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

The Senate Budget Subcommitee number three on Health and Human Services will come to an order. Good morning, everyone. The Senate continues to welcome the public in person and via the teleconference service for public comment. For individuals wishing to provide public comment, today's participant number is 877-226-8163 and the access code is 439-8318 we are holding our Committee hearings here in the 1021 O'street building.

I ask all rest of the members of the subcommittee to be present here in room 1200 so we can establish our quorum and move forward. Today we will be hearing budget proposals from two department that include the California Department of Social Services and the California Department of Aging. In between those proposals, we'll be hearing presentations and have oversight committee items.

The first issue on the agenda is our first oversight item in the panel discussion covering older adult homelessness and the Home Safe Housing and Disability Advocacy Program and Community Care Expansion Program. All right, great. So before we get started with the panel, and before I bring the panel up, I will turn to CDSS Director Kim Johnson for some opening remarks. Welcome.

Thank you, Madam Chair and committee members: Kim Johnson, California Department of Social Services; you'll hear from all of us this morning about the tremendous work of the Department of Social Services and its community partners, county human service agencies, and many other partners that have helped really rapidly expand the housing component that's integrated within the social services, health and human services array. Each program is embedded into our, for example, CalWORKS program supporting families, child welfare system services, adult protective services, and disability benefits.

And we really believe this integration and this expansion of this component is allowing for long-lasting outcomes. Each of our programs must utilize a housing-first approach. We are part of the larger departments and focus on utilizing that approach first, and we do believe that yields to greater outcomes.

I want to note that as your agenda outlines, we'll talk a lot about both unsheltered populations and the older population, the fastest growing population of those 50 and older, and the four programs that the Department has expanded in that effort to support them. But I also want to specifically highlight Project RoomKey.

This was a program that was stood up in a number of weeks during the COVID pandemic and really designed to both create an opportunity to support those who had immediate sheltering needs related to being COVID positive, but also to prevent COVID. And again, the partnerships that were created with many, many different entities, including hotel operators, et cetera, to ensure that we had over 61,000 individuals supported in that was tremendous. But I also want to note that it's an example of that.

We took that opportunity to then pair case management and navigators to connect those individuals to longer term housing and supports. And again, our deputy director will show more about the outcomes in that space. And I think it's a lesson we can learn about the transition from those shorter term sheltering operations to the longer term supports.

I'll also note that many of these expansions are consistent with the activities outlined in the master plan on aging, which you'll also hear about later today, and also part of the long-term care continuum that's available for, again, our older adults and those with disabilities in California. So, we very much look forward to sharing these outcomes with you in the panels today. Thank you so much.

Thank you so much, Director. So now I'm going to welcome the panelists, both who are in person and on Zoom, joining us for our first oversight item. Welcome, Patty. And I apologize. I'm really bad at names. Patti Prunhuber, Director of Housing Advocacy, Justice in Aging. How did I do? Okay, great. It's going to get worse. Claire Ramsey and Hanna Azemati, California Department of Social Services, Trent Rhorer, Executive Director, San Francisco Human Services Agency, welcome on Zoom. Lito Morillo, Director, Kern County Human Services Department, also on Zoom. Rebecca Watson, Managing Director of Change Well Project; Jonathan Russell, Chief Strategy and Impact Officer from the Bay Area Community Services on Zoom and Michael Weinstein, CFO, and founding partner; and Linda Kaufman, Director of Government and Public Affairs, synergy programs. Thank you for the panelists for joining us both on Zoom and in person for our back to in-person presentations. Very exciting. So, let's begin with the presentation from Ms. Prunhuber. Welcome. Please proceed.

Thank you so much. Good morning, Chairman-

I am so sorry.

I'm going to cut you off really quick. Could we do a roll call quickly and establish quorum?

[Roll Call] We have a quorum.

Go ahead.

Again, thank you and good morning. Thank you for inviting me to speak about this pressing issue of older adult homelessness. My name is Patti Prunhuber. I am the Director of Housing Advocacy at Justice in Aging. We are a legal advocacy organization that uses the power of law to fight senior poverty and to advance equity for all as we age. While we are a national organization, we focus a lot of our work here in California. So, what do we know about older adults experiencing homelessness in California?

We know that it's rising dramatically. I'm sure you've all been reading in the papers and that this trend will continue unless we swiftly take steps to reverse it. And older adults, which are defined in different ways, but I'm going to use age 55 plus, are the fastest growing age group of people experiencing homelessness in California, and we see the steepest increase for those over age 65.

In your materials on page four, you will see a chart, and it shows that from 2017 to 2021, homelessness among those 65 and over more than doubled, growing by 131%. And that same data show that the total number of individuals aged 55 and older who needed to access homeless services was 57,715. Roughly 45% of all individuals who come in contact with the homeless response system in 2021 were aged 50 and older, and almost half of those became homeless for the first time after age 50.

And the precipitating reasons behind their homelessness also vary, some from their younger counterparts. The rent affordability crisis is hitting all Californians low-income renters. But older adults are most likely to struggle with rent unaffordability. They are more rental cost burdened than the population as a whole.

And additionally, as older renters age, they face an increased likelihood that their fixed incomes haven't kept up with escalating rents, they have depleted their savings or they have lost a spouse or partner, resulting in older renter households aged 75 and over facing the highest cost burdens. And they also face increasing disability and health conditions that make retaining housing more difficult. So, how precarious are California's older renters?

A snapshot from last month's US Census Household Pulse survey found that 28% of renter households in California aged 55 and older reported that they were very likely to be evicted within the next two months. And I know that you've also heard about the racial disparities in homelessness. We know that black, indigenous, Latinx, and LGBTQ face a substantially increased risk of homelessness. And the evidence suggests that the racial and ethnic disparities in homelessness intensify with age.

So, I'd like to turn next to the kinds of additional barriers that make keeping or getting into housing more challenging for older adults, just to name a few. 36% of people experiencing homelessness of all ages report disabling conditions, and we know that percentage is much higher for older adults experiencing homelessness. And many housing programs exclude or can't serve older adults who have disability-related needs. And living on the streets at any age is incredibly difficult.

But older adults who are living on the streets are more likely to experience health declines and develop chronic conditions that are typical of a housed person 20 years older than their chronological age. They will consequently require more assistive services to obtain and maintain housing. Many of our seniors cannot navigate the coordinated entry system used to provide homeless services. They face technological, language, mobility, and transportation barriers.

We need to update the assessment tool that is used to prioritize who should get housing services, fondly called the VI-SPDAT, and we need to incorporate and prioritize the needs of older adults in our housing decision tool that we use, and shelters are not kind to older adults. Older adults do not feel safe, and their disabilities cannot be accommodated.

As a result, two thirds of Californians overall experiencing homelessness are unsheltered, and older adults are disproportionately represented in that unsheltered group living in a tent, a vehicle, or on the street. And older people are particularly vulnerable to the recent severe weather that we've had and are about to get again today. So, California has directed substantial resources to prevent and end homelessness.

But we need age targeted solutions for older adults and where the state has focused its homelessness efforts on a specific population, for example, veterans or transitional aged youth, we have seen significant progress in reducing homelessness and that tailoring solutions to a specific population works. Yet these resources have not been targeted to older adults as a group with a program tailored to their specific concerns and needs. And I acknowledge and recognize the very good work of, as we call it, HDAP and Homesafe.

But they are for very specific subpopulations connected to a benefit program administered by the department. So, we need to focus on older adults as a special population within the overall interagency strategy to prevent and end homelessness, and we need to focus on prevention. We've been able to increase our capacity to get people housed, and we still are losing ground. We can't rehouse people fast enough to stem the tide of new older adults entering homelessness.

If we can't bail this leaking boat fast enough, we have a serious inflow problem. Several local rental assistance programs targeted to seniors are demonstrating that this approach is highly effective as a homeless prevention strategy. And I'll just lift up Santa Monica; the city of Santa Monica has a program called Preserving Our Diversity. Stanislaus County has a program to keep older adults housed, and San Diego County is about to launch its shallow senior subsidy program, and it's time to take it statewide.

The CDSS administered HDAP and home safe programs are essential and vital. They can avert homelessness for a specific group of people, as I've mentioned, but it doesn't reach the vast majority of older adults at grave risk of homelessness. We are already facing a crisis of homelessness among older Californians, and we are at a pivotal moment. Unless we quickly invest in practical, long-term solutions that address the specific needs of older adults, this alarming surge in older adult homelessness will worsen. But here's the good news.

California's master plan for aging has committed to a goal of housing for all ages and stages, which identifies as a key strategy preventing and ending older adult homelessness. An age friendly set of solutions include a targeted rental subsidy program for older adults at risk of homelessness. And this is one of the initiatives identified in the master plan, removing barriers to obtaining integrated housing and health related supports in community settings and continuing to invest in more deeply affordable, accessible, and age friendly housing. Thank you.

That concludes my remarks, but I'm happy to address any questions.

We'll hold off questions until the end of the panel. Thank you so much. Moving on to Claire Ramsey and Hanna Azemati.

Yeah, hi. Thank you Chair Menjivar and Members, I'm Claire Ramsey. I'm the Chief Deputy Director for Disability, Aging, and Housing integration at the Department of Social Services. I'll let my colleague Hanna Azamati introduce herself, and then I'll proceed with my remarks.

Hello. My name is Hanna Azemati, Deputy Director for the Housing and Homelessness Division. It's a pleasure to be here. Thank you for-

So thanks. I'm going to start overarchingly talking about the questions that you've addressed directly to the Department and highlighting three programs that we administer through the Department of Social Services, the HDAP, which is the Housing Disability Advocacy Program, Home Safe, and our newest program, Community Care Expansion.

And Ms. Prunehuber gave you good context, but the Department is really leading from a place of understanding that older adult homelessness is growing, that it is a significant problem in our state, and that older adults, often with disabling conditions and people with disabilities, struggle more to find housing and retain housing. And so we've created our programs, as Director Johnson said, to really ensure that our social services and housing programs are integrated and are working together to serve some of California's most vulnerable residents.

I'll start with a short overview of HDAP, but I do just want to say that the agenda did a good job laying out the major pieces of that program. But HDAP was established in 2016 with the goal of assisting people either experiencing homelessness or at risk of homelessness who are likely eligible for disability benefits. And it provides both housing supports and disability benefits advocacy, and it has four core components. It includes outreach, case management, benefits advocacy, and housing support to eligible individuals.

Both the Budget Act of 2021 and the Budget Act of 2022 provided $175,000,000 for HDAP, 25 million in each year, ongoing and 151 one-time in each year to expand the programs. CDSS has already issued awards for the one-time funding in both years. Recently, we awarded 133.75 million in the match-exempt funding to 57 counties and two tribes, and that represents an additional 14 participating counties. And then we're in the process of awarding the 25 million in match-required funds this coming spring for those communities.

HomeSafe is a program directed to serve people who are connected to our Adult Protective Services, or APS, program that can include people who are already clients of APS or are in the process of being enrolled in APS, or for our tribal members who do not actually have an APS system the same way the counties do, instead who appear eligible and are identified by the Tribal Social Services Agency serving to alleviate elder abuse.

Again, those are for people in APS who are experiencing or at risk of homelessness for reasons of abuse, neglect, self-neglect or financial exploitation. Grantees operating our Homestay programs utilize a range of strategies. I won't name them all, but it does include homelessness prevention and housing stability, case management, financial assistance, legal services, and other services that will help ensure that someone receives the wraparound they need to stay successfully housed or to be rapidly rehoused, we have awarded, oh, excuse me.

First, let me just say that the budget of 2021 and 2022, both years appropriated $92.5 million in match-exempt funding that's available over multiple years. CDSS has awarded those funds. Most recently, we awarded $82.9 million to all 58 counties. And for Homesafe in particular, this represents a very large expansion. Previously, we had less than 30 counties participating, and now we have all 58, which represents an expansion of 33 new counties. So I want to also talk to you about sort of how we implement these programs.

So counties and other local communities, including tribes, are continuing to ramp up and implement these programs, to scale them, to meet the need and to serve the communities that they're working in. We're seeing that communities are doing a good job moving forward to implement these programs. But for some counties, this is new and it does take time to ramp up, to staff up, and to be ready to provide the full array of services.

So we generally see that six to 18 months is needed to implement and expand programs. To support this expansion and growth, CDSS's Housing and Homelessness division alongside Changewell Project, who you will hear from in a few minutes, is offering robust TA to grantees on a wide range of issues.

And I'll let Changewell speak for themselves in terms of the services they're providing, but they bring a lot of expertise, both in disability benefits advocacy, tribal outreach, family support resources, and housing and homelessness programs, along with local working with local governments. A couple of pieces I want to also highlight on our data outcomes for people who have used our programs so far. HDAP launched in 2017-18 and has enrolled more than 5500 Californians and helped permanently house more than 2800 people.

We see that we have an 80% retention rate for those six months after exiting the program. In our HomeSafe program, since its inception in 2018, we have enrolled more than 5600 clients and provided more than 2000 instances of housing-related financial assistance, and we see an 85% retention rate six months after exiting the program. In our HDAP program, we also see successful outcomes in our disability advocacy.

Currently, we see a 78% approval rate for our disposed disability benefits applications, and I know it was an interest that we have a number of years that it takes for some benefit applications to go through, because sometimes people are approved at initial application, but sometimes they need to go through a redetermination process or an appeal.

HDAP can serve people through the life of their disability case, but that does mean we don't always hear disposed outcomes very quickly because it does take time to go through the full process. So we're excited that this disability advocacy has resulted in very high rates of approval, much higher than the typical rate for all beneficiaries, which in California is 39%. And for those experiencing homelessness, the estimate is that they generally have a 10 to 15% initial application approval rate.

So I just mentioned that to highlight the importance of the disability benefits advocacy. Now I'd like to turn to our community care expansion program, which is a really new, exciting program that we've been administering since it was passed in 2021 through the budget. Community care expansion is a statewide investment in infrastructure funding to address homelessness, support healthcare delivery reform, and strengthen the social safety net.

It allows for the acquisition, construction, and rehabilitation to preserve and expand adult and senior care facilities and other residential settings that serve SSI SSP and the Cash Assistance Program for Immigrants, CAPI, both applicants and recipients who are experiencing or at risk of homelessness. We also have a preservation component to this program, which allows us to help preserve currently operating residential care settings by allowing them to draw down operating subsidies, and that is also for the same target SSI SSP CAPI population.

The '21 budget appropriated $805,000,000 in funding for the CCE expansion and preservation programs, and the 2022 budget appropriated an additional 55 million to fund specifically those operating subsidies to preserve licensed facilities. Investing in these settings will help ensure that SSI and SSP and CAPI applicants and recipients who need personal and supportive services will have access to housing options that meet their needs and will prevent me prevent homelessness.

To Ms. Prunehuber and Director Johnson's point, this really is integral we see to making sure we have a strong continuum of care to provide housing options for people who are older and have disabilities and aligns with our master plan for aging goals, both of ending older adult homelessness and of making sure we have affordable, appropriate options at all ages and stages.

A total of $570,000,000 has been made available through the CCE expansion funding through a joint RFA that was done alongside the Department of Healthcare Services and their Behavioral Health Infrastructure Continuum Project, BCHIP. We are currently continuing to review applications which are accepted on a rolling basis, and applications for the expansion can be provided with a capitalized operating subsidy reserve, or COSR, and that can be awarded for up to five years.

And that's to basically make sure that as we're growing the number of beds and units that we have, that we're making sure that they're operating in a stable environment and able to be fiscally sound. As of February 2023, CDSS has awarded a total of $207,000,000 through the CCE capital expansion for 32 different projects, and we have a CCE awards dashboard which specifically highlights the projects that we have awarded so far. We are continuing to review applications and will continue to announce awards on a rolling basis.

Additionally, in June of 2022, we released a notice of funding availability for the preservation portion of the CCE program. In response, 35 counties accepted more than $186,000,000 in noncompetitive allocations. We do also post that award information on our building Cal HHS website and I'll make sure you have the links for all these awards dashboards so that you can look and see where we're providing the allocations. Our counties have submitted their preservation plans to us in January.

We are in the process of reviewing them and expect programs to start standing up as early as later this spring. But they will be stood up by counties on a rolling basis to help preserve those facilities that are at risk of closure in their communities. And again, those are facilities that are specifically serving SSI, SSP, or CAPI recipients.

In addition to the $186,000,000 awarded, we have also put out the letter notifying counties of the additional $55 million that was made available in the Budget Act of 2022, and we are currently reviewing responses and we expect an award letter to be released later this spring. Two last things I just want to highlight. I was asked specifically about program barriers and obstacles.

I think there are just a couple I want to highlight, and I know you've all heard this in all of your other housing and homelessness hearings, but obviously some of the biggest barriers are just a lack of safe and affordable permanent housing in communities. We are glad that CCE is helping to address the infrastructure side of that, but on our home safe and HDAP, we are also trying to mitigate that by using evidence-based rapid rehousing and prevention models, and always with a housing-first approach.

And we can also provide financial assistance and other pieces to help stabilize people in housing and help create the transition into permanent housing. We have also seen that for local staff, and you may hear about this from other panelists, that we do have a lot of people who are new to the housing and homelessness space within the social services space. So these are two sort of huge programmatic areas that are working together more and more as the homelessness crisis has deepened.

But for many counties, having this cross-cutting work is new and they are working to stand up programs and to make sure that they are working at connected and in collaborative ways. And RTA through Changewell can also help support counties to make sure that they have good relationships between their housing and social services programs. Finally, we've also seen that there is a lack of data in the housing and homelessness space.

And again, I know you've heard about this, but pit counts and point-in-time counts are not always representative of the true face of homelessness and do not always capture everyone. And homelessness data has generally been highly decentralized. So with the establishment of our homeless data integration system, HDIs, we are seeing the opportunity to learn more about what homelessness looks like in our state in a more overarching fashion and to understand where we can target and look to build on successes we've had.

I just want to end with a success story from one of our grantees, and I want to share their story. So this is from Santa Cruz County. A client in Santa Cruz County was 83 years old, homeless, and living in her car with her daughter when she was referred to Homesafe. She was suffering severe medical consequences of her homelessness, including frequent hospital emergency room visits due to infections, lack of medication, and untreated wounds.

The client, along with her adult daughter, had been experiencing homelessness for two years. Adult Protective Services and Homesafe completed a thorough assessment of the client's needs and risks, including family dynamics, engaged her and her daughter in developing a long-term housing navigation plan. With Homesafe's support, the client moved into permanent housing in December of 2019, where she and her family hosted their first Christmas gathering in years. As of November 2022, she and her daughter continue to be safely and independently housed in this unit.

The client's health has greatly improved and her reliance on emergency medical services is greatly reduced. So we're excited that our programs are having these impacts and we look forward to continuing these impacts as the money continues to roll and we see our multi-year efforts bear their fruit. That concludes my presentation. Happy to take questions at the end.

Thank you so much for that robust background. We're going to move on to our panelists via Zoom. Representing San Francisco Human Services Agency, Trent. Rohr. All right.

Good morning, Committee Chair and members. I'm Trent Rhorer. I'm the Executive Director of the Human Services Agency in San Francisco. I really appreciate the opportunity this morning to share San Francisco's experience in implementing the Housing Disability Assistance Program, or HDAP, and also Homesafe. So first, let me talk about how HDAP works in San Francisco. So our agency has long had an SSI advocacy program for disabled clients that's embedded in our general assistance program.

But we've seen through the years that the approval rate for homeless clients was much lower than for those who are housed. The SSI application process, as you know, it's difficult. It's paper intensive, requires a lot of appointments, documentation, and it's much harder for someone without a place to live to manage all that, even with the assistance of SSI advocacy staff that we provide.

So we really viewed HDAP as a great opportunity for funding to provide outreach, client engagement, case management, SSI legal services, and advocacy services, and of course, temporary or permanent housing while the application process is going on to provide an easier path and increase the likelihood that disabled homeless adults get approved for SSI and get permanently housed. So there are two paths of entry in the HDAP program in San Francisco.

One is the traditional path through our general assistance program, where applicants for general assistance are assessed for a disability, and homeless applicants with high needs are referred to the HDAP team. And then the second path, and this really is a function of, or as a byproduct of the increased funding, is through a roving multidisciplinary team. It's comprised of social workers, our department's eligibility workers, staff from Bay Area legal aid, and they do outreach into our noncongregate shelter hotels.

We did this with project roomkey hotels through our congregate homeless shelters and even on the street. So the roving MDTs, multidisciplinary teams, conduct the disability assessment and the enrollment into HDAP, which triggers the SSI application process, but it also facilitates enrollment in other supports. So the benefit programs that we administer at HSA, including general assistance, Calfresh, MediCal, and IHSS, if they happen to be in a homeless shelter, and then this team also facilitates placement into temporary or permanent housing.

