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Tobacco Control Programs Use Business Process Mapping to Strengthen Workforce tobacco control programs, preventable disease, tobacco industry, diverse workforce, grants management, mapping workshops, technological support, united states, tobacco product, young people, comprehensive tobacco control programs, public health, tobacco company, department of health, cigarettes and smokeless tobacco, smokeless tobacco products, health care system, youth and young adults, smoking cessation, reduced smoking, tobacco related disparities, astho, association of state and territorial health officials Amy Ciarlo Since the beginning of the COVID-19 pandemic, public health agencies have experienced significant turnover across leadership and staff throughout various programs, including tobacco control. Between 2021 and 2023, nearly 30% of all state and territorial program managers were experiencing turnover (e.g., in some cases, vacancies lasted months) or were new to this role, having less than two years of experience. This decline in workforce reduces capacity to address tobacco use—the nation’s number one cause of preventable disease, disability, and death. Tobacco control program staff require a level of knowledge that can take time to build, including: Historical context of tobacco industry marketing influence. Policy, systems, and environmental change strategies. Emerging products and changing regulations. The complexity that goes into helping people who use tobacco to quit. Finding qualified applicants that will stay in these roles long term has been challenging across jurisdictions. In response to this need, the Tobacco Control Network, in collaboration with CDC’s Office on Smoking and Health, convened a nine-month learning community with three state tobacco control programs (Alaska, Arizona, and New Jersey) to address hiring and onboarding challenges, which concluded in March 2024. Subject matter experts Health Management Associates (HMA) supported by educating participants on business process improvement (BPI) methods, facilitating business process mapping workshops, and consulting on the development of individual state implementation plans to address key challenges identified during the mapping processes. A similar model with specific OD2A grant recipients focused on procurement, contracting, and helping address spend-down of funding. Business Process Mapping and Implementation Planning Each state participated in a two-day, in-person BPI workshop to outline all steps, from filling a vacancy to completing the onboarding of new hires. This was a lengthy exercise, as agencies often have many elaborate processes in place, due to an organizational requirement, an expectation held by leadership, or a past purpose that is no longer relevant. Understanding why the process happens and visualizing the steps in sequential order helped teams identify “waste” or areas for improvement, including overwork (e.g., too many meetings), waiting (e.g., on an approval, for a training to become available), extra processing (e.g., duplicating efforts), and unused talent (e.g., insufficient training and alignment of skillsets). States then drafted implementation plans to address key issues, outlining steps with detailed timelines and tasks assigned to individuals to increase accountability. Each state team finalized their plans as part of the learning community, with some activities in progress or already completed. However, all three varied in their processes, their approaches to solutions, and the activities outlined in their implementation plans: One state’s BPI workshop focused on grantees at the county-level and streamlining onboarding, as counties lacked consistency in their hiring and onboarding approach. Their implementation plan focuses on a team of state health agency staff and local partners establishing a guidance document that assists new local staff in their first three months. Another state’s BPI workshop centered on addressing challenges in building a diverse workforce, with goals to establish a standardized practice for job postings and reduce re-posting of vacancies. The mapping process allowed collaboration across multiple departments and with health agency leadership. During the final state BPI workshop, the team identified excess meetings as a pain point and are reworking them to reduce redundancy and streamline the onboarding process. The implementation plan also prioritizes making training materials more engaging and better understanding training needs among new program staff. Lessons Learned The state teams gathered to share key takeaways from the learning community, as reported by HMA, informing recommendations for other programs looking to address hiring and onboarding challenges. Successes Participation led to team building and a mutual understanding of the process. Participants trusted one another to share with transparency. The mapping activities remained agnostic by highlighting inefficiencies in the process and not the people. Individuals with new perspectives had the opportunity to comment on system improvements. Teams recognized the numerous demands on team members and grantees, how much duplication existed across processes, and the number of approvals or layers in the hiring procedures. Teams created clearly identified roadmaps to improve hiring and onboarding staff. The learning community brought together partners across the state to address challenges that impacted their work but were not part of their everyday tasks. Challenges Staff representatives from HR or Grants Management were not present during the mapping workshops, causing gaps in information during these sessions. Power dynamics created difficulty for all participants to contribute equally. There was a lack of consideration for equity and challenges from new hire perspectives. More structured technical assistance and check-ins following the development of implementation maps were needed to support follow-through. Some participants had a sense of ownership or attachment to the established process and were protective of maintaining the status quo. Recommendations Ensure all participants understand the vision by providing an example of similar work in advance as reference material. Prior to the mapping activities, conduct a series of key informant interviews to ensure the right people are in the room, gain an understanding and awareness of organizational and interpersonal dynamics that may impact the process, and identify opportunities to establish bidirectional communications between state and local staff. Plan for ongoing technical assistance follow-up to ensure understanding of the initiative and support implementation. Ensure logistics can accommodate the process, such as proper room size and technological support. In Conclusion Given the challenges identified in this pilot learning community, states would likely benefit from change management prior to beginning BPI activities. Having intentional conversations up front can prevent these common challenges, as outlined previously. Overall, all state participants agreed that the learning community was valuable to their work, increased their organization’s knowledge and capacity, strengthened their relationships within their agency, and they intend to continue working on their improvement plans. One state team shared, “A major success from this mapping workshop was understanding the significance of engaging and listening to colleagues from diverse departments. The workshop facilitated a clearer understanding of civil service and HR operations, emphasizing the hurdles faced by hiring managers.” While business process mapping and implementation plan development can be laborious, the results are well worth the effort. website yes

