Will Humble Medicaid, Public Health Law, Wills Blog

The Federal COVID-19 Public Health Emergency Ends Thursday: What Will Change? 

The biggest thing that most folks will notice is that payment for COVID testing, treatment and vaccination will start running through people’s regular health plan rather than being paid for separately by the federal government.

Other emergency provisions expire too. For example, vaccination requirements, waivers for the Emergency Medical Treatment and Active Labor Act, enhanced discharge planning & nursing care plans, certain critical access hospital requirements, and some kinds of hospital quality & performance improvement programs will end. You can download an explainer for those things on the Center for Medicare and Medicaid Services website: Guidance for the Expiration of the COVID-19 Public Health Emergency.

From a big picture point of view, COVID-19 will no longer be treated differently… it’ll be treated like any other disease or illness.

Requirements for remaining on Medicaid (AHCCCS) will change a bit too. The COVID-19 public health emergency gave generous incentives to state Medicaid programs if they agreed to not disenroll anybody during the emergency declaration. That disenrollment suspension has expired & AHCCCS has begun determining whether their members still qualify.

AHCCCS thinks about 600,000 of their 2.5 million members may lose eligibility once their year-long redetermination process is finished… and 1/2 of those could be for failing to respond to requests from AHCCCS for information to determine eligibility.

See: AHCCCS Doing Full Court Press to Prepare for Member Redeterminations

The Kaiser Family Foundation put together that summarizes the things that will end or change on Thursday including Medicaid match rates, requirements for private health insurance, and other countermeasures like the numerous Emergency Use Authorizations for COVID-19 tests, and treatments like antiviral agents, monoclonal antibodies, and vaccines. 

Here are some bullets summarizing the changes that will happen:

The end of the federal public health emergency also removes the legal foundation that the U.S. Department of Homeland Security has been using as grounds to immediately turn away and expel people seeking asylum in the U.S. (known as ‘Title 42’).

After Thursday, Customs and Border Protection and the Border Patrol (part of CBP) will no longer be able to immediately expel asylees using Title 42 authority. Many asylees have been waiting in Mexico for the opportunity to request asylum once Title 42 ends…  and we’ll begin to see next week whether the system and communities are able to responsibly manage the situation.

Will Humble Vaccination, Wills Blog

New RSV Vaccine Approved for Seniors

FDA licensed the first-ever vaccine for RSV last week. Vaccines for RSV have been researched for at least 20 years. The is called Arexvy (GSK). The vaccine is licensed for adults ages 60 and older.  A similar vaccine from Pfizer is expected to be approved in June (same demographic).

CDC still needs to recommend the vaccine before it will be available. The next Advisory Committee on Immunization Practices meeting is on June 21/22.

A vaccine to protect infants is expected to gain FDA approval later this year. That one is developed by Pfizer. It’s expected to be licensed to give to pregnant women. Infants would be protected by passive immunity as antibodies pass through the placenta.

Will Humble Public Health, Wills Blog

Public Health Journalism this Week

Will Humble State Legislature, Wills Blog

Legislative Update: May 8, 2023

The House and Senate came in for some brief business on Wednesday, May 3 and then adjourned again until tomorrow. The House now has its full contingent of members, while the Senate is still down one member until the MC Coard of Supervisors names a replacement for Sen. Teran.

Floor votes have been scheduled in both the House and Senate for Monday and I expect that to continue throughout the week. So far none of the bills that we’ve taken positions on are up for votes next week – but that could change quickly.

There are rumors of a budget deal between the Governor and House & Senate leadership – but word is that the Appropriations chairs haven’t been involved – which is unusual.

Two good things happened last week. Both chambers passed a bill to give AHCCCS expenditure authority to draw down federal dollars. The Governor signed it quickly. 

Without that authority, AHCCCS wouldnt have been able to make May payments to their contracted health plans, which could have delayed payment to providers. 

In another development, we avoided a potential trainwreck in Arizona’s emergency management system last Wednesday. HCR2039 governor; state of emergency, which would have dismantled the Recovery phase of emergencies in Arizona (had the voters approved it) was derailed.

Last-minute questions by Senator Bennett in last Wednesday’s (R) caucus meeting about that ballot referral got the attention of other Republican members. It appeared after the Caucus meeting that the Resolution won’t be going to the Senate floor after all.

Ballot Referral Could Dismantle Arizona’s Emergency Management System

If voters ended up approving it, it would have ended Governor-proclaimed states of emergency after 30 days (including public health emergencies) unless extended by the Legislature in 30-day increments. It would impact all declared emergencies like floods, fires, chemical spills, and other kinds of disasters – not just public health emergencies.

Had it not been stopped last week it would have gone directly to the ballot in November 2024 (Governor Hobbs is unable to veto ballot referrals).

See our Legislative Session Working Powerpoint with the bills we’ve taken positions on.
Will Humble Return on Investment, Wills Blog

U.S. Department of Education College Scorecard

The Education Department unveiled changes Tuesday to its College Scorecard which now includes data about what college graduates make four years after completing their degrees and student debt trends. The Department of Education Scorecard is designed to help prospective students “find high-value postsecondary programs” that align with their goals. 

The Scorecard was originally developed during the Obama administration as an online tool with data about college costs, acceptance rates, graduation rates and student body diversity. Its original intent was to just prospective students, families, educators, and others information to help them compare colleges.

