Will Humble Medicaid, Public Health Law, State Legislature, Wills Blog

CMS Puts Medicaid Block Grants on the Table

A couple of days ago CMS released guidance encouraging states to ask for Medicaid waivers that would block grant the services “able bodied adults”.  The block grant would come with increased flexibility about how to spend those federal dollars and what services to provide- but would cap federal funding for that portion of the program. They’re branding the initiative the Medicaid Healthy Adult Initiative.

Here’s the letter that CMS sent to the State Medicaid Directors and their ”Fact Sheet”.

It’s an optional program, so governors will have a choice whether to take the bait or not. I haven’t seen any media responses from our governor about whether he’s interested in such a new block grant waiver. The Oklahoma governor already directed his state health department to begin the waiver application work.

Also, as is standard operating procedure these days it seems, it’s likely that a state or group of states will sue CMS in federal court challenging their authority to approve such waivers – likely arguing that CMS doesn’t possess the authority to do this under the existing law.

Will Humble Medicaid, Public Health Law, State Legislature, Wills Blog

CMS’ New Medicaid Fiscal Accountability Rule Expected this Spring

The new regulation could blow a $2B hole in the AHCCCS Budget & undo Medicaid expansion

CMS is proposing a set of new wide-ranging regulations that would change the way states can pay for their share of Medicaid costs including supplemental payments. The proposed “Medicaid Fiscal Accountability Rule” will have profound implications for the ways in which States finance Medicaid programs and pay for Medicaid services.  It basically changes the ways states can finance the state share of Medicaid costs (including provider taxes like our hospital assessment that pays for Medicaid expansion).

AHCCCS put together a Summary Document that details how the proposed new regulations could impact Arizona’s Medicaid program. Their comment letter is 4 pages long and outlines the challenges the new rule would pose in Arizona.

CMS says that they’re proposing the new rule to “address states’ increasing reliance on donations, taxes, or other financing strategies that CMS perceives mask or circumvent current Medicaid rules regarding how states are permitted to generate the state portion of the Medicaid match.”  

In my opinion, CMS (Seema Verma) wants to force states to finance their match with unpopular taxes so states can’t raise that match and instead cut eligibility and/or services.

One thing is certain with the proposed new Rules…  it’ll be a game changer in terms of how states are able to finance their portion of Medicaid programs (likely including our hospital provider assessment which pays for the state match for our Medicaid expansion). CMS even concedes that they don’t know how the new Rule will play out in states or how it will affect the real people that rely on Medicaid services.

The comment period ended yesterday (we turned in comments) and the final rule will be announced in the coming months.

Will Humble Immigration Policy, Social Determinants, Wills Blog

US Supreme Court Temporarily Allows Homeland Security to Enforce their New ‘Public Charge” Rule

Last week the US Supreme Court granted the president’s request to immediately begin enforcing the Department of Homeland Security’s new “public charge” rule which overhauls how DHS makes decisions about granting legal permanent resident applications. The final rules block legal immigrants from extending their temporary visas or gaining permanent residency if DHS decides the applicant is “likely to rely on designated public benefits in the future”.

The implementation of the new public charge” final rule now has the green light while it’s under judicial review in the lower courts. The SCOTUS issued this Order (which is different from a full on opinion). The Order stayed the temporary injunction issued by the district court.  If DHS gets the result they want in the lower courts, then the Plaintiffs (NY etc.) will appeal to the supreme court.  As is often the case these days, it was a 5-4 decision with the usual cast of characters on each side of the issue.

DHS will now begin considering whether applicants for legal permanent status have received Medicaid (AHCCCS), the Supplemental Nutrition Assistance Program (food stamps), or Section 8 Housing assistance in the past.  The definition of a “public charge” in the new Rule is: “an individual who receives one or more designated public benefits for more than 12 months in the aggregate within any 36-month period”. 

Medicaid limits eligibility (for immigrants) to qualified legal immigrants with refugee status, veterans, and people lawfully present in the US for 5 years or more. State Medicaid programs can elect to provide coverage to legally present immigrants before the 5-year waiting period ends (Arizona does not). 