States Support Postpartum Health with Medicaid Expansions astho, association of state and territorial health officials, 2023 state legislative session, medicaid expansions, postpartum health, the consolidated appropriations act, national women s health week, postpartum coverage, affordable care act, premium tax credits, affordable care, 12 weeks, united states, extended postpartum coverage, health a priority, medicaid program, national women s health, mother s day, 2023 legislative, vaginal birth, physical activity, women s health week, postpartum care, coverage for 12 months, 60 days, state plan amendment, care act, postpartum depression, health care Sowmya Kuruganti National Women’s Health Week reminds us that postpartum care is critical for the long-term health of the birthing parent and baby. National Women’s Health Week’s 2023 theme—Women’s Health, Whole Health: Prevention, Care and Wellbeing—is a reminder that postpartum care is critical for the long-term health of the birthing parent and baby. The first year after pregnancy can be full of physical, emotional, and mental health challenges that have long-term or even life-threatening health impacts without timely diagnosis and treatment. In September 2022 CDC reported that 23% of pregnancy-related deaths occur from seven to 42 days postpartum, and 30% of deaths occur 43-365 days postpartum. Among all pregnancy-related deaths occurring from 2017 to 2019, approximately 84% were deemed preventable. Black and American Indian and Alaskan Native <!--(AI/AN)--> women have two to three times higher rates of pregnancy-related death compared to white women. These disparities, like others, are driven by social and economic factors that are rooted in structural and systemic racism and discrimination. Health insurance coverage is one such factor that supports positive maternal health outcomes by facilitating access to care before, during, and after pregnancy. In the United States, 40% of births are covered by Medicaid, which is the primary source of health coverage and access to care for those of low income. Organizations like ASTHO and the Association of Maternal and Child Health Programs support extending Medicaid coverage through one-year postpartum to combat disparities in maternal health outcomes. Federal Legislation for Postpartum Coverage under Medicaid For the majority of states that have adopted Medicaid expansion under the Affordable Care Act (ACA), all people with income up to 138% of the federal poverty level (FPL) are eligible for Medicaid. In states without Medicaid expansion, pregnant people can be eligible for coverage during pregnancy and up to 60 days postpartum under federal law. After 60 days postpartum, these people may lose coverage for the rest of the year-long postpartum period based on general state Medicaid eligibility requirements. Prior to 2021, states could extend Medicaid coverage to postpartum people through a section 1115 demonstration waiver or through state funds. The enactment of the 2021 American Rescue Plan Act, gave states another option to extend Medicaid coverage to 12 months postpartum via state plan amendment for five years. So far in 2023, CMS has approved the State Plan Amendments for five states (Alabama, Arizona, Colorado, Oklahoma, and Rhode Island) implementing a 12-month postpartum expansion. To date, a total of 33 states have expanded Medicaid coverage to 12 months postpartum via Section 1115 demonstration waiver or state plan amendment. 2023 State Legislative Session Depending on states rules for modifying Medicaid coverage the legislature may need to direct the health department to submit a state plan amendment. So far in 2023, three states enacted legislation related to expanding coverage to 12 months postpartum. In Mississippi, SB 2212 authorizes the state’s Division of Medicaid to provide 12 months continuous postpartum coverage to people who qualify. Utah’s SB 133 extends coverage for 12 months postpartum for women eligible for Medicaid during pregnancy. In Wyoming, HB 4 temporarily extends Medicaid coverage for qualifying pregnant women for 12 months postpartum, ending March 31, 2027. Other states introduced bills to extend postpartum coverage during this session. The Alaska Legislature passed legislation (SB 58) directing the Department of Health to submit a state plan amendment extending postpartum coverage to 12 months, and to raise the household income level for eligibility to 225% of the FPL. The bill is currently awaiting action by the governor. Iowa introduced legislation (SF 57) to enact postpartum coverage for 12 months postpartum by Medicaid State Plan Amendment. This would extend the current 60-day postpartum coverage for Medicaid beneficiaries. The Missouri legislature passed (SB 45) that would extend MO HealthNet postpartum coverage from 60 days to 12 months postpartum for women who are either currently receiving or eligible to receive aid to families with dependent children, or eligible to receive benefits via the income eligibility standard. Pregnant women eligible for MO HealthNet and receiving mental health treatment for postpartum depression, related mental health conditions, or substance abuse treatment within sixty days of giving birth would remain eligible for benefits for those services for an additional 12 months. The bill is currently awaiting action by the governor. Nebraska introduced legislation (LB 419) to extend postpartum coverage for 12 months postpartum that would extend the current 60 day postpartum coverage. Texas introduced legislation (HB 12) to extend postpartum coverage to 12 months; it has passed in the House and is now pending in the Senate. Its passage would significantly change the current coverage structure, which uses state funds to provide postpartum people a limited package of postpartum services through the Healthy Texas Women program under HB 133, and subsequently submitted 1115 waivers to draw down federal funds for the program and extend coverage to six months postpartum. Wisconsin introduced companion bills (AB 114/SB 110) extending postpartum coverage for 12 months postpartum for women eligible for Medicaid during pregnancy. This action would extend coverage from the current 60 days and amend the previous 90-day Section 1115 Waiver submitted in 2021. Studies have demonstrated numerous benefits of extending Medicaid coverage for postpartum people and, given these positive impacts, ASTHO expects that more states will take action to extend Medicaid to 12 months postpartum. ASTHO will continue to monitor and report on this essential maternal public health issue. website yes

