May 10, 2019 Edition

Governor Newsom Releases 2019-20 May Revision, Includes Funding for LHDs

Yesterday, Governor Gavin Newsom released the 2019-20 May Revision, which includes updated figures and proposed investments to the Governor’s January budget proposal.

Notably, Governor Newsom’s May Revision includes a proposed investment of $40 million one-time General Fund (available over four years) for local health departments (LHDs) and tribal communities for infectious disease prevention, testing, and treatment services. CHEAC and HOAC applaud Governor Newsom for the inclusion of this funding.

Over the coming weeks, Senate and Assembly Budget Subcommittees will hear funding proposals and modifications included in the May Revision. A Budget Conference Committee will meet upon subcommittees’ conclusion of business to reconcile items where the Senate and Assembly actions do not align. Recall, the Constitutional deadline for the Legislature to pass the budget is June 15.

CHEAC details key areas of interest to local health departments in our May Revision Budget Memo.

Additional links related to the May Revision and Budget Process are available below:

Governor’s May Revision Summary

Department of Finance Proposed Trailer Bill Language

Department of Health Care Services (DHCS) May Revision Highlights

May Revision Press Conference Video

Assembly Budget Sub. No. 1 Hears All Member and Stakeholder Proposals, Including CHEAC/HOAC Budget Request

On Monday, the Assembly Budget Subcommittee No. 1 on Health and Human Services held a marathon hearing of all health-related member and stakeholder proposals. In previous years, the subcommittee considered member and stakeholder proposals during hearings throughout the spring as related department items were addressed. However, this year, the subcommittee implemented a new process in which all of these proposals were heard in one hearing.

Monday’s hearing featured nearly 100 member and stakeholder proposals, spanning a broad range of departments, topics, and issues. In her opening remarks, Acting Subcommittee Chair Assembly Member Eloise Gómez Reyes expressed gratitude for number of proposals, indicating the committee found virtually all of the proposed investments “meritorious and compelling and worthy of our time and consideration.” Acting Chair Reyes outlined funding constraints of state spending and budgetary processes despite the state’s strong economic performance and indicated her hope to advance a number of key public health- and healthcare-related proposals.

Several Assembly Members and stakeholder organizations presented budget requests associated with legislative bills, including areas related to maternal mental health, Alzheimer’s disease awareness and prevention, and asthma prevention services.

Notably, CHEAC Past President and San Bernardino Public Health Director Trudy Raymundo presented our CHEAC/HOAC budget request for $50 million ongoing General Fund for local health department (LHD) communicable disease infrastructure. Ms. Raymundo outlined ongoing challenges experienced by LHDs throughout California, particularly in light of unprecedented increases in infectious diseases and decreased and siloed state and federal funding. In her presentation, Ms. Raymundo underscored the fact LHDs are the only entity statutorily responsible for infectious disease prevention and control, as well as the need for flexibility in funding to enable jurisdictions to address conditions and diseases specific to California’s diverse communities.

Assembly Member Jim Wood inquired about funding cuts experienced by LHDs as a result of the Great Recession and the lack of a funding restoration, particularly in 1991 Health Realignment. Wood, indicating that he had heard from LHDs in his district, expressed his desire to support the funding request and emphasized the importance of flexible funding. Acting Chair Reyes further inquired about communicable disease rates in San Bernardino County and expressed her gratitude for Ms. Raymundo presenting the budget request on behalf of her county and all California LHDs.

A video clip of Ms. Raymundo’s budget request presentation is available here.

All member and stakeholder proposals were held open. A hearing agenda is available here. A full recording of the subcommittee hearing is available here.

Senate Budget & Fiscal Review Sub. No. 3 Hears Update on CCS WCM Implementation

On Thursday, the Senate Budget & Fiscal Review Subcommittee No. 3 on Health and Human Services held a hearing that included an informational update on the California Children’s Services (CCS) Whole Child Model (WCM) implementation. Recall, SB 586 (Chapter 625, Statutes of 2016) established the WCM in designated County Organized Health System (COHS) jurisdictions through which CCS case management and service authorization responsibilities were transitioned from counties to the Medi-Cal managed care plans.

Thursday’s hearing featured Department of Health Care Services (DHCS) Director Jennifer Kent to provide an update on implementation activities. Director Kent discussed the phased-in implementation process, as well as the delayed Phase Three implementation in Orange County due to network adequacy concerns. Orange County will be the final county set to transition to the WCM on July 1, 2019.  Director Kent discussed various implementation challenges, including case management activities, transportation benefits, and eligibility determinations.

The hearing also featured panelists from the Health Plan of San Mateo, the California Children’s Hospital Association, Family Voices of California, and the Children’s Specialty Care Coalition. Panelists discussed their respective experiences in implementing the WCM in specified jurisdictions throughout the state, as well as successes and challenges with the transition of these services to a managed care model.

Much of the informational item during the hearing focused on the WCM evaluation plan. Stakeholders have expressed concerns about DHCS’s scope of work, methodology, and metrics for the evaluation and its consistency with the intent of SB 586. Director Kent indicated during the hearing that an evaluation date previously published by DHCS was erroneous; the WCM implementation evaluation will occur three years after the full implementation of WCM, which is consistent with statute. Director Kent further reiterated her department’s commitment to soliciting feedback and input from stakeholders and ensuring the evaluation meets all elements delineated in statute.

Subcommittee Chair Senator Richard Pan inquired about care coordination efforts and changes in service provided by counties versus health plans, and evaluation strategies, and data sources to be used in the evaluation process.

Given that the item was informational, no actions were taken by the subcommittee. The hearing agenda is available here. A video of the hearing is available here.

Legislature Faces Fiscal Committee Deadline Next Friday

This week, the California Legislature maintained a steady pace of committee and floor activities as it approaches a series of upcoming deadlines. Today marks the last day for policy committees to meet prior to June 3, and next Friday marks the last day for fiscal committees to hear and report to the floor bills introduced in their house of origin.

Both the Senate and Assembly Appropriations Committees will hold suspense file hearings next Thursday where hundreds of bills will be considered. Many bills are expected to advance to the floor, where many more will be held on suspense and become two-year bills.

The Legislature over the coming weeks will be increasingly immersed in the budget process, particularly given Governor Gavin Newsom’s release of the May Revision yesterday.

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

CDC Vital Signs Examines Maternal Mortality

This month, the U.S. Centers for Disease Control and Prevention (CDC) Vital Signs publication examined pregnancy-related deaths in the U.S. According to the CDC, about 700 women die each year from complications of pregnancy, finding that about a third of deaths occurred during pregnancy, a third occurred at delivery or in the week after, and the remaining third occurred one week to one year postpartum.

Heart disease and stroke caused more than 1 in 3 deaths, and other significant factors were infections and severe bleeding. Black and American Indian/Alaska Native women were found to be three times as likely to die from a pregnancy-related cause as white women. The Vital Signs publication outlines strategies to improve maternal and pregnancy-related outcomes for health care providers, hospitals and health systems, and states and communities.

This month’s CDC Vital Signs is available here.