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

Senate Budget Subcommitee number three in Health and Human Services will come to an order. We continue to welcome people in public and also via the teleconference for your public comment. I would ask that the rest of my Subcommitee Members would join me so we can establish a quorum. Today's participant number for those who wish to call in is going to be 877-226-8163 with an access code of 736-2834 as always, we're in 1200 room in the 1021 street building. Today we'll be hearing our last budget proposals from the January Budget plan. We're going to be hearing the departments under the California Health and Human Services Agency, Department of Healthcare Access and Information, EMSA, Department of Managed Healthcare, Department of Aging, Department of Public Health and Department of Governmental Services, Department of State Hospitals, California Health Benefit Exchange, Department of Rehab and Department of Social Services. They will be presenting their April Finance letters, which are Administration proposals to amend the Governor's Budget. Okay, can't establish a quorum, so we'll begin with a sub sub Subcommitee and the first issue on the agenda is a Calfresh and nutritions programs overview issue. No. That is first one is incorrect. We're going to still go. There is no overview panel today. We're going to go straight into issue number one as it relates to SB 852. All welcome H-CAI. Thank you.

Good morning. I'm Vishal Pagani, Deputy Director at the Department of Healthcare Access and Information. Today I will be providing an overview of the budget change proposal to transfer administrative resources for SB 852 implementation. Initially proposed in the Governor's Budget for fiscal year 2021 and later enacted under SB 852. The CALRX program represents a groundbreaking solution for addressing prescription drug affordability. The intent of CALRX is to increase competition in the pharmaceutical market where there is low competition, drug shortages or fragile supply chains. CalRX empowers the State of California to develop, produce and distribute generic drugs and sell them at Low cost. As part of the 2021 Budget Act, CaLHHS received a one time appropriation of 2 million General Fund for consulting Services and position authority for one position to support CALRX implementation for a total request of 2.184 million General Fund. Since HCAI is administering the CALRX program on behalf of CALHHS, an interagency agreement was established to transfer 1 million to HCAI for HCAI to enter into a contract for legal services involving complex issues related to the development, regulatory approval, marketing and distribution of generic and biosimilar drugs. The contracting resources have to date advised HCAI in executing the contract for CalRX's first target drug, which is the development of a generic version of a biosimilar insulin. In March, the Governor announced the partnership with a nonprofit drug manufacturer, CivicRX, to make available biosimilar insulins at $30 per vial and $55 per pack of five pens. This partnership will bring down the price of insulin by about 90%, saving cash paying patients between $2000 and $4,000 annually. This BCP requests to transfer and reappropriate the remaining 1.184 million General Fund and one position from Cal HHS to HCAI. This would centralize the administrative resources for SB 852 to one Department and allow for additional time for HCAI to expend and encumber the remaining funds. That concludes my overview and I'm happy to answer any questions.

Thank you turning into LAO for any comment.

Jason Constantouros, LAO, we have not raised concerns with this proposal and wanted to reiterate two points about it. The first is that, as the Department noted, that agency has already delegated much of the responsibility for implementing SB 852 to the Department and has transferred some of the funds through an interagency agreement. This proposal more formally recognizes that existing structure, so it seems reasonable. The other point to reiterate is if you can see on page four of your agenda, you'll see that it transfers existing resources from agency to Department, so the net effect is neutral to the state General Fund. Thank you.

Department of Finance

Joseph Donaldson, Department of Finance, no additional comments. Thank you.

Perfect. Thank you so much. Deputy Director. We're going to hold the item open and move on to issue number two. Nope. We're moving on to a new Department, Health and Human Services Agency, starting with issue number one under their Department. Good morning.

Good morning. My name is Deanne Wharton and I'm with the Office of Systems Integration, and I'm pleased to be here. Thank you for having us here today. We have two items that we're covering. First one is our proposal for additional resources or additional positions and expenditure authority, and the other is regarding some trailer Bill Language. So I'm going to start with the first one.

Health and Human Services OSI is requesting three positions in Annual Automation Fund Expenditure Authority of corresponding $600,000 to enhance our enterprise wide capabilities, improve our project delivery outcomes, and improve our technical services capabilities. Two of the three positions that we're asking for are technical manager positions that are being requested to add some structure and to continue to expand our enterprise capabilities. Work that we initiated last year with some staff level resources. The third resource is a communications strategy specialist.

OSI has a large volume of ongoing communications that it must develop and maintain, including responses to federal partner requests, budget change proposals, special project reports, inquiries, et cetera. So currently those are largely handled by our project delivery teams, which isn't the best strategy if we're looking to structure and harmonize our communications with a single voice across OSI. So this position would help us do that. That's an overview of our proposal. Happy to answer any questions on that first item, or it moves the second.

You can move on to the second.

Okay. The second is to request some trailer Bill Language to authorize up to $200 million in General Fund loan to help us cover vendor payments and others. As you know, OSI is reimbursed by our departments for the work that we do, and there can be a variety of things that can extend or produce a delay for those, for example, federal reimbursements or reprioritization to handle unanticipated needs or process glitches. And so we'd like to get that authority to cover those if needed.

The number itself is based on a review of the historical invoices that we've had and really represent a conservative kind of upper end need. We certainly don't anticipate that we're going to need to use all of those funds, but because it does require statutory approval, we'd like to put that in place. I think it bears noting that we remain committed to being able to forecast our needs in minimizing the level of the loans that we need.

We are putting in an enterprise resource management solution right now that should help us do that, as well as forecast for other fiscal needs.

Thank you so much. Thank you. Any comment?

Brian Metzger, Lao we have no concerns with this proposal.

Thank you. Department of Finance.

Matt Aguilera, Finance we just wanted to note also that we suggested in the language that the Department, front end or front load the contracts to the extent possible to help address the cash flow need and thereby minimizing the need for General Fund.

Thank you so much. I don't have any questions, Senator. Perfect. Thank you. We're going to hold the item open, move on to the second issue.

And Matt Aguilera for Finance will be presenting on behalf of agency for this item. So this issue two contains various reappropriations and technical adjustments outlined in the agenda. And I'll quickly go over those, and then we'll answer any questions you might have after that. The first item is a requested reappropriation of 8.8 million over five years for the children and youth Behavioral health initiative. That's consistent with the original $50 million timeline outlined for this program.

And so we're aligning the funds consistent with the overall program in that area. The second request is a reappropriation of 2.5 million for equity training through June 30 of 2024. And this is consistent with the contract work required in this program area. Then the third item here is a technical change under the Gender Affirming Care Fund, where a BCP contained in the Governor's Budget had some dollars that were lower than what was actually in the budget. So we're adjusting the budget downward consistent with the BCP.

The fourth item is another technical adjustment where we're just moving dollars among programs for existing employee comp funding. And then the last issue in this item is we're proposing language to provide 5.51 million one -time over five years to reappropriate that consistent with the five-year program for the suicide and Crisis Lifeline authorized by AB 988. We're also proposing to extend exempt contract code requirements in order to get these services online as soon as possible. And with that, we're open any questions you might have.

Thank you. First, turning to LAO.

Ryan Miller, LAO.

We have no concerns with these proposals.

Thank you so much. I don't have any question on this, Senator, thank you so much. We're going to hold the item open, move to our next Department, EMSA, on issue number one. Hello.

Hello. Good morning. I am Craig Johnson with the Emergency Medical Services Authority. I'm the Chief of Administration in the HR division. We will provide a brief overview of the three budget proposals currently under consideration and be available for any questions you might have. And with that, we'll start with Tom.

Good morning. This is related. Hi, I'm Tom McGinnis, the chief of the EMS Division for the EMS Authority, and I'm here to discuss proposal number one with you. This is related to CEMSIS, maintenance and operations. This proposal is requesting $4.9 million in General funding in the fiscal year 23-24 and then $185,000 in fiscal year 24-25. The requested resources will provide the maintenance and operations of the California EMS Information System, also known as CEMSIS, which is needed to ensure that CEMSIS can continue to monitor and continuously improve California's emergency medical services system and to meet the needs of the patients and provide clinical care monitoring for the 39 million residents of the state and the roughly 268,000,000 visitors in the state each year. CEMSIS is a secure, centralized data system for collecting data about individual emergency medical services, request patients treated at hospitals and EMS provider organizations. CEMSIS uses a universal data standard called the National EMS Information System, or NEMSIS for short. CEMSIS provides the only statewide means of monitoring the care that EMS agencies and EMS providers perform in the state for the citizens and those visiting the state. This also allows us to assess the overall health of the EMS system and identify areas where local and statewide events are exerting strains on the system or placing the system itself into peril. Throughout the COVID-19 pandemic, CEMSIS was proven to be essential source of information that was critical during the patient care evaluation process. EMSA is responsible for maintaining a safe, effective and efficient system of prehospital emergency medical care for all Californians. This responsibility is codified in Health and Safety Code Sections 1797.1, 1797.6, 1797.102, and 1797.227, to that end, EMSA relies on CEMSIS. EMSA has historically contracted the management and hosting of CEMSIS for the data repository to one of our local EMS agency partners, also called LEMSIS. EMSA was in about the second year of a three year contract with one of these LEMSIS' when EMSA was informed by that entity that they were no longer able to meet their contractual obligations to support CEMSIS. This created an immediate and urgent need to migrate the system to hosting and management of CEMSIS over to EMSA in order to maintain its operations. To that end, IMSA insured an emergency contract with the Image Trend Corporation in September of 2022 for them to monitor, maintain and operate the system of CEMSIS. The emergency contract included a two year base term with two optional years of extension. EMSA secured emergency funding from the Department of Finance and the Legislature for the first year of the base term and one year of consulting service from the Office of Systems Integrations, the folks at OSI for the contract Management and support. EMSA is currently in stage two of the California Department of Technology's project approval lifecycle PAL process for the development of a new statewide EMS data system. The California EMS Data Resource System known as CEDRS, which includes the migration of CEMSIS to EMSA, is in its business case. EMSA intends to be completed with the POW process by June of 2024. And that includes my presentation on proposal number one.

Thank you so much turning it over to LAO for any comment.

Will Owens, LAO, we have no concerns with this proposal.

Thank you. Department of Finance.

Selena Noreli Department of Finance. Nothing further to add.

Great seeing nothing further, we're going to hold the item open. Move on to the second issue.

