on January 28, 2019 – SUPPORT
AB 414 by Assembly Member Rob Bonta and SB 175 by Senator Richard Pan institute a state-level individual health insurance coverage mandate in California beginning in 2020. The measures require Covered California to determine a financial penalty for not obtaining health insurance and specify that penalty revenues be directed to improve the affordability of healthcare coverage in California.
AB 1718 (Levine) as introduced on February 22, 2019, and SB 8 (Glazer) as introduced on December 3, 2018 – SUPPORT
AB 1718 by Assembly Member Marc Levine and SB 8 by Senator Steven Glazer prohibit smoking and disposal of any cigar or cigarette product on state coastal beaches and in state parks. Both Senator Glazer and Assembly Member Levine have carried these same measures the past several years, all of which were vetoed by Governor Jerry Brown.
AB 739 (McCarty) as introduced on February 19, 2019, and SB 38 (Hill) as introduced on December 3, 2018 – SUPPORT
AB 739 by Assembly Member Kevin McCarty and SB 38 by Senator Jerry Hill would prohibit the sale of any flavored tobacco products in the state of California. Authors of both measures point to the significant increase in flavored tobacco product and electronic cigarette device use among youth and young adults in California as the need for the measures.
On Thursday, the Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services began hearing proposals under three state departments. Under the Emergency Medical Services Authority (EMSA), department leaders detailed proposals for additional staffing in response to various measures passed last year. The Office of Statewide Health Planning and Development (OSHPD) did the same, with much attention around the request for $50 million General Fund authority for mental health workforce development through loan repayment and scholarship programs.
The Department of Public Health (CDPH) section of the hearing began with a State of the State’s Public Health overview by Dr. Karen Smith, State Health Officer and CDPH Director, similar to that provided in earlier this week. Subcommittee Chair Dr. Richard Pan during this time highlighted the importance of local health departments and capacity needs, foreshadowing next Wednesday’s Senate Health Committee informational hearing on California’s public health infrastructure. The subcommittee delved into a slate of items proposed in the Governor’s budget proposal; discussion on several key items of interest are noted below:
Oral Health Program. CDPH provided updates on the status on the work identified in the State’s Oral Health Plan and noted declines in Proposition 56 funds to the Oral Health Program. Dr. Kumar, CDPH’s State Dental Director indicated that despite declines in revenues, that the Local Oral Health Program (LOHP) would be made whole. He further discussed his urging to local health jurisdictions to think about alternative revenue streams in the long-term to make this work sustainable. He indicated that to account for the decline in revenue, the state could explore adjusting the frequency of reporting and surveys. CHEAC expressed appreciation for the State’s commitment to ensuring LOHP funding would not be harmed.
California Home Visiting Program Expansion (CHVP). CDPH representatives briefly touched on the Governor’s proposal to provide $23 million ongoing General Fund to expand participation in current and new sites for CHVP and their approach to incorporating new evidence-based models. CDPH indicated that the money would not be enough to fund all counties and that the department would solicit input from local health departments on evidence-based models currently used, but that the exploration would begin with evidence-based models at the federal level. CHEAC indicated our support for the additional funding and expressed our interest in engaging further.
Black Infant Health Program Expansion. CDPH provided an overview of the Governor’s proposal to provide $7.5 million General Fund to expand the Black Infant Health Program. The department indicated their plans to expand the number of sites, build a statewide awareness campaign and collect and analyze data to inform progress made in addressing black infant mortality. CDPH also indicated their interest in developing comprehensive and robust strategies to improve recruitment and retention in the program and their discussions with local MCAH directors. CHEAC expressed our support for investments to address African American infant mortality and strongly urged consideration for additional models beyond what is currently used within the Black Infant Health Program. CHEAC highlighted successes in other county strategies and underscored our interest in engaging further.
Women, Infant, and Children (WIC) Local Assistance Estimate. CDPH discussed declines in available funding due to caseload/participation declines. The department noted that California served roughly 65 percent of those eligible to participate in WIC, which is better than the national participation rate of 54 percent – based on 2016 data. CDPH highlighted their work to increase program participation including using data and research to better match WIC and CalFresh eligible participants, increasing benefits through providing tele-breastfeeding support, providing electronic recertifications, and the launch of the WIC electronic benefit transfer (EBT) for Napa and Solano scheduled for May 2019. Senator Pan showed interest in the State’s multi-agency approach to looking at data and asked for an update to be provided in the future.
Maternal, Child, and Adolescent Health Medi-Cal Oversight Activities. Representatives from CDPH discussed their request for five additional positions to perform oversight responsibilities for Title XIX Medicaid reimbursement to local health jurisdictions. CDPH referenced addition enforcement additional requirements for documentation and These positions would be funded with General Fund and local reimbursements. While CHEAC does not have a position on this request, CHEAC did take the opportunity to highlight that recent changes to Title XIX also impacts the workload at the local level and that additional training and technical assistance from the State would be beneficial.
All items were held open.
Agenda and background materials can be found here.
On Monday, the Assembly Budget Subcommittee No. 1 on Health and Human Services began their work to hear budget issues related to the various departments. This hearing featured a State of the State’s Public Health by Dr. Karen Smith, State Health Officer and Director of the California Department of Public Health (CDPH) and a budget overview and miscellaneous issues under the Department of Health Care Services (DHCS).
Dr. Smith provided a handout to highlighting the various ways to view the health status of Californians, including number of deaths, premature deaths, greatest percentage increase in deaths, disparity ratios, years lived disability and/or infectious disease. She noted that chronic diseases accounted for 75 percent of all deaths in our state. She also shared unsettling statistics including one-third of California’s children are overweight, the prevalence of diabetes has increased 37 percent and that 46 percent of adults are prediabetic. In highlighting significant threats to public health, Dr. Smith described the opioid epidemic, rising rates of suicide and alarming rates of sexually transmitted diseases in California.
