IN THE LOOP

HIV advocates in California and across the U.S. are calling on federal, state and local authorities to prioritize people living with HIV (PLWH), chronic liver disease and other underlying health conditions for the COVID-19 vaccines.

While early studies suggested that HIV may not significantly affect COVID-19 outcomes, emerging data indicate that PLWH may be at increased risk for severe COVID-19. However, it is not yet known if this is due to suppressed immunity (low CD4 cell counts) or other comorbidities common among PLWH, such as cardiovascular disease, hypertension, obesity and diabetes. Social determinants of health may also have contributed to these findings: poverty, poor healthcare access, and other socioeconomic factors that are common among PLWH are also risk factors for severe COVID-19. Large and rigorous studies are needed to better understand what is driving worse COVID-19 outcomes among PLWH.

While awaiting these necessary and critical studies, APLA Health and the San Francisco AIDS Foundation are urging California’s Community Vaccine Advisory Committee to include PLWH in the same category, Phase 1C, as all people with an underlying health condition which increases their risk of severe COVID-19. The Advisory Committee is responsible for providing input on vaccine delivery and helping to ensure an equitable distribution while supplies of the vaccine remain limited.

APLA Health and San Francisco AIDS Foundation are also urging the committee to address the impact of systemic racism and inequality that drive the disproportionate impact of HIV and now COVID-19 on Black and Brown communities. Acknowledgement of this reality is essential to building back the trust needed to combat the pandemic.

In California, there are currently three priority phases for vaccine distribution. The first phase is for healthcare workers and residents in long-term care facilities. The second group includes education, childcare, agricultural and other essential workers, as well as individuals over age 65, and others in congregate living facilities. The third phase includes people ages 50-64 as well as people ages 16-49 with underlying health conditions that make them more susceptible to serious COVID-19 disease and other individuals in danger of exposure to the virus through work.

The LA County Department of Public Health recently opened COVID-19 vaccine eligibility to all people 65 and older while efforts continue to vaccinate people in the first phase. Starting this week, all locations that are currently providing vaccines can also begin offering appointments to persons in this age category. If your healthcare provider does not have vaccines, you can visit VaccinateLACounty.com to book an appointment. You can also call 1-833-540-0473 for assistance with making an appointment.

Please note that the vaccine supply is still extremely limited. The LA County Department of Public Health continues to urge patience as it works urgently with federal and state partners to expand capacity and supply in the weeks ahead.

The National AIDS Treatment Advocacy Project has published a number of studies on HIV and COVID-19. These findings are preliminary and should be read with caution. Several studies document increased susceptibility to serious COVID-19 disease because of reduced CD4 cell counts. A study in San Francisco showed increased mortality from COVID-19 was likely due to homelessness or living in a congregate housing situation. You can learn more about COVID-19 and considerations for PLWH from the U.S. Centers for Disease Control and Prevention here.

Budget proposes emergency investments to address COVID-19 related needs and avoids cuts to healthcare, public health and safety-net programs

Earlier this month, Governor Gavin Newsom released his 2021-22 state budget proposal, which predicts stronger than anticipated revenues and includes a series of emergency investments to address the health and economic impacts of COVID-19. The proposed budget avoids cuts to healthcare, public health and safety-net programs that millions of Californians rely on to support themselves and their families. However, the budget also assumes slower revenue growth in subsequent years, which could require revenue increases or spending cuts in the near future.

Emergency Investments

The Governor is calling for immediate action by the Legislature on a package of investments to respond to the COVID-19 crisis, including providing $600 cash payments to low-income Californians, extending the state’s eviction moratorium, taking steps to reopen schools, and providing small business assistance through loans and tax credits.

The one-time cash payments, dubbed the Golden State Stimulus, would provide $600 to all 2019 taxpayers who received a California Earned Income Tax Credit (CalEITC) in 2020, as well as to 2020 taxpayers with Individual Taxpayer Identification Numbers (ITINs) who are eligible for and receive the CalEITC in 2021. If this proposal is approved within the administration’s anticipated timeframe, the payments would be sent out to tax year 2019 CalEITC recipients in February and March 2021. ITIN taxpayers would receive the additional tax refund after they file their 2020 tax return, typically in February through April of 2021.

Newsom is also urging lawmakers to extend the eviction moratorium put in place last year. Last August, the Governor and Legislature enacted AB 3088, which protects tenants from evictions through January 31, 2021 if they are suffering financial hardship because of the pandemic and are paying at least 25% of their monthly rent. Newsom has not said how long an extension he would support, though lawmakers have introduced legislation to continue the eviction moratorium through the end of the year. The Governor is also proposing to quickly allocate $2.6 billion in federal renter relief, targeted to stabilize the lowest-income at-risk renters and small property owners.

Healthcare

The Governor’s budget does not propose any major health coverage expansions, though it does include new funding to indefinitely extend certain telehealth flexibilities that were put in place during the pandemic. Maintaining telehealth benefits in the Medi-Cal program is a top priority for APLA Health and other healthcare providers, as telehealth has helped to increase access to care and reduce health inequities among low-income Californians. The administration has yet to release specific details of its telehealth proposal.

