Assembly Budget Subcommittee No. 1 on Health and Human Services

Good afternoon and welcome. This is the Assembly Budget Subcommittee Number 1 on Health and Human Services. Today we will be discussing Aging and Long Term Care services and supports for older Californians in the human services space. It we are having an in person hearing here at the state capitol in room four. 44. Most panelists today will be in the room and presenting in person. We will have two panelists who are testifying remotely.

We are accepting public comment at the end of the hearing, both in the hearing room and on the phone. The phone number to connect is on the Committee website and should be on the screen. If you are watching over the Internet. The number is toll free 877-692-8957 and the public access code is 131-5444 if you encounter any problems, please contact the Assembly Budget Committee at 916-319-2099 and a staff Member will assist you. Those wishing to testify in person may do so when we start public comment.

That will be once we've completed all of the discussion issues on the agenda. We will begin public comment after all of the Members have concluded their questions for those panels.

There will be no votes taken in today's hearing and I want to note that we are accepting written feedback through the sub one email account and the address is budget sub one at ASMCAGov. Before we invite our first panel to begin, I'll make a few introductory comments and open it up to my colleagues if they would like to do the same. Today we are talking about programs, issues and needs concerning older adults.

We have worked hard over the past several budget cycles to build up, to expand and to fortify our major programs expanding the in home supportive services program to align with MediCal expansion efforts to more of the undocumented community increasing grants to the SSISSP recipients and implementing Calfresh expansion for this community creating programs interventions for seniors at risk of and experiencing homelessness and investing in the Older Californians Act and Area Agencies on Aging Programs.

The Great Recession saw tragic cuts to Aging and Long Term Care programs across the board. The Legislature and the Governor have together rebuilt these programs now in accordance with the master plan of aging that is focused on equity and community based services. While we are looking at a fundamentally different kind of budget outlook this year, we are mindful of the commitments we have made in the master plan and all of the carefully laid out protective efforts to prevent cuts to these precious and life sustaining programs.

With that said, I am grateful to all of our panelists who are here in person. Thank you to the Members who are attending and I'll open it up to my colleagues to see if they would like to make any comments. Dr. Jackson,

Thank you very much, Mr. Chair. Obviously, such an important subject now and even more important subject in the future. We know for sure that we have a huge wave coming, and we can see it coming. This is not going to be a surprise and shame on us if we're not prepared for it. We know we need more senior housing and supportive services when it comes to those things.

If you're like my grandma who's refusing to leave her home, and if you wanted to take care of me, you're going to have to move in with me. And that's what my dad had did, ended up moving in with her, but she was not going to leave her home, but she did her job, and now it's time for us to do ours. So, so many things that you've already outlined, Mr. Chair.

But one thing is for sure, this is something we can actually be prepared for if we think long term, if we are disciplined and we make sure that we get the basics right. And so, looking forward to learning more today. Thank you.

Thank you. With that, we will begin with issue one, which is our first of two overarching oversight issues. For this issue, we will focus on programs under the Department of Social Services and impacted communities. As a reminder for those panelists who are presenters, please present in the order that your name appears on in the agenda. I'd like to remind all of our panelists to please limit your remarks to five minutes maximum when possible.

Given the density of our agenda of speakers today and our desire to turn to public comment before too late this afternoon or early evening, we will have 10 presenters on this panel for issue one, beginning with Director Kim Johnson from the Department of Social Services. Please begin when you are ready.

Thank you and good afternoon, Mr. Chair. Dr. Jackson. Kim Johnson, California Department of Social Services and want to just thank you for your opening remarks and providing this opportunity to highlight both the programs within the Department of Social Services that are focused on older adults and persons with disabilities and the trends we are seeing as we administer these programs throughout the state. As is mentioned here, California's population is aging.

By 2031, in four Californians will be age 60 or older, and these older adults will be more culturally, ethnically, and linguistically diverse than ever before. This means that California has a responsibility to ensure that we are building our services, supports, and our workforce to meet the need. We also know a significant number of older adults in California live in poverty. In 2021, 12.3% of adults 65 and over lived below the federal poverty line.

And as your agenda points out, that older adults are the fastest growing group experiencing homelessness across California. Because the Department of Social Services administers a significant number of programs targeted to support low-income Californians, we are particularly focused on ensuring Californians who may be aging without significant personal income or resources are still able to have stable housing to age in place safely.

Including your grandmother, Dr. Jackson, to have a caregiver of their choosing, and to have income and food security to meet the increased needs as more Californians age, and some with significant challenges, the Governor and Legislature, as you have pointed out, have invested at significant and historic levels and expanded eligibility to ensure people can access the supports and services that they need.