Items discussed under DHCS included an overview of the department’s budget and Medi-Cal estimate, recommendations from the AB 340 Workgroup and proposals related to Proposition 56 Tobacco Tax revenues. Of interest, the Governor’s proposals to provide $30 million for developmental screening for children and $23 million for trauma screenings for children and adults were included under the Proposition 56 discussion.
All items were held open.
The agenda and materials can be found here.
The California Legislative Analyst’s Office (LAO) recently published its analysis of the use of Proposition 56 tobacco tax revenues in Medi-Cal to improve access to quality care. The LAO examines financing and access and quality care monitoring under the Medi-Cal program and summarizes how Proposition 56 funding has been used in the Medi-Cal Program to date.
Medi-Cal began receiving Proposition 56 funding in FY 2017-18. Annually, Medi-Cal receives approximately $1 billion. With tobacco use projected to continue to decline, Proposition 56 revenues for Medi-Cal are also expected to gradually decline on a year-over-year basis. The LAO found that the FY 2018-19 budget generally allocated Proposition 56 funding in Medi-Cal in accordance with the 2017-18 agreement, with the bulk of funding going to provider payment increases. The LAO report goes on to examine Governor Newsom’s FY 2019-20 budget proposal which includes provider payment increases, loan repayment programs, and new supplemental payment programs (such as payments for developmental and trauma screenings and family planning services).
The LAO further assesses the governor’s proposed Proposition 56 expenditures in Medi-Cal and lays out a number recommendation for the Legislature’s consideration. Notably, the LAO recommends rejecting proposed supplemental payments for developmental screenings as managed care plans are already required to arrange such services and are already being compensated for these screenings. The LAO recommends strong consideration of the value-based payment program proposed by the Newsom Administration to improve areas of known deficiency within Medi-Cal. Other recommendations center on Medi-Cal access and quality care monitoring and provider payments. The full LAO report is available here.
Late last week, the U.S. Department of Health and Human Services (HHS) released the final rule regarding the Title X family planning program. The final rule, set to be published in the Federal Register next week, prohibits Title X providers from referring patients to certain reproductive health services and limits sites that are eligible to receive Title X funds. Clinic sites that refer patients to other facilities for abortion services will no longer qualify for Title X funds to provide low-income women with comprehensive family planning and other preventive services including breast exams, cancer screening, and sexually transmitted disease/infection testing.
The final rule also removes the requirement that Title X clinics offer pregnancy options counseling to pregnant women that include abortion, adoption, and prenatal care referrals and promotes the participation of organizations offering natural family planning or abstinence as a method of family planning.
In California, eight LHDs are Title X subgrantees, delivering reproductive health services to residents at 46 sites in those jurisdictions. LHDs that are not subgrantees work closely with community-based Title X providers to ensure access to essential health services. In July 2018, CHEAC submitted a letter of concerns to HHS about its then-proposed Title X regulations highlighting the important role of LHDs in providing comprehensive reproductive health services and expressing concern with the potential impact on California’s public health infrastructure.
On Wednesday, Governor Gavin Newsom’s Chief of Staff Ann O’Leary indicated that California plans to sue the Trump Administration over its issuance of the final rule. During an event hosted by the Public Policy Institute of California (PPIC), O’Leary called the final rule “unconstitutional” and indicated other states, such as Washington and New York, plan to pursue legal action against the federal administration, as well.
The final rule will take effect 60 days after its publication in the Federal Register. Additional information on the final rule is available from HHS here.
This week, the U.S. Centers for Disease Control and Prevention (CDC) released a report finding that the once-significant decline in annual HIV infections has stopped and new infections have stabilized in recent years. The report includes the most recent data on HIV trends in the United States from 2010 to 2016. After approximately five years of substantial declines, the number of HIV infections began to level off at about 39,000 infections per year beginning in 2013.
According to the CDC, annual HIV infections have declined in some populations, but increased in other populations. Among gay and bisexual men, HIV rates remained stable during the study period. Rates decreased by 17 percent among heterosexual men and women and decreased by 30 percent among people who inject drugs, though rates have begun to stabilize. The CDC estimates that the decline in HIV infections have plateaued because effective HIV prevention and treatment are not adequately reaching target populations. The CDC points to significant gaps in rural areas and among disproportionately impacted populations such as African-Americans and Latinos.
The full CDC report is available here.
The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) recently announced a grant opportunity available to local health agencies for the 2019 Minority AIDS Initiative – Substance Use Disorder Treatment for Racial/Ethnic Minority Populations at High Risk for HIV/AIDS (MAI-High Risk Populations). The purpose of this program is to increase engagement in care for racial and ethnic minority individuals with substance use disorders (SUD) and/or co-occurring substance use and mental disorders (COD) who are at risk for HIV or are HIV-positive that receive HIV services/treatment.
The anticipated award amount is $500,000 per year up to five years. Applications for funding are due on April 22, 2019. Additional information about the funding opportunity is available here.
The National Interoperability Collaborative (NIC) will host a webinar on Friday, March 8 from 4:00 pm to 5:30 pm on the critical importance of upstream prevention work to more effectively combat the ongoing nationwide opioid epidemic. Presentations will cover innovative practices, including those detailed in the NIC Opioid Use Disorder Prevention Playbook, as well as state and national examples. CDPH Director and State Public Health Officer Karen Smith will be an expert panelist on the webinar and will detail California’s ongoing activities to prevent opioid use disorders in California.
Additional information and registration are available here.