2021 ANNUAL REPORT
IMPACT
Community health centers have a proud and storied history of advocacy. Since their founding, health center leaders have marched for equality, fought for social justice, and have been leading community activists. Since the earliest days of the health center movement, health center pioneers have advocated for the health of their patients and the health of their communities.
CaliforniaHealth+ Advocates (Advocates) builds on that legacy and takes a bold step into the future, advocating for community health centers to help them advance their mission through lobbying, advocacy, and meaningful engagement with elected officials and candidates for office.
INFORMATION
Established in 2016, Advocates is committed to promoting healthy people and healthy communities by strengthening California’s system of community health centers and improving the lives of the patients they serve.
By advocating for policies and legislation at both the state and federal level that promote coverage, access to care and social justice within California’s communities, Advocates aims to advance the core values of community health centers to the benefit of their patients and communities. As the advocacy affiliate of the California Primary Care Association (CPCA), we advocate on behalf of more than California’s 1,330 community health centers that provide care to over 7.2 million people – that’s 1 in 5 Californians.
MISSION
Community health centers have a mission to serve everyone who walks through their doors, regardless of their ability to pay or their insurance status. A part of what makes CaliforniaHealth+ Advocates (Advocates) so successful is the support from mission-driven individuals.
Advocates is proud to be a part of a movement that will change the destiny of community health.
We are thankful to our supporters who share our values and are ready to strengthen institutions that provide for those most in need.
POLICY
STATE UPDATES
In 2021 your collective voices helped to keep pressure on the state Legislature and Newsom Administration about the urgent needs of California’s community health centers and the more than 7.2 million patients that they serve.
The Legislature wrapped up the first year of the two-year session in mid-September and the Governor took final actions on hundreds of bills, including CaliforniaHealth+ Advocates’ 2021 legislative priorities.
The 2021 legislative session was heavily focused on access. The signing of AB 133 was transformational as California became the first state in the nation to expand Medi-Cal coverage to adults 50 years of age or older regardless of immigration status. Additionally, the signing of SB 4 (Gonzalez) & AB 14 (Aguiar-Curry) is a critical step towards expediting the deployment of broadband infrastructure throughout the state, closing the digital divide, and providing a vital pathway to connect Californians to necessary health care.
Sponsored Bills:
Assembly Bill 32 (Aguiar-Curry) Telehealth/telephonic care:
Senate Bill 316 (Atkins/McGuire) Same-Day Visit:
SB 806 – Medical Board Sunset Review – SIGNED BY GOVERNOR
NOTE: Chaptered bill contains negotiated agreement on Post-Graduate Training License
AB 654 – COVID reporting clean up – SIGNED BY GOVERNOR
SB 4/AB 14 – Broadband bills – SIGNED BY GOVERNOR
SB 806
The PTL restricted physician training license resulted from a 2017 bill that revised postgraduate training and licensing requirements for medical school graduates in California.
Beginning January 1, 2020, all medical school graduates who applied for a medical license, regardless of whether the medical school attended was domestic or international, were required to successfully complete 36 months of postgraduate training. Residents were also required to obtain a PTL to participate in and practice medicine in an accredited postgraduate training program in California. CPCA members, many of whom work closely or directly with residency programs and training physicians, voiced significant concerns about the PTL and worked with staff to develop successful strategies.
In 2021, CPCA staff formed a coalition of health care partners to draft and propose several bills to resolve the unintended consequences of the PTL’s implementation. California Health+ Advocates worked closely with a coalition to move SB 806 which was victoriously signed into law! As the Medical Board of California’s sunset bill, SB 806 reflects language darafted by CaliforniaHealth+ Advocates and the coalition to address CHCs’ workforces concerns with the PTL.
