Will Humble Professional Development, Wills Blog

Musings from the President: The Year Ahead by Kelli Donley Williams, AzPHA President

Have you paused recently before answering the standard dinner party question, “What do you do for a living?” Prior to the pandemic, I had no hesitation in proudly saying without concern, “I work in public health.” But on a recent vacation, when asked this question multiple times a day, I tried variations that wouldn’t lead to dark conversations about vaccine deniers, the horrors of American politics, or predictions on the next disease coming our way.

(For the record, vaccines are the best life-saving public health tool ever, with seat belts perhaps coming in second. I rarely want to talk about politics, much less with strangers. And finally: I have no idea! Alas, my public health degree didn’t come with a crystal ball.)

By the end of the trip, I had reevaluated, dodging any invasive follow up questions. Instead, I told anyone who looked my way, “I work in public health!” And, I’d like to encourage you to do the same, with pride and joy for our field.

Yes, we are slowly emerging from a global pandemic where communication about public health strategies and advancements was unclear at best. And yes, unfortunately millions have died from COVID since 2019. However, imagine what our community and state would look like today if our public health work force hadn’t shown up and done their very best?

I had the chance to volunteer with the public health corps at Maricopa County Health during the first round of vaccines. I watched public health workers and retirees volunteer in droves to drive around the county, working long, thankless hours to get vaccines in the arms of the willing. They did so at risk to their own health and wellbeing. They did so when the call came, regardless of the time of day or weather. They did so because they remembered that working in this field is not about the individual, but about the greater community need.

We before me is the ultimate public health tenant. I watched these heroes in action, and it refilled my professional sails. What an honor to be part of this field, to work and walk alongside each of you.

In 2023, our association will be focused on three primary areas: increasing public health infrastructure, including workforce; health equity; and firearm safety. I hope to see you at our February conference and to share more details about each of these. And further, I hope you’ll find new ways to get involved with AzPHA this year. Join the book club, be a mentor, attend a Friday “conversations and coffee” to hear what colleagues in another corner of Arizona are working on.

Join us. Together, we can improve the public health in Arizona!

Will Humble Professional Development, Wills Blog

AzPHA Annual Conference: Don’t Miss Out – Registrations Filling Fast

Addressing Health Disparities:
Building Infrastructure & Engaging the Next Generation of Public Health Leaders
View Our Agenda & Conference Brochure
Desert Willow Conference Center
4340 E Cotton Center Blvd, Phoenix, AZ 85040
Thursday, February 23, 2023
8:30am – 4:30pm

Register Closed

Maricopa County Department of Public Health is Offering Free Scholarships to AZPHA Members:Use Scholarship Code AZHD2023 When Registering

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See Our Sponsorship Opportunities and View Sponsorship Benefits in Our Sponsorship Packet
Will Humble Vaccination, Wills Blog

Righting Arizona’s ‘Vaccines for Children’ Ship

The U.S. Vaccines for Children Program makes sure kids whose parents can’t afford vaccines can still get their kids vaccinated. Funding for VFC comes via the CDC, who buys vaccines at a discount and distributes them to states. States distribute them to physicians’ offices & clinics that take part in the VFC program. The Arizona Department of Health Services manages the VFC program in our state.

Doctor’s offices and clinics are required to be enrolled as a VFC provider by ADHS to take part in the Medicaid (AHCCCS) program…  so, the number of providers enrolled in VFC has a direct impact on the adequacy of a state’s care network for kids enrolled in AHCCCS.

Arizona lost 50% of its Vaccines for Children providers during the Ducey administration, going from 1,200 providers to 600…  reducing access to childhood vaccines & harming AHCCCS network capacity

Why the decline? Anecdotally, providers who left VFC over the last few years say they quit because of the administrative hassles imposed on them by the state during the Ducey administration (ADHS not AHCCCS). At the top of the list of grievances is ADHS’ punitive practice (during Director Christ’s tenure) of financially punishing providers with wastage rates over 5% making participation financially difficult (see this letter to AZAAP members regarding the former ADHS policy).

Arizona now has 6 VFC providers per 10,000 Medicaid eligible kids, while the national average is 24 providers per 10,000 Medicaid kids…  meaning Arizona only has a quarter of the number of VFC providers per Medicaid kid compared with the national average. Many people believe the declining immunization rates among AZ kids are in part due to a thinning network of VFC providers in Arizona.