Hi, my name is Rick Trussell. I'm the Deputy Chief of Administration with EMSA. Proposal Number Two is the appointment of a Chief Medical Officer. This proposal is requesting one permanent position and $312,000 General Fund beginning in 23-24 and ongoing. The additional resources will be utilized to establish a Chief Medical Officer position within EMSA. The Administration has proposed statutory changes to Health and Safety Code 1797101 to remove the requirement that the EMSA Director have an MD and add Health and safety Code Section 1797101 to create a CMO position for EMSA is required to be a licensed physician and surgeon in California and have substantial experience in the practice of emergency medicine pursuant to provisions of Chapter five of Division Two of the business and Professions Code. Based on these statutory changes, EMSA proposes to establish a CMO who is a physician surgeon licensed in California with substantial experience in emergency medicine, who shall be appointed by the Governor upon nomination by the Secretary of the California Health and Human Services. The creation of a CMO position within the leadership team will address the clinical components needed for patient safety and care while bringing substantial experience in the practice of emergency medicine. The CMO position highlights the importance of having physicians as part of the leadership team and has a strong medical perspective and presence involved in the Department statewide. Decision making and policy implementation. The CMO's duties will include approving revisions to standard scope of practice for all EMS providers, local optional scope of practice for applications and trial study applications. The CMO will also review and approve all EMSA's EMS plan sections having clinical care impact, final review, and approve EMSA regulations that set clinical practice and other duties. Additionally, the CMO will also provide oversight of state level quality improvement through CEMSIS, data analysis and reporting and EMS response activities that will affect patient care and outcomes, including medical personnel qualifications, licensing requirements, staffing levels, medical pharmaceutical inventories for medical teams sent into the field, such as the California Medical Assistance teams, alternate care site teams, and ambulance strike teams, and also create and manage a clinical operations manual for any type of team sent out to support a disaster medical response.

Thank you, Will.

We have no concerns with this proposal.

Thanks. Department of Finance

Selena Noreli, Department of Finance. Nothing further to add.

I think we've exhausted this conversation from the previous time. No further questions. Perfect. We're going to hold the item open, move on to issue number three under EMSA.

Yes. There it is again. My name is Craig Johnson. I'm with IMSA Chief over Administration and HR Division. So the staffing Allocation Resources proposal requests for four positions and 775,000 in General Fund in 23 and 24 and ongoing. The requested resources will allow EMSA to properly align staff allocation and reporting structure requirements mandated by the California Department of Human Resources, which is critical for EMSA to sustain operations and achieve its mission. In the past several years, EMSA has experienced an increasing workload in operations and staffing levels through the implementation of new programs and the expansion of existing programs within the emergency medical services systems and EMS personnel divisions. As a result, in the increased workload, program complexity and increased staff members, EMSA span of control for its managers within these divisions has exceeded requirements mandated by CALHR. Not meeting CALHR's span of control requirements maintains vacancies, leaving EMSA less able to meet its mission of preventing injuries, reducing suffering, and saving lives by developing standards for and administrating an effective, statewide, coordinated system of quality emergency medical care and disaster medical response that integrates public health, public safety, and healthcare. The resources requested in this proposal will begin to properly align the proportion of management staff with rank and file based on actual and projected workloads and meet critical operational requirements vital to achieving EMSA's mission. The positions include two staff services managers threes, one for the EMS Systems Division and one for the EMS Personnel Division One staff Services Manager Two, which will support the EMS standards and Training Section in the EMS Personnel Division and one staff Services Manager, one to support the EMS Systems data program. And that concludes and open for any questions you might have.

Appreciate it.

We have no concerns with the proposal.

Thanks.

Department of Finance nothing further to add.

Appreciate it. Nothing on our end. EMSA, thank you so much for your presentation. We're going to hold that final item open. Moving on to our next Department on managed healthcare. Issue number one.

Thank you. Good morning, Madam Chair and Senator Roth. My name is Dan Southern. I'm the Chief Deputy Director at the Department of Managed Healthcare, and I'll provide an overview of the five DMEC proposals starting with issue One, the position authority the DMEC submitted 2023-2024 Workload BCPs in the fall of 2022 requesting resources to address critical information technology gaps and to conduct more frequent financial examinations of health plans and risk bearing organizations.

The workload BCPs did not include physician authority due to the DC's 22% vacancy rate in the fall of 2022. The 22% vacancy rate was a result of the DMEC's authorized Position authority increasing by approximately 18% or 89.5 positions as of July 12022. Currently, all vacant positions are in active recruitment process and the DMC has made substantial progress in filling vacancies. The DMEC's vacancy rate as of today is approximately 9% and continues to decline each week.

The DMC's existing authorized vacant positions are obligated for critical legislative approved workload, and the DMHC is continuing to focus on filling all vacant positions. This request will increase the DMC's regular ongoing positions but will not include additional expenditure authority for salaries and benefits. DMHC is requesting position Authority only and will use ongoing funding requested through the 2324 workload BCPs to Fund these positions. That's the end of my proposal. Overview More than happy to answer any questions.

Thank you so much. Elio.

Jason Constanturo, Cellio Given the department's improvement in its vacancy rate, we have not raised concerns with this proposal.

Thank you.

Department of Finance Joseph Dalton Department of Finance no Additional Comments thank you.

Thank you. No additional comments. On our end, we're going to hold the item open, move on to issue number two.

In fiscal year 2021, the DMEC received approval and funding to conduct focused investigations of 25 full service commercial health plans regulated by the DMEC to assess whether enrollees have consistent access to medically necessary behavioral health services. The behavioral health focused investigations assess areas of health plan delivery systems that are not commonly assessed. During our routine medical surveys, the DMC anticipated conducting 25 investigations over a period of five years by investigating five health plans per year.

During this process, the DMC identified three additional health plans for a total of 28 health plans meeting the investigation eligibility criteria. Additionally, several factors have increased the complexity, difficulty and volume of work associated with these investigations.

Those include, based on feedback from external stakeholders, the DMC expanded the scope of these investigations to incorporate a review and analysis of Health plan's non quantitative treatment limitation Comparative Analysis this component of the investigation was not considered as part of the original DMT proposal since the federal law pertaining to the non quantitative Treatment limitations passed in December of 2020, which was subsequent to the submission of the original proposal.

The investigations require health plans to submit documents, data, and information not otherwise, as part of the health plan's routine surveys. Reviewing this documentation requires significant time and coordination between the DMUC and its vendor to complete the reviews. A significant amount of time is also spent with the DMUC Special Investigators in our Office of Enforcement who have been conducting enrolling and provider interviews to determine barriers to obtaining and providing behavioral health services.

Due to the significant impact of the factors I described, the DMHC is unable to timely complete the focus investigations without the additional requested resources. Conducting the focus investigations is necessary to determine why enrollees continue to experience delays in obtaining behavioral health care services and identify non compliant practices or barriers to care and health plans delivery systems.

The DMC's Office of Plan Monitoring is requesting eight positions and approximately $3 million in fiscal year 23-24 decreasing to $2.9 million in fiscal year 24 and 25, and annually thereafter from the Managed Care Fund to continue and complete the focused behavioral health investigations and to incorporate long range behavioral focus assessments into the routine medical survey process. That concludes my overview. More than happy to answer any questions.

Hello. So wanted to just reiterate a few points. First, this is a proposal that increases the department's expenditure authority, as you can see on page 16. Just want to remind the Committee that the Department is funded entirely from fees assessed on health plans, and so when the Legislature authorizes an increase in expenditure authority for the Department that results in an increase in fees on those health plans, it doesn't impact the General Fund.

Now, as to the proposal, as the Department noted, this is additional workload for an initiative that was enacted by the state a few years ago. We follow the workload analysis done by the Department and aren't raising concerns with it.

That said, while we aren't raising concerns with the proposal, we think this is an initiative the Legislature will want to keep track of periodically, given the initiatives focus on access to behavioral health, which has been a key topic of interest for the Legislature, and also given some of the workload uncertainties identified by the Department. Thank you.

Thank you.

Department of Finance Joseph Dalton Department of Finance no additional comments. Thank you.

Thank you so much. Just two points or not sure if there are questions actually, but I do appreciate the recognition of the increased workload that we're seeing here. I think even I have know. My office has several stakeholders have reached out regarding some of the issues that they're seeing in SoCal with patient times and the workload, the caseload on our workforce. How do you anticipate, I mean, the workforce issue is just getting even more severe. Right.

I just see this continuing to increase with these positions that you're requesting. Are you going a little bit above anticipating? Sorry, let me rephrase that. Sure. The positions that you requested, is that with the intent that perhaps the workload is even going to grow bigger, or is this eight with the Max of what the workforce looks like or the caseload looks like right now? Sure.

This is a little bit different than workforce. We are investigating the health plans to ensure compliance with the laws and then determine barriers enrollees are facing. And we will be putting forth our first year investigation reports we put on our website probably within the next quarter, which will include a summary of those first year investigations. These positions will help us conduct those investigations, get back on track.

We moderately underestimated the workload resources we needed, and this is to supplement that to get us back on track to complete these investigations. And then we'll take those positions and include them in our routine medical surveys to incorporate the work we're doing in the behavioral health investigations into our normal, ongoing routine medical surveys.

Okay with that? No, I appreciate that.

With the previous underestimate, with this request, with this new number, do we think that's going to be enough?

Sure.

Yes.

Perhaps requesting maybe one or two extra just in case.

No, I think this is going to be satisfactory for us to get back on track and complete these investigations.

Perfect. Thank you. Seeing nothing else, we're going to hold the item open, move on to issue number three.

The DMC is requesting a technical adjustment of negative 62.6 full time equivalent positions in 23-24 to correct the FTE display area in Hyperion system and the galley, the inadvertent posting area was due to a positive 31.3 positions that should have been a negative 31.3 in fiscal year 23-24 entry. Pursuant to the position transparency budget drill during the 2021 budget process, this is a technical fix and results in a net zero impact to the Managed Care Fund and authorized physicians.

Hello.

This is a technical correction to a display issue and we have no concerns with it.

Thank you. Department of Finance.

Joseph Donald's Department of Finance. No additional comments. Thank you.

This is like a Kevin Malone accident from the office with any other. Great. We're going to hold the item open, move on to issue number four.

Okay. Under existing law. Health plans must provide their enrollees with certain documents that describe the benefits of the enrollees Health plan product. State and federal laws dictate the types of information Health plans must include in these documents, and each health plan is left to develop its own documents. Under the Knox-Keene act the DMEC is required to annually review these documents filed by health plans, and currently, each health plan's documents are slightly different.

The DMEC is proposing to require health plans to use DMEC developed templates for these documents. The standardized forms will help ensure enrollee facing documents clearly and correctly explain benefits, cost sharing, limitations and exclusions of healthcare services in an organized and standardized manner, and provide consistency in information presented to consumers. The health plans will no longer need to develop the documents on their own, which should save the health plan's time and resources.

Health plan documents will largely be uniform, which will also decrease the amount of time the DMEC staff must spend reviewing the plan documents to ensure documents comply with state and federal laws. The DMEC intends to use as appropriate documents developed by our colleague agencies, including the Department of Healthcare Services, and Covered California as guides in the development of the DMEC standardized templates.

Additionally, the DMEC requests an Administrative Procedures act exemption, and the intent of that is it's essential to allow the DMEC to develop, implement and refine the templates consistent with ever changing state and federal laws, in a timely and efficient manner.

The DMEC is requesting one position in limited term expenditure authority equivalent to two staff of $1.2 million in fiscal year 23-24 and fiscal year 2425 decreasing to $258,000 in fiscal year 25-26 and annually thereafter from the Managed Care Fund to implement the mandatory use of standardized forms that describe the benefits of the enrollees Health plan product. More than happy to answer any questions.

Elio any comments?

Just to reiterate, there are two items in this issue. There's the proposed trailer Bill, which would require the development and use of standardized templates for certain documents, and then additional resources, which are summarized on page 19 to the Department to develop those templates. We understand the overall rationale of the proposal and see the advantage of having a standardized template and aren't raising concerns with this proposal.

