Will Humble Disease Control, Wills Blog

Responding to Arizona’s Measles Exposures: An Epidemiology Perspective

An alert clinician in Arizona quickly recognized a case of measles in someone – a good thing considering that the doc may not have ever seen a case during her or his residency or practice before. Maybe they have, if they are working on the Colorado Strip and have already seen some cases over the last couple of months.

The doc reported the case to their county health department – which began the public health response to the exposure to measles last week in Maricopa and Coconino Counties.

For county epidemiologists, this index report started a cascade of work in their mostly behind-the-scenes investigations. Their first task is to reconstruct the timeline. They need to know exactly when and where the contagious individual was as measles can spread four days before and after a rash appears and can linger in the air for up to two hours after an infected person leaves a room.

In this case, the timeline points suggest a single index case traveling between Phoenix and Flagstaff — possibly connected to outbreaks currently active in Utah and northern Arizona. I don’t know this for sure – just seems like the most likely scenario.

Next comes exposure assessment. Who is really at risk? Babies under 12–15 months (too young for their first MMR shot) are always a top concern.

Unvaccinated pregnant women are another priority. This was something of a teen-type concert I’m told (a singer named Tate McGraw).

Since the anti-vax movement has ramped up in the last 15 years it’s possible that some of the concert goers were susceptible unvaccinated teens. Outreach interventions come next.

Interestingly, directly contacting concert ticket holders rarely works. Past investigations have shown that email lists bounce, phone numbers are outdated, and tickets don’t always reflect attendance.

Instead, the team focuses on broader interventions: issuing public notices, sending Health Alert Network (HAN) advisories to local clinicians, and using Epi-X to notify providers in other states about potential exposures. Media coverage about the places where exposures happened are important too.

In the coming days, county epis will focus on active case finding, checking logs, watching clinics for anyone presenting with fever, cough, red eyes, or the characteristic measles rash, and preparing for potential secondary cases.

They’ll calculate incubation periods, plan follow-ups, and double-check that messaging reaches the right audiences (the best they can).

Phone calls, log or lab review, case investigations and contact tracing work and public and clinician advisories are important (and sometimes labor-intensive) steps in preventing new cases.

The work is detailed and mostly invisible to the public, but it’s exactly what stops a handful of exposures from snowballing into a full-blown outbreak.

In the end, this cluster of exposures is a reminder about how important it is for doctors and labs to report and for county epidemiologists to move fast, think strategically, and focus on evidence-based interventions where they can make the biggest impact.

Time will tell whether this exposure ends up snowballing or not. The key factors are how many unvaccinated persons were exposed, whether their cases get identified and reported fast, whether or not there’s prompt isolation of new cases and quarantine of unvaccinated exposed persons and how effectively exposed susceptible contacts are found (and whether they cooperate with quarantine recommendations).

What You Need to Know About Measles

  • Symptoms: High fever (101 °F or above), cough, runny nose, red/watery eyes, and a red blotchy rash starting on the face and spreading downward.
  • Who’s at risk: Infants under 12–15 months, unvaccinated children, and unvaccinated pregnant individuals. Adults with two doses of MMR are protected.
  • Exposure windows: Measles can spread four days before and four days after rash onset. The virus can linger in the air for up to two hours after an infected person leaves a space.
  • What to do if you were potentially exposed: Monitor for symptoms through November 27. If symptoms appear, call ahead to your healthcare provider before visiting to prevent the virus spreading..
  • Community impact: Measles is highly contagious (90% of unvaccinated people exposed may get infected) so staying up-to-date on vaccinations protects not just you, but your community.
Will Humble Affordable Care Act, Public Health Law, Wills Blog

What the New Funding Deal Means for Public Health

Congress just passed the Continuing Appropriations Act, 2026 to end the federal government shutdown and keep agencies running. The bill is a mix of short-term and long-term funding.

Some agencies are funded through September 30, 2026, while others only have temporary funding through January 30, 2026, under a continuing resolution (CR).

The deal keeps the government open and gives Congress more time to pass full-year spending bills—but it also means another potential shutdown could happen at the end of January if lawmakers can’t agree again.