States get matching funds from CMS when they choose to provide Medicaid coverage to legally present immigrants who are children or pregnant before the end of the 5-year waiting period.  33 states have elected to cover lawfully residing immigrant children and 25 states cover legally present pregnant women – Arizona does not.

Fortunately, the new Rule doesn’t consider whether benefits were used by an applicant’s kids. So, lawfully present kids that are receiving benefits (e.g. Medicaid) won’t have that used against them if the child later applies for legal permanent residency (a “green card”).  The public charge rule will use a “totality of the circumstances” test for applicants, which means that DHS will use the statutory factors and now the new factors laid out in the final rule.

Here are some things to remember about this new Rule

  • This is an issue of legal immigration- unauthorized migrants are largely ineligible for public assistance;

  • This doesn’t directly impact current legal permanent residents (current green card holders). The public charge test won’t be applied to legal current residents (green card holders) applying for citizenship;

  • The new rule isn’t retroactive – meaning public benefits received before 10/15/19 won’t be counted as a public charge; and

  • The new rules don’t apply to refugees. Existing statute prevents DHS from using these criteria for refugees and a couple of smaller exempt groups.

However, this issue is still not resolved. A group of states are still challenging the new DHS regulations arguing that the new rules are inconsistent with the law passed by congress a couple of decades ago (on which the new rules rest).  The district court ruling from a few months ago agreed with the challengers that they were likely to win, and temporarily blocked DHS from implementing the new regulations.

Public health note: 

Even though the final Rule excludes benefits received by children, this policy will still have a significant impact on children’s health as well as the health of their families and our communities.

We know from both national reports and from assistors and community organizations working in Arizona, that families are afraid and withdrawing from or reluctant to participate in benefits for which they or their children are legally eligible. Nationally, nearly one in four children have an immigrant parent, and almost 90% of them are US citizens.  Missing out on safety net programs for which folks are entitled can result in bad health outcomes because of social determinants that won’t be addressed and missed doctor’s appointments which could result in missed developmental screenings and interventions.

The fate of the new regulations are in the hands of the Judicial branch and to some extent in the hands of the voters this fall.

What we can do is to get the word out to families in this category that signing up their kids for safety net benefits to which they’re entitled won’t count against them when they apply for legal permanent status- nor will it count against their kids if they eventually apply for a green card. We can minimize the public health impact of this decision if the public health system is effective in ensuring that families know this important information! 

Will Humble Disease Control, Prevention, Wills Blog

WHO Declares the new Coronavirus a Public Health Emergency of International Concern

Last Thursday the WHO declared the international Coronavirus outbreak a Health Emergency of International Concern.  WHO defines a public health emergency of international concern as “an extraordinary event” that constitutes a “public health risk to other States through the international spread of disease” and “require a coordinated international response.”  

The most important words there are the require an international response words.  Declaring the Coronavirus a public health emergency of international concern allows the WHO to better coordinate the international response and hold countries accountable if they don’t implement certain standards regarding things like travel, trade, quarantine or screening.  The declaration can also free up additional resources to implement interventions.

There’s still a chance that a combination of public health interventions can slow or stop the spread of this new virus – but the chances of that happening are decreasing in my opinion because of that fact that it has now spread to some countries with less mature public health systems.  Much will depend on whether persons are truly communicable before they have symptoms- a key indicator for how effective isolation interventions can be.  Other key information that’s still not complete includes how virulent (serious) and how communicable the virus is.

If it begins circulating in the US at some point, we will have advantages that China doesn’t have right now- a better understanding of the etiology of the disease and the most effective treatment options.   

However, it has to be said that the Chinese have advantages that the US public health system won’t have – in that they’re able to implement public health interventions that we could never do because of civil liberty constraints. 

Will Humble State Legislature, Wills Blog

Legislative Update

This Policy Update is already pretty long…  so I don’t think I’ll list all the bills we’re tracking again here- but here’s a link to last week’s update that has the core bills we’re tracking and our positions on them.

However there are a few new bills that have been proposed since last week’s update- so I’ve included those below:

SB1472  Maternal Health; Postpartum Visits – AzPHA Supports

This is a terrific bill from Senator Carter that would direct AHCCCS to require their contracted health plans to increase post-partum visits by new moms and increases the appropriation that would be required to pay for this important initiative.  There are a ton of important physical and behavioral health reasons to implement this important initiative.