Starting January 1, 2022, domestically trained medical graduates with the PTL can apply and receive an unrestricted physician and surgeon license if they have received 12 months of board-approved Graduate Medical Education (GME) training in the U.S. International medical graduates with a PTL are eligible for the unrestricted physician and surgeon license after 24 months of board-approved GME in the U.S. The Program director or specified individual must attest before the resident can receive the full unrestricted license. At time of initial renewal, residents with the physician and surgeon license must show that they received credit for 36 months of training, including 24 months in the same program. You can learn more details in the MBC’s latest PTL announcement.
After two years of flagging the PTL’s unintended consequences for numerous state agencies and engaging with members of the Capitol to support proposed solutions, CaliforniaHealth+ Advocates is proud of this major accomplishment. We would like to thank the residency program directors and CHCs who advocated alongside us. We could not have overcome this hurdle without collective support and commitment to the current and future CHC workforce.
SB 806 Addresses the Following:
Ineligibility to enroll
and bill Medi-Cal for moonlighting services – Federal regulations exclude providers with restricted licenses from enrolling in Medi-Cal. Thus, residents with the PTL cannot bill Medi-Cal while they are moonlighting – a secondary job to gain training and income. CHCs rely on moonlighting residents to close the physician workforce gap and care for patients in medically underserved areas.
which disincentivizes applicants for California residency programs, decreases Medi-Cal patients’ access to care, and widens the physician shortage gap.
Inability to obtain
a Substance Abuse and Mental Health Services Administration (SAMHSA) Drug Enforcement Agency X-Waiver – Residents were experiencing challenges obtaining an X-waiver to treat opioid use disorders because the PTL is a restricted license.
Requirement to Extend
BUDGET WINS
Governor Newsom’s 2021-22 Final State Budget demonstrated a strong commitment to transition California from pandemic response to pandemic recovery.
HEALTH CENTER BUDGET PRIORITY:
Health4All:
Thanks to your advocacy and support we were able to secure $48 million in the first year, growing to $1.3 billion, to expand eligibility for full-scope Medi-Cal coverage to income-eligible adults aged 50 and older, regardless of immigration status.
At the earliest, this eligibility extension will begin May 1, 2022. (This is for 2021 and doesn’t recognize Medi-Cal coverage for all immigrants)
HEALTH CENTER BUDGET PRIORITY:
Medi-Cal Rx Transition/SPP Augmentation
The enacted budget maintains the $105 million non-hospital clinic supplemental payment pool (SPP), which was created to help CHCs mitigate the financial losses incurred by the pharmacy transition. With great fiscal uncertainty that comes with the Medi-Cal Rx pharmacy transition, staff continues to prioritize work with the legislature and administration on a future budget augmentation to the size of the SPP in FY22-23 from $105 million to $205 million annually.
Medi-Cal Telehealth Flexibility and Payment
The enacted budget, and AB 133 health omnibus trailer bill, extends current telehealth flexibilities including payment parity for audio-only through December 31, 2022. It also proposes a stakeholder process to determine Medi-Cal telehealth policy for January 1, 2023, and beyond. Although this extension is temporary and does not include the more robust evaluation requirement in Assembly Bill 32, it is a step forward and a testament that telehealth, including audio-only, has transformed care delivery and is here to stay. In Fall 2021, as part of the AB 133 requirement, health center leaders were at the table with Department of Health Care Services’ (DHCS) newly convened Telehealth Advisory Workgroup, where critical conversations were had regarding billing, utilization management, patient consent, and evaluation post-2022. Importantly, in these conversations, DHCS expressed their long-term commitment to payment parity and willingness to allow for the establishment of patient relationships through telehealth modalities. Telehealth will continue to be one of our top policy priorities for this year and we look forward to working with you, legislative champions, and the administration on permanent telehealth policies in the FY 22-23 budget.Medi-Cal RX and Supplemental Payment Pool
On January 7, 2019, Governor Newsom issued Executive Order (N-01-19) to create a single-purchaser system of drugs in California.