As we have launched and expanded these programs, we have done so focusing on a set of core principles. Number one, a commitment to embedding equity in our programs and policies, which includes ensuring language access, among other items, using a person centered approach to think cross programmatically and cross divisionally. Because, again, we are here to serve people and not programs.

The third is to engage our stakeholder community throughout the state and to utilize the expanded public forums created through the master plan on aging to have difficult and necessary cross cutting conversations, and also to use data to inform our decision making. So we make sure we're reaching out to Californians across the state and using that to inform our decision making.

Since the launch of the master plan in 2021, the Department of Social Services has been involved in over 35 different initiatives across all five goal areas, and I'll cover some of those highlights in just a moment. I've previously spoken with this Committee in previous hearings about ensuring that we as a Department are intentionally organized in a way that facilitates integration and connection across our programs. And in this case, that's no different.

In 2021, I shifted our directorate support to ensure there was a Chief Deputy Director responsible for advising and assisting the formation of policies and practices, including the community Care Licensing Division, where again, our adult and senior care settings are supported disability determination service adult programs, which includes our in home supportive services program and our housing and homelessness division. So again, intentional leadership and support to make those cross connections real.

And we have, in fact done that just as we speak to our investments in housing and homelessness. Over the last two years, California again has significantly invested in the department's programs to ensure older adults have access to housing supports, case management, and affordable housing options. Just some examples of this cross coordination that I want to lift up is kind of across the board in these programs.

But for example, even through the pandemic project roomkey was established and we were intentional about thinking about unsheltered populations who would need also access to in home supportive services. How could we make that a reality in this innovative model that again became a national model across the country?

That program served more than 61,000 California since its launch, and we have great results across the counties who have implemented that have transitioned individuals participating in that program into permanent housing solutions, and grateful for that effort to continue through the course of this fiscal year. As we look across the trends with adult and senior care settings and look at stabilizing and expanding more options in the long term care continuum, this includes the launch of our newest program, the Community Care Expansion program.

And so together again, the Governor and Legislature have invested $860,000,000 to expand housing options for older adults applying for or receiving SSI and SSP or cappy or at risk of experiencing homelessness. And as of February, CDSS has announced a total of 207,000,000 through the capital expansion component of this program for 32 projects across the state. We're continuing to review our applications and making awards on a rolling basis.

Additionally, we've awarded $249.5 million to 35 counties for their preservation programs, which include the operating subsidy payments for licensees. Also want to note that the $350,000,000 we've invested together to be spent over multiple years for the Housing and Disability Advocacy program, which now serves older adults and people with disabilities experiencing or at risk of homelessness in 57 counties. It also includes two tribes that are administering this program. Since its launch, we've enrolled more than 500 Californians and helped permanently house more than 2800 individuals.

Six months post exit of the program, 80% of the participants retained that housing. We also have, of course, $185,000,000 we've invested to be spent over multiple years for our Home Safe program, which serves elders and dependent adults experiencing at risk of homelessness and that is across all 58 counties and since its inception, we have enrolled more than 5600 clients and provided more than 2000 instances of housing related financial supports. Six months post the exit of this program, 85% of participants have retained housing.

As we turn to in home supportive services program as part of our medical expansion that you mentioned, now serving undocumented adults a California for all as we continue to strive towards 50 or older and ensuring that they receive the in home care they need regardless of immigration status is tremendous.

In that expansion, we also, of course, which you'll hear more about, have launched the IHSS Career Pathways program, a 300 $1.0 million investment that's providing multiple prongs to both retain and upskill the existing workforce to recruit new in home supportive service providers, but also for those who want to move on to other healthcare career pathways, giving them those connections to the healthcare workforce system.

The IHSS program has also launched a new permanent backup system, again building on lessons learned in the pandemic and temporary systems that is now permanent to help IHSS recipients avoid disruptions in care. And again, that's operating across the state and all 58 counties.

Also, in terms of the Adult Protective Services program, it's great that we have had additional federal investment that we haven't had prior, but also, again, the expansion to include the definition of elder to include everyone 60 and older to ensure people can again live free from abuse and neglect. We've invested over $70 million in 2021 to support this expansion and an additional 9.2 million for ongoing social work training for those working in adult protective services.

Finally, California increased the state supplemental payment level by 23.95% starting January 1 of 2022 and another 10.3% on January 1 of this year. Additionally, the Administration is proposing another approximate 8.6% increase effective January of next year. And the cash assistance program for immigrants, also known as cappy benefits, have been increased at that same pace as the SSISSP grants to ensure again, we are a California for all in ensuring immigrants have access to the same level of support.