Our outcomes so far have been impressive. We've enrolled about 400 people into HDAP so far, 233 of them, or 61%, have been permanently housed. The remaining are temporarily housed while they're still in the process, the application process, or the appeal process for SSI. We had a 31% approval rate so far, and while that sounds low, 38% of clients still have their applications pending, and I'm going to touch on that in a moment. We only have had 2% denied once they completed the appeal process.

So our original HDAP funding, we were one of the initial grantees in 2019, was about 1.1 million a year. The increased funding has allowed us to almost triple, receiving three times as much money, $3.5 million currently. And this increased funding enabled us to launch the MDTs, the multidisciplinary teams that I talked about. We could not do that staff-intensive service work with just the initial grant.

We've enrolled an additional 175 clients into HDAP, and they would not have been served through that baseline grant. And then, really importantly, we're able to fund full legal services versus just SSI advocacy alone, which allows the HDAP client to continue the appeal process well past initial denial, all the way through reconsideration, through a hearing with administrative law judge, and even taking cases to civil court. We have faced several challenges that I want to touch on in HDAP.

One of them is out of our control and it's staffing shortages at the federal Social Security offices, but as well as the state disability hearing offices, which leads to really long processing times for applicants and for appeals. So the average SSI application for our HDAP client takes now 18 months to resolve, which is almost twice the amount of time it took prior to the pandemic. In some cases even take up to three to four years. Housing, of course, is a challenge.

The staff from DSS mentioned that in San Francisco we're fortunate to have a large amount of local dollars dedicated to permanent supportive housing, and we're therefore able to transition clients off the HDAP-funded housing subsidy into permanent housing. But SSI SSP alone cannot support rents and living expenses in a large portion of the state, as you know. And so HDAP really needs to consider whether an ongoing funding source after SSI adjudication can be provided for permanent housing subsidies even after someone's on SSI.

The other challenge is the resource-intensive nature of this work. The program has had really good success in placing eight-step clients in housing and getting them on SSI. But this navigation process can be extremely time-consuming.

Clients are older, clients are experiencing disabilities, a lot of mental health issues, and so using HDAP to pay not only for attorneys and the subsidies, but also social workers who can develop these relationships and maintain this sort of trusting interactions with clients and support them during the long SSI process. And it's really been a key to the program's success. And the other challenge, frankly, is the uncertain funding future.

We're operating this program with one-time dollars that are going to expire at the end of fiscal year 24. Given how long that the SSI application process takes.

As I mentioned, the resource intensive nature of the work and the reliance on the ongoing housing subsidies during the process, the funding cliff is really going to force us to begin to reduce our enrollments so that we ensure we're not in a situation where we have a lot of people still in the program and no funding or resources to support them. Let me shift gears real quick to Homesafe.

Homesafe provides homelessness prevention services for adult protective services clients who are currently housed but who are at risk of eviction or otherwise losing their housing. Homesafe also provides housing transition services for APS clients who are experiencing homelessness or in our homeless shelters, and we use the Homesafe funding and staff to provide them placement into permanent housing.

So Homesafe provides all clients with the traditional protective services through APS to resolve and mitigate their risk to their safety, but also through Homesafe provides housing-related intensive case management for clients who are at risk of homelessness, things like short-term financial assistance, payment of back rent, payment of utility bills, purchasing services like pest abatements or heavy cleaning for hoarders and hunters, and then connection to legal assistance for eviction prevention and landlord mediation.

For clients who are experiencing homelessness, Homesafe, as I said, facilitates the client's transition into permanent housing from shelter settings through case management as well as rental subsidy patches, and then for clients who are unable to live independently even with our Homesafe services. The Homesafe program provides placement into assisted living or sort of higher levels of care, and we provide rental patches for residential care facilities and also help clients enroll in our MediCal assisted living waiver. Really to ensure long-term success. Similar to HDAP, our outcomes have been impressive.

In the short time we've been running the program, we've served 208 clients, 92 of whom are still active. Out of 116 people where the cases were closed, 90% of them were stably housed when we closed the case. So we either retain their housing, their existing housing, or facilitate a transition into a higher level of care. In terms of the funding expansion, we went from $950,000, the initial grant, to now over 2.2 million serve more clients. Of course, we've more than doubled our caseload.

We serve about 130 clients at any given time now. We've expanded our program, staffing additional case managers to provide direct services to clients. And then the new staff allowed this new service model where we are working with APS clients in our homeless shelter systems and working to transition them into permanent housing. It's not just APS clients who have permanent place to live. The challenge similar to HDAP, the clientele in APS require a tremendous amount of resources.

Intensive case management for Homesafe clients can last as long as seven to nine months compared to a typical APS case where it would be open for an average of four to six weeks. So clearly you can see that the nature of the intensive resources they require. So this, though, coupled with similar to HDAP, the uncertain financial future is going to force us to wind down these services again so we don't have clients active in the program and no resources to support them.

I think given the success so far of HDAP as well as Homesafe, it's obviously something that we don't want to be forced to do. So this concludes my remarks. Of course, I'll be here for questions. Thanks.

Thank you so much, Trent. Moving on to another participant on via Zoom, Lito Morillo from Kern County Human Services Department.

Good morning, Committee Chair and Committee Members. Lito Morillo, Director of Kern County Human Services, thank you for this opportunity to share current experiences as it relates to HDAP, Homesafe, and CCE. I know you've heard from the rest of the panel members in regards to a lot of statistics as well as the program overview, kind of give you a little bit more closer information related to these programs and how it's impacted Kern.

Based on a 2022 point-in-time count, Kern's homeless population is about a little over 1600. Like many other counties throughout the state, Kern is continuing to struggle with homeless population due to a myriad of factors, including first and foremost, obviously, lack of affordable housing. It could be related job loss, domestic violence, physical disabilities, mental health, substance abuse disorders. This obviously gets exacerbated as we're talking about older adults or individuals with disability only because of the challenges that are unique to them specifically.

Although the homeless population is a challenge, we're fortunate that we have the tools like HDAP, Homesafe and CCE. It's safe to say that without these programs, Kern's homeless population would definitely be significantly higher. Prior to having these programs in place, our individuals with disabilities and older adults that were struggling with homelessness largely went unnoticed and unserved, which is really counterintuitive when you think about the demographics, which shows the largest growing population of our homeless is really older adults and those with disabilities.

I'm going to kind of go over the programs individually and its impact in Kern specifically. So I'll start with HDAP, Housing Disability and Advocacy Program. Obviously, it's designed to help disabled individuals apply for disability benefits while also trying to provide housing supports. As for Kern, our HDAP program offers outreach, case management, benefits, advocacy, and housing supports to all program participants. Currently, we have about 58 active participants in the program.

The majority actually been placed in permanent housing, about 40, and while the others are in temporary housing that we're hoping to transition in permanent housing in the coming year. As we establish their housing, whether it be temporary or permanent, we're also working with them as part of the disability advocacy in terms of getting them applied for and hopefully approved for benefits such as SSI or social security disability or CAPI or veterans disability assistance.

We're also working with them on establishing these benefits really to help them with their housing going forward. So as we're providing these permanent temporary housing in the interim, we're looking at these benefits that hopefully can sustain them going forward after our benefits stop for them with regards to HDAP. To get onto the HDAP program here in Kern, all they have to do is really contact our two on one line and that referral process will start for them that way.

We have coordinated entry partners that are available that could also take referrals, and then our human services department, we have a housing unit that's specifically geared towards and focused on homeless assistance for our clients. An assessment is completed on the HDAP participant, and then that participant will then also not only get help with housing navigation in hopes to find that permanent or temporary housing, but they'll also again get that disability advocate that will help them apply for the benefits they may be entitled to.

Housing assistance is available to obviously HDAP participants until their disability can be established. But as the previous speakers have spoken to, it's really taken close to one to two years to get their eligibility determination approved, which obviously extends the cost for each of the participants in terms of overall cost per participant and program. I've seen some circumstances last up to three years before disability determination can be determined, which really is one of the challenges with regards to the HDAP program.

But I did want to kind of share a quick story with regards to HDAP and how it's impacted one particular individual that really came to mind when I was told that I'd be presenting. The person I'm going to speak to, I'm going to call her Betty. She was diagnosed and suffering from a real severe mental illness. She went untreated because of being homeless, and like many other cases like this, she had no family support or exhausted them because of her condition.

Betty was referred to HDAP in October of 2020. Because of HDAP, we're able to find an apartment for Betty, which I'm happy to say she's still residing there now. In November 2021, she began receiving SSI benefits, and through the case management she received through HDAP, she was connected to mental health services that she needed, and because of wraparound services support, her mental health improved so much so that she was able to actually reestablish a relationship with her family, which was really nonexistent prior.

Betty still has to continue her positive path, obviously, but this wouldn't have been possible if it wasn't for HDAP. Now, in the county match related to HDAP waiving that, that really helped us expand the HDAP program. As I shared with you earlier, we were serving about 58 individuals currently right now. Prior to that it was 44 and before that it was 33 respectively. So obviously not having a county match has kind of allowed us to expand the program accordingly.

But again, one of the challenges that we continue to face is the longer people are on the program because their eligibility termination takes so long, the more cost involved per participant. Now I'm going to switch over to the Homesafe program. Regarding Homesafe, Kern County was really part of the initial pilot. There was 2325 county pilots that started the Homesafe program. We participated in pilot because we felt strongly that this would really benefit our homeless population, particularly our obviously older adults, independent adults.

Just to kind of give you some numbers related to the home safe program, in 2020, we served 95 clients, APS clients. In 2021, that number went up to 178. And in 2022, it's 379. That's the number of clients we served under the Homesafe program. Again, prior to Homesafe adult protective services, dealing with these individuals that were at risk of homeless or being homeless was a common thing.

We dealt with it with our referrals pretty commonly, but with Homesafe, the beauty of it was that we actually have a tool now that we could truly use to fund or prevent an older adult from being homeless or help them or house them if they're already homeless. That's an incredible tool to have in the field. And I know from just anecdotally, our social workers have commented over and over again that prior to Homesafe, we really were just stuck with housing navigation or maybe counseling.

Again, the quick anecdotal story that I have is in 2020, we had an APS referral. We got on an 80-year-old client that was living out of her car. She had no prior APS history and was living out of her car, and come to find out she was living out of her car as a result of a domestic dispute with her husband. Through the Homesafe program, we're able to set her up for temporary housing.

And as a result of our intervention and support we were able to find her permanent housing in her situation, which she's still currently living in now. Again, similar to HDAP, not having county match requirement, as you can see, has kind of greatly increased the number of participants we're able to serve. It went from 95 when it originally started to 379 now, where we're currently at.

As far as CCE goes, this program is obviously designed for the construction or and or rehabilitation of senior care facilities that serve SSI and CAPI clients. In Kern, our Behavioral Health Department has taken the lead on this project. We've submitted a plan to the state that we're looking at rehabilitating six assisted living facilities that were at risk of closure due to existing deteriorating facility conditions.

These facilities are in good standing with community care licensing and have critical and or operation cash flow gaps that place these facilities at risk of not meeting CCL and quality standards, and as a result, are at high risk of closure. As part of the plan, the six facilities that were identified, through extensive research and feedback from the community, we wanted to make sure that they obviously served our clients. We're looking at, with CCE, the plan that was submitted.

The six facilities house about 242 beds, and initially, we're looking at serving close to 100 individuals. Again, these are potentially facilities that would be closed if not for this grant. And you're talking about potentially 100 individuals that could be displaced, are obviously homeless. The ongoing challenges in general, again, similar to the other panel members that have spoken so far, affordable housing is really the biggest challenge here in Kern. Our vacancy rate for affordable housing is right around 2%. This makes finding housing even more challenging.

And when you factor in, like inflationary pressures, affordable housing becomes even more elusive and then sensitive resources. Dealing with the homeless population requires a great deal of resources. We've actually set up a unit similar to what San Francisco has done to focus on this. On occasion for example, we have instances where hotels and motels might be closed, and there's families, older adults, individual disabilities at these locations that will be displaced because they're being closed down for various reasons.

But that being said, the tools that we have in place now allows us to have that flexibility to help those individuals. When years pass, it would really be more of a housing navigation, trying to find pockets and where we can place these individuals. But we're fortunate to have the tools that we have now. Also the expansion of APS. Prior to this year, we were APS clients. You had to be 65 or under 65 with a disability of some sort.

Now, because APS clients were able to serve six and older. That allows us to broaden and obviously serve more clients in general. Technical assistance that we've received has been very good. They've been very responsive in terms of answering a lot of the needs and questions that we have, especially at the beginning of the implementation of our projects, making sure that we're using the funding correctly and obviously in a way that obviously got us more efficiency. That concludes my presentation.

I'd be happy to answer any questions after we're done. So thank you.

Thank you so much Lito. We're going to move on to Rebecca Watson from the Change Well Project.

Thank you, Chair Menjiavar and members, for the opportunity to provide testimony today on Change Well Project and the work we're doing with Homesafe and HDAP programs across California in partnership with CDSS. My name is Rebecca Watson. I'm one of the two managing directors at Change Well Project. Changewell Project is composed of a team of individuals with decades of experience working in housing and homelessness services and in disability benefits advocacy. Our team comes from direct community services work with program participants. I'll use myself as an example.

I worked first in legal services organizations for 10 years, representing low-income clients across Los Angeles County as they sought Social Security benefits. I came to Change Well because I believe deeply in the transformative power that steady income support provides to an individual or a family, and I want to help grow HDAP programs across the state that are a critical part of ensuring that every individual in California who is entitled to a Social Security benefit receives that benefit.

Drawing on our team's deep expertise addressing homelessness, our primary goal in supporting the implementation of programs is supporting the implementation of programs that are transformative in the communities they serve and deeply stabilizing to program participants.

Our team focuses on creating systems-level responses that address challenges holistically while making decisions across around program infrastructure quickly to meet crisis-level needs and to build a workforce with the broad range of skills needed to effectively run expanded programming during 2022, we provided 47 California counties and 23 tribal communities with individual indepth technical assistance focused on designing or redesigning programs for a new, expanded scale and strengthening overall systems of care to support better housing outcomes for program participants.

Much of our work is about leveraging resources across funding streams to provide comprehensive housing and supportive services. This work included work with 13 Homesafe programs and 11 HDAP programs. We also provided over 3300 system administrator program leaders, and direct service staff attendees with high-impact training to develop the key competencies needed across multiple disciplines to create and scale transformative housing programs and systems. One specific best practice we focus on is addressing any racial disparities that exist in these systems through a program lens.

We've done this through focused webinars and learning communities for systems leaders and program leaders on looking at the data in their entire system and program, finding the areas where there are disparities, and taking concrete steps to address those disparities.

A primary best practice we support is housing first, which requires working with counties to advance their understanding of how the local rehousing system operates, the underlying philosophies and approaches to rehousing, how their program fits within the larger rehousing system, and how they can leverage all resources available to ensure that people stay housed or are rehoused as quickly as possible.

One more virtue of CDSS programs and funding is their flexibility in providing resources that fill critical resource gaps that inevitably exist for older adults and individuals with disabilities that have no income or a fixed income source in an ever-increasing housing market. HDAP provides that benefits advocacy, as we've heard, helping folks to obtain income, which is a significant gap. And with Homesafe, there's the focus on having highly flexible prevention dollars to keep older adults housed, which addresses another significant gap.

We hope these programs put in place the operational framework that makes this happen, moving from the theory of housing first or racial equity to the actual practice. How are you budgeting? How are you staffing? What do your policies and procedures look like from a participant perspective, and is your infrastructure reflective of the best practices and approaches that we know work I wanted to give a few examples of bright spots we've seen, and there are a lot of bright spots across California communities.

The Placer County HDAP program has exceptionally strong results with their disability benefits advocacy. They have a 63% approval rate for SSI SSDI initial applications and an 80% approval rate at hearing. Out of 78 HDAP clients who were homeless or in temporary shelter, 48 are now in permanent housing. They've been able to accomplish these outcomes because they have collaboration as part of their culture, and so they have very strong relationships with local health providers, the housing authority, and local community nonprofits.

Their program is deeply connected within their community. Everyone knows about their program, from hospital social workers to other county departments to shelter providers. They leverage other county systems like the county health and behavioral healthcare system to connect HDAP participants to healthcare treatment. The Solano County Homesafe program is another example I wanted to mention. The county approached us for assistance as they had a brand new home safe program starting in 2022 and wanted help really quickly operationalizing it and getting it off the ground.

Their leadership recognized that providing housing services was a whole new line of business for their APS social workers. They wanted training on best practices, all the fundamentals of approaches, including working within a housing-first framework. So we worked intensively with them, trained their entire team on these fundamentals so they could really start their program quickly with a solid platform of best practices for their staff. And we also, of course, heard from Kern County.

I wanted to mention that they're a great example of using their CDSS program dollars and leveraging other resources in the county to create one streamlined housing unit. This is a practice we've seen different counties doing with the increased amount of funding. We worked with Kern on thinking through structuring their streamlined unit and then also provided full-service training to their whole team on everything from housing case management to program management.

And then I'll conclude by just mentioning some common barriers or struggles that we see in communities across the state and that we're really directing our technical assistance towards these programs are being asked to connect previously large, unconnected systems, social services and the housing and homelessness system, health and behavioral health and social services. This is a significant lift to do this.

The programs, they're largely situated within social services or human services at the county level, and they're asked to operationalize this brand new sort of line of business, learn a new language, catch up with the best practices that the homeless response system uses in its approach. Staff, both at a program management level and at a direct services level in these programs, need deep training in the homeless response system and approaches to work. And with HDAP programs, staff also need intensive training in disability benefits advocacy best practices.

The need for housing supports is large and in some communities, larger than available funding. So we work with communities to think about how to prioritize equitably and how to think about the balance between the number of people served and ensuring adequate supports are available for those are because these are such common challenges, this has really become part of the foundation of how we provide technical assistance. This concludes my remarks, and of course, I welcome questions at the end.

Thank you so much, Rebecca. Turning over to a panelist via Zoom, Jonathan Russo, representing Bay Area Community Services.

Thank you so much. Great to be here with you all. And good morning, Senators Menjivar, Eggman, Grove, and Roth. Thank you so much for the opportunity to share with you on this critical topic today. I'll begin by introducing myself. I'm Jonathan Russell. I'm the chief strategy and impact officer for an agency called Bay Area Community Services, more commonly known as BACs. And we are comprehensive homelessness housing behavioral health service provider, founded in 1953 in Oakland, California. And we're celebrating our 70th anniversary this year.

We serve, on average, about 20,000 individuals a year across all of our communities. We currently are in six counties, including Sacramento County, and primarily in the East Bay. And we actually have a history of providing aging services to a diverse range of populations from the very beginning of our founding as an agency. I'm here today to talk a little bit about the amazing program that is the Community Care Expansion Program, of which BACS was very fortunate and honored to be one of the first awardees.

We were awarded $19.4 million, a grant to acquire and rehabilitate, and included some operating subsidy reserves for the transformation of a private pay retirement center that was closing and to really transform that into a comprehensive campus of services for individuals experiencing homelessness and housing insecurity, including specifically physical and behavioral health care services. But really focusing on the additions of the physical health care services so that we could have this special focus on older adults and other populations with medical fragility and other complex, disabling criteria.

So let me provide a little bit of context about us and the community we serve. We, of course, as much has been shared in the documents for this meeting and also already discussed, are seeing a precipitous increase year over year in the individuals that are older adults experiencing homelessness that we serve.

What was for us just in 2018-2019 for example, 30% of our interim housing programs in Oakland is now well over 50% and continuing to increase some programs over 65% folks older than 55 years old. This vulnerability and this stark increase has really been validated by a local study, specifically in Oakland called the Hope Home Study, that was completed by UCSF Bennyhoff Homelessness and Housing Initiative led by Dr. Margo Kuchel, that has been following 450 older adults experiencing homelessness since 2013 in Oakland.

So this is the heart of whom we serve. And I will say many of the folks in that study have actually been or are currently individuals at. You know, the thing that we're learning that is creating a lot of identifying a lot of gaps in our system of care for individuals experiencing homelessness. Is that a lot of what older adults obviously experience, especially in the homelessness context, is higher rates of cognitive and functional impairment.

25% of the folks in that study have reported some or been identified as having some form of cognitive impairment, and including 40% having one or more impairment in their basic activities of daily living. There's obviously the prevalence of the geriatric conditions that this study has shown is that folks in their mid 50s have worse overall physical health care conditions than the general population does in their essentially being unhoused. And this is what we see every day, is a geriatric accelerator.

Obviously, structural racism's impact on adult homelessness is stark. We see in this study and in the population we serve every day. Over 80% of those studied were black, and consistently, that is nearly four times higher than the general population in Oakland and Alameda County. More broadly, one of the things that has really struck us is that this escalating problem really puts California at the center of the crisis.

We know, based on national studies, that it is very likely that this population of older adults experiencing homelessness will triple by 2030. And based on the 2022 annual Homelessness Assessment report to the Congress, we know that California already accounts for one in three of individuals experiencing homelessness across the country. And now, for the first time, more than one half of those experiencing unsheltered homelessness across the nation. We are the epicenter, and therefore, we are the place that has the opportunity to transform this.

