Public Health System Capacity in Arizona: Learning from the COVID-19 Pandemic Response | Center for Rural Health

Public Health System Capacity in Arizona: Learning from the COVID-19 Pandemic Response | Center for Rural Health

Publication Date: Friday, August 18, 2023

Authors:  Bryna Koch, Michelle Moore, Brianna Rooney, Mona Arora, Jennifer Peters, Daniel Derksen

About The Report

This important report reviews the public health response to the COVID-19, explores health disparities, identifies unmet health needs, makes recommendations, and suggests interventions to improve health outcomes and reduce health disparities. It also provides a good overview of Arizona’s public health system.

Read & Download the Report

Final Call to Nominate Colleagues for AZPHA’s Annual Awards

This is the final call to nominate folks for our 2023 Annual Awards. Nomination deadline has been extended to September 22, 2023

Please take a moment to nominate colleagues here by Friday September 22!
Join Us for our Annual Public Health Awards Event: 
Thursday, October 26, 2023

5:00pm – 8:30pm

Note the Venue Change: Event will Be Held at the

University Club of Phoenix

39 E Monte Vista Rd, Phoenix, AZ 85004

Tickets are only $60 and includes food and drink tickets

Register Today


Nominate colleagues here by Friday September 22!

September is National Suicide Prevention Month

To bring additional attention to this important public health issue, this month we will highlight at risk populations in Arizona and simple steps we can all take to decrease suicides.

American Indians have a disproportionately high rate of suicide among all Arizonans. According to the University of Arizona’s Center for Rural Health, suicide death rates in 2021 were highest among American Indian and Alaska Native (AIAN) people, males, and people who live in rural areas. 

The Arizona Department of Education’s Office of Indian Education is encouraging individuals to check on others and know how to reach out for help.

It can be scary to discuss suicide. It is a tough conversation, and one where both parties must be vulnerable. But it is also a courageous conversation and one we encourage you to have if you have any concerns.

For more information, consider calling 9-88, or chat online with someone for advice:

The majority of suicide deaths in Arizona and nationally are by firearm. Arizona has an especially difficult history with firearm deaths, as detailed in AzPHA’s recent white paper. What can we do?

See the Report: Firearm Violence in Arizona: Data to Support Prevention Policies

Gun locks are one protective factor that can help slow down someone who is suicidal. Having to find the lock for the gun, and the ammunition ideally stored elsewhere, may be enough time to stop the person from dying by suicide.

AzPHA will have more than 100 gun locks available for distribution at our February 2024 conference. We encourage you to take one and have a discussion with your family or someone else you know how owns firearms. We can all do a better job of keeping firearms safe and out of the hands of those who may be considering suicide.

It can be scary to discuss suicide. It is a tough conversation, and one where both parties must be vulnerable. But it is also a courageous conversation and one we encourage you to have if you have any concerns.

For more information, consider calling 9-88, or chat online with someone for advice:

State Agency Budget Requests are in: A Summary

The state is still in the first quarter of the new fiscal year, but it’s already time to start the budgeting process for next year. On September 1, most state agencies submitted their wish lists for the year ahead – proposals that the Governor will consider as she puts together the state budget she will release in January.

The Governor’s office hasn’t published all the agency requests, but some of the outlined priorities include:

  • The Department of Health Services, which requested new spending for:
    • 38 new staff members to help license and monitor health and childcare facilities, group homes, and health professionals
    • More resources for the Arizona State Hospital
    • Enhanced administrative support for public health outreach and partnerships with tribal communities
    • More funding for school vision and hearing screenings
    • State dollars to backfill federal cuts to sexually transmitted infection control programs
  • The Department of Environmental Quality, which seeks new resources to:
    • Backfill increased costs associated with agency operations
    • Direct all municipal water taxes into the Safe Drinking Water Fund
    • Enhance the air quality programs by adding two staff members to work on air quality state implementation plans
    • Upgrade the smoke management database for prescribed burns
    • Boost programs that remove PFAS from firefighting materials
    • Enhance the Recycling Grants Program
  • AHCCCS Seeks more money in their  FY2025Budget for:
    • An increase of $596.5 million in state General Fund monies and an increase of $32.6 million in Other Appropriated Funds for a net appropriated funds increase of $629.2 million above FY 2024.
    • Money is mostly for anticipated caseload growth and Cap Rate adjustments
    • 10-page cover letter outlines the details: FY2025Budget
    • Note: Sadly, the request does not include funds for secure residential behavioral health facilities

AzPHA Draft Resolution – Structural Racism is a Public Health Crisis: Opportunities for Intervention

Read the Resolution

Many of AzPHA’s public health priorities are driven by Resolutions that are approved by our members.  AzPHA has dozens of Resolutions in place dating back to the 1930s. They are all available on our website: AzPHA Resolutions

Early resolutions focused on the importance of food safety regulations, tuberculosis control, family planning, and other public health issues. More recent Resolutions have focused on support for addressing the opioid epidemic, certifying community health workers, and addressing electronic cigarettes. Our Resolutions are important to us because they set our public health advocacy priorities.