The maximum grant level for an individual this year is 1134 dollarsventy three cents and for a couple, 1928 dollarsixty two cent. The projected maximum grant level for an individual in 2024, with the 8.6% proposed increase of the federal amount, will be $1,193.62 for an individual and 2036 dollarsforty $0.09 for a couple. So again, we know that many older Californians, especially those that are Low income or experiencing homelessness or abuse or neglect, are facing serious and ongoing challenges.

But we believe that the investments and expansions that we've made together over the last two years, in addition to our core and ongoing core safety net programs, have positioned California to help address these challenges and to help build that California for all ages and abilities. You'll hear from additional speakers from the Department on some of the specifics of what I've referenced, and I'm glad to answer any questions. Thank you.

Thank you. Next, Mr. Ramsey.

Thank you. Claire Ramsey, Chief Deputy Director for the Department of Social Services, filling that role that Director Johnson spoke about around aging, disability and housing integration. No further comments from the Department, but happy to answer questions.

Thank you. Next we have Dr. Margot Kushel. Thank you for being with us.

Thank you for having me. Chairman Arambula, other Members of the Committee, I'm Margot Kushel, a practicing physician, professor of medicine, and a researcher on homelessness at the University of California, San Francisco. So, as you know, in California, approximately 171,000 people experience homelessness nightly, of whom about 136,000 we call single homeless adults. So these are not folks in families or young adults. In the early 1990s, 11% of single homeless adults were 50 and older, and nearly half are now.

That means that approximately 65,000 Californians are homeless in age 50 and over, and about two thirds of them are unsheltered due to the impacts of structural racism. Black, Indigenous, and Latinx Californians are at a dramatically increased risk of homelessness. People who experience homelessness in their 50 s and 60 s have worse health problems than those in the General population.

In the extraordinarily high prevalence of chronic diseases, geriatric conditions such as difficulties with activities of daily living, cognitive and mobility impairments, and the like, a large proportion actually meet criteria for nursing home placement and deserve and require the services that would allow them to live safely in the community. Instead, many live in homeless shelters unequipped to assist people with their degree of disability or outside with no help at all. Homelessness is, at its root, a housing problem.

California has only 24 units of housing for every 100 extremely low-income households with a shortfall of a million units. Older adults are those most likely to be severely cost-burdened, paying over 50% of their income in rent, with diminished opportunities in the job market, or on fixed or even no incomes. They are extremely vulnerable to homelessness. Nearly half of people 50 and older who are homeless had their first ever episode after the age of 50.

Those first homeless after the age of 50 had worked their whole lives in physically demanding, low paid work, struggling against rising housing costs, and then at some point after the age of 50, they faced a crisis, either the breakup of a marriage, their job loss or illness of themselves or their partner, the death of their partner or of their parent that led to their homelessness. Homelessness, as you know, is deeply catastrophic to health.

While homeless people face exposure to the elements, are at extraordinarily high risk of being victimized, face barriers to accessing healthy food, medications, and longitudinal health care, they have extremely high rates of use to the emergency Department and hospitalization.

To give you some sense, one quarter of homeless adults over 50 have been at least one night in the hospital in the past six months, people who are homeless are at a 3.5 fold older adults increased risk of dying compared to their similarly aged housed counterparts, and we have found that those who are first homeless after 50 have an even higher risk than those who are homeless before 50 and remained homeless.

But we also found that those who regained their housing dropped their risk of dying dramatically. These statistics should give us all pause, but also call us to action. As a physician, I can say that there is no medicine as powerful as housing. With a structural deficit in deeply affordable housing, it is going to take us a long time and yes, a lot of money to end this crisis. This can make it sometimes seem that what we are doing isn't working.

But there's no question that the investments that the state has made thus far has prevented an even worse crisis. We need to continue our focus on preventing new entrances into homelessness and ending homelessness among older adults. Early evaluation of the Homesafe program, which Director Johnson mentioned, has suggested is reaching people at extraordinarily high risk and intervening in real time to prevent their homelessness. As the eviction moratoria from the COVID crisis end, older Californians could be facing a wave of evictions into homelessness.

For older adults on fixed income, shallow subsidies may be enough to keep some of them out of homelessness. For those with significant behavioral challenges, permanent supportive housing, or subsidized housing with appropriate supports and services, those that address both behavioral health challenges and the challenges faced by older adults, support for personal care and other aging related needs could not only allow individuals to live with dignity, but importantly, to prevent avoidable use of institutional care, such as nursing homes and cursorial settings, and prevent their deaths.

