2022 ANNUAL REPORT
Strength In Numbers
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.
Community health centers have a mission to serve everyone who walks through their doors, regardless of their ability to pay or their insurance status. Advocates is proud to be a part of a movement that will change the destiny of community health.
Our Strength In Numbers was on full display as CaliforniaHealth+ Advocates was able to build on our mission by advocating for a stronger, more equitable Medi-Cal delivery system.
The Legislature wrapped up the second of the two-year session in mid-September and Governor Gavin Newsom took final actions on hundreds of bills, including CaliforniaHealth+ Advocates’ 2022 legislative priorities.
Our Strength In Numbers was on full display as CaliforniaHealth+ Advocates was able to build on our mission by advocating for a stronger, more equitable Medi-Cal delivery system. As a result, the Governor extended all current telehealth flexibilities beyond the pandemic by signing the health budget trailer Senate Bill 184 and Advocates-sponsored Assembly Bill 32; added more behavioral health support by signing another bill sponsored by Advocates, Senate Bill 966; and added more resources to help strengthen our workforce.
Senate Bill 316 (Eggman) Same Day Visits
Assembly Bill 32 (Aguiar-Curry)
After a two-year trek through the Legislature, AB 32 was signed by the Governor on September 25, 2022. AB 32 further expands access to telehealth and telephonic visits for Medi-Cal recipients post-pandemic. Building off the Medi-Cal Telehealth Policy adopted in SB 184 as part of the 2022-2023 State Budget, AB 32 furthers the intent of the new policy, particularly around the ability to use telehealth to establish new patients. AB 32 allows all Medi-Cal providers, including Federally Qualified Health Centers (FQHCs) and Regional Health Centers (RHCs) to establish patients using audio only for sensitive services, when the patient requests audio only, and when patients do not have access to video modalities. This flexibility expands access and allows patients who have historically faced barriers to accessing in-person services and who have limited access to technology to get the services they need.
Senate Bill 966 (Limón)
In May 2020, the Department of Health Care Services (DHCS) announced through a COVID-19 News Flash that the Administration will temporarily add the services of Associate Clinical Social Workers (ASWs) and Associate Marriage and Family Therapists (AMFTs) at FQHCs and RHCs as a billable visit (pursuant to State Plan Amendment 20-0024). ASW or AMFT services that meet visit criteria and are provided after March 1, 2020, are eligible for reimbursement at the Prospective Payment System (PPS) rate; this temporary change was to remain in effect through the end of the COVID-19 public health emergency including any extensions.
CaliforniaHealth+ Advocates worked with Senator Monique Limón and our co-sponsors at the California Association of Marriage and Family Therapists to introduce SB 966, which would allow health centers to continue to use ASWs and AMFTs after the public health emergency. Thanks to the persistent advocacy efforts by community health centers (CHCs) and the support by the Legislature, Governor Newsom signed SB 966 into law on September 27, 2022!
DHCS stated their intention to continue the inclusion of services provided by ASWs and AMFTs in FQHCs, RHCs and Tribal FQHCs beyond the public health emergency in their Medi-Cal COVID-19 Public Health Emergency Operational Unwinding Plan.
TOPICS of interest
Senate Bill 1014 (Hertzberg) Supplemental Payments and Labor Management Cooperation Committees
A bill of interest to CaliforniaHealth+ Advocates was SB 1014 authored by Senator Hertzberg. The legislation required Federally Qualified Health Centers (FQHCs) to participate in a Labor Management Cooperation Committee (LMCC) to be an eligible participant in the proposed Enhanced Clinically Integrated Program established under DHCS. Community health centers were gravely concerned that the LMCC mandate would have exacerbated health access inequities across California, effectively excluding most health centers and their patients from accessing these critical Medi-Cal resources. The bill would have also undermined the intent and leadership of FQHCs’ patient-led board of directors. As a result, Advocates opposed the bill and shifted efforts to the Advocates’ workforce budget proposal.