The Ducey-era ADHS never conducted an analysis to determine why so many providers have stopped participating in VFC during the Ducey administration. Thankfully, the Arizona Partnership for Immunization is now partnering with the OMNI Institute to figure out why so many have quit so we can right the VFC ship.

They’ve developed this Childhood Vaccine Provider Survey for medical provider offices that administer vaccines to children to collect data that can be then used to develop interventions to reverse this troubling trend. The survey takes 10-15 minutes to complete depending on your answers. Responses will be combined with other providers’ responses and no identifying information will be included in any report. Here’s the link to the Childhood Vaccine Provider Survey

The results of this landmark report can then be used to conduct interventions that either reverse Ducey administration VFC policies, change ADHS operational procedures, inform staffing changes, or explore moving VFC to AHCCCS. But…  good results depend on good participation – so please get the word out!

Participate in the Survey

Related: Childhood Vaccination Rates Continue to Drop In the 2021-2022 School Year

Will Humble State Legislature, Wills Blog

State Legislature Off to a Slow Start

By late January the state legislature is usually in full swing with jam packed committee agendas and a bewildering number of bills to go through. That’s not the case this year. House and Senate Health Committee meetings have been routinely canceled or not scheduled at all – and committee agendas are pretty light with just a few bills.

Maybe that’s because about half of the state legislature is new this year and members are still getting their sea legs. I’m not sure. 

Anyway – that’s good for at least right now, because we’re busy getting ready for our annual conference on February 23. We’re just about to get our agenda set and expect to announce that early next week. 

The Senate Health committee is scheduled to meet on Tuesdays from 2-4pm…  but Senate Health isn’t meeting this week. House Health is scheduled for Mondays from 2-4pm. They are meeting this week, but it’s a pretty light agenda.

I expect most of the action in House Health to be about HB2284; homelessness; housing; facilities. That bill would dictate how the Arizona Department of Housing should allocate funds for individuals experiencing homelessness. The drama is all about the details. 

It would require ADOH to use the money for parking areas that have access to potable water, electric outlets and bathrooms sufficient to serve that parking area and camping facilities. 

Importantly, it requires ADOH to spend money on those things before spending monies on permanent housing for individuals experiencing homelessness. It also prohibits people experiencing homelessness from camping and storing personal property anywhere except those designated areas. Here’s a more detailed review of the bill from Leg Council: HB2284 Discussion

It took us awhile to take a position on the bill because there are lots of pieces to it and it’s a bit out of my wheelhouse. A few of our Public Health Policy Committee members did some research and determined that the bill, as is, would do more harm than good – and we’ve signed up in opposition to the bill (although I don’t plan on speaking in Committee about it tomorrow).

The other bill we’re tracking with action so far is HB2001, which would exempt ADHS from the Administrative Procedures Act (that law provides the requirements for agency rulemakings). ADHS would be exempt only if the proposed rules reduce a regulatory burden without jeopardizing health and safety and don’t increase costs to the persons regulated. The public would have a minimum of 15 days to comment on the rules.

That bill passed through the House Health Committee 9-0. We signed up neutral on that bill. While I trust that Director Cullen will use the additional authority wisely and for good public health purposes, I’d like to see the exemption time limited to ensure that a future administration doesn’t use that authority to dismantle health and safety regulations at the Department. Hopefully that bill will be amended to limit it to just 3 years or something like that.

Here’s our bill tracking spreadsheet thus far. This list will grow substantially as the legislative session progresses.

Will Humble Professional Development, Wills Blog

Register Today: The Hertel Report 2023 Winter State of the State

Register Today: https://www.thehertelreport.com/product/2023-winter-state-of-the-state/

AZPHA Members Use Coupon Code AZPHA2023 for $15 Off at Checkout

2023 WINTER STATE OF THE STATE

Arizona healthcare leaders provide fresh insight and trends impacting our local managed care industry. Stakeholders and guest speakers from across the healthcare continuum will add to the conversation.