1493 Dispensing Hormonal Contraceptives – AzPHA Supports

This is a bill we support from Sen. Ugenti Rita which would allow a pharmacist to dispense a self-administered hormonal contraceptive to a person 18 or over under a standing order. There are checks and balances in this statute to ensure that best practices are used. This is a net public health benefit as teen births are the number one cause of inter-generational poverty and the bad health outcomes that result.

HB2535 Preventive Dental Care (AHCCCS) –  AzPHA Supports

This bill from Representative Shah would boost the adult oral health coverage for Medicaid members to include two regular cleanings, fluoride 15 treatment, and one set of X-rays annually.  We are in support of this common-sense bill.

SB1397 Health Insurance; Preexisting conditions

This bill provides a partial backstop in case the US Supreme Court strikes down the Affordable Care Act. It would prohibit health insurers from offering health insurance plans that exclude people with preexisting conditions from coverage. It’s silent on whether people with preexisting conditions could be charged higher premiums (in other words – yes – they could)

This Week’s Member Action Item:

HB 2608  Overdose; Disease Prevention (syringe services) will be heard in the House Health and Human Services Committee at 9 am on Thursday January 30.  Please sign in to the azleg system and express your support for this important bill.  It will decriminalize syringe services programs in Arizona. 

It’s currently a felony to provide syringes to injection drug users via a syringe access program even though these programs are evidence-based programs that reduce the spread of Hepatitis C, HIV and other blood-borne pathogens and engage injection drug users in treatment.  We have supported bills like this for the last several years, but they have yet to be successful.

Will Humble Assurance & Licensure, Disease Control, Firearm Safety, Injury Prevention, Opioids, Prevention, Public Health, Public Health Law, State Legislature, Tobacco, Vaccination, Wills Blog

It’s Public Health Policy Showtime

The 2020 Legislative Session and it’s showtime for public health legislative advocacy. Over the coming weeks and months, we’ll be trying to influence our Arizona elected officials to make evidence-based public health policy decisions.  Each week we will have an ask or two from our members to contact their Legislators and to sign up in favor of or against bills that will be under consideration in the next few days. 

If you haven’t yet signed up on the www.azleg.gov system yet please do that in the next few days so you’ll be prepared to add yours to our collective public health policy voice.  The instructions for signing up for the state legislature’s website is in this blog post from a couple of weeks ago this blog post from a couple of weeks ago.

Hundreds of bills have been proposed so far and we now have a starter list of those that we’ll be focusing on. This list will build and then shrink in the coming weeks.  Below is where we are right now.  We have 2 action items for you this week:

This Week’s Member Action Items:

HB 2608  Overdose; Disease Prevention (syringe services) will be heard in the House Health and Human Services Committee at 9 am on Thursday January 30.  Please sign in to the azleg system and express your support for this important bill.  It will decriminalize syringe services programs in Arizona. 

It’s currently a felony to provide syringes to injection drug users via a syringe access program even though these programs are evidence-based programs that reduce the spread of Hepatitis C, HIV and other bloodborne pathogens and engage injection drug users in treatment.  We have supported bills like this for the last several years, but they have yet to be successful.

SB1170  AHCCCS Dental Care for Pregnant Women will be heard in the Senate Health and Human Services Committee on Wednesday morning at 9 am.  This bill from Sen Carter would expand oral health coverage for pregnant women enrolled in AHCCCS to include preventive and other services.  This is a terrific bill for public health because a mom’s oral health status is directly linked to birth outcomes. 

A new systematic review found a clear relationship between periodontal disease and pre-term birth, low birth weight and preeclampsia (potentially dangerous high blood pressure during delivery).   

Here’s the list of bills that we’re conducting advocacy for and against so far:

Tobacco Control

HB2636   Tobacco Retail Licensing –  AzPHA Supports

This bill (sponsored by Representative Blackman) would facilitate a licensing system for stores that wish to sell tobacco products including e-cigarettes.  It also references the amendment to federal FDA law that raises the tobacco sale age to 21.  This bill would be helpful to ensure compliance with the new federal age standard. The licensing system would be coordinated by the ADHS and begin on January 1, 2022.

