May 3, 2019 Edition
On Monday, the Assembly Budget Subcommittee No. 1 on Health
and Human Services continued to hear the Governor’s January budget proposals.
This hearing focused on issues under the purview of the California Department
of Public Health (CDPH) and included three key proposals of interest to local
health departments. Highlights are provided below.
STD Funding. Dr.
Gil Chavez, Deputy Director for the Center for Infectious Diseases at CDPH
presented the Administration’s request for $2 million ongoing General Fund beginning
FY 2019-20. Recall, this builds upon the one-time funding that was included in
the FY 2018-19 enacted budget. Dr. Chavez highlighted the increased rates of
STDs in California and the related health disparities that exist. He further
underscored the need for ongoing funding and the great work local health
departments have done to date.
The Legislative Analyst’s Office (LAO) noted that the amount
of $2 million does not have an analytic basis, but instead is simply a continuation
of the funding passed in last year’s budget and mentioned their interest in
working with the Department of Finance and others to determine the appropriate
level of STD funding needed in our State.
CHEAC expressed support for the Governor’s proposal while
also noting that the amount of investment local health departments need to
address communicable diseases, including STDs, is much greater.
California Home Visiting Program (CHVP). CDPH representatives from the Center for Family Health at CDPH provided members with a brief overview of the Administration’s proposal to provide $23 million ongoing General Fund to increase participation in CHVP, expand to additional jurisdictions and utilize additional evidence-based home visiting models. During their presentation, CDPH provided a three-year timeline for the funding. In year one, CDPH would provide additional funding to existing sites. In year two, CDPH would expand into new counties. In year three, CDPH would expand the number of evidence-based models that could be utilized. The budget subcommittee asked CDPH to comment on whether these activities could overlap in year 1. CDPH indicated that preparation activities would overlap in year 1 but did not express a reconsideration of the timeline.
Acting Chair Reyes also expressed considerable concern with
her county not being one of the counties that receive CHVP funding currently and
further expressed an interest in understanding the criteria to be used to
expand to additional counties. Members continued to question CDPH’s approach in
both selecting counties to expand to and with selecting additional models. CDPH
referenced their ongoing discussions with local MCAH directors in informing
CHEAC shared our support for the ongoing investment in CHVP
and expressed an interest in engaging in discussions around the State’s
Black Infant Health (BIH). CDPH representatives presented the Governor’s proposal to provide $7 million to local health departments to expand the BIH program. CHEAC expressed support for the Governor’s additional investment into the BIH program, but also shared concerns around the current prescriptive nature of the program and the need for additional flexibility in implementing interventions. Acting Chair Reyes voiced her appreciation for the comment around flexibility and asked CDPH about whether that could be incorporated. CDPH discussed the work of the Perinatal Equity Initiative (PEI) and indicated their desire to use the PEI data to potentially inform new strategies.
All items were held open.
Meeting materials can be found here.
link to the hearing can be viewed here.
On Thursday, the Governor’s proposal to rename and refocus the
Council on Health Care Delivery Systems (Council), established by the 2018
Budget Act, to the Healthy California For All Commission (Commission) was heard
in the Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human
The California Health and Human Services Agency (CHHSA) provided
a brief overview of the proposal, including reverting the $5 million expenditure
authority for the current Council and providing it instead to the Commission. Commission
membership would be expanded to 13 members and would include the Secretary of CHHSA, six members appointed by
the Governor, three members appointed by the Senate Rules Committee, three members
appointed by the Speaker of the Assembly and three ex-officio members (the Executive
Director of Covered California, Director of the Department of Health Care
Services, and the Chief Executive Officer of the Public Employees’ Retirement
CHHSA noted two reports that would be required of the Commission.
The first report would be due July 2020 and would be an analysis of California’s
existing health care delivery system and options for preparing to transition to
a single-payer system. The second report would be due in 2021 and would detail
options for key design considerations. Key components of that report would
include eligibility and enrollment, benefits, provider participation and
payments, cost containment, governance and administration, information
technology investments, and the integration of federal spending on health care
The Legislative Analyst’s Office (LAO) noted the proposal represents
a shift in the focus for the Commission and that previously activities were broader
in understanding health care delivery systems and exploring various alternatives.
The LAO indicated this proposal recasts and focuses the work on now bringing
California into a single-payer system.
The Legislature raised questions around how the $5 expenditure
authority would be utilized; however, a detailed plan was not presented at this
A link to hearing materials can be found here.
Trailer bill language can be found here.
This week, the
California Legislature continued a steady pace of committee hearings as it
begins to shift its focus toward floor sessions and budget deliberations which
will occur throughout the month of May. Today marks the deadline for bills
without a fiscal impact to be heard in policy committees and advanced to the
floor of their house of origin. Recall, bills with a fiscal impact had to be
acted upon by
last Friday’s deadline.