Medi-Cal Billing Abortion Services
FQHCs can only offer abortion services in compliance with federal rules if those services are entirely self-funded and/or do not utilize federal subsidies or resources. Offering abortion services requires FQHCs to create a new service line due to the federal Hyde amendment prohibition on using any federal dollars to support elective abortions, meaning that 330 grants dollars cannot be implicated in any way. To provide guidance to FQHCs interested in adding abortion services as an out-of-scope service line, CPCA, Essential Access Health, and legal counsel worked with DHCS to develop a billing pathway that would allow FQHCs to bill for Medi-Cal covered abortion services
and be paid through fee-for-service (FFS) reimbursement – outside of their usual prospective payment system (PPS) rate. As a result of our advocacy, DHCS posted “FQHC, RHC and Tribal Clinic Providers: Abortion Services” to their Medi-Cal News Provider website. The newsflash confirmed that DHCS Medi-Cal Program will reimburse FQHC, RHC, IHS/MOA and Tribal FQHC providers at a fee-for-service rate for abortion services effective October 1, 2022. This guidance from DHC was limited to Medi-Cal billing guidance and did not address accounting strategies for federal funding compliance. As a result, we partnered
with legal counsel Feldesman Tucker Leifer Fidell to host a webinar focused on legal guidance on federal compliance. This webinar provided direction to health centers interested in offering abortion services. We remain in partnership with Essential Access Health and legal counsel to ensure that our health centers have the support they need. Advocates is also part of HCAI’s stakeholder workgroup focused on reproductive health grants and continues to monitor available grants to ensure that health centers are represented and aware of available funding.
Budget wins with regard to telehealth and workforce support conveyed a strong commitment to delivering on the promise of equity and access and prioritizing the health and safety of all Californians.
Senate Bill 184
The final trailer bill language contained in SB 184 includes details regarding permanent FQHC/RHC telehealth policy. SB 184 makes it clear that DHCS will continue coverage of and payment parity for synchronous telehealth, including both video and audio-only, as well as asynchronous telehealth modalities for all Medi-Cal providers. There are also details regarding the establishment of patients through video synchronous interaction for FQHCs, and establishment of patients via asynchronous modalities under specific conditions. These are permanent telehealth flexibilities that went into effect on January 1, 2023. This was a huge win and a major policy step forward thanks to the consistent work of CPCA membership’s advocacy, legislative champions, and the Administration to establish comprehensive, permanent telehealth policies under Medi-Cal.
Assembly bill 204
Clinic Workforce Stabilization and Retention Program
The Clinic Workforce Stabilization and Retention program provides up to $1,000 in retention payments to eligible community health center staff across the state.
The program was unveiled in AB 204 (see Section 19) as part of the 2022-23 California State Budget, which also includes an additional $5 million to launch new postgraduate training programs for Nurse Practitioners (NPs) and Physician Assistants (PAs) in community health centers. CPCA supported AB 204 and worked on the legislative proposal with the Administration, Legislature, and labor stakeholders. Advocates provided guidance and direct assistance for qualifying health centers to help health centers operationalize the bonus retention program.
Leading up to the June Primary and November general election, Advocates met with candidates vying for seats in both the Assembly and Senate.
With the state facing a myriad of issues going into 2023, these meetings have been critical in establishing relationships, educating candidates on CHC priorities, and highlighting the important role health centers play in communities across California. Along with our health center leaders, we were able to formally interview candidates running for districts across the state and, with Board approval, offer endorsements to those that showed a commitment to the mission and values of CHCs. This first foray into the endorsement process showed the candidates our commitment to supporting them. We hope this support turns into a long-lasting relationship in return.
Each Advocates-endorsed candidate won their race. They are as follows:
Dobbs v. Women’s Health Organization
On June 24, 2022, the Supreme Court issued its decision in Dobbs v. Women’s Health Organization, which was substantially similar to the draft leaked in early May.
This decision overturned the 1973 Roe v. Wade decision that first conferred a constitutional right to abortion. The Dobbs decision means that states are free to impose abortion restrictions far more restrictive than the Mississippi 15-week ban at issue in the case.
CaliforniaHealth+ Advocates’ CEO Francisco Silva issued a strong statement when the Dobbs decision was leaked. Read the statement here.
