March 31, 2022 Edition

CHEAC Publishes March 2022 #WeArePublicHealth Newsletter

CHEAC is proud to publish the latest edition of the #WeArePublicHealth Newsletter, featuring the critical work of California local health departments in protecting and promoting the health of all Californians.

The March 2022 edition features an op-ed by Senator Richard Pan and Assembly Member Cecilia Aguiar-Curry, the work of public health nurses in local jurisdictions, nutrition and obesity prevention efforts, and public health laboratory services.

The newsletter may be accessed here.

Legislature Wraps Up Busy Week of Policy Committee Hearings

This week in Sacramento was marked by a flurry of legislative activities in both the State Senate and Assembly as lawmakers present and hear measures in policy committees. Lawmakers engaged in a steady pace of policy committee hearings as they work toward a 10-day Spring Recess set to begin next Thursday, April 7.

Of note this week, Assembly Member Buffy Wicks put a pause on AB 1993 which would require employers to require each employee or independent contractor to be fully vaccinated against COVID-19. AB 1993 was set to be heard in the Assembly Labor and Employment Committee on Tuesday, but the measure was pulled from the agenda one day prior to the hearing. Assembly Member Wicks explained her decision via Twitter, indicating in part that “we’re now in a new and welcome chapter in this pandemic, with the virus receding for the moment” which provides an opportunity for the author to work with labor entities and employers that raised concerns over the bill. AB 1993 is part of a broader package of measures proposed by the “vaccine caucus,” a handful of Senators and Assembly Members with a strong interest in public health protections against COVID-19.

Recall, last week, legislative leaders pledged quick action on AB 2179 to extend pandemic-related eviction protections for residents who are participating in state rental assistance programs. The measure was advanced out of the Assembly on Tuesday and received final approval from the Senate today. Acting Governor Eleni Kounalakis, shortly after the bill’s passage, signed the measure into law, becoming the first woman in state history to sign a piece of legislation into law. Governor Gavin Newsom departed California yesterday for a family vacation in Central and South America; the Newsoms are set to return to California on April 12.

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

Communicable Disease Control

SB 1479 (Pan) as amended March 21, 2022 – SUPPORT

SB 1479 by Senator Richard Pan would require CDPH to continue and expand COVID-19 testing in K-12 schools, preschools, and childcare centers. The measure would also require LEAs to create a COVID-19 testing plan aligned to CDPH guidance and designate staff to report data to CDPH as well as the school district. SB 1479 was heard on Wednesday in the Senate Health Committee and advanced on a 9-2 vote. The measure now moves to the Senate Education Committee.

Health Coverage/Health Care Reform

SB 967 (Hertzberg) as introduced February 10, 2022 – SUPPORT

Senator Robert Hertzberg’s SB 967 was heard in the Senate Health Committee on Wednesday. This measure would require the Franchise Tax Board to provide a checkbox on individual income tax returns for taxpayers to indicate their interest in no-cost or low-cost health care coverage. Covered California would be required to annually outreach for enrollment efforts to individuals expressing interest. SB 967 was unanimously advanced to the Senate Government and Finance Committee on a 11-0 vote.

SB 1473 (Pan) as amended March 10, 2022 – SUPPORT

SB 1473 authored by Senator Richard Pan, would extend the Covered California (Exchange) enrollment program period for health care coverage to November 1 through January 31. Enrollment occurring prior to December 31 would begin coverage starting January 1, and if enrollment occurs after January 1, coverage should begin February 1. SB 1473 was heard in the Senate Health Committee on Wednesday and was advanced out of the committee on consent.

LHD Administration & Simplification

AB 2381 (Daly) as amended March 4, 2022 – SUPPORT

Assembly Member Tom Daly’s AB 2381 was heard in the Assembly Judiciary on Tuesday. AB 2381 would establish an address confidentiality program for code enforcement officers, public health officers, and public health workers, and others. This measure was passed from the Assembly Judiciary Committee to the Assembly Appropriations Committee on a 10-0 vote.