Thank you so much.

Department of Finance Joseph Donaldson Department of Finance no additional comments. Thank you.

Perfect. Thank you. We're going to hold the item open. Move on to issue number five.

All right. The DMC is requesting to reduce expenditure authority over a number of fiscal years ending in fiscal Year 28-29 of $471,000 this reduction is tied to the withdrawal of the enforcement, investigations and ediscovery software application, BCP, that was included in the 23-24 Governor's Budget. The resources were inadvertently duplicated through a workload and the SB 85 legislative BCP. So that concludes my overview. More than happy to answer any questions.

Pretty simple.

Yes, we have no concerns with this proposal.

Thank you.

No additional comments. Thank you.

Thank you. Going to hold the item open. Thank you so much for your presentations today.

Thank you.

We're now moving on to proposals from the Department of Aging, starting off with issue number one. Hello, CDA.

Good morning. So I do have three proposals to present to you today's name. OH, I'm so sorry. Deputy Nicole Shimosaka, Deputy Director of Administrative Services at CDA. Thank you.

Thank you.

I do have three proposals for you all this morning. The first one I will present on is our administrative efficiencies for the area agencies on aging, with which we partner. We have requested budget Bill Language that would allow us to streamline the distribution of funding and alleviate cash flow issues for the local AAA's. Currently, we enter into separate contracts with the AAAs for every single program that we administer with them on an annual basis. This is a labor intensive process, both for CDA and for the local partners, because for every single one of these contracts, not only do we have to develop the terms and the conditions and the information within the contract, but then we also have to do the funding allocation and all of those documents as well, which then have to be taken from the AAA to their Board of Supervisors to review and approve and execute. The entire process can take three to four months to complete for every single contract. And this sometimes creates delays in funding where funding does not reach the AAAS until September or October of the fiscal year. What we have found is that the terms and conditions of these base programs typically does not change from year to year. The requirements are federally driven, and they have been relatively stable over the years. So what this proposal would do would enable CDA to directly allocate funds to the AAAs at the start of the year in July, and we would put the terms and conditions into a separate memorandum of understanding, which would only require local board approval when the terms and conditions change. This would get funding to the AAAs sooner, enabling them to enter into contracts with their own local providers faster, which would avoid disruptions in program services. Other programs used this model, such as child support. The second part of this administrative efficiencies proposal would enable CDA to increase the amount of funding advanced to AAAs from one 6th to one fourth of the overall amount. On the standard basis for our AAAs that have expressed cash flow concerns, we do currently allocate the one 6th amount of their funding upon execution of the contract. But what we're finding is that some of our smaller rural nonprofit partners are still having challenges with this advance amount. Particularly what comes to mind is our nutrition infrastructure program, where they're able to purchase vehicles and refrigeration units and quite large purchases. Even with the advance, they're having to open lines of credit or even get loans. So what this would do is it would provide that cash flow in order to allow them to make these significant purchases, but then also operationally as well. They would have what they need and not wait on reimbursements, which can take time. The current allocation levels are not sufficient for our smaller AAAs and they do not have cash to float the larger purchases. This proposal would help to address small AAA cash flow needs.

Hello.

Thank you Madam Chair Jenny Bella with the analyst office. We've reviewed the proposals and they appear to be reasonable solutions to the challenges that the Administration has presented and we have no concerns.

Thank you. Department of Finance

the Department of Finance, nothing further to add.

Thank you so much. I do appreciate the department's response to some of the stakeholders'concerns we heard a couple of weeks ago or maybe months ago, time kind of warps together. This is I really like this proposal. Thank you so much. But for now, we're going to hold it open and move on to the next issue.

Thank you. The second proposal that I'll cover is our Calfresh Healthy Living program expansion proposal. The California Department of Aging requests an increase of 3.2 million in reimbursement authority to support five permanent positions and increase local funding in area Excuse me, local funding in fiscal year 23-24 and ongoing, which would provide increased services, program site expansion and enhanced curricula for the Calfresh Healthy living activities targeted to low income adults aged 60 and older. Specifically, CDA requests 645,000 in state operations and 2.5 million in local assistance ongoing. The Healthy Living program, also frequently known as SNAP ED, provides older adults with education and training about healthy living and good nutrition and how to make healthy food choices on a limited budget. The funding increase allows CDA to expand healthy living services in five more planning service areas, which would serve an overall eight additional counties. CDA will provide the increased funding to our AAA partners that operate healthy living programs. The funds will be used to increase their client counts and client services. The AAAs will also leverage this funding to increase services to diverse and underserved populations in the state, including communities of color, immigrant communities, LBGTQ plus communities, tribal organizations and veterans. CDA will use a portion of the funding to enhance technical support and training to the AAAs. The AAA partners are uniquely suited to provide the Calfresh Healthy Living program, given the depth of experience in providing community based services to Low income older adults.

Thank you LAO.

Jenny Bella, LAO, no concerns on the proposal.

Department of Finance

Department of Finance no additional comment at this time.

Thank you. Just a quick question. I do appreciate that the expansion would include some of these most vulnerable population. Are those populations not included in the current 31 counties in California? Are they not prioritized or are they just going to start being prioritized now?

No, we do currently prioritize these communities, but what this will do is it'll allow us expand even further beyond what we're currently doing today because we will be able to bring those eight additional counties into the fold. Whereas right now our funding is really at capacity, we don't have the bandwidth to bring in more. So this is a continued focus for the Department, but it will just be able to expand and enhance the policy.

It's just more for the eight additional counties versus the actual community demographics?

Yes, but the program does focus on the demographics.

Thank you so much. We're going to hold that item open, move on to issue number three.

Thank you. This is the final item from CDA. This one is for our statewide no wrong door feasibility assessment. It's a request for Federal Expenditure authority for $411,000 to enable CDA to receive a federal grant funds that would establish a statewide no wrong door system Leadership council. The no Wrong Door system is a critical component of the state's master plan for Aging. During the development of the Master plan for Aging, a key concern that was consistently raised throughout the process was that finding and assessing services and supports for older adults and persons with disabilities is very confusing and frustrating. It often requires an individual to navigate duplicative and complex intake, assessment and eligibility processes, and a maze of agencies, organizations and eligibility requirements, often during a time of crisis. Through an effective no wrongdoor system, older adults, persons with disabilities and caregivers would have a single access point to receive information and referrals for services and supports in their area. During the grant timeframe, CDA will research best and promising practices of other states''no wrong door systems, identify and meet with key state and local partners that should participate in a no wrong door system, which would include agencies that are currently offering supports and services to older adults and would further our collaboration with these partners on practices and processes for a system of seamless referral. The project has two key objectives, developing a structure for collaboration and oversight for the statewide, or, excuse me, the State leadership council, and building connections and pathways that support older adults, persons with disabilities, and caregivers to successfully and seamlessly access supports and services in their areas. The grant work will conclude in October 2025.

Thank you, LAO.

Jenny Bella, LAO, no concerns to raise for the subcommittee.

Department of Finance no additional comment at this time.

Awesome. Thank you so much for your three presentations. We're going to hold that final item open, move on to our next Department, Public Health. Starting off with issue number one.

I'm Marin Klein, the acting Deputy Director for the Center for Environmental Health, and this proposal is requesting to reappropriate 1.2 million General Fund from current fiscal year to budget year. This is to continue the implementation of regulating industrial hemp products. So CDPH is currently establishing a regulatory structure for industrial hemp products. The regulations that established the initial fees and application process became effective in July of 2022. CDPH has conducted outreach to industrial health associations to get the word out about our licensing requirements. We have also set up an industrial health program website, frequently asked questions to assist the industry in understanding the licensing process. While some firms have applied for licensure, revenues still remain lower than anticipated. So this industry seems to be more diverse than originally anticipated, and it is harder to locate firms that are engaging in industrial hemp manufacturing. So we have established a process to identify industrial hemp manufacturers through complaints, referrals and other agencies, internet searches and observations of products available. So I'm happy to answer any questions.

Welcome back, Will.

Yes, Will Owens, LAO, we have no concerns with this proposal.

Thank you.

Selena Noreli, Department of Finance, nothing further to add.

Just a quick question, just for my knowledge, what does the process look like? I hear it's through complaints. Do we have an approximate number of how many we're missing and how many we need to find?

No, we don't have a good idea of the landscape of how many manufacturers are in California. The statute gave the Department the authority to license only California manufacturers and only extractors that are also from out of state, but out of state retailers or out of state manufacturers. Those. We do not have the authority to license those. So we have worked with the California Hemp Council and with also the roundtable, the US Roundtable. We have asked them for any assistance in kind of gauging, what is the estimate of the landscape of how many manufacturers are in the State of California? And we can't seem to get a number out of anybody. So we are kind of looking at products that are on the shelf at retail. Who's manufacturing those products? Are those coming from California manufacturers? We also have set up an email on our website where we are receiving complaints, and then we're following up on those complaints on those products to see if they're manufactured in California and we can go and license those businesses.

I guess I'm wondering if there's like a bar we're looking for where perhaps in the next year, hey, we still need to roll over because we haven't found them. Is there something we're gauging that where we feel comfortable in saying, I think we've got them.

We're definitely doing assessments and reviewing all of the information that's coming in, and we're just trying to make some projections right now.

Okay, thank you so much. We're going to hold that item open, move on to issue two. Joining us on Zoom, Maria Ochoa.

My name is Maria Ochoa. I'm one of the assistant deputy directors in the Center for Healthy Communities and CDPH. And just confirming that you can hear me?

Yes.

Okay, perfect. So today I'll give a brief overview on our spring finance letter for protecting children from the damaging effects of lead exposure. So lead poisoning is one of the most common environmental illnesses in California. Lead can have harmful effects on a child's body, which may lead to lifelong learning, behavioral, reproductive, cardiovascular and other health problems. Within CDPH, the Childhood Lead Prevention Branch leads these efforts and is supported by fees assessed and collected annually from lead polluters. Most of the funds are distributed to the 48 local health jurisdictions that conduct lead poisoning prevention and basic case management. CDPH is requesting two positions and 9.7 million from the Childhood Lead Poisoning Prevention Fund in fiscal year 2023 through 2026, and 6.1 million ongoing for additional case management activities that have increased as a result of the 2021 Centers for Disease Control and Prevention Updated Blood Lead reference value from five deciliters to 3.5 and to also address the finding of a 2019 audit by the California State Auditor that recommends CDPH's CLIP program to focus more on primary prevention of childhood lead poisoning. Of the 9.7 million, 5.9 will be allocated for basic case management services to be performed by state and local staff. 3.6 million will be allocated to develop and enhance local General prevention measures outlined in the 2023 through 2026 scope of work proposed by contracted local Health jurisdictions. 214,000 will be allocated in state operations to establish two positions to provide direct services provided by state and local public health nurses, community care workers and environmental professionals that perform case management, care coordination and environmental investigations to identify and remove lead sources. And that concludes my update, and I'm open to any questions.

Thank you so much, Assistant deputy Director LAO, any comment?

We have not raised concerns with this proposal.