In response to the decision, we convened a Reproductive Health Workgroup that has been exploring ways that health centers can offer abortion services without running afoul of the Hyde Amendment banning the use of federal funds for abortions. The first step was for DHCS to allow Federally Qualified Health Centers to be reimbursed for abortion services under the state Medi-Cal program; that guidance was issued on September 1, 2022.
Advocates also endorsed Proposition 1, which California voters overwhelming supported on November 8th at the ballot. Proposition 1 enshrines the fundamental right to reproductive freedom in the California Constitution.
the End of the COVID-19 Public Health Emergency
During the national public health emergency (PHE), the annual reevaluation of ongoing eligibility for public programs, including Medi-Cal, was temporarily paused to ensure ongoing access to health coverage during the pandemic.
When the COVID-19 continuous coverage requirement expires at the end of the PHE, California will need to conduct a full redetermination for all beneficiaries.
States will have up to 12 months, plus two additional months due to renewal processing policies, to return to normal eligibility and enrollment operations, which includes conducting a full renewal for all individuals enrolled in Medi-Cal.
In California, Medi-Cal enrollment has increased roughly 16 percent from the beginning of the pandemic to 14.5 million beneficiaries today. Out of those, two to three million beneficiaries could no longer be eligible for Medi-Cal, and there is concern that many more enrollees could lose coverage due to the redetermination process.
On April 12, 2022, Health and Human Services Secretary Xavier Becerra signed a renewal of the COVID-19 Public Health Emergency, effective April 16, 2022. PHE extensions had been active for 90 days, but the PHE could technically have been terminated sooner. However, HHS indicated that they would have provided states with a 60-day notice prior to the termination of the public health emergency declaration for COVID-19.
Medi-Cal PHE Unwinding Strategies and Toolkits
The Department of Health Care Services (DHCS) had been actively preparing for the end of the PHE and resuming coverage eligibility and enrollment operations through two phases of an Unwind Communications Strategy:
Phase 1: Updating Medi-Cal Beneficiary Contact Information –
Managed care plans are currently focused on conducting outreach to educate Medi-Cal beneficiaries about updating their contact information with their county social services agencies. This is a critical step to avoiding coverage loss. This phase is currently in process.
Phase 2: 60-Day Prior to the COVID-19 PHE Termination –
Once states receive the 60-day notice of the PHE termination, DHCS will shift the focus of the campaign 60 days prior to the end of the COVID-19 PHE. At that time, DHCS will encourage beneficiaries to report any changes in their personal circumstances and check their mail for upcoming renewal packets, should the county be unable to complete the renewal using information already available to them without having to contact the beneficiary.
California also launched a statewide coordinated campaign to reach beneficiaries with messages across multiple channels using trusted partners called DHCS Coverage Ambassadors. A customizable Medi-Cal Continuous Coverage toolkit and webpage are available to help push communications to Medi-Cal beneficiaries and encourage them to update their contact information with their counties to ensure they receive important information about keeping their Medi-Cal coverage. DHCS encourages everyone to join the mailing list to receive the latest information and updated toolkits.
Beneficiaries no longer eligible for Medi-Cal may qualify for tax subsidies that allow them to access affordable coverage through Covered California, or they may be eligible through their employer-based health coverage. Covered California, in partnership with DHCS, will launch a program to ensure that eligible individuals losing Medi-Cal will not experience a gap in coverage by enrolling in Covered California with financial help.
CPCA knows that health centers and consortia play a key role in ensuring that community members are connected to and enrolled in health coverage programs. With the anticipated expansion of full-scope Medi-Cal to undocumented adults in 2023, and reinstatement of Medi-Cal redeterminations when the PHE ends, we know this will require an incredible amount of staff time and resources to support coverage enrollment and retention in our communities. To help fund these services, CPCA was pleased to see the Governor include $60M in additional total funds allocated to the Health Enrollment Navigators Project through FY 2025-26 and continue project activities with an emphasis on COVID-19 PHE-related activities in the May Revision Budget.
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.
NHCW took place August 7-13, 2022. 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 posts, 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 July 27, 2022, which provided an update on Advocates’ federal priorities, reviewing our advocacy resources, and providing tips on how to use NHCW to advocate for health centers.
