Black Health Equity Advocacy Week
CBHN is proud to announce a major success in declaring May 1-5, 2023, and every first week of May thereafter, as Black Health Equity Advocacy Week in California. This comes after Assemblymember Akilah Weber, M.D., (D-San Diego), with the unanimous support of the California Legislative Black Caucus (CLBC), introduced ACR-53, a resolution that establishes the first of its kind, a statewide focus on the need to address the health disparities gap for Black Californians. The resolution also commends CBHN for its efforts to improve the health, well-being, and life expectancy of Black Californians.
View Press Release CBHN_ACR53Release_Draft for Dr Weber review_Approved
CBHN 2023 Budget and Legislative Priorities:
AB 85 (Weber) Social Determinants of Health: Screening and Outreach: It would require health plans and insurers to pay for the screening for social determinants of health. This bill will ensure that healthcare teams have the resources to conduct SDOH screenings and to adapt their workflows in a way that doesn’t contribute to further burnout and allows them to discuss behaviors and social factors that influence patient health outcomes. Furthermore, this bill will increase efforts to bridge patients to community resources or government social services to address their SDOH needs by requiring health plans and insurers to provide access to community health workers. Finally, this bill will establish a workgroup to create a standardized model and procedures for connecting patients with community resources, to assess the need for a centralized list of accredited community providers, and to determine gaps in research and data to inform policies on system changes to address SDOH.
Significance: AB 85 is intended to close the gap between community-based organizations (CBOs) and providers to improve follow-ups after screening and collaboration efforts with community organizations to assist patients with their social needs.
AB 11 (Jackson) Affordable California Commission: It would create the Affordable California Commission to assess factors contributing to California’s rising cost of living.
Significance: For Black Californians, stagnant wages and the rise of inflation at 8.2% have made it difficult to afford the cost of food, housing, healthcare, and energy. The bill would require the Commission to produce a report on its findings and recommendations to address the major causes of the rising cost of living and submit it to the Legislature by August 31, 2025. This is an essential step in assessing the factors driving up California’s cost of living and determining tangible recommendations.
AB 41 (Holden) The Digital Equity in Video Franchising Act of 2023: It would rename the Digital Infrastructure and Video Competition Act of 2006 (DIVCA) to the Digital Equity in Video Franchising Act (DEVFA). AB 41 strengthens anti-discrimination statutes by establishing a state policy to require certain cable operators or video service providers to offer equal access to subscribers within the service areas. The bill defines equal access as “the equal opportunity to subscribe to an offered service that provides comparable capacities and other quality-of-service metrics in a given area for comparable terms and conditions.” The bill gives the Public Utilities Commission (PUC) the right to exercise its oversight authority as established by state and federal law.
Significance: According to the 2020 American Community Survey, only 83% of Black households in California have broadband, putting them at a significant disadvantage in getting their school work done or finding jobs. AB 41 strengthens antidiscrimination provisions in the statutes and empowers CPU to enforce them.
AB 228 (Wilson) Infant Formula Stockpile: It would also establish the Infant Formula Advisory Committee to make recommendations for developing guidelines for the procurement, management, and distribution of infant formula and advise the development and implementation of the program. The bill would require the committee to provide an annual report to the Legislature with feedback regarding the program’s implementation and updates regarding policy changes and public comments.
Significance: The baby formula shortage impacted Black and many low-income mothers. According to the Centers for Disease Control and Prevention, fewer than 74.1% of Black infants are breastfed, lower than all other groups. The same report attributed “unsupportive work policies and lack of parental leave” as significant factors for Black and low-income mothers to stop breastfeeding early. AB 228 would implement the 2022 FDA’s recommendation for each state to have a strategy to have a stockpile of infant formula to ensure California has safe and reliable infant formula in case of shortages.
AB 249 (Holden) School sites: Lead Testing: Conservation: It would require the community water system that serves a school site built before January 1, 2010, to test for lead in each school site’s portable water system by January 1, 2027. If the lead level exceeds five parts per billion, the bill requires the community water system to report its finding to the local educational agency within two business days. Under this bill, the local educational agency informs the students’ parents or guardians of where elevated lead levels are found and shuts down all fountains and faucets at those vicinities.
Significance: The food and Drug Administration set the maximum contaminant level for lead in drinking water at zero since lead harms human health even if exposure is low. Lead exposure is a major problem for school systems in urban and rural areas for lower-income students, and research has shown that Blacks and Hispanics are at more risk for lead exposure than other groups. This bill would set the lead action level for drinking water for childcare centers and k-12 schools at five parts per billion, lessening the exposure of our children to lead in drinking water.
AB 425 (Alvarez) Medi-Cal: Pharmacogenomic Testing: The bill would define pharmacogenomic testing as laboratory genetic testing by a laboratory with specified licensing, accreditation, and certification, to identify how a person’s genetics may impact the efficacy, toxicity, and safety of medications. The bill would cover the benefit under Medi-Cal if a medication is being considered for use or is already being administered, and is approved for use, in treating a Medi-Cal beneficiary’s condition and is known to have a gene-drug or drug-drug-gene interaction that has been demonstrated to be clinically actionable if an enrolled Medi-Cal clinician or pharmacist orders the test.
