Today marks the deadline for non-fiscal bills to be heard and advanced to the floor by policy committees of the California State Senate and Assembly. Recall, last week, a similar deadline was passed for all legislative measures with fiscal implications to be heard and advanced by policy committees. Bills that did not meet the deadlines will become two-year measures, able to be acted upon again only during a brief window in January 2022. Measures that did not meet the deadlines will be indicated as such on the CHEAC Weekly Bill Chart.
The Legislature has generally shifted its focus to the state budget and appropriations processes. Senate and Assembly Appropriations Committees continue to hold hearings and refer any bills with associated costs over $150,000 to the suspense file. All bills on suspense files are then internally assessed by the appropriations committees to determine total anticipated costs to the state. Legislative fiscal committees face a deadline of May 21 to hear and advance fiscal bills to house of origin floors. As such, Senate and Assembly Appropriations Committees are anticipated to meet during the fourth week of May to announce suspense file results. Any bills held on suspense will be considered dead and will not advance through the legislative process.
Of particular note, Governor Gavin Newsom next week will release his Administration’s May Revise Budget, which will provide updated budgetary projections, additional details on proposals made in the Governor’s January Budget, and new investments depending on available resources. Budget subcommittees will hold multiple hearings over the coming weeks as the Legislature and Administration approach constitutional deadlines to finalize the state’s budget in June.
Below, we highlight a few bills of interest to CHEAC Members. For a full update, the latest edition of the CHEAC Weekly Bill Chart is available here.
This measure, authored by Senator Hurtado, was heard in Senate Appropriations Committee this week. SB 464 would modify California Food Assistance Program eligibility criteria to include noncitizens meeting all CalFresh eligibility criteria except for requirements related to immigration status beginning January 2023. SB 464 has been placed on the Senate Appropriations Suspense File.
Senator Richard Pan’s SB 17 would establish a statewide Office of Racial Equity to be governed by a Racial Equity Advisory and Accountability Council to coordinate, analyze, develop, evaluate, and recommend strategies for advancing racial equity across state agencies, departments, and the office of the Governor. This measure would require the Office to deliver an annual report and develop a statewide Racial Equity Framework and state agencies to create a Racial Equity Plan that aligns with the Racial Equity Framework. SB 17 has been placed on the Senate Appropriations Suspense File and will be acted upon at a later date.
This week, Senate Budget & Fiscal Review Subcommittees resumed hearings in preparation of the Governor’s May Revise Budget that will be released next week. On Tuesday, the Senate Budget & Fiscal Review Subcommittee No. 3 on Health and Human Services (HHS) convened a hearing to review proposals under the purview of the Office of Statewide Health Planning and Development (OSHPD), Department of Managed Health Care (DMHC), Department of Public Health (CDPH), Department of State Hospitals (DSH), and Covered California.
Notably, during the hearing, Subcommittee members received an update on the ongoing COVID-19 pandemic response, including vaccination efforts, from state and local public health officials. CDPH Chief Deputy Director Susan Fanelli briefed senators on the latest statewide COVID-19 transmission rates, hospitalizations, and test rates, COVID-19 vaccination allocation and administration activities, and the Blueprint for a Safer Economy framework. Ms. Fanelli additionally discussed the Department’s broader public health prevention and response activities, challenges, and needs to adequately prepare for future public health emergencies and pandemics.
Further, Ms. Fanelli indicated infrastructure and workforce continue to be the most significant challenges for public health and reiterated the importance of sizable investments in staffing, data systems, and public health infrastructure. One-time investments following public health emergencies, as noted by Ms. Fanelli, do not allow state and local health departments to establish and sustain critical infrastructure that is only temporarily stood up during emergencies, such as the COVID-19 pandemic.
