Will Humble Uncategorized

CDC Vaccine Recommendations in Limbo Amid Leadership Uncertainty

Last week the CDC’s Advisory Committee on Immunization Practices recommended expanding RSV vaccinations to adults aged 50–59 with underlying health conditions and endorsed a new combination meningococcal vaccine for teens.

Normally, this ACIP recommendation would be translated into policy when (if) the CDC adopts the recommendation. Not this time. Acting CDC Director Susan Monarez has recused herself because of “legal limitations” pending her Senate confirmation… meaning the CDC Chief of Staff  – Matthew Buzzelli (a former federal prosecutor with zero medical or public health training) will decide whether to adopt the ACIP recommendations.

Health insurance coverage for vaccines typically follows CDC recommendations. Under the Affordable Care Act private insurance plans must cover new vaccine recommendations in the next plan year.

Until the CDC officially adopts ACIP’s recommendations, coverage for both these vaccines will remain as is. Buzzelli may very well not decide at all or veto the ACIP’s recommendation.

Will Humble Professional Development, Wills Blog

That’s A Wrap: AZPHA’s 2025 Conference

Thank you to all the attendees, speakers, sponsors, exhibitors, poster presenters and AZPHA board members who attended our 2025 conference on April 3! 

All in all we had about 250 attendees at the conference – and by all accounts, engagement was very good – with little attrition as the day progressed.

Here’s a link to the conference Speaker Biographies, Session Learning Objectives and our final Conference Brochure.  Below are links to many of the presentations that our speakers shared with you during the conference. 

Thanks again for attending and enjoy the rest of the Spring. 

Will Humble Prevention, Wills Blog

U.S. Supreme Court Could Roll Back, Freeze or Eliminate Preventive Health Coverage – Oral Arguments Tomorrow (4/21/25)

On Monday the U.S. Supreme Court will hear Braidwood Management v. Becerra, which could roll back and freeze coverage for key preventive health services and screenings currently required by the Affordable Care Act. The new name for the case is Kennedy v. Braidwood Management, Inc.

At issue is whether commercial health plans have to continue to cover (w/o co pays) the Category A & B preventive services recommended by the U.S. Preventive Services Task Force (USPSTF).​

USPSTF A & B Recommendations

Braidwood argues that USPSTF members have too much unreviewable authority; that they’re “principal officers” under the Constitution who should require Senate confirmation (task force members aren’t Senate confirmed). Because USPTF members aren’t Senate confirmed, the Plaintiffs argue that their decisions are void.

The Biden administration argued in the lower federal lower courts that USPSTF members are “inferior officers” – meaning that they’re adequately supervised by the HHS Secretary and that the recommendations are therefore valid.

​The District Court ruled that all preventive-care coverage requirements that the task force has established since 2010 are invalid.

The U.S. Court of Appeals upheld that District Court decision but disagreed with invalidating all the post 2010 decisions, concluding that HHS should only be prohibited from enforcing the preventive-services coverage requirements against the Braidwood company itself, but not others. In other words that it doesn’t apply to the health care industry as a whole.

It’s unclear whether Kennedy’s Solicitor General will pull punches during oral arguments tomorrow in response to guidance he may get from Trump or because he doesn’t agree with the post 2010 TF decisions or preventive screenings etc. It’s a real risk, as some political appointees are more interested in keeping their jobs than doing them.

ACA’s Preventive Services Requirements are the Next Target for Opponents of the Affordable Care Act:
Braidwood Management v. Becerra

If the Supreme Court sides with the District Court, insurers could opt out of covering services recommended or updated by the USPSTF since 2010, including screenings for colorectal cancer in adults aged 45–49, depression screenings for adolescents, and HIV prevention medications like PrEP – effectively freezing preventive care standards as they existed in 2010.

If they side with the Appeals court, only Braidwood employees would be excluded from getting coverage for preventive health services.

The Supreme Court might even throw out all the currently mandatory coverage for preventive health services. 

Without mandated coverage, many insurers will reintroduce copays or exclude certain preventive services altogether, causing decreased use of preventive care resulting in delayed diagnoses, higher healthcare costs, and widened health disparities.

The ACA’s preventive service mandates will remain in effect until the Supreme Court makes their decision later this summer.

Oral arguments in the case will be held Monday, with a decision this Summer.

Court to hear challenge to ACA preventative-care coverage – SCOTUSblog

Will Humble Uncategorized

Public Health Journalism this Week

Fluoride removal push concerns experts

U.S. Health Secretary pushes reevaluation of fluoride in water – Arizona PBS

Who’s been held accountable for Arizona’s $2.5B Medicaid fraud?