HB2637   Tobacco Definition –  AzPHA Supports

This bill (sponsored by Representative Blackman) will define electronic cigarettes as a tobacco product for the all purposes of state law (although I don’t think that this would extend for tax purposes although I’m not sure yet).

HB2173   Smoke Free AZ Act Amendments –  AzPHA Supports

This bill sponsored by Representative Kavanagh would amend the voter approved Smoke Free Arizona Act to include electronic cigarettes.  Because this amends a voter approved initiative it will need a supermajority vote in the legislature.

Immunizations

HB2050 Immunizations; Parental Control – AzPHA Opposes

This (Fillmore) bill would essentially get rid of the current system by which schools track whether students are vaccinated or not.  Currently, parents decide whether to vaccinate their children and schools can’t require students to receive the recommended immunizations OR refuse to admit or otherwise penalize a student because the student has not received the recommended immunizations as long as the parent signs a personal exemption. Bad bill

HB2486  Immunization Requirements – AzPHA Opposes

This bill would basically do away with the FDA vaccine approval process and replace it with criteria set by this law for the purposes of implementing vaccination requirements.  The FDA has a rigorous approval protocol that includes all the core elements to determine whether they are safe and effective.  The data are reviewed by independent panels and approved using rigorous protocols.

This bill adds a series of additional requirements that, unless met, mean that a vaccine is eliminated from any vaccination requirement. It’s basically an IED to get completely rid of all vaccination requirements.  Bad bill.

Oral Health

HB 2244 Dental; Native Americans –  AzPHA Supports

This bill would require AHCCCS to seek federal authorization to reimburse IHS and tribal facilities to cover the cost of adult dental services that are eligible for a federal medical assistance percentage of 100%.  Authorizes AHCCCS to seek CMS approval to reimburse Indian health care dental providers that receive 100% FMAP for the cost of dental services. Passed House Health 9-0 this week.

HB2423 & SB1170  AHCCCS Dental for Pregnant Women –  AzPHA Supports

These bills from Rep. Butler & Sen Carter would expand oral health coverage for pregnant women enrolled in AHCCCS to include preventive and other services.  This is a terrific bill for public health because a mom’s oral health status is directly linked to birth outcomes.

A new systematic review found a clear relationship between periodontal disease and pre-term birth, low birth weight and preeclampsia (potentially dangerous high blood pressure during delivery).   The implications of the study are profound.  

HB2535  Preventive Dental Care (AHCCCS) –  AzPHA Supports

This bill from Representative Shah would boost the adult oral health coverage for Medicaid members to include two regular cleanings, fluoride 15 treatment, and one set of X-rays annually.  We are in support of this common-sense bill.

Social Determinants

HB2104 Child Care Assistance and Training –  AzPHA Supports

This bill would let ADES waive work requirements for people enrolled full time in an accredited educational institution in order to continue to provide supplemental child care assistance subsidies for the dependent child. 

Disease Control

SB 1028   Public Health Surveillance –  AzPHA Supports

Adds “an emerging public health threat to the list of things that can trigger ADHS enhanced surveillance orders and compliance with mandatory public health interventions.  The idea is that the bill would provide enhanced surveillance authority for emerging public health threats that aren’t yet a full public health emergency- along the lines of doing enhanced surveillance when persons were getting severe lung illnesses from the bootleg vaping products that contained vitamin e acetate.

Workforce

SB 1167 Graduate Medical Education – AzPHA Supports

This important bill from Sen Carter would set up a program to reimburse primary care residency programs and qualifying  Community Health Centers.  This bill is important because it addresses the shortages that we face in rural and under-served areas by setting up residency programs that will have a ling-term positive impact on access to care (especially primary care) in these areas. 

HB 2296 Native American AHEC – AzPHA Supports

This bill would create a sixth Area Health Education Center (AHEC) that will focus on the Indian Health System. AHECs are committed to expanding the health care workforce, while maximizing diversity and facilitating distribution, especially in rural and under-served communities and offer creative, hands-on and innovative health career curriculum for pre-college level students.