All Californians deserve to age with dignity and security. We all benefit when we have access to safe housing, even in a difficult budget year. We must recommit to doing everything we can to end the crisis of senior homelessness.

Thank you, Doctor. Next we have Tiffany Whiten with SEIU.

Mr. Chair, Members Tiffany Whiten with SEIU California, representing over 410,000 long term care providers across the state. Thank you for the opportunity to share with you all today. There are several priorities and concerns related to the IHSS program, but I will only touch upon three this afternoon. The IHSS program currently employs just over 600,000 IHSS providers and serves more than 690,000 recipients. The IHSS program is a life saving program for recipients and cost saving alternative for our state.

One of the biggest concerns is ensuring we have an infrastructure that meets the growing demand of the program as the aging population continues to grow rapidly and as more providers are needed to meet the specific needs of the consumers. If California does not adequately invest in the workforce, older adults and those living with disabilities will not receive the proper care that they need. Caregivers will continue to live in poverty, and the public expense of caring for these populations will only increase.

One solution to help build on this infrastructure is to establish a statewide collective bargaining rather than the current 58 county structure that exists today. This fragmented structure at times forces providers to decide between health care benefits or increased wages. Some counties currently don't or won't bargain with providers, but rather take a penalty, and others spend months negotiating over increases as little as $0.25.

If we as a state are going to prepare ourselves, we must make investments on the front end to support the workforce so we can recruit and retain providers to meet the needs of the current and future consumers of the IHSS program.

We currently have a Bill AB 1672 by Assemblymember Haney moving through the legislative process to establish a statewide bargaining structure, but we ask this Committee to consider appropriating funds for the purposes of startup costs alongside an anticipated delayed implementation in an effort to give the state and departments the ability to staff up appropriately and adequately prepare for this change. The second item is concerning to the same population of older adults and those living with disabilities, which is access to respite providers.

Respite is designed to give primary caregivers reprieve while ensuring the health and well being of caregivers and their dependents in an effort to reduce or eliminate burnout. Respite is an essential component to the stabilization of the IHSS program as a whole. Despite respite being so essential, providers struggle to locate and connect with providers who can offer respite, particularly for families who need support provided in languages other than English.

We are proposing, through AB 1006 McKinnor to require the no wrong door system to create a respite referral registry in order to connect those enrolled in the medical program with respite providers. Recent analysis by the California State Auditor have begun to point to some of the critical weaknesses of the respite delivery system as it exists today. Having taken stock of some of these issues, it's important to start moving, making moves in the right direction to support families now and in the immediate future.

We would request consideration from this Committee at the appropriate time to dedicate funding to the no wrong door system for the purposes of establishing this vital respite registry. Third, and lastly, is related to the need to extend the timeline and appropriate funding to continue the IHSS career pathways, which Director Johnson has already noted and I'm sure will be discussed in the second panel.

This program is a paid and incentive training program for IHSS and WPCs providers, helping to advocate racial, gender, and linguistic equity by reframing and repositioning the workforce as one to be invested in, valued, and treated with dignity. The IHSS career pathways programs respond 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 formal career ladders exist within the IHSS and providers seeking career advancement have to look outside of IHSS to other professions and industries. This only serves to exacerbate the current impeding workforce crisis. The IHSS Career Pathways program launched in fall of 2022 with a limited number of classes first being offered starting in October of 2022. It opened with an enormous amount of interest and excitement.

CDSS IHSS career pathways web page had more than 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 2023. Whenever CDSS released new classes, many, if not all, appear to reach capacity very quickly. Providers have described their experience encountering full and waitlisted classes during CDSS multiple informational sessions on the program.

As with any pilot program, there have been significant upfront activities and costs to build the infrastructure and processes necessary to launch the program. 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 a built organizational capacity including hiring, onboarding, and training staff. Finding and hiring quality instructors in all 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 vendors, and while the program launched in 2022, implementation has been in phases and the initial release of classes were limited. In 2022, there were only 37 courses and approximately 140 class sessions offered.

The two vendors for the request for proposal did not start their training delivery until January of 23, and since January there have been more than 40 new courses and over 500 classes sessions added to the course catalog. Vendors and CDSs continue to ramp up the program and build the course catalog as 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 gain skills 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 that encourage pathway completion, application, and workforce retention. The first is completion of 15 hours of courses within a career pathway.

