5 Things California: Q&A w/John Baackes, Public health in the budget, HCBS spending plan

While DJ is away on vacation, I’ll be bringing you the next few editions of 5 Things We’re Watching. I’m the managing editor here at State of Reform where I have my eye on health care and health policy in California and a number of other states.

Feel free to email me any feedback or tips on what you think we should be covering!

Emily Boerger
State of Reform

1. Lawmakers pass “placeholder” budget

Facing today’s constitutional deadline, lawmakers passed what stakeholders are describing as a “placeholder” budget yesterday afternoon. The over $260 billion budget, which passed on party-line votes, differs significantly from Newsom’s May Revision in several aspects including its long-term funding for California’s public health system.

In addition to Newsom’s plan to allocate $3 million to study the state’s public health needs, AB 128 includes $200 million annually for local health jurisdictions, $40 million annually for state public health functions, and $35 million annually to develop the public health workforce. Lawmakers are expected to continue to hash out differences with Newsom in the coming weeks.

2. DHCS releases HCBS spending plan

DHCS released its spending plan for state Home and Community-Based Services (HCBS) earlier this month, laying out approximately $3 billion in enhanced federal funding for 35 different initiatives. The spending plan covers five broad areas of funding – direct care workforce support, HCBS navigation initiatives, HCBS transitions, enhanced capacity and models of care, and infrastructure and support.

In this piece, State of Reform Reporter Eli Kirshbaum breaks down the spending plan, highlighting notable funding allocations in each area including the $1 billion in enhanced federal funds (EFF) and $2 billion in total funds dedicated to the Housing and Homelessness Incentive Program. Other funding allocations include $50 million in EFF to nursing home recovery and innovation, and $75 million in EFF to mental health first aid in schools and back-to-school toolkits. DHCS plans to submit the proposal to CMS by July 12.


3. Baackes discusses public option

LA Care Health Plan CEO John Baackes is leading what he describes as the country’s only functioning public health insurance option. In this Q&A, Baackes discusses the co-existence of a public option and commercial insurance, offering lessons learned from LA Care’s experience on the individual market: “It is not single payer, it is not Medicare for all. It is a public entity without shareholders that competes with the commercial plans on a level playing field.”

Baackes also offers his take on health policy moving through the legislature this year, noting his concern about the lack of policy aimed at supporting safety net providers. “We’re not taking the lessons learned [from COVID] and trying to make the safety net stronger by giving it the resources it needs. There’s no bill along those lines, and I think that’s something that the legislature needs to be talking about, and it needs to be a long-term, multi-year view.”


4. CalAIM and CBOs

Maria Lemus, Executive Director of Vision y Compromiso, says the CalAIM initiative hasn’t presented an adequate plan for including community based organizations (CBOs) in its reform of Medi-Cal. She says CalAIM conversations have so far primarily focused on the technical side of implementation – such as funding and reimbursement – but she hasn’t heard enough discussion about the “warm handoff” between health plans and the community.

In this conversation, Lemus describes the impact of community health workers, or “promotores,” and their role as bridges between medical care and community-based supports. “Partnering with community-based organizations to really provide that day-to-day support – whether it’s exercise programs, or it’s nutrition, or it’s wellness programs – I think can turn the tide in wellness for our residents.”


5. Racism as a public health crisis

Nearly a year after 155 organizations penned an open letter to Gov. Gavin Newsom asking him to declare racism a public health crisis, the governor has yet to do so. Advocates have argued an official declaration is a necessary first step toward advancing health equity and creating targeted policies.

Several of California’s local jurisdictions have already issued such statements, as well as the executive leadership of other states including Nevada, Wisconsin, and Michigan. The legislature included over $100 million for programs to address health disparities in their budget proposal – something proponents of the declaration have also called for.