Vulnerable Populations

HB 2608  Syringe Services – AzPHA Supports

This bill would decriminalize syringe services programs in Arizona.  It is currently a felony to provide syringes to injection drug users via a syringe access program even though these programs are evidence-based programs that reduce the spread of Hepatitis C, HIV and other blood-borne pathogens and engage injection drug users in treatment.  We have supported bills like this for the last several years, but they have yet to be successful.

HB 2549 Adult Protective Services Audit – AzPHA Supports

A recent report from the Developmental Disabilities Planning Council has identified several critical shortcomings in the performance of the Adult Protective Services program at the Arizona Department of Economic Security. This bill would charge the Auditor General’s Office with contracting for an independent evaluation of APS’ performance- an evaluation that is sorely needed.  It includes a $300K appropriation to conduct the review.

SB 1086 Licensing Surveyors –  AzPHA Supports

Appropriates $3M & 44 staff positions in FY 2021 for additional (ADHS) long-term care facility surveyors.  Normally, these services would be paid for via a licensing fee.  In this case, the bill contemplates a general fund appropriation. 

The genesis of this bill is as a result of the 2019 Auditor General’s Report that found the ADHS is not adequately following up on complaints at skilled nursing facilities in Arizona. Passed Senate Health 8-0 last week.

HB 2031   School Marshals – AzPHA Opposes

Lawmakers just introduced a new bill that would bring guns into Arizona schools.  HB 2031 would create a school marshal program that would allow school employees across Arizona to carry concealed firearms on school grounds, during school hours.  There is no evidence in the literature that we could find to demonstrate that this is an evidence-based intervention to prevent violence and injury in schools so we are opposing the measure.

SB 1164 Severe Threat Order of Protection – AzPHA Supports

This bill would create a new kind of severe threat order of protection (with judicial review) and place new requirements for persons for who the orders have been issued including prohibiting the person from buying or having a firearm during the order’s duration.

SB 1169 School Health Program – AzPHA Supports

This bill from Sen Carter would support the costs of placing nurses and psychologists in Arizona public schools. The bill includes a detailed list of application standards for schools.

Nutrition

SB1221   SNAP; benefit match –  AzPHA Supports

This bill would direct an appropriation of $800K to the ADES to develop the infrastructure to create a produce incentive program within SNAP (food stamps) and to help enrollees to buy Arizona grown fruits and vegetables. 

Will Humble Assurance & Licensure, Wills Blog

Candid Report on Protecting Vulnerable Adults from the Arizona Developmental Disabilities Planning Council 

The Arizona the Arizona Developmental Disabilities Planning Council- expands resources through planning for folks with developmental disabilities and their families. The Council advocates for folks of all ages to achieve the highest possible level of independence while being included in the life of the surrounding community.  

This week they released an important (and candid) report entitled “Abused and Neglected: A Roadmap for Improving Arizona’s Adult Protective Services”.  It’s a thoughtful report that identifies key shortcomings of the current Adult Protective Services system and provides some common-sense recommendations to improve the current system.  It’s only 24 pages long so don’t pass on reading it because you thought it would be too lengthy!  Here are some of the conclusions and recommendations:

  • APS should complete an outside audit of its operations. Any new system, intake, investigation, or data collection system should be first informed and tested by APS staff before program-wide implementation. Staff are the most knowledgeable of the shortcomings of the current system and can suggest immediate applicable solutions.

  • APS should be adequately funded to ensure accountability, transparency, and effectiveness.  Continuous state funding is needed to increase the number and quality of staffing, improve training, and support a data reporting system that ensures responsiveness to vulnerable adults and their families. Incremental increases in funding are not enough to foster significant improvement in the effectiveness of APS. 

  • Changes need to be made to Arizona’s APS program to build public trust and increase its effectiveness. First and foremost, there needs to be more transparency about how APS conducts investigations. APS must increase outreach to educate agencies and the public about the role APS plays in the protection of vulnerable adults in our communities throughout the state.

  • Collaboration with police and family advocacy centers, which offer forensic interviewing and victim services, can strengthen investigations and increase substantiation rates. The extent of collaboration between law enforcement and APS varies across Arizona but must be strengthened to ensure adequate protection of vulnerable adults.

