IN THE LOOP

LGBTQ civil rights took a huge step forward on June 15, when the Supreme Court ruled that sex discrimination as defined in the Civil Rights Act of 1964 also applies to workplace discrimination based on sexual orientation and gender identity.

LGBTQ organizations and advocates across the country hailed the ruling for extending workplace protections to millions of gay, lesbian, bisexual, and transgender individuals, including in over half the states where such workplace discrimination has remained legal.

In his majority opinion, Justice Neil Gorsuch, a 2017 Trump appointee, wrote that “An employer who fires an individual for being homosexual or transgender fires that person for traits or actions it would not have questioned in members of a different sex. Sex plays a necessary and undisguisable role in the decision, exactly what Title VII [Civil Rights Act] forbids.”

Despite this broad interpretation of sex discrimination, three days before the Court ruling the Trump Administration Department of Health and Human Services (HHS) finalized a rule that removes nondiscrimination protections for LGBTQ and other groups when it comes to healthcare and health insurance.

The HHS ruling is one of many rules and regulations put forward by the Trump administration that define “sex discrimination” as only applying when someone faces discrimination for being female or male, and not discrimination on the basis of sexual orientation or gender identity.

The new rule reversed federal healthcare protections that had been included in the Affordable Care Act (ACA) under the Obama administration. The new rule will further harm already vulnerable transgender individuals in the midst of a global pandemic, allowing healthcare providers to refuse care and treatment including transition-related care.

The Supreme Court ruling will make the HHS rule much more difficult to defend or sustain, and LGBTQ advocates and clinics have already filed lawsuits to overturn the new rule.

Fortunately, California’s non-discrimination laws are strong and have not changed. California independently protects equal access to healthcare regardless of a patient’s sex, gender identity, or gender expression, including access to transition-related care. These provisions are still in full effect, regardless of the federal actions taken by the Trump Administration.

Shortly after the HHS rule was published, agencies that regulate or provide oversight of health insurance in California reiterated that California’s non-discrimination protections are still in effect. Notices are now available from the Department of Managed Healthcare, Department of Healthcare Services, and Department of Insurance. Anyone who thinks they are the victim of discrimination should contact their health plan.

This week Governor Newsom and the Legislature announced a state budget deal that avoids cuts to health and safety net programs — good news for vulnerable Californians given the unprecedented health and economic impacts of COVID-19.

One of the key issues facing lawmakers was how to address the state’s $54 billion budget deficit in the absence of additional help from Congress. Newsom had proposed significant cuts to Medi-Cal and other social services programs, which would take effect immediately and only be restored if Congress passed another COVID-19 relief package. The Legislature had proposed a much smaller set of cuts, and these cuts would have only taken effect in October if federal help failed to arrive.

In the end, Newsom and the legislative leaders reached a compromise that spares cuts to health and safety net programs and instead makes immediate cuts to public universities, courts, and housing-related programs. These programs will be restored later this year if Congress and President Trump provide another round of stimulus funding, which could happen in late July.

The Legislature is expected to vote on the final budget this week and the Governor has until the end of the month to “blue pencil” (reduce or eliminate) any budget items and sign the final deal. Because this year’s tax deadline was extended to July 15 due to COVID-19, legislators are expected to make additional budget modifications in August once they have a more complete revenue picture.

This week we’re providing a breakdown of the budget items that will have the most significant impact on APLA Health and the people we serve.

Public Health

The budget maintains funding for public health programs and allocates federal dollars for COVID-19 testing and contact tracing. In some good news, the $5 million each for HIV, hepatitis C, and STD prevention activities included in last year’s budget is now ongoing. This funding was previously set to expire next year if state’s fiscal outlook did not improve.

The budget does include a $100 million loan from the AIDS Drug Assistance Program (ADAP) Rebate Fund to help close the budget deficit. APLA Health and other advocates were successful in getting strong protections to ensure the loan does not impact ADAP clients’ access to medication and other services. The ADAP Rebate Fund is the primary funding source for California’s ADAP and recently created PrEP Assistance Program.

The budget does not include a much-needed budget augmentation for the California Syringe Exchange Supply Clearinghouse, which provides critical harm reduction and COVID-19 supplies to the state’s syringe service programs. APLA Health and other groups will be advocating for this critical augmentation to be included in any budget modifications later this year.

Medi-Cal

The budget deal avoids virtually all of the cuts to the state’s Medi-Cal program that had been proposed in the Governor’s revised budget last month. This means all Medi-Cal benefits will continue uninterrupted, including optional benefits like optometry, audiology, speech therapy, physical therapy, and other services. The budget also implements a recent expansion of the Medi-Cal Aged and Disabled Program for individuals with incomes between 123% and 138% of the federal poverty level.

