State Auditor Releases Report on CDPH ELC Funding

Today, California State Auditor Elaine Howle issued an audit report on California’s management and use of federal COVID-19 funding allocated to the California Department of Public Health (CDPH). Recall, Auditor Howle in August 2020 designated the state’s management of federal COVID-19 funds a high-risk issue given the substantial amount of funds received and the risk of mismanagement of the funds.

The report released today focuses on the state’s use of approximately $467 million earmarked for the implementation and enhancement of programs related to the CDC Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Cooperative Agreement. The federal government provided $555 million to California from March 2020 to mid-December 2020 for state-level COVID-19 response efforts. Of this total amount, CDPH allocated $88 million to nonprofit partner Heluna Health. CDPH was then responsible for using the remaining $467 million to expand the state’s ability to test individuals for COVID-19 and to conduct case investigations and contact tracing among residents potentially exposed to COVID-19.

Under the state audit, it was found that the state’s testing of individuals for COVID-19 met or exceeded CDPH’s initial targets but statewide contact tracing has lagged well behind original plans. In early 2020, CDPH estimated statewide contact tracing would require more than 31,000 staff from local health departments. CDPH planned to assist LHDs in reaching the number of required contact tracers by temporarily reassigning 10,000 state employees to LHDs. In January 2021, however, the State Auditor determined that only about 12,100 contact tracing staff were employed statewide, including both staff hired or redirected by LHDs and staff reassigned by state agencies. According to Auditor Howle, this workforce was inadequate to meet the sharp year-end increase in COVID-19 cases realized statewide.

Further, the State Auditor reviewed state management of ELC COVID-19 funds that were allocated to 58 LHDs. CDPH allocated $286 million of its $467 million ELC balance to LHDs, and the State Auditor determined CDPH’s oversight of these funds has been insufficient. Namely, CDPH, as of mid-February, had not approved all ELC work and spending plans submitted by LHDs and quarterly fund reporting procedures were not entirely finalized at the time of the State Auditor’s report. As a result, the State Auditor determined that gaps in reporting and reviews have left untracked more than $40 million in ELC COVID-19 funds provided to LHDs.

Last, the State Auditor additionally reviewed CDPH’s oversight of the development of new information technology (IT) systems to track COVID-19 data. In establishing new IT systems and procedures, the Auditor determined CDPH did not retain an independent verification and validation consultant to perform key, early error identification steps. CDPH additionally did not prioritize oversight of the IT system, according to the Auditor, resulting in potential errors in data and IT functionality.

Auditor Howle identified a series of recommended actions for CDPH as a result of her office’s findings. CDPH is recommended to:

  • Better leverage contact tracing as a tool to limit the spread of COVID-19 by reevaluating its contact tracing plan and update it to incorporate staffing efficiencies and create and implement a plan in partnership with LHDs to hire, train, and retain the number of contact tracing staff it determines necessary to limit the spread of COVID-19
  • Ensure it has all necessary planning information in place related to funding allocations made to LHDs by reviewing and approving all initial ELC workplans by April 15, 2021
  • Ensure it is performing necessary oversight and providing LHDs with guidance on improving their ELC COVID-19 activities by putting into place procedures to ensure that CDPH receives all required quarterly updates from LHDs
  • Ensure the state has accurate COVID-19 data by directing its IT consultant to monitor system performance and data validation efforts, among other IT management considerations

CDPH concurred with the State Auditor’s recommendations and identified ways it plans to implement improvements. The full State Auditor’s report is available here.