CHEAC Executive Director Michelle Gibbons addressed the Subcommittee, urging the Legislature that California cannot wait until the next public health crisis to invest in local health departments. The California Can’t Wait Coalition, consisting of health departments, public health workers, community public health advocates, and over 100 organizations, is urging the Legislature and Newsom Administration to invest $200 million General Fund ongoing for public health infrastructure and workforce, as well as $3.45 million for an assessment of public health workforce as proposed by AB 240 (Rodriguez). Ms. Gibbons discussed the historic and severe underfunding of public health and its significant impacts on local health department workforce, programs and services, and our broader communities. While local health departments are receiving federal funds for ongoing COVID-19 response, Ms. Gibbons noted that this funding does not support the day-to-day work of local health departments beyond COVID-19, making the case for desperately needed ongoing, sustainable, and flexible funding for local health departments throughout the state.
Dr. Julie Vaishampayan, Stanislaus County Health Officer, represented the Health Officers Association of California (HOAC) and appeared before the Subcommittee to discuss local experiences of responding to the ongoing COVID-19 pandemic and other public health issues with limited staffing, resources, and infrastructure. Dr. Vaishampayan highlighted the significant demands on local health department staff during the pandemic, including emergency response activities and vaccination efforts, and expressed the dire need for ongoing and flexible funding to support the critical roles of local health departments in California.
Hector Dela Cruz, Chief Environmental Health Specialist with Los Angeles County Department of Public Health and member of SEIU Local 721, also presented to the committee, discussing the far-reaching functions of environmental health in residents’ daily lives. Mr. Dela Cruz provided a firsthand experience of rededicating environmental health staff and resources to respond to the COVID-19 pandemic and highlighted the need for additional workforce and resources to adequately prepare, protect, and promote the health of the community.
Following the panel presentations, Subcommittee No. 3 members asked extensive questions of witnesses exclusive to public health infrastructure and workforce. Subcommittee Chair Senator Susan Talamantes Eggman inquired about the role of communications in increasing COVID-19 vaccine administration, local health equity efforts, and needed workforce resources for local health departments.
Senator Richard Pan, during his comments, acknowledged the value and work of front-line public health officials and workers throughout the pandemic and condemned recent instances of harassment and threats against public health professionals statewide. Dr. Pan inquired about the limitations of one-time funding for public health departments, public health emergencies requiring surge staffing and staff redirections, state public health informational technology capacity and needs, mutual aid arrangements for public health, and public health laboratories in the state, among other topics.
All items during Tuesday’s hearing were held open for later action following the release of the Governor’s May Revise Budget next week. The agenda from Tuesday’s hearing is available here. A video recording of the public health component of Tuesday’s hearing is available here, beginning at 2:09:13.
Earlier this week, the Assembly Committee on Emergency Management, chaired by Assembly Member Freddie Rodriguez, convened a hearing entitled “The Role of Cal OES and Emergency Management in Providing an Equitable Response to the COVID-19 Pandemic.” The hearing featured two panels – one with local representatives and one with state officials.
Up first, the local panel featured Los Angeles County Fire Chief Daryl Osby, Yolo County Health Officer Aimee Sisson, Los Angeles County Chief Science Officer Paul Simon, and Sean Rogoff, Director of Special Operations, Global Medical Response (GMR). Drs. Sisson and Simon discussed their respective counties vaccination efforts, and both highlighted their coordinated vaccination efforts with local partners including fire and EMS. Chief Osby discussed Los Angeles County Fire’s partnership with their local public health department to support PPE distribution during the initial stages of the pandemic and subsequent testing and vaccination activities. Mr. Rogoff emphasized GMR supporting vaccination clinics in several jurisdictions statewide as well as partnering with EMSA on mobile vaccinations for the homebound. Dr. Simon recommended to the Committee that the state continue to support the Medical Health Operational Area system and encouraged increased coordination with CalOES and federal partners to enhance local efforts.