Public Health

The CR keeps current funding levels for CDC, HRSA, NIH, SAMHSA and the EPA. These agencies can continue their work for now but could face funding uncertainty after January 30, 2026.

Funding for the National Health Service Corps, Community Health Centers, and Teaching Health Centers also continues at current levels through the same date. The Special Diabetes Program and certain emergency preparedness programs under the Pandemic and All-Hazards Preparedness Act were extended as well.

One good thing is that telehealth flexibilities for Medicare (which had recently expired) are now extended – but only through January 30, 2026. This gives patients, especially in rural areas, continued access to care from home and gives providers time to adjust to long-term telehealth policies, for now.

Sadly, extending enhanced advance premium tax credits weren’t in the package – meaning that Marketplace premiums are set to explode in 2026 as the enhanced tax credits expire. There was apparently a ‘handshake’ deal to take up the extension of those credits by the Senate leader Thune – but not the House Speaker. Basically, there is almost no chance the enhanced premium tax credits will be extended.

Health Insurance Marketplace Open for 2026 Coverage: Folks Should Wait to Commit until after the Tax Credit Issues are Resolved – AZ Public Health Association

Here’s the bullet listing of public health program funds that were extended – as is – through Jan. 30, 2026:

  • Community health centers
  • National Health Service Corps and teaching health centers
  • The Special Diabetes Program.
  • Some of the authorities of the Pandemic and All Hazards Preparedness Act.
    • It didn’t include provisions to reauthorize HPP, PHEP, or other public health programs – those still need to be reauthorized in the new year.
  • Extends Medicare telehealth flexibilities
  • The Sexual Risk Avoidance Education Program
  • The Personal Responsibility Education Program
  • Family-to-Family Health Information Centers.

Federal workforce

The Act directs federal agencies to restore staffing levels to what they were before the shutdown began. Agencies must also reimburse states for any costs they covered while federal funding was paused. Federal employees are protected from furloughs through January 30, 2026, and the bill instructs agencies ‘to spend cautiously’ and only focus on essential needs until full-year budgets are passed.

The bill also prevents automatic PAYGO cuts that would have affected programs like Medicare and certain agriculture supports, giving both states and providers more financial stability.

USDA, WIC, and SNAP

The USDA and FDA got full-year funding through September 30, 2026. That means critical nutrition programs like WIC and SNAP are OK for the next 10 months.

  • WIC funding: $8.2 billion through FY 2026
  • SNAP mandatory funding: $107 billion through FY 2026

AHCCCS

Unlike WIC and SNAP, Medicaid is an entitlement program. Its funding continues automatically and isn’t part of the annual appropriations process. So, it wasn’t directly affected by this shutdown fight.

But – larger changes proposed under H.R. 1—which will reshape and cut funding for Medicaid and other health programs are still in place.

This deal ends the shutdown and gives temporary stability. USDA, FDA, and VA are safely funded through the end of the next fiscal year, so nutrition programs like WIC and SNAP are secure.

But core public health agencies like CDC, NIH, HRSA, SAMHSA, and EPA—will face another funding cliff at the end of January unless Congress acts again. Telehealth flexibility is safe until then too. Medicaid was never in danger this round, but the larger policy debates over health funding will continue into 2026.

Boutique budget bill issue: Hemp

The spending bill also redefined the word “hemp” in federal law. After a 1-year implementation period, intoxicating products made from farmed hemp (Delta-8, THCA etc.) will no longer qualify as “hemp” under federal law (hemp has been OK under federal law while marijuana is still a Schedule 1 narcotic).

Hemp will now be redefined to require that total tetrahydrocannabinols (including THCA) be ≤ 0.3% on a dry-weight basis. That closes the THCA loophole used by chemists who know how to convert THCA to delta-9 THC which is what makes you high.

We can expect lots of state and marijuana industry responses and litigation over the next 12 months. Why?

