Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services

Good afternoon. My name is Lisa Coleman. I'm with the California Commission on Aging, and we wanted to say thank you to the committee and to the staff. I'm coming to speak about issue 27, advancing Older Adult Behavioral Health. While we are disappointed that we didn't get that final $10 million for the media to work on stigma Against Mental health, we are very appreciative of the $40 million investment and encourage you, as this budget process moves forward, that you would stay strong and recognizing that behavioral health services are essential to all around physical and mental health. Thank you.

Thank you.

Good afternoon, ma'am, chair and members. I'm Tom Renfrey. I'm with the California Association of Alcohol and Drug Program Executives, speaking on issue number 38 strengthening Oversight for Substance use disorder licensing and certification. CADP just supports the staff recommendation on this item. Regarding the language that allows the Department of Healthcare Services to increase licensing and certification fees for providers, we support the staff recommendation consistent with the administration's proposal to increase these fees for the licensing fund, but phasing in the fee increase of no more than 20% per year, adjusted for inflation. After that, this will be a big help to substance use disorder providers that we represent, for whom the original proposal of 75% fee increase was going to be a huge burden for these providers who operate on pretty slim margins. And so this proposal, this recommendation from the staff, will be a big help to these providers, and we urge your support. Thank you.

Thank you so much.

Good afternoon, Madam Chair, Members of the Committee. Jedd Hampton with the California Association of Health Plans, representing 43 ... license health plans, representing 28 million Californians. I'd like to briefly speak on three items, if I could, very quickly. On item 65, regarding the MCO tax, we've been working very closely with the legislature and the administration on the renewal of the MCO tax. We appreciate all the hard work that has gone into the issue and maintain our position that the MCO tax must be used to directly benefit the Medi-Cal program, must be affordable for purchasers of health coverage in the individual employer markets, and must be predictable, stable, and equitable. Moving forward on item 137, regarding covered California premium subsidies, we are pleased to see the legislature's recommendation to require the individual mandate penalty revenue to be annually deposited in the Healthcare Affordability Reserve Fund to lower costs for healthcare purchasers through the exchange. So we certainly believe that this proposal is moving forward in the right direction. And lastly, on item 67, regarding hearing AIDS, we are disappointed to see that a new benefit mandate is being moved in the budget process without any consultation or input from the health plans. We strongly believe that this proposal should receive a full policy committee hearing, as it is a new healthcare coverage mandate on the plans. We would like to see that done similarly to similar proposals in years past, just to note that this proposal will increase premiums on commercial payers, the same commercial payers that are paying the MCO tax. And lastly, we are concerned that this new mandate violates the essential health benefits program, which means that the state will now be on the hook for paying for these costs moving forward. It's important to note that this will be the first time that if this proposal passes and the governor signs a budget, that a proposal violates the essential health benefits, and we are concerned about the precedent about passing mandates that violate the essential health benefits moving forward. Thank you.

Anyone else looking to provide public comment in person? See none. Moderator will turn to the teleconference, see if anyone is online.

And ladies and gentlemen, if you wish to speak on this, please press one, then zero. At this time.

Moderate. How many people?

We have four at the moment.

We can begin.

We'll start with line eleven. Please go ahead.

Thank you. Good afternoon, Madam Chair and members. Grace Eco here on behalf of the California Alternative Payment Program Association, or CAPPA. We're calling in on a few issues today. On issue 176, we support the staff recommendation and want to underscore the need to have a single set, single voucher type for all income eligible families that supports Equitable and fair access to all child care. On issue 178, CAPPA supports the COLA increase for all programs. Further, we also support issue 180 for all programs. Lastly, we support staff recommendations for issue 181 for the cap to family fees and Elimination of Family Fee Repayment plan. We appreciate the streamlining of verification for child care as it is burdensome to families, and hope to align childcare verification programs with other programs. We ask to be included in these conversations as Kappa represents the community partners doing the work in the field, kappa represents those enrolling the families, and we encourage the community to reach out to us so we can provide further information and data to support you in this process. Thank you so much. Thank you.