Assembly Considers DHCS, CalAIM Budget Proposals

On Monday, the Assembly Budget Subcommittee No. 1 on Health and Human Services heard various proposals under the Department of Health Care Services (DHCS), and the Department of Managed Health Care (DMHC), regarding the California Advancing and Innovating Medi-Cal (CalAIM) initiative and various Medi-Cal benefits, and DMHC proposals.

Jacey Cooper, State Medicaid Director & Chief Deputy Director of Health Care Programsat DHCS provided an overview on CalAIM, stating that it is moving Medi-Cal towards a population health approach that prioritizes prevention and Whole Person Care (WPC). She indicated that the goal is to meet people where they are in life, with  CalAIM offering coordinated and equitable access to services that address, physical health, behavioral health, developmental, dental, and long-term care needs to help people be healthier.

Ms. Cooper spoke about various deadlines that have been established for DHCS, Managed Care Plans (MCPs), and counties to meet to transition Medi-Cal beneficiaries from existing delivery systems to services proposed in CalAIM, such as Enhanced Care Management (ECM). She also mentioned DHCS, in partnership with plans and providers, had successfully launched Community Supports previously known as In-Lieu of Services. Information regarding Community Supports by county is available on the DHCS website here. Additionally, Ms. Cooper discussed DHCS activities related to their behavioral health initiatives.

Assembly Budget Subcommittee No. 1 Chair Assembly Member Joaquin Arambula asked DHCS several questions related to CalAIM, including how the transition to ECM would be handled and how funding would be equitably distributed.

Additional items considered by the Assembly Budget Subcommittee No. 1 included discussion regarding specialty mental health, suspension of Medi-Cal benefits for inmates, skilled nursing facility financing, and dental managed care. No action was taken by the committee and items were held open. The full agenda for Monday’s hearing is available here. A video recording of the hearing is available here.

Pan, Aguiar-Curry Pen Op-Ed on Rebuilding Public Health Workforce

Senator Richard Pan and Assembly Member Cecilia Aguiar-Curry this week penned an op-ed in CalMatters, urging the Legislature and Governor to fund the Public Health Equity and Readiness Opportunity (Public HERO) initiative to bolster the state’s public health workforce and training pipeline.

The Public HERO Initiative builds on the Governor’s $300 million ongoing budget proposal for state and local public health by targeting new one-time investments to strengthen public health recruitment and retention efforts and training and pipeline opportunities. The initiative anticipates developing future public health laboratory directors, epidemiologists, microbiologists, and nurses needed to address health inequities and protect residents from increasing rates of STDs, diabetes, tuberculosis, and other conditions.

More information on CHEAC’s Public HERO Initiative is available here. The CalMatters op-ed is available here.

California Budget and Policy Center Issues Fact Sheet on Public Health Spending

The California Budget and Policy Center (CBPC) published a public health spending fact sheet that highlights the chronic underfunding of public health in California. The fact sheet details the California Department of Public Health as well as local health department’s critical role in protecting and promoting California’s health and well-being, and how funding has not kept pace with the cost of preparing for and responding to ongoing and emerging public health threats.

The fact sheet also highlights how public health departments were not adequately prepared to respond to COVID-19 as a result of the chronic underfunding. In addition, the fact sheet highlights the proposed investment of $300 million for public health infrastructure at the state and local level and emphasizes this as a critical first step in reversing the underfunding and protecting Californians.  

The CBPC fact sheet is available here.

Governor Issues Executive Order on Drought

Governor Gavin Newsom on Monday issued Executive Order N-7-22 to address historic drought conditions statewide. The Governor’s order calls on local water suppliers to activate drought contingency plans and directs the State Water Resources Control Board (SWRCB) to evaluate the adoption of regulations banning irrigation of “non-functional” turf adjacent to large industrial or commercial buildings.