Basically, because this still doesn’t end the sale of hemp derived THC products at non-licensed marijuana dispensaries in states and state licensed dispensaries. Those places are kinda pissed that the hemp folks are marketing THC products derived from what was hemp at head shops and stuff and want them to knock it off.

Will Humble Professional Development, Wills Blog

AzPHA Student Representative, Dr. Rynn Whealy, Receives National Award

On November 1st, the AzPHA Board of Directors Student Representative, Dr. Ryann Whealy was presented the Council of Affiliates Outstanding Student Award. And coincidentally, her fellow board member, Rebecca Nevedale, had the honor or presenting the award in her role as Chair of the Council of Affiliates. Congratulations, Ryann, on receiving this prestigious award!

Below are the remarks Rebecca shared about Ryann’s contribution to AzPHA.

“Our next award to present is the Outstanding Student Award, and this one is very special to me because the recipient is mine!

Now Doctor Ryann Whealy is the student representative on the Arizona Public Health Association Board of Directors. Ryann has volunteered her time to support programming efforts for the association including to revitalize and expand academic partnerships. She has contributed to the work of AzPHA through her statewide outreach, student engagement and community connections in Flagstaff, where she attended Northern Arizona University. (Go Lumberjacks!)

Ryann aligned her work with AzPHA during National Public Health Week as she coordinated and moderated “Advocacy Starts Here: Amplifying Voices for Public Health” a live panel featuring a mayor, state policy leaders and public health professionals.

The person who nominated Ryann wrote: ‘Ryann’s leadership, reliability and statewide impact are exceptional. She has shown initiative well beyond her formal responsibilities, helped with infrastructure for future student engagement and extended AzPHA’s reach across Arizona’s diverse regions and institutions…’

And I would add that I’ve (Rebecca Nevedale) been on and off the AzPHA board for at least 15 years, and Ryann has truly been the most engaged and inspirational student we’ve had. It took her a while to see how she could contribute, but once she did, our board benefited greatly. We are a stronger board because of Ryann, and we are better prepared to welcome student representatives in the future. She recently moved to Philly so is the Pennsylvania Affiliate’s member now (well… when her AZ dues expire), but she has left such a legacy in the Grand Canyon state.

It has been an incredible honor to watch Ryann over the last few years – going from a somewhat timid and quiet board member to one that (while still quiet), has figured out how to contribute so greatly and think so forward about our affiliate’s academic relations and student connections. It’s truly a great honor to present our 2025 Outstanding Student Award to Dr. Ryann Whealy.”

Will Humble Assurance & Licensure, Wills Blog

GRRC Approves ADHS’ Licensing Fee Update

Last Tuesday the Arizona Governor’s Regulatory Review Council unanimously approved ADHS request to raise fees for licensing healthcare institutions!

The new fees will replace about $3.4M in state general funds that were used to help ADHS fix serious problems in its licensing system. Those problems grew worse under the previous administration, when the agency was short on staff, struggling financially, and suffering from poor leadership.

A report from the Arizona Auditor General found that ADHS had fallen far behind on handling complaints — even serious ones involving unsafe conditions in hospitals and care homes. Some complaints were wrongly labeled as “low risk,” which meant dangerous problems could go unchecked for a year or more. Many were never investigated at all.

By increasing licensing fees, ADHS can now hire and keep the staff needed to do prompt inspections, respond to complaints quickly, and make sure healthcare facilities meet safety standards.

These fees are modest and reasonable, especially compared to the cost of leaving patients at risk. They also make sure that the facilities themselves (not taxpayers) fund the system that keeps them accountable. It essentially immunizes ADHS from  losing the $3.4M in annual revenue that comes from the General Fund.

Thanks to the council’s unanimous vote and ADHS’s leadership for taking a step toward restoring how we protect vulnerable people in our care systems.

Will Humble Medicaid, Public Health, Wills Blog

Noem & Rubio’s $100K H-1B Visa Surcharge: How their decision will harm rural voters who overwhelmingly voted for their boss

The US Homeland Security and State Departments are adding a $100,000 surcharge for most new H-1B applications including physicians and nurses – something that will have a profoundly bad impact in some hospitals, especially rural ones.

