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In public health and health care, tracking and measuring performance isn’t just about generating numbers—it’s about accountability. For state agencies, transparency in reporting is the foundation for finding gaps, distributing resources effectively, and improving outcomes for vulnerable populations.
AHCCCS’ recent report under state law shows the power of measurement in holding agencies accountable.
The report provides some demographic, housing, and incarceration data on Arizona’s population of persons with a Serious Mental Illness (SMI), shedding light on the significant challenges they face.
For example, the report reveals that 12% of Arizona’s SMI population (7,812 individuals) experienced homelessness last year, compared to just 0.2% of the general population.
Half of those experiencing homelessness in Arizona have an SMI designation, highlighting the disproportionate burden on this population.
Housing instability isn’t the only issue. Nearly half of SMI members on the housing waitlist remained there for more than 6 months and 6.4% of the SMI population was incarcerated in the past year—a rate more than 10 times higher than that of the general public.
Reports like these force state agencies to confront hard truths and give advocates and policymakers the tools they need to spark interventions.
Without data transparency, systemic challenges can remain hidden, and meaningful improvements may never materialize.
The Transformative Potential of SB1311
Senator Miranda’s SB1311, passed in the 2024 legislative session, is a big step toward improving transparency in the metrics and outcomes for persons in Arizona with a serious mental illness.
The new law builds on the previously existing reporting requirements by mandating enhanced data collection and analysis and tying funding to specific performance benchmarks.
The First Year of reporting under SB1311 is due by December 31, 2025. Some of the outcomes required by the bill include:
SB1311: Mental Health; Oversight; Documentation
The data AHCCCS will publish next year will provide for more accountability in Arizona’s public mental health care system like minimum performance standards for housing programs serving individuals with SMI. This is critical, given the stark reality that so many SMI members spend months or years waiting for housing.
AHCCCS Tackling Housing Instability with Their New ‘H2O’ Program
The bill also emphasizes collaboration across systems. For example, it directs AHCCCS to work with the Arizona Department of Corrections to reduce incarceration rates among the SMI population.
By addressing the root causes of criminal justice involvement— like untreated mental health conditions and housing instability—SB1311 aims to provide the data needed to inform interventions that break the cycle of incarceration that disproportionately affects those with SMI.
Another benefit of the new law is its focus on equity and access, requiring agencies (AHCCCS’ Managed Care Contractors) to disaggregate data by demographic factors such as race, ethnicity, and geographic location, ensuring that disparities are found and addressed.
SB1311 also includes mandates for stakeholder engagement, requiring AHCCCS to ask for input from individuals with SMI, their families, and advocacy organizations. This ensures that reforms are informed by the voices of those most affected by the system’s shortcomings.
A Path Forward
By providing and monitoring performance we’ll be in a better position to identify gaps in the system and make necessary and targeted and systemic improvements.
These new data will also be key to informing performance metrics to hold AHCCCS, their contractors and the state legislature accountable for the performance of (and funding for) Arizona’s public behavioral health system.
The old adage from the U.S. Management Association is right: What gets measured gets done.
AHCCCS’ latest report highlights some of the basic information about outcomes and social determinants for folks Serious Mental Illness (SMI) designation. The findings paint a challenging picture about homelessness, housing waitlists, and incarceration rates among the 63,000 folks living with a serious mental illness in Arizona.
Housing & Homelessness
Let’s start with homelessness. The report reveals that 7,812 SMI members experienced homelessness in the last year – 12% of the SMI population. To put that in perspective, Arizona’s general population has a homelessness rate of just 0.2% (14,200 out of 7.5 million according to the latest ‘Point in Time’ Survey).
About half of all individuals experiencing homelessness in Arizona have a SMI designation (7,812/14,200). That means SMI members are overrepresented in Arizona’s homeless population by a factor of 60.
AHCCCS data also found that half of the SMI population on the housing waitlist had been waiting for stable housing for more than 6 months. That’s a long time for people who need housing stability to manage their health and daily lives.
