November 8, 2019 Edition

Senate, Assembly Health Committees Hold Joint Informational Hearing on Access to Care and Children’s Preventive Services

On Monday, the Senate and Assembly Health Committees held a joint informational hearing related to 1) access to care in the Regional Model counties, and 2) children’s preventive services in Medi-Cal.

State Auditor Elaine Howle presented findings and recommendations of the recently released audit report, which determined that Regional Model health plans have not provided all Medi-Cal beneficiaries with adequate access to care and the Department of Health Care Services (DHCS) has not adequately conducted oversight activities of the health plans. DHCS Acting Director Richard Figueroa and Chief Deputy Director Mari Cantwell responded to the audit report and indicated their Department’s progress in responding to the audit’s findings and recommendations, including on topics such as alternative access standards, access and quality monitoring, and the upcoming request for proposal (RFP) process for Medi-Cal Managed Care Plans. DHCS reiterated their work toward strengthening oversight and working closely with health plans and county stakeholders, including CSAC and CHEAC.

Stakeholders from Anthem Blue Cross, California Health & Wellness, and Partnership Health Plan were featured on a panel to discuss their roles in ensuring access to care, implementing community-based initiatives, and conducting activities to improve access and quality to care among Medi-Cal beneficiaries in Regional Model counties. Dr. Andy Miller, Butte County Health Officer, also appeared to provide insight related to access to care issues experienced by beneficiaries in Butte County and surrounding jurisdictions and to express interest in working with DHCS to potentially move to a different Medi-Cal Managed Care model.

The second component of the informational hearing featured Children’s Preventive Health Services and the six-month auditee implementation progress report. Recall, State Auditor Howle in March released the audit report finding that an average of 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 Joint Legislative Audit Committee (JLAC) and the Assembly Health Committee previously held an informational hearing in late April on the report, and Monday’s hearing was centered on the implementation progress of the report’s recommendations.

Similarly, DHCS Acting Director Richard Figueroa and Chief Deputy Director Mari Cantwell discussed activities and policies implemented since the report, as well as ongoing and future activities to ensure child preventive health screenings, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) and adverse childhood experience (ACE) screenings.

Representatives from Central California Alliance for Health and Children Now appeared to provide insight on progress made since the report, as well as challenges for future consideration. Public comment largely featured stakeholders from various health access, public health, healthcare delivery, and children’s advocacy entities.

Video footage of the hearing is available here. The full agenda is available here.

CDC Releases Report on Adverse Childhood Experiences (ACEs), Recommends Primary Prevention Approaches

This week, the U.S. Centers for Disease Control and Prevention (CDC) published a report in its Morbidity and Mortality Weekly Report (MMWR) estimating the proportion of adult health problems attributable to adverse childhood experiences (ACEs). The CDC’s Vital Signs report also covers the topic of ACEs and details opportunities for preventing ACEs.

According to the CDC, nearly 16 percent of adults in its study population of 25 states reported four or more types of ACEs, which are significantly associated with poorer health outcomes, health risk behaviors, and socioeconomic challenges. 61 percent of adults had a least one ACE, and females and several racial/ethnic minority groups were at greater risk for experiencing four or more ACEs. Additionally, young adults reported exposure to more ACEs than older adults, particularly those aged 65 and over. According to the CDC, many people do not realize that exposure to ACEs is associated with increased risk for health problems across the lifespan.

The CDC recommends the utilization of primary prevention strategies in curbing ACEs, particularly through the creation of safe, stable, nurturing relationships and environments for all children and families. Other recommended best practices for state and local governments, healthcare providers, employers, and residents include:

  • Strengthening economic supports for families (e.g. earned income tax credits, family-friendly work policies);
  • Promoting social norms that protect against violence and adversity (e.g. public education campaigns to support parents and positive parenting, bystander approaches to support healthy relationship behaviors);
  • Ensuring a strong start for children (e.g. early childhood home visitation, high quality childcare, preschool enrichment programs);
  • Enhancing skills to help parents and youths handle stress, manage emotions, and tackle everyday challenges (e.g. social emotional learning programs, safe dating and healthy relationship skill programs, parenting skill and family relationship approaches);
  • Connecting youths to caring adults and activities (e.g. mentoring and after school programs); and
  • Intervening to lessen immediate and long-term harms through enhanced primary care to identify and address ACE exposures with screening, referral, and support, victim-centered services, and advancement of trauma-informed care for children, youths, and adults with a history of ACE exposures.

The CDC determines that preventing ACEs through these various strategies could reduce a significant number of health conditions, including up to 21 million cases of depression, up to 1.9 million cases of heart disease, and up to 2.5 million cases of overweight or obesity.

The CDC Vital Signs report is available here, and the CDC MMWR report is available here.

Webinar on Adolescent SUD and Suicide Prevention to be Held on November 20

The Action Collaborative on Bridging Public Health, Health Care, and Community will be holding a webinar on Wednesday, November 20 at 9:00 am PST detailing a recent Trust for America’s Health (TFAH) report on adolescent substance use and suicide. The TFAH report is part of its series Pain in the Nation which calls for a comprehensive National Resilience Strategy.

The webinar will feature findings of the report Addressing a Crisis: Cross-Sector Strategies to Prevent Adolescent Substance Use and Suicide and will detail various items including risk and protective factors related to adolescent substance use and suicide, evidence-based approaches to improve adolescents’ life circumstances, and cross-sector recommendations to prevent adolescent substance use and suicide. The webinar is available here.

NACCHO Board Approves New and Updated Policy Statements

The National Association of County and City Health Officials (NACCHO) Board of Directors last week approved new and updated policy statements on a range of topics. The NACCHO policy statements inform and support NACCHO’s national advocacy for local health departments and programmatic work, as well as message to the general public stances on various issues and topics. The statements also support local communities in policy development, programs, and stakeholder education.

A new policy statement on Local Health Department Preparedness was approved which combines two previous statements on All Hazards Preparedness and Preparedness Planning. A number of updates to policy statements were also improved, ranging from health department accreditation, foundational public health services, and integration of services and supports for community health. NACCHO’s full suite of current policy statements are available here.