The new fee doesn’t apply to docs and nurses who are already in the U.S. on H-1B status –but all new H-1B applications will be subject to the new fee. 

Noem can approve waivers on a case-by-case basis if she thinks “in the national interest” (whatever that might mean to her).  Perhaps it’ll mean the waived fees are only for white South Africans.

State Department to Cut Refugee Admissions & Prioritize White South Africans – The New York Times

The H-1B visa is an employer-sponsored, nonimmigrant visa that allows U.S. companies to employ highly educated foreign professionals in “specialty occupations” that require a minimum of a bachelor’s degree or its equivalent – like doctors and nurses. 

H-1B FAQ – United States Department of State

The new fee will be especially bad for (red) rural America.

Rural and underserved communities often depend on foreign-born clinicians to keep their hospitals and clinics staffed. 

A KFF analysis found that immigrants account for a meaningful share of hospital physicians and other clinical staff… more than a quarter of hospital physicians are immigrants, & foreign-educated nurses have become an important source of hires for many hospitals.

Those clinicians disproportionately practice in specialties and places where U.S. graduates are scarce: family medicine, internal medicine and rural hospitals.

  • H-1B-sponsored physicians made up 1.6% of the physician workforce in rural counties versus 0.95% in urban counties
  • H-1B-sponsored physicians were nearly 400% more common in the highest-poverty counties than the lowest-poverty counties
  • India is by far the largest source (≈71% of approved H-1B petitions

The surcharge changes what had been workable pathway into an unaffordable proposition especially for rural hospitals.

Rural hospitals almost always run on thin money margins and a $100K hit to the budget for a single doctor effectively rules out that option for many.  

Clinics and small hospitals that routinely sponsor international medical graduates or foreign-educated nurses will likely pause or stop most new sponsorships. That means openings that had been filled by foreign clinicians will remain vacant or close.

Residency programs, fellowship placements and other training pipelines that rely on international trainees will be scaled back especially among (rural) programs that can’t afford the fee may reduce slots that have been helping a lot in rural and underserved areas.

The bottleneck is worse because we already have a structural shortage of physicians (and residency slots to train physicians) in primary care and rural areas.

The long and short of it is rural areas will be seeing even more delayed care, longer ambulance runs, service limits, clinic closures, and longer drives for rural patients – many in places that voted for Trump by a wide margin.

Trump’s new $100K visa fee could pummel red state hospitals – POLITICO

Just another example of bad policy making – at least bad for here. This will be helpful for hospitals and medical care in India though.

Will Humble Healthcare, Public Health, Wills Blog

Arizona Submits Rural Health Transformation Grant Application to Feds

Governor Hobbs’ team turned in Arizona’s plan for the federal Rural Health Transformation Program, which is meant to help people in rural areas get better access to health care and support the doctors, nurses, and clinics that serve them.

The $10B national fund was included in HR1 as political cover for cutting Medicaid funding starting in 2027 which will, over time, have a profoundly bad impact on access to care in rural America.

AZ’s plan focuses on supporting the rural health care workforce and improving access to care. For the workforce part, it asks for $57M/year for 5 years to support medical residencies, training, and education for people who want to work in rural health. That is really good.

From the report: Rural Health Workforce Development and Training Program to recruit and retain clinicians and allied health professionals using high school educational pathways, education accessibility incentives, financial incentives (including stipends, commuting, and relocation support), and provider upskilling and residency support (both tied to rural service commitments). 

It also has some money to keep current doctors and nurses in rural areas by helping with relocation and commuting. 

Note: See how Noem and Rubio are working against rural healthcare in the next blog about their new $100K H1B visa application surcharge for foreign born doctors: Noem & Rubio’s $100K H-1B Visa Surcharge: How their decision will harm rural voters who overwhelmingly voted for their boss – AZ Public Health Association

The plan requests $45M/year for 5 years to expand telehealth, mobile clinics, co-located services, and better health transportation. Some of it’s for behavioral health and substance use services, including naloxone access, tele-behavioral health, and crisis services ($10M).