The Governor’s order comes as the state continues to experience significant drought conditions, amidst dry, hot weather. Additional information is available here.

Governor Newsom Announces Notable Appointments

Governor Gavin Newsom recently announced several appointments of interest. These include:

  • Maral Farsi, Deputy Director of Legislative and Governmental Affairs, California Department of Public Health – Ms. Farsi has served as Deputy Director of Legislative and Inter-Governmental Affairs at the Governor’s Office of Business and Economic Development since 2018. Farsi was Regional Director of Governmental Affairs for CVS Health from 2014 from 2018, a Health Policy Manager at Optum from 2011 to 2014, and a Policy Analyst at the California Association of Health Plans from 2008 to 2011. She holds a Master of Science degree in Law from the University of the Pacific, McGeorge School of Law and a Master of Public Health Degree from the University of California, Los Angeles.
  • Jennifer Lim, Deputy Director of External Affairs, Communications and Outreach at the California Department of Industrial Relations – Ms. Lim served as Deputy Director at the California Emergency Medical Services Authority since 2013. Prior to that, she served as Assistant Director of Legislation and Communications/Public Information Officer at the California Department of Rehabilitation from 2007 to 2013 and as a Vocational Rehabilitation Counselor, Training Officer, and Americans with Disabilities Consultant from 1997 to 2000. She held several positions at the Benson Enterprises and Mourning Hope from 1997 to 2007 and was also a research Publications Specialist/Public Information Officer at the Solano County Office of Education from 2000 to 2002.
  • Joe Stephenshaw, Senior Counselor on Infrastructure and Fiscal Affairs, Office of the Governor – Stephenshaw has been Staff Director for the Senate Budget and Fiscal Review Committee since 2017. He has held several positions in the California Legislature since 2008, including serving as a Policy Consultant in the Office of the Senate President pro Tempore, a Special Advisor to the Speaker of the Assembly, and as a Budget Consultant for both the Assembly Budget Committee and the Senate Budget and Fiscal Review Committee. Mr. Stephenshaw was a Budget Analyst for the California Department of Finance from 2005 to 2008.

President Biden Issues FY 2023 Federal Budget

President Joseph R. Biden, Jr. on Monday issued his administration’s federal budget proposal for the 2023 federal fiscal year. The $5.7 trillion budget proposal seeks to continue the nation’s recovery from the COVID-19 pandemic, strengthen the country’s fiscal and economic conditions, promote economic and job opportunities, and address nationwide challenges related to climate change, health, and equity.

At a high-level, the Presidents FY 2023 Budget seeks $127.3 billion in discretionary funding, a $26.9 billion increase over the 2021 enacted level, for the U.S. Department of Health and Human Services. This amount excludes funding for the Indian Health Service (IHS), which the Biden Administration is proposing to shift from discretionary to mandatory funding. Major health- and public health-related investments set forth in the President’s Budget include:

