Biweekly Briefing Articles

Preparing for the End of the Public Health Emergency and Title 42 

Come May 11, your hospitals could have fewer tools to manage increasing volumes. That’s because May 11 is the date the federal public health emergency expires, and likely along with it — Title 42. This pandemic-era policy was put in place under the Trump administration and allowed the United States to turn away or rapidly expel migrants seeking asylum. When Title 42 expires, the region is expected to see an influx of migrants who will need significant resources and support, including acute medical care at your hospitals.

Last week, in a unanimous vote, the San Diego County Board of Supervisors approved a comprehensive plan sponsored by Chairwoman Nora Vargas and Supervisor Joel Anderson that directs the County Chief Administrative Officer (CAO) to “develop a Comprehensive Preparedness Plan to identify actions that can be taken to ensure asylum seekers entering the U.S. will not add to the region’s current homeless crisis.” The board item also directed the CAO to report back in 30 days on short-term actions, continue working with regional organizations to advocate for federal funding and resources, and send a letter to the San Diego delegation in support of comprehensive immigration reform.  

“Now, more than ever, we should lead the way in building a just and humane immigration system that rises to meet the challenges of the current situation around the world,” Vargas said in a statement after the Tuesday vote. 

Our region has long been recognized for its collaborative support of asylum seekers. Since 2018, San Diego Rapid Response Network has provided 125,000 asylum seekers respite shelter and assistance, including shelter and transition services, travel assistance, nutrition services, medical screenings, legal assistance, and financial support. Less than 1% of the asylum seekers who receive medical screenings have been referred to acute hospitals for additional care.

However, even with the newly approved preparedness plan, there will be a significant increase in the number of asylum seekers requiring resources and health services across our extensive border region. This will almost certainly result in increased volumes for your hospitals. To assist with local planning in both San Diego and Imperial counties, the San Diego Healthcare Disaster Coalition has also formed a Title 42 Workgroup.

Unfortunately, the potential termination of Title 42 will come at a difficult time, as the Feb. 28 end of California’s state of emergency means a number of waivers that your hospitals have relied on for the past several years — specifically the space waiver — will no longer be able to be utilized. This has been a vital resource that has allowed you to easily convert space for temporary additional beds, a flexibility that may be greatly needed if your hospitals were to experience a surge of patients — for whatever reason.

Although hospitals can continue the use of space in a manner different from statutory and regulatory requirements, a program flex request must be submitted to the California Department of Public Health (CDPH). And if your hospital is looking to make temporary changes permanent, those projects must be submitted to the Department of Health Care Access and Information (HCAI) for review and approval. To assist hospitals in submitting a flex request, the California Hospital Association has developed a document that provides guidance on the steps that must be taken with CDPH and HCAI, both of which have committed to a quick turnaround for these requests.

Understandably, there is a great sense of unease, given the current financial struggles that many of your hospitals are facing, and uncertainty about what the coming weeks and months will bring. But I know that each and every one of you will rise to the challenge — with the same flexibility, resilience, and courage you have shown for the past several years.

And you can count on HASD&IC to be your partner, your advocate, your sounding board — on this and all issues that come before you.