Justice System
Another statistic from the report: 6.4% of SMI members were incarcerated in the past year. That’s over 10x the incarceration rate for Arizona’s general population of 0.6%. For those with a serious mental illness incarceration often results from untreated symptoms, a lack of housing, and insufficient community support.
Interventions Under Way
So, where do we go from here? Fortunately, AHCCCS is stepping up.
Their new H2O (Housing to Outcomes) initiative aims to tackle housing instability head-on by integrating housing solutions with health care services.
As described in our recent blog post below, H2O is designed to address the root causes of housing insecurity, expand access to stable housing, and improve health outcomes for Arizona’s most vulnerable residents. It’s a promising step in the right direction, and AHCCCS deserves credit for recognizing the urgency of the situation and acting.
AHCCCS and ADOA are also partnering to build a new facility on the grounds of the AZ State Hospital to provide ‘bridge housing” for persons with a serious mental illness. I’ve been keeping tabs on the construction each time I go down Van Buren – and the facility appears to be coming along quickly.
The facility will have a separate (physically attached) outpatient behavioral health service setting. Residents will not have to be in treatment to access housing services.
According to a PowerPoint from AHCCCS, it’ll have 24/7 shelter staff for supervision & security. Housing & services will be available by referral only (no walk-up services).
The overall challenges with the lack of housing, the wait for stable housing, homelessness and incarceration continue to be huge problems and far more needs to be done.
But… measuring challenges like homelessness, long housing waitlists, and incarceration among the SMI population brings the scope of the problem into focus.
With initiatives like H2O, there’s hope that future reports will show meaningful progress. After all, what gets measured truly can get done. In my next post I’ll highlight the added measures that will become available next year at this time as a result of the successful passage of SB 1311 last year.
The Centers for Medicare and Medicaid Services runs with an annual budget of $1.5 trillion—22% of the total federal budget. That’s more than the Defense Department! With this massive responsibility, CMS is at the heart of the U.S. healthcare system, overseeing programs and policies that touch the lives of nearly every American.
Running an agency with such a scope and impact requires a leader with deep administrative experience managing large budgets and complex systems.
CMS, located within the US Department of Health and Human Services, plays a pivotal role in administering Medicare, the federal program that provides healthcare for Americans over 65 and those with certain disabilities. They’re also responsible for making sure states are implementing their Medicaid programs following federal law and regulations. Beyond that, CMS ensures states manage their Medicaid and Children’s Health Insurance Programs in line with federal standards.
CMS also regulates a large portion of the private insurance market. The agency oversees health plans offered through the Affordable Care Act marketplaces, ensuring they follow ACA requirements. This includes setting standards for coverage, protecting consumers from discriminatory practices, and fostering affordability and accessibility in health insurance.
Another essential part of CMS’ mission is quality assurance. The agency ensures that healthcare facilities receiving Medicare and Medicaid funds meet rigorous standards. From hospitals to nursing homes, CMS holds care providers accountable to ensure safety, effectiveness, and dignity in the services they offer.
These programs collectively provide care for millions of vulnerable Americans, making CMS critical to the health and well-being of the nation.
With such enormous responsibilities, CMS is arguably one of the most consequential federal agencies. That’s why choosing a leader for this organization is not a decision to take lightly.
President Trump’s proposal to appoint Dr. Mehmet Oz, a TV personality with little administrative or managerial experience, raises serious concerns.
Running CMS is not about charisma or media skills; it’s about managing a vast and complex system that directly affects the health of millions and the stability of our economy.
The stakes couldn’t be higher.
For an agency overseeing 22% of the federal budget and shaping the health of a nation, we need a leader with proven experience in managing large organizations and navigating complex systems—not someone whose background is in entertainment.
Let’s hope that in this critical moment that the US Senate actually does their job during the confirmation process for Mr. Oz.
I. for one, am not confident they will.
Imagine going grocery shopping and, with just a glance, knowing how healthy each item is for you. That’s what Australia’s Health Star Rating system offers—an easy-to-read star ranking on food packaging, helping consumers make healthier choices.