Department of Finance

Department of Finance. Nothing further to add.

Appreciate it. Perfect. Thank you so much. Seeing no further questions, we're going to hold the item open and move on to issue number three as it relates to AB 81.

Good morning. Michelle Bell, Internal Operations Division Chief at the Center for Healthcare Quality. CHTQ requests to reappropriate $939,000 from the State Department of Public Health Licensing and Certification Program Fund 3098 to the Reimbursement Fund 0995 in 23-24 and ongoing to implement the provisions of Chapter 13 Statutes of 2020 AB 81, which affects the quality and accountability supplemental payment, or WASP, program for skilled nursing facilities in California. In fiscal year 21-22, Budget Pinch Proposal A BCP was approved providing CHCQ with six positions and 939,000 funding authority from 3098. Due to a clerical error, the Fund source was listed as Fund 3098 rather than Fund 095. This excess expenditure authority from Fund 3098 should be transferred to 0995 in order to avoid an unnecessary increase in healthcare facility licensing fees that support Fund 3098.

Thank you so much. LAO.

this is a technical adjustment. We have no concerns with this proposal.

Department of Finance

Dept of Finance, nothing further to add.

Thank you so much. Seeing nothing else, we're going to hold the item open. Thank you so much and move on to issue number four.

CDPH requests 4 million in General funds for 2324 and ongoing to support the workload of the staffing Audits section for skilled Nursing facility minimum staffing requirement audits. In 22-23 staffing audits BCP was for $4 million in General Fund for one year only. CDPH will continue to have an interagency agreement with DHCs to provide federal matching funds, which are currently budgeted $5 million. CDPH is required to complete this staffing audit work by Health and Safety Code 127666. DHCS's SNF Quality and Accountability Fund 3167 sunsetted on January 1 of 2023. Prior to that, this Fund provided the state funded portion of the funding for the CTPH Staffing Audits Program. Through this IAA since DHCS's special Fund was funded primarily through transfer from the General Fund, it is appropriate that CDPH should now have a General Fund appropriation for the state funded portion of the Staffing audit program's workload. There's no net change to the amount of General funding being used. It's simply that the Intermediary Fund 3167 is now gone.

Thank you. Hello.

We have no concerns with this proposal.

Nick.

Nick Mills, Department of Finance. Nothing further to add.

See nothing else. We're going to hold the item open. We're going to move on to issue number five. Thank you, Michelle. Is it Marie or Marie? Thank you.

All right, so me again. Miren Klein, Acting Deputy Director, Center for Environmental Health. So I know that the write up in the agenda had two questions for this proposal. I will provide the overview of the proposal and then finance will answer question number two. So this proposal will make changes to the licensure, denial, suspension or revocation procedures for medical X ray machine and radioactive material users. So currently, CDPH is only able to take disciplinary actions on licenses for crimes that are specifically committed during the performance of the X ray duties. Current law prevents CDPH from taking disciplinary action on a licensee who has been convicted of crimes that are substantially related to their duties. These proposed changes will bring the Department into alignment with existing standards for similar licenses that are already issued by other entities, such as the California Podiatric Medicine Board, the Pharmacy Board, and the Physical Therapy Board. The proposal also expands our current civil penalty authority to cover all statutory and regulatory violations related to medical radioactive material and X ray machine use. Happy to answer any questions on the proposal.

We can move on to answering the second question.

Great. Hello, Madam Chair, my name is Shalina Nirali from the Department of Finance, and I'll be answering the second question. The connection of this trailer Bill proposal to the budget is that the expansion of the civil penalty structure may generate revenues. In addition, this trailer Bill is largely conforming the radiological Health branch's denial, suspension and Revocation authority with other licensing and certifying bodies within the state and within DPH. For the next question, given the technical nature of this proposal to align with existing enforcement standards, the Administration determined that trailer Bill was the most appropriate vehicle. Additionally, keeping this language in a trailer Bill would authorize the statutory changes at the beginning of the new fiscal year. Happy to answer any further questions.

Thank you. LAO, any comments?

We haven't raised concerns with the proposal.

Thank you. The last part you mentioned, Shalina, that it would potentially bring in some revenues. What would it be used for the.

Revenues would be used for continued operation of the program. This is a revenue generated program for the licensing, right? Correct.

Okay, perfect. Thank you so much. Seeing no other questions. Thank you for the presentation. Center this Department. We'll move on to the Next Department, Developmental Services.

Good morning. Carla Castañeda, Department of Developmental Services. We have four issues before you today. Issue number one is for compliance with home and community-based services requirements. Over the last few years, we've had a number of limited-term positions that have supported technical assistance. This proposal requests that those continue permanent and ongoing with an additional six positions for department workload on monitoring the additional sites. Additionally, the request includes 50 positions for Regional Centers.

Given the additional sites that require HCBS compliance monitoring, that is an approximate one position per 1000 individuals. In your agenda, you had asked a little bit about proportion of providers not in compliance. As of March 2023, only one provider had not met the initial requirements for policies and procedures to be in place. The Centers for Medicare and Medicaid Services had encouraged states to submit corrective action plans, and the state of California did that in November. With that, that was recognizing some of the workforce challenges and the department has a number of initiatives in progress that anticipate to help providers over the next year.

Those are things like the training for direct service professionals, some of the internship opportunities, as well as rate adjustments that are creating that more person-centered, outcomes-based system. But at the moment, there is not a number that will be something that we identify as we continue to monitor. Let me make sure I answer the last question. How will we ensure compliance?

So that would be part of the regular Regional Centers' monitoring as well. So Regional Centers, as they're doing monitoring, they'll be looking at facility records, consumer records. Those visits include walkthroughs of the facilities, consumer interviews, and of course, working with providers on any issues they identify. Happy to answer any questions.

Thank you. Lao?

Ryan Anderson, Legislative Analyst Office. we have reviewed this proposal and have no questions or concerns to share at this time.

Department of Finance?

Chris Odneal, Department of Finance. Nothing further, Madam Chair.

Thank you. Just a quick question. I remember when we brought this up a couple of weeks ago, I had some of the concerns regarding what we were determining, as in compliance under the final rule. And I'm wondering, given that we do have that extension until next year, if we have opportunity to perhaps maybe deepen that definitions for compliance versus going straight into the maintenance ongoing portion of it. Any thoughts on that?

I believe that's something that's ongoing. Just this last week there was a webinar where CMS was providing additional feedback to states. In June, they will be coming for visits of heightened security facilities. That will give us a little more information as well. So the training and assistance will be something that's ongoing.

So, there's potential for deeper defining that compliance?

I think that will continue to evolve, yes.

Okay. No other questions. We're going to hold that item open. Thank you. Moving on to issue number two.

Thank you. Carla Castañeda, Department of Developmental Services. The next request is for position authority only. The largest request is 44 positions to implement initiatives recently funded in the 2021 budget. There were resources to implement the Rate Model and Quality Incentive Program, as well as establish a self-determination Ombudsperson office and implement a performance incentive program for Regional Centers. With that, the department met with our existing staff. Some of the stakeholder engagement helped to identify areas where we could use additional support in the budget request.

There is a list of all the positions that are supported with these resources. Additionally, over the years, we will establish positions and redirect resources to support operations. Our Human Resources Branch and our Accounting Unit have reviewed a number of the classifications that have been in the blanket, and for those that have been in the blanket for over two years, we are asking for that permanent position authority as well.

Thank you. LAO? Great. Department of Finance?

Nothing further, Madam Chair.

See nothing else on our end. Going to hold the item open. Move on to issue number three.

For issue number three, we are requesting an additional position to support security efforts in the Governor's budget. We had requested resources focusing on headquarters work and some of the patching requirements with new systems. This additional position would help us with also providing that support for Regional Centers.

Perfect. Nothing? Nothing? Nothing? Thank you so much. We're going to hold the item open. Move on to issue number four. Last issue in your Department.

Thank you. For issue number four, we are requesting one position for the associate construction analyst position. Over the years, as our facilities age, they just require additional deferred maintenance support and special repairs, as well as the legislature sees capital outlay requests. These staff help support those efforts and make sure that they stay on track as close as possible to limit any cost overruns. It's recently been supported by a part-time retired annuitant. So we're looking for the permanent ongoing position.

Thank you so much.

Thank you.

Nothing further.

Thank you so much. I appreciate. We're going to hold the item open. We're going to move on to our next department here. State hospitals. Welcome them up. Hello.

Good morning, chair Members of the Committee, Brent Hauser, Chief Deputy Director of Operations, Department of State Hospitals. I'll be presenting the overview for issue number one before transitioning to my colleagues for the remaining two Department of State hospital issues. For issue number one, DSH requests $615,000 General Fund one time in 2023-24 to support five physicians that were included in the 2021 Budget act with limited term funding, which expires at the end of this fiscal year.

This funding is needed to continue to support the workload of processing medical invoices and payments from external medical providers that contain protected health information in compliance with the Health Insurance Portability and Accountability Act. The additional year of funding for the accounting positions at each state hospital location will address the continued workload associated with the transactions of medical invoices that has sustained over the past five years that will ensure prompt payments, continuity of medical vetters, providing services to DSH patients, and safeguarding protected health information.

Happy to answer any questions on issue number one.

Thank you, LAO, Willow and Zeleo. We have no concerns with this proposal. Department of Finance. Nina Hong, Department of Finance. Nothing further to add? Thank you so much. We have nothing further to add on our end. We're going to move on to issue number two and hold that item open.

Good morning. JC Thompson, Department of State Hospitals. I'll be covering issue two for the Department. We're requesting to shift $100,000 from reimbursement authority to Federal Trust Fund authority, which will support the Patient education and Vocational Services program. There are no cost to the General Fund associated with this Fund shift. This will just accommodate the department's ability to receive and draw down federal funds directly rather than utilizing the Department of Developmental Services as a pass through. Happy to answer any questions.

No concerns with this proposal. Nina, nothing further to add? Great. Yep, pretty straightforward. Nothing further. We're going to hold the item open. Move on to issue number three.

Good morning. I'm Sean Hammer, Deputy Director of Administrative Services. To present issue number Three, the Department of State Hospitals requests a reappropriation of 26 million from the General Fund for the construction phase of the Colinga Hydronic Loop Replacement project. This project will replace the existing piping system, which is severely corroded and deteriorated. The hydronic loop replacement will ensure the pipes are able to distribute domestic hot water and heating adequately and efficiently to the hospital facilities, which includes patient occupied buildings.

The project entails a complete distribution loop connecting to six existing buildings and nine below grade connection points. Also included within this project is demolition, soil compaction, material testing, asphalt welding and inspections. The reappropriation is necessary to ensure project continuity should regulatory reviews not be completed in the current fiscal year. This reappropriation will allow DSH to proceed to construction in fiscal year 23-24. That's the end of this presentation and happy to answer any questions.

Thank you. No concerns with this proposal. Department of Finance. Dominic Cadaria, Department of Finance.

Also have no concerns.

Thank you.

Great.

One of our colleagues introduced a resolution today for Tap Water Day, so very important to ensure that the pipes carrying this water allows us to drink it or what. Have you any other comment? Well, thank you so much. We're going to hold that item open. I appreciate you sharing 10 minutes of your time with us up here. Move on to the Next Department. California Health Benefit Exchange, Issue number one.