I will say positively in our experience and also in the study, over 70% of those followed through the study for years of older adults do have some form of non emergency department physical health care, that is to say, often some form of primary health care. So, thankfully, we have developed systems where accessing health care is happening, even for those that are older adults experiencing homelessness.

But, so to speak, in many cases, it's at risk of what I call health care to nowhere in that they are served well in the clinic, but still without the most critical medicine that doctors can't currently prescribe, which is permanent, stable, dignified, safe housing. Additionally, the vast majority of folks that we are serving in our programs and that were studied in this are on fixed incomes of about $1,150 or less.

This is where the transformation, really, the transformational, what I would call a once in a generation opportunity of the community care expansion program has been so exciting and an opportunity to really change the game for us, so to speak. We were awarded, as I said, $19.4 million for the acquisition and adaptive reuse of a center in Hayward, California, in Alameda.

It's over four acres, a complex of multiple buildings with 158 residential rooms and large administrative areas that we are using just about 10 million of that to contribute to the acquisition of the property, which we've completed and did in August of last year. The balance of that acquisition supported with local capital, about 5 million of that, will go towards some initial rehabilitations of the site that will be comprehensive of both the residential and what I will describe as some clinic areas.

And then four and a half million of that will operate as a capitalized operating subsidy reserve for some of the permanent housing on site. So this program has really unlocked an opportunity for us to really try to develop a model that meets those specific and unique needs that we just described of older adults experiencing homelessness and in some ways, what we're trying to do.

The large portion of this property funded by the CCE funds will be up to 90 units of what we call permanent supportive housing plus.

So this is permanent supportive housing that is designed not just with the onsite case management and support needs, the broader potential behavioral health or mental health support needs, but really focusing on adding those additional physical health care supports so that folks we know that are coming in that specifically have medical fragilities or other disabling conditions, many of them older adults, can have also that opportunity to receive those medical supports, to age in place, to receive support on site.

I will say, currently, none of our models, none of our designs, and frankly, none of our funding streams for things like permanent supportive housing include really embedded ways to provide those specific needs in addition to the other supportive services. So that will be the majority of what is funded by this project on site.

As I said, up to 90 units of that souped up permanent supportive housing plus, in addition, we'll also have roughly 45 beds of what we call medical respite or recuperative care, which is specifically designed to serve folks that are coming out of emergency institutions, usually inpatient hospitals, that have some need for medical support and need a step down and a transition support there.

Additionally, because of the excitement around serving this population locally, we're going to have a federally qualified health clinic on site that will be able to provide comprehensive services and be a medical home for individuals served there, including those experiencing homelessness in the community. Again, specifically designed at serving folks that are on fixed incomes, that are really receiving services there, and that are older adults. There's also the potential, and we're awaiting notification.

We had also applied for the Behavioral Health Continuum Infrastructure Program that is looking to potentially provide the balance of the site for residential treatment. So specifically mental health services, including substance use services and residential treatment for folks that have mental health needs and those clinical supports. So on the whole, the idea is to use and leverage these wonderful programs to create a unified, comprehensive campus of services for the community.

One thing I will say in terms of a need, and something that I think we really need to think about as a community, as a state, as we continue to innovate, is calane. Obviously, the California Advancing and Innovating MediCal Program has unlocked what will provide a lot of the basic supportive services, ongoing funding for that permanent supportive housing. So we will be able to, on a per member, per month cost payment basis, provide and cover many of those services.

But we currently don't have any basic, easily accessible way to provide medical health care services in ongoing ways in these permanent housing contexts. There are agencies that are working to innovate on things like the home and community based services waiver, but it is difficult and currently complex to really build that.

So one of the things that we think is really important as we figure out how to do this and provide these physical health care, inclusive housing environments for older adults is how can we unlock ways to really embed the physical health care in a stable, ongoing, sustainable way going forward. Thank you so much for your time.

Thank you so much, Jonathan. Our final panelists are representing Psynergy Programs, Michael Weinstein and Lynda Kaufmann.

Can you hear me okay? I don't know. I'm so excited by everybody else probably writing more notes than anybody. So I just want to say that we are providers. Mike and I both are RCFE and ARF administrators. We have been for many years, Mike for 27 years and myself for 20. In synergy programs. I want to talk a little bit good on the questions that were asked. So since 2005, Synergy has primarily served SSI adults with serious mental illness moving from higher levels of care.

IMDs, MHRCs, SNFs, STP programs, which are specific psychiatric medical services for individuals that have a psychiatric disorder. In 2013, we met. So 2010, years ago, we met with a group of county partners and conservators asking what older adults wanted and needed. And that began the conversation 10 years ago, what they need, living with schizophrenia in the least restrictive care. So 98% of our residents are coming from those higher level locked settings. They could be state hospitals also. Sorry, I took too many notes.

So one of the things that we wanted to create with Vista Esperanza, which is in 54 bed RCFE in North Highlands, is individuals that have a minor medical issue. So they maybe are in a locked setting right now. And this is the case of three individuals that we've been following that they cannot manage to do their own finger sticks, or they can't pull their own insulin, therefore, they cannot leave that lock setting.

So one of the greatest goals is that we will have 24 hours nursing so that we are able to support individuals. So that will be a very different dynamic. Currently, when I took all of our demographics, currently, our clients have anywhere from two diagnoses up to 18, including medical access to personality disorders, COPD, insulin dependent diabetics, all things that we can manage. And you guys all know this, all things that we can manage. But it's a lot. Some of our clients really are medically compromised.

But I would say the average diagnosis is eight when we went through every single record of every single current client. I'm going to have Mike talk a little bit about the challenges of our CFE operators with the SSI population. And right now, 98% of our 242 clients are SSI individuals placed in our care by county partners. You want to talk a little bit about that?

A little bit about the operators. Because I've been working as an administrator for 27 years, and during the time when I entered the business in '96, I organized a group of operators in Santa Clara County, and we were able to work together and pull resources. And Santa Clara County at that time provided a patch. And as we know, our clients receive about one $200 a month, and operators get about $1,100. And that's really not a sustainable model anymore.

And so this is a little bit off the topic here, but I do want to touch on this, because when the clients go through our program and then are ready to discharge to a lower level of care, which will be a regular board in care, many of these operators are leaving the business because the $1,000, $100000 a month is not a sustainable model. And so we were able to work with Santa Clara County and organize a system where providers that were licensed did receive a patch.

And the county also provided some training and supervision to the operators as well, to allow them to function and to provide the care that was needed for this group of clients. So this is a piece that needs to be addressed, because these small operators really are the backbone of the system. And it would be great to see a program where operators throughout the state got the support they needed in the way of patches and also additional training.

Because without them staying in the business and having sustainable models, the work that we're doing becomes very difficult. So that's just one thing I wanted to touch on because I know that's a very helpful piece, that $300 in additional dollars per month that these operators received really help them to keep their doors open.

Madam Chair, if I could ask just one question on that, is that okay? So when you say the patch, is that per resident or is it per facility?

Per resident. Typically they would get anywhere between $30 to $50 additional per day. These dollars really help them to hire the staff that had the right kind of training and background. And typically most of these facilities are operated by families or six beds, and a lot of them don't have the experience in working with the mental health population. So really, by supplementing these providers and allow them to hire appropriate people, provide better nutrition, and keep their houses in better order.

And I said, we're talking a little bit about why a lot of these operators are leaving the business today, because you really can't do it today. You can't do it on one $100. And so it's just a very important part of all the work that you're doing by putting money into capital improvements, then you have to be able to keep these places running. And I said, the majority of, we know a majority of our operators are these very small places.

I did work with them and I know a lot of the things that they were going through and tried to assist them as much. And we continue to also try to help operators as much as we can because we know it's a really important part of the model.

So one of the things I wanted to mention about rcfes and our ability to take clients is the flexibility of an RCFE, opposed to maybe a locked, secured setting. Allows us to work with AOT clients, the Carecorp clients, mental health diversion, individuals that are having the least restrictive care yet. They also have a mental illness that needs to be treated and maybe some medical issues also. The property is located in North Highlands. Formerly was a school.

Mike and his organization purchased it, I think in 2018, and it is 2023 and has taken this long. COVID was a huge interruption. The costs of building went up substantially in that period of time. Staffing, staffing, staffing. Can't say it enough. I'm sure everybody is. It's a real struggle with staffing right now. It's about 50% completed right now. So I think we will be opening the summer. I think it's exciting. Without these funds, I really can't say.

There's not a lot of banks that are stepping up and saying, oh, we'll lend you the money for an SSI Medi Medi program. It's very challenging, so incredibly appreciative of these funds. So 54 clients. So one of the unique parts of our program, similar to what the gentleman from backs was saying, is that we have an RCFE and then adjacent to a lot of our programs we have a specialty mental health outpatient clinic.

So we have psychiatrists, we have four psychiatrists right now, two psychiatric nurse practitioners, therapists, all to help the individuals living in the think, you know, truly whole person know medical management. Jorge Mendes, our vice president, he created the whole person care model for Santa Cruz before he joined our organization. So it's important for all of us and it's especially important for somebody who has a mental health diagnosis. We have outside eating there. Hopefully all of you guys will come on a tour at some point.

We added 2000 sqft for outside socialization, eating things like that. We want people to have fresh air. The grant allows us to fund this project which we anticipate summer 2023. I wanted to talk a little bit about the RCFE or the CCE grant itself. It was daunting. I'm probably being nice about that. It was big, it was huge and we're pretty okay smart. We brought in a consultant to help us and she was amazing from the future organization and it was big.

So some of the questions they asked are about demographics, which all of you guys know. When you're admitting somebody to a boarding care, you don't ask about gender identity, you don't ask about where they were born, what their origins are. You don't ask any of those things yet we happen to have it because we have our clinic and we could go talk to our clients. I think it would be very overwhelming for a small operator to navigate that.

I've tried to communicate in a lot of different groups about this but people think zero, I can use this for the Regional Center. No, can't use it for. It's I think educating people is beneficial. Like Mike said, supporting the board of care operators more so. One thing I find interesting is as an ARF RCFE administrator every year maybe it's two years, have to take 6 hours of dementia training.

It's a CEU and you're mandate and it makes sense because even as an adult residential facility you want to recognize maybe some of those things that are looking like dementia. There is no requirement right now for mental health recognizing depression, suicidality. And that is something that I think is a pretty easy fix because I think with education, understanding behaviors, how you mitigate those behaviors. I think it would allow others the opportunity to come into this particular field.

Three years ago, as far as the CCE application, three years ago, I wouldn't have been able to, we wouldn't have been able to even apply for these funds because it was typically limited to a nonprofit. Teresa Pasquini and Lauren Ratagliotta really advocated on a whole different level to allow for profits. We are a for profit, but we're also a really good provider. We do a good job. We care a lot, we treat our clients really well, a lot of health, good nutrition.

So that alone, I think, allowed an opportunity for others to come in to do this work and support them. You want to say anything else unless.

You have some questions?

Okay, that's it.

Great. Perfect. We're going to jump into questions. I really appreciate you sticking around. I'll kick us off with a couple of questions. On the prevention side. Patty, you mentioned it. And Trent, you mentioned it. I want to hear more about on the preventative side, with CalFresh emergency allotments ending and majority of our seniors being on the one to two households are going to go down to $23 a month potentially. How are those conversations going? How worried are we to further push this population into homelessness?

And I'll start off with that question.

I can start as Trent Rhorer, San Francisco Human Services we are very concerned about the reduction in the emergency allotment. We are fortunate in San Francisco, we have a locally funded food support community food support network of about $33 million. That's on top of what we had our contracts with the food bank already and our home delivered meal programs, our congregate meal program. So the 33 million in addition to that, we serve thousands and thousands of people and we still have room to grow.

And so what we're doing is pretty aggressive marketing campaign to CalFresh recipients, letting them know their allotment is going to go down. We have the ability to text clients. We are doing PSAs. So really trying to working with our community based partners to get the word out. And in all of that messaging, it's not only your benefits are going to be reduced, but here are the options you have specific to the neighborhood all throughout the city. But it's a real concern in San Francisco alone.

The value or the total amount of the reduction is about 11 and a half million in CalFresh benefits each month in San Francisco.

Thank you, Patti. I don't know if you wanted to add anything to that.

I would just say thank you for lifting up that issue. It's a real concern. And California individuals who are receiving SSI just recently became eligible for food stamps for the first time. We were the last state in the nation to join the food stamp program with our SSI population. And I'm just extremely concerned because the participation rate is already low. And there's been some press around the fact that people are not getting what they need.

And in this period of food inflation, it all comes out of the family budget. And as Matthew Desmond says, the rent eats first, so it will cause hunger.

Thank you. Second question. Then I'll kick it over to my Subcommitee Members. Can, you know, several of you mentioned the difficulty in finding affordable housing. Can you talk about the unicorn units, that perhaps they put so much restriction on them that you have vacancies and you can't put our seniors in there? Anyone?

I'll just say quickly, from the community care expansion perspective, I think we're really trying to take a broad approach, as you heard from the different speakers today.

We're really trying to fund a broad array that is Low barrier to access. Yes, it is prioritizing the SSI, SSP cappy population, but that's a large population in California. There's more than 1.1 million recipients right now. And we know it's a population that struggles because of the fixed income to find housing.

So we are trying to go in the opposite direction with CCE to make it low barrier, to make sure we're meeting people where they're at to fund that array of beds, including the RCFEs, the adult residential facility beds, but also permanent supportive housing beds and medical respites. So because we don't run any of the housing side, housing authority or that side of the programs, I can't speak to that.

But I think from our perspective, and that's true with all our programs, we want them to be low barrier. We want them to be flexible, and we want them to meet our recipients where they're at and provide the services as quickly as possible. And I'll let others speak to other pieces of that.

Yeah, Jonathan from BACS. I'd be happy to speak briefly specifically around permanent supportive housing. I think one of the things that we are very excited about in this context and specifically with the CCE program is this. And I will say one of the things that is truly innovative is the opportunity to get what we call a COSR or a Capitalized Operating Subsidy Reserve, which is really exactly what you need to truly have permanent supportive housing where people are paying 30% of their income right.

This is what is covering the offset in cost to subsidize. Given that that is that state money, and I believe it's state general fund funding, that portion of it and then some local funding, our permanent supportive housing is able to be, as was just described, more flexible. Right. It's not passing through certain funding streams that might require and potentially put on some more unintentional barriers.

So while there will still be the prioritization process and we're going to be working closely with our county, the sort of state based operating reserves and local county operating reserves allow us to really create, I would say, the lowest barrier version of permanent supportive housing in terms of really prioritizing people accessing it.

And that is really helping to change that kind of what you're talking about, those gaps and really getting people into units in efficient ways or potential barriers or documentation that can really slow the process.

Perfect. Thank you. I'll kick it off to my subcommitee. Senator Eggman, thank you.

If I could just ask and stay on this CCE, because it's exciting. We have pots of money that we can actually help with. But then we just heard from synergy saying it was incredibly hard to access it. So I'm wondering also just from the departments, what's your response to that?

Two things. Thank you for the question. First, I'll just say with the application process, we know that it was a lot of pieces to put together, and we really tried to balance two things. One is making sure that we had a wide array of operators, from big to small, people who don't normally seek state grants in all areas of the state. That was truly important to have that accessibility to us.

We also wanted to make sure that we were receiving enough information, though, on the other side, to be really excellent stewards of all these state resources that are being poured into this program, and to make sure things like if somebody said they were going to build something or rehabilitate something, there was something on the other end and they were serving the clients that they were supposed to serve. So I think we are certainly open to lessons learned about whether we can streamline things, simplify things.

We did provide technical assistance to applicants and to pre license people who are in the pre licensing process, but we're really open to feedback around that and just making sure we're finding that right balance. So we have the results at the end to show from all this work up front.

And if I could ask just for my own education, does it all just go to providers? Does it go to the county and then the county could administer some at the same time, or it's just for a construction of an individual site?

It's a mixed array of who's receiving the funds. But I'll turn to my colleague to answer more specifically on who we're funding.

Sure. Thank you. I'm Hanna Azemati, Deputy Director of Housing and Homelessness Division. So CCE has two components. The first is the expansion side, which has invested $570,000,000 in capital acquisition, rehabilitation and construction. And that is run through or allocated through a competitive process. We launched our RFA in January of 2022 alongside Department of Healthcare Services for their beach up program, which is a similar program focused on behavioral health care continuum, and that is open to for profit, non profit cities, counties. So very open to applicants.

And I'll just add to what Claire was sharing, that as part of the investment in technical assistance to support applicants, that also included an initial stage in the application process where there was actually a much more narrow set of information requested and pre application consultations were held based on that narrow set of information with the technical assistance provider to then support the applicants to go through the application process from there.

So we know that 1700 pre application consultations were held with applicants to support them throughout that process from the very get go. And then on the preservation side, the model is a little bit different there.

What we have done is chosen a non competitive allocation process where we have identified all of the counties that have eligible facilities and allocated dollars to them to then be able to identify the facilities that are at highest risk of closure and figure out what the best way is for that county to allocate resources on the preservation side. So those are both capital dollars and operating subsidies as well.

Thank you. Go ahead.

Can I just mention one thing? I will say through the pre application process? Sharona Q. She was amazing. Now, granted, she had to repeat herself five times for terms that we just were not familiar with, to be honest. But yes, through every step of the way, if we had a question, she would answer within a couple of hours. If it was something about the property, she would get people on the line.

But getting operators to apply, getting them to those pre application, that's where I see the challenges. Once you get the Sharona, it's pretty amazing. About that part, I said, we're lucky.

Because we have a group of professionals in our accounting and different areas that really were very helpful for us internally to put this together. But it is a big project, and if you don't have the financial background and a lot of operators don't then looking at it becomes really daunting. Is this something I can even do? If there were some consultants out there, perhaps it could help some of these smaller operators. I think that maybe more than would maybe stepped up and applied for funds.

But it was a big process. But I will to say the state was amazing in helping us and we received all the help that we needed. And so it was a really good process. We really enjoyed it.

May I also ask, do you see any hope coming with CalAIM to be able to bridge some of these gaps for the operation part and for the funding part of that? Is that going to be how big a lifeline? Because I hear that issue about the patch. I certainly understand that issue about there's not enough for operational costs. And so I guess the department's ideas about that.

Yeah, thank you for that question. Claire Ramsey from CDSS. I'll just say I don't want to speak overly to Department of Healthcare Services CalAIM, just because I don't know those programs as intimately. But I will say that we are trying to think creatively about how these different pieces all fit together to serve the same population.

I think that's really at the heart of what you'll hear a lot of Health and Human Services Agency departments talking about, which is this person centered model where we're no longer trying to think programmatically, but we're trying to think about the person and how we're providing the needed services to them. I think there are opportunities within CalAIM, I'm not clear yet, that they will work exactly like an operating subsidy payment.

But more to what Jonathan mentioned from BACS around, they are providing a number of community supports for individuals who are enrolled in medical, which everyone on SSI is. So we think it's going to provide a lot of service rich possibilities. And then just to be clear, what we are really excited about with the $55 million offered in fiscal year 2021 and another 55 and 2022 that that is operating to provide that patch. And that's what the plans we're receiving right now from counties to basically the.

County is requesting the patch funding.

Exactly. And they're identifying the facilities at high risk. They're going to be as Lito described and they will be able to work out by county kind of what they think is needed to keep facilities in business.

And so we'll be learning more over the coming year and beyond about sort of what that right amount was, what kept facilities going, and whether it needed to be every bed was getting a particular amount, or if some additional operating subsidies into the facility, stabilized the entire facility, and therefore stabilized more beds than even the direct recipient beds that they were serving.

So I think there's a lot of exciting data to come on this, and we do want to continue to work to see where CalAIM can support.

Okay. And then just my final question, and thank you for the indulgence, Madam Chair, on the issue of people being able, like, if you have a voucher to be able to get a place, are you finding that people's, and especially your older people, you have a long history, like credit history or any of those kinds of things, preventing people from being able to actually use that voucher that they have in their hand?

I can speak to that, Senator, thank you for that question. It's incredibly frustrating to see these vouchers being offered to individuals, and that the ability to actually secure a location if you are unhoused and looking for a place or need to move, is in some places, as Low as 25%. That means 75% of the vouchers are going unused.

And is that because of people's credit history, or is that because they cannot find a place that will rent?

Well, I think that it is for a number of reasons. It is our source of income discrimination law not being fully enforced. I think your bill around credit history is very important.

I'll bring it back this year. Yeah.

She didn't plant that question, really. And I think also, looking at the maximum income that you have to have, the Department of Employment and Fair Housing has indicated that when you look at an applicant, you should only look at whether they have three times the portion of the rent that they are going to have to contribute and not the full fair market rent. And yet, many landlords and rental companies ask for that full amount, which, of course, anyone on SSI could not meet.