Foods are rated from 0.5 to 5 stars, considering nutritional elements like sugars, sodium, saturated fats, and positive components like protein and fiber.
Health Star Rating – Health Star Rating
Australia’s Health Star Rating simplifies complex nutritional data into a clear visual cue, and it’s worked wonders for informing consumers. If implemented in the U.S., it could support public health by guiding shoppers toward better choices without needing a nutrition degree to decipher the details.
But here’s the roadblock: America’s processed food lobby. Given the enormous influence of these food giants, who profit from less-than-healthy products, they’d put up quite a fight against a system like this.
The simplicity and transparency of the Health Star Rating could deter shoppers from heavily processed foods, potentially affecting the bottom lines of companies that rely on them.
The benefits of the Health Star Rating in Australia are clear: consumers have a straightforward way to make informed choices, leading to better health outcomes.
Implementing a similar policy in the U.S. could be an important step toward combating diet-related health issues—but only if we can navigate the hurdles posed by the powerful processed food industry. It’s time to put consumer health first.
The recent Supreme Court decision in Chevron U.S.A. v. Natural Resources Defense Council has sent shockwaves through the regulatory landscape. In a 6-3 ruling last summer, the Court overturned the long-standing Chevron doctrine.
Loper Bright Enterprises v. Raimondo aka Chevron
That doctrine allowed federal agencies like the FDA, CMS, and EPA to interpret ambiguous congressional statutes within reasonable bounds. By scaling back Chevron deference, this ruling shifts more power back to the courts and away from agencies—a change with far-reaching implications for public health policy.
The Big Picture: Why the Chevron Ruling Matters
For four decades, Chevron deference allowed federal agencies to shape policies around complex issues where Congress provided only general guidelines.
Agencies like the FDA, CMS, and EPA could implement policies based on their specialized understanding. In areas as vital as drug safety, environmental protections, and health care standards, this deference was often crucial.
Under the new Supreme Court ruling, courts are less likely to give agencies the benefit of the doubt in interpreting vague statutes, meaning many existing and future policies could face intense scrutiny.
The Chevron ruling adds new layers of uncertainty to agency-led initiatives at the federal level, including those addressing critical public health issues.
The Impact on Health Agencies: FDA, CMS, and EPA
For the FDA, which relies on scientific and clinical expertise to regulate everything from prescription drugs to food safety, the reduced deference may impede its ability to keep up with rapidly evolving medical and technological advancements.
Without Chevron deference in place the FDA faces new prolonged legal battles simply to implement new safety standards, slowing down the approval of new life-saving drugs and even limit the FDA’s ability to regulate health products, such as e-cigarettes or supplements, which pose potential risks to public health.
The CMS is similarly affected. CMS has leaned on Chevron deference to implement policies improving care standards, controlling costs, and expanding access to essential health services.
The reduction of deference means that any new or even existing CMS guidelines could face court challenges, delaying or complicating their implementation and creating uncertainty in the health care system. Policy adjustments to improve patient outcomes, for instance, might now require explicit congressional approval, slowing progress and innovation.
The EPA is perhaps impacted the most by the overturning of the Chevron doctrine. Under the new ruling, the EPA’s ability to enforce environmental standards will be curtailed, affecting public health—especially when it comes to issues like air quality and exposure to harmful chemicals.
Without Chevron deference, the EPA’s hands are tied in setting stringent standards on pollutants and chemicals, potentially compromising public health protections against environmental hazards.
The Chevron Ruling—A Temporary Mixed Blessing?
While this Chevron decision is already causing immediate challenges, it also holds a potential short-term benefit given the likely actions of the upcoming Trump administration.
Under the Biden administration, the ruling is likely to create hurdles for evidence-based, health-focused policies. However, the incoming Trump administration will likely be less aligned with public health interests, and the Chevron ruling may even act as a brake on agency rulemakings that might undermine health protections.
