Will Humble Social Determinants, Wills Blog

Predatory Debt Collection Protection Act Policy Paper

The protections in the Predatory Debt Collection Protection Act will provide greater protections for the issues raised above, bringing Arizona much more in line with the recommendations provided by the National Consumer Law Center to enable those in debt to pay off what they owe without placing them in a position where their ability to meet their daily living needs are not impacted by the loss of housing, transportation, or other resources.

This from the Grand Canyon Institute provides an analysis of the Predatory Debt Collection Protection Act initiative along 3 themes:

  • The Initiative’s Impact on AZ Law & Comparisons to Other States 
  • The Initiative’s Impact on Medical Debt
  • The Initiative’s Impact on Debt Collection through the Courts
Predatory Debt Collection Protection Act Policy Paper
Will Humble Air Quality, Climate Change, Wills Blog

Arizona’s Electric Vehicle Infrastructure Deployment Plan Approved

Arizona is one of the first states in the nation to have its Electric Vehicle Infrastructure Deployment Plan given the stamp of approval from the Federal Highway Administration

The Arizona Department of Transportation submitted its draft proposal in August and with the federal approval this week, $11.3 million will be made available immediately with another $16.3 million coming in October to begin implementing the plan. This is a portion of the overall $76.5 million allocated for this program in Arizona over the next five years through the recently enacted federal Infrastructure Investment and Jobs Act

The next step for ADOT is to solicit and award the contracts to upgrade existing stations as well as develop new locations along designated alternative fuel corridors. Advertising for bids to upgrade existing stations will begin in Spring of 2023 followed by bid solicitations in autumn 2023 for new construction. The plan calls for stations to be no more than 50 miles apart wherever possible. 

Currently, the alternative fuel corridors are identified as all five of the federal Interstate Highways throughout the state. These are Interstates 8, 10, 15, 17, and 19, which account for more than 20% of all the vehicle miles traveled in Arizona. 

The specific goals of the plan are reducing electric vehicle drivers’ “range anxiety” by closing gaps in the charging network along the designated corridors and ensuring the network is resilient, equitable, accessible, and reliable. Also the plan aims to identify new charging locations as part of an ongoing public outreach process and will use data to evaluate the system and make improvements. 

A copy of the plan, more information, and contact information to leave feedback are available here: azdot.gov/evplan

Will Humble Reproductive Health, Social Determinants, Wills Blog

Abortion Care Now Largely Illegal in Arizona

View Our Newly Updated Report: Women’s Reproductive Rights in Arizona: 1864-2022

Ever since the territorial days, Arizona has had a history of severely restricting women’s reproductive freedom. From territorial era laws passed in 1864 to the laws restricting both abortion and contraception passed in 1901 (called the Comstock Laws), Arizona lawmakers and governors have actively sought to restrict women’s reproductive rights.

When the U.S. Supreme Court announced their decisions in the 1960s and 1970s (Griswald v Connecticut & Roe v Wade) Arizona finally began to allow more reproductive freedom (including the right to have an abortion), but only because the courts had forced their hand.

Arizona law regarding abortion care was again thrown into flux in the summer of 2022 when the U.S. Supreme Court overturned Roe v. Wade once again allowing states to decide how they regulate or prohibit abortion care. Throughout the summer of 2022 it was unclear whether and what kind of abortion care was legal in Arizona.

Arizona had laws on the books from the territorial days limiting abortion to only those cases when it was necessary to save to life of the patient, to a new 2022 law that generally allowed abortions as long as it was before 15 weeks’ gestation.

That confusion was resolved on September 23, 2022, when Pima County Superior Court Judge Kellie Johnson ordered the lifting of the injunction in the Nelson v. PP case. In her decision she dismissed the relevance of the new law limiting abortions to those at less than 15 weeks of gestation because the state legislature included in the session law that the 15-week gestation age limitation does not “… repeal by implication or otherwise Section 13-3603 or any other applicable state law regulating or restricting abortion.”

Women’s Reproductive Rights in Arizona: 1864 – 2022

September 23, 2022, any clinician in Arizona who performs an abortion (whether medication or surgical) that is not necessary to save the life of the patient can be charged with and convicted of a violation of ARS 13-3603 and if found guilty, punished with between 2 and 5 years in the state penitentiary.