The following panel, made up of state officials, focused on lessons learned and was comprised of CDPH Director Tomás Aragón, EMSA Director Dave Duncan, and CalOES Director Mark Ghilarducci. Dr. Duncan detailed the various programs EMSA instituted or expanded including ambulance strike teams, distribution of PPE/ventilators, CalMAT teams, and their mobile vaccination efforts for the homebound. For CDPH, Dr. Aragon expressed his sincere appreciation of all the hard work of local health and EMS officials and staff during the pandemic, and he discussed their efforts to address vaccine disparities in various communities. Dr. Aragon noted at the end of his remarks discussing how CDPH will need to examine finding a balance of supporting local efforts while also utilizing the scale of state government to support that work. Director Ghilarducci outlined all the programs run through CalOES during the pandemic including Project Roomkey, Housing for the Harvest, Great Plates, and their support for the FEMA mass vaccination sites in Northern and Southern California.
An agenda and the video of this hearing can be found here and here.
This week, California Legislative Analyst Gabriel Petek issued a post setting forth a framework for the Legislature to allocate the anticipated $26 billion to be received by California from the recently enacted federal American Rescue Plan (ARP). Notably, the Legislature will face important decisions on to allocate California’s share of fiscal recovery funds. States have been granted considerable flexibility in allocating ARP funds, presenting a unique opportunity for the California Legislature.
Mr. Petek, in his post, urges the Legislature to clearly define its goals and develop a plan for allocating federal funds. Given that the ARP does not require states to spend its entire federal allocation immediately, Mr. Petek recommends that the Legislature not allocate all funds this year. The LAO further advises the Legislature to take a deliberative approach to consider how any contemplated allocations will interact with the state’s significant anticipated budget surplus and the limitations posed by the constitutional state appropriations limit (SAL).
The LAO sets forth the following general considerations for the Legislature as it assesses how and where to invest ARP funds:
Define Goals and Invest in Planning
Identify Significant Challenges – The LAO notes the unprecedented amount of funding to be received by the state, allowing the state to consider large investments to address significant challenges facing residents, such as childcare, homelessness, housing affordability, broadband access, and more.
Develop a Plan – Given significant pandemic-related direct assistance provided to individuals by the federal government, the LAO recommends taking time to develop a plan for the allocation of funds. The state has until the end of 2024 to expend its funding.
Other Considerations – The LAO identifies a series of other considerations, including whether to include additional program details in legislation or determining what additional resources might be needed to allocate funding effectively.
Gaps in Federal Assistance – Several populations and entities were not eligible for recent pandemic-related federal assistance, including undocumented immigrants and special districts. The LAO recommends considering whether ARP funds should be used to aid those who did not receive any from the federal government.
Disparities – The LAO points to the notable disparate health and economic consequences caused by the COVID-19 pandemic, recommending the Legislature consider targeting assistance to residents more acutely impacted by job losses and other long-term consequences of the pandemic.
Maximize Longer-Term Benefits
Mitigate “Cliff” of Federal Assistance – In preparation for some federal assistance to expire by the fall, the LAO suggests the Legislature use a portion of federal funding to phase out assistance to individuals and businesses that might still be experiencing the impacts of the pandemic.
Prepare for Service Needs as California Reopens – A significant increase in demand for certain services, including CalWORKs benefits, may be realized as public health restrictions lapse and more individuals resume normal daily activities.
Plan for Possible Long-term Pandemic Impacts – While COVID-19 vaccine distribution continues, public health concerns related to vaccine outreach and education, COVID-19 variant monitoring, and future stress on health systems will exist. The LAO recommends the Legislature plan in advance for these possible needs.
The full LAO report on the ARP allocation framework is available here.
The California Legislative Analyst’s Office (LAO) this week issued an analysis of the estimated costs of expanding full-scope Medi-Cal coverage to all otherwise-eligible residents regardless of immigration status. The LAO notes their analysis is not of a specific legislative measure – such as AB 4 (Arambula)– but instead a cost estimate of a coverage expansion.
