• California: On Jan. 1, California became the first state to offer health insurance to undocumented immigrants, regardless of age. Previously, the state had expanded access to Medi-Cal to undocumented children, young adults ages 19 to 25, and older adults ages 50 and older. Under the new expansion, around 700,000 undocumented residents between the ages of 26 and 49 will be eligible for full coverage through Medi-Cal. According to ABC News, the California Health and Human Services Agency has committed $835.6 million for 2023-2024 and $2.6 billion annually in the years after to expand full Medi-Cal eligibility to all income-eligible adults in the state, regardless of their immigration status. "In California, we believe everyone deserves access to quality, affordable health care coverage – regardless of income or immigration status," said Gov. Gavin Newsom's (D) office. "Through this expansion, we're making sure families and communities across California are healthier, stronger, and able to get the care they need when they need it." (Kekatos, ABC News, 12/29/23)
• District of Columbia: The Department of Justice last week dropped its appeal of a ruling that would have affected health insurers' ability to use copay accumulator programs. In 2022, the HIV+Hepatitis Policy Institute, Diabetes Leadership Council, and Diabetes Patient Advocacy Coalition filed a lawsuit against HHS and CMS, challenging the 2021 Notice of Benefits and Payment Parameters rule. The rule allowed health insurers to use copay accumulator and maximizer programs to prevent copay assistance from counting toward patients' deductibles and out-of-pocket limits. In September 2023, the U.S. District Court for the District of Columbia ruled in favor of the patient advocacy groups. Although the federal government initially appealed the ruling and said it was writing a new rule on the policy, it eventually dropped the appeal. According to Modern Healthcare, patient advocacy groups have cheered the government's decision to drop the appeal. "Now that the government has dropped its appeal, we hope this is a signal they will accept and enforce the court ruling and issue guidance stating that copay assistance, in most instances, must count for patients," George Huntley, CEO of Diabetes Leadership Council and Diabetes Patient Advocacy Coalition. (Berryman, Modern Healthcare, 1/17; Wilkerson, STAT+ [subscription required], 1/17)
• Georgia: CDC last week recommended doctors considering testing for "forever chemicals" in patients' blood to gauge community-wide exposure. Forever chemicals refer to per- and polyfluoroalkyl substances (PFAS), which are commonly used in nonstick cookware, water-resistant fabrics, personal care products, and more. Exposure to PFAS has been linked to several health conditions, including cholesterol increases, decreases in birth weight, lower antibody responses to vaccines, kidney and testicular cancer, pregnancy-induced hypertension, preeclampsia, and changes in liver enzymes. In the new guidance, CDC said clinicians should first evaluate a patient's exposure history before determining if testing could help them reduce exposure. Clinicians who decide to conduct blood testing to measure PFAS levels can do so through Clinical Laboratory Improvement Amendments-certified commercial clinical laboratories. According to CDC, systemic testing for PFAS may help public health officials assess community-wide chemical exposures. Although there is currently no way to treat PFAS levels in the body, some way to reduce exposure include installing a water filtration system, testing private well water, limiting consumption of food products that are known to be contaminated with PFAS, and using consumer products that are free of PFAS. (Monaco, MedPage Today, 1/19)

Climate change exacerbates cancer risk and worsens cancer survival, producing higher numbers of complex, high-acuity patients. Health systems must grapple with a population whose expensive needs cannot be met. Advisory Board's Ellie Wiles outlines the implications for health systems and poses four questions to ask about your organization's preparedness.