The new features let students also explore what they might expect as a salary early in their career for all levels of degrees (bachelors, masters, doctorate). Tuition costs and scholarship/grant availability are also indirectly captured as the tool lets students see Folks can also compare median debt and monthly debt payments for various university degrees by school.

I did a quick query for the UA College of Public Health Bachelor’s & Master’s degree programs below. Anyway- I just thought this is an interesting tool for both parents and students to explore as they think about fields of study and colleges.

University of Arizona Bachelor’s Degree in Public Health

MEDIAN EARNINGS 4 YEARS POST GRADUATION: $47,452

MEDIAN DEBT: $21,000

University of Arizona, Master’s Degree in Public Health

MEDIAN EARNINGS 4 YEARS POST GRADUATION: $76,477

MEDIAN DEBT: $47,242

Will Humble Disease Control, Wills Blog

American Journal of Public Health: Mpox Vaccine Interest Survey Prioritization and Data Flow: Maricopa County, Arizona, July–August 2022

Abstract: With increasing Mpox cases in Maricopa County, Arizona, the county’s health department launched a survey on July 11, 2022, to gather eligibility and contact data and provide clinic information to those interested in JYNNEOS as postexposure prophylaxis (PEP) or expanded postexposure prophylaxis (PEP++).

Survey data were matched to case and vaccination data. Overall, 343 of the 513 respondents (66.9%) who reported close contact with an mpox case patient received PEP and 1712 of the 3379 respondents (50.7%) who were unsure of their contact status received PEP++. This outreach intervention connected potential close contacts unknown to MCDPH with PEP or PEP++. (Am J Public Health. 2023;113(5):504–508. https://doi.org/10.2105/AJPH.2023.307224)

Will Humble Medicaid, Wills Blog

What’s Up with AHCCCS’ Funding Problem: Is it A Crisis?

AHCCCS could soon run out of money and would no longer be able to pay their contracted health plans for the services they’ve been providing to Medicaid members. How is that happening, you ask?

About a month ago HB 2624 was signed into law giving AHCCCS expenditure authority for half of the $3B AHCCCS has already received from the feds this fiscal year.

That money is intended to cover formula adjustments in the capitation rates for the Managed Care Organizations who contract with AHCCCS. The bill was passed with the understanding that the remaining 50% would be approved as part of continuing budget negotiations.

That subsequent approval hasn’t happened yet – hence the anxiety about how AHCCCS is going to be able to pay their bills the rest of this fiscal year. Without the remaining expenditure authority approved by the Legislature, AHCCCS will need to delay the May monthly capitation payments to their contracted Managed Care Organizations. 

In the interim, this delay means the Agency and the State are unable to meet those payment obligations, resulting in instability for Arizona’s business community, private partners and any local organizations that rely on funding from the MCOs. 

Note: This legislative effort just seeks the authority to spend federal monies (i.e., zero dollars from the state general fund).

Will a fix happen before May comes? We’ll see. Right now, it appears the majority in the legislature is content to let AHCCCS’ contractors provide care ‘on the house’. We should know soon.

Will Humble Health Equity, Opioids, Wills Blog

Free Support Helps Providers Increase Medication Assisted Treatment Capacity

The Arizona Center for Rural Health is offering free support for experienced (and less experienced) Medication Assisted Treatment (MAT) providers to help them increase capacity to provide MAT services. Participation in the Arizona Center for Rural Health’s AzMAT Mentors Program is free and open to Arizona controlled substance prescribers.

If you’re interested or would like to learn more about our program, please visit their website: https://crh.arizona.edu/mentor and complete the program forms!

Will Humble Disease Control, Environmental Health, Social Determinants, Wills Blog

The Tamale Bill is Toast but ADHS Can Still Improve the Cottage Food Program by Being More Generous About What Foods Qualify

With the veto of HB2509 it appears that the cottage food program will stay where it is for at least another year. Unless there’s a Strike All bill that expands cottage foods that satisfactorily address the concerns of the Interim ADHS director and/or the Governor, it appears we’ll be in stasis for the program and the 15,000 persons registered in the Cottage Food program.

In the meantime, is there an administrative fix that could responsibly expand the list of foods that participants can prepare that wouldn’t need a statutory change?

The answer is yes – but it would require ADHS Interim Director Cunico to be more generous with the list of ingredients ADHS considers to be acceptable under the existing program. Here’s how Interim Director Cunico could do that if she were so inclined.

See the list of foods/ingredients ADHS allows in the current program

ADHS adopted the FDA Food Code 2017 to govern food production and sale in Arizona. That document defines potentially hazardous food that:

 “… require time/temperature control for safety to limit pathogenic microorganism growth or toxin formation… including an animal food that is raw or heat-treated… that is not modified in a way so that they are unable to support pathogenic microorganism growth or toxin formation…”

Determining which ingredients and foods that meet that definition is both an art and science. 

There are certain ingredients – shellfish for example – that are clearly potentially hazardous. Many other meats also potentially hazardous – but others the current ADHS cottage food program considers potentially hazardous should more appropriately be called theoretically hazardous. The bottom line is that the current listing of ingredients the department considers acceptable is unnecessarily restrictive and can be expanded without requiring a statutory change.

My point is that ADHS should collaborate with the University of Arizona Food Product and Safety Lab and others to build a more generous menu of ingredients and combination of ingredients they’ll allow in the existing cottage food program. Such a revised list would be unlikely to include tamales, but many other foods could and should qualify.

Whether ADHS Interim Director Cunico is willing to do so is unknown.

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