Thank you, Madam Chair, committee members. Joseph Donaldson, Department of Finance. I'll be presenting on this issue. So under the Federal Affordable Care Act, federal dollars are not allowed to be used to provide abortion services. When ACA was passed, plans that covered abortion services would charge consumers a flat premium of no less than $1 per month to not violate this federal policy. But in California, all plans are mandated to cover abortion services.

Thus, all consumers were impacted and thus required to pay this $1 monthly premium. As a result, the 2021 Budget Act included 20 million General Fund ongoing for cover California to make these payments on behalf of individuals equal to the cost of these premiums. Due to increased enrollment, Covered California requests an augmentation of 350,000 ongoing to this original appropriation. The current appropriation is not sufficient to provide these services to that extent needed, and the increased expenditure authority will serve an estimated 29,000 additional enrollees.

It's also important to note that this proposal is for 23 and 24 and annually thereafter. However, Department of Finance, in collaboration with Covered California, submitted an approved JLBC letter authorizing the increase of appropriation in 22-23 or the current year pursuant to current law. In the agenda, you had a question kind of two pronged related to enrollment and pending legislation. For the first part, related to enrollment, Department of Finance has worked with Covered California to stay apprised of any budget needs related to changes in enrollment related to this program.

This proposal reflects the current needs reflected by Covered California based on the enrollment figures at the time of that request. If additional funding is needed in the coming fiscal year, current law enables finance to increase that appropriation. Additionally, the administration will consider any future augmentations as part of our annual budget process. To the second part of your question, for AB 2530, funding for this fill is subject to an appropriation since it requires new General Fund costs.

This discretionary expenditure was not included in the Governor's budget. Nevertheless, the administration will continue to consider funding this bill through the May revised process, subject to availability of funds and accounting for the ongoing budget deficit. I'll pause there if you have any questions.

LAO, any comment?

Thank you. Luke Koushmaro with the Legislative Analyst Office. We find that due to the increase in Covered California's enrollment over recent years, an augmentation is merited. However, we note that the legislature could consider directing the administration to make the augmentation adjusted based on the enrollment in Covered California on an ongoing basis rather than doing a level adjustment of $350,000. Such adjustments are done in the Department of Healthcare Services and in the California Department of Corrections and Rehabilitation to ensure programs stay right sized for the population they serve.

We know that there's a few different issues that could impact the enrollment in Covered California in the coming years, which could result in a need to make such augmentations. First, beginning this year, the continuous coverage policy that's been in place in medical related to the COVID-19 pandemic is expiring, and as a result, a number of individuals are likely going to lose medical eligibility, some of whom could become eligible for and enroll in Covered California.

In addition, currently, Covered California enrollees who are income-eligible receive enhanced federal subsidies that are set to expire at the end of the calendar year 2025. Once those end enrollment, Covered California could decline. And in addition, the legislature has considered recently different changes to financial assistance that the state provides to cover California enrollees, which, depending on where that ends up going, could also impact enrollment.

So, given these factors, the legislature may want to take action now to direct the administration to do a population-based adjustment rather than doing ongoing levels adjustment. Thank you.

Thank you so much. Joseph, can you just clarify for me on question number two regarding when you requested the current enrollees, you got a different number: now we're seeing Covered California announce another different number of enrollees. Can you explain to me how you're addressing that again?

Yeah. So, in the question, I believe the number of enrollees was the 1,739,360 enrollees. I think that number needs to be. Contextualized a little bit.

I think it's kind of a difference between looking at plan selections and plan effectuations. This number represented plan selections which to kind of go into the details of that is, individuals have selected a plan but have not made a purchase yet for their healthcare services, whereas plan effectuation is somebody who selected a plan and then made a payment towards a healthcare plan which kind of locks in that healthcare coverage.

So the difference between health plan selection and effectuation, there's a little bit difference in those numbers. There's usually a level of attrition from selection to effectuation. So when Covered California brought up or requested the need to address this increase in enrollment, the 350,000 ongoing was going to be sufficient based on the enrollment numbers at that time. And like we stated, there's mechanisms within both current law that if numbers do fluctuate in the current year, we can adjust the appropriation if needed via letter to the JLBC.

And as we've said through our annual budget process, we are reviewing these numbers and make adjustments as needed.

Thank you. See no other comments here. We're going to hold the item open, move on to our next department. Thank you so much. Department of Rehab.

Good afternoon. Victor Duran, Chief Deputy Director with the Department of Rehabilitation. The DOR is requesting $11.2 million in federal Fund authority over the next four fiscal years to support the California sub minimum Wage to Competitive Integrated employment project, or CSP. This project is federally funded through the Disability and Nation Fund out of the Rehabilitation Services Administration.

And the purpose of this project is to both provide and research the efficacy of a set of comprehensive interventions for individuals with the most significant disabilities who are in or are considering entering into sub minimum wage. Thank you. I'm happy to answer any questions.

LAO. Bryan Anderson, Legislative Analyst Office. We have no concerns with the proposal. In fact, see a need for.

This sort of research into enhancing competitive integrated employment. Just to note, despite the linkage between this and the sub minimum wage phase out, you will note that the timelines are somewhat misaligned. The state's currently on track to eliminate sub minimum wage employment by 2025. That would be about midway through the proposed study period. So just FYI, we still see the need for it.

Just important to highlight Department of Finance. Omar Sanchez of the Department of Finance. Nothing further to add. Thank you.

Thank you, Chief Deputy Director. Actually, I'm curious about that, of the timeline alignment. Can you speak on that?

Sure.

So this was an opportunity, a competitive grant opportunity that came out of the Federal Rehabilitation Services Administration. So the timing was out of our hands. And recognizing that in California we will end sub minimum wage by 2025, we also recognize that while sub minimum wage ends in 2025 in California, the individuals who would have otherwise gone into sub minimum wage are still going to be there.

Young people today are going to be aging into working age, and we want to make sure that after sub minimum wage is over, their journey is to competitive integrated employment. Not to the couch, not to a day program. And so our hope is that this project will be one of the tools that we'll bring to bear to support those individuals, both who are currently in sub minimum wage as we phase that out.

But those individuals who are going to be entering workforce age after the end of sub minimum wage and who would have otherwise gone there.

I appreciate that response. Thank you. We have a question over here.

Thank you. I guess I did just think this is a good opportunity to ask the Department if you're going to be getting this grant to look at some things. It really wasn't really very satisfactory when we had our last presentation on this topic. I'd like to know, how many people are we talking about in this category? How many people are we talking about physically into another category?

And what the actual plan is for those people currently working under sub minimum wage, and what are we going to do to accommodate them? Right. Because I remain under the assumption that we're not going to be able to place all these people in competitive labor market. And I am also under the firm belief that work is good for people, having purpose is good for people. People feel good about it. So what are we going to do to bridge that? Are we going to use internship funding?

Are we going to use something? I remain committed to the belief that we need to be able to find some way to bridge between what people can actually be qualified to do and what the market is willing to bear, and that we have some responsibility to bridge that. So, I don't know. Perhaps we're not ready in 25 and maybe we need an extension to look at this a little bit longer.

But when we had the initial presentation, people couldn't answer my questions about how many people are in this program, how many people we were talking about, what kind of places are they in now and what kind of places will they be going. So before, I'd like some more information on this and for the LAO to continue to look at this. It's an area of concern for me. When the Bill passed, I was concerned like, is this reasonable?

I understand it's a just issue, but is it really reasonable to take away an opportunity for folks who have had it for a long time? And we know people get better when they do things, but having that opportunity to do things, I think, is a gap that we're missing and how we're going to either supplement or find a bridge. Thank you.

Thank you. And I and the Administration share your commitment to the belief that employment has great value beyond economic benefit.

It provides a sense of purpose, a sense of structure, social connectedness. And this project is one small pilot project that is part of a much larger constellation of efforts aimed towards phasing out sub minimum wage. And this project will both be one element of that effort, but also help bring to light the interventions that are evidence based, that will support the ongoing effort of ensuring that people who would have gone into sub minimum wage are entering competitive, integrated employment. And we'll be happy to follow up with some additional data.

Thank you. We're going to hold the item open. Thank you for your presentation.

Thank you.

Moving on to the next Department DSS issue.

Good morning, Madam Chair, Members of the Committee, Yang Lee with Department of Social Services.

I'm so sorry. Let's establish quorum first.

If you could call the Roth Senators Menjivar. Here. Menjivar. Here. Eggman. Eggman. Here. Grove. Roth.

Here.

Roth here. We have a quorum.

Apologize.

No problem. So let me start again. Yang Lee, Department of Social Services. The first proposal is for the council's migration in. What we're asking for is $922,000 journal Fund to support two positions and to convert three limited positions to permanency to support, to support the sauce project. I know that we have had a lot of conversations about sauce already, so I'm not going to go into much in details for this project, but happy, I'll just get into the questions about the caseload dynamic data dashboard.

So this dashboard that we have tracks application approval denials and discontinuous. It's designed just to replace a static report that currently existed before. So there's nothing new beyond that. It's just transitioning from one to the next, which is the dashboard in terms of the data that was used. Like I said, it's just the transition itself or Dean, we're not using the same type of data that the county was providing initially in regards to working with stakeholders.

We're happy to have this conversation with stakeholders to figure out what is it that they feel like it's lacking. But I do want to note that there are other places where we do have some of those data already. One example is the CALWORKS, if you're looking for CALWORKS, sanctions by race and ethnicities. We have that with the CALWORKS dashboard so we can provide more information to the staff Committee so they could have that information, too.

Thank you. LAO.

Brian Metzger. LAO, we have no concerns with this proposal.

Department of Finance.

Tamar Weber, Department of Finance, no additional comments. Thank you.

Thank you. Just to confirm on that part, working with the stakeholders, you haven't started working.

With stakeholders so far, to my knowledge, no, because this is a current dashboard that was just a replacement of the static report that we had initially. I'm not aware of. Maybe there would have been stakeholders who were interested, but I'm not aware to my knowledge at the moment. Okay.

In this dashboard, it's going to be a public facing dashboard.

Correct?

Yes.

Yes.

Thank you, colleagues seeing nothing. Thank you. We're going to hold the item open, move on to issue number two.

On item number two, we're asking for one time $5.9 million for over two years to continue to support the development of the Cal Spark project. This is the project that's going to be supporting the childcare programs that we have as social resources. We're in the stage two analysis at the moment, and this resources will really help us push with the planning with the project.

LAO, long time no see.

Jackie Rosa with the Legislative Analyst Office. We're still reviewing the Cal Sparks proposal specifically, but this does just raise broader questions about data migration from the Department of Education to the Department of Social Services of Childcare Systems. So specifically, we reached out to the Department of Education and DSS just to get an update on whether there have been any data migration challenges, an anticipated completion date of those migration activities.

But then also we're aware that there is a current interagency agreement between DSS and the Department of Education that allows DSS to access necessary childcare program information to administer the programs that's set to expire. Our understanding is this fiscal year, so June 30, 2023. So just getting a bit more information on whether there's a plan to extend that at least until the completion of data migration activities, including Cal Sparks, Department of Finance.