Planned Parenthood of Arizona is likely to appeal the lifting of the injunction on the 1973 ruling to the Arizona Supreme Court, where is stands little chance of being overturned. The Arizona Supreme Court was recently increased in size from 5 to 7 justices, giving Governor Douglas A. Ducey an opportunity to fill the court with his preferred appointees. Governor Ducey is a well-established foe of abortion services and presumably ensured that his appointees share is values in that regard.

Unless the election in November 2022 drastically changes the makeup of the Arizona State Legislature and the Democratic candidate for Governor (Katie Hobbs) is elected, abortion services will remain illegal to perform in Arizona through at least 2024 with no exceptions unless the clinician establishes that the procedure is necessary to save the life of the patient.

A voter initiative changing the Arizona Constitution to guarantee the right to abortion services will likely be initiated in 2024. If the effort can collect the more than 300,000 valid signatures needed to qualify for the ballot, and if the initiative survives the inevitable legal challenges to keep it off the ballot, Arizona voters will have an opportunity to again make abortion services legal beginning in late 2024.

At a practical level, Arizona women will be forced to seek abortion services in neighboring states like California, Nevada, New Mexico, or Colorado, all of which allow abortion services. Several resources exist to help women that are living in states with restrictive abortion laws such as I need an abortion. However, many women who can’t afford to or are unable to travel will be forced into motherhood in a state with little commitment to safety net services.

Will Humble Medicaid, Wills Blog

Disappointing News: Director Snyder Will Be Leaving Her Post as AHCCCS Director at the End of the Year

Disappointing news today out of AHCCCS. Director Snyder announced that she’ll be leaving AHCCCS at the end of the year. I’ve been a state government aficionado for many years, and Jami is the best and most thoughtful AHCCCS Director in a long time.

As we have all observed and can attest to, most state agencies have been starved for talent in the agency director position. Not so at AHCCCS, where Jami has been a shining star among Ducey appointees.

We thank Jami for her service & leadership over the last 4 years even as we remain disappointed that she won’t be here when the next administration begins 100 days from now.

Below is the letter Director Snyder addressed to stakeholders earlier today:

 

__________________

Dear Stakeholder Partners – 

I am writing today to let you know that I will be leaving AHCCCS at the end of the year. 

I’ve been honored to serve as the director of AHCCCS for the last four years. During that time, your partnership and advocacy have been essential to our success in spearheading delivery system transformation, navigating through the COVID-19 pandemic, and advancing the agency’s nationally recognized work related to whole person care. I am incredibly proud of what we have accomplished together. 

As you know, we have an outstanding team at AHCCCS. I will be working with them over the next three months to ensure a smooth transition, including beginning to lay the groundwork for the exciting initiatives outlined in our 1115 demonstration waiver currently under review with the Centers for Medicare and Medicaid Services (CMS) and slated for approval in October.  

Again, thank you for your guidance and unwavering support over my tenure. It has served as the foundation of our continued progress as a Medicaid program and as a tremendous source of strength for me personally. 

Sincerely,

Jami

Will Humble Affordable Care Act, Health Insurance, Wills Blog

HHS Proposed New Rule Streamlining Enrollment in Federal Healthcare Programs

Last week the US Department of Health and Human Services proposed a new rule that would reduce red tape and streamline administrative processes to help children, older adults, people with disabilities, and others from underserved communities connect to health care coverage through Medicaid and CHIP. 

This proposed rule follows President Biden’s executive orders in April 2022 and January 2021 directing federal agencies to take action to expand affordable, quality health coverage, including by strengthening Medicaid and the Affordable Care Act.

This rule would standardize eligibility and enrollment policies like limiting renewals to once every 12 months, allowing applicants 30 days to respond to information requests, requiring prepopulated renewal forms, and establishing clear, consistent renewal processes across states.

The proposed rule also removes some administrative hurdles for people who do not have – but are eligible for – Medicaid (AHCCCS) and CHIP (KidsCare).

It also simplies enrollment for Medicare Savings Programs, which permit Medicaid to pay Medicare premiums or cost sharing for Medicare beneficiaries with lower incomes. 

There will be a 60-day comment period, and comments on the notice of proposed rulemaking must be submitted to the Federal Register no later than November 7, 2022. For more information on how to submit comments or to review the rule in its entirety, visit the Federal Register.

Will Humble Public Health, Social Determinants, Wills Blog

Applications for Vitalyst System Change Grants Open

The Vitalyst Health Foundation is now accepting applications for their Systems Change grants. These are three-year awards for up to $175,000 in total. You can View the Slide Deck here that explains more about the System Change grants.