And we'll go to line 18. Please go ahead.

Thank you. Madam Chair member Kathy Thunderling McDonald with the County Welfare Directors Association. We appreciate all of the hard work this year and especially appreciate your support for needed funding for county healthrest operations so we can assure access to critical nutrition benefits. Of course, we also urge consideration of funding for county options for youth with complex needs for whom unlicensed placements are currently the only option, and look forward to continued discussion with you and your staff regarding that issue. Thank you so much. Thank you.

And next we're going to line 15. Please go ahead.

Hello, good afternoon ... I'm calling on the Los Angeles Regional Food Bank and I'm calling in support for something hunger is at a record level in our community. We've seen a 200% in demand with our food bank specifically serving approximately 800,000 people each month. Want to take the time to thank you all for the comprehensive and bold approach for addressing food insecurity and poverty in the Senate budget plan. We're very grateful as a food bank for the $6 million investment in CalFood, which is critically needed. And we're also very grateful for the inclusion of funding to automate an increase to CalFresh minimum benefits to $50 a month. That being said, CalFresh recipients are experiencing a benefits clip today and we urge the inclusion of funding to fully implement the increase in benefits. Thank you once again. Also thank you for funding protect thank you.

Madam Chair. We now have ten in queue still.

Okay, if we could limit our comments to 45 seconds please.

And we'll go to line 19, please go ahead.

Good afternoon, chair and members. Jared Call with Nourish California. I just want to thank you for including so many anti-hunger priorities to help address the hunger cliff. Really want to thank you for your leadership on issue 187, raising the CalFresh minimum benefit and strong support for issue 164, accelerating the EFAP expansion timeline. Also strongly support issues 166, summer EBT, 185 removing the three-month time limit, 188 the CalFresh Safe Drinking Water pilot extension, and also want to express our support for issue 178 to keep the COLA for the CATFD program. Thanks so much.

Thank you.

And next we'll go to line 13. Please go ahead.

Hello, my name is Sanda Mystia and I'm with Optimist Youth Homes and Family Services, an agency focused on serving children, youth in and at risk at foster care. Here Ingen County, and calling in support of the 18 million budget to establish the slip housing supplement for youth extended inextended foster care that was included in the assembly budget. We can help end rent homelessness if the Senate includes an investment in the final budget.

We'll go to line 17. Please go ahead.

Good afternoon, Madam Chair and Committee Members. Tyler Rinde with the California Alliance of Child and Family Services. We greatly appreciate and thank the Senate subcommittee for including the extension of implementation of AB 1051, making changes to presumptive transfer, prohibiting adoption, facilitators, rejecting the trailer bill language proposal for psychiatric residential treatment facilities, and supporting staffing for the state to process background checks quicker through Guardian. We continue to advocate for our Foster Family Agency budget request within ASW to support social workers and foster youth in home-based care. Thank you.

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Good afternoon, Madam Chair and members. Jolie Onodera with the California State Association of Counties. I'd like to briefly comment on just two issues an issue 35, behavioral Health Payment Reform. CSAC continues to support the Administration's proposal for $375,000,000 in one time general fund to support county behavioral health payment reform that takes effect this July. And lastly, we are in strong support of the subcommittee's proposed action on issue 72, approving the withdrawal of the Governor's budget proposal to avert nearly $50 million approved in the 2022 Budget Act for public health workforce development programs. Thank you.

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Good afternoon, Madam Chair and Senators Rosanna Elliott, on behalf of the Early Care and Education Coalition, I want to thank the Senate for their continued commitment to child care and the rate increases, as well as the commitment to the alternative payment structure and the family fees. Thank you again for your continued commitment. Thank you.

Line 22, please go ahead.