Regrettably the budget does not expand full scope Medi-Cal for undocumented seniors, a key priority for health advocates given the disproportionate impact of COVID-19 on Latinx and immigrant communities. Instead the budget includes language to expand full-scope Medi-Cal for this population when the state’s fiscal outlook improves, which could be years away.

The budget includes some changes to the Medi-Cal program which will have a negative impact on community health centers like APLA Health. The budget maintains the Governor’s proposal to transition all Medi-Cal pharmacy services from managed care to fee-for-service — known as Medi-Cal Rx — which would eliminate savings from the federal 340B drug discount program that health centers rely on to expand critical healthcare and support services for low-income Californians. Fortunately, Newsom and lawmakers restored supplemental funding for 340B providers intended to replace lost revenue from implementation of Medi-Cal Rx.

Other Safety Net Programs

The budget does not include any cuts to two key safety-net programs for seniors and people with disabilities: In-Home Supportive Services (IHSS) and Supplemental Security Income/State Supplementary Payment (SSI/SSP) grants.

There are also no cuts to the CalFresh program, but the budget does include changes that will help those enrolled to retain benefits and those who are eligible to access the program more easily. The budget also includes $30 million to support food banks’ response to COVID-19.

There are no grant cuts or eligibility cuts for CalWORKs, but the final budget restores the CalWORKs lifetime limit for adults to 60 months — adding 12 additional months that were cut in the last recession. This change is proposed to take effect May 1, 2022

This budget also expands the California Earned Income Tax Credit (CalEITC) to tax filers using an Individual Taxpayer Identification Number (ITIN), rather than a Social Security number, with children under age 6 — estimated to amount to about $60 million worth of tax credits next year.

Housing and Homelessness

The budget recognizes the need to protect unhoused Californians from the devastating impacts of COVID-19. The budget includes $550 million in federal funding for Project Roomkey, which provides hotel and motel rooms for vulnerable people experiencing homelessness. The budget includes an additional $300 million for local governments to address homelessness and preserves $500 million in funding for state tax credits for affordable housing construction.

You can find more details on the state budget deal here. The final budget will be available here after it has been passed by the Legislature and signed by the Governor. The state fiscal year begins on July 1st.

The Los Angeles Homeless Services Authority (LAHSA) released the results of the 2020 Homeless Count earlier this month. Overall, while the County has continued to increase the number of people who are rehoused, homelessness in the County increased by 12.7% over the last year — from 58,936 individuals in 2019 to 66,433 this year. In the City of Los Angeles, homelessness increased by 14.2% over the last year — with 41,290 individuals experiencing homelessness. LAHSA estimates that an average of 207 people exit homelessness every day, but 227 people fall into homelessness at the same time.

Two-thirds of unsheltered adults experiencing homelessness were homeless for the first time. However, the number of individuals experiencing homelessness in LA County who are sheltered increased by 27%, and 88% of people placed in permanent housing have not returned to homelessness. The highest rates of homelessness continue to be in the ‘Metro’ and ‘South’ regions of Los Angeles. You can review data on various regions of Los Angeles here.

LAHSA stressed that the increase in homelessness is perpetuated by a combination of factors, including inadequate affordable housing supply, income inequality, and systemic racism. Even with new initiatives like the Housing Central Command, Project Roomkey, and COVID-19 rent freezes and eviction moratoriums that are keeping some people housed, the homelessness crisis continues to grow.

Black people are four times more represented among people experiencing homelessness than in the County population overall. With this year’s results, LAHSA signaled a renewed commitment to implementing the recommendations from the Ad Hoc Committee on Black People Experiencing Homelessness report from December 2018.

The number of people living with HIV who are also experiencing homelessness decreased by 5%, from 1,221 individuals in 2019 to 1,165 individuals this year. As in past counts, the number of people living with HIV who are also experiencing homelessness is likely higher due to underreporting. Access to stable housing is one of the most important interventions for people living with HIV to improve their health outcomes, is an effective way to reduce and prevent new infections, and a key strategy for ending the HIV epidemic in LA County. APLA Health continues to advocate for people living with and at risk of HIV, stressing to local leadership the importance of prioritizing people living with and at risk for HIV into affordable housing.

If you are in need of housing assistance, or are at risk of experiencing homelessness, please reach out to APLA Health for more information and to schedule an appointment with one of our housing specialists. Call 213-201-1637 or send an email to bbrown@apla.org.

The deadline for responding to the U.S. Census has been extended because of the COVID-19 emergency until October 31, 2020. The Census count is confidential, you can complete the Census online, and your response helps determine how hundreds of billions of dollars in federal aid are distributed to all 50 states and localities like LA County. This funding supports a broad range of programs from senior housing to assistance for disabled veterans to programs combatting violence against women. Your response can be completed in minutes: https://2020census.gov/.