And I just finally, just. I wanted to say thank you to synergy. I work closely with Teresa Pasquini, and I heard the name so often.

Senator Roth, do you have any questions?

Just one, Madam Chair. Thank you. I'm curious, maybe I missed this, but regarding the CCE construction acquisition rehabilitation program, how do you account for the potential capability differential between cities and counties and the private sector in the profits and nonprofit arena, in terms of preparing appropriate and complying applications?

Sometimes in other areas, I noticed we put money in various buckets, and we let the large cities and the large counties fight it out in the one bucket, and we let the other folks deal with it in the other bucket, and it sort of potentially simplifies the process in terms of giving folks a fair opportunity to compete. If you've answered this before, just tell me to shut up and move on.

I don't think I'll be doing that. But no, I had not answered that. Thanks for the question. I will just say that we were mindful of this concern as we set up the CCE program. We did not want to find out at the end of all this work that we ended up with all the facilities located in urban centers and all the other counties ended up losing out. So we did create a regional model to ensure that the allocations were spread out throughout the state.

We also have a tribal set aside. We've been able to award a couple of awards to tribal entities to build properties not too far from Sacramento. We also have set aside 20% of the funds so that we can be flexible. If we see that there are underserved areas or other needs, we are able to be nimble and meet them. And I will also just say in our application process, we are seeing a lot of joint applications where people are working together.

So it might be a for profit and a behavioral health accounting. behavioral health, I believe. I'm sorry, I'm not sure if it's a nonprofit or a for profit. I'll have Deputy Director Azemati confirm. But the facility that Kern received an award for, I believe, is a joint application so that there really are partnerships forming to support these projects.

And when you get. Not to belabor it, when you get enough data to make the analysis meaningful, perhaps you could supply us with sort of a breakdown as to successful percentages in terms of successful city county applications versus the private sector profits, the nonprofits, just so we can see how the funding was distributed and whether there is any perceived inequity that we may need to deal with in some other way.

Yeah, we'd be happy to follow up with that. We have provided a list of all the properties that have been awarded so far that Ms. Schmidt has and can certainly distribute to the committee. But we'll continue to provide that information and do the analysis as we go forward.

Perfect. Thank you for your hard work. Thank you, Madam Chair.

I'll end with one final question that I have. Hannah, you mentioned regarding the process of finding facilities are on the brink of closure. We've heard from a larger boarding care, and even for you, there were some difficulties in navigating that. Were any smaller boarding care facilities awarded a CCE grant?

Yes, we have a number of very small facilities that have been awarded. For example, in Chico, there are actually two facilities that are right adjacent to one another, each serving having six beds that I'm remembering off the top of my head that won awards in this last round that we just announced. And there are other examples as well, and we can share those with you. So we have been able to get those awards to small operators as well as larger ones.

Perfect. Thank you so much. That ends all our questions here. I want to thank all the panelists, both in person and in Zoom, for joining us and giving a really in depth background on this topic. Very important. Thank you so much. Thank you.

Thank you.

Thank you.

We're now going to be moving on to issue two. We're going to be looking at Department of Social Services, Housing and Homelessness division overview, welcoming back Deputy Director Hannah Azemati.

Sorry. Hi, Hanna Azemati, Deputy Director of Housing and Homelessness Division at the Department of Social Services. Thank you for the opportunity to present here today. The California Department of Social Services Housing and Homelessness Division schools are to design, support and oversee the delivery of programs that are tailored to the unique needs of children, families, older adults, and people with disabilities who are experiencing homelessness or housing instability and are served by the local social services agencies.

The division takes on a variety of activities to help support the effective implementation of DSS housing and homelessness programs within the broader system of care. We work collaboratively with our sister departments within the California Health and Human Services Agency, including the Department of Healthcare Services, Public Health, the Department of Aging, amongst others, as well as multiple state agencies striving toward the same mission to end homelessness by creating person-centered program delivery with a focus on equitable access to safe and stable housing.

DSS Director Johnson also serves as a Council Member on the California Interagency Council on Homelessness, and the CDSS team works side by side with our sister departments on the state's action plan to end homelessness. The Housing and Homelessness Division oversees seven housing and homelessness programs that are embedded in the social services delivery system with significant one-time program expansion dollars with multiyear spending authority totaling more than $2 billion invested over the last two years.

The majority of these funds are made available to county social services agencies and tribal governments throughout the state via noncompetitive funding allocations across all 58 counties and set-asides for tribal governments. DSS encourages and works with grantees to blend and braid the tremendous state infrastructure investments with a wide array of health and social service interventions.

This specifically actually, and I'm pleased to report that as of February 2023, the Department has made all of these funds available via applicable funding notices and has awarded over $1.6 billion in funds to over 350 grantees to implement housing and homelessness programs statewide. The remaining 400 million is available via relevant funding announcements, and we are in the process of reviewing submitted applications.

Along with these significant funding expansions, in 2021, program eligibility was also expanded to serve families, older adults and adults with disabilities at risk of homelessness who are not yet in receipt of an eviction notice. This really has allowed grantees to stem the inflow into the homelessness system and also provide supports and services further upstream. The proposed 2023-2024 budget maintains these investments. There were no cuts or changes to our division's investments.

Additionally, all of the onetime investments in fiscal year 21 to 2022 and fiscal year 22 to 2023 provide multiyear spending authority to ensure that grantees can commit to longer term support for individuals and families who are enrolled in our programs.

This allows local communities the flexibility to provide services and supports in response to individualized needs, whether that be short-term or one-time intervention or longer-term services and supports by way of connection to other permanent assistance programs that can be accessed through complementary systems that can include the healthcare delivery system or coordinated entry systems. Now I'll highlight some of the efforts that we have made to provide technical assistance and also make advances on our equity goals.

So robust access to tailored support and resources, such as tools and templates for capacity building and guidance, and how to stand up programming has been instrumental to program success. And you heard a little bit about that from the Change Well Project earlier. DSS launched a comprehensive technical assistance initiative in partnership with Change Well to provide grantees direct and intensive support in areas related to integrating housing and homelessness programs as well as disability benefits advocacy, tribal outreach, family support resources through a data informed racial equity lens.

DSS has supported over 2300 participants through 28 different activities in partnership with Change Well, and that includes webinars, trainings, resource guides, program tools, cohort-style learning collaboratives, and Change Well has also launched a digital learning platform for independent learnings. DSS has focused on its work with tribal governments to expand access to housing resources and program supports as well. Five of our seven programs designate tribal governments as eligible grantees. That includes the Bringing Families Home program, Home Safe housing and disability advocacy program, community cares expansion, and Project Roomkey.

An all tribal leader letter announcing the first ever tribal funding set aside, as well as program guidance applicable to program implementation in tribal communities, was released in July of 2022. The CDSS Office of Tribal affairs and our division led tribal consultations and provided technical assistance to support outreach and engagement with tribal agencies across the state. We have received requests from 24 tribal agencies to operate our programs, and an additional five tribes have also submitted letters of interest.

We are currently finalizing our award decisions and are excited to announce them very soon. In early spring, Director Johnson and Chief Deputy Director Ramsey already spoke to our programs for older adults and adults with disabilities, so I'm going to focus on some of the overview and providing you some background on our programs focusing on families. Families with children represent 35% of California's homeless population.

Supporting families in obtaining and retaining stable housing, of course, leads to better outcomes for parents as well as children across multiple systems, from education to workforce, child welfare to health. It is a keystone to not only addressing our homelessness crisis but also in breaking the cycle of intergenerational poverty, which disproportionately impacts people of color. So we have three programs that serve families.

The first is the CalWorks Homeless Assistance program, which is our entitlement program that provides payments for temporary shelter for up to 16 cumulative calendar days, as well as payments to secure and maintain housing, including a security deposit and last month's rent or up to two months of rent arrears. In fiscal year 21 to 2022, just over 47,000 families were served through this program. The CalWorks Housing Support program provides temporary housing, rental subsidies and supportive services to families in the CalWorks program.

HSP has served more than 66,000 families and permanently housed more than 31,000 families since the program's inception in 2014. And we know that based on data that is reported to us by counties six months after exiting HSP programs, 88 participants are able to retain their housing. The Bringing Families Home program provides those same resources to families in the child welfare system to keep families together, as well as stably housed.

That program has served over 4700 families and permanently housed 2200 families since it launched in 2016. So in the interest of time, I will pause here since you've heard, as I noted, about our older adult and programs for people with disabilities. But I'm happy to elaborate further or answer any questions. Thank you.

Thank you. Turn to LAO or DOF and DOF for any comments.

Emily Marshall, Department of Finance no additional comment at this time, but happy to answer any questions.

Lourdes Morales with the Legislative Analyst Office. You just heard the Administration provide an overview and an update on some of the recent investments it received to support its housing and homelessness programs.

And so I just want to take a moment to provide additional context around these resources. So the state has made significant investments in recent years, and the resources within Department of Social Services are just one part of the state's broader effort to support housing affordability and homelessness. Historically, it's been bonds and tax credits that support the state's efforts to support housing. Those efforts continue. Most recently, in 2018, voters authorized $6 billion in funding to support housing and homelessness programs.

In addition to that, the state has authorized about $20 billion in funding around four key state departments that have historically supported housing and homelessness efforts, those being the Department of Housing and Community Development, the California Housing and Finance Agency, the Interagency Council on Homelessness, and the Tax Credit Allocation Committee.

These resources have supported a variety of activities, including providing flexible aid to local governments to address housing and homelessness needs to provide emergency rental assistance to subsidize the development of affordable housing, as well as to support first-time home buyers. And so, in closing, the state has made significant investments in recent years towards this effort. And the Department of Social Services Resources really represent sort of one part of this larger effort that focus on very specific populations that are engaged in the state safety net programs.

Happy to take any questions when appropriate. Thank you.

Thank you so much. I have a question. You mentioned a brief overview of the CalWorks Homeless Assistant Program. You mentioned you saw a little bit over 45,000, you served a little over 45,000 individuals. But of that I see for the temporary 16 days allotment, I see that of that, only about 2700 people moved from the 16 days temporary into permanent housing. Why are so many families receiving temporary, but then not being, why is there no pipeline to permanent?

Thank you for that question. That has to do with the way that the statute has defined eligibility for the permanent housing portion of the homeless assistance program. Specifically. In large part, a key factor is that the rent of a unit that somebody wants to use the permanent housing dollars for has to be at most 80% of their income. And so that has created some challenges for access.

So would you say, are they continuing in that temporary cycle or are they just returning to homelessness?

No. The larger context for this program is that we strongly encourage our counties and local operating partners to break this homeless assistance program, which is really a crisis intervention with our other programs. So you oftentimes see folks being co-enrolled with our housing support program, which provides a lot more flexibility in terms of offering rental subsidies as well as supportive services, case management. We talked about credit barriers earlier, so credit repair is one of the investments that are able to be made.

And so oftentimes families are helped through other programs once they enter into or being identified as in need of housing and homelessness services through the Homeless Assistance Program.

Thank you so much, colleagues. Thank you. We're going to be moving on to the next issue. Hanna, thank you so much. Are you on this one? Yeah, we're going to be moving on to issue number three on housing and homelessness, expanded programs and permanent position funding.

Thank you. The program expansions in fiscal year 2021 to 2022 built upon an ongoing workload associated with operating housing and homelessness programming that has regularly expanded in scope and size over the years. To meet this expanded ongoing need, the Housing and Homelessness branch actually grew into the Housing and Homelessness division just some months ago, in July of 2022.

And the 17 positions in this BCP are really meant to address the ongoing workload that's associated with the operations and administration of ongoing housing and homelessness programs to fulfill the legislative mandates for our department, as well as provide the critical services for our grantees so that they, in turn, can serve individuals and families experiencing homelessness effectively. Happy to take any questions.

Questions?

Emily Marshall, Department of Finance no additional comment this time, but happy to take questions.

LAO, no concerns to raise at this point.

No questions on my end, colleagues. Perfect. Moving on to issue four, housing and disability advocacy program technical changes.

Sure. First of all, I commend your agenda, did a really robust job of summarizing a lot of the TBLs and BCPs. So I will stay high level and just highlight on this one that two changes are being requested as part of the HDAP TBL.

The first is it extends the sunset date for the grantee match exemption and the waiver of the requirement to collect interim assistance reimbursement to align with the expenditure timeline of the one-time funds that were appropriated in the Budget Act of 2022 to match with that. And then secondly, this TBL clarifies that the Department of Social Services has an obligation to develop regulations corresponding to the entirety of the HDAP statute by July of 2024.

And we think that these technical changes really support streamlined implementation of the one-time funds included in the 2022 Budget act and clarify the scope of our authority to develop regulations for all of HDAP statutory provisions, not just the changes that were enacted in AB 135. So it's a clarification to that effect.

LAO, DOF, any comments?

Emily Marshall, Department of Finance no comment at this time.

Louedes Morales, LAO, we have no concerns to raise for the committee.

No comments on my end, colleagues. Great. We're going to hold this item open and move on to issue number five.

Thank you. Hana Azemati, Department of Social Services, Housing and Homelessness Division here again, I think the background provided was really robust, so I will just highlight that there were three changes being requested. First, this TBL clarifies tribal eligibility language in the tribal home safe programs.

So since tribes do not administer adult protective services and instead have unique and locally responsive elder adult service programs and systems, the requirement to only serve those who would otherwise be eligible for APS does not meet the identified tribal services needs for Homesafe. And so we want to clarify that.

Second, the TBL adds the definition of senior, which means the same as the term elder as codified in the APS program, and is inclusive of persons within an age range established by the tribal law or custom for tribal programs. Third, this TBL adds appropriate cross-references to codified definitions used in the APS program to define dependent, adult, and elder.

And then finally, this TBL also extends the sunset date for the grantee match exemption to align with the one-time funds appropriation to June 30, 2025 so that there is consistency there. So these changes are really important to make sure that we're able to equitably serve our tribal members in Homesafe and also ensure that eligible older and dependent adults who are being served by APS are also able to be served by Homesafe.

LAO, DOF, any comments?

Emily Marshall, Department of Finance no additional comment at this time.

Lourdes Morales, LAO, no concerns to raise for the committee, thank you.

No questions on my end, colleagues. Great. We're going to hold this item open and move on to issue number six, housing investment, power and duties, technical changes.

Thank you. Hanna Azemati, again, Department of Social Services, Division for Housing and Homelessness. The agenda does, again provides a very strong background. So three changes to highlight on this TBL is the first, technical change clarifies that DSS is authorized to expand 10.5 million in general funds of the total amount of funds included in the 2022 Budget Act for housing and homelessness programs on data collection, data tracking and technical assistance.

Second, it authorizes Department of Social Services to modify or waive at its discretion any DSS housing or homelessness program requirements that conflict with tribal law or custom in line with the equity-focused best practices that have been established. And then third, it authorizes DSS to implement program guidance through the all-county letter process. And we think these changes are really important, again, because they ensure that we're able to continue administering equitable and data-driven housing and homelessness programs. Thank you.

Does LAO or DOF have any comments?

Emily Marshall, Department of Finance no additional comment at this time.

Lourdes Morales, LAO, no concerns to raise for the committee.

No concerns or comments on my end. Nothing for my colleagues. We're going to hold this item open and move on to issue number seven, bringing families home program technical changes.

Thank you. Hana Azemati, Department of Social Services, Housing and Homelessness Division. I want to highlight four components of this TBL that are being requested. So first is we're trying to clarify the program eligibility to include a tribe, a tribal entity or agency.

Second, also trying to clarify in terms of clarifying the program eligibility, we're also clarifying that under the definition of homelessness, individuals fleeing domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or family member, including a child those count as eligible under the definition of homelessness. The second change being requested is updates to outdated definitions of permanent housing in the BFH statute to align with housing best practices.

And specifically, we're clarifying that permanent housing must be subject to landlord-tenant laws and without a predetermined limit on length of stay. Third, were the TBL requests to extend the sunset date for the grantee match exemption related to the one-time funds to June 302025 to align again with the expenditure timeline of the one-time funds appropriated in the 2022 Budget Act.

And then finally the TBL requests that DSSB require to develop BFH regulations to implement changes made to the statute via AB 135 by July of 2024. So all of these changes are really important again because they will position us to make sure that BFH continues to serve families in the child welfare system using an equity lens and best practices. Thank you.

Thank you. Any comments from LAO, DOF?

Emily Marshall, Department of Finance no additional comment at this time.

Lourdes Morales, LAO no concerns to raise for the committee.

No comments on my end. Colleagues going to hold this item open and move to issue number eight, CalWorks pregnancy and homeless assistance implementation as it relates to SB 1083.

Thank you. Hana Azamati, Department of Social Services Division, Housing and Homelessness. SB 1083 implements several different policy changes that streamline processes and access for the homeless assistance program. This request with SBCP includes two associate governmental program analysts and one staff services manager.

One to implement SB 1083 policy changes provide high quality, ongoing technical assistance, as well as guidance and oversight to counties to make sure that they're adopting these changes in line with the intent these resources are needed to adequately implement SB 1083, provide key guidance on legislative updates, and deliver that oversight and technical assistance to communities. So I will pause there and take any questions.

DOF, LAO?

Emily Marshall, Department of Finance no additional comment at this time, but happy to answer any questions.

Lourdes Morales, LAO no concerns raised for the committee.

No questions on my end. Colleagues? Hanna, thank you so much for joining us and presenting all those BCPs. We're now going to be moving on to our next department, Department of Aging. The next section would be budget proposals from Department of Aging, and we'll start off with issue one, an overview of Department of Aging.

Is that right? Oh, red means on. Okay. Good afternoon, Madam Chair and Members. I'm Susan DeMarois, Director of the California Department of Aging, and I'm proud to be joined today by our Chief Deputy Director, Mark Beckley, and our Deputy Director of Administrative Services Nicole Shimasaka. Mark Nicole and the entire CDA team have led us through a period of accelerated and unprecedented growth, and I thank the CDA team.

Before we launch into the budget, I wanted to first thank the Legislature and the Governor for the tremendous support and the resources over the last several years of the public health emergency that have enabled the Department to respond to the COVID-19 pandemic and to better serve our priority populations, older adults, people with disabilities, family caregivers, and communities of color, who all were disproportionately impacted by the pandemic.

California fared far better than other states because we had the resources to reach deep into diverse, rural, and low-income communities to provide PPE, vaccines, boosters, offer our friendship line, and deliver close to 100 million life-sustaining meals. So thank you very much. Before we respond to budget questions, I wanted to briefly highlight two areas. The first is the role of the Department of Aging and the second is the master plan for aging.

As California's state unit on aging, CDA oversees a network of 33 area agencies on aging, covering all 58 counties. These local agencies provide a wide array of services to people with the greatest economic and social need. While senior nutrition is by far our largest program, we also offer information and assistance, health insurance counseling, family caregiver supports, employment and job training, and much more.

In addition to the AAAs, we also support the statewide network of 11 caregiver resource centers, the designated and emerging aging and disability resource connections, in partnership with state independent living centers and the Long-term Care Ombudsman program led by Blanca Castro. We also collaborate with the Department of Healthcare Services on two programs to provide direct services to MediCal beneficiaries. The first is we oversee the Community-Based Adult Services, or CBAS, centers serving older adults and people with disabilities.

And I want to thank all of the Senate staff who took the time in December to visit CBAS centers in Ventura County. We also oversee the Multipurpose Senior Services program, an intensive in-home case management program.

In the past year, we've had the privilege of overseeing dozens of new initiatives, which you'll hear more about, including Cal Grows, our direct care workforce effort that recently awarded 78 community grants totaling $89 million to train and compensate frontline staff. Our digital divide efforts that offer devices, service plans, and technology training to older adults and our nutrition infrastructure grants enabling the purchase of equipment and vehicles to store and transport food.

Since June of 2019, when Governor Newsom took executive action to establish California's master plan for aging, the Department of Aging has led this whole of government effort on behalf of the Administration under the direction of CalHHS Agency Secretary Dr. Mark Galley. I want to acknowledge the incredible leadership of the Legislature every step of the way, from inception to implementation to today's hearing to today's hearing earlier, when we heard about older adult housing.

And we heard from one of our key master plan stakeholders, Patty Prunehuber, who, along with Eric Harris at Disability Rights California, co-chairs the master plan for Aging, Disability, Aging and Community Advisory Committee stakeholder Group Goal number one, as you heard in our state's master plan, is housing for all ages and stages. Goal two is health reimagined. Goal three is inclusion and equity, not isolation. Goal four is caregiving that works, and goal five is affording aging.

We've touched on all of those topics already this morning in this hearing. Working in partnership, the Governor and Legislature have made historic investments in all five bold goal areas, cutting across multiple agencies and departments and engaging philanthropy and the private sector in this work. Dozens of states are now following California's lead and embarking on their own master plans for aging.