  • Applicants are welcome to discuss their Systems Change Grant proposal with a Vitalyst team member. You can complete the Discovery form and note interest in Systems Change Grants, and they’ll schedule a 30-minute conversation via phone call or Zoom with you.
  • LOIs are due by 5pm on Friday, October 28th to this Vitalyst online portal and refer to these instructions for portal submission.
  • Notifications of invitation to submit a full proposal will be made on Friday, December 9th.
Will Humble Public Health, State Legislature, Wills Blog

Dozens of New Laws Take Effect this Weekend… Some Good & Some Bad – Our Summary

The 2022 Legislative Session ended 85 days ago, which means the bills that passed and were signed become effective next Saturday (laws become effective 90 days after the end of the legislative session).

The session was an enigma. We lost a ton of important public health authority, but there were also positive policy developments & increased investment in several public health programs (because for the first time in forever we had a bipartisan budget). Here’s a summary of the laws that will take effect next Saturday (with links to the language):

Laws Taking Away Public Health Authority

SB 1009 Greatly restricts the public health emergency authority of future governors & state health directors. Ducey enjoyed 700+ days of public health emergency authority (A.R.S. § 26-303) but future governors will only have 120 days of public health emergency authority – after which the legislature must approve extensions in 30-day increments.

HB2616 Permanently takes universal classroom masking away as a public health intervention. Parents must give expressed written consent for their child to wear a mask in the classroom.

HB2453 Prohibits the state or any political subdivision from requiring anybody to wear a mask or face covering on the governmental entity’s premises.

HB2086 Prohibits the ADHS from requiring the COVID-19 vaccine (or it’s ancestors) from being required for school attendance.

HB2498 Prohibits a government entity from requiring anybody to receive a vaccination for COVID-19 (including staff & ancestor vaccines).

HB2507 Prohibits state/local government from directly or indirectly requiring or enforcing anything that ‘adversely affects a religious organization’ during a public health emergency, including ‘exclusion, restriction, segregation, limitation, refusal or denial’.

Laws Taking Away Reproductive Rights

SB1164– Reduced the gestational age in which abortions can be performed from 20 weeks to 15 weeks.

Laws Improving Home & Community Based Services

HB 2157 – Appropriates $1.44B in Medicaid in FY 2022 to implement the American Rescue Plan Act of 2021 (ARPA) home & community-based services for persons with developmental disabilities. AHCCCS Plan Here

SB1272 allows AHCCCS to extend post-partum Medicaid for up to one year after birth in the SOBRA eligibility category (to 150% of federal poverty).

Laws Improving Access to Care

HB2144 Requires health insurers to cover biomarker testing as part of patients’ treatment plans

HB2113 People with Down Syndrome are now automatically medically eligible for AHCCCS & DD services

SB1162 Expands the list of exemptions from the 90-morphine milligram equivalent (MME) limit on opioids prescriptions to include patients experiencing chronic intractable pain or receiving opioid treatment for perioperative care following an inpatient surgical procedure.

SB1444 Prohibits ADHS leadership from retaliating against a patient due to family participation in Arizona State Hospital Independent Oversight Committee meetings (retaliation has been common). Makes the ASH Superintendent and Chief Medical Officer attend and participate in meetings (they’ve been blowing them off).

SB1162 Prohibits a court from collecting a fee for forcible entry or detainer (housing) & eliminates the $18 forcible entry and detainer filing fee.

Good Budget Items

The Medicaid pregnancy provider rate will increase by 88% for certain pregnancy care provider codes (59400, 59510, 59160, & 59618).

KidsCare members will be able to remain eligible for 12 months.

There will be a new chiropractic care benefit for AHCCCS members (when ordered by a primary care physician or primary care practitioner). Limit 20 visits/year.

Behavioral health providers will be added to the ADHS’ student loan repayment program if they agree to work in public or non-profit BH hospitals, & BH residential facilities.

$105M will be invested over 3 years invested in various programs to enhance the nursing workforce, including:

  • Nurse education programs for universities and community college districts to supplement their existing nurse education programs;
  • Money for institutions that provide clinical training to nurses;
  • Transition to practice program – “nurse residency” program for new graduate nurses;
  • Behavioral health technician training programs; and
  • ‘Accelerated’ nursing programs ($6 million to Creighton, $44 million to other universities)

$25M was appropriated to encourage development of secure BH residential facilities. Priority populations are persons with SMI diagnoses chronically resistant to treatment & court ordered to a secure facility.