AzPHA Resolutions stay in place until and unless the Members vote to remove or update a Resolution. Resolutions are developed by AzPHA Members and are forwarded to the Board for review. Members must approve all Resolutions.

We are pleased to announce the publication of a 2023 AzPHA Resolution that is up for vote of the entire membership:

Structural Racism is a Public Health Crisis: Opportunities for Policy Interventions

This resolution has been in the works for years (some have been asking for such a statement for decades!). A special note of thanks to the team who instigated this process over the past several months, to get it to where we could review and vote on it as a community. These folks took time out of their “regular” jobs to craft this resolution into something we can all lean into:

  • ·       Marcus Johnson, Former AZPHA President
  • ·       Lauriane Hanson, AzPHA Board Secretary
  • ·       Penny Allee Taylor, AzPHA Board Member: PH Policy
  • ·       Satya Sarma, MD, Chair AZPHA Board Member
  • ·       RJ Shannon, Member
  • ·       Vivian Huang, MD, MPH, Member
  • ·       Jannah Scott, ThD, MPH Member (YWCA Metropolitan Phx)

We encourage you to carefully review this new proposed Resolution and reply to the ballot you received last Friday by Saturday, September 30. We believe it is far past time for this Resolution and we look forward to membership ratification!

AzPHA Members Vote Here Before 9/30/23

Time to Play Hardball with Agency Director Nominations? Here’s a Playbook

After the shenanigans at yesterday’s “Director’s Nominations” Committee it’s clear that Governor Hobbs nominees won’t be getting a fair shake from the Committee or the Senate. As such, it’s time for the Governor to look at other (legal) options for permanently placing talented folks into Director posts. There are several legal options that the Governor can consider.

Sen. Jake Hoffman scolds a Hobbs’ nominee for plagiarism. No, really

Arizona Senate panel rejects Gov. Katie Hobbs’ housing director

Senate committee doesn’t ‘vet’ nominees. It sabotages them

The statutes about senate confirmation requirements are sufficiently vague and provide loopholes that could give Team Hobbs some stability and governance options in the absence of Senate feasance. See: 38-211 – Nominations by governor; consent of senate; appointment Here’s that statute [ARS 38-211].

If the term of any state office that is appointive pursuant to this section expires, begins or becomes vacant during a regular legislative session, the governor shall during such session nominate a person who meets the requirements of law for such office and shall promptly transmit the nomination to the president of the senate. If the senate rejects the nomination the nominee shall not be appointed, and the governor shall promptly nominate another person who meets the requirements for such office. If the senate takes no formal action on the nomination during such legislative session… the governor shall after the close of such legislative session appoint the nominee to serve, and the nominee shall discharge the duties of office, subject to confirmation during the next legislative session.

The Governor has Several Work-Arounds

Option 1: Replicate the ‘Herrington’ Model

You’ve probably heard that agency directors can serve up to one year without being confirmed by the Senate. While that’s true – the reality is that the law ARS 38-211 is more permissive than that. When the Legislature is in session, that ‘one year clock’ doesn’t start until the Governor actually sends the nominee’s name to the Senate. If the Governor doesn’t send the nominee’s name in, then the clock doesn’t start.

For example, Governor Ducey named Don Herrington as the acting (Interim) ADHS director in the Summer of 2021. Ducey never formally nominated Don nor sent his name to the Senate… meaning the ‘one year time clock’ never started for him & he ended up in the job for more than 18 months despite the time limit in 38-211E: ‘In no event shall a nominee serve longer than one year after nomination without senate consent.’ Why was Herrington allowed to be the Director for way more than 1 year?  Because he was never really the nominee according to the statute.

Hobbs could keep replicating the Herrington model. Simply keep naming ‘Acting’ agency directors. Appear to be recruiting a permanent nominee without really doing it. Never formally nominate the person but tell them and their staff and stakeholders that the acting status is permanent. Not an ideal arrangement, but it supplies more stability than the status quo.