Specifically, the Executive Order directs the Department of Health Care Services (DHCS) to transition all pharmacy services for Medi-Cal managed care (MCO) to a Fee for Service (FFS) by January 2021. Due to a conflict of issue concern, DHCS decided to postpone the transition till January 1, 2022. Covered entities under the 340B program will experience a loss in program savings that will significantly impact both patients and health centers.
SPP Calculations
In April 2019, CPCA conducted a survey of its CHC members to better understand the impact of the pharmacy transition, which showed a projected loss of at least $150M annually. This would drastically impact healthcare services and overall care to patients. In the Fall of 2019, DHCS, in collaboration with CPCA, developed a template for CHCs to voluntarily submit to DHCS to validate their projected losses of 340B savings due to the pharmacy transition. Ninety-four (94) CHCs submitted data through this collection process and DHCS ultimately relied on this data to determine the initial funding amount for the Non-Hospital Based Supplemental Payment Pool (SPP).
We are grateful for the administration and legislature’s leadership that established the Supplemental Payment Pool in the FY20-21 budget to remedy these losses, which allocates $52.5M General Fund with a federal match to the pool each year for a total of $105M.
As we look back on the creation of this fund based on data that is now three years old, we know the financial burden is far greater than we initially understood. In March 2021, CPCA ran a second survey to better understand the scale of projected losses of 340B savings. Combining CPCA 2021 survey data with projections of other eligible 340B entities, such as CHCs who did not respond and county clinics, CaliforniaHealth+ Advocates estimates the total loss at $205 million per year across eligible entities. That same year, DHCS ran a very similar survey in October because they wanted to validate our data. With this information in hand, CaliforniaHealth+ Advocates immediately began advocating for a doubling of the SPP fund. While grateful for our legislative champions, Assembly member Gipson and Senator Hertzberg, we were not successful in securing the additional funding for the FY 21-22 budget. We will be working in the next budget to increase the SPP.
To help CaliforniaHealth+ Advocates ramp up its advocacy efforts, Advocates hired ALZA Strategies, a communications firm with the goal to help build awareness about the dire need to increase the SPP.
Gubernatorial Recall
Leading up to the election, CaliforniaHealth+ Advocates educated its network on the importance of the election and provided the resources necessary for individuals to be aware of key registration dates, on how to vote and what the election meant. By using social media, the weekly update, website, health center discussion forums, Public Affairs Peer Network and Advocacy Committee, Advocates was able to amplify the message on how important this election was and the impact it could have on health care access for years to come.
FEDERAL UPDATE
COVID-19
VACCINE PROGRAM
President Biden’s first priority was enacting a major COVID Relief Bill soon after taking office.
He succeeded, and the American Rescue Plan Act (ARPA) was signed into law on March 11, 2021, less than two months after his inauguration.
The $1.9 trillion package included assistance for all sectors of the economy, from stimulus checks for individuals and an extension of federal unemployment insurance payments to considerable funding for states and localities.
California Health Plus Advocates worked with NACHC to secure $7.6 billion for community health centers and look-alikes, which provided a vital lifeline as many health centers were ramping up major vaccine clinics and working to bring patients back into their health centers safely.
Soon after the American Rescue Plan was enacted, after advocacy from CaliforniaHealth+ Advocates and National Association of Community Health Centers (NACHC) about the importance of vaccine equity, HRSA announced the Health Center COVID-19 Vaccine Program. This program allowed California’s health centers to apply directly to HRSA for vaccine doses and greatly enhanced their ability to vaccinate their patients.
TELEHEALTH
In June, CaliforniaHealth+ Advocates hosted a very successful virtual Telehealth Town Hall with Congresswoman Doris Matsui, Congressman Mike Thompson, and representatives from health centers throughout California.
Health centers shared their experiences with providing vital services via telehealth and the importance of continued telehealth flexibilities. The Members of Congress discussed their support for telehealth, including legislation that they have sponsored.