Good afternoon, Madam Chair and members. Nicole Wordelman, on behalf of the Children's Partnership, we appreciate your work and the work of staff. The Children's Partnership supports many elements of the Senate budget. However, in particular, we wanted to thank you for your inclusion of 2.4 million annually to extend the comprehensive perinatal services program for up to twelve months post-pregnancy, which will draw down 5.1 million in federal funding. Additionally, the deletion of the trigger language for continuous medical coverage for children zero to five is especially appreciated. Thank you very much for your action on these. Thank you.

We'll go to line 25. Please go ahead.

Good afternoon, Chair and members of the committee. Anna Johnson with John Burton Advocates for Youth. I've personally experienced homelessness in California, and we're calling in support of an 18 million budget asked to establish the Silk Housing Supplement for youth and extended foster care that was included in the Assembly Sub three budget. And we would like your support in ensuring that remains in the final budget. Thank you. Thank you.

Line 23, please go ahead.

Thank you. Darby Kernan, on behalf of Leading Age California, we're supportive of your action on issue 21, restoring the healthcare workforce delays and rejecting the Governor's proposal, and in addition, on the Advancing Older Adult Behavioral Health. While we understand the need to reduce some funding, we did support the $50 million in the Governor's budget. We still feel strongly that older adults need this access to these services. Thank you. Thank you. We're going to hear public comments for three more minutes, so if you could please shorten your comments. Thank you.

We'll go to line 26. Please go ahead.

Good afternoon, Madam Chair. And senators. My name is Christina Torres and I'm a former foster who has experienced homelessness in Kern County. I'm calling in support of the 18 million budget app to establish the ... Housing Supplement for youth and extended foster care to have housing affordability and stability. Thank you. Thank you.

Line 27, please go ahead.

Hi, my name is Asani Dunlap. I'm a former foster youth, and I'm in support of calling for the 18 million budget to establish the Silver Housing Supplement. Thank you.

Line 28, please go ahead.

Good afternoon, my name is Elizabeth Klus, and I am a former foster youth that has experienced homelessness in both Ventura and Los Angeles County. I'm calling in support of the 18 million budget. Ask to establish the Soap Housing Supplement for youth in extended foster care. Thank you. Thank you.

Line 29, please go ahead.

Good afternoon, my name is Anisa Khan Mohammed, calling with allies for every child in Los Angeles County. I'm calling in support of the $18 million budget. Ask to establish the Silk Housing Supplement for youth in extended foster care that was included in the assembly budget. We believe this funding is critical to ending foster youth homelessness. Thank you. Thank you.

Line 30, please go ahead.

Hi. This is Gabby Davis, with the California Association of Food Bank. Thank you for the comprehensive and bold approach to addressing food insecurity and poverty in the Senate's budget plan. We are very grateful for the 60 million investment in CalFood, inclusion of funding to establish CalFresh ... care benefits, inclusion of funding to automate an increase of CalFresh minimum benefits to $50. The CalFresh recipients are experiencing the benefits club today. We urge inclusion of funding to fully implement the increase in benefits, and we also call for action to reimagine ... and poverty for all. Thank you.

Line 31, please go ahead.

Good afternoon, Chair. My name is Jared Giarrusso-Khlok. I'm representing Alzheimer's Association. I'm speaking in support of that home and community services, an extension which will help continue the good work they're aware as well as Master Plan for Aging, Advancing Older Adult Behavioral Health, may revision as well. Thank you.

Thank you.

Line 36, please go ahead.

Good afternoon, Chair. My name is Karina Laigo from the Childcare Law Center. We're very grateful for the proposals by the Senate and support the proposals regarding rates, waiving, family fees and the homeless harmless policies, and hope that the delay in 20,000 spaces I'm disappointed about the delay in 20,000 spaces. Thank you. Thank you.

Line 37, please go ahead.

Good afternoon. This is Rebecca Gonzales with the National Association of Social Workers, California Chapter. Want to thank you for the hard work of this committee. Want to thank you for not delaying money to increase the mental health workforce. But also, I'm here to advocate for the 18 million for the self-housing supplement for youth. Also very supportive of the CalWorks. We need to work to reimagine CalWorks, and we hope the Legislature's final budget includes safety net for all improved Cali THC and YCTC and Cal Fresh $50 minimum benefit. And in addition, we hope to continue working on the Foster Family Agency funding. Thank you so much for your commenting in the final budget. Thank you.