Significance: The genetic variants impact how people metabolize medications, which in some cases can cause adverse reactions if the medication they take is incompatible with their genetic makeup. This bill would establish Medi-Cal coverage of pharmacogenomic panel testing to reduce adverse drug events, improve clinical outcomes, and create more equitable access to better medication management.
AB 632 (Gipson) Health Care Coverage: Prostate Cancer Screening: This bill would prohibit a health care service plan or a health insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, from applying a deductible, copayment, or coinsurance to coverage for prostate cancer screening services for an enrollee or insured who is 55 years of age or older or who is 40 years of age or older and is a high risk, as determined by the attending or treating health care provider.
Significance: The incidence of prostate cancer is almost 70 percent higher in African American men, who have a two-fold higher rate of prostate cancer mortality relative to men of other
race. African American men are diagnosed with the more aggressive disease by stage and
grade, at younger ages, and higher incidence compared to white men in settings of
equal access to treatment. The clinical value of prostate cancer screening has been scientifically validated. This bill would make early prostate cancer screening possible for many high-risk and underserved populations by eliminating deductibles, co-pays, and other out-of-pocket expenses.
SB 9 (Cortese) Raising the Age for Extended Foster Care Act of 2023: It would expand the dependency and transitional jurisdiction of the juvenile court to a nonminor who has not attained 22 years of age if the court makes a finding that the nonminor is experiencing homelessness or is at reasonable risk of homelessness if they are not under the jurisdiction of the juvenile court, among other requirements. The bill would also make these nonminors eligible for benefits under AFDC-FC, CalWORKs, Kin-GAP, and AAP.
Significance: According to the Anne E. Casey Foundation, most young individuals age out of foster care without marketable skills or resources and face barriers, including housing instability and homelessness, behavioral health issues, and involvement in the criminal justice system. SB 9 would allow eligible foster youth to remain in the foster system until they reach 22, helping them maintain services and plan for a better transition.
SB 10 (Cortese) Pupil Health: Opioid Overdose Prevention and Treatment: It would require local education agencies to include opioid overdose prevention and treatment in the School Safety Plans, including synthetic opioids like fentanyl. It requires the California Department of Education to collaborate with California Health and Human Services Agency to develop and distribute an Opioid Antagonist Training and School Resource Guide to local education agencies on how to use opioid antagonists such as naloxone on school campuses.
Significance: According to the Centers for Disease Control and Prevention, fentanyl overdose deaths tripled among Black teens. This bill would expand overdose prevention and treatment to reduce overdose and fentanyl-related deaths among youth.
SB 90 (Wiener) Health Care Coverage: Insulin Affordability: It would prohibit a health care service plan contract or a disability insurance policy issued, amended, delivered, or renewed on or after January 1, 2024, from imposing a deductible on an insulin prescription drug or imposing a copayment of more than $35 for a 30-day supply of an insulin prescription drug, except as specified for a high deductible health plan. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.
Significance: Around 4 million adults in California live with diabetes, and approximately 263,000 more Californians are diagnosed with type 1 diabetes yearly. According to the Department of Health and Human Services Office of Minority Health, 13.4% of Black men and 12.7% of Black women have been diagnosed with diabetes. Blacks are twice as likely to develop type 2 diabetes than white, and they are twice as likely as non-Hispanic whites to die from diabetes. Californians with diabetes rely on daily doses of insulin for survival. Without access to insulin, patients can develop serious health complications, including cardiovascular disease, blindness, and kidney disease. According to the legislative findings, the average insulin price nearly tripled, resulting in one in four patients reporting insulin underuse. National law under the Inflation Reduction Act creates a $35 monthly cap on insulin, yet this legislation is limited to seniors and Medicare enrollees. SB 90 will extend this protection to patients with commercial insurance.
SB 238 (Wiener) Health Care Coverage, Independent Medical Review: requires health plan denial of care for mental health disorders for youth ages 0-21 to be automatically reviewed by an Independent Medical Review System (IMRs).
Significance: In 2019, 13 percent of California’s children 3 to 17 years of age reported having at least one mental, emotional, developmental, or behavioral health problem, and 8 percent of children have a serious emotional disturbance that limits participation in daily activity. Black and Latinx children were about 14% less likely than White youth to receive treatment for their depression. According to the legislative finding, since 2017, the IMRs overturned 79 percent of healthcare service plan’s and disability insurers’ decisions to deny mental health care to youth. While the IMR process allows for greater oversight of health plans, it burdens the consumer to initiate and delay or prevent children and youth in California from accessing critical, timely mental health treatment. Language barriers, health literacy, and demanding jobs may prevent some parents from filing IMRs, furthering mental health access inequities. Under SB 238, health plans, not consumers, must submit those denials to the IMR process for claims to be reviewed automatically.
