March 6, 2020 Edition
On Wednesday, Governor Gavin Newsom declared a State of
Emergency for California to enhance the State’s ability to respond to COVID-19.
The Governor, joined by California Health and Human Services Secretary Ghaly,
California Department of Public Health (CDPH) Director and State Health Officer
Sonia Angell, and Office of Emergency Services (OES) Director Mark Ghilarducci,
convened a press
conference to announce his actions and provide greater context for
taking such measures. The Governor assured Californians that as a state, we are
prepared and that the State of Emergency is focused on ensuring greater
resources and flexibility as we continue our response efforts.
The Governor’s State of Emergency proclamation
does the following:
- Allows the state to enter into contracts to
arrange for the procurement of materials goods and services needed to prepare,
contain, respond to and mitigate the effects of COVID-19.
- Allows out-of-state personnel, including medical
personnel, to provide services with approval from the director of the Emergency
Medical Services Authority (for medical personnel) and Office of Emergency
Services (for non-medical personnel).
- Prohibits price gouging through September 4,
- Allows for the use of state-owned properties
that OES determines are suitable in COVID-19 efforts.
- Allows for the use of fairgrounds determined
suitable for COVID-19 efforts.
- Waives the 30-day time period for local health
emergency renewal and 60-day time frame for local emergency renewal for the
duration of the statewide emergency.
- Directs OES to provide assistance to local
governments that demonstrate extraordinary or disproportionate impacts from
- Directs CDPH to waive licensing requirements to
ensure hospitals and health facilities can adequately treat patients legally
isolated as a result of COVID-19.
- Directs state agencies, in coordination with OES
to provide updated and specific guidance relating to preventing and mitigating
COVID-19 to schools, employers and employees, first responders and community
care facilities by March 10.
- Allows for emergency transport of patients to
medical facilities beyond acute care hospitals under the approval of EMSA.
- Allows DSS to waive current law, regulations,
licensing standards and procedures regarding the use of community care
facilities, day care facilities, and residential care facilities for the
The day after declaring a State of Emergency, the Governor also
free medically necessary testing for individuals covered under commercial and
Medi-Cal health plans regulated under the Department of Managed Health Care.
This includes waiving cost-sharing for emergency room, urgent care and provider
visits for COVID-19 screening and testing.
This week, the U.S. House of Representatives (415-2) and
Senate (96-1) both overwhelmingly passed an emergency spending package to
combat the coronavirus (COVID-19) that has been spreading throughout the United
States. President Trump signed the measure this morning at the White House.
The $8.3 billion spending bill provides funding to various
federal agencies responsible for fighting the virus and includes $2.2 billion
for the Centers for Disease Control and Prevention (CDC). The measure provides funding
to the National Institutes of Health for worker-based training to prevent virus
exposures for health care workers and emergency first responders as well as funding
to federal HHS to purchase medical supplies and any vaccines developed to treat
coronavirus once available.
Of particular interest to local health departments, $950
million of the total directed to the CDC is to be appropriated to States,
localities, territories, and tribes to carry out surveillance, epidemiology,
laboratory capacity, infection control, mitigation, communications, and other
preparedness and response activities. Of that amount, $475 million must be
allocated within 30 days of enactment. This funding will be directed to every
grantee that received Public Health Emergency Preparedness funding for FY 2019,
and the measure included a provision that allows States and localities to be
reimbursed for costs they incurred responding to COVID-19 starting on January
20, 2020, through the date of enactment of the bill.
February 21 bill introduction deadline past us, the California Legislature has
begun scheduling its bill hearings in policy committees over the coming weeks.
The CHEAC Legislative Committee is meeting again today in-person in Sacramento
to review legislative measures of interest to local health departments and
public health. Bills on which positions are taken today will appear on next
week’s CHEAC Weekly Bill Chart.
CHEAC Weekly Bill Chart is available here.
On Monday, the Assembly Budget Subcommittee No. 1 on Health
and Human Services, chaired by Assembly Member Joaquin Arambula, convened to
hear budget items related to the California Department of Public Health (CDPH).
Arambula foreshadowed much of the work that lies ahead for the subcommittee,
indicating they have roughly 16 scheduled hearings and the largest workload in
terms of stakeholder and Administration proposals. Because of this he indicated
the new process for submitting stakeholder proposals for the Subcommittee’s
consideration – requiring proposals being championed by an Assembly Member and
submitted by the March 2 deadline to be heard.
State of the State’s Public Health
State Public Health Officer and CDPH Director Dr. Sonia
Angell provided a State of the State’s Public Health before the subcommittee
beginning with an issue at the forefront of many members, coronavirus. She
indicated 43 confirmed cases of coronavirus in California, 24 cases were
repatriated Americans, 10 cases were travel-related, 5 cases were person to
person where they had exposure to a known traveler and lastly 4 cases of
community transmission not tied to travel.
Dr. Angell provided a brief history of public health and
briefly touched on a variety of other issues including chronic disease, health
equity and disparities, and adverse childhood experiences. She also highlighted
broader issues impacting one’s health including climate change, mental health,
homelessness, substance use disorders and criminal justice involvement. Dr. Angell
noted that CDPH is exploring ways to strengthen surveillance noting that some
of our current surveys are not designed to engage key populations.
Following Dr. Angell’s presentation, Assembly Member Mathis
asked several questions focused on coronavirus to which Susan Fanelli, Chief
Deputy Director of Policy & Programs provided responses. He inquired about
current expenditures by CDPH in response, whether CDPH has enough funding for
response activities, the availability of mobile units and personal protective
equipment, such as masks.