While the bulk of measures proposed by lawmakers have a fiscal impact, a number
of non-fiscal measures made their way through committees this week.
highlight several actions on bills of interest to CHEAC Members. The latest
edition of the CHEAC Weekly Bill Chart is available
Access to Health Services
as amended April 11, 2019 – SUPPORT
AB 1494 by
Assembly Member Cecilia Aguiar-Curry would require Medi-Cal reimbursement for
services provided by community clinics or fee-for-service providers via
telehealth, telephone, or off-site (such as a shelter or home) during or within
90 days after expiration of a state of emergency. The measure was set for
hearing in the Assembly Appropriations Committee on Wednesday. Assembly Member
Aguiar-Curry waived presentation, and the measure was placed on the Suspense
Emergency Medical Services (EMS)
1544 (Gipson) as amended April 22, 2019 – OPPOSE UNLESS AMENDED
Mike Gipson’s AB 1544 would enact the Community Paramedicine or Triage to Alternate
Destination Act to allow local emergency medical services agencies (LEMSAs) to
develop local community paramedicine programs. The measure requires LEMSAs to
use or establish local emergency medical care committees (EMCCs) and
establishes the Community Paramedicine Medical Oversight Committee to advise
the EMS Authority on and to approve minimum medical protocols for all community
paramedicine programs, among other activities. The measure was scheduled for
hearing in the Assembly Appropriations Committee on Wednesday. Assembly Member
Gipson waived presentation, and the measure was placed on the Suspense File.
438 (Hertzberg) as amended May 2, 2019 – OPPOSE
SB 438 by
Senator Robert Hertzberg was heard in the Senate Health Committee on Wednesday.
The measure would restrict the use of non-governmental-operated public safety
answering points (PSAPs), including 9-1-1 EMS dispatching centers. The measure
would allow municipal agencies providing EMS services in their jurisdictions to
circumvent existing medical control oversight responsibilities of LEMSA medical
directors. Witnesses from CSAC, EMSAAC, and EMDAC provided lead testimony in
opposition to the bill. CSAC, RCRC, UCC, CHEAC, EMSAAC, and EMDAC are all
opposed to the measure. The measure was advanced to the Senate Floor on a
unanimous 9-0 vote.
Health Coverage/Health Care Reform
4 (Bonta) as amended March 28, 2019 – SUPPORT
Rob Bonta’s AB 4 would expand Medi-Cal coverage to all undocumented adults with
income at or below 138 percent of the federal poverty level (FPL). The measure
was scheduled for hearing in the Assembly Appropriations Committee on
Wednesday. Assembly Member Bonta waived presentation, and the measure was
placed on the Suspense File.
414 (Bonta) as introduced on February 7, 2019 – SUPPORT
AB 414 by
Assembly Member Rob Bonta was set for hearing in the Assembly Appropriations
Committee on Wednesday. The measure would establish a state-level individual
health insurance coverage mandate in California and would require Covered
California to determine a penalty for not obtaining health insurance. Revenues
generated from fines would be directed toward improving the affordability of
coverage in California. Assembly Member Bonta waived presentation, and the
measure was placed on the Suspense File.
Maternal, Child, and Adolescent Health
464 (Mitchell) as amended April 11, 2019 – SUPPORT
SB 464 by
Senator Holly Mitchell would require specified health facilities providing
perinatal care to implement an implicit bias program for all health care providers
involved in perinatal care within those facilities. Hospitals would be required
to provide patients with information on filing a discrimination complaint, and
CDPH would be required to track and publish specified maternal morbidity and
mortality data, among other activities. SB 464 was set for hearing in the
Senate Appropriations Committee on Monday. Senator Mitchell waived presentation,
and the measure was placed on the Suspense File.
On Tuesday, the
Joint Legislative Audit Committee (JLAC) and the Assembly Health Committee
convened an informational hearing related to California State Auditor Elaine
Howle’s recent report, “Department of Health Care Services: Millions of
Children in Medi-Cal Are Not Receiving Preventive Health Services.” Recall, the
report, released in
March, determined that an average 2.4 million children in Medi-Cal per year did
not receive all required preventive health services between FY 2013-14 and FY
2017-18. The report further examined other screening rates, including
immunization goals, and options available to DHCS to compel Medi-Cal health
plans to meet established performance levels.
JLAC and Assembly Health Committee hearing featured an overview of the report
and findings by State Auditor Elaine Howle and a key member of her staff. Ms.
Howle detailed key recommendations for consideration by legislators and DHCS
around access standards, reimbursement rates, contracting, performance
standards, and internal audit procedures.
Jennifer Kent also appeared as a witness in the hearing, providing an overview
of DHCS activities undertaken as a result of the Auditor’s findings and other
initiatives related to preventive services and screenings as part of the
Governor’s proposed budget. Director Kent further detailed key modifications to
DHCS practices and procedures in an attempt to increase Medi-Cal preventive
service utilization, screening, and health plan compliance. Committee members
questioned Director Kent on a broad array of topics, including provider
reimbursement rates and incentives, performance metric oversight, and regional
disparities in preventive health services access and utilization, and
informational technology challenges.
