States have yet to spend hundreds of millions of federal dollars to address COVID-related health disparities

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This story was originally published by Kaiser Health News.

The Biden administration in March 2021 announced it was investing $2.25 billion to address COVID health disparities, the largest federal funding initiative designed specifically to help underserved communities hardest hit by the virus.

Two months later, the Centers for Disease Control and Prevention awarded grants to every state health department and 58 major city and county health agencies. The money is intended to help limit the spread of COVID-19 among those most at risk in rural areas and among racial and ethnic minority groups, as well as improve their health. The CDC initially said the grant had to be spent by May 2023, but earlier this year it told states they could ask to extend that deadline.

A year later – with COVID having killed 1 million people in the United States since the start of the pandemic and hospitalized millions more – little money has been used, according to a KHN review of about a dozen grants state and county agencies. While some states and localities have allocated a large portion of CDC money to projects, they have still spent only a small portion.

The Missouri Department of Health spent none of its $35.6 million. Wisconsin, Illinois and Idaho — whose state health departments each received between $27 million and $31 million — used less than 5% of their grants.

The Pennsylvania Department of Health has used about 6% of its nearly $27.7 million grant.

The California Department of Health spent just over 10% of its $32.5 million funding.

Public health agencies give a litany of reasons for this: They need time to hire people. They blame their state’s lengthy budget process. They say it takes time to work with nonprofits to set up programs or for them to put the money to use. They are already tapping into other federal dollars to address COVID disparities.

The rise in unspent COVID relief dollars is a major reason Republicans in Congress oppose Democrats’ efforts to appropriate billions of additional federal dollars to manage the pandemic.

The slow disbursement also highlights the ripple effects of years of neglect for public health systems and the boom and bust cycle of statutory funding. “These are investments that are overwhelming a system that has been starved for so long,” said Dr. Usama Bilal, assistant professor of epidemiology and biostatistics at Drexel University in Philadelphia.

Dr. Kirsten Bibbins-Domingo, chair of the department of epidemiology and biostatistics at the University of California, San Francisco, added that it is difficult for under-resourced public health systems battling a pandemic to establish links with local nonprofit organizations so quickly.

“The pandemic has brought these big health disparities to light, but it has also brought to light the fact that [public health systems] don’t have the structures in place to build direct partnerships with communities,” she said.

The funding is intended to reduce the disproportionate effect of the pandemic on minorities. When adjusting for age differences between racial and ethnic groups, black, Hispanic, and Native American communities experienced higher rates of COVID-related hospitalizations and deaths compared to whites. Such adjustments are necessary, the researchers say, because communities of color tend to be younger.

Despite the need to address these issues, the Riverside County Health Department in California spent approximately $700,000 on its $23.4 million grant, which is separate from state health department funds. .

“Public health has always been underfunded, and all of a sudden it’s a lot more money than we ever get,” said Wendy Hetherington, head of the agency’s public health program. . “It’s great that we got this funding because it’s needed, but we’re having a hard time trying to spend it.”

Part of the problem was that county health officials had to wait six months for local government approval to spend it. Then, she said, she faced delays in negotiating contracts with nonprofits in the area.

The pandemic has brought to light these large health disparities, but it has also brought to light the fact that (public health systems) do not have the structures in place to partner directly with communities.

– Kirsten Bibbins-Domingo, chair of the Department of Epidemiology and Biostatistics at the University of California, San Francisco

Stan Veuger, a senior fellow at the conservative American Enterprise Institute, echoed the concerns of Republican lawmakers, saying the slow rollout of these grants shows Congress has sent more pandemic relief than states and local governments have. needed it, as their tax revenues rebounded much faster than expected.

“It raises questions about why this separate grant program was put in place,” he said.

Rachel Greszler, senior fellow at the Heritage Foundation who has opposed Congressional funding of new COVID relief, said slow spending also shows how much time states need to absorb an influx of revenue. and developing programs, especially when governments face labor and supply shortages. chain problems.

The CDC said the money could be used to help prevent the spread of the COVID virus, improve data collection, expand COVID-related health services, and address social and economic issues that have kept many minority communities from living. receive appropriate care during the pandemic. .

CDC officials are working with groups on implementing the grant, spokeswoman Jade Fulce said.

Since the term “health disparities” encompasses challenges faced by all types of population groups, silver can be applied to almost anything that affects health.

The Illinois Department of Public Health received $28.9 million and spent $138,000, according to spokesman Mike Claffey. The state plans to spend some of the money on American Sign Language translation of COVID documents, outreach to people in prison, mobile health units for rural areas, and hiring community health workers. .

“The goal was to design programs that strengthen the health care infrastructure and address these historic inequities in meaningful and meaningful ways,” Claffey said.

The Florida Health Department plans to use $236,000 of its nearly $35 million grant for newborn hearing screenings after COVID-related shutdowns led to a drop in timely checks, a said spokesman Jeremy Redfern.

The Miami-Dade County Health Department spent $4 million of its $28 million grant from the CDC. He donates money to local non-profit groups to address food insecurity and language barriers. Like other jurisdictions, the county noted that it has awarded funds that groups have yet to spend, including $100,000 to improve literacy within its large Haitian community. Saradjine Batrony said she hopes to help between 60 and 100 people from May with this grant.

“The language barrier is what’s kept people from getting vaccinated,” said Batrony, who was a researcher at the University of Miami before starting her own business last year focused on translating health documents. in Haitian Creole.

Nearly $4.6 million of the Pennsylvania CDC grant went to the state’s Office of Rural Health, which last fall planned to give money to 20 counties. As of May 5, it had not funded any.

“Over the past two months we have had issues with county leaders losing momentum and interest in the COVID-19 work,” said Rachel Foster, rural COVID-19 program manager for the agency based at Penn State University. “In rural Pennsylvania, cases are low, interest in vaccines has waned, and rural residents feel the pandemic is over.”

Some counties and states say they were tackling health inequity issues before the CDC’s disparity money.

Philadelphia’s $8.3 million grant follows several CDC awards that also addressed issues affecting underserved communities, spokesman Matthew Rankin said. Philadelphia spent about $147,000 of the disparity grant.

The University of Florida Jacksonville Health System received $1.25 million last July from Duval County to expand services to communities disproportionately impacted by COVID. But by early May, the university had yet to receive the money, spokesman Dan Leveton said. “We are not worried because we have other COVID funding that we are using at the moment and we will use CDC funding when it arrives,” he said.

Mississippi received $48.4 million, the largest award to a public health agency from the grant. The agency has spent $8.2 million so far, spokeswoman Liz Sharlot said, though it has already used other federal relief funds to address health disparities related to the COVID.

As states figure out how to spend the money, health experts worry about the political consequences and for the communities that need help.

“The money is badly needed, but we have to consider that these health services have been overburdened for a long time and they don’t really have enough staff to handle it,” Drexel’s Bilal said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.

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