May 14, 2021 Edition

Despite Record-Breaking Surplus, Newsom Fails to Invest in Public Health Infrastructure and Workforce

Today, Governor Gavin Newsom released his Administration’s May Revision, detailing new and adjusted budgetary investments based on the state’s latest revenue projections. The Governor’s May Revision represents a $267.8 billion budget of which $196.8 billion is provided by state General Fund.

Notably, despite a record-breaking $75.75 billion surplus, Governor Newsom fails to propose any new, ongoing investments for public health infrastructure and workforce. The California Can’t Wait Coalition, representing public health officials, local leaders, frontline workers, and health equity advocates, expresses deep dismay over Governor Newsom’s failure to include new dollars to rebuild the state’s 61 local health departments.

CHEAC Staff has published a May Revision Memo providing CHEAC Members with a summary of investments included in the Governor’s May Revision. The California Legislature will begin its review of the Governor’s May Revision starting next week, and CHEAC Staff will continue to keep its Members apprised of significant budget developments as the Legislature approaches the June 15 constitutional deadline to pass a state budget.

Suspense File Hearings Set for Next Week

The California Legislature this week convened a number of budget hearings to review state agency and department budget proposals while anxiously awaiting today’s presentation of the Governor’s May Revise. The Legislature remained in a bit of a holding pattern ahead of next week’s Senate and Assembly Appropriations Committees suspense file hearings which are anticipated to occur on Thursday, May 20. Recall, any bill that has an annual cost of $150,000 or more is referred to the suspense file in the appropriations committees. The vast majority of bills proposed by the Legislature end up being referred to the appropriations committees’ suspense files.

At the suspense file hearings next week, the committees will convene to hear the results of the relatively nebulous suspense file process in which committees determine which bills can and cannot be afforded by the state based on the latest available revenue figures. No presentations or witness testimony is taken during suspense file hearings. Bills that are advanced off the suspense file will remain in play and may be amended by the appropriations committees to reduce overall costs of proposed policies. Bills deemed too expensive will be held on suspense, ultimately preventing the measure from continuing through the legislative process.

Hundreds of bills will be reviewed by appropriations committees next week, including CHEAC’s sponsored measure, AB 240 (Rodriguez), to require an assessment of the state’s local health department workforce and infrastructure. Results of suspense file hearings will be reported in next week’s CHEAC Weekly Update and Weekly Bill Chart.

This week’s latest edition of the CHEAC Weekly Bill Chart is available here. Below, we highlight a handful of measures that were referred to appropriations suspense files this week.

Health Coverage/Health Care Reform

AB 4 (Arambula) as introduced December 7, 2020 – SUPPORT

AB 4, authored by Assembly Member Joaquin Arambula was heard in Assembly Appropriations Committee this week. The measure would expand Medi-Cal benefits to all undocumented adults at or below 138% FPL, contingent on appropriation by the Legislature in the annual Budget Act or other measures. Would expand eligibility requirements and enrollment plan to ensure individual continues to obtain care. Requires DHCS to collaborate with counties and public hospitals to maximize federal financial participation. AB 4 has been placed on the Assembly Appropriations Committee Suspense File.

Access to Health Services

AB 32 (Aguiar-Curry) as amended April 22, 2021 – SUPPORT

Assembly Member Aguiar- Curry’s AB 32 was heard in the Assembly Appropriations Committee this week. The bill requires health services provided by an enrolled clinic through telehealth to be reimbursed by Medi-Cal on the same basis, to the same extent, and at the same payment rate as in-person services. Providers would be authorized to enroll or recertify Medi-Cal program beneficiaries using telehealth services, and DHCS would be required to both seek necessary federal approvals and to convene an advisory group that includes specified representatives, including designated public hospitals and counties. Additionally, DHCS is required to consult with stakeholders to develop one or more federally permissible alternative payment method for FQHCs and RHCs for specified services. AB 32 was placed on the Assembly Appropriations Committee Suspense File.

Communicable Disease Control

SB 306 (Pan) as amended March 24, 2021 – SUPPORT

SB 306, authored by Senator Richard Pan was heard in Senate Appropriations Committee this week. The measure would allow pharmacists to provide expedited partner treatment (EPT) for STDs. Both private and public health insurances would require coverage for at home STD kits. Additionally, SB 306 would add EPT treatment and liability protections for physicians when diagnosing STDs. Requires third trimester congenital syphilis testing for pregnant women, HIV counselors to perform specified STD tests and requires counselors to provide appropriate counseling and referrals before performing tests. Requires reimbursement in the Family PACT program, for STD related services to the uninsured, income eligible patients, or patients without healthcare coverage who are not at risk for pregnancy or do not require contraceptive services. SB 306 has been placed on the Senate Appropriations Suspense File.