The Arizona State Hospital can give out up to $700,000 in hiring bonuses this fiscal year. ASH will also enjoy an additional $7M appropriation for upgraded video/audio.

ADES’ Adult Protective Services will receive an increase in funding so hire an additional 95 staff ($11M).

Development Disabilities providers will receive a 9.7% rate increase. The reimbursement rate for Elderly and Physically Disabled providers will increase 11%.

The Housing Trust Fund (administered by the Arizona Department of Housing) will receive an additional $60M next fiscal year. Another $15M is earmarked for ‘homelessness’ but with few details about how that can be used (at least there will be a new administration for half of the fiscal year).

Will Humble Public Health Law, Wills Blog

The ‘Arizona Agenda’ Produced a Good Summary of the Propositions Related to Public Health: Here’s Their Analysis

PROP 132: Initiatives; supermajority vote; requirement

Summary: Prop 132 would amend the state Constitution to require a 60% vote to increase taxes at the ballot.

Arguments for it: Proponents argue it protects taxpayers from runaway spending by requiring the same kind of supermajority vote at the ballot as lawmakers need at the Capitol to raise taxes, and that the higher threshold will make it harder for out-of-state special interests to raise taxes on Arizona citizens.

Who’s for it: Arizona Chamber of Commerce and Industry, The Goldwater Institute, Gov. Doug Ducey, Arizona Tax Research Association (ATRA)

Arguments against it: Lawmakers already need a two-thirds majority vote to pass any increases on taxes or to roll back tax credits and exemptions, and that supermajority requirement has hindered lawmakers’ ability to pass even common-sense tax increases. The same rule isn’t applied to tax cuts. They note the original bill highlights supporters’ real intent, as it would have applied that supermajority requirement to all initiatives.

Who’s against it: League of Women Voters of Arizona, Arizona Center for Economic Progress, Arizona Education Association. The AZPHA Board is currently asking membership to ratify our OPPOSITION to 132

 

PROP 209: Predatory Debt Collection Protection Act 

Summary: The measure makes multiple changes to state statutes on wage garnishment debt collection. It limits the interest rate on medical debt to 3%. It would protect more equity in homes, vehicles, household goods and bank accounts from being taken by creditors. It also limits the amount that can be garnished from your wages to pay off debts.

Arguments for it: Medical debt, in particular, causes many Arizonans to fall into bankruptcy. The standards for wage garnishment and asset collection are outdated. People shouldn’t lose their homes or vehicles because of predatory debt.

Who’s backing it: Healthcare Rising Arizona (which receives support from the SEIU-United Healthcare Workers West), Arizona Public Health Association, Arizona Students’ Association, Phoenix Workers Alliance, Neighbors Forward AZ, Democrats of Casa Grande.

Arguments against it: The measure is supported by out-of-state special interests. It would have far-reaching effects and could cause creditors to charge more to make up for lost costs. It would be bad for business.

Who’s opposing it: Goldwater Institute, Arizona Chamber of Commerce & Industry, Arizona Free Enterprise Club, Tucson Metro Chamber, Greater Phoenix Chamber, Arizona Bankers Association

 

PROP 211: Voters’ Right to Know Act

Summary: Prop 211 would change state law to require political groups and people spending more than $50,000 to influence the outcome of an election to disclose the original donor of contributions over $5,000. It would also require real-time reporting of significant campaign spending and allow the Arizona Citizens Clean Elections Commission to enforce the provisions of Prop 211. Allows civil penalties for violations.

Arguments for it: “Dark money” is a corrupting influence on our democratic system and Arizona voters deserve to know who is funding political campaigns. Prop 211 will bring transparency and accountability to campaign messaging because voters will know who is paying for those ads. And it’ll stop regulated utility companies like Arizona Public Service (APS) from secretly funding the campaigns of their own regulators, as has happened in past elections.

Who’s backing it: League of Women Voters of Arizona, former Phoenix mayors Paul Johnson and Terry Goddard. The AZPHA Board is currently asking membership to ratify our SUPPORT for 211.

Arguments against it: Disclosing the names of political donors will open them up to threats and harassment from opponents.