According to the LAO, with a January 1, 2022, implementation date, the additional cost of expanding full-scope coverage to all otherwise-eligible individuals but for their immigration status would total $790 million General Fund ($870 million total funds) in 2021-22. On an ongoing basis, the LAO estimates the additional cost of expansion would be $2.1 billion General Fund (nearly $2.4 billion total funds). The LAO anticipates ongoing costs likely would grow over time in line with inflation and would be adjusted to reflect changes in caseload and utilization.
The additional costs of coverage expansion reflect the difference between: 1) Medi-Cal costs of providing full-scope coverage to the newly eligible population; and 2) Medi-Cal costs that otherwise would be incurred if only restricted-scope coverage were maintained for this population. The LAO identifies a number of considerations and outstanding questions for the Legislature, primarily relative to caseload and per-enrollee costs.
The Office of California Governor Gavin Newsom this week identified a series of actions to build upon the state’s work to vaccinate California’s hard-to-reach communities against COVID-19. As part of the effort to promote COVID-19 vaccines, California Governors Newsom, Brown, Schwarzenegger, and Wilson created and published a new PSA, available here. The Governor’s announcement includes seven distinct strategies to support COVID-19 vaccine rollout, including:
Vaccine Progress Data: The state’s covid19.ca.gov website now displayed data on the state’s progress in vaccinating groups and communities, including statewide and country progress by the Vaccine Equity Metric (VEM), race and ethnicity, or age. Dashboards are anticipated to be updated weekly on Wednesdays.
Phone Bank and Door-Knocking Campaign: A new state “Get out the Vaccine” effort will coordinate with 70 community-based organizations to employ callers and door-knockers to help residents make a plan to get vaccinated. The program is in partnership with Healthy Future California and the UCLA Clinical and Translational Science Institute’s STOP COVID CA initiative. About 2,000 individuals from targeted communities will be employed to make peer-to-peer appeals and provider support to overcome vaccine barriers.
CBO Support: The state is expanding its partnership with the Public Health Institute (PHI) Together Toward Health initiative, bringing the total amount of funding to $85.7 million and supporting a total of 480 organizations to date. The state is also partnering with the Sierra Health Foundation on a new $29 million Vaccine Equity Campaign to invest in CBOs and faith-based organizations statewide. The new funding builds upon previous funding awarded by the California Department of Social Services (CDSS) and the Labor & Workforce Development Agency (LWDA) to support community-based trusted messengers and other related outreach efforts. Additional information is available here.
Vaccine Equity Grants: The state is making available an additional $34.2 million in funding for underserved and high-risk communities and ZIP codes most impacted by COVID-19. Counties with a population over one million will receive $1.5 million for every one million people. Those with populations between 500,000 and one million will be eligible for $650,000 in grant funding. Counties with populations under 500,000 will be eligible for $350,000 in funding to expand vaccination programs and achieve equity goals.
Vaccine Equity Plans: The Governor’s Office notes that leaders of California’s 61 local health jurisdictions, working in partnership with the state’s third-party administrator, created and submitted plans to the state to promote vaccination equity in their communities. This includes a wide range of approaches, from small mobile vaccine clinics in remote areas to engaging influencers to reach specific groups or populations to partnering with schools and faith-based partners for outreach, education, and selection of vaccine sites.
Vaccines for Homebound Residents: Homebound residents can contact their health care provider to receive an in-home vaccine. The Governor’s Office notes that these services are expanding statewide and individuals may also utilize myturn.ca.gov or the state’s CA COVID-19 hotline to be connected with their LHJ to arrange for in-home vaccination.
Transportation to Vaccine Appointments: Individuals who do not have transportation means to reach their vaccine appointment can receive free transportation through myturn.ca.gov or by calling the state’s CA COVID-19 hotline. Transportation includes automobile transit for ambulatory patients and non-emergency medical transportation for non-ambulatory patients including wheelchair vans, gurney transit, and other options. Medi-Cal managed care and fee-for-service beneficiaries will be connected with their health plan or service provider to access this service as an existing health benefit.