The budget also proposes to implement the so-called California Advancing and Innovating Medi-Cal (CalAIM) initiative on January 1, 2022. CalAIM is a multi-year initiative that seeks to improve health outcomes for millions of Californians enrolled in Medi-Cal by better coordinating care, addressing social determinants of health, and implementing value-based initiatives and payment reform. The budget also continues the Governor’s Medi-Cal Rx initiative to transition all Medi-Cal pharmacy services from managed care to fee for service on April 1, 2021. Medi-Cal Rx will not change Medi-Cal eligibility or benefits.

The proposed budget does not expand Medi-Cal coverage to seniors regardless of immigration status — a top priority for immigrant rights and healthcare advocates. Newsom proposed extending health coverage to all low-income seniors in January 2020, but he subsequently withdrew the proposal due the economic impact of the pandemic. Lawmakers recently introduced legislation to provide Medi-Cal coverage to undocumented adults and seniors.

Public Health

The Governor’s budget continues COVID-19 response activities, including funding for enhanced laboratory capacity and testing, surveillance, prevention and coordination with local health departments. The proposal also includes roughly $300 million as an initial estimate for vaccine distribution, including a public awareness campaign to increase uptake of the vaccine.

While the budget consists of much-needed COVID-19-related support, no new funding for local public health departments is included. Local health departments are currently stretched to their limits and few resources remain to address other pressing public health challenges such as rising STD rates and drug overdose deaths. APLA Health is urging legislative leaders to increase funding for local health departments and community-based organizations so they can adequately respond to COVID-19 and continue to address other public health priorities.

Other Safety-Net Programs

The federal Supplemental Security Income (SSI) program provides a monthly cash benefit to low-income seniors and people with disabilities to pay for housing and other necessities. In California, the SSI payment is augmented with a State Supplementary Payment (SSP) grant. The Governor’s budget does not include an increase for the SSP portion, but the federal government is expected to increase the SSI portion by 2.2% in January 2022. The state-only Cash Assistance Program for Immigrants (CAPI) benefits are equivalent to SSI/SSP benefits.

The California Work Opportunity and Responsibility to Kids (CalWORKs) program provides cash aid and services to eligible families that have children in the home. The budget proposes a 1.5% increase in CalWORKs grants to begin October 1, 2021.

Last year, federal COVID-19 relief legislation authorized emergency benefits for the Supplemental Nutrition Assistance Program — also known as CalFresh. The emergency allotments raise each household’s monthly allotment of CalFresh to the maximum allowable amount based on household size. The Governor’s budget includes funding for people enrolled in the California Food Assistance Program (CFAP) — which provides food stamps to undocumented Californians who do not qualify for federal benefits — to also receive emergency allotments.

Housing

The Governor’s budget includes a series of investments to address California’s ongoing housing and homelessness crisis. In addition to the emergency actions to prevent evictions and foreclosures highlighted earlier, the budget allocates $750 million to extend the “Homekey” program. Funding would support competitive grants for counties to acquire and rehabilitate hotels, motels and other buildings and to convert them into interim or permanent housing for people experiencing homelessness. The budget also includes $250 million to acquire or rehabilitate adult residential facilities and residential care facilities, with a specific focus on securing housing for low-income seniors.

The release of the Governor’s budget kicks off a months-long negotiating process with the Legislature before the budget is finalized in June. The fiscal year begins on July 1, 2021. You can find additional budget analysis from the California Budget & Policy Center here.

On January 6, Governor Newsom released the California Master Plan for Aging that will help build a “California for All Ages” over the next decade that meets the needs of the state’s changing demographics. With an average life expectancy of 81.9 years, by 2030, adults 60 and over will make up one-quarter of California’s population, and the Master Plan acts as a “blueprint” for state government, local government, the private sector, and philanthropy to prepare California for the coming demographic changes and outlines policies that promote healthy aging.

The Master Plan includes five bold goals:

1. Housing for All Ages and Stages to secure millions of new housing options to age well;
2. Health Reimagined to close the equity gap and increase life expectancy;
3. Inclusion & Equity, Not Isolation to keep increasing life satisfaction as we age;
4. Caregiving That Works by creating one million high-quality caregiving jobs;
5. Affordable Aging to close the equity gap in and increase elder economic sufficiency.

Each goal includes a set of strategies that engage state and local leadership as well as private sector partners and community-based organizations. The plan also includes 100 “action-ready” initiatives that are ready to implement in 2021, which you can read about beginning on page 25 of the Master Plan.

The Master Plan is accompanied by a Local Playbook with a toolkit for collaborative and cross-sector partnerships, a Data Dashboard with general data on aging as well as data specific to each goal, and opportunities for the public to engage with the plan’s implementation via the EngAGE website. While there is currently only a small amount of funding dedicated for the plan’s strategies, there is an expectation that more funding will be made available through the legislative process.

The Master Plan also highlights the need to recognize California’s diversity and the need to address life-long disparities and inequities faced by Black and Brown communities and LGBTQ+ Californians. APLA Health and other community partners have identified the need for a greater focus on these populations in the plan’s strategies moving forward. As a complement to the statewide plan, the LA County Commission on HIV has also developed a set of recommendations for older adults with HIV, and APLA Health and our partners will continue to engage with the Equity workgroup to ensure that the needs of LGBTQ+ seniors and older adults living with HIV will be adequately met through the plan.

You can watch the Master Plan release virtual summit from January 13 here, with presentation slides available here.