The plan is the state's 10-year blueprint, providing strategic direction as we move toward the year 2030, when one in four Californians will be age 60 or older. Imagine nearly 11 million Californians, the equivalent of all of Los Angeles County, being age 60 or older.

In fact, much older, as the fastest growing demographic in our state is age 85 and above, the US census confirms older adults nationwide are more diverse than ever, a point of immense pride in California, where our strength comes from our racial, ethnic, cultural, sexual orientation, gender identity, economic, geographic, and religious diversity. In January, Senate President Pro Tem Toni Atkins joined Secretary Galley and the Governor's senior advisor on aging, disability, and Alzheimer's, Kim McCoy Wade to launch years 3 and 4 of the master plan.

We released 95 new initiatives and unveiled a new, publicly accessible initiative tracker to accompany the data dashboard on aging. In closing, I want to lift up five areas of focus over the next two years of the master plan. One delivering more behavioral health supports to older adults as we strengthen the mental health continuum across the lifespan.

Recent tragic events in Monterey Park and Half Moon Bay have motivated us to redouble our efforts on behalf of older adults. Two, delivering a no wrong door system of care built with and for consumers.

We're embarking on the state's first consumer satisfaction survey ever this summer. Three, examining the high cost of home care and identifying financing options to help the growing missing middle-income population. Four, analyzing our home and community-based capacity and infrastructure with our sister Department, DHCs, to jointly develop a statewide hcvs, gap analysis, and roadmap. And fifth, preparing the AAA network for 2030 in order to meet the demands of a growing population that is much older, more medically complex, and more diverse than ever before in the 50-year history of the Older Americans Act.

Thank you, and I'll remain for any questions.

Thank you so much, Susan. We're going to move on to issue number two, master planning for aging phase three, infrastructure and capacity. Welcome, Mark.

Great good morning, Chair Menjivar and members, happy to be here today. I'm Mark Beckley, Chief Deputy Director for the California Department of Aging. For our master plan for aging phase three proposal, we're requesting 10 positions and 1.7 million general fund to provide needed information technology resources to continue to support the implementation of the master plan for aging. Specifically, we're requesting two positions to serve as IT project managers to oversee three key IT projects that will be essential for the implementation of the master plan.

The first project is the migration of the MPA data dashboard from CDPH to CDA. The second is the establishment of a statewide learning management system so that all of our aging network partners can avail themselves of learning resources and training resources.

The third is the implementation of an enterprise client relationship management system to be used by our AAA partners, and then finally the development of a customer-facing web portal, which we're really excited about, that would enable individuals throughout the state to access services for their areas.

The proposal also requests the establishment of three additional IT security staff as CDA continues to collect datasets to support the master plan for aging in the areas of transportation, health caregiving, and other areas to better understand the needs for older adults. We need to ensure that these data sets are secured and that we're using the appropriate security protocols and policies to safeguard them as we use them. The staff will also be providing oversight and training for local data exchanges among our local partners.

The BCP also proposes two infrastructure positions, a systems and a database administrator, to oversee access permissions system controls for the new systems that we'll be establishing as part of our MPA initiatives, as well as to develop, configure, and expand our existing department databases to accommodate the new data sets that we'll be acquiring. And then finally, we're requesting three new contract analyst positions.

These positions would support the procurement of the new IT systems that I just mentioned, as well as procurement activities related to the 41 active program initiatives that we currently have underway to implement various aspects of the master plan for aging, and happy to take any questions.

I'll turn over to DOF and LAO for any comments.

Hersh Gupta with the Department of Finance. No additional comments at this time.

Thank you Madam Chair, Ginni Bella with the Legislative Analyst Office. We're continuing to review this proposal but don't have any concerns to raise at this time.

Thank you, colleagues. Any questions? Thank you. We're going to hold this item open and move on to issue number three related to health insurance counseling advocacy program modernization.

Great. Thank you. Mark Beckley, Chief Deputy Director, California Department of Aging. The Health Insurance Counseling and Advocacy Program, or HICAP, provides health plan and long-term care insurance to approximately 51,000 Medicare beneficiaries annually through our 26 HICAP programs. CDA's recently launched a HICAP modernization initiative to identify and address gaps and needs for the HICAP system. This proposal would get us started on two of the goals of the HICAP modernization initiative. The first is the need for additional HICAP volunteers.

Over the past six years, we've seen a decline of 26% in HICAP volunteers statewide. Many of these volunteers are older adults themselves and we did see significant declines during the pandemic. The second need is also the need for additional volunteer training. As we know, training is becoming increasingly complex with the complexity of Medicare Advantage plans, services to dual beneficiaries, as well as prescription drug benefits. So it's really important to invest in adequate training for the HICAP staff.

A third goal of the plan that's not addressed in this proposal is really to increase the awareness, public awareness of the HICAP program. Currently we serve less than 1% of Medicare recipients. In other states, we see penetration rates of between 2 to 7%. That is a goal of the state to increase public awareness and to provide more counseling services statewide. So what this position would do is it would continue to maintain an additional volunteer coordinator position at each of the HICAPs.

They would be responsible for recruiting new volunteers and training those volunteers at the state level. We'd also be able to maintain three positions that oversee statewide training, research and analysis for our HICAP modernization efforts as well as fiscal management for our HICAP contracts.

Thank you, Mark. Does DOF or LAO have any comments?

This is Hersh Gupta with Department of Finance. No additional comment at this time and.

We have no concerns with the proposal.

Thank you. Related to this, BCP is a stakeholder proposal, which we're going to hear next. I'd like to welcome on Zoom Mr. Michael Costa, the Executive Director of California Association of Area Agencies on Aging, to talk about issue number four.

Thank you, Chair Menjivar and colleagues for the opportunity to speak with you today about the California Association of Area Agencies on Aging Budget Act. I'm Michael Costa, Executive Director of C4A, which represents the 33 area agencies on aging in California, covering all 58 counties.

The intent of my remarks here is to stress the importance of providing sufficient funding to support the expansion and ensure the sustainability of the Aging and Disability Resource Connection Program and to help further the goals of the administration's master plan on aging. We'd like to thank Senator Alvarado-Gil for championing both of our requests.

The vision of ADRCs is to establish trusted sources of information in every community where people, particularly older adults and people with disabilities, can turn to access the full range of long-term services and supports. Currently, 10 million is allocated annually to ADRCs to accomplish this vision. Right now, all 10 million is allocated among 15 designated and eight emerging ADRCs.

There is no additional funding available to support AAAs or independent living centers who are in the process of applying for emerging status, such as Alameda, Contra Costa, and LA counties. C4A has recently been informed that an additional seven to nine AAAs have withheld applications to become emerging ADRCs due to concerns about adequate funding going forward and a number of independent living centers. Our partners in the ADRC program have also withheld applications.

For the ADRC program to continue development, it's a critical aspect of the master plan's intent to develop a no wrongdoor strategy, the allocation must be raised. We are asking that the allocation be raised beyond 10 million over two years, with an additional 5.972 million allocated during fiscal year 23-24 and 9.671 million allocated in fiscal year 24-25. That, we feel is the only way that the program can expand throughout California. Our second ask deals with caregiver support.

We also believe it's important to make it easier for localities to meet the federal match requirements for the Federal Caregiver Support Program, which requires a 25% match. To achieve this goal, C4A recommends that the state provides a 15% state match, which is 2.69 million, we estimate, reducing the local match requirement to 10%. We also recommend that the state make an additional investment of 5 million to support the disproportionate number of women of color providing unpaid care for their family members.

I and a number of folks from the AAAs are available to provide additional details about our ask. Thank you.

Thank you so much Michael. Turning over to DOF and LAO for any comments.

Hersh Gupta, the Department of Finance will continue to review the proposal this time.

Ginni Bella with the LAO, we're happy to provide the subcommittee with any technical assistance you may need.

No questions on my end, colleagues, we're going to hold that item open and then move on to the next issue here. The next issue on the agenda is an oversight item on both the Department of Aging and Department of Social Services programs under the state's home and community-based spending plan. So then next, I will invite all the panelists to move on up. Welcome.

Perfect. We will start with Jackie Barocio from the Legislative Analyst Office to provide an overview of HCBS's plan. Next we will hear from Mark Beckley, Deputy Director, who's here with us on their department's HCBS program. We also have Leora Filocina from the California Department of Social Services on the IHSS Career Pathways program. Michael Costa, who's on Zoom, will then give comments regarding to the California Association of Area Agencies on Aging.

Brent Wakefield, President of Meals on Wheels from San Diego County, who joins us from Zoom, will then speak, and we'll end it with Tiffany Whiten, the senior government relations advocate from California State Council of SEIU. Welcome. Go ahead, Jackie.

Jackie Brussi with the Legislative Analyst Office thank you. We were asked to provide a brief overview of the HCBS spending plan and then also update in terms of where things are today. With regards to the overview, in 2021, as a part of the American Rescue Plan act, the Federal Government temporarily increased the federal match for Medicaid HCBS, or home and community based services, by 10 percentage points.

As a part of the 21-22 budget package, the state decided to draw down all or the full amount of the additional federal HCBS funds resulting from this temporary increase to the federal Medicaid match rate. This decision ultimately freed up $2.8 billion General Fund that otherwise would have been spent on Medicaid HCBS programs.

As a condition of drawing down these additional HCBS funds, as I'll refer to them in my presentation, the Federal Government requires states to spend an equal amount of funding on HCBS enhancements or expansions. Additionally, the Federal Government requires states to comply effectively with the maintenance of effort or MOE requirement, which includes one, not imposing stricter HCBS eligibility rules two, preserving existing service levels within HCBS programs and three, maintaining HCBS provider payment rates for as long as it takes for the state to spend all the dollars.

Originally, the state had until March 31, 2024 to fully spend the $2.8 billion in HCBS enhancements and expansions. However, in June 2022, the Federal Government released updated guidance where they said states, if they so choose, could extend this deadline by a year to March 31, 2025. So our understanding is you may see like different expenditure deadlines out there, March versus May.

Our understanding is relative to the March federal deadline, departments and expenditures may need, actually would need to end expenditures by December so that they are allowed to just close out cost, reconcile reimbursements and things like that for those last three month period. So I just wanted to explain the differences in those deadlines. In terms of where we are today. So of the $2.8 billion in HCBS funds as of September 2022, only 282,000,000 has been spent.

There are many reasons for this, but one of the main reasons is because within the various HCBS enhancements and expansions that the state is pursuing, some of them were one time and just layered on top of existing programs and were pretty easy to get out the door. However, some of these programs are new endeavors that the state is taking on, so it just requires a longer timeline to ramp up services and actually implement the program, and also, many of them are doing contracts with third parties, and that also takes time to run the RFA process. Additionally, the Administration and the current budget assumes that the end date of the HCBS enhancements and expansions will adhere to that original March 31, 2024 or December 2023.

Essentially a December 2023 expenditure deadline, meaning that the Governor's Budget does not include or take up any of the additional extension time that we were allowed by the Federal Government. Our understanding is the reasons behind this is one, the Administration continues to project that all HCBS funds will be fully expended by December 2023, so an extension is not needed.

But then also there's concerns around the MOE requirement potentially being just administratively burdensome and presenting challenges in other Medicaid endeavors, and then also limiting the ability of the state to make any changes to program eligibility rules or service levels. Given that this issue may come up in future hearings, as you specifically touch on certain HCBS enhancements and expansions, some of the questions the legislature may want to ask the Administration is one what would happen if the funds aren't full?

Or what would need to happen in each of these initiatives for the funds to be fully spent, especially for those initiatives where no dollars have gone out the door. We're essentially talking about a nine month period where we need to spend the dollars then. But if that is not possible and there's money left on the table by the time we reach December 2023, what will happen?

Our understanding is that the administration's interpretation of federal guidance is that the expenditure deadline essentially is dependent on how long it takes to spend these funds. So if that happens, we hit December 2023, there's still money on the table. The deadline will automatically be adjusted based off of updated projections.

However, under that scenario, it's unclear to us if the Administration would propose to keep the money in their current program commitments and just extend the deadlines for those program commitments, or would they shift the dollars to another program commitment just to spend the money as quickly as possible. Additionally, even though the expenditure deadline, based off of the administration's interpretation, would automatically adjust to reflect updated expenditure projections, there's still a question about, practically speaking, should that decision be made today or sooner through the budget process rather than wait until December, the benefit of making the decision sooner, it could potentially could allow departments to modify any contracts that still reflect a December 2023 date. And by doing that, we would minimize the potential for a gap in services or programs turning off and then having to restart them after we modify the contracts. Thank you.

Thank you so much, Jackie. Mark, I'm going to turn it over to you.

Thank you. Mark Beckley, Chief Deputy Director of California Department of Aging we've been asked to provide updates on our HCBS initiatives, and I'm happy to do so. I'll note that CDA has 41 active initiatives underway. Of these, 17 are HCBS initiatives. It's quite a long list, so I thought I would just highlight five of our larger initiatives and provide updates on those. And I'm happy to answer questions about any of the other initiatives that you might have.

So the first initiative I'd like to highlight is our California Grows program, which Susan had talked about in her opening remarks. This is a program that provides training and stipends to non IHSS direct care workers throughout the state. The initiative consists of two components, standardized online training through DSS's career pathways platform and coaching from a professional consulting organization. And then the second is our CalGrows Innovation Fund, which provides $89 million to 78 community based organizations to provide specialized training to direct care workers.

We're happy to say that we did get grants out to all 78 organizations, and they're currently in the process of developing their programs. We also have two initiatives, as Susan had mentioned in her remarks, as well targeted to bridge the digital divide for older adults in California. The first program is our access to technology for older adults and persons with disabilities program. This provides 46 million to 42 participating counties.

And then the second program is our Digital Connections program, which provides 17 million to 170 participating home and community based providers. These providers include CBAs, MSSP, PACE, and AAA programs. In both of these programs, grantees are able to purchase devices, digital service plans and offer training to program participants. To date, we've executed 35 of the 42 contracts. All the contracts are out to our providers. We're just waiting to receive them back, and we've received 90 provider contracts back.

The next program I'll highlight is in the area of senior nutrition. So this is our Nutrition Infrastructure grant program. In this program, we are awarding $40 million in funding to our 33 AAA providers. And again, I believe Susan had mentioned this program as well in her opening comments. This is to provide funding to local senior nutrition program providers to purchase equipment to improve and expand their facilities so that they can serve more older adults throughout the state.

To date, we have 32 of the 33 contracts back from our AAAs. And then the last program I'd like to highlight is our Cal Compass program, which is a pilot program that provides $5 million to seven adult day health and adult day centers to expand dementia capable services in their communities to prevent institutionalization and improve health outcomes. The seven grants were awarded last November, and the grantees currently have services underway.

Thank you, Mark. Turn it over to Leora.

Thank you Madam Chair and Committee Members. My name is Leora Felicina. I am the Deputy Director of the Adult Programs Division at the Department of Social Services. My division is responsible for career pathways. I'm really excited to actually provide an update about career pathways. It's actually a really exciting program for us.

Career Pathways is a new state training program for IHSS and WPCs providers that is meant to increase the quality of care for our recipients, assist with recruiting and retaining providers, and provide opportunity for career advancement through training. Providers can complete classes in five separate career pathways. Two of them are general. Those include general health and safety and adult education, and then three specialized pathways that include cognitive impairments and behavioral health, complex physical care needs, and transitioning to in home care and community based living.

To implement career pathways, we completed two procurements. We brought on some really great training vendors. We brought on some other vendors to help us create career lattices, career growth materials, and also for coaching services so that providers can obtain information that they need, in particular who are interested in furthering their careers in the healthcare fields. Classes launched in October of 2022, with classes being primarily provided by our county and public authority partners.

In January 2023, more classes were launched by two new vendors, we brought on Homebridge and the Center for Caregiving Advancement. More classes have been added as of March 2023. For the period of January through March of 2023, we have a total of 1,949 classes available. They're being offered in multiple languages, mostly online. Depending on the class and the vendor, providers can take classes in English, Spanish, Armenian, Cantonese, Mandarin, Russian, Vietnamese and Korean.

We have the approximate capacity today for 16 to 18,000 providers to attend training per month based on our current classes. We are seeing attendance at approximately 50% to 70%, which is not unheard of in the training world. That's pretty average attendance. So roughly we're seeing 8-11,000 providers attend classes each month at this point. The great news is that those classes fill up every time we post a new course catalog.

So every time we send a message, every time we message it, every time we post a new course catalog, people are very excited about the training and they fill up almost immediately. Our vendors do run waitlists because we know there is a high absentee rate. They are doing their absolute best to reach out to providers at the last minute when class spaces open up. With regards to ensuring how all of the HCBS funds will be spent, we are continuing to ramp up the training.

So we went from more than just 5000 course hours in October through December to more than 23,000 course hours in January. Our plan is to continue to proactively communicate through our normal channels. Emails, we utilize banner messages on our electronic services portal where 99.9% of our providers go to fill out their timesheets. We do social media posts. We have done our best, absolute best to make sure that accessing courses is easy. Claiming money, claiming your incentive payments are easy.

And we have also provided coaches to career pathways participants to provide person to person assistance and help them navigate not only the program, but also understand what opportunities are available to them in related healthcare fields if they wish to continue their training and education. So we're really trying to get, at the really core of our goals of this program is really to get people the information they need, get them the training they need, and to make it easier to be an IHSS provider with the hope of recruiting and retaining those folks in the program. So the next question was about assumptions that we're making to project that all the funds are designated, that we're going to spend all the money. So we continue to ramp up training classes and training hours.

So we're really leaning in and trying to get folks a lot of classes out there and available. At the current attendance rate of 8-11,000 providers, we anticipate at least we're looking at around 100,000 providers attending some type of training by the end of December. Additionally, since the program began, providers have attended over 33,000 hours of training. So that's just in the short time that we've been up. As classes continue, based on current attendance rates, we believe that we will expend the funds.

Additionally, we are starting to receive claims for incentives. So the program started in October. Providers are paid for the time they attend training as well as they qualify for incentive payments for meeting certain criteria. So if they complete 15 hours of training in one of the five career pathways, they qualify for a $500 incentive payment. They can get up to two of those. If there's a second incentive payment, if they complete 15 hours of training in a specialized career pathway and they work for somebody for a minimum of 40 hours in one month who has that specialized need, they qualify for a second incentive payment of $500. The third incentive payment is that they complete that 15 hours and this is the same 15 hours, it's not additional 15 hours.

So if they take 15 hours of training in one of those specialized career pathways, they can qualify for a center payment 2 and 3, which if they continue to work for that individual for six months at a minimum of 40 hours per month, they then qualify for a $2,000 incentive payment. So right now we haven't really met the six month mark yet.

So it's really kind of hard for us at this moment to determine the incentive payments and those kinds of things and what we're going to be looking at. And I do want to say that we also recognize that this was not a one and done program. So this is a program that we continue to monitor. We will continue to monitor and adjust our communication strategies accordingly.

The fact that we've had such a phenomenal response to our communications and the classes are full and people are really excited is really a great sign that we will continue to be successful and really kind of capitalize on this momentum through the end of the year and expend the funds.

So the third, I believe, really is about how many providers do we expect to go through the trainings and receive incentive payments and how do we see the winding down of the program to ensure providers are aware of the deadlines that they must meet. So like I said, it's been phenomenal and very successful. We are continuing to monitor data, look at incentive payments.

We are restarting to see, of course we've got lots of training claims come through, so we've had over 8000 training claims come in through the door at this point that we're really busy processing. I think it's really important that the reaction from the provider community every time we send messages related to career pathways has just been, it's shocking. What we've seen is that whenever we send a message, we get over 100,000 hits on our career pathways website, often in one day, sometimes over the weekend.

So that's great. To continue the momentum, we are planning on doing messaging beginning in April to remind providers of the requirements. So to really start to tell folks what the rules are, to remind them to claim their incentive payments, to remind them to claim their training time. We'll be posting additional messages on the electronic services portal using our social media outlets as well as our partners.

So we do partner with the counties, public authorities, the labor organizations, help us out with some of that messaging as well. We are committed to ensuring that providers receive the wages and the incentives through this program. So we're doing everything we can to support IHSS providers and ensure that they actually get the payments, they get the training they need and by extension our recipients. And then the final question is, will the Administration propose to extend the program expenditure deadlines?

And I think Ms. Barocio kind of addressed this piece. At this point, we believe that we will expend the funds based on our current attendance records and our ability to ramp up training hours at this point. So we'll be monitoring data and ensuring that we're changing our communications approach appropriately. We're ramping up those training classes and we're getting people the information they need to come into the program and successfully complete it.

Thank you. We're going to move on to. And welcome back Michael Costa, who's on Zoom.

Yes, thank you, Chair Menjivar and colleagues, for the opportunity to speak again, this time about the impact of cuts in program funding for a number of HCBS programs that Area Agencies on Aging provide directly or contract out to our community partners.