Madam. Chair, there's just one more in queue. Line 34, please go ahead.

Thank you. My name is Marshawn Tabin with San Francisco-Marin Food Bank. First, I want to just point out that hunger is still at all time level high. We're still serving around 56,000 families per week per month. So we really appreciate that food insecurity of poverty is in a Senate budget plan. And we are grateful for the $60 million investment in the cow foods program, which is critical in serving the needs of the community. We're also grateful that the increase to the Cal Fresh minimum is in there as well at $50. If New Jersey can get their folks $95, California can do $50.

Thank you for calling in. Thank you. That concludes our public comment on Via teleconference. I'm going to allow the three remaining in person to give your public comment 45 seconds.

Hi, my name is Michelle Marciniak. I'm chair of Let California Kids Hear. I'm a mom. I'm representing the 8000 families that need access to timely hearing AIDS. I can't thank you guys enough for adding the Let California Kids Hear Act to the budget item today. We are so grateful and thank you. And I would just say that only one in ten health plans cover hearing-aidsin this state. We wouldn't have to do this if the health plans would cover the hearing-aidsfor children in this state. It is a developmental emergency and it needs to be addressed. In 1998, we passed newborn hearing screening. There have been multiple attempts in the last 25 years. They have all been killed and our children need help.

Thank you.

Madam Chair, Members, thank you for extending we were in the Assembly. Andrew Shane, GRACE End child poverty. We want to thank the Senate for your plan. First and foremost, we stand ready on a more equitable revenue system. We thank you for rejecting the safety net reserve withdrawal, the MCO tax approach, the permanent extension of the Cowworks grant increases, the plan for CalFresh minimum, Abod, S and B and TNB. I want to thank you for the fantastic panel on Reimagined Cal works. We know the Senate is supportive and we really look forward to working with you in partnership. And finally, ask and align with JBay on the Silk housing supplement. Thank you so much.

Thank you.

Good afternoon. Linda Nguy with Western Center on Law and Poverty. In the interest of time, I will align my comments with Mr. Shane, but noting particularly around the reimagined cowworks, really appreciate that conversation. On the healthcare side, we do support the modified adoption of the MCO tax and do want to thank that it includes the removing of triggers for continuous medical coverage for young children and the share of cost reform as well as the rejection of the covered California sweep and corresponding affordability investment, extending the CPSP benefit to one-year cleanup language to eliminate the medical asset test that was done in the 2021. Budget. And finally, the hearing aid coverage for children and funding for Health, Equity and Racial Justice Fund. Thank you.

Thank you. Last public comment.

Hi. Thank you, members. Mark Farouk, on behalf of the California Hospital Association, just want to thank this committee relative to the MCO tax framework considered here today. Look forward to continuing discussions on that. We stand with other providers to encourage the adoption of the MCO tax that ensures that providers can meet the needs of their patients and communities. It is essential that the MCO tax funding should be fully dedicated to the medical system that provides coverage to an average of one out of every three Californians. Lastly, we encourage Legislature not to delay funding providers until future budget years. Spending priorities for MCO funding and categories for funding should be discussed and established now.

Thank you.

Thank you so much. See no other public comment that will conclude our public comment section. Consultant, if you can please establish a quorum.

Senator Menjivar. Here. Menjivar. Here. Eggman. Eggman. Here. Grove? Grove. Here. Roth. Here. Roth. Here.