Later in the summer, at the request of CaliforniaHealth+ Advocates, Congresswoman Matsui led and Congressman Thompson signed a letter to HHS Secretary Becerra about telehealth in the Medi-Cal program.
The letter asked the Centers for Medicare & Medicaid Services (CMS) to clarify that states can elect to reimburse for telehealth (including audio-only) at parity with in-person visits in Medicaid and receive a federal match. CMS released this clarification in December 2021, which will be useful in Advocates’ continued negotiations with the state over the future of telehealth coverage. community health centers and look-alikes, which provided a vital lifeline as many health centers were ramping up major vaccine clinics and working to bring patients back into their health centers safely.
340B
CPCA has been working very closely with NACHC and ourpartners to advance advocacy efforts in response to threats impacting the 340B program.
Successful Efforts to Prevent the Insulin / Epi Pen Rule from Implementation
In 2020, the U.S. Health Resources and Services Administration (HRSA) released a final rule to implement the Trump administration’s executive order requiring community health centers receiving a 330 grant to demonstrate an established practice of offering insulin and injectable epinephrine at no more than the 340B price plus a minimal administration fee to patients making less than 350% of the FPL who also have a high cost-sharing requirement for either drug, high unmet deductible, or are uninsured.
However, since the 340B program was created, CHCs have been providing medically underserved patients with affordable access to medications, including insulin and Epi-Pens. Given that CHCs already offer this benefit, the rule would have done little to nothing to help patients and instead would have imposed unnecessary administrative burdens on CHCs.
Additionally, since prices are set by drug companies, CHCs have no ability to impact the price of insulin or other drugs. This rule would not have met its intent since it did nothing to change the price that drug companies charge for insulin. Thus, for the 90% of diabetic patients who are not CHC patients, this regulation would have zero impact on the price they pay for insulin.
The 10% of diabetic patients who get their care from CHCs are already assured access to affordable insulin and other drugs.
EVENTS
National Health Center Week
National Health Center Week (NHCW) is an annual celebration with the goal of raising awareness about the mission and accomplishments of America’s health centers over the past five decades.
This year’s NHCW took place August 8 – 14, 2021. CaliforniaHealth+ Advocates provided a toolkit that consisted of resources for fundraising, sample calendar of events, social media, and community outreach.
The toolkit also included advocacy resources such as talking points, sample social media post, and infographics for health center leaders to use as they engaged with Members of Congress and advocated for CHC top priorities.
Additionally, CaliforniaHealth+ Advocates hosted a pre-NHCW webinar on August 3, 2021, where we provided an update on our federal priorities and our asks, going over our advocacy resources, and providing tips on how to use NHCW to advocate for health center priorities. A total of 86 people attended the webinar.
Phone2Action Advocacy Campaigns
Virtual Day at the Capitol 2021
CaliforniaHealth+ Advocates kicked off the three-day event on May 25th with a virtual welcome address from Corinne Sanchez, Advocates’ board chair and President & CEO of El Proyecto del Barrio, Inc. Assemblywoman Cecilia Aguiar-Curry and Assemblyman Mike Gipson spoke to attendees and participated in a question-and-answer session with members facilitated by Advocates’ SVP of Strategy, Integration & System Impact, Andie Martinez Patterson. Aguiar-Curry is the author of AB 32, the 2021 legislation that will allow CHCs to continue to utilize telehealth and telephonic visits post the COVID-19 pandemic. Mike Gipson championed our budget request to include an additional $50 million dollar appropriation to strengthen the Non-Hospital Clinic Supplemental Payment Pool.
Community health center leaders, staff, and patients met with 88 legislators and/or their staff over a two-week period thanks to the coordination of the Consortia Policy Group. Health center representatives worked to educate their elected officials and legislative staff on CaliforniaHealth+ Advocate’s sponsored legislation and priorities related to the FY21-22 State Budget.