SB 694 (Eggman) Medi-Cal: self-measured blood pressure device and services: It would make self-measured blood pressure (SMBP) devices and SMBP services covered benefits under the Medi-Cal program for the treatment of high blood pressure.
Significance: In California, almost 30 percent of adults have been diagnosed with HBP, disproportionately impacting communities of color, particularly African American and American Indian communities. HBP also has a significant impact on maternal health, and HBP can be managed. Improving hypertension diagnosis, treatment, and control is critical for improving the cardiovascular health of all Americans and reducing major cost drivers in the healthcare system. A key component to achieve this is SMBP monitoring, an evidence-based strategy recommended in national guidelines to improve blood pressure (BP) control for individuals with hypertension. SB 694 will ensure Californians with Medi-Cal coverage can access SMBP devices and correlated services, providing clarity to healthcare providers, guaranteeing coverage for patients, and saving state resources.
SB 873 (Bradford) Prescription drugs: cost sharing: This bill, by January 1, 2025, would require an enrollee’s or insured’s defined cost sharing for each prescription drug to be calculated at the point of sale based on a price that is reduced by an amount equal to 90% of all rebates received, or to be received, in connection with the dispensing or administration of the drug.
Significance: It would immediately help Californians afford their medications and improve health outcomes by requiring health insurance companies and their Pharmacy Benefit Managers (PBMs) to pass along at least 90% of negotiated rebates to patients at the pharmacy counter. Sharing rebates with patients at the point-of-sale will not only reduce out-of-pocket costs for patients, but it will also improve medication adherence rates – as demonstrated by UnitedHealth’s OptumRx practice of sharing rebates at the pharmacy counter, which enabled patients to save an average of $130 per eligible prescription and improved adherence rates between 4-16%.
CBHN Budget Priority 2023/24
SUPPORT Governor’s Budget Change Proposal – 4260-079-BCP-2023-GB DHCS Implementation of SB 987 – California Cancer Care Equity Act
Support for the Governor’s Budget Change Proposal (BCP), which requests three permanent and one limited-time position at the Department of Health Care Services (DHCS) to implement SB 987 (Chapter #608 , 2022) – the Cancer Care Equity Act. The BCP requests new positions and limited-term expenditure authority to provide oversight and monitoring resulting from new statute which assures Medi-Cal patients with a complex cancer diagnosis can request a referral to an NCI (National Cancer Institute) Designated Comprehensive Cancer Center.
Support for Creating the Health Equity and Racial Justice Fund
Support for $50 million over two years in a one-time investment to fund a pilot investment to create the Health Equity and Racial Justice Fund. The Health Equity and Racial Justice Fund will support projects proposed by nonprofit organizations, clinics, and tribal organizations that serve disproportionately impacted communities of color and low income to address the social determinants of physical health and behavioral health and reduce the unequal burden of the leading causes of death and illness, in children and adults, would be eligible.
Racial Equity Commission
Support for the creation of the Racial Equity Commission, Chapter 4.6 (commencing with Section 8303), within the Governor’s Office of Planning and Research. The commission shall develop resources, best practices, and tools for advancing racial equity based on publicly available information and data. The commission will prepare an annual report that summarizes feedback from public engagement with communities of color, provides data on racial inequities and disparities in the state, and recommends best practices on tools, methodologies, and opportunities to advance racial equity. The report will be submitted by December 1, 2025, and no later than April 1, 2026, and annually after that, to the Governor and the Legislature and shall be posted publicly on the internet website of the commission.
$11 million one-time appropriation request to the Department of Public Health for the integration of existing adult Sickle Cell Disease clinics into CalAIM
Support for a one-time appropriation of $11 million in 2023/2024 fiscal year budget to ensure the integration of Networking California for Sickle Cell Care (NCSCC) into CalAIM. NCSCC’s 12 clinics provide the kind of comprehensive care management service that CalAIM supports. By targeting a special population with specific needs and providing reimbursement for Sickle Cell Disease services and associated costs, the clinics are already well-positioned to be integrated into existing reimbursement mechanisms.
The funds will provide adults with Sickle Cell Disease access to specialty care and care management; improve the quality of care delivered; support workforce expansion; conduct data capture and surveillance to monitor disease incidence, prevalence, outcomes, and cost-effectiveness of specialized care; and provide for administrative support for the centers. This support is intended to provide reimbursement for Sickle Cell Disease services and associated costs while the clinics are integrated into existing reimbursement mechanisms.
Request $14 million to fund the Local Equitable Access to Food (LEAF) Program: support of funding SB 907 (Pan) – the Local Equitable Access to Food (LEAF) Program, which expands Electronic Benefits Transfer (EBT) access at all certified farmers’ markets in California and also seeks to increase the number of farmers’ markets in low-income communities throughout our state. To meet the statutory requirements outlined in SB 907, we request $14 million in one-time funding to establish the LEAF grant program, which the Department of Food and Agriculture will develop along with the Department of Social Services. The grant funding could also be used to scale and improve EBT processes at existing farmers’ markets and establish EBT access at new certified markets in low-income communities.