Thank you. Today we'll be voting a vote only calendar. We're going to be voting on issues around California. Health and Human Services Agency MSA. Department of Healthcare Access Information california Department of Aging, Department of Healthcare Services, Department of Public Health, Department of Developmental Services, department of State Hospitals, Department of Community Services and Development, Department of Rehabilitation, Department of Child Support Services and Department of Social Services. As this is our last hearing, if you indulge me, just a couple of remarks. I want to thank my subcommittees, my consultants, my staff, for being a new legislator, chairing this for the first time as a new member, for the support I received, for indulging me in all my questions and guiding me and learning so much. I learned so much in the past couple of months. Coming into a budget deficit, sharing a subcommittee like Health and Human Services, well, was inexperienced to say the least. Hearing stakeholder proposals for further investments for children, the IDD population, foster you with the complex needs senoras who need healthy or clean drinking water, pay centers, children's families. Where do you cut? Where do you further invest? There was no convincing me on this end. It was more about, well, we're in a budget deficit, right? Every single stakeholder proposal had merit and had a compelling story to it. So that was the hard part. It wasn't to be convinced that it was needed. It was more of, well, we're in a budget deficit, but even in a time of deficit, I am proud of what our sub three did, how we were able to balance and weigh out what was needed right now. To help people thrive and continue to survive and what could be pushed off for a couple of years or just balance in our sense. So I am proud that we push landmark around Medi-Cal reimbursement. I am proud that we address the childcare issue, although there still needs to be a lot of work there. There's something that I feel we can be proud of. The workforce investments that we talked about in every single hearing and the importance of not delaying those. It was an overall wonderful experience from the experts and the professionals that came to speak to the kids who provided public comments, to the parents to like the seniors I mentioned who shared their lived experiences in Spanish. And I was so honored and privileged to be able to understand their stories as a Spanish speaker myself, the impacts of the decisions that we made and these rooms, they're not confined to the statistics or the datas that we see on paper. They play an active role in the people we heard and even more so from the people that didn't have the ability for them to either call or come in and share their story. In the first hearing, I did state my goals around accountability, the oversight that I wanted to bring through those lens, and I think we did that. And I hope, if I'm given the honor to continue that I'll continue to do that in this sub three, to not accept the status quo and ensure that there is accountability. It's been a wonderful experience. So with that, I remain optimistic and hopeful that we will overcome our current deficit in the upcoming years and protect Californians who need it the most. I look forward to working with my counterparts in the other House and the governor to come up with the final budget. I'd like to turn to any of my Subcommittees who'd like to give any remarks.

I would just thank you, Madam Chair, for this is a big budget Subcommittee and coming in as a freshman, I think you provide a refreshing change of heart for all of us, and we are grateful to have you. And thank you to the budget sub staff who work so hard.

Thank you, Senator. Senator.

Thank you, Madam Chair. It really has been a privilege to work with you as a brand new member. As a matter of fact, I just text my colleague from Stocton and I go, she really is very good, and you really are. And I love your no nonsense approach, but I also love your heart for the issues that matter. We don't agree on everything, but there are some things that we really agree on. And the good thing is that some of the things that we agree on are things that I'm very passionate about. So I appreciate that. I would like to make some comments, if I may, with your indulgence on item number 65, item number 23, and item number 67. Item number 67 is a very tough issue. Kids deserve hearing-aids, and I agree. But this issue was brought up and not consulted with the plans. It's just another mandate on plans. And what's really frustrating is that $10 million a year has been allocated to this program. And from my understanding, only 24 hearing-aids were issued from the Department after getting $10 million. So where's that money? And why are we putting EMATA on plans and we don't know where all that money is? That how this program has been in place for the last few years. So I have that question. So I'm going to lay off on that until I can find the answers to that, because it wasn't an item up for discussion. And we just got the information last night. The manufacturing I don't think the station.

I would say that it was an item for discussion during our sub three when they proposed it to us. I will say that, okay.