This week, the Public Policy Institute of California (PPIC) released results of a statewide survey that sought to gauge public sentiment toward receiving the COVID-19 vaccine.
Overall, PPIC found that four in 10 Californians (39 percent) report that they have already received the COVID-19 vaccine. One in four (26 percent) say they will get the vaccine as soon as it is available, and 15 percent say they will get it either in a few weeks (six percent) or a few months (nine percent) after it is available. One in five Californians are more hesitant, saying either they would wait a year or more after it is available (seven percent) or would not receive the vaccine altogether (12 percent).
PPIC additionally explored survey responses by race and ethnicity, finding that three in 10 African Americans in California said they would either wait a year or more (11 percent) or that they would not receive the vaccine altogether (18 percent), making this group the most likely race/ethnic group to hold this view toward COVID-19 vaccines. PPIC also determined vaccine hesitancy is not uniform throughout the state with residents in the Central Valley, Inland Impire, and Southern California more likely than those in the Los Angeles and San Francisco Bay Areas to express vaccine hesitancy. A significantly higher number of Republicans indicated vaccine hesitancy compared to independents or Democrats.
On Wednesday, U.S. Federal District Judge for the District of Columbia Dabney Friedrich issued a ruling vacating the U.S. government’s nationwide ban on evictions set forth by the U.S. Centers for Disease Control and Prevention (CDC). Recall, the CDC in September 2020 issued an order barring landlords from evicting tenants for the nonpayment of rent, citing a 1944 public health law that gives the agency certain powers to prevent an outbreak of communicable diseases from spreading across state lines.
In this week’s ruling, District Judge Friedrich determined the CDC exceeded its authority in imposing the nationwide eviction moratorium, ruling that the Public Health Service Act does not grant the CDC the legal authority to impose such a restriction. The case was brought against the U.S. Department of Health and Human Services by the Alabama Association of Realtors. Following Wednesday’s ruling, the U.S. Department of Justice filed an appeal and Judge Friedrich issued a temporary stay on her ruling.
The CDC’s eviction moratorium is set to expire on June 30, 2021. The ruling from Wednesday’s case is available here.
U.S. President Joseph R. Biden, Jr. on Tuesday announced a new federal COVID-19 vaccination goal necessary to reaching more Americans and more fully reopening the country’s economy. The Biden-Harris Administration now aims to reach 70 percent of U.S. adults with at least one dose of COVID-19 vaccine and 160 million Americans with two doses of COVID-19 vaccine by July 4, 2021. The new goal amounts to another 100 million vaccine doses over the next two months.
Relatedly, the White House this week announced that it will be storing untapped vaccine into a federal bank available to states seeking additional COVID-19 vaccine supply. Those states will be permitted to order up to 50 percent above their weekly allocation, while states declining their complete allotment during a single week will have access to their entire share the following week. The move by the Biden-Harris Administration to allow for additional allocation flexibilities comes as demand for COVID-19 vaccines has dropped sharply throughout the country over the last weeks.
Further, the Biden-Harris Administration this week signaled its support for waiving intellectual property protections for COVID-19 vaccines. Experts suggest waiving intellectual property protections for the vaccines will increase supply of vaccines, particularly among low-income and developing nations, necessary to bring the pandemic under control. The Administration will soon engage in negotiations on waivers with the World Trade Organization.
This week, the U.S. Department of Health and Human Services (HHS) announced the availability of over $1.25 billion from the recently enacted American Rescue Plan to support ongoing COVID-19 response activities nationwide. These investments include:
Rural COVID-19 Support: HHS has announced the availability of nearly $1 billion to strengthen COVID-19 response efforts and increase vaccinations in rural communities. The Biden-Harris Administration will increase the number of vaccines sent to rural communities, expand testing and other COVID-19 prevention services, and work to increase vaccine confidence. HRSA’s Rural Health Clinic COVID-19 Testing and Mitigation Program will provide $460 million to more than 4,600 rural health clinics, as well as $398 million to existing grantees of the Small Rural Hospital Improvement Program (SHIP) to work with approximately 1,730 small rural hospitals and critical access hospitals. Additionally, HRSA will make available nearly $100 million in grants to eligible rural health clinics nationwide to address health equity gaps. Additional information on HHS’ investments in rural areas is available here.