  • Preparation for Future Pandemics and Advancing Health Security – The Biden-Harris Administration Budget proposes significant investments ($81.7 billion) in pandemic preparedness and biodefense to enable an agile, coordinated, and comprehensive public health response to future threats. The Budget also provides $40 billion to the Office of the Assistant Secretary for Preparedness and Response (ASPR) to invest in advanced development and manufacturing of vaccines, therapeutics, and other diagnostics for high-priority threats. The Biden-Harris Administration also proposes $28 billion for the U.S. Centers for Disease Control and Prevention to enhance the public health system infrastructure, domestic and global threat surveillance, public health workforce development, public health laboratory capacity, and global health security.
  • Building Advanced Public Health Systems and Capacity – The FY 2023 Budget proposes $9.9 billion in discretionary funding to build capacity at the CDC and state and local levels, representing an increase of $2.8 billion over the 2021 enacted level. These resources are anticipated to improve the core immunization program, expand public health infrastructure and workforce in states and territories, and support efforts to modernize public health data collection.
  • Expanding Access to Vaccines – The Biden-Harris Administration proposes establishing a new Vaccines for Adults (VFA) program to provide uninsured adults with access to all vaccines recommended by the CDC Advisory Committee on Immunization Practices (ACIP) at no cost. The VFA program, designed to complement the Vaccines for Children (VFC) program, would reduce disparities in vaccine coverage and promote infrastructure for broad access to routine and outbreak vaccines.
  • Ending the HIV/AIDS Epidemic – The Budget includes $850 million across HHS to reduce new HIV cases, increase access to pre-exposure prophylaxis (PrEP), and ensure equitable access to services and supports for those living with HIV. The Budget proposes a new mandatory program to guarantee PrEP at no cost for all uninsured and underinsured individuals, provide essential wrap-around services through states, IHS, tribal entities, and localities, and establish a network of community providers to reach underserved areas and populations. These activities are aligned with the Administration’s National HIV/AIDS Strategy for the United States, 2022-2025.
  • Advancing Maternal Health and Health Equity – The FY 2023 Budget proposes $470 million to reduce maternal mortality and morbidity rates, expand maternal health initiatives in rural communities, implement implicit bias training for health care providers, create pregnancy home demonstration projects, and address the highest rates of perinatal health disparities. The Budget seeks to extend and increase funding for the Maternal, Infant, and Early Childhood Home Visiting program, as well as strengthen collection and evaluation of health equity data.
  • Expanding Access to Health Services for Low-Income Women – The Biden-Harris Administration provides $400 million, an increase of nearly 40 percent from the 2021 enacted level, to the Title X Family Planning Program, which provides family planning and preventive health services to low-income communities.
  • Accelerating Innovation Projects for Health – The FY 2023 Budget proposes a major investment of $5 billion for the Advanced Research Projects Agency for Health (ARPA-H) to drive innovation in health research and speed application and implementation of health breakthroughs. ARPA-H is anticipated to have an initial focus on cancer and other diseases such as diabetes and dementia. Funding for ARPA-H, along with additional funding for the National Institutes of Health (NIH), total a $49 billion request to support research that enhances health, lengthens life, reduces illness and disability, and spurs new biotechnology productions.

The release of the proposed budget by the President comes just weeks after Congress passed funding for the 2022 fiscal year and sets off a lengthy process in which Congress considers funding proposals for the next fiscal year.

A statement from HHS Secretary Xavier Becerra on the FY 2023 Budget is available here. The Biden-Harris Administration has published a series of fact sheets on the FY 2023 Budget; these include a general overview fact sheet and a fact sheet on pandemic preparedness and biodefense. The full FY 2023 Budget Proposal is available here.

FDA Authorizes Second COVID-19 Booster Dose for Older and Immunocompromised Individuals

On Tuesday, the U.S. Food and Drug Administration (FDA) authorized a second booster dose of either the Pfizer-BioNTech or the Moderna COVID-19 mRNA vaccines for older adults and certain immunocompromised individuals. The FDA previously authorized a single booster dose for certain immunocompromised individuals following completion of a three-dose primary vaccination series.

According to the FDA, the action will make a second booster dose of COVID-19 vaccines available to other populations at elevated risk for severe disease, hospitalization, and death. Emerging evidence suggests a second booster dose of an mRNA COVID-19 vaccine improves protection against severe COVID-19 and is not associated with new safety concerns.

Specifically, the FDA amended emergency use authorizations (EUAs) as follows:

  • A second booster dose of the Pfizer-BioNTech COVID-19 Vaccine or Moderna COVID-19 Vaccine may be administered to individuals 50 years of age or older at least four months after receipt of a first booster dose of any authorized or approved COVID-19 vaccine
  • A second booster dose of the Pfizer-BioNTech COVID-19 Vaccine may be administered to individuals 12 years of age and older with certain kinds of immunocompromise at least four months after receipt of a first booster dose of any authorized or approved COVID-19 vaccine.
  • A second booster dose of the Moderna COVID-19 Vaccine may be administered at least four months after the first booster dose of any authorized or approved COVID-19 vaccine to individuals 18 years of age or older with the same certain kinds of immunocompromise.