SB 744 (Glazer) as amended April 29, 2021 – OPPOSE UNLESS AMENDED

Senator Glazer’s SB 744 was heard in Senate Appropriations Committee this week. SB 744 would require CDPH create a program to provide expedited release, during a declared public health emergency, of specified health care data to researchers of specified institutions of higher education. This measure would also require any electronic tool used by local health officers for reporting communicable disease cases to include capacity to collect and report data including where the patient resides, the number of people the patient resides with, the occupation of the patient, and the cities the patient has traveled to in the past 14 days. SB 744 has been placed on the Senate Appropriations Suspense File.

Pfizer-BioNTech COVID-19 Vaccine Authorized for Minors Ages 12-15

The U.S. Food and Drug Administration (FDA) on Monday expanded the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine to include adolescents ages 12 through 15. The FDA amended the EUA originally issued for the vaccine on December 11, 2020, for administration of the vaccine in individuals 16 years of age and older.

Based on available safety data for the vaccines, the FDA determined the immune response of adolescents was at least as good as the immune response of older participants and the vaccine is 100 percent effective in preventing COVID-19 among individuals ages 12 through 15.

On Wednesday, the U.S. Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) convened a meeting to review the FDA’s expanded EUA for the vaccine. The ACIP unanimously endorsed the safety and efficacy of the vaccine among individuals 12 through 15 and recommended the CDC Director approve the use of the Pfizer-BioNTech vaccine nationwide. CDC Director Rochelle Walensky, shortly after the ACIP meeting, adopted the recommendation.

On Wednesday evening, the Western States Scientific Review Workgroup met to review the evidence from the Pfizer-BioNTech clinical trial among minors and, similar to the FDA and CDC, endorsed its safety and efficacy. The workgroup released a statement clearing the way for the vaccine to be administered among minors statewide.

The California Department of Public Health (CDPH) notes that approximately 2.1 million Californians in this age group are now available to be vaccinated against COVID-19. The state’s MyTurn COVID-19 vaccine registration site has been updated to allow parents, guardians, and emancipated minors to schedule a vaccine appointment.

Additional information, including the Western States Workgroup statement, from CDPH is available here.

Biden-Harris Administration Identifies Additional COVID-19 Vaccination Strategies

This week, the Biden-Harris Administration identified a number of additional strategies to inoculate Americans against COVID-19 in an attempt to reach the country’s goal of vaccinating 70 percent of the U.S. adult population with one vaccine dose by July 4.

The Administration announced the following:

  • Free Rides to Get Vaccinated: President Biden announced a new program from ride-sharing companies Lyft and Uber to offer free rides to anyone going to get a vaccination site to get vaccinated. Lyft and Uber will promote rides to and from tens of thousands of vaccination sites though their apps. People will be able to simply select a nearby vaccination site, follow directions to redeem their free ride, and receive transportation. The feature is anticipated to launch in the next two weeks and run until July 4.
  • Community College Vaccine Sites: The Biden-Harris Administration will launch partnerships between federal retail pharmacy partners and community colleges to provide on-site clinics for students, staff, and local communities.
  • Grassroots Support: The Administration also announced the availability of funding to state, territorial, tribal, and local governments for community outreach and engagement to connect people to vaccinations, including through engagement of community-based organizations and faith-based organizations. State, local, and community leaders can use FEMA assistance to fund the cost of in-person, phone, and online community engagement, and community outreach workers supported by this funding can conduct a variety of critical missions.

Additional information from the White House is available here.

CDC Updates Masking Guidance for Fully Vaccinated Persons, California Still Assessing

On Thursday, the U.S. Centers for Disease Control and Prevention (CDC) announced that fully vaccinated adults against COVID-19 can resume activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance. The move by the CDC represents a significant milestone in the COVID-19 pandemic and follows a previous announcement by the CDC relaxing face covering guidance in outdoor settings.

Notably, the CDC’s updated guidance does not apply to health care settings, and the CDC still requires individuals to wear masks when using public transportation, including buses, trains, and airplanes.

At the time of this posting, the California Department of Public Health (CDPH) continues to review the CDC’s updated guidance. Additional information is anticipated from the state over the coming days.

The CDC’s updated face covering guidance for fully vaccinated persons is available here.