Option 2: Recess Appointments

Now that the legislative session is officially over, a different part of the confirmation statute applies:

If the term of any state office that is appointive pursuant to this section… becomes vacant during a time in which the legislature is not in regular session, the governor shall nominate a person who meets the requirements of law for such office and shall transmit the nomination to the president of the senate during the first week of the next regular session. The nominee shall assume and discharge the duties of the office until rejection of the nomination or inaction of the senate.

Now that session is over, when Hobbs nominates folks for posts who require confirmation, the person’s one year time clock won’t start until at least early January – and even then, not until Hobbs actually formally sends the person’s name to the Senate. This could be paired with the Herrington model. Simply keep the recess appointment directors “acting’ on paper indefinitely.

Option 3: The Wizard of Oz

Even persons who Hobbs has formally nominated for agency director posts but for whom the Senate took no action (e.g., Carmen Heredia at AHCCCS, Karen Peters at ADEQ etc.) have options for staying in the agency’s decision-making position indefinitely without confirmation.

For example, prior to the one-year time clock running out on an agency nominee (in March 2024) Hobbs could move the nominated director to a Deputy position that doesn’t require confirmation. Hobbs could then name a new ‘Acting Director’ (possibly even the former deputy). The Governor’s Office could make it clear to agency staff and stakeholders that the Deputy is the ‘real’ director, providing governance certainty for stakeholders and staff.

The Acting Director could stay on indefinitely as long as Hobbs doesn’t formally nominate the person to the job. The Governor could even rotate the directors on paper – with the acting director and deputy trading positions after a year. Again, staff and stakeholders could be told exactly who the real decision-maker is Not ideal: but again… better than the status quo that Hoffman has delivered.

AHCCCS Releases Updated Provider Payment Suspension Fact Sheet with New Resources

AHCCCS updated the Provider Payment Suspension Fact Sheet on Aug. 23, 2023 to provide new information and resources about its efforts to stop fraudulent behavioral health billing and to protect members in tribal communities who’ve been targeted.

The Provider Payment Suspensions Fact Sheet includes additional provider enrollment and claims payment system changes made since June 14, 2023, a flow chart of the Credible Allegation of Fraud payment suspension process, and a flier about the 4 Steps to Review Provider Credibility.

Additional system-wide improvements to the Medicaid claims payment system include:

  • Implemented emergency rules to enhance and expand AHCCCS authority to exclude providers affiliated with bad actors,
  • Requiring behavioral health providers to submit additional assessment, treatment plan, and medical records documentation with their claims,
  • Requiring fee-for-service providers billing more than 2 units of hourly codes or 4 units of 15-minutes codes on a single date of service, to provide additional documentation.

Additional changes to the AHCCCS provider enrollment process include:

  • Revision of the Provider Participation Agreement (PPA) to explicitly require that if a provider stops providing services to AHCCCS members during an ongoing investigation, they must help the member transition to a new provider for treatment. 

Work Requirement for SNAP (Food Stamps) Kicking in October 1

As part of the federal debt ceiling negotiations last year Congress implemented revisions to the Supplemental Nutrition Assistance Program (SNAP) that require “able-bodied adults without dependents” to meet certain work requirements to keep their benefits.  Beginning !0/1/23 “Able-bodied” adults without dependents (people between 18 and 52 who are physically and mentally fit for work and lack dependents who are minors) must meet one of the following requirements:

  • Work 80 hours per month. This includes any combination of:
    • Paid work
    • Self-employment
    • Volunteer work
    • In-kind work: working in exchange for food, rent, or other needs. Proof must include the value of the work and the number of hours worked.
  • Participate in an approved Nutrition Assistance Employment and Training activity a minimum of 80 hours per month;
  • Participate in a combination of work and an approved Nutrition Assistance Employment and Training for a minimum of 80 hours per month.
  • Show good cause for not meeting work requirements such as having an illness, not having transportation, or unreasonable working conditions.

Interestingly, the measure only applies to people living in Maricopa County – the rest of the state is off the hook. Weird that it only applies to Maricopa County, huh. I looked into that and it must be because Maricopa has the lowest unemployment rate (the federal law excludes areas with higher unemployment rates).

There are also exceptions for people experiencing homelessness, veterans, and former foster care youth.

A full list of exceptions is here: Work Requirements for Able-Bodied Adults Without Dependents | Arizona Department of Economic Security

People can apply for SNAP online at