Another $5M is for maternal-fetal health, supporting obstetric care and mental health resources for mothers.

The 7 person Arizona Office of Economic Opportunity (in the Governor’s Office) will oversee and coordinate many of the initiatives, but ADHS and AHCCCS will oversee other parts:

Workforce Development  OEO
Behavioral Health and SUD Expansion Grant AHCCCS
Chronic Disease Prevention and Management Grant ADHS
Improving Rural Maternal-Fetal Health Grant ADHS
Telehealth, Mobile Clinics, Service Access Expansion OEO
Technology upgrades, administrative streamlining OEO
Coordination and Oversight OEO

Editorial Note: Seems to me that too many of the responsibilities are tied to a current 7-person office run out of the Governor’s Office (OEO). If it were me, I’d consider giving AHCCCS?ADHS more of these responsibilities (especially workforce development).

Governor Hobbs hopes to hear back from the federal government by New Year’s Eve, with funding starting in early 2026.

See Arizona’s 90-page Rural Health Transformation Plan
Will Humble Behavioral Health, Healthcare, Wills Blog

A Win for Mental Health in Maricopa County

Good news! Voters in Maricopa County said yes to Proposition 409, narrowly approving (51-49) a $898M bond for Valleywise Health — our county’s public safety‑net health system.

What this means in plain language: for about $25‑30 more per year in property tax for the average household, we’re going to build and improve real mental and behavioral health services.

  • Valleywise will be building a new 200‑bed behavioral health hospital to replace the old facility — which is more than 50 years old — and double the number of beds for people with serious mental illness.
  • Arizona is ranked 48th in access to mental health care. In Maricopa County, the suicide rate in 2023 was about 17.5 per 100,000, higher than the national average.
  • This bond also supports outpatient clinics, emergency services, and training programs — meaning more people will get help where they live, when they need it.

The result shows that a small majority of voters in Maricopa County care about the members of their communities who struggle with mental illness and care about families who need a place to turn when the system isn’t working.

Thanks to this measure, Valleywise will be better equipped to answer that call. It’s a strong step toward health equity, better mental‑health access, and a safer, stronger community.

Will Humble Affordable Care Act, Wills Blog

Health Insurance Marketplace Open for 2026 Coverage: Folks Should Wait to Commit until after the Tax Credit Issues are Resolved

Marketplace Open Enrollment Period began yesterday and runs through January 15, 2026. During the last Open Enrollment Period just over 400,000 Arizonans elected health coverage through the Marketplace.

Now is a good time to do the research and shop for a plan – but it’s NOT a good time to sign on the dotted line. Why? Because you can’t be sure how much your plan will cost – until Congress figures out whether there will be enhances advance premium tax credits or not.

How to handle Obamacare uncertainty | 12news.com

Finding health coverage can feel complicated and honestly mind numbing. Fortunately, we have Cover Arizona to help you with certified enrollment assistors who can find the best healthcare options. The services are free, and appointments are available in-person and over the phone.

Cover Arizona helps community members understand their health insurance options and helps them apply for AHCCCS, KidsCare and Marketplace coverage.

You need to pick and pay for the first month coverage by December 15 to get coverage by January 1, 2026…  but it’s probably best to do your window shopping now but wait until the tax credit issue is resolved before actually signing up.

Visit CoverAZ.org or call 1-800-377-3536 to schedule free, one-on-one assistance.

