October 26, 2018 Edition

CHEAC Hosts Successful 2018 Annual Meeting

Last week, CHEAC held its 2018 Annual Meeting in Sacramento, featuring an expanded lineup of plenary speakers, robust workshops, and additional programming. Nearly 130 local health department and agency directors, managers, and staff attended the conference and meeting.

Evaluations from the conference were very positive and indicated attendees found significant value in the expanded attendance from LHD leadership and staff, networking and best sharing opportunities, and the dynamic lineup of speakers and presenters. Given the new format of the meeting, CHEAC Staff welcomes any additional feedback and input from attendees as we plan future meetings. We would also like to extend our sincere gratitude to the 2018 Annual Meeting Planning Committee, CHEAC Executive Committee, and meeting sponsors and exhibitors.

All 2018 Annual Meeting materials, including the program and presentations, are available online here. Be sure to save the date for the 2019 Annual Meeting in Pasadena, California!

LAO Publishes 1991 Realignment Report

The California Legislative Analyst’s Office (LAO) recently released its long-awaited report, “Rethinking the 1991 Realignment,” which examines the impacts of recent changes to 1991 Realignment, including the impact of the In-Home Supportive Services (IHSS) Maintenance of Effort (MOE) agreement that was reached in 2017. The report details the history of 1991 Realignment, discusses increased program costs and responsibilities, and evaluates the benefit of 1991 Realignment to the State and counties.

In assessing 1991 Realignment and impacts, the LAO established four guiding principles for Realignment:

  • Counties’ share of costs reflect their ability to control costs in the program;
  • Revenues generally cover costs over time;
  • Flexibility to respond to changing needs and requirements; and
  • Funding is transparent and understandable.

Due to various changes to 1991 Realignment without corresponding changes to its funding structure, the LAO concludes that 1991 Realignment no long meets the core principles of a successful state-county fiscal partnership. Counties’ share of several program costs exceeds their ability to control those costs, and overall Realignment revenues are not sufficient to cover costs of programs over time. Further, LAO determines the flow of funds in Realignment is extremely complex and not flexible enough to allow counties the ability to respond to changing needs and requirements.

The LAO outlines a number of options to better align the fiscal structure of 1991 Realignment and achieve its four guiding principles. The options available include:

  • Change cost-sharing ratios by reducing county share for IHSS and increasing county share for another program;
  • Better align revenues and costs by updating growth allocations and increasing funding to address existing shortfalls; or
  • Other improvements to align principles including applying lessons from 2011 Realignment, tracking Realignment revenues and costs, encouraging counties to maintain reserves, and considering long-term impact of policy decisions on ability to control program costs.

The LAO report is expected to contribute to the ongoing conversations between key entities at the state and local level regarding 1991 Realignment and the impacts of the IHSS MOE. The full LAO report is available here.

CHEAC Welcomes Feedback on Proposed Federal Rule on Public Charge

As a friendly reminder, CHEAC welcomes members to assess the impact of the Trump Administration’s proposed rule on public charge on LHD operations and services and provide written comments to Jack Anderson via email (janderson@cheac.org) by COB on Friday, November 16, 2018.

Recall, the U.S. Department of Homeland Security (DHS) U.S. Citizenship and Immigration Services recently published in the Federal Register proposed changes to how the federal government determines whether an immigrant is likely to become a “public charge.” Individuals applying for seeking adjustment of a status or a visa must establish that they are not likely at any time to become a public charge under the proposed rule. DHS also proposes to require all individuals seeking an extension of stay or change of immigration status to demonstrate that they have not received, are not currently receiving, and are not likely to receive public benefits as defined in the full text of the proposed rule.

For any changes to public charge to take effect, the following must occur:

  • Proposed changes must be published by the Federal Register (occurred October 10, 2018);
  • A 60-day comment period must occur (deadline set for December 10, 2018);
  • The Administration must review submitted comments;
  • A final rule must be issued and will be deemed effective 60 days after the issuance of the final rule.