White House Details COVID-19 Public Health Workforce Investment

On Thursday, the Biden-Harris Administration announced it will invest $7.4 billion from the recently enacted American Rescue Plan to recruit and hire public health workers to respond to the ongoing COVID-19 pandemic and prepare for future public health threats. Of the total amount, the Biden-Harris Administration will invest:

  • $4.4 Billion to Surge Public Health Staffing for COVID-19 Response
    • State and Local Support: This funding is anticipated to help states and localities increase their public health staffing and expertise available to lead local vaccination efforts, testing and contact tracing, and other critical public health activities. This funding includes at least $500 million for the hiring of school nurses as schools begin to reopen for in-person instruction.
    • Public Health AmeriCorps: CDC and AmeriCorps will launch the Public Health AmeriCorps program to build a new workforce ready to respond to public health needs of the country.
    • Recruit and Train Public Health Leaders: The CDC will expand its current workforce programs, including the Epidemic Intelligence Service (EIS). Expanding workforce training opportunities is anticipated to support workforce diversity in public health to help reduce longstanding health disparities and inequities. In addition, the Administration will invest $80 million to train public health professionals to help modernize the public health data infrastructure.
    • Laboratory Workforce and Preparedness: $337 million will be invested to strengthen the public health laboratory workforce pipeline by expanding fellowship and internship programs.
  • $3 Billion to Prepare for Future Pandemics
    • Modernize the Public Health Workforce: The CDC will create a new grant program to provide under-resourced health departments with the support needed to hire staff and build a strong public health workforce. The grant program will offer community health workers and others hired for the COVID-19 pandemic response an opportunity to continue their careers beyond the pandemic as public health professionals. CDC will convene federal, state, local, and territorial health experts to inform and design the new grant program.

Additional information from the White House is available here.

TFAH Issues Report on Chronically Underfunded Public Health Infrastructure

This week, the Trust for America’s Health (TFAH) issued a report examining federal, state, and local public health funding trends, potential risks, and recommended investments and policy actions to prioritize prevention and effectively address ongoing and emerging threats. The report details significant nationwide public health challenges, including obesity, tobacco use, infectious diseases and foodborne illnesses, substance use disorders, suicide, and climate-related natural disasters. To adequately prepare for and address these challenges, TFAH indicates the need for a strong, well-resourced public health system focused on prevention, preparedness, wellness, and community recovery.

However, chronic underfunding and investments into the public health infrastructure remain a consistent and significant obstacle. In 2017, public health represented just 2.5 percent — $274 per person – of all health spending in the country. TFAH identifies evidence-based public health interventions, such as childhood vaccinations, school-based violence prevention programs, and indoor smoking bans, as effective strategies to improving health outcomes, preventing illness and death, and saving money over the long-term.

The TFAH report goes on to examine federal public health spending, finding that the budget for the U.S. Centers for Disease Control and Prevention (CDC) has not kept pace with the nation’s growing public health needs and emerging threats, particularly as it relates to substance misuse and weather-related emergencies. The CDC’s FY 2019 budget reflected a $143 million (two percent) increase over FY 2018 – after accounting for inflation, this increase for FY 2019 is essentially flat compared to the previous year. Looking further back, TFAH finds the CDC’s budget fell by 10 percent over the past decade (FY 2010-19) after accounting for inflation. California ranks 43rd in total CDC state funding per capita.

Critical CDC initiatives are examined by the report, finding that funding and support provided by the federal government over a broad range of topics – including community prevention, public health emergency preparedness and response, chronic disease prevention, substance misuse, and suicide prevention – are severely inadequately resourced and unable to provide sufficient support to states.

TFAH examines state public health funding and indicates that the ability of state health departments to fulfill critical and fundamental public health roles is heavily affected by federal funding. State public health funding was found to hold stable or increase in 33 states from FY 2017 to 2018; California’s state public health funding increased slightly by 2.8 percent during this period. Local public health funding is also examined by the report, finding a considerable number of local health departments throughout the U.S. experienced funding decreases over the past several fiscal years.

Citing the $4.5 billion gap between current funding and what is needed to build a strong nationwide public health infrastructure, TFAH details a series of policy actions and investments to achieve optimal health for all people in all communities. Recommendations include:

  • Substantially increase funding for the CDC, particularly in areas of community prevention, public health emergency preparedness and response, surveillance and data, healthy aging, and social determinants of health
  • Increase state and local investments in public health, prioritizing social determinants
  • Work across sectors to improve effectiveness and efficiency of public health investments

Given ongoing and emerging threats to the public’s health and safety, TFAH urges adequate investments into federal, state, and local public health systems and infrastructure. The full report, “Impact of Chronic Underfunding of America’s Public Health System: Trends, Risk, and Recommendations, 2019,” is available here.

California HiAP Task Force Hosting Regional Listening Sessions

The California Health in All Policies (HiAP) Task Force is undertaking an effort to set new priorities for the task force for the next decade. As part of this effort, the state will be hosting four regional listening sessions to hear from local health departments, governments, and community-based organizations about the most pressing health equity issues present in state regions, as well as how the state can better support stakeholders to promote health and equity.