Again, I'm Michael Costa, Executive Director of C 4A. We represent 33 AAAs in California serving all 58 counties. Triple As are authorized by the older Americans and Older Californians act to provide a wide range of home and community based services to Californians over 60 years of age, as well as individuals living with disabilities under 60 years of age. Recently, a growing number of AAA's are also providing services directly or indirectly to medical recipients through the Cal Aim program.

My colleague from Meals on Wheels California will speak about the impact of ending nutrition infrastructure program funding at 12/31 of this year. So I'll not address that here, but know that C4A supports the recommendations that Meals on Wheels California will make. I also will not talk to programs that Deputy Director Beckley spoke to earlier, such as Cal Grows.

But there are a number of other programs that are going to be impacted by this 12/31 deadline, and they include the fall prevention and home modification program, which involves training, education and assistance for individuals at risk. 30 out of 33 AAAs participate in this program, which has very broad appeal. As of December, 3606, individuals have been assisted through 312 trainings.

Another program that's going to be negatively impacted is legal services, which an additional amount was provided to help folks during COVID to deal with issues such as fraud, landlord tenant issues, discrimination, et cetera. Although Covid may be gone, these issues are not. They're ongoing, and these AAAs are currently delivering services in this area that will have to be curtailed. Another program is the Employment Opportunities program, which was able to increase funding for senior employment under title V by increasing slots and enhancing program infrastructure.

Those slots are at risk and the program will have to be curtailed as well. A new program called Intergenerational Activities involved efforts to build relationships across generations and reduce social isolation for older Californians. Another program that will be impacted by the 12-31 deadline. Family Caregiving, there's an amount that was able to be augmented the program that funded AAA education, training and arrest services, that will be negatively impacted. And there were a couple of other programs involving building state and local leadership among AAAs and AAA leaders.

That's a smaller amount of money, but that's going to be negatively impacted as well, including an amount of money that was made available to actually look at the options for network development for AAAs to begin to contract with healthcare. And the amount that will be impacted is actually the amount that would be used to develop a network to attain that end.

So given the impact of waiver end on a wide range of programs, from larger programs like Cal Grows to the smaller programs I've talked about. We urge this Committee and the Legislature to request that the Administration apply for the one year extension of the HCBS waiver for these programs, including the nutrition infrastructure funding that Meals on Wheels will talk to, to the extent that a partial waiver extension is an option available to the state. Thank you.

Thank you so much. Moving on to Brent Wakefield.

Hello, everybody. Good afternoon. Thank you so much for this opportunity. I'm honored to be here. Thank you Chair Menjivar and members, Brent Wakefield, President and CEO of Meals on Wheels San Diego County. But I'm also the President of the Meals on Wheels California State Association, and we represent more than 50 senior nutrition providers across the state.

And they're all different sizes, a lot of small ones, in geographically very diverse, remote areas that don't have much access to funds or to infrastructure, and big ones like San Francisco Meals on Wheels, Los Angeles, San Diego. We, as our agency, we here in San Diego do provide about 650,000 meals a year to seniors across the county, and these are homebound seniors.

So just, I think you all know what Meals on Wheels does, and so that actually equates to about 330,000 touches a year to seniors just in San Diego County. So you multiply that across the state, and the impact we're having on a daily basis is pretty remarkable. And you could imagine during the pandemic, we were all really tapped out. My agency had a 47% increase in demand for services the first month of the pandemic, which was staggering.

We were delivering to about 1300 clients a day, and we went to 2200 a day in one month. So we were kind of wiped out by that. And as were our colleagues. We have some colleagues whose increased by 200%. So what did that do to us? I was raised by my lovely Mexican grandmother, and she would always, if something happened, all of a sudden she would come up with a solution, jerry rig our infrastructure. She called it a chicanada, right?

And it was usually involving a garden hose, a bucket, and some duct tape if it was outside. And if it was inside, it was dental floss, scotch tape, and bubble gum to make something work. And these Chicanadas were really meant to last for a month, two months, and then you look for the permanent solution, right? And we're looking for the permanent infrastructure solution. And we worked with the lobbying firm. We raised private funds to pay them.

And we worked with wonderful people like Michael Costa, who just spoke, and also Susan Demoris. I wanted to give her a shout out in the California Department on Aging. And these people are kind of our brains and the ones who really help us get at the root issues and how we can address these. And we got in front of you all, as they did, and we were able to.

We were happy to get a result in the sense that in June of 2021, the Governor and Legislature responded to our plea and gave us $40 million in general funds for infrastructure, one time only funds. And we were blown away. So we're all celebrating and dancing and doing our happy dance. This, to us, is really what we need to move forward if we're going to continue to do this on a daily basis and save people's lives, frankly. We are isolation interrupters as well as nutrition providers.

And so what happened then is now we've been announced in June 21 that these funds are coming. And then June 15 of 2022, the California Department on Aging issued an update that maintained that the funding end date would be December 31 of 2024. However, a few months later, and driven by this administration's decision to substitute federal funds for the originally approved General funds, the Department of Aging issued a program memo notifying the AAAs, and then it trickled its way down to us that the funding would end a full year sooner, in keeping with the expiration of the federal home and community based services Fund. Basically, here's the language. The entirety of the HCBS spend plan package will expire December 31, 2023. Federal guidance from the Center for Medicare and Medicaid Services allows for states to exercise a one year time extension of HCBS spend plan.

At this time, California, however, does not intend to exercise the time extension and plans to end the HCBS spend plan programs on December 31, 2023. So what we're dealing with now is a spending deadline issue that somebody had mentioned before. And so if you think of us, big Meals on Wheels in California, here in San Diego, where I have 90 employees and I have reserves. I can, if you all say, okay, buy something and then we'll reimburse you because that's really, right now it's a reimbursement model.

I can do that. Right. So one of the things that I'm saying is how are the smaller meals on wheels that might be two or three employees that deliver to 50 people who are probably serving the most underserved communities in our entire state. How are they going to actually front $57,000 for a new van or these hotshots that we call them, which are even more expensive? They have to get a bank loan. And then what we're all dealing with right now are supply chain issues. Right?

So unfortunately, we're not sure that we're going to be able to buy things by that date. A lot of us are trying to get electric vehicles, et cetera, or just even normal Ford trucks that are equipped with the heating unit on the. So I'll give you a few examples here, just so you kind of make it more relatable. Example one is the provider, and that's what we are.

We're your community partners, where your providers that have benefited from all these funds, or we hope to benefit, order an electric vehicle and then they're informed by the manufacturer of the vehicle that it's going to take 12 weeks to get vehicles and then an additional 12 weeks to assemble them. Okay. The timeline is contingent on whether the vehicles are even available from the manufacturer due to supply chain issues. And in addition, the vendor must pay upon receipt of the vehicle.

But the senior nutrition provider may not have received funding yet, or likely won't because you have to have spent the money already and provide an invoice before you're reimbursed, leading to the need for that smaller nonprofit or any other nonprofit in that regard to find funding with banks to get a line of credit, et cetera. And then the second example is a provider had a lucky break, right?

And this actually happened to me. An e-vehicle when someone else had ordered it, they canceled their order and I had access to this. Right. And it's eliminating that eight to 10 month wait time. I'm still probably not going to get that until October or November maybe. And this deadline is December 31 of 2023. So simply put, for a lot of these agencies that are doing amazing work, it's not going to be possible for them to actually purchase the big ticket items.

Now, there are other things, like on my, here's my contract with AAA. I actually have a copy of it here. I've got some of the smaller things like thermal food bags, storage racks and things like that that are just going to take me two or three months to get. The big ticket items that cost the most, that are the most burdensome for my colleagues across the state are the vans, and those are probably not going to be available, if they're lucky, until November because of backlog.

And so some of them aren't even going to get them by December. What we're asking the state is to either request an additional one year time extension allowed by CMS, or commit now to appropriating General Fund Dollars in the 2023-24 budget to offset any of those dollars that are lost. I think it's heartbreaking we finally achieved this mega infrastructure goal and that we might not be able to spend those dollars.

So we're actually right now surveying all of our members so we can come back to you hopefully in a month or so with everybody's contracts, their expected deadlines, when they think they're going to get product, and the dollar amounts too, just to put some specific numbers around there. But I'm really happy to take any questions that I can from this Committee. I'm sorry I have a more folksy approach.

My wonkish friends here are sustaining me with all of your policy matters to try to get the point across. But I can speak on behalf of other meals on wheels across the state, hopefully answer some questions, and hopefully work with you all to provide some solutions. But I appreciate the time. So thank you all so much.

Thank you, Brent. Our final panelist is Tiffany Whiten from the State Council of SEIU.

Hi. Hi there. Good afternoon, Madam Chair and members. Tiffany Whiten with SEIU California, representing over 400,000 long term care workers. Thank you for the opportunity to speak with you all today. I was asked to respond to four questions, so I'll just jump right in. Regarding the IHSS career pathways, training, and incentives, and why it's important to IHSS providers and the recipients.

The home care workforce, including the IHSS workforce, consists disproportionately of women of color and immigrant workers who have historically been excluded from basic worker protections and been subject to poor job quality. It is the workforce that has been too long unseen and unappreciated.

This underscores the importance of the IHSS Career pathways program, a paid and incentivized training program for IHSS and WPCs providers, helping to advance racial, gender, and linguistic equity by reframing and repositioning the workforce as one to be invested in valued and treated with dignity. The program aims to provide high quality, accessible training to IHSS and WPCs providers statewide to stabilize, provide to work to the workforce and encourage the recruitment retention of providers to improve the quality of care for consumers, and to provide opportunities for career advancement in home and health care.

The CPP aligns with California's master plan on aging's 23-24 initiatives to diversify the pipeline of direct care workers by testing and scaling emerging models, to explore opportunities to expand career pathways for direct care workers and to develop an inventory of evidence based training, career ladder, and certification programs that are accessible, person centered, and culturally and linguistically responsive.

The IHSS career pathway program responds specifically to the industry's lack of opportunities for training and career advancement for IHSS providers, a contributing factor to the workforce shortage currently plaguing the industry. No former career ladders exist within the IHSS, and providers seeking career advancement have to look outside of the IHSS program to other professions and industries. This only serves to exacerbate the current and impeding workforce crisis.

We are at a critical juncture and must work to stabilize and uplift the workforce by formalizing training opportunities and building out career pathways within IHSS. What is exactly the purpose of CPP and what they are embarking on? The benefits of paid training are far reaching as providers are empowered with knowledge and foundational and specialized skills through the CPP, consumers can benefit immensely from an improved care experience.

The completion of career pathways and the recognition that comes with it, such as through certificates and incentive payments, can have a profound individual effect on providers, increasing providers confidence, satisfaction adeptness while simultaneously addressing large scale systemic issues like the workforce shortage and increasing profile of the job. Regarding the timeline of the pathways program of implementation, we heard a lot from the Department earlier. The IHSS career pathways launched in Fall 22, with a limited number of classes first being offered starting in October 22.

It opened with an enormous amount of interest and excitement. The CDSS IHSS career pathways web page had about 300,000 hits in a three day period, and classes filled quickly. Courses continued to be added on a rolling basis, including a large release of classes in January 23 and March 23. Whenever cdss released new classes, many, if not all, appeared to reach capacity very quickly. Providers have described their experience encountering full and waitlisted classes during CDSS's multiple informational sessions on the program.

The Center for Career Advancement, or CCA, is currently a training vendor for CPP, and they have also fielded a multitude of calls and emails from IHSS providers who are frustrated and angry that they cannot get into classes that are already full, reflecting a sense of desperation and a genuine desire to enroll in the classes. CCA currently has a waitlist of over 3000 providers. CDSS's courses course catalog will also reveal full classes across multiple training vendors, particularly for those classes that are instructor led.

In CCA's own experience, most classes reach capacity within two to 3 hours of opening registration. The current setup also does not account for attrition, a challenge that needs to be addressed. So if a provider misses a class they signed up for, their seat is basically relinquished because the seat cannot be filled by another provider on the spot. The program is only beginning to tap into the high demand for training and career pathways, and yet classes are set to end in less than a year from now.

I would note CCA is contracted to deliver classes until February of 24, so we would have some questions around that timeline for the Department. Regarding the challenges with implementing the program, in particular with the short time frame available for providers to take advantage of the training opportunity and earn the stipends, as with any pilot program, there have been significant upfront activities and costs to build the infrastructure and processes necessary to establish the CPP. The process has been time and labor intensive.

The state and training vendors have developed and invested in technical systems and infrastructure, including websites and learning management systems, as well as built organizational capacity including hiring, onboarding and training staff. Finding and hiring quality instructors in all the languages needed to teach the diverse IHSS workforce is one example of the upfront activities that took a considerable amount of time and effort for CCA and while the program launched in October 22, implementation has been in phases and the initial releases of classes were limited in number.

In 2022 there were only 37 courses and approximately 140 classes sessions offered. The two vendors from the request of proposal did not start their training delivery until January of 2023, and since January there have been more than 40 new courses and over 500 classes sessions added to the course catalog. Vendors in CDSS continue to ramp up the program and build the course catalog. As the demand is extremely high and classes reach capacity quickly, there is concern that providers will not be able to enroll in enough classes to complete a career pathway by the time classes are scheduled to end, and therefore they will not be eligible to receive incentive payments nor will they obtain real knowledge or skill gain to advance the goals of the program of improved care, retention and job skills. In addition to being paid for their hours spent in training, there are three types of incentive payments which we heard about earlier that encourage pathway completion, application and workforce retention

For completion of 15 hours of courses with the career pathway, the second is for providing at least 40 hours of care to a consumer in the first month after completion of a specialized career pathway, and the third one is for providing at least 40 hours of care per month to a consumer for six months after completion of a specialized career pathway.

The incentive pathways, particularly the type 2 and 3 incentive payments, promote the retention of IHSS providers in the program, but the number of providers who may be eligible to receive these payments 1 and 6 months after training is potentially very limited, especially depending on when the Department stopped accepting claims for this payment. This is counterproductive to the CPP's goal of improving the retention for providers.

As of the end of last year, only about 1000 providers statewide had submitted training claims and there were less than 100 incentive claims submitted. We can reasonably assume this is likely in part due to the limited number of classes offered, which meant many providers were unable to enroll in enough open classes to complete a pathway. Based on the courses available in the fall, it is also probable that most of these incentive claims were for English speakers, which points to the issue of language equity for nonenglish speakers. The full potential of the state's investment in training may not be reached if providers who are progressing through a pathway are forced to cut their learning journeys short when CPP ends. The extension by the state to continue funding the CPP program through all of the fiscal year of 23-24 would help alleviate some of this pent up demand for these opportunities.

Lastly, what ways would additional time to implement support the success of this program? The goals of the CPP are ambitious and broad to advance provider skills, to improve care for consumers, to promote recruitment and retention and build their workforce, and to foster career pathways. These ambitious goals are achievable and would be more impactful if there is additional time to implement the program.

It would allow for more equitable access to CPP so that all languages and ranges of technical abilities have a chance to partake in the program. Additional time to implement the program would also give all stakeholders the chance to explore how to make paid training opportunities and career pathways permanent as part of the IHSS program. On a practical level, if the program were halted and then resumed in the future, the state and training vendors would incur extraneous program costs and would experience needless inefficiencies.

Training vendors would have to cut staff, leading to a deficit of experience and institutional knowledge, and may startup activities would have to be repeated and refreshed, causing delays and duplication. On the ideological level, we share the state's urgency around building a strong direct care workforce as articulated in the master plan of aging. We view the CPP as part of a long term vision and a strategy to support the directcare workforce by cementing training and career pathways into the IHSS program beyond the pilot program stage. Again, I thank you for the opportunity to speak with you all on this very important issue.

Thank you so much. Tiffany, does Department of Finance have any comments?

Yes, this is Hersh Gupta with Department of Finance. I just want to reiterate a couple of the points that Jackie had brought up earlier. So the Governor's Budget reflects that all HCBS funds will be expended by the December 31 deadline. And at this time, the administration does not believe that an extension is necessary.

But based on the feedback that we've heard today, and we continue to monitor the implementation of these programs and are working diligently to expand the funds, as folks like Ms. Filosena have pointed out as well. And I'll also just quickly add that any change to the deadline or shift is going to require a notification to the Joint Legislative Budget Committee and is going to be something that we would consult the legislature about.

Thank you. I'll start off with saying I'm worried that we're not going to be able to expand all the funds by this deadline. I'm worried that if we want to meet that deadline, it's going to be rushed and that these programs aren't going to give the actual impact we're looking to see. Right. We heard from Meals on Wheels smaller entities that are struggling to meet to find, to put money up front.

I worry that with the IHSS entity that right now is struggling to get providers an entity that we desperately need to invest in. And given the deficit, it's going to be hard to find other ways this incentive is needed. So with that in mind, I have a couple of questions. My first one is the IHSS incentive program. If it was me, I would want the $2,000 do the six months. Right.

So if we're ending in December 31 and they're training, they would have to end by June, the training to qualify to work for six months before the deadline. If you anticipate, you mentioned Leora, you mentioned that training is going to go all the way up to December. There's no room for the six months to show proof of that. Can you clarify that process for me, please?

Sure. Thank you so much for the question. Leora Filosena, deputy of adult programs with CDSS so our plan is to start. So we're anticipating the first round of those incentives. Six months incentive payment should be coming in in April. We will have to do a very robust communication out to providers to make sure that everybody is aware of those timelines for those incentive payments. We recognize that the six months is a tough timeline to do, but actually it was a requirement in the statute.

So we've been tied to the six months with the incentive payments. All three of those are laid out in the statute. So we're trying to do our best to support providers to make sure that those that work for people can get it. And one of the things that we did do in response to some concerns that were raised to us through the stakeholder, we had a lot of public calls.

We also had meetings offline with other stakeholders, and there was a concern about that particular incentive payment because initially we had interpreted the statute to say that they had to work for a new recipient. So we actually changed our interpretation because we had the flexibility and we opened it up to everybody who is currently working in the program to get to that incentive payment. So we have been very responsive in really trying to ensure that people have access. It's just the timing and we recognize that.

But I do believe that, I know that's the largest incentive, but I do believe that people will still be able to access the training and get the other incentive payments as well. So at this point, we are just monitoring the situation, trying to figure out what's going on. Like I said, we don't even know how many people will be able to claim that incentive payment until we get that information in. The earliest that would be, would be April of 2023.

And Jackie, you mentioned, is it better to look at it now than later? This notion of monitoring the situation, monitoring until November, is going to be too late. Right. So I'm interested in seeing what we can do sooner than later. My second question to you, Jackie, is can you provide a little bit clarification? You spoke a little bit about what would happen should we not expend all those monies by December 31? Where would that go? Would that be shifted to other initiatives within HCBS or elsewhere?

So that's a question that we would definitely recommend the Legislature seek clarification from the Administration. As the Administration did note, they would provide notification to the Legislature if there were any proposed changes of shifting dollars to existing HCBS initiatives or if they wanted to shift dollars for a new HCBS initiative. However, to the extent that the Legislature wanted to provide just a level of certainty of what ultimately would happen if funds are unexpended in December? That's something that you could also pursue.

Specifically, would you want to specify that unspent funds should remain within their existing program commitments? Another option that I would also raise, too, is our understanding is that the Federal Government allows states to, we could choose to extend deadlines for certain HCBS initiatives. Like I mentioned in my comments, some of the HCBS initiatives, such as the one time payments to IHSS providers, most of that money has already gone out the door. Those payments were made March 2022, so some of them may not require an extension.

However, for those in which the legislature believes they would want to extend it to ensure that every provider has an opportunity for the incentive payment, for example, that is an option that you could pursue. Specify specifically which programs you would want to extend the duration of the program and ensure that any unspent dollars remain in those programs.

To that I would know. We heard from Meals on Wheels how long any new program, you know, shifting funding to a new initiative would just create the same challenges. So I would be interested in maintaining these funds within these programs that you all have invested so much already. I'll turn to my colleagues right now for any questions. Senator Roth?

Well, I'm a little confused. Maybe someone could answer this. What percentage of these HCBS funds that we receive remain unspent? 1 and 2. What's the monthly burn rate? I guess that's you finance.

Yeah. Thanks for the question. Hersh Gupta, Department of Finance, that really varies across the programs.

Well, but just give me the total, because it's hard for me to run a calculator. If I'd been able to do math, I wouldn't have gone to law school, but I'm sure you can.

We got a calculator right here.

I have a calculator. So as I mentioned, my comments, of the $2.8 billion, only 282,000,000 have been spent. So that's just about 10% of funds so far.

And we have about eight to nine months left in this calendar year, which is the timeline that you've indicated the funds need to be spent. Except for the cleanup, that could extend to March of 24, correct?

Right. The remaining funds, under the assumptions that include in the Governor's Budget, would need to be spent essentially within the next eight to nine months without an extension.

Speaking of the extension, is there some process then that needs to be followed in order to obtain an extension? Or is this something that we can just, or you can just let you LAO. The Administration can just decide to do on March 24 of 2024. And it happens.