‘It’s gonna have a terrible outcome’: What this former AHCCCS director says about Medicaid cuts

Work requirements may be coming for Medicaid in Arizona. What to know

RFK Jr.-backed bill to ban certain junk food in public schools signed

Will Humble State Legislature, Wills Blog

Legislative Update: April 19, 2025

The AZ legislative session is in a bit of a stasis right now.

No doubt you’ve heard about the standoff between Hobbs & the majority at the legislature regarding funding for services for folks with developmental disabilities.

Last week Hobbs told the legislature she’ll be vetoing any new bills that arrive at her desk until the DD funding shortfall for the current fiscal year is resolved – hence the stasis.

Gov. Hobbs declares moratorium on all bills until disabilities funding passes | Arizona Capitol Times

I expect final votes on bills will be suspended next week – with the major activity being back and forth between the House and Senate on bills that have passed each chamber but in different forms.

No doubt there will also be internal discussions about the DD funding shortfall as well.

I don’t know if there will be any Director Nominations committee hearings next week. Nothing is posted yet. Several nominees haven’t had their hearings yet (including AHCCCS, ADHS, and ADEQ). 

Below is the main list of bills that we’ve weighed in on this session and their status. 

Senate

SB1019 photo enforcement; traffic (AzPHA opposes) Still Alive
SB1071 SNAP TANF verification (AzPHA Opposed) SENT To GOV
SB1108 international medical licenses; provisional licensing (no Position)

SB1308 sober living homes regulation (AZPHA Supports) SIGNED
SB1612 RFP document retention; AHCCCS (No Position) PASSED BOTH Sent Back to Senate w Changes
SB1347 comprehensive dental; ahcccs (AzPHA Supports) Died
SB1604 licensed secure health facility; defendants (AzPHA Supports) PASSED BOTH Sent Back to Senate w Changes
SB1623 GME appropriations (AzPHA Supports) Died

House

HB2001 behavioral health temporary licenses (AzPHA Supports) Conference Committee

HB2012 emergency use products; employers (AzPHA Opposed) VETOED

HB2130 claims; prior authorization (AzPHA Supports) Died

HB2058 immunization proof; higher education (AzPHA Opposed) VETOED

HB2063 parental notification; school immunizations (AzPHA Opposes) VETOED

HB2125 insurance coverage; hearing aids (AzPHA Supports) Died

HB2126 medical records; parental choice (AzPHA Opposes) VETOED

HB2145 registered sanitarians; qualifications (AzPHA Supports) SIGNED

HB2164 school lunches; ultra processed food (AzPHA Supports) SIGNED

HB2165 SNAP; prohibited purchases (AzPHA No Position)VETOED

HB2175 claims; prior auth; company conduct (AzPHA Supports) LANGUISHING

HB2176 training; investigations; complaints (AzPHA Neutral) ON LIFE SUPPORT

HB2257 DCS, vaccination; child placement (AzPHA No Position) ON GOVS DESK

HB2291 opioids, red cap packaging (AzPHA Supports) SIGNED

HB2449 AHCCCS presumptive eligibility (AzPHA Opposed) CONFERENCE COMMITTEE

HB2894 Silver alert criteria (AzPHA Supports) LANGUISHING

Will Humble Medicaid, Wills Blog

AHCCCS Asks Permission to Implement Work Requirements & Five-Year Benefit Limit

​AHCCCS just turned in their waiver request to the CMS asking permission to implement work reporting requirements and establish a five-year lifetime limit on Medicaid benefits for certain adults.

The proposal aligns with Senate Bill 1092 (enacted in 2015) which requires AHCCCS to annually ask CMS permission to implement a work requirement & 5-year lifetime benefit cap for able bodied adults.

See the Final Submitted Waiver Request

As you might expect – the real key in the waiver is the definition of who is ‘able bodied.’

AHCCCS’ proposal has a long list of categories of adults that are exempted because they’re not considered ‘able bodied.’ More on that in a bit.

Once approved by CMS (which will happen unless they think AHCCCS was too generous with excluding populations), “able-bodied adults” aged 19 to 55 would need to engage in at least 20 hours per week of qualifying activities like a job, school attendance or participation in “Employment Support and Development” programs in order to keep their Medicaid coverage.