In this light, the Chevron decision, which seemed like a net negative for public health policy last week, now could be potentially beneficial for the next four years.
U.S. public health policy is set to face unprecedented challenges with the nomination of Robert F. Kennedy Jr. as Secretary of Health and Human Services, the world’s largest public health agency, and its $1.7 trillion budget, including the National Institutes of Health, Centers for Disease Control and Prevention, Food and Drug Administration, and the Centers for Medicare and Medicaid.
Kennedy’s longstanding opposition to vaccines—a critical achievement in public health—is a clear indicator of his disregard for evidence-driven decision-making.
He has publicly doubted vaccines’ safety and efficacy, despite overwhelming scientific consensus on their role in preventing diseases and saving millions of lives. He believes adding fluoride to optimal levels in drinking water causes a litany of health problems (without providing evidence) even calling for water systems to stop adding fluoride (he calls it a poison).
See this Evidence Review documenting the clear scientific benefits of community water fluoridation: Community Water Fluoridation: An Evidence Review – Mel & Enid Zuckerman College of Public Health
He has spread several conspiracy theories including claims that Wi-Fi causes cancer and school shootings are caused by antidepressants. He believes, without evidence, that chemicals in water can lead to children becoming transgender; and that AIDS may not be caused by the HIV virus.
Kennedy’s reliance on personal beliefs rather than verified data could have serious implications for public health policies. The HHS is responsible for ensuring the safety and effectiveness of medical interventions and overseeing agencies like the FDA, CDC, NIH and CMS. With Kennedy at the helm, these agencies may face pressures to adopt policies grounded in ideology rather than science, endangering the progress made in controlling infectious diseases and advancing medical safety and public health standards.
For example, Kennedy (who believes “there’s no vaccine that is safe and effective”) would be in charge of appointments to the Advisory Committee for Immunization Practices, who sets vaccine recommendations for the CDC doctors and the general public. If confirmed, we can expect him to populate the ACIP with hand-picked anti vaccine zealots. As the head of CDC, he would be in the position to undermine the Vaccines for Children program. Even if congress doesn’t dismantle VFC, Kennedy would be in a position to over-regulate VFC providers to get them to quit participating in VFC. He has also pledged to suspend NIH research on cancer drugs and those for infectious diseases (e.g. vaccines) for 8 years while the NIH focuses on studying ‘chronic diseases’.
Not all of Kennedy’s ideas lack merit—his proposal to improve SNAP’s nutritional impact by limiting purchases to healthier foods is a reasonable initiative that could positively affect health outcomes for low-income families. Proposals like restricting sugary beverage purchases with SNAP benefits could help combat diet-related diseases (note, however, that HHS does not run the SNAP program.
At a time when public health needs strong, evidence-driven leadership, Kennedy’s history raises concerns. His confirmation will likely lead to policies that reduce trust in established health measures, with dangerous consequences for FDA regulations and the broader health and healthcare landscape among the HHS agencies and the American people.
Public health policy should be rooted in science, not ideology, and with Kennedy as Secretary of HHS, that foundation is at risk. Not just at risk actually. In peril.
AZPHA opposes Kennedy’s confirmation by the U.S. Senate.
Firearm violence in the United States is taking lives at a rate that’s hard to wrap our minds around. According to a new report from the Commonwealth Fund, the U.S. gun death rate is 15 per 100,000 people, putting us shockingly close to Haiti’s rate and even higher than some war-torn countries. Let that sink in for a moment—the number of Americans dying from firearms each year is at levels we’d expect in active conflict zones.
Comparing Deaths from Gun Violence in the U.S. with Other Countries | Commonwealth Fund
In Arizona, we’re seeing this crisis up close. Our report on firearm violence paints a painful picture of gun-related deaths and injuries across the state. Arizona’s firearm death rate is one of the highest in the country, with both homicides and suicides taking a huge toll on families and communities. Gun violence isn’t just a tragic statistic—it’s a preventable public health crisis that’s affecting young people, communities of color, and rural areas across Arizona.