  • Current state law does not give APS authority to investigate and substantiate cases of emotional abuse. For people with I/DD, bullying and intimidation are pervasive and lifelong concerns. APS authority needs to be expanded to include investigating incidents of emotional abuse.

Sadly, the executive budget released by the Governor last week didn’t propose any additional investments ADES’ Adult Protective Services Program nor were vulnerable adults mentioned in the state of the state address.

There are a couple of bills out there including HB 2549 which would charge the Auditor General’s Office with contracting for an independent evaluation of APS’ performance- an evaluation that is sorely needed.  It includes a $300K appropriation to conduct the review.  HB1086 would  appropriate $3.3M to ADHS for 44 staff to investigate nursing home complaints.  

Perhaps this important (and surprisingly candid) report that came out of his executive branch will raise awareness that Arizona’s Adult Protective Services program needs some attention and resources.

Also, make sure to read the article in today’s Arizona Republic about the shortcomings of our Adult Protective Services system. Very informative.

Will Humble Public Health, Wills Blog

APHA Webinar: Advocacy in the Current Political Climate: Know the Rules and Get Involved

This free webinar is designed to help new and advocates understand the general ethics and legalities related to lobbying and advocacy. The presentation will address common advocacy and lobbying restrictions for employees in non-profit organizations and government agencies and the activities that public health advocates can participate in regardless of their employer and/or profession (yes, even you, state employees!).

The webinar will be held at 3 p.m. ET/noon PT on Monday, February 3. Those who RSVP will receive an emailed link before the event. You can RSVP here. 

APHA will cap this at 100 attendees, but we will make a recording available, as well. Please let me know if you have any questions! 

Will Humble Behavioral Health, Early Childhood, Injury Prevention, Marijuana, Maternal Health, Medicaid, Opioids, Oral Health, Prevention, Public Health, State Legislature, Vaccination, Wills Blog

Governor’s Budget Request Summary

Every mid-January Arizona Governor’s propose their budgets for the upcoming fiscal year. Those budgets set the governor’s priorities and can be influential in what ultimately comes out in the budget. The extent to which the governor’s budget drives the ultimate outcome depends a lot on the relationship between the governor and the majority party in the legislature chambers.

The relationship between the current governor and the majority party in the legislature is cozy and so in the era that we’re in right now- the content of the gov’s budget will likely closely resemble what ultimately comes out this session.

The governor released his budget last Friday and there were some good things in it but also some disappointments. Here goes a summary of his proposal.

Good Things in the Proposed Budget

Newborn Screening Expansion

Arizona’s newborn screening program is run out of the ADHS public health laboratory.  The team tests newborns for a series on metabolic and other disorders and gets the information back to doctors and parents fast so that they can make quick interventions that are critical to good outcomes.  The program is funded by a fee that hospitals and health plans (and AHCCCS) pay for the services which include testing blood spots immediately after birth and again with a new blood spot after a few days.

The program currently bills $36 for the first test (the blood spot test that’s collected right after birth) and $65 for the second test which is collected several days later. The governor’s budget proposes combining the fees into one and boosting the total from $101 to $113.

More revenue would come to the program because of the higher fee ($12 total) and because collections would increase because there would only be one bill.  The extra money would cover the deficit that the program is currently running and allow them to  do 2 additional tests now recommended by HHS:

1) spinal muscular atrophy, a genetic disorder that affects motor nerves; and

2) X-linked Adrenoleukodystrophy, which causes deterioration of myelin, reduces the ability of nerves to communicate with the brain.

Childcare Help for Working Families

The Child Care Development Fund provides subsidies that help low-income working families and foster parents afford childcare. The proposed budget increases funding for the Development Fund by $55M which would go toward boosting rates to childcare providers that participate in the program (which should hopefully build the network and perhaps even get rid of the waiting list).

Some of the money would also go toward providing incentive bonuses to quality childcare facilities ranked by First Things First and help unranked facilities achieve certification.

The folks that can participate in the program include low-income parents who are working; teen parents in school and residents of homeless or domestic violence shelters.

Assistance to Kinship Families

The governor’s budget proposes increasing what is called “kinship assistance funding” which is financial assistance for family members who are caregivers for children that’s called “kinship care.”