There will also be a 5-year lifetime limit for Medicaid enrollment in AZ for “able-bodied adults”. ​

Exempt Populations:

  • People who are at least 56 years old;
  • Those who qualify for services through the Indian Health Service or Tribally-Operated Health Facilities;
  • Native Americans;
  • Women up to the end of the 12-month postpartum;
  • Former Arizona foster youth up to age 26;
  • People determined to have a serious mental illness or who have have a qualifying SMI diagnosis;
  • Those in active treatment with respect to a substance use disorder;
  • People receiving temporary or permanent long-term disability benefits from a private insurer or the government;
  • Individuals who are receiving Supplemental Nutrition Assistance Program, Cash Assistance, or Unemployment Insurance income benefits;
  • People who are exempt from ADES’ SNAP Work Requirement programs;
  • Individuals who are determined to be medically frail; 
  • Individuals who have an acute medical condition (physical and/or behavioral) that would prevent them from following the requirements;
  • Full-time high school students who are older than 18 years old;
  • Full-time trade school, college, or graduate students;
  • Victims of domestic violence; 
  • People taking part in AHCCCS Works;
  • Individuals who are homeless or who were recently homeless for up to six months post-housing; 
  • Individuals who have recently been directly affected by a catastrophic event such as a natural disaster; 
  • Parents, caretaker relatives, foster parents, and legal guardians, and caregivers of individuals diagnosed with SMI;
  • Caregivers of a family member who is enrolled in the Arizona Long-Term Care System (ALTCS);
  • Individuals who were incarcerated within the last six months; or
  • Veterans regardless of the discharge status.

Effective implementation will depend on AHCCCS’s ability to cross-reference databases to find exempt individuals, collaborating with agencies like ADES, Social Security etc. for data sharing.

Additionally, it’ll be super important to set up user-friendly systems for “able-bodied” members to report their work, school attendance, or ESD program participation is crucial to prevent unnecessary loss of coverage due to documentation challenges.​

I expect the work program and the 5-year benefit limit for able bodied adults to begin October 1, 2025.

See the Final Submitted Waiver Request

AHCCCS Seeks Public Input on Proposed Medicaid Work Requirements & 5-Year Lifetime Limit on Benefits – AZ Public Health Association

Will Humble Medicaid, Public Health Law, Wills Blog

House Budget Resolution Threatens Big Medicaid (AHCCCS) Cuts

Last Wednesday the U.S. House of Representatives passed a Republican-led budget resolution (216–214) setting the stage for large Medicaid cuts.

While last week’s resolution doesn’t explicitly target Medicaid, it tells the House Energy & Commerce Committee to find $880B in cuts over the next decade—most of which will need to come from Medicaid because that’s basically the only place the Committee can find that level of cuts (Medicare and Social Security are supposedly off the table).

When enacted, these cuts will impact over 79M Americans who rely on Medicaid and the Children’s Health Insurance Program, including about 550,000 people in Arizona (mostly ‘childless adults’).

Most likely the way they’ll do it is by implementing a per capita funding cap and reducing the federal match rate for Medicaid expansion population to 65% from the current 90%.

Arizona is a ‘trigger state’ – so as soon as the federal contribution for ‘childless adults’ drops below 80% 550,000 Arizonans will immediately be kicked off AHCCCS.

Arizona’s Medicaid on the Brink: 550,000 May Lose AHCCCS Health Insurance Amid Federal Cuts

The resolution also allows for up to $4.5 trillion in tax cuts for rich people and raises the debt ceiling by $4 trillion.

The Senate’s version of the budget resolution differs, instructing committees to increase deficits by $5.8 trillion without clear implications for Medicaid cuts.

The two chambers now need to negotiate and come up with a compromise.

If the House resolution is also passed by the Senate and implemented, it will cause big reductions in Medicaid eligibility and kick 550,000 people off AHCCCS – disproportionately impacting rural Arizona – which incidentally voted for Mr. Trump by a wide margin.

New Fiscal Analysis: The Economic Impact of Federal Medicaid Cuts in Arizona

Will Humble Firearm Safety, Wills Blog

A National Public Health Week Call to Action: Let’s Use a Public Health Approach to Address Gun Violence

In 1964 the Surgeon General released a report titled “Smoking and Health” concluding that cigarette smoking is a major cause of lung cancer. The report was a top news story, and led to laws requiring warnings on cigarette packages and bans on advertising. Since then, additional Surgeon General reports focused on secondhand smoke and new tobacco distribution systems, such as e-cigarettes, again resulting in changes to law.

Although it took roughly half a century after the first report for public understanding to follow, smoking rates have declined by more than 50%, decreasing both lung cancer and lung cancer death rates. In addition, tobacco companies settled a lawsuit with states to recover billions of dollars in healthcare costs attributed to tobacco.

In June of last year Surgeon General Vivek Murthy declared firearm violence a public health concern. Was the 2024 Surgeon General Advisory declaring gun violence a public health problem poised to do the same thing?

In March of this year, the report disappeared from the Health and Human Services website by executive order

Gun violence takes multiple forms including suicide, homicide, domestic violence, mass shootings, and mental health effects of witnessing violence.