Firearm Violence in Arizona: Data to Support Prevention Policies
The statistics are grim, especially when we look at specific groups. Firearms are now the leading cause of death for kids and teens in the U.S., and this is just as true in Arizona. The burden is especially heavy for Indigenous and Hispanic communities, who experience higher rates of firearm deaths than the state average.
Firearm Violence in Arizona: An Avoidable Public Health Crisis – AZ Public Health Association
These aren’t just numbers; they represent real lives—children, parents, and friends who are lost forever because of preventable violence. And the ripple effects of this violence are profound, creating lasting trauma, fear, and uncertainty in Arizona communities.
But it doesn’t have to be this way. There are proven steps that Arizona can take to reduce gun violence, save lives, and create safer communities. The evidence is clear that a few common-sense, foundational laws could make a meaningful difference:
It’s time to act. Arizona can be a leader in addressing this public health crisis by passing these evidence-based laws that we know save lives. Other states that have adopted these measures have seen real reductions in gun violence. Every day we delay is another day that lives are lost unnecessarily to firearm violence.
By taking these four steps, Arizona can make a meaningful difference and help protect families, children, and communities across the state.
Editorial Note: We had hoped there would be an opening available to pass some evidence-based policies to stem the tide of firearm deaths in Arizona like passing child access prevention, ‘Red Flag’ laws and state background checks. Sadly, those efforts will now be set aside for yet another year. While some legislators will likely propose such laws again – like in previous years they will not be given an opportunity by leadership to be assigned to committees.
When the Trump administration takes the reins of the executive branch in a couple of months, we’re likely to see a public health policy shift rooted in “Project 2025.”
Unlike the Biden administration’s focus on evidence-based policies and health equity, Project 2025 pushes for reducing federal oversight, cutting programs for vulnerable communities, and giving states greater control over health decisions.
Appointing Robert F. Kennedy Jr. as Secretary of Health and Human Services would reinforce this shift, as Kennedy’s views often diverge from mainstream public health approaches, especially on issues like vaccination and disease prevention.
If Project 2025 takes center stage, agencies like the CDC, FDA, and CMS might scale back regulatory efforts, particularly those aimed at addressing social determinants of health, climate impacts, and preventive healthcare.
This shift could lead to limited funding for programs that support underserved communities, such as initiatives targeting maternal health, opioid addiction, and mental health support. Priorities might pivot toward deregulation and personal choice, rather than federal mandates rooted in public health research.
The roadmap could also mean a push to deregulate the pharmaceutical industry and roll back FDA approval processes, potentially emphasizing speed over rigor. Additionally, climate-focused health initiatives could be deprioritized or cut altogether, despite growing evidence on the health risks of climate change.
Ultimately, Project 2025 promises a major reorientation, replacing much of the evidence-driven focus of the last few years with a less regulated, state-led model. As public health experts warn, such a move could risk widening health disparities, undermining infectious disease prevention, and reducing access to safe, effective medical care.
Related:
The Heritage Foundation’s Project 2025 has published a report that is essentially a blueprint for what they urge the incoming Trump administration to accomplish. While the report itself distances itself from Mr. Trump, the narrative pursued by their leadership over the last year suggests the team at the Heritage foundation has been collaborating closely with the persons that would be expected to have power shortly.
The report proposes extensive changes to the U.S. Department of Health and Human Services including CDC, FDA, HRSA, CMS and the NIH. While framed as cost-cutting and efficiency measures in the report, the reforms risk eroding critical public health infrastructure and reducing agency effectiveness.
Here’s a breakdown of the potentially damaging public health impacts if these recommendations were implemented:
Implementing the recommendations from Project 2025 may lead to a fragmented, underfunded HHS, significantly weakening the nation’s ability to support and protect public health. Instead of enhancing efficiency, these reforms may compromise public safety, worsen health inequities, and hinder the government’s ability to respond to health crises.
