May 10, 2019 Edition
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
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.
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.
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.
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.