Register Here https://www.thehertelreport.com/product/2023-winter-state-of-the-state/

GUEST SPEAKERS

  • Dr. Charlton Wilson
  • Mark Stephan, MD & Seth Dubry, MD
  • Equality Health
  • Paul Rose
  • Chief Executive Officer of Western Asset Protection
Will Humble Public Health, Social Determinants, State Legislature, Wills Blog

Substantial Advancements in Addressing the Social Determinants of Health are Hallmarks of Governor Hobbs’ Budget

Governor Hobbs Releases 2023-24 Budget Proposal 

Governor Hobbs released her proposed budget last Friday. It reflects a governor who is committed to improve the social determinants of health and assist families. The budget makes critical investments to protect the health and wellness of all Arizonans. 

  • $463M and $115M in federal fund expenditure authority to utilize year three of federal funding given directly to AHCCCS and DES respectively for home and community-based services programs
  • $257M for AHCCCS program caseload growth and unwinding of federal Covid-19 policies
  • $150M deposit into the Housing Trust Fund to assist families and individuals who are currently or at risk of becoming unhoused
  • $50M General Fund set-aside for a refundable child tax credit for low-income families beginning tax year 2023
  • $24M to make feminine hygiene products tax exempt
  • $20M to expand the income eligibility cutoff for the KidsCare program from 200 percent of the federal poverty level to 300 percent of the federal poverty level
  • $16M to make permanent a sales tax exemption for infant diapers
  • $9.7M to address an Arizona State Hospital staffing shortfall
  • $11M to fully fund the adoption subsidy for adoptive parents, backfill federal funding, and implement the Positive Parenting Program
  • $6.1M in ongoing funding to augment existing Title X family planning dollars to provide expanded family planning services to low-income women, doubling the current amount provided to women in Arizona
  • $14M to reduce caseloads for Adult Protective Services
  • $4.4M to make permanent federal funds to increase Arizona Early Intervention Program (AzEIP) Provider Rates
  • $2.5M to expand the Healthy Families AZ program for voluntary home-visits to families that are at high risk of abuse or neglect, adding capacity for additional 300 families
  • $2.7M for Medicaid enterprise system modernization
  • $200,000 in ongoing funding for pregnancy services that are inclusive of all options and support personal choice

Of course, a budget proposal is just that, a proposal. The ultimate result will come later this spring after negotiations with the state legislature… but it certainly is nice to have an executive proposal that prioritizes evidence-based strategies to improving the health status of ordinary Arizonans.

Will Humble Medicaid, Wills Blog

AHCCCS Eligibility Redeterminations Start April 1; 25% (600K) of Currently Enrolled AHCCCS Members May Lose Eligibility 

The big federal omnibus bill signed by President Biden last week directs states to begin their Medicaid redetermination efforts starting on April 1, 2023. AHCCCS thinks about 600,000 of the 2.5 million currently enrolled AHCCCS members may lose eligibility over the coming year once redetermination happens.

The federal government gave states an extra 6.2% in federal contribution toward a state’s Medicaid costs in exchange for not disenroll people from Medicaid during the public health emergency. The omnibus bill phases out the 6.2% enhanced federal match. Beginning on April 1, the enhanced match will drop 5% and continue to drop each quarter until the enhanced match is eliminated on Jan. 1, 2024.

The bill didn’t end the public health emergency (in fact HHS just extended it until August 2023) but redetermination will now begin on April 1 rather than when the emergency expires.

Healthcare providers can help get the word out that AHCCCS members should ensure that their mailing address, phone number & email address are up to date on www.healthearizonaplus.gov and urge AHCCCS members respond to requests from AHCCCS for more information.

The State Medicaid Advisory Committee met last week and AHCCCS staff provided an overview and update on various projects including how they’ll be redetermining eligibility later this year.

AHCCCS has a “Return to Normal” webpage with more info including community and contractor resources.

Will Humble Professional Development, State Legislature, Wills Blog

Governor Hobbs Taps AzPHA Member Zaida Dedolph Piecoro to be her Health Policy Advisor

Good news! Governor Hobbs has tapped AzPHA Director of Public Health Policy Zaida Dedolph Piecoro to serve as her health policy advisor. Zaida is a long-time member of AzPHA and has been serving as the Director of Public Health Policy on our Board of Directors for the last few years. She begins her new post on Tuesday,

Zaida stepped down from her role at the Children’s Action Alliance and also stepped off our Board of Directors last Friday to avoid any kind of perceived conflict of interest.