Last year Arizona extended the eligibility to all caregivers, regardless of income levels, without filing an application. This year, the proposal is to double the “Grandmother Stipend”.

Suicide Prevention

There have been some solid interventions in the last year to help reduce suicides in Arizona enhancing crisis-response teams, expanding suicide-prevention resources, initiating a campaign to address social isolation, and establishing a Suicide Mortality Review Team. I reviewed some of that in last week’s policy update.

The governor’s budget proposes a general fund appropriation of $400K to help with the work at the Suicide Mortality Review Team. We expect additional evidence-based policy interventions to result from the surveillance work that the Team will undertake using this appropriation.

Protecting Vulnerable Adults and the Elderly

The governor’s proposed budget proposes increasing some (targeted) reimbursement rates to providers of therapy and respite and habilitation care (hopefully stabilizing and improving the availability of those serves for folks that qualify).  The proposal is to increase state funding by $5M which would bring in an additional $11.7M in federal matching funds.

The budget also proposes reimbursement rate increases for providers of aging and adult services for vulnerable and homebound adults and seniors. That increase is $1.5M plus the federal match.

Interestingly, he also proposes tapping the Medical Marijuana Fund to the tune of $6M to provide health care services to 18,000 uninsured or underinsured Arizonans who need treatment for substance abuse. No match or general fund impact with that one.

Disappointments in the Proposed Budget

Adult Protective Services

We had hoped that the governor would have recognized (as did the vulnerable adult task force did) that ADES’ Adult Protective Services needs additional funds and technology to better follow up on neglect and abuse complaints of vulnerable adults. No additional resources were proposed by the governor for this important need. 

Hopefully legislators will recognize the performance shortcomings in the Adult Protective Services program and determine whether additional funds are needed or whether processes and/or personnel and leadership need to change to improve performance. Look for an upcoming series from Stephanie Innes in the Arizona Republic for more on APS.

Abuse & Neglect Investigations in Nursing Homes

We’re disappointed that the governor’s budget proposal fails to address the fact that the ADHS licensing program needs additional funding to be able to adequately follow up on complaints filed by families about nursing home neglect. 

A recent Auditor General’s Report showed that many important complaints are not currently being followed up on.  The agency acknowledged in their response that they don’t have adequate resources to follow up on complaints.

Editorial Note: I’m partly responsible for the lack of resources in the program.  Back during the Recession, the licensing general fund was swept and we were given the ability to charge fees to nursing homes to support our inspections. When we did the math to calculate those fees, we neglected to include Indirect costs which shortchanged the program by 25%.  My bad.

The Senate’s proposed budget includes additional funds (I don’t know if that’s general fund or a fee increase) to help do a better job following up on nursing home complaints.

State Loan Repayment Program

Last year the state’s health care provider loan repayment program which places practitioners in rural and underserved areas that have a dearth of health care providers received a $750K increase. We had hoped that this would be continued for future years, but alas the governor’s budget proposes not funding that increase again.

Oral Health Coverage for Pregnant Medicaid Members

We had hoped to see a proposal to make the small appropriation that would be needed to begin providing oral health coverage for pregnant Medicaid members.  Here’s a blog post from back in March that lays out the case for this important intervention.

State Employee Salaries

We had hoped that there would be a proposal to increase the salaries of public health workers in state government.  Nope.  Again, no increase for hard working state employees (except at DCS etc).

Salaries aren’t the only thing that slows turnover- employees also need to know that their efforts are valued and that they have the ability to make decisions and participate in the development of agency priorities- but salary is part of the equation and state employees have not seen raises in many years.

Will Humble Federal Budget, Federal Public Health Bud, Wills Blog

Final FY 2020 Federal Budget

Federal elected officials finalized the federal budget just before Christmas.  The federal budget included a $4.4B increase for the U.S. Department of HHS including decent increases for CDC and HRSA, including $50M in new CDC funding to improve public health data systems at CDC and state, local, tribal public health departments and an increase of $75 million for CDC’s global disease detection programs.

AzPHA is pleased that the final bill provides both CDC and the NIH each with $12.5M to study gun violence prevention.

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