Phone2Action Advocacy Campaigns
Phone2Action is a digital platform that allows advocates to contact their elected officials with a simple click of a button. In 2022, CaliforniaHealth+ Advocates launched eight campaigns to advance CHC legislative and budget priorities at the federal and state levels. In 2022, 487 people took action at least once, sending a total of 4,040 emails to legislators and posting 277 tweets.
Day at the Capitol 2022
Day at the Capitol (DAC) is CPCA’s statewide annual event that allows health center leadership, clinicians, staff, patients, and advocates to engage in dialogue with legislative offices on budget and legislative priorities impacting CHCs. In preparation for DAC, CaliforniaHealth+ Advocates hosted a webinar on April 14th that outlined the day’s events, our legislative priorities, and provided a venue for those traveling to the State Capitol to ask questions in advance.
DAC was held in person on April 20th, the first time in two years due to the COVID-19 pandemic. Over 150 health center leaders from across the state came to Sacramento to collectively advocate on behalf of health center budget and legislative priorities.
The day began with a press conference on the south steps of the State Capitol to highlight CPCA’s budget priority relating to the $50M Supplemental Payment Pool (SPP) augmentation. At the press conference, we heard from our SPP legislative champion, Assemblymember Wendy Carrillo (AD-51), Jane Garcia (CEO, La Clinica de La Raza), Dean Germano (CEO, Shasta Community Health Center), and CPCA’s new President and CEO, Francisco Silva. This was followed by our DAC Lunch Program, held at the Hyatt Regency Hotel.
As Keynote Speaker, Francisco shared his vision for CPCA and emphasized how important it was for health center leaders to be at the table when any major health policy is made. DAC culminated with a legislative reception and awards program where we honored Senators Pan, Eggman, and Limon, and Assemblymembers Carrillo, Salas, and Aguiar-Curry for their support of health centers. We were also joined by California’s Attorney General, Rob Bonta, who shared why it was important for health centers to advocate directly to their legislators.
NACHC Virtual Policy & Issues Forum 2022
NACHC Policy & Issues Forum (P&I) is an annual advocacy event hosted by the National Association of Community Health Centers (NACHC). P&I draws health center leaders from across the country to focus on critical health care issues, in addition to collectively advocating for CHC priorities with their Members of Congress.
This year’s P&I, originally scheduled as in-person for the week of February 14th, was changed to virtual only due to the surge in COVID-19. Although P&I Education Sessions still took place during that week, NACHC shifted their advocacy day and instead had a virtual “Head to the Hill Week” which took place the week of March 14th-18th. This provided an opportunity for California health center leaders to meet with their Members of Congress to discuss health center funding, telehealth, and the importance and impact of health centers in their communities. In preparation, CaliforniaHealth+ Advocates hosted a California State Delegation meeting on Wednesday, March 2nd to brief health center leaders on topics of interest and ways to enhance their advocacy on Capitol Hill.
CaliforniaHealth+ Advocates strengthened the Government Affairs department by adding a few members to the team with strong knowledge of community health centers, strong reputations in the Capitol building, and a passion for health equity. In 2022, Advocates welcomed Dennis Cuevas-Romero, Laura Sheckler, Taylor Jackson, and Taylor Beckwith.
Dennis Cuevas-Romero was hired in September of 2022 as Vice President to lead the CaliforniaHealth+ Advocates Government Affairs department. Prior to joining Advocates, Dennis worked at the California Medical Association and the ACLU Center for Advocacy and Policy. Dennis was also appointed by former Gov. Edmund G. Brown, Jr. as the Deputy Director for Legislation at the California Department of Consumer Affairs. Dennis has a bachelor’s degree from UC Berkeley and a Juris Doctorate from the University of the Pacific, McGeorge School of Law.
In January 2022, Laura Sheckler joined Advocates as the Deputy Director of Policy and Regulatory Affairs. Laura was the first Consortia Policy Group colleague to join the GA team, and we were excited to have that perspective on our team.
Laura has worked in community health in the San Francisco Bay Area since 2004, with roles ranging from direct service to clinic management, program administration, and most recently as Director of Community and Government Affairs with the Community Clinic Consortium. Her work has focused on improving access to coverage and care for the remaining uninsured, addressing social determinants of health, and developing and strengthening inter-organizational networks.