It’s a uniquely American problem. Overall firearm-related death rate here is over tenfold higher than 28 other high-income countries. Guns are now the leading cause of death for children under age 18, surpassing car accidents, infections, and cancer. Arizona  loses over 1,300 people a year to gun violence at rates over 40% higher than the nation. 

Labeling gun violence a public health problem reveals the true scope of the problem and emphasizes comprehensive, evidence-based approaches to prevention and intervention.

Public health research has found effective solutions to gun violence. These include solutions that don’t infringe on the rights of law-abiding gun owners – licensing, safe storage, and interventions to prevent access for those who pose harm.

Due to a 20-year ban on research related to gun violence that just ended in 2022, we need to improve collection and sources of gun violence data and use them to evaluate short and long-term outcomes of gun violence interventions, as well as investigate best methods to implement these solutions.

AzPHA Report: Firearm Violence in Arizona: Data to Support Prevention Policies

The Surgeon General’s Advisory called for a collective commitment of the nation to open our eyes to the problem, demand evidence-based interventions, and implement regulations that work to mitigate the problem.

In addition, the Surgeon General’s Advisory pushed for a neutral space to talk about the unintended consequences of gun ownership and the need for more research and action on effective strategies. A recent survey of gun owners found high levels of support for gun safety policies. 

In a week that celebrates the value of public health and highlights important gains in health outcomes, like decreases in tobacco-related diseases, infectious diseases, motor vehicle deaths, infant mortality, and improvements in water and food safety, it is important to recognize future challenges.

Even more importantly, we need effective tools, such as Surgeon General’s advisories based on science, to guide prevention strategies that will improve the health of all Americans.

Dr. Sarah Lindstrom Johnson is an Arizona Public Health Association member and an Associate Professor at Arizona State University whose work focuses on decreasing the consequences of violence for youth.

 Jean Ajamie is an Arizona Public Health Association member and an advisor and advocate for youth health and safety and former deputy associate superintendent for school safety for the state of Arizona.

Burt Feuerstein is an Arizona Public Health Association member and a Professor of Child Health and Neurology at the U of A College of Medicine – Phoenix and Emeritus Professor of Lab Medicine, Neurosurgery, and Pediatrics at Univ of CA San Francisco.

Will Humble Health Insurance, Medicaid, Public Health, Wills Blog

Kennedy Cans Everybody Who Calculates the Federal Poverty Limit: Is his Goal to Set the FPL Artificially Low Next Year to Kick People Off Safety Net Programs?

Eligibility for federal safety net programs like Medicaid, SNAP, WIC, and Kids Care requires that applicants establish that they financially qualify.

In order to do the means-testing we need to be able to compare a family’s income to a benchmark to make sure they really need and qualify for a benefit like Medicaid, SNAP or WIC. That benchmark is called the ‘federal poverty level’ (FPL).

For several decades, the federal government has had a small crew of objective and apolitical statisticians who specialize in using economic data to set up the FPL.

The team takes Census Bureau poverty-line figures, adjusts them for inflation, and creates the FPL for the country each year (Alaska and Hawaii have a different FPL than the rest of the US).

This week Secretary Kennedy fired all the staff who do the rigorous and unbiased calculation of the FPL this week. Well, actually, he put them on administrative leave until June 1, at which point they’ll all be canned.

Trump HHS Eliminates Office That Sets Poverty Levels Tied to Benefits for at Least 80 Million People – KFF Health News

HHS will still need to develop an FPL annually – but they’ll no longer have the staff to do it.

Perhaps one of the DOGE bros will take a few minutes and make one up from now on.

There’s a good chance that the mass firing was done so Kennedy/Musk can set their own (arbitrarily low) FPL next year to kick millions of people off safety net programs like Medicaid, SNAP, WIC, and marketplace cost sharing subsidies.

Time will tell – but these guys are good at finding where the hinge points are so they can cause as much damage as possible with the least possible effort.

Will Humble Social Determinants, Wills Blog

Arizona Justice Reinvestment Grant: Does Your Organization Want to Apply?

If your organization supports people affected by substance use or the justice system, you may qualify for a new grant opportunity known as the Arizona Justice Reinvestment Grant. As part of Proposition 207 (Smart and Safe Act aka retail marijuana) Arizona funds organizations that help these communities and persons who were victims of overcharging for marijuana possession by county prosecutors.

This grant is designed for organizations working on:

  • Substance use prevention, treatment, and early intervention
  • Reentry, diversion, rehabilitation, and job training for individuals affected by the justice system
  • Addressing factors that contribute to crime and supporting community safety initiatives
  • Restoring civil rights and clearing charges from records (also known as expungement)

Justice Reinvestment Grant Information Session 4/17/25 9-11am

Justice Reinvestment Information Session 4/24/25 9-11am

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