Our understanding is it's a state decision. There's no application process. We don't have to seek CMS approval. The state can decide to do it. The process in which that could be done, it could be done through statute, it could be done through the budget process. There is existing control section language that the administration has said that if it looks like funds are going to be unspent, they could also just notify us through a section letter.

However, as we mentioned, there are benefits in making this decision sooner, potentially through the budget process, and also just as a part of the budget package itself. So there's a level of certainty because, as we noted, making this decision potentially in the fall, it could create just program disruptions and a risk of maybe programs not being able to modify their contracts fast enough, having to close down and then restart.

Well, given the large amount of funding that apparently remains unspent, has the Administration developed an overall game plan for expenditure? If you think it's going to be expended by December of 23, which you've indicated, is there an overall game plan that's been prepared, given the breadth of the programs, to have some idea of how much money is going to be spent down every month to get to zero by December 31 of 2023?

Yeah, and that's something that each Department is monitoring on their own for their set of programs.

That doesn't work very well, doesn't. I mean, you have departments, and that's why you have a chain of command. So somebody's got to be at the top, whoever is at the top. Does the person at the top have a game plan?

Understood. Yes. Department of Healthcare Services, in conjunction with Department of Finance, are ultimately overseeing the operation and expenditure of these HCBS dollars. And so in April, actually, we're going to get an updated expenditure picture of how much funding has been spent across all programs. And that's information that all departments are reporting up to, Department of Healthcare Services. And so from there, we'll have a much more updated picture.

And actually, the 10% figure that Jackie pointed out is how much funding has been expensed since as of September of 2022. So it is a slightly outdated picture. And I'll also note that for many programs in that current snapshot of expenditures as of September 2022, there are several programs for which very little funding has gone out the door. And I wanted to be clear that for a lot of programs, funding actually might go out in large chunks. And so the picture of what funding remains could change pretty rapidly. In a short frame of time.

Well, let me just. So with respect to the report that you're going to receive in April, I assume you're going to send us a copy or the chair a copy to. Will that report from the agency also include, in addition to the amount of money spent, the monthly projection of expenditures going down to zero by December of 23?

That's something I'll have to double check on with Department of Healthcare Services as they monitor.

The reason I'm asking is that would be nice to know. If we're sort of assuming we're going to finish this thing off and spend the money down to zero by December 31, I think it would be good for the chair to know, the committee to know, the Legislature to know that there's a plan to do so.

Absolutely. And I'll just quickly add that at least if there's not a precise numbers timeline, I know that each Department is being asked their ability to expend funds down for each of their programs. And so that is a key piece of information and part of our monitoring of the implementation process.

Well, just one final, I guess, comment or question. It's my understanding initially that this money that we received enabled the Administration, I guess, and the Legislature, because it's sort of a joint thing with the budget, to free up about $2 billion of General Fund medical expenditures and General Fund in the budget. 2 billion could then be used, assuming something else in the budget. Did I get the number right?

It was 2.8, but the Federal Government, they wouldn't allow states to supplant funding. So then that's why they said, you must reinvest that 2.8 in HCBS enhancements and expansions. But at the time, we essentially were assuming the General Fund is going to pick it up. So it did have an effect of freeing up General Fund, but it was freeing up General Fund for proposals that were categorized as HCBS expansions and enhancements that probably originally in the budget we were going to spend General Fund on.

Well, I guess my question is, if we are all wrong on this and the Federal Government says, I assume you didn't spend it, so you have to give it back.

No, our understanding is the administration's interpretation of what the federal guidance is, is the expenditure deadline is reliant on how long the state will take to spend the funding. Right now, the reason why the Administration is still assuming a December 2023 expenditure deadline is because their projections, they're assuming we're going to spend all the money by December 2023. However, if we reach December 2023, and there's still money on the table. We have to extend the deadline at that point.

Okay. And under no circumstances would the Federal Government be able to claw the money back.

We haven't seen any guidance that says that the Federal Government can claw the money back. But we know that DHCS, they're in constant communication with the Federal Government, but they haven't heard anything of that sort.

But if there happened to be a clawback, it would only be a clawback out of the HCBS programs and have no other impact on our budget.

These dollars are just limited HCBS programs. So in theory, if tomorrow the Federal Government said we want to claw it back. Yes. But again, no guidance has been issued by the Federal Government that indicates that they would call anything back. If anything, the allowance of a one year extension was them hearing from states that sometimes it's taking time to ramp up these programs. So they did the one year extension because they do want states to use this money.

Thank you. Thank you, Madam Chair.

Senator Eggman.

Thank you. And thank you for that clarification. I think Senator Roth and the chair have asked a lot of the questions I had because I was very excited. I mean, that was one of our big thrusts last year, was to make sure we had workforce training and development and career pathways. And I heard the Deputy Director talking and I was excited. And then I heard Tiffany talking and I was sad. So I was wondering where that disconnect came from. So I don't know if anyone could just speak to that part just really briefly.

Thank you for that question. I apologize. I don't want to have my back.

That's okay.

I'm going to try to talk out of the side of my mouth. I think that we have done our best in partnership to really implement something that benefited our provider community. We did not have a long time. This was a nine month implementation of a program that is a very large program and nothing that we had ever done before. So I think that it is a starting.

You know, Tiffany, I'm sure, probably has some additional comments that she'd like to make, but I think that with the time constraints and all of the activities that have been completed, I think that it's a pretty solid program. It is part of the HCBS plan, so that's where we landed. But I'm not sure if Ms. Whiten has any additional comments.

Thank you, Senator Eggman, for the question. I think for us it is. It's a wonderful program. We're all very excited. Unfortunately, if it doesn't live up to the expectations of what we all hoped, then it falls a little bit short of what we were hoping that it would do. It's unfortunate that the program would end in December. It sounds like the claims would be paid out to march. That's still three months short of a full fiscal year.

So we're still cutting it short, even if we get done in March. And to have us come back in another year and say that's the difficulty with one time money, especially on training that should be going ongoing for a population that's going to continue to grow. These providers are going to continue to need training. The recipients are going to continue to need their providers trained in very specialized areas, and we're cutting it short from a fiscal year.

So as an advocate, we of course, would want to come back and say we should extend this program for a longer period of time. We unfortunately wouldn't even get a full fiscal year to kind of see how that plays out and what that looks like so that we can make a determination on kind of funding for an ongoing basis. So we do have a bit of concerns not to take away from the great program that is out there.

I think we all can agree that it's a great program. We just needed to kind of go a little longer and go a little further, and particularly in our opinion, on an ongoing basis so the providers can actually get the training to provide the necessary services to their recipients.

All right. One of the idioms in my head that my mom said all the time was haste makes waste. So trying to rush it, which I loved. Mr. Wakefield, talking about meals on wheels and not wanting to spend it just on silly things because you have to wait too long to get the van that you want. Nobody wants us to spend this money unnecessarily, but want it to have the greatest impact.

So I just really very much want to thank the LAO for bringing this all to our attention. And then just, I guess, to ask the Director, do you think you can make it by 23, or should we really start planning for that extension now? Because I was just back in DC this last week and speaking with different departments, and everybody talked about the possibility of a clawback as things change.

At the Department of Aging, we are working daily with our partners, and as you heard, and thank you for that question, Senator. In the case of the nutrition dollars, our key partners with whom we contract are the area agencies on aging. They in turn subcontract with meals on wheels and other providers. So there is a bit of a cascading effect in terms of contracting.

Also, many of our AAA partners and our community based partners need to obtain board approvals, whether it's their nonprofit board of directors or their county Board of Supervisors, to be authorized to make some of these purchases. So there is a lag involved. But I know that Nicole Shimasaka and her team meet regularly with all of the AAAS on all of the fiscal matters. And we're really working in lockstep to ensure that these dollars are spent by December 2023.

And maybe to the LAO or to anybody. So it's not an issue of paralysis that we have so much money, we don't know what to do and we can't do right. It's just an issue of timeliness and implementation and deadlines. Is that what we're to understand?

Yes, that is our understanding in terms of the most recent number that we have of 10% of the funds being expended thus far. It really is an issue of just some of these programs are completely new programs. Some of them are completely new initiatives that we've never done before.

And it just takes time to get the contracts in place, get the support staff and to implement, and then also, in some cases, for providers to go through the program and then submit their reimbursement claim to then get the dollars out the door.

Okay. Thank you very much. And so, Mr. Finance, you've heard all this.

Yeah, thank mean. I want to be clear, too, that the Administration, as you've heard from all our colleagues here, we care about these programs. We really want to see them implemented and see them do what they were designed to do. And I think we're doing our best to just continue taking this feedback into account, get the latest expenditure pictures to the extent we can as departments collect the information from their stakeholders and partners on the ground.

I also just want to maybe contextualize this, too, within some of Jackie's earlier comments regarding the maintenance of effort requirement that comes along with these funds. And so, as Jackie mentioned, you can extend the deadline for some of these programs to expend all of their dollars, but that maintenance of effort requirement actually still continues to apply to all Medicaid HCBS programs.

And I think just part of the challenge there is that the maintenance of effort requirement actually restricts the state's ability to make changes to some of the other impacted programs that fall under Medicaid HCBs and has resulted in some significant delays in federal approval for a lot of other programs that the state has as priorities with CMS.

So I think there is a double edged sword here, and we're trying to strike that balance by evaluating this deadline in light of the feedback that we're hearing from stakeholders, but very much want these programs to do what they're designed to do and look forward to monitoring the situation.

And is there a way to modify the other requirement on being able to show that?

This is that maintenance of effort requirement? My understanding is that that is set for the HCBs, Medicaid funding at the CMS federal level that was a negotiation with the state prior to that funding going out.

Okay. You agree, Director?

And that's something we can also circle back with. Department of Healthcare Services is really the one who works on that. So happy to circle back. Okay, thank you.

Yeah.

Senator Roth?

I think you answered my question, but I'm not sure I understand the answer. I was going to ask, and my colleague asked it directly, why not just extend? So it's the maintenance of effort issue that is driving the decision on the extension.

That is one of the primary concerns. Yes.

And explain to me, maybe it was covered and I was brain dead. The maintenance of effort requirement, how long does it extend? So if we end the program, if you end the program in December of 23, does that end the maintenance of effort?

The maintenance of effort requirement is the later of whenever we get the last dollar out or whenever the deadline is that we've set to extend the Fund.

I see. So the maintenance, if you spend all the money by December 2023 and do not request an extension, your maintenance of effort requirement stops December 2023. And what you're concerned about is if you extend it for this another year, you'll have a further maintenance of effort requirement, extending another, I guess it's a calendar year, which will drive costs up in some other related programs, less so.

Costs and I think, and more just delays in approval for other programs, other waivers in the Medicaid space, other for social services programs as well. So it's a lot of just process issues on the federal side that this would run into. And then also the actual maintenance of effort requirement pertains to the changes to any of these programs. And so it would restrict our ability to do that in an efficient way.

So I guess it's a balancing act. You have to balance the value of allowing these programs to mature and getting the full benefit out of these programs, which might require an extension versus the impact on these other programs during this maintenance of effort period.

Exactly.

Okay. Well, thank you for your response. Thank you for your indulgence, Madam Chair.

I had the same question, so it was perfect. Thank you so much for this. I appreciate it. Again, reiterate what I mentioned, very interested in seeing what we can do with this extension sooner rather than later. But also to know, it did sound, though, because of those maintenance of efforts concerns that it doesn't look like there's a possibility to extend when it comes to November because those concerns are still going to be there.

So it doesn't seem like it's an option to do it even now or later on. So that, still very concerned about that. And again, I've mentioned before, earlier today, Calfresh emergency allotments with the nutrition program. That's a huge way to close that gap for our seniors. Right. And again, we can't stay here, talk about this forever. I want to, but we would definitely be following up on this topic. Thank you so much.

Great.

We're going to be moving back to the Department of Social Services.

And the. First item on our list is going to be the issue one on an overview, but before that, we're going to welcome back Director Kim Johnson for another opening remarks.

Thank you. Thank you very much, Madam Chair. Committee Members. Kim Johnson, Department of Social Services and as we've moved now to this portion of the agenda related to in home supportive services, I also just want to recognize the recent passing in Women's history month of Judy Heumann, a national and international leader and activist for disability rights. As you'll hear, California continues to lead in supporting older adults and those with disabilities with our in home supportive services program serving over 615,000 individuals across the state.

And you've just heard quite a bit about the career pathways program and the excitement related to the launch of that.

And you've heard Ms. Filosena mention not only the ability to really up-skill the current workforce and how they can support who they're serving today, but also recruit new members of that workforce and also really connect for those who might want to move on to a further healthcare career pathway and quite a bit of investment there that we've made together the Administration and Legislature related to workforce and healthcare career pathways specifically.

So I want to commit to this Committee, given that last conversation and panel, a continued interest in finding those ways to connect existing Members of the IHSS workforce to those other healthcare career pathways and finding additional ways to support ongoing training and support for them. And you'll hear this also as our community care licensing division joins later this afternoon, too. But a real focus, right?

You've heard through the master plan on aging and our priorities in that space that we have to kind of, no matter where an individual having some additional needs is residing, whether it's an adult and senior care setting or in their home, that we are having the right competencies and skill sets of our workforce and providing those training opportunities to support them. So I just want to commit that as an ongoing goal of the Administration as we move forward.

And I also just, Ms. Filosena mentioned it, but I want to just really appreciate the amount of time and energy, both SEIU and their particular CCA program. But the public authorities and the counties and the workforce spent with us in developing this program. Why was it taken up so much? I think that was because they created it, and I think that really matters in terms of how we go forward with program design going forward.

So we're grateful for that partnership and those opportunities to build on what had been done prior and more to come as we go forward. You'll also just hear in these next updates around the Governor's Budget proposal to have that full year of implementation related to the SSI and SSP increase. Very excited to continue that momentum and work.

And you'll also hear from our adult protective services work, new federal funding again, one time in nature, but just incredible opportunities for the counties and the state to build capacity around supporting those participating in our adult protective services program. You've heard about home safe earlier on the panel, and also just expand the service array, looking at different ways we're doing case management in connection to other services that we have.

Finally, you will hear from the community care Licensing Division, who supports childcare, children's residential and adult care settings. I want to say here, and especially given the first panel with synergy and actual provider and delivery of those services, the tremendous work that has happened in these settings, especially in the COVID pandemic for licensing and our oversight, we really did have to pivot quite a bit. We actually created together an infection control module that we were very focused on providing technical assistance and support to these settings.

Given all that, we saw the tragic loss of life in the pandemic, and so so much of our work was trying to be adaptable and resilient, as were the operators of these programs in Covid. And so we're doing a bit of a recalibration in our licensing division now in terms of really getting focused back on our care inspection tools that you'll hear more about and implementing those fully to ensure the health and safety of all those in our settings.

So, I appreciate the opportunity to provide some opening remarks, and I'm also here for questions. Thank you.

Thank you, Director. Our first issue is the overview and in home supportive services. Welcome back.

Thank you, Madam Chair and Committee Members. My name is Leora Filosena. I am the Deputy Director over adult programs. I oversee the in Home Supportive Services Program, the Cash Assistance Program for immigrants, SSI, SSP, and the Adult Protective Services programs. The agenda did a really great job of giving a great overview of the program. I think it really emphasizes the importance of this program as being a backbone of HCBS services here in California.

I could talk about the program forever, so I'll just provide some highlights and definitely answer questions. The IHSS program provides domestic and personal care services to children and adults with disabilities and older adults to keep them safely in their own homes and communities and avoid institutionalization. IHSS is a very large program. We're the largest program in the country that does this, over 600,000 recipients receive services from providers here in California.

And just for the magnitude, I always love to let folks know that we actually issue over 1.2 million checks per month. So it is a very large program. IHSS is largely administered by the counties with oversight of cdss. So county social workers perform an annual in home assessment based on a needs based assessment and determine what services IHSS services a recipient needs based on their ability to perform certain tasks.

Some examples of IHSS services include domestic and related tasks such as basic house cleaning and meal prep or cleanup, personal care service such as bed baths, ambulation, and feeding. There are paramedical tasks that include managing medication and injections. There's protective supervision and accompaniment, as well as some one time services. This is not a comprehensive list, but the authorization of these services often means the difference between someone staying in their home and being institutionalized, you know, I can't stress that enough.

As far as CDSS's role, we do some oversight activities as well as we're considered the payrolling agent and we're responsible for all payrolling activities. That includes the operation of the case management information and payrolling system, which is the system of record for IHSS.

I think one of the most important tenets of the IHSS program, and what I feel I should stress the most is that this is a self directed program, which means that IHSS recipients manage and direct their own care, and their Independence is really one of the most important things about this program. Recipients are served by providers who can be a family member, a friend, or someone else. IHSS providers here's another unique twist to the program.

IHSS providers are considered employees of the recipient and for purposes of hiring and managing the provider. The current budget for IHSS for the 22-23 fiscal year is 18.5 billion. The Governor's Budget proposes a total of 20.5 billion in 23-24 which is an increase of about $1.9 billion. The increase is due to expansion of full scope MediCal to undocumented adults aged 50 and older, regardless of immigration status, the conclusion of enhanced federal funding, and growth in the projected caseload and cost per hour.

The 22-23 costs include a half year impact of the minimum wage of $15.50. And while in fiscal year 23-24 the IHSS costs include a full year impact of not only the 15.50 minimum wage implementation and a half year impact of the $16 minimum wage implementation. So that's kind of a highlight of the program. I'm glad to answer any questions, or we can move on to the second question.

Any questions, Senator Roth?

Just a quick one. I've been out of this world for several years, but I remember back when we had payrolling issues. I assume the payrolling is going smoothly and there are no.

Oh, that's a great question. Thank you for asking that, because we can actually take credit for something that actually went really great. So we have implemented electronic timesheets. So it was an initiative that we started a few years back with the. We built the electronic services portal, and it has improved timesheet processing exponentially. So at this point, about 99.9% of our providers are using an electronic method to submit their timesheets.

And if they're on direct deposit, they're actually getting their paychecks within three to four business days. And I've been in this program for a long time, and that was unheard of back then. Right. We got a lot of complaints. It was taking two weeks to get people's checks, but now we're seeing people get paid in three or four business days. So those payrolling issues have been really resolved with going electronic.

Thank you for the great effort, by the way. It's rare that people say they like my questions, so I appreciate that, too.

I actually do have a question. Given that MediCal was expanded to undocumented individuals, what is the impact of the actual utilization of that on the IHS program?

So we are seeing, So, it is a phased in approach on that piece and I apologize, Madam Chair, are you asking from a fiscal standpoint or from a program standpoint?

Workforce. Fiscal. Both yeah.

Sure. So I would probably defer to my Department of Finance colleague on the financial piece. We are seeing an increased caseload, but it is really a phased end. So, right now we're dealing with. Not dealing with, we're actually including individuals who, I believe, mostly minor cases, and then there's a phase in for those that are 50 years and older. For this fiscal year, we have not seen a huge increase in caseload as of yet. We are monitoring that, though.

So these cases will be part of our IHSS residual, which is our state funded IHSS program. We are monitoring that. We have not seen a huge influx of cases, but that doesn't mean it won't happen as we go. We do anticipate there is going to be a bit of a phase in. So, as far as the fiscal impacts, I would defer to Department of Finance on that.

Yeah, Aanam Khan, Department of Finance. Leora is correct in speaking in terms of the undoc. 50 plus expansion. We're phasing in the cost for both the services and Administration, so we're not going to see cost fully implement. We have a limited number of costs included in current year's budget with the bulk of the funding coming in in budget year due to the caseload.

Thank you so much, Or Leora can you also speak about the IHSS backup provider system?

Sure, definitely. So we have implemented the IHSS backup provider system that happened in October of 2022. As far as we are aware, all counties have confirmed that they have a backup system and it's up and running. Our current utilization rate in it is very hard. It takes a little bit of time for us to get that data because of the way providers submit their timesheets. So, we don't have any insight into how many people are requesting the services.

We have insight into how many people get paid to provide those services. We have heard anecdotally that finding backup providers can be difficult sometimes depending on the area of where the recipient lives and or their needs. But I do want to make sure that I mentioned that our experience with the counties administering these programs is that they are very diligent about really working and trying to find people backup providers when they need them.

I'm not sure if there were any other questions that you had with regards to how that it's up, it's running and of course we continue to listen to our stakeholders and their feedback and provide technical assistance to counties as needed.

Perfect. Thank you so much. Does LAO have any comments?

Thank you, Madam Chair Jenny Bella with the Legislative Analyst Office. As you heard today, there are no major new proposals for the In Home Supportive Services Program in this budget. That said, there are a few things we're monitoring and expect some updates for at the May revision. The first is what was previously mentioned is the enhanced federal funding for the program. Now, this is not the HCBS spending plan enhanced funding. This is federal funding that was associated with the public health emergency.