CHEAC Sponsored Budget Request
The Subcommittee also heard CHEAC’s budget request for $20
million for STD Navigation Services (see agenda item 17). Our Assembly champion
and author of our sponsored bill AB 3224, Assembly Member Freddie Rodriguez
highlighted the request and introduced Trudy Raymundo, San Bernardino County
Public Health Director who delved deeper into the need and overview of our
request on behalf of CHEAC. Several organizations testified in support our request
during the hearing. No action was taken on this or any other items during the
End the Epidemics Coalition Budget Requests
Six budget requests from the End the Epidemics Coalition
were also heard during the hearing, which CHEAC supported. The requests
- $3 million ongoing General Fund for STD
- $5 million ongoing General Fund for the Office
of AIDS Syringe Exchange Supply Clearinghouse;
- $2 million one-time General Fund for the
development of a Master Plan on HIV, HCV and STDs;
- $15 million General Fund to address HIV health inequities;
- Increasing ADAP and PrEP-AP eligibility from 500
percent FPL to 600 percent FPL to align with new Covered California subsidies;
- $15 million ongoing General fund for HCV
prevention, linkage to and retention in care.
Wellness Trust Proposal
Though not included on the agenda, during the public comment
period of the hearing, Kat Deburgh from the Health Officer’s Association of
California presented their budget request, co-sponsored with the Public Health
Institute, requesting a one-time
appropriation of $180 million General Fund ($36 million per year) to launch the
Wellness Fund. A handful of public health organizations, including CHEAC
testified in support.
2019 Budget Act Funding Delays
The Subcommittee also expressed concerns with CDPH delays in
getting 2019 Budget Act funding, particularly the $40 million in infectious
disease funding, out to local jurisdictions.
Please see the hearing agenda
and/or watch a recording
of the hearing for further details.
On Monday, the
Legislative Analyst’s Office (LAO) published a report detailing the Newsom
Administration’s sweeping California Advancing and Innovating
proposal to transform the state’s Medi-Cal program. The LAO’s report provides
an overview of the primary components to be reformed through the CalAIM
Focus on Medi-Cal’s High-Cost, High-Risk Enrollees – The CalAIM proposal aims to coordinate
care through a new “enhanced care management” benefit and provide additional
optional “in lieu of services” as alternatives to traditional and often more
expensive, Medi-Cal benefits.
and Streamlining Medi-Cal Managed Care – DHCS proposes to restructure a number of current benefits
out of Medi-Cal’s fee-for-service delivery system and into managed care, set
payment levels for managed care plans on a more regional basis, and consider
establishing a full-integration pilot where managed care plans offer physical
health, dental health, and behavioral health services.
Components of the Current Section 1115 Waiver – CalAIM intends to continue certain
programs that are under the current Section 1115 waiver such as public hospital
funding and an expansion of substance use disorder services.
How Behavioral Health Services are Financed and Delivered – Included in the CalAIM proposal are a
number of reforms to improve service delivery for county behavioral health,
including streamlining financing, integrating behavioral health services at the
local level, and changing eligibility rules around behavioral health services.
indicates that many of the CalAIM components are still under development and
are yet to be finalized through the legislative and budget processes. Recall,
Governor Gavin Newsom in his January budget proposed $348 million General Fund
($695 million total funds) for CalAIM for a half year of implementation
activities in 2020-21; ongoing costs are anticipated to be $395 million General
Fund ($790 million total funds) moving forward.
the overall CalAIM proposal, the LAO determines many of its approaches,
including the vision of managed care plans in the Medi-Cal program, additional
tools to managed care plans to address
the broad needs of beneficiaries, and opportunities to receive federal funding
for services not previously eligible, are promising. The LAO further indicates
that CalAIM has the potential to move Medi-Cal toward greater standardization
across the state, reduce some complexities of the program, and address
behavioral health system barriers.
LAO indicates many components included in the broader CalAIM proposal raise
many questions and present significant risks to the state. Among the questions
and risks identified by the LAO are the readiness of managed care plans to take
on significantly expanded responsibilities under the proposal, the likely
difficulties that state and plans would face ensuring that in-lieu of services
are cost-effective, how new benefits would expand the supply of already-limited
services and interact with existing services, and how the state could minimize
new complexities the proposal may introduce.
Legislature begins it budget process and considers the broader CalAIM proposal,
the LAO recommends a number of considerations:
on Resolving Key Questions – In
discussing its recommendation, the LAO indicates the Newsom Administration has
not submitted any trailer bill or statutory language for the proposal, making
its recommendations to the Legislature challenging. Instead, the LAO suggests
focusing on specified overarching questions, high-risk/high-cost populations,
managed care activities, and behavioral health reforms.
Implementation Delays – The
LAO recommends the Legislature explore and identify potential implementation
delays given CalAIM’s aggressive implementation timeline. The LAO points to the
significant actions necessary by the state and managed care plans to implement
its components, as well as the risks that unplanned delays could present to the
overall Medi-Cal program as reasons for exploring implementation delays.
Potential Fiscal Risks – In
determining which components of the CalAIM proposal to ultimately approve, the
LAO recommends the Legislature consider the potential for CalAIM to result in
significantly higher costs to the state on an ongoing basis, what fiscal
transparency measures are needed to ensure accurate tracking of CalAIM
expenditures, and what policies should be in place to mitigate potential fiscal
risks of CalAIM.
Robust Legislative Oversight and Evaluation – The LAO determines legislative oversight of CalAIM
implementation will be critical to ensuring smooth and successful transition of
the sweeping Medi-Cal program reform. To assist in this oversight, the LAO
recommends the Legislature establish a framework for an independent and robust
evaluation of adopted CalAIM components.
The full LAO
report on CalAIM is available here.