The four sessions will be held during the following dates and times:

  • Bay Area: Monday, May 24, 1:00 pm-3:00 pm
  • Central Valley: Wednesday, May 26, 1:00 pm-3:00 pm
  • Southern California: Wednesday, June 2, 9:00 am-11:00 am
  • Northern California: Thursday, June 3, 10:00 am-12:00 pm

Organizations who are led by, serve, or represent Black, Indigenous, and People of Color communities and/or groups impacted by health inequities are encouraged to attend.

Additional information and registration are available here.

California’s ACEs Aware Initiative Launches “State of CAre” Provider Engagement Campaign

On Thursday, the Department of Health Care Services (DHCS) and the Office of the California Surgeon General (CA-OSG) announced their “State of CAre” campaign to raise awareness of Adverse Childhood Experiences (ACEs) and the long-term health effects they can have on children and adults.

The campaign initiative commits to offering a free, two-hour online training and certification, improvements and updates to the online training modules, refreshed website, and lessons learned and best practices shared on the ACEs Aware Grants webpage. In addition, providers will be trained to serve Medi-Cal beneficiaries exposed to prolonged toxic stress, which will result in transformative health outcomes.

Additional information about the campaign is available here.

Governor Expands Drought Emergency to 41 Total Counties

On Monday, Governor Gavin Newsom expanded his recent regional drought emergency proclamation to encompass the Klamath River, Sacramento-San Joaquin Delta, and Tulare Lake Watershed counties to accelerate action to protect public health, safety, and the environment. In light of this week’s announcement, 41 counties are now under a drought state of emergency, representing 30 percent of the state’s population.

The Governor’s proclamation directs the State Water Resources Control Board to consider modifying requirements for reservoir releases and diversion limitations to conserve water upstream later in the year to maintain water supply, improve water quality, and protect cold water pools. The state of emergency also enables flexibilities in regulatory requirements and procurement processes to mitigate drought impacts and directs state water officials to expedite review and processing of voluntary transfers of water, enabling available water to flow where it is needed most.

A copy of the Governor’s proclamation is available here. Additional information from the Governor’s Office is available here.

UCLA Issues Brief on WPC Implementation Strategies and Enrollees

The UCLA Center for Health Policy Research this week issued a new health policy brief exploring the rollout of each Whole Person Care (WPC) program pilot, including implementation strategies and enrollee experiences. The report analyses interim data from the statewide evaluation of WPC to present a snapshot of the 25 participating pilots’ enrollee characteristics and key program implementation efforts.

The policy brief is intended to inform efforts to transition the WPC program into Enhanced Care Management (ECM) and In-Lieu of Services (ILOS) components of the California Advancing and Innovating Medi-Cal (CalAIM) initiative. The brief can also serve as a tool for organizations that are developing population health management programs for high-need, high-risk enrollees.

Findings from the policy brief analysis demonstrate differences across pilots in implementation strategies relative to target populations served and services offered. The findings also show the pilots’ choices in delivering care coordination, establishing data sharing infrastructure, and forming partnerships. Data is present on enrollee profile, including the demographics and health status of enrollees and the utilization of services by these individuals prior to enrollment.

UCLA indicates the data presented in the brief highlight the promising strategies that can be replicated statewide under the CalAIM initiative. Findings also point to the level of efforts needed for the transition to CalAIM to broaden the infrastructure and services since many WPC pilots focused on specific target populations and a narrow menu of services.

The full UCLA Center for Health Policy Research policy brief is available here.

NACCHO to Hold Webinar on Public Health Workforce Strategies

The National Association of County and City Health Officials (NACCHO) Performance Improvement Team will host a webinar on Thursday, May 27, from 8:00 am – 9:30 am PT to discuss information on developing workforce strategies to meet immediate needs and long-term strategies. The webinar will feature former Commissioner of Health for the Commonwealth of Virginia and various public health experts to lend their expertise and insight on the Public Health Workforce.

Additional information and registration are available here.

County Health Rankings to Hold May Webinar on the Advancement of Racial Equity

The County Health Rankings & Roadmaps, co-sponsored with the Mobilizing Action Toward Community Health (MATCH) Program, will be hosting their webinar series on, “Advancing Racial Equity,” on Tuesday, May 18 at 3:00pm. The webinar will feature representatives from the Michigan Institute of Public Health and the research and program manager from Milwaukee County, Wisconsin, government for a discussion on the intersection of racism and public health. The webinar will further discuss racism as a contributing factor to poor health outcomes and declaring racism as public health crisis as steps toward racial equity in our communities.

You may register for this webinar here.