No additional comments. Thank you.

Actually, my question is to Lao, just to clarify, the June 30 date that you gave is for that system to seize in existence.

The Department may have additional information, but our understanding is it's for an interagency agreement between the Department of Social Services and Department of Education to allow the Department of Social Services to access care information they need to administer the programs and hopefully through Cal Spark and maybe other data migration activities. Once those are completed, the interagency agreement wouldn't be needed. But our understanding is that data migration has not been completed.

So we're just asking for a status update on if there's a plan to extend the interagency agreement.

I'm happy to respond to that. It is in the works. We're working with the CD, Department of Education with that transition. So we do have a plan at the moment, and we're happy to share anything with Department of the LAO because.

We don't anticipate everything to be transferred over by the 30th, right?

No, it's going to take a little bit longer than that. I think for the most part, a lot of the system is still at CDE at the moment. We are, like I said, with the agency agreement with them, we're getting all the data from them in partnership with Department of Education, but it's taking a bit longer to develop the system. So Cal Spark is one of the mechanisms that we're going to use to make sure that all the data will be at Department of Social Services.

But with any system, there's a lot of planning involved and to implement it takes some more time than what we have envisioned initially, but it's a work in progress and we're in great partnership with CDGE on this whole project.

Okay, thank you. Any other comments? Thank you so much. We're going to hold the item open, move on to issue number three.

Yes, this one is the promised neighborhood state operations funding. Where we're asking to is to shift funding from the current year to the budget year. We have $500,000 that was budgeted for state operations to provide technical support to some of the entities that receive the funding. There's four entities that receive funding from $12 million from a General Fund from the 2022 Budget Act. We don't have the expertise for this program, so we're hiring a contractor to do some of that work.

And it's taken a bit longer to execute the contract. So we're asking for a shift of the points so it could maximize the usage next fiscal year.

LAO

Ryan Anderson, Legislative Animal's office.

No comments or concerns for this Department of Finance.

Tamar Weber, Department of Finance. No additional comments. Thank you.

Thank you. I haven't memorized who works for who yet. Thank you. Any questions on our end? Seeing none, we're going to hold the item open and move on to issue number four.

Sure. The statewide verification hub for this proposal. We're requesting one time $2 million to be available for two fiscal year for vendor contract sources to help us continue to put the planning, designing development of the state verification hub. We're also asking for $12,000 ongoing just to reclassify a position. So happy to answer any questions you might have on this proposal.

Issue four.

Hold on. I'm sorry. I am so sorry.

Number promised neighborhood state.

Yeah, I talked about that earlier.

You just spoke about Cal management.

Sorry, my apology there, you all missed it. Let me go back to facility management system. So for this proposal, we're asking for a one time permanent IT position and to reappropriate $22 million from the 20 Budget act and the 22 Budget act for the next two fiscal years to continue the development of the facility management system. The repropribration of funding will be used to extend 16 limit term position.

And like I said, this is all just helping out with the development of an IT project that we're working on for the community care licensing.

LAO

Angela Short with the LAO. No concerns to raise with this proposal.

Thank you.

Thank you and colleagues, this is issue three. We went back, so if anyone has any questions, see now we're going to hold that item open. Jump to issue five.

Sure. Once again, my apologies. So issue five, statewide verification hub. We're requesting one time $2 million available for two fiscal years for vendor contract sources to just continue to support the design of the statewide verification project. We're also asking for $12,000 ongoing to reclassify one position. It's it position to a manager position. Happy Ganner and answer any questions you.

Might have about this LAO.

Brian Mitzkar, Lao we have no concerns with this proposal.

Department of Finance Tamar Weber Department of.

Finance no additional comments. Thank you.

I'm having trouble understanding the difference between this and Cal Sauce.

Sure. Happy to answer that question. So Cal Sauce is a system that we're going to use for eligibility purposes for all the programs that we have. Cal Works, California Medical and for some of the case management for the county workers. The statewide verification is a system that's going to use to help verify some of the eligibility component for A lot of our mean test programs requires for you to provide your income and your residence status of residency.

Right now, we use a slew of different sources in order to determine, to help verify those data points, to verify those information. What we're hoping to do is develop a system that can streamline that process and requires the less work of the clients and also the county workers to make sure that these individuals qualify for the programs that we have.

Is this embedded within CalSauce?

My understanding is that will be part of it. I'm not too sure about the technical component. I don't have my colleagues who are in the project, but it will be in a component of it. But I'm happy to get back to you.

Yeah, because I guess the verification, I mean, you can do that through cals with E benefits, you have to upload.

Your data, but the county worker still needs to verify it. Those information are uploaded into the system, but at the end of the day, the worker still has to verify this information to make sure that they're accurate. Okay.

And to understand the process. So then I would upload a document onto my app, E benefits, if you will, and then with this process, then this will verify what I uploaded versus it going to the county, not just.

Upload, verify the actual information too.

Okay. We're just speeding the process with this.

This will definitely speed the process and this will make it a lot more simpler for the county staff to verify. And also, there might be other information that might not need to be verified because whatever system that we're using, whatever points of data that we're using has those information already, too. So those are a few things that will help streamline the process overall and will make things more efficient for the county social worker.

Okay, thank you. No questions. Thank you so much. We're going to hold that item. We're going to go on to issue number six.

Yes, this last one should be really simple. The Department is asking for 60 authority. We're not asking for any funding for the child none adult care program, just to continue to implement the programs that we have at Department.

Good starting point. Asking for no money.

Jackie Barisia Legislative Analyst Office we're still reviewing the proposal and we'll raise any concerns with the Subcommitee at that time.

Department of Finance Tamara Weber, Department of Finance no additional comments. Thank you.

Thank you. No additional comments from us. Thank you.

I just realized that today is the 4 May, so May the fourth be.

Thank you so much, Mr. Lee. We're going to hold the item open. That ends our presentations from departments. We're moving on to the final section of our agenda. This is our stakeholder proposals for investments. We received four proposals, and we will be hearing all four of them. I'd like to start off with the first one and welcome. Presenter for the support for Public Guardians and Conservators. You will have three minutes to present.

Thank you, Madam Chair and Members, Trent Smith, on behalf of the California State Association of Public Conservators, Public Guardians and Public Administrators, first, I'd like to thank Senator Eggman for her support and sponsorship of this particular proposal. Just so you understand, public conservators and public guardians are county employees who take care of some of the most vulnerable people in our society when the courts deem that they are unable to care for themselves.

Currently, counties spend about $256 million a year on these services and the state provides zero, which is why I'm here. And there isn't a presentation on the other side of the railing. We have been asking for state support for almost 20 years because as far as we can tell, this is the only social service program mandated by the state and administered by the counties that receives no state funding.

Meanwhile, cases continue to grow as our population gets older, as mental health becomes a bigger focus for care, conservators and guardians are asked to provide that care. And again, it's being done completely with county dollars and no state dollars. So, think of things like there was the Omnibus Conservators act in 2006. There was the incompetent to stand trial reforms imposed by the state. Even care court last year is going to lead to more cases coming our way.

And yet the state has yet to give us any financial support. So as you begin to consider other reforms, whether it be an LPS or probate conservatorship, you just need to understand that there are not the people there to provide this service. We are encouraged. The Governor has put forth some proposals to provide placement so beds and treatment facilities, because that's the other part that we don't have a place to put these people.

But unless the state steps up, there won't be the people to manage these cases and make sure they get the care. So we're asking for the state's support, and we recognize the fiscal condition of the state, but we will continue to be here, especially as you consider reforms, to add more cases. So I'm happy to take any questions. And as the representative of the Walt Disney Company, I also appreciate the May 4 reference. So thank you.

Thank you so much. zero, question. Thank you. Yes. You mentioned you've been coming for about 20 years, you said.

Yeah, the last six or so years in a more formal capacity. But as the other bills have been put forward, we always say, hey, we need funding. And we've gotten to the point, frankly, where we've started to oppose really good policy changes just because they don't have the funding and we can't take on the caseload.

So what have conversations look like with the Administration regarding this? And departments, what are your conversation with departments?

I think there's a recognition that more funding needs to be provided, but frankly, they have looked at this as a county responsibility. The state gives the county a lot of money to do certain things, and the county should continue to spend based on their priorities. And we understand that. And that's been the way we've operated for as long as these programs have existed.

But as the state continues to make new reforms and policy and our caseloads get bigger, we're kind of at that point where we just need the state help. So I think there's been some recognition, perhaps even some sympathy, but making that first commitment to put a state dollar forward again, that puts us on that side of the rail where we continue to defend and keep it, rather than this side of the rail where we have to get that first dollar.

And would you say there's one Department in particular that you've been having the most conversations with?

Well, actually, that's a great question, Madam Chair, because we don't have a home, there's no state funding. We don't have a Department. So we get that question even by your consultants. Should this be housed in the Department of Healthcare? Services, Department of Social Services, Department of Aging. We like any or all of those. I have made the joke that if you want to put the money in Caltrans, we'll take it. We just would like the money.

You guys just need to tell us where you want it to flow through. So we've talked to the Health and Human Services Secretary again. I think there's some sympathy from a policy standpoint, but we're really talking about a fiscal issue here.

Thank you. Go ahead, Senator.

Just to say I concur, and we've tried this for the last couple of years, and the more folks currently in San Joaquin county, six month waiting list to get a conservator. So if you have somebody that you're trying to treat or to conserve, if there's nobody there, then the county just doesn't do it. And so folks are just back out on the streets, continuing to deteriorate, ending up in our prisons and in our jails and in our emergency rooms.

I think what the budget is asking for is reasonable. We don't Fund them. We have an increased need for them. Through all the programs that we put into place, there's going to be, to continue to be an increased need for public guardians, and we need to find a way to fit the need.

Thank you. Senator Roth.

Thank you, Madam Chair. Frankly, during the care court conversation that we had, I guess it was last year, one of my concerns that I expressed during these hearings to the Secretary of Health and Human Services and others was the ability of counties and the funding available inside the counties to satisfy the obligations that were going to be imposed on counties through the care court proposal. The response was, I guess hope was the word that was either used or implied. And Hope doesn't necessarily bring about action.

So I'm very, very supportive of this. I join my colleagues. I think, frankly, I encourage counties to volunteer for the CareCorp program, to step up and participate, because I told know we listen to whining all the time, but when whining meets action and there's no money and there's a Bill, at least you'll be able to present the Bill to those of us in Sacramento and the Administration and say, hey, we provided the services. We don't have the money.

This is the Bill for the services, and this is what it actually costs. So hopefully that's what's going to happen through the CareCorp process. And hopefully, because you all and the folks that you represent are critical to that process, we'll get some funding sent down the pipe in your direction. So you can adequately do the job that we ask you to do.

We appreciate those comments. And to be clear, court, the goal in care court is to keep people out of conservatorship, and we recognize that. But once they go through that process and it's determined that you can't keep them out of a conservatorship program, then we're it. And again, we just don't have the capacity, as the Senators indicated, just in her county.