The FDA notes its actions apply only to the Pfizer-BioNTech and Moderna COVID-19 Vaccines, and authorization of a single booster dose for other age groups with these vaccines remains unchanged.

Shortly after the FDA’s decision to authorize an additional booster for specified populations, the U.S. Centers for Disease Control and Prevention (CDC) updated its recommendations to align with the FDA’s authorization. Separately, the CDC also allowed adults who received a primary vaccine and booster dose of Johnson & Johnson’s Janssen COVID-19 vaccine at least four months ago to now receive a second booster dose using an mRNA COVID-19 vaccine.

The Western States Scientific Safety Review Workgroup shortly thereafter issued a statement supporting the expanded eligibility of second booster doses of Pfizer-BioNTech and Moderna vaccines for certain individuals.

Additional information from the FDA is available here.

CDC Releases Data on Youth Mental Health During the COVID-19 Pandemic

The U.S. Centers for Disease Control and Prevention (CDC) this week released new analyses exploring the mental health statuses of U.S. high school students during the COVID-19 pandemic. According to new data, in 2021, more than one-third (37 percent) of high school students reported they experienced poor mental health during the pandemic, and 44 percent reported they persistently felt sad or hopeless during the past year.

The new CDC analyses also describe other challenges youth encountered during the pandemic:

  • More than half (55 percent) reported they experienced emotional abuse by a parent or other adult in the home, including swearing at, insulting, or putting down the student
  • 11 percent experienced physical abuse by a parent or other adult in the home, including hitting, beating, kicking, or physically hurting the student
  • More than a quarter (29 percent) reported a parent or other adult in the home lost a job

Before the pandemic, the CDC notes, mental health was getting worse among high school students. Lesbian, gay, and bisexual youth and female youth reported greater levels of poor mental health, emotional abuse by a parent or caregiver, and having attempted suicide than their counterparts. Over one-third (36 percent) of students indicated they experienced racism before or during the COVID-19 pandemic. The highest levels were reported among Asian students (64 percent) and Black students and students of multiple races (55 percent).

School connectedness, defined as a sense of being cared for, supported, and belonging at school, had an important effect on students during a time of severe disruption. Youth who felt connected to adults and peers at school were significantly less likely than those who did not to report persistent feelings of sadness and hopelessness (35 percent vs. 53 percent); that they seriously considered attempting suicide (14 percent vs. 26 percent); or attempted suicide (6 percent vs. 12 percent). However, fewer than half (47 percent) of youth reported feeling close to people at school during the pandemic.

The CDC notes that youth with poor mental health may struggle with school and grades, decision-making, and their health. Mental health problems in youth are also often associated with other health and behavioral risks such as increased risk of drug use, experiencing violence, and higher risks of sexual behaviors.

Additional information from the CDC is available here.

Biden-Harris Administration Launches

This week, the Biden-Harris Administration this week launched, a new one-stop website for vaccines, tests, treatments, masks, and the latest COVID-19 guidance and information.

As part of, a new Test-to-Treat locator is available to assist individuals access pharmacies and community health centers nationwide for COVID-19 testing and treatment. The Administration has launched over 2,000 Test-to-Treat sites with further expansions underway, including at federal sites such as the Veterans Affairs and Indian Health Service facilities.

Additional information is available here.

Public Health Communications Collaborative to Hold Webinar on April 13

The Public Health Communications Collaborative, a partnership between the CDC Foundation, de Beaumont Foundation, and Trust for America’s Health (TFAH), will host a webinar on “Communicating Through COVID-19 and Beyond” on Wednesday, April 13 from 10:00 am to 11:00 am.