There was a letter. Okay. And then item number 23, I'm going to lay off that as well because the State shouldn't be in the business of storing manufactured in our Cam. But I realize that we need to have a storage place and have it it needs to be available because we're not doing anything about the Fentanyl crisis on a proactive level. So we do have to have a reactive situation. I understand that the MCO tax I'm so grateful that this committee on your leadership addressed the issues of making sure that there was a shorter amount of time period and adding code sections to the medical reimbursement that would be available. I'm very disappointed there's no money in there for financially distressed hospitals, because you and I both know that $150,000,000 is not going to go anywhere, especially with all the hospitals that are applying. And it's very difficult to think about people not having access to hospital care, specifically in my district. And I know we disagree on this issue, but I'm very disturbed. Planned Parenthood got $2 million last year, more than all of our distressed hospitals combined, and there's another $50 million in there in this budget, which just makes no sense to me whatsoever. Again, I appreciate being part of the conversations of the MCO Tax. I think that we need to make sure that medical recipients and medical providers not recipients, but providers that private access to medical recipients, especially in poorer communities, have access to health care. And this is a way that the plans have stepped forward to do this. But I don't think throwing the plans under the bus for the hearing aid issue when the state couldn't even deliver 24 hearing-aids with millions of dollars and then also the poison pill in the code section for abortion services, that just makes me sick.

Thank you. I'm seeing no other public comment on our end. I'd like to give the opportunity for our friends at Department of Finance to come provide some final remarks. Thank you.

Madam Chair. Committed members. Andrew Duffy, Department of Finance. Thank you for allowing the Administration an opportunity to speak on the Committee's actions today. While some of the actions are inconsistent with the Administration's budget, the Administration looks forward to working with the Legislature to finalize the 2023 Budget Act. I'm here to answer any questions. Thank you so much for the time.

Oh, Andrew. I was expecting something longer. I hope you missed my witty comments for the next couple of months. So we're going to move on to our votes now. We're going to be taking votes in six separate calendars. Calendar one will consist of voting on items one through four, seven, nine through 10, 12 17 through 21, 25 through 28, 30 to 33, 35 through 37, 40 through 46, 48 through 60, 62, 64, 66, 68, 72, 75 through 76, 79 through 82, 85 through 86. Could have been 85, 89, 91 through 93, 96, 97, 101 through 111, 113, 115 ,116 through 132, 134 through 136, 139 through 146, 148, 149, 152 through 155, 157 through 159, 161, 163, 165 through 167, 169, 171, 172 through 174, 177, 179, 184, 185, 187 and 188. Can I get a motion moved by Senator Grove? Moved by Senator Grove. Those items can I get roll?

Yes. Senators Menjivar aye. Menjivar aye Eggman. Aye. Eggman. Aye Grove. Grove. Aye Roth. Roth Aye.

Those items are adopted on a Four-zero vote. Moving on to calendar number two, voting on issues 6, 13, 15,16, 22, 24, 34, 47, 61, 94, 95, 133, 138, 147, 156, 116, 164, and 168. Do I hear a motion moved by Senator Eggman? Could we get a roll?

Senators Menjivar aye, Menjivar aye. Eggman aye. Eggman. aye Grove. No. Grove no. Roth aye. Roth aye.

Those items are adopted on a three to one vote. Moving on to calendar number three, voting on issues 5, 8, 11, 14, 29, 38, 39, 63, 69, 71, 73, 74, 77, 78, 83, 84, 87, 88, 98 through 100, 112, 114, 137, 100 and 151, 162, 171, 175, 176, 178, 180 through 183 and 186. Do I hear a motion moved by Senator Eggman? Can we get a roll.

Senators Menjiv ar aye Menjivar Aye. Eggman aye. Eggman aye Grove. Roth aye. Roth aye.

Those items are adopted on a three to 0 vote. Okay, we're going to move on to now a final calendar vote on items 65, 23 and 67. Do I hear a motion moved by Senator Eggman? Roll, please.

Senators Menjivar Senator Menjivar aye. Menjivar aye. Eggman aye. Eggman aye grove. Roth. Roth aye.

Item adopted, three to zero. That concludes our voting calendar. That is all, folks. Budget subcommittee number three on Health and Human Services has adjourned. See you in a year, maybe.