And I could tell you all kinds of different horror stories from different counties where people think they're getting those services because the court issued an order. But on the back end, if there's no people there to provide the work or no place to put them, the system's not working like people envision it.

And it's the same thing across the healthcare playing field that we're dealing with with respect to mental health services, obviously, that we have the full continuum. We want the residential care facilities, we want the outpatient facilities. We want those at that end of the continuum to solve the problem. But at some point, some folks don't respond to that and you need acute care, psychiatric beds. In care court. We hope that the court directed care plan works and that people participate.

But at some point, under the care court proposal, conservative shifts become an issue, and that's where you come in. So, we have to fund it somehow. So, look forward to working with you. Thanks for bringing it forward and thanks to my colleague for sponsoring it.

I'm not going to disagree with any of those. That is a true fact. We need support in this. I guess going back to my question, know, navigating this past 6 - 7 years of formally coming to requests, what conversations have been secured? Like, has CWDA perhaps gotten in the mix and provided some insight in your conversations with departments? What departments have asked or what one specifically said? Maybe this falls under this potentially. That's the part where I haven't been.

Able to, I think there's all kinds of local support, CSAC, different county levels, professional organizations. But when it comes to state government, the conversations, we haven't been able to secure a conversation with a Department of Healthcare Services. I think there was a recent conversation with the Department of Aging and they kind of said, this isn't our deal. And so that's why we have tried again at the agency level, the Department of Finance. Again, we'll let them.

It's been my experience no particular Department or agency is going to step up and volunteer to take on a new program. It's going to have to be either come from above the agency or the governor's level or the legislative level to say, you, particular Department or agency, you take over this work. And we've even advocated that. One of the weaknesses here is data, because there is no state agency that oversees this. All the counties do things a little bit differently.

So, it's very difficult for us to even collect all of the information and the data in the same way so that you can look and get a better gauge of how these programs are working. And we've advocated and said if there was some central state agency or Department, you pick or whoever volunteers, which, again, I don't see any volunteers stepping up, it can all be funneled through, and we could actually probably have a more efficiently run program that way, too. So, we're open for suggestions.

As I've told you again, we'll take Caltrans or anyone that'll take on the task.

My final question to you is, I know different counties are doing different things, but are you seeing a where does this program normally fall under in some of these counties?

Well, it does vary. Some it's under the Department of Social Services, some it's Health Services. Some will fall under the sheriff corner. So, it's quite diverse. And that's sometimes frustrating even when we have discussions because, again, it's hard to get the information when you're dealing with different counties, and some counties do a better job than others. Again, it's at the discretion of each county.

So the larger San Francisco, as you might imagine, they have a more robust program, but I think even know at their limits where other counties might have one or two people, if it's a very small county, but it varies from county to county. Department of Social Services Probably, I guess, would be the most common one.

Thank you so much. See? Nothing else. I appreciate your presentation. We're going to hold the item open, move on to our second proposal.

Thank you. And thank you for all of your questions. Thank.

Yes, good afternoon, chair and members. My name is Andrea San Miguel, I'm the Policy Director for Planned Parenthood Affiliates of California. So I'm here to represent the seven Planned Parenthood affiliates across the state who offer high-quality, affordable health care at over 110 health centers, resulting in 1.3 million patient visits annually.

As sponsors of this budget proposal, we believe this funding would support reproductive health patients access to integrated mild to moderate behavioral health services where they are already seeking care, regardless of their age or insurance coverage.

PPAC's policy interest in supporting behavioral health screenings, referrals and integrating mild to moderate interventions does predate the COVID-19 pandemic, but I would say in 2020 and 2021, it was certainly exemplified that affiliates could have a role to support behavioral health, and as the affiliates that serve the constituents you represent, they can tell you this patient need does continue.

So successful pilot efforts would demonstrate how community health centers, which primarily provide sexual and reproductive health services, can be relied on as part of the broader statewide effort to improve access to behavioral health services. The Planned Parent health centers are well represented to implement screenings interventions for existing patients, 91% of whom are covered by Medi-Cal, Family PACT, or are uninsured. Affiliates are doing what they can to make use of the no-wrong-door policy and contracting with managed care plans when possible.

However, building programs up to scale is what really enables improved access for more patients, and that is where the challenge is now. With the resources and incentives in this proposal for example, Planned Parenthood Los Angeles could prolong and expand their work offering behavioral health services to teens at wellness centers on campuses and to adults at specific healthcare locations.

Planned Parenthood of the Pacific Southwest would be able to seek resources to train clinicians, do more robust screenings for depression and other mental health disorders, and expand the care coordination team currently seeking to do this work, potentially even standing up a limited direct behavioral health care program. And Planned Parenthood Mar Monte would have the resources to sustain their existing successes and efforts, building on existing pilots and collaborations with counties.

So in the past, the state has seen the benefit of integrating dental into primary care behavioral health into primary care settings, and it is our belief that in the coming years it will be successfully, if there is funding in the coming years, that there will be similar evident demonstrations that integrating this mild to moderate behavioral health screenings and interventions into a predominantly reproductive health setting will also support existing patients. So we disrespectfully request your consideration of these goals and the budget proposal itself.

Thank you. Seeing that I think we were, me and Senator Eggman were talking about we were wanting mental health therapists everywhere. People are asking for mental health therapists everywhere, but we're bleeding mental health therapists, you know, we are struggling in our schools, our hospital and so forth. Just to clarify, are you asking to bring in some to your facilities, to PPAC facilities?

So the affiliates have been working to various degrees to have licensed and then unlicensed those who are working up towards their licensure clinicians to be able to serve either doing universal screenings, for example, or offering limited sets of counseling services. So agree, there is a workforce struggle with this and kind of everything else within publicly funded healthcare right now and beyond. I would say it's all of the above. Patients are asking for services wherever they are and wherever it's easy for them to seek care.

I would not see it as sort of a competition of resources. I think it's statewide we're all on the same page that there is a workforce challenge. But yes, ultimately there would be some licensed clinicians in the facilities and are.

You looking to start this pilot in specific counties or statewide?

I think we're looking for something that would be potentially as a pilot, it would be somewhat narrow, limited mostly by the either managed care plans or those who are outside Medi-Cal. Given the split in the two items. The hope, though, I think would be to not exclusively limit to certain counties initially, but obviously all of that would be up to negotiation, depending on how much funding does ultimately become available at some point.

And the pilot program would be for a year?

We're hoping to secure funding over three years. Just given what we know on the ground about the challenges of doing any program expansion involving workforce, that does require more than a one year fiscal year cycle to be able to secure staff.

So 25 million over three years?

Correct.

Any other questions? Thank you so much for your presentation. We're going to hold the item open, move on to our third presentation on Birthing Justice for California Families pilot project. Hello, Molly.

Red's good. Sorry, haven't sat at this table. Good afternoon, Chair and members. Molly with Planned Parenthood Affiliates of California as well. Planned Parenthood, alongside Black Woman for Wellness Action Project, are requesting funding to support the Birthing Justice for California Families pilot project, a pilot project that will build upon California's efforts to improve birth outcomes for all Californians and advance birth equity by expanding access to doula care in California.

We've made efforts to improve maternal and infant health outcomes, yet deep inequities in birth outcomes still exist, particularly for Black women and birthing people in California who are four to six times more likely to die from pregnancy-related causes than their counterparts. Even after controlling for factors like socioeconomic status and education, Black women and birthing people remain at a higher risk for maternal mortality and morbidity.

Research points to racism and implicit bias, in addition to other social determinants of health, as factors that contribute to these inequities. It's been established that dual care is an important tool and a resource to improving birth outcomes, yet it remains an underused resource. Women of color who have the highest risk of negative birth outcomes are most likely to report wanting but not having access to doula services. This is in large part due to the cost of doula care, which poses a barrier to access.

An additional group, often overlooked, are incarcerated birthing people with higher risks of adverse birth outcomes and comorbidities or coexisting conditions that can lead to complications in pregnancy. Incarcerated birthing people stand to benefit tremendously from access to doula care the birthing justice for California Families pilot project will advance equity by ensuring that more birthing people, particularly those in this gap, who do not qualify for Medi-Cal.

But cost remains a barrier have access to a critical component of the perinatal care necessary to enjoy a safe birthing experience. The project, by creating grants for community-based doula groups and local public health departments, will remove the cost barrier to care for those who need access while ensuring that invaluable care that doulas provide is recognized and compensated in a manner that's sustainable and equitable.

It also encourages the development of a pipeline of doulas capable of offering culturally congruent care through allowing grant funding for training everyone's deserving of dignity and the supports necessary to ensure a safe, healthy, and joyous birthing experience. As a pilot project, we'll have an opportunity to see how access to doulas can improve birth outcomes and support access to full-spectrum doula care to a broader group of birthing people.

I respectfully will request support of this proposal as it moves through the process, and thank you for your time today.

Thank you so much. Any questions? I don't have any questions on this one. Thank you so much for your presentation. We're going to move on to our last presentation, our stakeholder presentation on California Medicine Scholars Program.

Hello Madam Chair and members, My name is Rowena Robles and I am the Executive Director of the California Medicine Scholars Program. It is a statewide education pipeline to address California's physician shortage crisis, and it begins supporting students at the community college level. The program is simultaneously addressing one health workforce shortages and two centering equity and student access and matriculation in higher education. The program is an intersegmental effort engaging four University of California medical schools, seven public and private universities, 38 community colleges and counting.

We just added another one yesterday, so 39, and dozens of community health clinics in regions such as the Central Valley, the Inland Empire, and the Imperial Valley communities are already experiencing extreme shortages in primary care. We have implemented and launched California Medicine Scholar hubs in each of these regions with the addition of a Northern California hub as well. The program was started under HKAI through legislation by Senator Hurtato in 2021.

At the time, we received a one-time allocation of 10.5 million to fund the first three years of this seven-year pipeline. The program is now seeking 14 million in one-time funding to fund the rest of the pipeline for the 600 students which we will have recruited and enrolled by 2025. This will ensure that students already in our program are supported all the way to medical school as was originally intended by the legislature.

Our request is championed by Senator Caballero with the support of Senator Hurtado and Senator Ra. Thank you. On the Assembly side, Dr. Arambula is championing the request with support from Assemblymember Agiar-Curry. Because of the budget deficit, this request does not expand the existing program. It simply seeks to ensure that students already in the program are able to complete it and enter medical school.

I respectfully request that you support this onetime ask and ensure that no students slip through the cracks before they are able to complete medical school and enter the California healthcare workforce. Thank you.

Thank you so much. Confirming you have 600 students right now in this program.

We currently have 170 students. We just launched last June. We're on track to recruit 600 by 2025.

So the 170 students are the ones that are currently in school that the 10.5 million has supported.

The 10.5 million is supporting three cohorts of 200 students. So this 170 is part of cohort one. Cohort two recruitment is starting in June or July of this summer, and then the next summer, we'll be recruiting cohort three for a total of 600 students by 2025.

Got it. And how long is the program, meaning each for each student, how long are they in?

It's about seven to eight years from community college to get into medical school. That third cohort will be first year med students at the end of that seven years.