Will Humble Assurance & Licensure, Public Health, Wills Blog

AZPHA Backs ADHS Licensing Fee Increase: Hearing is Tuesday

Summary

  • In 2009 the state legislature ended funding to support regulation of nursing homes, assisted living, behavioral health and other care facilities, instead authorizing them to pay for those regulatory functions with license fees.
  • ADHS set those fees in 2009. For the first few years the fees provided enough revenue to do a decent job. By 2016 it was clear those fees were not sufficient, and the agency began falling behind on inspections and especially complaint investigations.
  • The result was catastrophic for patients. Thousands of complaints were never investigated or investigated way too late. The Arizona Auditor General documented ADHS’ nonfeasance and professional misconduct several times, filing scathing reports that were ignored by the agency during the Ducey era: See Auditor General’s Office Produces Scathing Review of ADHS’ Nursing Home Complaint Investigations During the Ducey Era
  • The state legislature held hearings trying to hold the agency accountable, with some success. General fund appropriations of $3.4M were infused into the agency’s licensing program in an attempt to improve their performance.
  • Under new leadership (and with the added funds) the agency finally began to improve their performance. With the state budget now at serious risk, the Department is seeking to finally raise their fees such that if the GF appropriation is cut they will be able to keep status quo.
  • The modest fee increases the agency is proposing are still not enough to meet their full regulatory responsibilities at medical and care home facilities. Additionally, the fee increases will not ensure good future performance. That will require continued improved agency leadership.

_________________________

For the first time in more than 15 years, the ADHS is planning to raise the fees it charges licensed healthcare and residential facilities. These licensing fees fund regulatory activities, including inspections, complaint investigations, and enforcement actions, across a wide array of facilities like assisted living and skilled nursing facilities, hospitals, residential behavioral health centers, group homes, and outpatient treatment centers.* Without adequate funding, ADHS can’t fulfill its mission to protect the public.

The revenue shortfall has been unsustainable for nearly a decade, and AzPHA has consistently urged the Department to increase its licensing fees since 2017. Sadly, Directors Cara Christ and Don Herrington ignored our pleas.

We’re delighted Interim Director Sjolander finally proposed the Rulemaking, taking a critical step toward ensuring that ADHS has the basic resources to regulate care environments.

The consequences of underfunding (and of unethical leadership during the Ducey Administration) have been dangerous. With resources stretched thin and a “head count cap” imposed by Ducey, former Director Christ and Assistant Colby Bower refused to acknowledge the Auditor General’s findings of major performance failures.

Instead, they reclassified more than 95% of high-risk complaints as “low risk,” effectively cooking the books to make the agency look competent. It wasn’t.

Report: Arizona Health Department may still put seniors at risk

How The Republic reported on resident harm in senior living facilities

These decisions delayed complaint investigation by up to a year – or even worse – closing hundreds of complaints (even serious ones) with no investigation… indefensible decisions that contributed to tragic and even lethal outcomes for vulnerable Arizonans.

While these outcomes were mainly the result of unethical director-level leadership decisions, it’s also clear inadequate funding contributed significantly to the Department’s failures.

Audit: Arizona’s system of protecting vulnerable adults is lacking

Suspected abuse of vulnerable adults in Arizona is rarely verified

After learning about the astonishing nonfeasance by the Department via the Arizona Auditor General’s Office (AZ Auditor Summary Letter), the state legislature appropriated $3.5M in state general funds to provide the ADHS with emergency resources, money that could easily disappear in next year’s budget.

This ADHS rulemaking essentially raises fees such that if state general funds are removed in FY2026, the Department won’t again be grossly understaffed and fail at their mission to protect the most vulnerable in our state.

Notice of Final Rulemaking

Economic Impact Evaluation

The proposed rulemaking (on the GRRC docket next Tuesday) looks to restore self-funding so ADHS can keep their current staffing levels even if the legislature removes their licensing fund GF appropriations. It doesn’t provide the agency with the ability to increase staffing levels (which they need to do), it just prevents them from losing inspectors.

The final approval of the new licensing fees will be considered by the Governor’s Regulatory Review Council on Tuesday, November 4, at 10 a.m. AZPHA will provide testimony in support of the fee adjustments.

GRRC Meeting Agenda – November 4, 2025

Our participation is important, as 14 entities sent in arguments complaining about the fee adjustments. AZPHA was the only organization that weighed in support.

It’s important to remember that the adjusted fees won’t guarantee ADHS will do their job regulating care facilities. It also requires an engaged governor’s office, talented and ethical director & assistant director leadership, quality staff and continued oversight from the Auditor General’s Office.

After all, we saw firsthand how quickly things can unravel when there’s unethical and poor-quality agency and 9th floor ‘leadership’.

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