ASTHO, in collaboration with CDC, provided full-time disability and preparedness specialists to 17 jurisdictions to better meet the needs of people with disabilities. In this brief, specialists share their thoughts on why people living with disabilities may be hesitant to get the COVID-19 vaccine and some approaches public health officials can take to address vaccine hesitancy in people living with disabilities.

Opportunities for Public Health Agencies to Advance Sustainable Financing of Community Health Worker Programs Advancing Sustainable Financing of Community Health Workers Explore how health officials can play key roles as funders, administrators, and policy designers to advance sustainable financing of community health workers. Many states face upcoming funding gaps for community health worker (CHW) positions, with COVID-19 related grant funding streams expiring. Concurrently, many states are rapidly beginning to cover CHW services under Medicaid. In addition, Medicare launched a new reimbursement opportunity for CHWs in January 2024. These factors create an opportunity for state and territorial health agencies to develop or contribute to equitable reimbursement and robust implementation. This report details how health officials can play key roles as funders, administrators, and policy design champions to ultimately advance sustainable financing of CHW services. Get the Report (PDF) website yes

The 2020 holiday season is coinciding with a nationwide surge of COVID-19 cases. With great concern that holiday travel to see loved ones may exacerbate community spread of the virus, many states are increasing public health measures before the winter holiday season. As of November 16, 2020, 13 states and D.C. had a quarantine requirement for out-of-state travelers. The U.S. territories also have instituted travel restrictions to limit the spread of COVID-19.

This Health Policy Update is an overview of state legislative activity to increase financial stability for families during the COVID-19 pandemic which may help to prevent adverse childhood experiences.

ASTHO staff identified a range of evidence-supported policies considered by state legislatures that could prevent ACEs. This report synthesizes these research and policy proposals and is intended for public health practitioners and policymakers who are considering adopting similar policies.

This blog post discusses mitigating risks of AI use in government agencies, emphasizing privacy, transparency, and ethical concerns.

Policymakers seek to prevent the spread of COVID-19 by focusing on non-congregate sheltering and alternative housing for unhoused populations.