Okay. And just for my clarification, and so far, for the three cohorts, they have funding for their first three years of the program?

Yes, and we were funded as a pilot.

Got it. And so the request is just so they can actually finish through.

To fund the rest of the pipeline, the rest of the pathway, until that third cohort is in medical school.

And where, are these cohorts in the Central Valley, Inland Empire?

We have four regional hubs in the Central Valley, the Inland Empire, Imperial Valley, and San Diego County, and then Northern California. And I have a list of the counties, but it's quite extensive.

Thank you. Any other questions? Senator Roth?

Thank you, Madam Chair. I just want to commend this effort and commend you, ma'am. This is a very important program, workforce development, particularly in the healthcare fields, because of the length of time necessary to train and gain the experience in order to provide the care to the people who we have promised care to, takes a long time. And we talk a lot here, and we try to walk the talk and walk the walk with respect to increasing diversity in these healthcare fields.

And that's a very, very important thing. But if we intend to and expect to see results, we're going to need to show students in high school and community college that it can happen to them, because we miss, I think, a lot of students who don't think that they can ever attain admission to a medical school or other healthcare schools, for that matter. And programs such as this show them that it is possible, and I think it's very, very important.

I have a wonderful example from the Inland Empire Hub, headed by the UC Riverside School of Medicine. They're entering class of, it wasn't quite 50, so let's just say about 45 students for orientation, they invited their parents and any other significant people in their lives to the orientation. And so it was just such a wonderful thing for most of these students were first generation, for their families to also see the experiences that they were entering into.

So thank you. Thank you, Madam Chair.

Thank you, Senator. Last question for me. The funding it provides tuition for them, or what else does the funding cover?

The funding funds regional hubs, and a regional hub is made up of a school of medicine, undergraduate institutions, both CSU and UC community colleges, and community health clinics. And so the pathway is supported and connected from when the student is in community college all the way through. So when that student transfers to a four-year year in their region, they're given a warm handoff.

Right, so I think that's what's significant here is one of the significant things about this program is that students are supported all throughout, and we're trying to target those places where students drop out.

Got it. So no fund no tuition. This is just for the infrastructure.

It's for the infrastructure. We do have some funding for student stipends. That's from that original 10.5 million. We're seeking funding elsewhere for summer stipends so students can participate in internship and volunteer opportunities and not have to work in the summers.

Perfect.

Madam Chair, I just want to note there have been some excellent news articles on this particular program and newspapers in the state, and the news articles themselves highlight some incredible stories of some of these, I think, mostly young students and what's keeping them moving toward their goal, in this particular case, of becoming physicians and surgeons. So thank you.

Yeah, we had a real nice Sacbee article a few weeks ago.

But thank you so much. Seeing nothing else, I appreciate your presentation. We're going to hold that item open.

Thank you so much.

That concludes our presentations. We're now moving into the public comment section. If you're in person, please step forward to provide a public comment. For those who wish to give a comment through the teleconference, you can do so through our number, 877-226-8163 with a access code of 736-2834 Go ahead,

Madam Chair, Senator Eggman, Senator Roth, distinguished staff. Rick Rollens here on behalf of ARCA, Association of Regional Center Agencies. I'm here today to speak in support and comment on two issues under Section 4300, Department of Developmental Services. We appreciate the administration's commitment to real-world HCBS compliance and this proposal for resources to support the Regional Center workload associated with monitoring and supporting service providers to achieve better outcomes for those we serve. On issue number three, shoring up the security of Regional Center data systems.

Security is a critical interest of ARCA. We support the request for DDS staff position in this area, but also note the need for funding for IT security at Regional Centers as individual records that contain sensitive information is maintained locally by the Regional Centers. Thank you for your consideration.

Thank you so much.

Chair, members, Kathy Mossburg, representing a couple of folks here today on behalf of the California Area Agencies on Aging. Under issue one, on the AAA efficiencies, C4A supports the department's request for administrative efficiencies that would allow the department to advance funds and also the data request. The department's request to provide annual local assistance via direct allocations and on behalf of GRACE End Child Poverty. Under issue four, CDSS promised neighborhoods.

We support the proposed shift and appreciate the department's swift work on implementing this program and engagement with local stakeholders. And we are supporting the program, becoming permanent and working with Senator Hurtado on that, and we're hopeful to work with the department to work off of these four initial areas to work to make this statewide. Thank you for your time today.

Thank you.

Good afternoon, Madam Chair and members, Jolie Onodera with the California State Association of Counties, representing all 58 counties here today in strong support of the proposal for investment from the California Association of Public Administrators, Public Guardians, and Public Conservators for the important work that they do. I'd like to align my comments with those presented by Mr. Smith earlier and would also like to thank Dr. Eggman for her continued support of this request. Thank you.

Thank you so much. Moderator if you can queue up those wishing to provide comment through teleconference and kindly let me know how many we have in queue.

Of course. Ladies and gentlemen, if you wish to make a public comment, please press one, then zero. We have about six in queue. We'll be going to line 14. Please go ahead. And 14, your line is open.

Thank you. Sorry about that. Good afternoon, Chair and members Jack Anderson with the County Health Executives Association of California, representing our local health departments throughout the state. I am providing comments on issue number two under 4265, Department of Public Health related to the Childhood Lead Poisoning Prevention Program.

TF is supportive of the administration's request for additional funding for the clip. However, we believe local health departments need additional funding beyond the amount requested to fulfill the requirements of the scope of work over the next three-year contract period. The state's new contract period increases workload for local health departments, both through the lowering of the blood-led reference value as well as multiple new primary prevention activities.

We are concerned that local health departments will have increased responsibilities without sufficient funding to support these tasks, and we hope to work with the administration and legislature to fine-tune the funding amount requested to adequately support local health departments in carrying out both case management and primary prevention activities. Thank you.

Thank you.

We'll be going next to line 20. Please go ahead.

Stephanie White with SEIU California related to the Department of Aging issue three, we support the proposal related to the No Wrong Door Leadership Council, for HHS issue two, we support Children and Youth Behavioral Health Reappropriate, 30th 2024. We support the Suicide and Crisis Line implementation of 988. We're concerned about some contract exemptions related to managed health care. Issue Two, we support enhancement of funding to expand the scope of enforcement of clarity.

For DDS issue one, we support the effort to ensure compliance with federal efforts to implement HCDF final rule and then finally, we support the stakeholder request for investment for 200 million for the public guardians, but would prefer if it was part of SB 43. Thank you so much.

Thank you.

Next we're going to line 19. Please go ahead.

Good afternoon. Chair and members, Elise Fandrick from Trenton Price Consulting on behalf of Black Women for Wellness calling in support of the Birthing Justice Pilot funding, which would support a three year grant program to provide doula care for pregnant and birthing people who are low-income and do not qualify for Medi-Cal or who are from communities that experience high rates of negative birth outcomes. As was testified, mortality and morbidity for Black and Indigenous pregnant people and babies remain considerably higher than the state's average.

And with the overturn of Roe v. Wade via the Dobbs v. Jackson decision, the maternal mortality rate is projected to increase by more than 33% for Black birthing people and 21% overall. This pilot and the associated doula care can deliver significant benefits to address this disproportionately high negative birth outcomes for these communities, as well as provide culturally congruent and client-centered care and advocacy that will reduce the impacts of racism and racial bias on birthing people of color and improve birth outcomes for their babies.

We strongly urge the committee to support for the proposal. Thank you.

Thank you.

And next we're going to line 22. Please go ahead.

Good afternoon. Linda Nguy with Western Center on Law and Poverty in support of the increased staffing through the California Lead Prevention Program, as well as echoing CHIA's point that that may not be sufficient, as well as noting that blood lead poisoning disproportionately impacts children of color, and so pleased to see that the federal lowered the threshold level. Also in support of the stakeholder proposal for the birthing justice and for California project, as well as the California Health Benefits Exchange $1 premium subsidy augmentation.

It's good that more people are accessing this. And finally, in support of, under the Department of Aging, the Calfresh Proposal. Thank you.

Thank you.

Next we're going to line 25. Please go ahead.

Alicia Benavidez Lewis calling on behalf of Alliance for Boys and Men of Color a coalition consisting of 112 organizations requesting the committee approve a 22 million funding submission to support innovative interventions and culturally rooted approaches to end domestic and sexual violence, including nonviolence programs for people seeking support and healthy relationships, or programs that are tailored for men, people with disabilities, LGBTQIA community, and culture rooted programs with wraparound support culturally responsive and culturally specific survivor services, including counseling, healing symbols, workshops, economic security opportunities and pilot grant programs to support restorative and transformative justice and programming and helpline for people at risk of using violence in their relationship. Thank you.

Next we go into line 24. Please go ahead.

Thank you.

Hello, Chair and members. My name is Sos Nazarian, and I'm a researcher in higher education. I am calling in support of the California Medicine Scholars Program. The program is truly unique in how it guides underrepresented students across the state to and through medical school, providing tailored supports that are critical to these students succeeding. I respectfully ask that the California Medicine Scholars Program be included in the 2023 budget. Thank you.

Thank you.

Next we're going to line 21. Please go ahead.

Good afternoon, Chair and ranking members. I'm Grace Glazer. On behalf of VALOR, a California-based national antisexual violence organization, and California Sexual Assault Coalition, VALOR, along with 112 supporting organizations, are respectfully requesting the committee approve 22 million in funding to be administered by CSS in support of innovative interventions and culturally rooted approaches to end domestic and sexual violence.

This funding will include programming for nonviolence interventions for people seeking support in healthy relationships, tailored for men, people with disabilities, LGBTQIA community, and culturally rooted programs with wraparound support. This will also include culturally responsive and culturally specific services, including counseling, healing circles, workshops, economic security, and pilot grant programs to support restorative and transformative justice in programs. This will also include helplines for people at risk of using violence in their relationship. We appreciate you considering this request. Thank you.

Thank you.

Next we're going to line 26. Please go ahead.

Hi. Good afternoon. My name is Dan Okenfuss, and I am the public policy manager of the California Foundation for Independent Living Centers. And I'm calling to echo comments made by the representative for the California Association of Area Agencies on Aging. We partnered with them on a budget act for expanding the Aging and Disability Resource Connections Program with the Department of Aging.

The additional budget investment will help Californians with disabilities and older adults live with the dignity, care, and the choice they both deserve and need and appreciate your support for additional funding for ADRC program. Thank you very much.

Thank you.

And we do have one person that did just queue up one moment while their line number is given, and next we'll be going to line 28. Please go ahead.

Hi, my name is Jessa Garcia. I'm currently a community college counselor within the Barstow area, and I am calling in support of the California Medicine Scholars Program. The California Medicine Scholars Program has already launched and enrolled its first cohort of students, and so, in the spirit of protecting our progress, I would like to ensure that these students make it to medical school as was originally intended by the legislator. Thank you.

Thank you.

And there's currently no one else in the queue Madam Chair.

Thank you Moderator. Seeing no one else here in public. That concludes our public comment section. If you still wish to provide a comment, you could do so in writing to the Budget and Fiscal Review Committee or through our website. With that, that concludes today's hearing on Senate budgets, subcommittee number three. Thank you so much, everyone.