Community-Based Workforce for COVID-19 Vaccinations: HHS is additionally making available nearly $250 million to develop and support a community-based workforce who will serve as trusted messengers sharing information about COVID-19 vaccines, increase COVID-19 vaccine confidence, and address any barriers to vaccination for individuals living in vulnerable and medically underserved communities. The funding will support hiring and mobilizing community outreach workers, community health workers, social support specialists, and others to conduct on-the-ground vaccine outreach. Additional information is available here.
This week, U.S. Health and Human Services (HHS) Secretary Xavier Becerra and U.S. Housing and Urban Development (HUD) Secretary Marcia Fudge announced a joint agency effort to increase access to COVID-19 prevention and treatment services, including testing and vaccinations, among disproportionately affected communities, including among HUD-assisted households and persons experiencing homelessness.
Under the announcement, the program will leverage the Health Center COVID-19 Vaccine Program which currently provides a direct supply of vaccines to nearly 800 health centers throughout the country. HHS and HUD expect the joint effort will reach over 6,000 multifamily housing properties, 6,700 homeless shelters, and approximately 7,500 public housing properties across the country.
The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), this week announced a new program to cover costs of administering COVID-19 vaccines to patients enrolled in health plans that either do not cover vaccination fees or cover them with patient cost-sharing. Since providers cannot bill patients for COVID-19 vaccination fees, this new program, the COVID-19 Coverage Assistance Fund (CAF), addresses an outstanding compensation need for providers on the front lines vaccinating underinsured patients.
CAF focuses on instances where individuals have insurance, but vaccines are either not covered or are but typically with patient cost-sharing. CAP will compensate providers for eligible claims at national Medicare rates to reflect newer information on the true costs associated with administering vaccines. CAF also builds on the HRSA COVID-19 Uninsured Program which has been reimbursing providers for vaccine administration fees associated with uninsured individuals.
The U.S. Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) this week included an article modeling future COVID-19 cases, hospitalizations, and deaths by vaccination rates and nonpharmaceutical intervention (NPI) scenarios in the U.S. from April through September 2021. The MMWR article provides background on the recent increase in COVID-19 cases realized in March and early April in the U.S. which coincided with the spread of COVID-19 virus variants and the relaxation of NPIs, such as business and capacity restrictions.
The CDC determines, based on data from six models, that with high vaccination coverage and moderate NPI adherence, hospitalizations and deaths are likely to remain low nationally with a sharp decline in cases projected by July 2021. Notably, lower NPI adherence could lead to substantial increases in severe COVID-19 outcomes among U.S. populations, even with improved vaccination coverage. The CDC notes that high vaccination coverage and compliance with NPIs are essential in controlling COVID-19 and preventing surges in hospitalizations and deaths over the coming months.
The U.S. Centers for Disease Control and Prevention (CDC) recently launched “Still Going Strong,” a national campaign to bring attention to ways older adults 65 and older can age without injury. The campaign aims to raise awareness about the leading causes of unintentional injuries and deaths in older adults. “Still Going Strong” will encourage older adults to continue participating in their favorite hobbies and activities while informing them and their caregivers of steps they can take to prevent injuries that disproportionately impact this population, including falls, motor vehicle crashes, and traumatic brain injury (TBI).
Governor Gavin Newsom this week issued a proclamation declaring May 2021 as “Older Californians Month” in the State of California. The proclamation pays tribute to the resilience of older Californians and memorializes the many lives of older Californians lost to the COVID-19 pandemic. The Governor’s proclamation identifies many actions taken by the Newsom Administration, including the state’s Master Plan for Aging, and commits to advancing an equitable California for all ages.