Under the proposed rule, the public charge test would be expanded to weigh whether an immigrant is receiving one or more specified public benefits, including non-emergency Medicaid, Medicare Part D, housing subsidies, and Supplemental Nutrition Assistance Program (SNAP), among other considerations. DHS is also seeking comment on whether to include the Children’s Health Insurance Program (CHIP) as a factor in public charge determinations.

The National Association of County and City Health Officials (NACCHO) has also put out a call for public comments, available here. Individual jurisdictions are also welcome to submit their own comments via regulations.gov and we ask that jurisdictions please provide a copy of written comments to CHEAC. Should you have any questions, please do not hesitate to contact the CHEAC Office.

President Trump Signs Opioid Legislation, NACo Webinar Recording Available

On Tuesday, President Donald Trump signed H.R. 6, titled “SUPPORT for Patients and Communities Act”, a comprehensive legislative package to assist in addressing the nation’s opioid epidemic. Earlier this fall, the U.S. Senate and House of Representatives passed their own opioid-related legislative proposals; the two chambers then reached an agreement on the legislation after two weeks of conference committee negotiations to reconcile differences earlier this month.

Key provisions of the expansive measure include an expansion of the grant program used to purchase naloxone; authorization for the U.S. Centers for Disease Control and Prevention (CDC) to combat the opioid epidemic through expanded data collection and grants for states, localities, and tribes; creation of a CDC grant program to prevent and respond to various opioid-related infections, including hepatitis and HIV; and provisions that allow providers to provide medication-assisted treatment (MAT) for up to 275 patients at any one time.

The National Association of Counties (NACo) recently held a webinar to detail key provisions of H.R. 6 and opportunities for localities. The webinar featured discussion on how the law could support local efforts to combat opioid misuse and addiction in communities and preview potential next steps for opioid legislation and action in Congress and the federal administration. A recording of the webinar is available here.

GAO Issues Report on Opioid Emergency Declaration

This week, the U.S. Government Accountability Office (GAO) issued a report that examines the federal government’s emergency declaration on the opioid epidemic, initially declared by the Acting Secretary of Health and Human Services in October 2017 and renewed in April 2018.

The report indicates that the emergency declaration allowed HHS to survey more than 13,000 providers to assess prescribing trends for medication-assisted treatment (MAT) and address any barriers to prescribing MAT. The declaration also allowed HHS to waive public notice periods for select Medicaid demonstration projects, enabling some states to test and evaluate new approaches for delivering Medicaid substance use disorder treatment services. Additionally, the report finds HHS took steps to expedite support for research on opioid use disorder treatments and disseminate information on opioid misuse and addiction.

The GAO found that the federal administration had not used, for a variety of reasons, 14 other authorities and functions that become available in a public health emergency. The full GAO report is available here.

Registration Closes Next Week for December 7 Health Equity Workshop

Registration for the Committee for California’s Health 2018 Workshop on Building Power for Health Equity will close next Friday, November 2. The all-day workshop will be held in Sacramento on Friday, December 7, 2018, and is designed for California local health department professionals to learn from, support, and inspire each other in advancing health equity work within LHDs. Space is limited to approximately 130 attendees, and hotel costs will be covered for up to two people from each LHD in California. Additional travel stipends will be available based on need. A networking a dinner reception is also scheduled for the evening of December 6 in Sacramento.

Additional information, including a draft agenda and registration details, is available here.

California County Children’s Well-Being Scorecard Released

The 2018-19 California County Scorecard of Children’s Well-Being was released this week. The report, published by Children Now, is an interactive report that details a comprehensive snapshot of how children are faring in each of California’s 58 counties over time and by race and ethnicity. The scorecard features indicators across four domains of health, education, early childhood, and child welfare.

The latest edition of the scorecard includes various enhancements, such as heat maps for each indicator, to allow users to make comparisons across counties and regions. The data included in the scorecard can provide insight on a variety of child-related measures and indicators and assist in informed local decision-making.

The scorecard is available here. A webinar on how to use the scorecard will also be held next Tuesday, October 30 from 11:00 am – 12:00 pm; registration is available here.