The webinar will feature a discussion of insights for protecting the public health through the current COVID-19 landscape and beyond. The webinar and an accompanying resource, “Impact and Insights from the Field of Public Health,” will offer stories and lessons learned from public health communications across the U.S. that can be used to address current and future communication needs.

The webinar will feature Dr. Ying-Ying Goh, Public Health Director and Health Officer of the City of Pasadena Public Health Department, as well as other leaders from local health departments. The webinar will be moderated by J. Nadine Gracia, President and CEO of TFAH.

Additional information, including registration is available here.

HHS Awards $256.6 Million for Title X Family Planning Providers

This week, the U.S. Department of Health and Human Services (HHS) awarded $256.6 million in grant funding to support 76 grantees to deliver equitable, affordable, client-centered, and high-quality family planning services. These grants are anticipated to restore access to Title X services nationwide and fill service gaps caused by more than a quarter of Title X providers withdrawing from the program over the past two and a half years in response to the previous administration’s Title X rule.

Essential Access Health in California was awarded $13.2 million. Several California local health departments have previously served as Title X subgrantees, delivering reproductive health services to residents at numerous community-based sites. LHDs that have not been direct subgrantees have worked closely with community-based Title X providers to ensure access to essential reproductive health services.

Title X is the only federal grant program dedicated to solely providing individuals with comprehensive family planning and related preventive health services. The program supports a diverse network of clinics, including state and local health departments, federally qualified health centers, hospital-based sites, and other private nonprofit and community-based health centers.

Additional information from HHS is available here.

2021 PH WINS Survey Findings Released, Finds Rising Burnout and Stress Among Public Health Workforce

Two years of pandemic response activities have contributed to increased stress, burnout, and post-traumatic stress symptoms among the country’s public health workforce, according to the 2021 Public Health Workforce Interests and Needs Survey (PH WINS). The survey, conducted by the de Beaumont Foundation and the Association of State and Territorial Health Officials (ASTHO), also found that public health workers remain committed to their jobs and communities.

PH WINS was conducted between September 2021 and January 2022 among nearly 45,000 staff in state and local governmental public health departments. Key findings of the latest survey include:

  • More than half of public health employees report symptoms of post-traumatic stress disorder, and one in five indicate their mental health is either fair or poor
  • Many public health workers, especially executives, report experiencing bullying, threats, and harassment
  • More than one in three public health employees indicate they are considering leaving their organization

Despite these challenges, public health workers largely report satisfaction with their job, as well as fulfillment in their profession.

PH WINS is the only nationally representative survey of state and local governmental public health employees. The survey, conducted in 2014, 2017, and 2021, collects information on engagement and satisfaction, demographics, intent to leave, training needs, and public health’s most pressing issues. Additional data and analyses, including a methodological report, will be released this summer.

Additional information is available here.

UCLA Researchers Release Study of Health Homes Program

Researchers at the University of California, Los Angeles (UCLA) Center for Health Policy Research (CHPR) recently released findings from the second Health Homes Program (HHP) Interim Evaluation report. The latest report provides updates on program participants’ enrollment patterns, demographics, and services received that were reported in the first interim evaluation report. The latest report additionally includes analyses of changes in HHP core metrics, health care utilization, and estimated Medi-Cal payment measures.

HHP was implemented by the California Department of Health Care Services (DHCS) with an overarching goal to attain the “Triple Aim” quality improvement initiative of achieving better health outcomes and lowering health care costs. As of September 30, 2020, the program served nearly 50,000 Medi-Cal managed care plan (MCP) beneficiaries with complex needs, including individuals with chronic health and/or mental health conditions and individuals experiencing homelessness. Extra services were provided at no cost to Medi-Cal members and through care coordination, which may be key to reducing avoidable health care costs.

The report assesses utilization of emergency departments and hospitals, outpatient services, and health screening and follow-up, among other areas. Findings from the report indicate some improvements in service utilization but other measures that reflect care processes and health outcomes showed no significant change after the first year of enrollment.

The full report is available here.