In December of 2022, Taylor was added to the Government Affairs team as Advocates’ lobbyist. Taylor has worked in California politics and policy for almost a decade, where she has fought tirelessly to protect California’s most vulnerable populations. She brings a breadth of experience and political acumen to CPCA from her years in the California State Capitol and as a lobbyist. Taylor previously worked as the Policy & Advocacy Director for the Center for Judicial Excellence where she led a multi-state policy agenda and ran a National Advocacy Training Series Cohort for survivors of domestic violence. Prior to that, she worked as a lobbyist for the California Nurses Association, representing over 100,000 registered nurses statewide. During her time in the Legislature, Taylor served as a Senior Policy Committee Consultant and a Leo T. McCarthy Center Fellow.
Taylor Beckwith was hired in December of 2022 to lead Advocates’ grassroots efforts. Before CPCA, Taylor was involved in various public health efforts and policy advocacy. Taylor was most recently the Tobacco Control Programs Manager with Breathe California Sacramento Region where she worked on local city and county ordinances related to tobacco control. Prior to that role, Taylor worked for Compadres for Tobacco-Free Los Angeles County, mobilizing community college campuses to adopt tobacco-free campus policies and spearheaded the movement for a tobacco-free campus policy at her undergraduate institution. Taylor has also worked as a contracted grant reviewer with the Center at Sierra Health Foundation since 2020 on funding opportunities related to substance use disorder and youth leadership aimed at supporting communities most heavily impacted by the War on Drugs.
Taylor holds a Bachelor of Arts degree in Psychology from Whittier College and will graduate with her Master of Public Health degree with a concentration in Social and Behavioral Sciences in August 2023 from the University of Florida. She also completed her Master of Public Health internship with Sacramento County Office of Education where she worked on School Based Mental Health and Wellness initiatives.
LIABILITIES & EQUITY
|Due to CPCA||156,102.00|
|TOTAL LIABILITIES & EQUITY||192,075.00|
CaliforniaHealth+ Advocates would like to thank each of the donors who generously and personally donated this past year towards our political advocacy efforts.
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.
Below is a list of this year’s donors.
Champion – 1K or more
California Dental Association PAC
California Medical Association PAC (CALPAC)
Californians Allied for Patient Protection (CAPP)
Centene/HealthNet (Louise McCarthy)
Berenice Nunez Constant
Greg Facktor and Associates
Prima Waste Management
The Doctors Management Company
Advocates – 500 or more
Rosa Vivian Fernandez
Leo and Lucy Myers-Peecci
Supporters – 250 or more
Leslie Abasta Cummings
Joel Ramirez MD
Andrea Schwab Galindo
Friends – 100 or more
Dennis Cuevas Romero
Melissa Marshall MD
Rakesh Patel MD
Graciela Soto Perez
Partners – up to 100
BOARD & STAFF
David B. Vliet, MBA
Chief Executive Officer
LifeLong Medical Care
Chief Executive Officer
Sacramento Native American Health Center
Chief Executive Officer
Community Clinic Association of Los Angeles County
Berenice Nunez Constant, MPH
Vice President, Government Relations
AltaMed Health Services Corporation
Director at large
Chief Executive Officer
Livingston Community Health
Director at large
Chief Executive Officer
Gardner Family Health Network, Inc.
Director at large
California Consortium for Urban Indian Health
Director at large
Terri Lee Stratton, MPH
El Dorado Community Health Center
Executive Vice President/Chief Strategy Officer
California Primary Care Association
Francisco J. Silva, Esq.
President & Chief Executive Officer
California Primary Care Association
Executive Vice President/Chief Strategy Officer
Dennis Cuevas-Romero, Esq.
Vice President of Government Affairs
Associate Director of Legislative Affairs
Associate Director of Grassroots Advocacy
Deputy Director of Political Engagement
Deputy Director of Government Affairs
Senior Administrative Assistant
Assistant Director of Policy
Deputy Director of Policy and Regulatory Affairs
Associate Director of Public Affairs and Communications