March 6, 2020 Edition

Governor Declares State of Emergency for COVID-19

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, 2020.
  • 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 COVID-19.
  • 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 elderly.

The day after declaring a State of Emergency, the Governor also announced 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.

Coronavirus Spending Bill Sails through Congress

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.

Legislature Begins Scheduling Bill Hearings

With the 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.

This week’s CHEAC Weekly Bill Chart is available here.

Assembly Subcommittee No. 1 Hearing Features State of the State’s Public Health and CDPH Items

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 hearing.

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 include:

  • $3 million ongoing General Fund for STD prevention;
  • $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; and
  • $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.

LAO Issues Report on Newsom Administration’s CalAIM Proposal

On Monday, the Legislative Analyst’s Office (LAO) published a report detailing the Newsom Administration’s sweeping California Advancing and Innovating Medi-Cal (CalAIM) 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 proposal, including:

  • Increasing 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.
  • Transforming 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.
  • Extending 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.
  • Rethinking 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.

The LAO 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.

In assessing 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.

However, the 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.

As the Legislature begins it budget process and considers the broader CalAIM proposal, the LAO recommends a number of considerations:

  • Focusing 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.
  • Exploring 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.
  • Mitigating 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.
  • Ensuring 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.