It was a 6.2% increase that we started receiving for the In Home Supportive Services Program and really all of Medicaid back in the beginning of January of 2020. So we have been having that enhanced federal funding which has offset general fund costs in the program for several years. The administration's budget assumes that that enhancement will end at the end of the current year and therefore general fund costs will kick in in the budget year.

Since the development of the budget, we have learned from the Federal Government that there is a bit more federal funding available in the budget year. So there will be some of that enhancement ramping down. So we expect some additional federal funding that will offset general fund costs in the budget year, and we expect to see that updated at the May revision.

The other thing we're monitoring is just overall, we always are watching the caseload and checking the administration's estimates against the most recent actual claims for the program. And one trend that really emerged during COVID was sort of for a long time, we see, of the cases authorized, about 91% of those cases submit a timesheet every month. And as you heard, the timesheets aren't necessarily regular, but on average, about 91%. And during COVID we saw that fall to about 88%.

And there's a variety of reasons for that. There could have been recipients, could have been hospitalized. There could have had hesitancy to have a provider come into their home during that time. In recent months, we've been seeing that number actually get closer to that pre-Covid average. So we're watching that and hope to have some updates again at the May revision. And finally, the last thing we're really watching is the implementation of all of these new initiatives that you've heard the Department is undertaking.

They're slower to start, but could be picking up faster. So we'll be watching that and hope to have some updates with the more recent data at the May revision as well.

Does DOF have any additional comments?

Yeah. Aanam Khan, Department of Finance. Nothing further to add at this time, but happy to answer any questions.

Great. Thank you so much. We're going to move on to issue number two, IHSS wage supplement.

Thank you again. This is Leora Filosena. I'm being joined by my colleague in case there are any technical questions. Leora Felosina, I am the Deputy Director of adult programs for this. Again, the agenda had a really great overview of this proposal. So essentially, just to kind of take it down to its brass taxes. What we want to do is update the statute so the wage supplement for IHSS wages works the same for all counties. Now that minimum wage is $15.50 an hour

So this is really kind of making a change that benefits three counties, but it actually is making the wage supplement more equitable now that we're at $15.50 an hour.

Does DOF or LAO have any comments? DOF

Aanam Khan, Department of Finance. Nothing further to add, but happy to answer any questions.

We view this as technical, and we have no concerns.

Colleagues, thank you. We're going to hold this issue open and move on to issue number three. The overview of SSI and SSP.

Thank you, Madam Chair and Committee Members. I'm Danielle Morris. I am the Chief of the Fiscal Appeals and Benefit Programs branch in the Adult Programs Division of the California Department of Social Services. So, the agenda did provide a thorough overview and review of the program and budget for SSISP. But there were a few key items which I wanted to touch on. SSISSP provides a monthly cash benefit to enable age blind disabled Californians to meet their basic living expenses.

SSI is funded by the US treasury and SSP is funded by State General Fund. The Federal Social Security Administration administers both SSI and SSP for the state, and it currently serves 1.1 million recipients in 20 different categorical variations, such as independent single adult or aged or disabled couple. So the governor's proposed budget includes a continued investment from the 2022 Budget act of increasing the SSP grant payments by 8.6, projected to be 146,000,000 for a half year cost, effective January 1 of 2024.

These increases are intended to restore SSP grants that were reduced during the recession of 2009. I don't know if there is any specific questions, but I'm happy to answer them.

DOF any comments?

Aanam Khan, Department of Finance nothing further.

Jenny Bella LAO, just one technical note. We just wanted to mention that the 146,000,000 proposed for the SSP grant increase is really the amount of the grant increase that will actually occur is an estimate, right? So the dollar amount is certain, the 146,000,000 is the proposal. And once we get closer to actually the time that the grant increase would happen, the Administration will perform an estimate to see what is the current caseload and how much of a grant increase can we afford with the 146,000,000?

In the past, when we've done that, the Legislature has also included Trailer Bill Language that really lays out that methodology. I just explained where the Administration does that math and comes back and reports to the Legislature in the fall before the grant increase goes into place, we just recommend the Legislature consider whether or not they would want that Trailer Bill Language again that would set out the parameters of how the grant increase would be determined and include that report back to the Legislature.

Thank you so much colleagues. Great. We're going to move on to issue number four, an overview on adult protective services.

Good afternoon. My name is James Treggiari and I'm the Program Administrator for Adult Protective Services. Adult Protective Services is a county-led CDSS-supported program that aids older adults aged 60 and older. Independent adults who are unable to meet their needs are victims of abuse, neglect, or exploitation. By far the most common type of abuse reported is financial abuse, followed by psychological emotional abuse, neglect, and physical abuse.

These makeup almost 94% of the over 400,000 cases of abuse reported to APS over a recent three-year span. The APS program provides 24/7 emergency response to reports of abuse and neglect of older independent adults who live in private homes, apartments, hotels, hospitals, and health clinics. APS social workers evaluate abuse cases and arrange for services such as advocacy, legal support, counseling, money management, and housing stabilization. Client services must be holistic, taking into account the many needs that clients have.

Support is often needed in most cases around self-care, independent living, ambulatory difficulties, and cognitive difficulties. Although APS helps clients from 18 to over 100 years old, 36% of our clients are between the ages of 65 and 74, and 28% are between the ages of 75 and 84. Most common reporters of abuse are family members, social workers, medical personnel, and financial professionals.

APS social workers conduct in-person investigations on complex cases, often coordinating with local law enforcement, assisting older adults and their families navigate complex systems such as conservatorship and local aging programs.

CDSS assists the county programs with policy and procedure guidance and development, data and reporting for federal grants, developing a robust set of trainings for APS workers statewide, and coordination with other state programs through efforts like the Master Plan on Aging to ensure older adults have access to the resources they need to successfully recover from abuse. Finally, I want to highlight the release of the APS statewide public dashboard, which is now available online.

The new dashboard utilizes data supplied by every county to give a snapshot of APS's cases and clients. It also provides longitudinal trends on 20 case-related metrics. The dashboard, updated on a monthly basis, includes statistics on active cases, closed cases, staffing and demographic data, types of abuse, services provided, and much more. With this dashboard, the public can better understand how elder abuse is impacting older adults in California communities and what APS is doing to respond.

These metrics and trends help APS plan for the current and future needs of older adults in California. So I'll stop on the overview question and see if there's any questions.

Turn it over to Department of Finance for any comment.

Aanam Khan, Department of Finance nothing further.

LAO?

Nothing to add on the overview. Thank you.

Colleagues, any questions? Great.

And then I'll move to the second question was regarding the implementation of federal APS grants and the APS expansion in the 2021 budget. COVID-19 relief funds were primarily distributed directly to the counties to allow for flexibility in how best to support their local programs and clients. Some uses included emergency shelter, technology for staff to reach clients, and expanding extended case management capabilities.

With ARPA rounds 1 and 2 funds, again, a majority of the funds are being given to the counties to direct to their programs to address and support local needs to the particular needs of their community. In addition, CDSS is using a portion of the ARPA funds to implement three statewide programs to benefit all APS programs in the state, which in turn benefit all older independent adults who need assistance from APS. Starting in spring of 2023, APS social workers will be offered a course from Cornell titled Interviewing for Decisional Abilities.

This interactive training and toolkit will allow APS workers to better understand and address the functional limitations of clients served and how best to respond. Second, APS contracted to integrate an online financial abuse reporting tool named Helpful. Through this tool, banks will have the ability to easily and quickly make financial elder abuse reports to APS and upload relevant documentation. This tool is expected to significantly shorten response times to claims of financial abuse from banks.

Third, APS contracted with the California Social Work Education program to provide stipends to Masters of Social Work students. This program is designed to address the frontline worker shortage for the APS programs are experiencing across the state by giving stipends to 110 MSW students to focus on working with older adults. The students receive a stipend for one year and in return commit to working for APS for one year post graduation. Effective of January 1, 2022, APS was expanded.

The definition of older adult was changed to 60 and older. Prior to this change, an adult between 60 and 64 would have to qualify as a dependent adult to receive APS services. The expansion also broadens the definitions of certain forms of abuse that enables APS social workers earlier intervention to prevent homelessness, as discussed earlier through the Homesafe program. The APS expansion broaden. Additionally, the program expansions allow the counties to do more extensive case management with APS clients.

CDSS is working with county APS leadership in several workgroups to help better understand the implementation of extensive case management. This includes an APS-focused workgroup with the Elder and Disability Justice Coordinating Council of the Master Plan on Aging and a county-led APS consistency workgroup. Additionally, the Budget Act of 2021 also required CDSS to explore options for a statewide APS data system and submit the findings in a report to the Legislature.

CDSS facilitated four virtual meetings in 2022 with the APS Data Workgroup, held public stakeholder meetings to discuss California's options for a statewide case management system or data warehouse system, as well as gather and evaluate data and feedback obtained throughout the stakeholder process. The report was released in November of 2022, and it identified three recommendations for a statewide system for the APS program that includes a state-built case management system, a vendor-built commercial case management system, and a data warehouse.

The report does not identify a preferred option, but rather identifies advantages and challenges to each of the considered systems, and with each recommendation, we recommend we continue to explore these options with additional input from stakeholders and further conversations regarding the required IT and system support these systems would require. That's the end.

Sorry. Yes, DOF any comments?

Aanam Khan, Department of Finance nothing further.

Nothing further.

Thank you. Quick question. You mentioned the MSW slots for the stipends, you know, way to retain them. Are you seeing that they leave after that one year shortly? Are you having trouble even filling those slots, given the workforce shortages we're having?

So the 2020 act was an expansion of a pilot program with those students that was initially offered only in a couple of MSW programs. I'm not sure if we have quite seen yet. We will have to take back the question as to whether we've seen retention yet because I'm not sure that the program's been had enough time to mature to know that if we've had any retention issues with those MSWs coming out of the program.

But we will definitely monitor that, especially with the expansion. And also considering the statewide issue and shortage, we're making sure that the MSW offering is offered throughout the state at different schools, geographically, all around the state, so that it's not located just in the urban centers, but that we're focusing also on getting MSWs in these programs to rural areas as well.

Thank you. Senator Roth? Great. Thank you so much. We're going to move on to issue number five, an overview of Community Care Licensing Division and welcome Kevin Gaines.

Madam Chair, Committee Members, good afternoon. Kevin Gaines, Deputy Director for Community Care Licensing Division with the Department of Social Services. I'll go ahead and get started with a quick overview of the Division and then we can answer your questions regarding our inspection protocols and updates, and then we can get to the proposals with your permission. So quickly, the mission of the Community Care Licensing Division is to promote health and safety, and quality of life for each person in community care through the administration of an effective collaborative regulatory enforcement system.

So we deliver those services in four program clusters. We have a rather large childcare program. We have a set of residential programs which include children's residential and a larger adult and senior care program that you've heard about in previous items in this hearing. And we have a relatively new service called Home Care Services. And we'll discuss a proposal on that in the coming minutes. Just some basic statistics on what we're doing across the state.

We have 1,566 authorized positions operating out of 18 locations throughout the state, providing licensing and oversight services to approximately 66,000 facilities and licensees of 32 different types. And together those serve about 1.3 million California residents. The bread and butter. The basic activities that we're involved in are license applications, complaints that occur within facilities, and inspections. Some of those are annual, some of them are on a different timeline, and I'll describe those as we get to inspections.

We also provide policy services, obviously instructions to the field. Just to give you some sense of the volume that takes place there. Over calendar year 2022, 28,000 facility inspections, case management visits, about 13,000, complaints investigated, 14,000. And we processed about 5,600 licenses, applications for new licenses. So we had a rather large workload that descended upon us due to the pandemic and between inquiries and investigations and complaints and other work.

Just to give you a sense of scope, just under 4,000 inquiries that were COVID-related. Hotline calls and complaints we handled during 2022, about 37,000. So I'll take your questions or I can go to our overview of inspections.

You can continue in the overview.

Okay, thank you. So recently, I guess prior to the beginning of the pandemic, we had an intention to move to a set of new inspection tools that will provide a really comprehensive look at the relative health of a facility. And so we had an opportunity during the pandemic to implement that new inspection protocol across all of our program clusters. And so I'll just provide you an update of those. That set of tools is called the Care Tools.

And so until March 1 of 2023, the adult and senior care programs focus their annual inspections on COVID-19 inspections and infection control activities. And we primarily use the Care Tool to monitor infection control activities there within facilities. And that's one domain of 12 domains of the full Care Tool for adult and senior care. These focused inspections were due to the high-risk settings of adult and senior care facilities and had the maximum effect of mitigating and preventing the spread of COVID-19.

The adult and senior care programs have completed their transition, however, to the full slate of Care Tools as of March 1. Did you have a question? Okay. The childcare program has been using the full slate of Care Tools since fall of 22 for all of their prelicensing and annual inspections, and is beginning to work on the creation of a single licensing tool to align with statutory requirements.

As for the children's residential programs, they're using the full slate of Care Tools for annual inspections in 12 facility categories and 11 facility categories for pre-licensing inspections. Children's residential program is in the process of developing care tools for their remaining smaller facility categories. Just to give you some numbers, the adult and senior care program has an annual inspection mandate in statute and met 85% of that total for calendar year 2022.

Childcare program has a mandate to inspect all facilities within three years, and at this point for calendar year 2022, they completed 45% of their inspection, so they're a little ahead of schedule. As for children's residential, their inspection mandate is a biennial one, and so with 55% of their inspections completed for 2022, they're ahead. And that is the update on our inspection protocols. If there's any questions, I'm happy to take those now.

Does DOF or LAO have any comments before our questions?

Diana Dominguez, Department of Finance, no comments.

Angela Short with the Legislative Analyst Office. Nothing to add for the overview.

Thank you. Mr. Gaines, can you speak know of these inspections? Is there a high percentage of things that you flag or your team is flagging to be worried about?

Worried about? No. In my tenure, I'm two years into the post as of February, and I've made it a point to visit each of my regional offices and to attend with an analyst. Inspections, complaints, other aspects of the job at least twice a month. And as I've observed, every inspection, because the tools we're using are so comprehensive, every inspection will generally turn up something.

The majority that I've seen are technical violations, ones that are not something that we'd cite relatively minor issues that don't pertain to health and safety at all. Every now and a blue moon will see and observe a larger-scale issue that may involve an immediate correction or a time correction that we would time over a week. An analyst would provide a week to provide a specific remedy to the issue. Give you an example.

In a childcare center I visited back in Palmdale in the summer of 22, there were exposed electrical outlets that were in immediate adjacency to children who were playing. We gave 24 hours to close those up. That deadline was met. That's an example of a relatively frequent observation that our analysts would see.

And then my final question is, what's the collaboration look like with the ombudsperson for these kinds of complaints?

The long-term care ombudsmans, they find themselves in adult and senior facilities, and they have freedom of movement within those. We see a lot of referral traffic. We receive complaints from the Ombuds Office, the local ombuds in various counties, and we maintain a relatively close, collaborative relationship. Our regional offices respond quickly to their complaints. Anecdotally, I hear that they hold regular engagement meetings to discuss issues of local concern. I think there's a very active relationship there.

Thank you, Mr. Gaines. Senator Roth.

Sir, what group of facilities has a 45% inspection rate every three years?

Our childcare program has a statutory obligation to visit all of the facilities within a three-year time period. We're at 45% as of the end of 2022.

Are you concerned about that?

Am I concerned about it? In terms of the ability to complete our obligations within three years? No, I'm not. For childcare, that's our biggest program, the biggest volume, but it's our biggest workforce as well. We see a fair amount of diligence to completing those mandates, as well as the complaint backlog is fairly low within our childcare program. I'm particularly proud of that piece of our division.

Of the facilities in your portfolio. Would you describe that as a low-risk, medium-risk, or a high-risk operation?

Childcare?

Childcare.

I would see it as low-risk, but always demanding of due diligence.

Odds are you're not going to be inspected in three years if you have a 45%.

No.

Do I understand the figure?

No, you're misinterpreted.

Probably.

The statutory mandate has us at mandates that we see everyone within a three year cycle. We are just about halfway done with that within one year.

Oh, I see.

So we're ahead of schedule.

I see. So I'm not concerned then.

I wouldn't be if I were you.

But you gave me a 45% figure. That's what confused me.

Yeah. We're 45% into our obligation in one year to complete within three years.

You can understand my confusion.

Yes, I apologize.

No problem. No further questions.

Thank you so much. Great. With that, then we're going to move on to issue number six, which is the Home Care Fund Stabilization.

Thank you. Kevin Gaines, Social Services. So, the agenda provides a pretty comprehensive overview of this proposal, but I'll just make mention of a couple of key items. The Home Care Program was initially established in 2016 as a 100% fee-funded program. This structure was created under assumptions about program revenues and operating expenses that have since been proven incorrect. Due to lower-than-projected revenue from unlicensed home care organizations, a critical shortage of personnel for inspections, and increased legal expenses.

The Home Care Program isn't currently sustainable as fully fee-funded as we originally intended. This particular proposal creates some statutory changes to stabilize the funding using state General Fund for 23-24 and for fiscal year 24-25 as well as a deferral of 711,000 General Fund as a loan repayment in fiscal year 23-24 and it also provides for 15 positions to increase our capacity to license home care organizations.

So nine of those requested staff would be to create an additional enforcement unit to conduct inspections and investigations, and it will provide a policy unit to provide some policy guidance for the maintenance of the program. Our data indicates that far fewer of our home care organizations sought licensure than we hoped they would at program implementation. 1,217 home care organizations applied for licensure rather than the expected 2000, and that led to a revenue shortfall of approximately $4 million.

Currently, we have 1,844 licensed home care organizations and it's estimated that we'll have 1,100 home care organizations operating without a license, which is obviously problematic. With the additional enforcement unit, we'll hopefully see an increase in regular inspections as well as an unlicensed complaint inspection capacity to perform. With these existing resources, the program completes approximately 65 visits per month, and with the requested resources we can increase that to approximately 400 visits per month.

We think this proposal is necessary to maintain the stability of the program and this program is pretty important as it ensures that older and disabled Californians receive a high standard of care while being able to maintain age in place and maintain their own homes. We think it's pretty important and hopefully you'll agree.

Thank you, Mr. Gaines, does DOF or LAO have any comments?

Hi, Diana Dominguez, Department of Finance no comments, but we can answer any questions.

Great.

Thank you. Again, Angela Short with the LAO. Just some brief comments on this. As you just heard from the Department, the Home Care Program since its creation was envisioned to be a self-sustaining program. However, given a number of challenges that has not yet come to fruition. As such, we find the request to add the positions to be able to increase enforcement inspections, increase licensing fee collection certainly makes sense.

We would also just add we find the administration's plan to reevaluate the fee structure to hopefully be able to establish a fee structure that can lead to the fund becoming self-sustaining in the longer term to be quite reasonable and the interim request to pause the General Fund loan accordingly also we find reasonable. Finally, I would just note, as described in your agenda, there is some trailer bill language aligned with this program that has not yet been made available for review.

But we will review that when it becomes available, and we'll certainly circle back with Committee staff and with the Department to discuss any comments we have at that time. Thank you.

Do we have a timeline on when that trailer bill language will be available?

Hi, Diana Dominguez with Department of Finance. The trailer bill language is still with Leg. Counsel, so it should be available soon.

Perfect. Thank you. Senator Roth any?

Well, just a comment. We see this in the DCA situation or issues, too, where we license people. We sort of insist that they be licensed, and then we tell them that they're going to fund 100% the licensing operation and the enforcement operation. And from a personal standpoint, I think that's the wrong sight picture when we're talking about consumer protection here.

I think it's one thing to require licensees to pay for the licensing itself and perhaps some of the ancillary services surrounding their own license, but to turn to licensees who are performing as they should be performing and say you're going to pay for other people's misconduct, and that's what drives up the cost in enforcement and litigation and all the rest, I think that's the wrong sight picture. That's just my comment. We'll see how this plays out.

I suspect it's going to play out the same way it does in a DCA arena where we license occupations and professions, and we keep having to drive the license fees up because the cost of government continues to go up. So I look forward to having the continued conversation with you on this particular one because it looks about the same to me. But thanks for continuing to work the problem. Thank you, Madam Chair.

Thank you.

Thank you. So we'll hold this issue open and move on to issue number seven, reinforce the caregiver background check system and background check resources. And welcome Greg Oliva.

Madam Chair, Senators and staff, good afternoon. Greg Oliva, Assistant Deputy Director for Central Operations and Community Care Licensing. I'll move right into the questions, the first one being to provide an overview of the proposal. So the Committee agenda provides an excellent overview of the program background as well as the proposal. To clarify, CDSS is requesting $1.5 million total to do for two purposes.

The first is $300,000 for each of three years to support the maintenance and operation of the Guardian Background Check System for a total of $900,000. And second, $600,000 over two years for consultant services to support CDSS's project approval lifecycle, stage two activities, as well as laying the groundwork for stages 3 and 4. This process will help us determine the most effective means to build a new background check system.