Who’s opposing it: Arizona Free Enterprise Club, Center for Arizona Policy Action

 

PROP 308: Tuition; post-secondary education

Summary: Prop 308 would change state law to allow all Arizona students, regardless of immigration status, to be eligible for financial aid and in-state tuition at Arizona universities and community colleges. Students must have graduated from an Arizona high school and been enrolled for two years. The measure earned bipartisan support at the Capitol. It would ask voters to repeal Prop 300 from 2006, which passed overwhelmingly at the time and barred non-citizens from receiving in-state tuition.

Arguments for it: Arizona students should be able to attend Arizona universities, regardless of immigration status. Undocumented students and Dreamers are a vital part of our economy. It’s good for business and it’s the right thing to do.

Who’s backing it: Arizona Chamber of Commerce and Industry, Southern Arizona Leadership Council, Arizona Education Association, Aliento Education Fund, Valley Interfaith Council, Stand for Children, Local First Arizona. AZPHA Board is currently asking membership to ratify our SUPPORT for 308.

Arguments against it: It offers in-state tuition to undocumented immigrants.

Who’s opposing it: Former Senate President Russell Pearce, the Arizona Republican Party, RidersUSA

 

PROP 310: Fire districts; funding; sales tax increase

Summary: Prop 310 would increase sales taxes by a tenth of a penny on the dollar to fund rural fire districts.

Arguments for it: Fire districts serve 1.5 million Arizonans and are responsible for not only fighting fires but providing emergency medical services in car crashes along major parts of Arizona’s highway system. Fire districts are strapped for manpower, equipment and resources, and 911 calls often take upwards of 30 minutes for a response.

Who’s backing it: Professional Fire Fighters of Arizona, Arizona Fire Chiefs Association, rural fire districts. AZPHA Board is currently asking membership to ratify our SUPPORT for 310.

Arguments against it: It’s a 20-year tax increase on all Arizonans to bail out rural fire districts, which already have access to a local tax base.

Who’s opposing it: Arizona Free Enterprise Club, Arizona Republican Party

Will Humble Professional Development, Wills Blog

Western Region Public Health Training Center Awarded $4.1M Grant

The Western Region Public Health Training Center was recently awarded $4.1 million by the Health Resources and Services Administration to help support a skilled and knowledgeable public health workforce. Over the next four years, they’ll continue to provide interactive training programs that impart critical skills for providing quality services that meet community needs and address emerging threats at the local, state and national levels.

The Western Region Public Health Training Center is one of 10 Regional Public Health Training Centers funded by the Health Resources & Services Administration (HRSA) to support the public health workforce.

They’re a consortium of public health professionals that develop and provide innovative, skill-based training to address gaps identified by training needs assessments for the public health workforce. They:

  • Develop and implement of skill-based public health trainings (online, in-person, webinars)
  • Offer free continuing professional education courses.
  • Are an accredited provider of CPEUs that is available to all Registered Dietitians/Nutrition and Registered Dietetic Technicians.
  • Are an accredited provider of continuing education contact hours (CECH) that are available to all Certified Health Education Specialists (CHES).
  • Provide stipends to support undergraduate juniors, seniors, and graduate students conducting community-based health projects.
  • Customize & implement online public health core competency and training needs assessments for public health organizations.
Will Humble Social Determinants, Wills Blog

Biden Administration Unravels the Trump Era ‘Public Charge’ Rule

The Biden administration finalized a new public charge rule last week which unravels the Trump-era policies that penalized low-income immigrants seeking health benefits & other services.

The new rule from the Department of Homeland Security rolls back the types of assistance immigration officers can consider when evaluating immigrants for a green card and deciding whether they’ll become a “public charge,” or dependent on government assistance.

The new updated regulations make it clear that Homeland Security can’t consider the use of health care, nutrition, or housing programs when making immigration decisions. The new rule clarifies that a child’s or other family member’s use of federal safety net programs won’t affect the applicant’s immigration application.

The now-repealed Trump administration rule said applicants could be deemed a public charge and denied residence or citizenship if they used noncash public benefits (housing vouchers, food assistance, or Medicaid).

Note: In 2021 President Biden issued an executive order directing the DHS to stop enforcing the 2019 “public charge” restrictions. Last week’s final rule makes that executive order moot.

Any future president that wants to change it back to the way it was during the Trump Administration would need to go through a lengthy rulemaking process (like the Biden administration just did).

See old blog post: Homeland Security Establishes Final “Public Charge” Rules – AZ Public Health Association August 19, 2019

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