NACHC Virtual Policy & Issues Forum 2021
Three-Day Advocacy Campaign in Coordination with Weeklong NACHC campaigns (federal or state)
FINANCIALS
Balance Sheet
ASSETS
| Cash | 167,046.20 | |
| Accounts Receivable | 5,000.00 | |
| Due from CPCA | 259,925.39 | |
| TOTAL ASSETS | 431,971.59 |
LIABILITIES & EQUITY
| Accounts Payable | 34,919.00 | |
| Due to CPCA | 93,683.49 | |
| TOTAL ASSETS | 128,602.49 |
| Retained Earning | 288,204.08 | |
| Net Loss | 15,165.02 | |
| Total Equity | 303,369.10 | |
| TOTAL LIABILITIES & EQUITY | 431,971.59 |
DONORS
CaliforniaHealth+ Advocates would like to thank each of the individual donors who generously and personally donated this past year towards our political advocacy efforts.
Because of their financial contributions, Advocates was able to create our Political Action Committee and lay the groundwork for a successful political program.
Advocates is grateful to all of our donors who believe in the mission of community health centers, and we would like to especially acknowledge the people who supported our efforts in this past year. We are grateful for you and thank you for your continued support.
For those interested in learning more about the Advocates Political Action Committee and would like to contribute, please click here.
Below is a list of this year’s c4 and PAC donors.
Champion – 1K or more
California Dental Association PAC – pac
Californians Allied for Patient Protection – c4
Carmela Castellano Garcia – c4
Louise McCarthy – pac
Corinne Sanchez – pac
Rebecca Pleitez* – c4
Anthony White – pac
Advocates – 500 or more
Reymundo Espinoza*- c4
Marty Lynch – pac
Anitha Mullangi – c4
Andie Patterson* – c4
Val Gotingco Sheehan – c4
Mary Szecsey* -c4
Anthony White* – c4
Supporters – 250 or more
Kelley Aldrich* – c4
Tim Fraser* – c4
Beth Malinowski – c4
Ginger Smith* – c4
Vernita Todd – pac
Yamilet Valladolid* – pac
Friends – 100 or more
Kerry Hydash – pac
Trong Le – c4
Bill Roth – c4
Partners – up to 100
Victor Christy – c4
Liz Oseguera – c4
Lynette Schlick – c4
Bethany Snyder – c4
* Signifies monthly donors.
BOARD & STAFF
Chair
Corinne Sanchez, Esq.,
President & CEO
El Proyecto del Barrio, Inc.
VICE CHAIR
David Vliet
Chief Executive Officer
LifeLong Medical Care
SECRETARY
Louise McCarthy
Chief Executive Officer
Community Clinic Association of Los Angeles County
TREASURER
Kerry Hydash
Chief Executive Officer
Family HealthCare Network
Director at large
Reymundo Espinoza
Chief Executive Officer
Gardner Family Health Network, Inc.
Director at large
Leslie Abasta Cummings
Chief Executive Officer
Livingston Community Health
Director at large
Berenice Nunez ConstantVice President of Government Relatiions AltaMed Health Services
Director at large
Terri Stratton
Executive Director
El Dorado Community Health Center
EX OFFICIO
Robert Beaudry
Acting President & Chief Executive Officer
California Primary Care Association
STAFF
Robert Beaudry
Acting President and Chief Executive Officer
Andie Martinez Patterson
Senior Vice President
Beth Malinowski
Director of Government Affairs
Eric Paredes
Associate Director of Grassroots Advocacy
Victor Christy
Deputy Director of Political Engagement
Victor Christy
Deputy Director of Political Engagement
Marissa Vismara
Senior Policy Coordinator
Kelley Aldrich
Associate Director of Legislative Affairs
Elizabeth Oseguera
Assistant Director of Policy
Mahnoor Khan
Senior Policy Coordinator
Ayo Taylor
Associate Director of Public Affairs and Communications