It’ll certainly be delightful & refreshing to have a friend of evidence-based public health policy on the 8th Floor advising the governor and her team on administrative and policy matters!

According to our By-laws, it’s Kelli Donley Williams’ responsibility to name a new Director of Public Health Policy to the Board. In the meantime, I’ll run the weekly public health policy committee meetings.

Will Humble Healthcare, Medicaid, Public Health, Wills Blog

Call to Action: Comment on ADHS’ Planned Revisions to the AZ Student Loan Program for Health Professionals: Comments Due by January 22

A law was passed last legislative session adding a Behavioral Health Loan Repayment Program to the existing ADHS State Student Loan Program for health professionals. The new law adds several disciplines to the list of folks who can qualify to participate in the program including behavioral health providers, behavioral health technicians, behavioral health nurse practitioners, psychiatric nurse practitioners, registered nurses, practical nurses, physicians, psychiatrists, or psychologists. Folks that qualify can have a generous portion of their student loans paid off if they serve in a behavioral health facility or the Arizona State Hospital.

Another change to the state student loan program makes folks eligible to participate if they work at an Indian Health Service facility, tribal or urban Indian health facilities that isn’t required to provide a sliding fee scale to be eligible.

ADHS has developed Administrative Code (Rule) changes to implement the new laws.  Whatever changes they adopt will be hard-wired into state code for many years so it’s essential that we examine the rules and make suggested changes while we can. This is an ‘emergency rulemaking’, meaning we have this one opportunity to examine the draft rules and make comments.

Comments are due in only 11 days: by January 22, 2023.

I especially urge those of you who have experienced the ‘back end’ of the student loan repayment program as a qualifying site or as a student to go through the rules and provide comments!

Here are the Proposed Draft Rules & a link to their Online Survey (Closes January 22, 2023).

I made the following suggested changes to the rules this morning adding an additional incentive for qualifying sites to donate to the State Loan Repayment Program (item number 6):

R9-15-104. Donations to a Loan Repayment Program

A person donating monies to a loan repayment program shall designate whether the donation may be used by the Department for either loan repayment allocations or for administrative costs associated with a loan repayment program or is to be used for loan repayment allocations for one or more of the following:

  1. The Primary Care Provider Loan Repayment Program, established according to A.R.S. § 36-2172;
  2. The Rural Private Primary Care Provider Loan Repayment Program, established according to A.R.S. § 36-2174;
  3. The Behavioral Health Care Provider Loan Repayment Program, established according to A.R.S. § 36-2175;
  4. A specific type or types of primary care provider, behavioral health care provider, or other eligible individuals; or
  5. A specific county in Arizona; or
  6. A specific qualifying service site or sites.
Will Humble State Legislature, Uncategorized, Wills Blog

Express Your Support or Opposition to Bills this Session on AZLEG.gov

The Arizona State Legislature uses the ‘Request to Speak’ (RTS) system facilitate tracking of bills proposed and allowing the public to register an opinion on bills and to request to speak on a bill in a committee. It replaces the old slips of paper used back in the day and lets committee chairperson know you want to speak to the committee. Under the old paper system, you could only sign in to speak or register an opinion if you were physically at the capitol.

After the initial setup at a kiosk located in the House or Senate, the RTS program allows you to participate from your home or office. When the committee is in session, the committee members and the public will see a list of names of people who have registered an opinion.

It also shows whether you want to speak or not, who you represent. You can also leave more detailed comments or links to resources in comment boxes. This information is also available if a person searches past committee agendas. Legislators, journalists and the public will see your bill position throughout the process.

A catch is that you’re required to come to the capitol the first time you use the RTS system. When you come to the Capitol, you create an account and sign in on one of the Kiosks in either the House or Senate.

If you create an account at home, you’ll only be able to use the Bill Status Inquiry application to track activity on a bill, not register an opinion or create a request to speak until you come to the capitol and sign in on one of the Kiosks here.

Here’s a quick tutorial summarizing how to get set up and use Arizona’s RTS system: Using the Request to Speak Program

Using RTS has a bit of a learning curve, but if I can become proficient at using it- anybody can!

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