panel rounded out the hearing, featuring representatives from health plans and
insurers, health care providers, and patient organizations. The hearing agenda
may be accessed
here. A recording
of the hearing is available
Alliance for Prevention Funding (CAPF) Wellness Trust Proposal will be featured
on a Dialogue4Health Web Forum next Tuesday, May 7 from 11:00 am-12:00 pm. CAPF
is a coalition of 20 statewide organizations, including CHEAC, advocating for
the creation of a California Wellness Trust to provide sustained funding for
public health prevention activities. Next week’s webinar will provide an
overview of CAPF’s draft proposal to create a wellness trust, detail community
successes and challenges in prevention activities, and actions needed to make
the California Wellness Trust a reality. Registration for the webinar is available
for the National Opioid Leadership Summit, hosted by the Public Health
Institute (PHI), is now open. The summit will be held on Tuesday, June 25 in
Sacramento and will provide opportunities for attendees to learn about, share,
and collaborate on solutions to the opioid crisis that bridge criminal justice,
health care, and public health sectors. The event will feature a keynote
address by U.S. Surgeon General Jerome Adams, as well as a number of other
speakers from the U.S. Centers for Disease Control and Prevention (CDC), the
Trust for America’s Health (TFAH), and the California Health Care Foundation
information and registration details are available
This week the Governor’s Office of Business and Economic Development (GO-Biz) conducted a webinar providing an overview of the CalCRG program including how to apply. A wealth of application and technical assistance materials as well as the archived webinar can be found here.
the California Budget and Policy Center (CBPC) released a brief, “Strategies to
Improve Maternal Mental Health in California.” The brief examines the impact of
untreated maternal mental health conditions on short- and long-term maternal
and child health outcomes, including significant medical and economic costs.
CBPC finds mothers of color and mothers with lower incomes in California are
more likely to experience prenatal and postpartum depressive disorders. To
improve upon rates of adverse maternal mental health conditions, the brief
discusses a number of strategies, including home visiting programs,
anti-poverty initiatives, and other support services. The report is rounded out
by an overview of current legislative and budget proposals under consideration
in California. The CBPC brief is available
Health Affairs this week published two health policy
briefs as part of its ongoing series, funded by the Robert Wood Johnson
Foundation, on the social determinants of health. The briefs are intended to
provide readers with a comprehensive examination of evidence, research, and
potential policy interventions that are fundamental to advancing a culture of
health. This week’s briefs include:
Childhood Home Visiting Programs and Health – This brief examines childhood home
visiting programs and their role in connecting new and expectant parents with
support services, screenings, case management, and caregiver skills training.
Researchers have found that various home visiting programs have resulted in
fewer preterm and low-birthweight babies, more children adequately immunized
and completing well-child visits, greater achievement of developmental
milestones, fewer child emergency department visits, and better maternal
physical and mental health outcomes. The brief also indicates that current
federal funding for such programming is insufficient to meet the need and calls
for an innovative and sustainable approach to delivering these critical
Effects of Early Care and Education on Children’s Health
– This brief examines
the landscape of nonparental early care and education (ECE) services, including
center-based care, public and private preschool, and Head Start. The brief
acknowledges that the outcomes of ECE on children’s educational and behavioral
outcomes are well-studied, but research on the impacts of children’s health is
a nascent subject. While ECE programs are not necessarily designed to improve
child health, a growing body of research indicates that such programming may
lead to short- and long-term improvements in health-related outcomes for
participants. An extended
summary of key
studies in the area of health impacts of ECE is included as part of the brief.
information on Health Affairs,
including additional health policy briefs, is available
Academies of Sciences, Engineering, and Medicine (NASEM) has announced it will
host a two-day in-person workshop, “Implications of the California Wildfires
for Health, Communities, and Preparedness.” The collaborative public workshop
will be held on June 4 and 5 in Sacramento and will convene experts to address
a series of topics related to public and environmental health, emergency
preparedness, and public initiatives and services.
the workshop include:
Assist in the identification of the current scale and probability of subsequent
wildfires in high risk regions in the West, including but not exclusively in
the state of California
Describe and define potential disproportionate deleterious outcomes on
vulnerable populations in the geographic areas identified
Explore the residual and chronic health consequences resulting from wild fires,
including respiratory and cardiovascular disease caused by released atmospheric
particulate matter, housing displacement, and post traumatic psychological
Identify challenges resulting from the increased scale and population of the
urban-wildland interface, and explore opportunities to increase community and
individual preparedness in the face of the wildfire threat
Suggest opportunities for improved institutional and government actions and
steps to mitigate the adverse and disproportionate impact of wildfires on
vulnerable populations, including community preparedness, resilience and
capacity building before, during, and after wildfires.
information on the workshop, including registration, resources, and a
forthcoming agenda, is available
This week, the
National Academies of Science, Engineering, and Medicine (NASEM) published
proceedings and an infographic on its recent workshop, “Health Interventions to
Prevent Firearm Injuries and Death.” NASEM indicates that firearm injuries and
death remain a serious public health concern throughout the U.S., burdening
individuals, communities, and health care systems. The materials examine
possible roles of health entities and health systems in addressing the ongoing
epidemic of firearm injury and death in the U.S.
of a Workshop
detail speakers’ presentations on research and programs to prevent firearm
injury and death, as well as discussion of the potential role of health
systems. A digital overview and infographic of the workshop is available
information on NASEM’s work on firearm injuries and death is also available