Second, for providing for at least 40 hours of care to a consumer in the first month after completion of a specialized career pathway. Third, for providing at least 40 hours of care per month to a consumer for six months after completing of a specialized career pathway.

The incentive pathways, particularly 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 one in six months after training is potentially very limited, especially depending on when the department stops accepting claims for this payment.

This is counterproductive to what I know the program's goal of improving the retention of the providers are at the end of last year, only 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 journey short when the program ends.

An extension by the state to continue funding the program, training through the fiscal year 2324 and contributing additional resources if needed would help alleviate some of these pent up demand for these opportunities. 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 parts 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 program costs and would experience needless inefficiencies. Training vendors would have to cut staff, leading to a deficit of experience and institutional knowledge, and many startup activities would have to be repeated and refreshed, causing delays and duplication. On an 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 program as part of a long term vision and strategy to support the direct care workforce by continuing training and career pathways into the IHSS program beyond the pilot program stage. Thank you so much.

Next we have Adrian Mohammed with UDW.

Good afternoon, Chair and Members Adrian Mohammed with the United Domestic Workers AFSME Local 3930 representing over 165,000 in home supportive service providers. As my colleague just mentioned, the IHSS program employs just over 600,000 providers and has almost 700,000 recipients.

And over the next 10 years, as the aging population continues to grow, there will be an exponential rise in the demand for long term care in California's workforce, and California, frankly, is not prepared for it, which is why we have done so much work creating the master plan on aging. Providing home care is a very intimate job and one that IHSS caregivers take great pride in.

Providers are eager to learn more about the work they do and how to better provide IHSS care because they care for the recipients and the loved ones and their community members. As my colleague just noted. In terms of the career pathways, however, as the population of older adults grows, that need for long term service and support is expected to grow by more than 40% between 2019 and 2030, from 6 million to just over 8.6 million.

According to the Department of Finance, about 55% of people receiving IHSS benefits now are older individuals. And while long term care facilities are an alternative to IHSS, the cost of care in these facilities varies from about 39,000 to about 170,000 yearly, depending on the recipient's degree of need. Clearly, IHSS is a life saving program for recipients and a cost saving alternative for our state. However, the program is struggling to recruit and retain the caregivers necessary to maintain this resource.

And we have many counties right now who are good actors. They are making sure that they are acting in the best faith, or, sorry, in the best regard of their recipients, the clients. But we also have counties that are not necessarily providing that same good faith inclusion, right? We have counties that have opted to take a fiscal penalty as opposed to actually paying our providers what they are worth. Specifically, in Kern and Alpine counties, we've had a lot of difficulty even just bargaining wages with them.

In Kern, county, we haven't had a contract there for about seven years. Right? And just to tell you what that looks like, that means the minimum wage incurred for our providers. It's 1550. Whereas in a county like San Francisco, a provider is getting just under $20 an hour, right? That all to say, there is still not a single county that is paying an HSS provider a living wage.

The average living wage in California for one adult and one child is $43.44 per hour, compared to the minimum IHSS wage of 16 dollarsforty six cents. This gross disparity has resulted in a growing shortage in the IHSS workforce, resulting in gaps in care for our most vulnerable communities.

According to a 2020 state audit of the IHSS program, almost 58,000 applicants who've entered the program without a caregiver and who received services for the first time in 2015 through 2019 did not receive services for an average of 108 days after their county approved their application. We believe this report highlights the numerous disparities in the structure of the current program and the state's current inability to meet future long term care demands.

These concerns include caregiver shortages, the effects of a rapidly growing aging population, and the negative impacts of consistently Low wages across the IHSS workforce. And while there have been a number of successful bargaining agreements that have been reached in various counties throughout the state, many IHSS providers live in counties with limited budgetary resources and a lack of local support, local support to invest in the program.

Therefore, transitioning bargaining from the local level to the statewide level within the governor's Administration will help to streamline the bargaining process and professionalize the IHSS workforce by providing livable wages and benefits, ensuring more equitable distribution of long term care funds, and allow the state to meet the long term care demands, especially as we approach this care cliff that we're foreseeing in 2030.

This change is long overdue within the IHSS program, and frankly, it's time for California to uplift and empower those individuals that are caring for our loved ones and the most vulnerable communities. And I just, again, want to couch this within the master plan on aging. Right. One of our biggest initiatives is growing our caregiver workforce. If we have a workforce that can make more money doing something else and they have to take care of their family Members, frankly, they will, because that's what they should do.

We have this need. We need to be investing within this workforce, especially as we are approaching this cliff. And one of the best ways the state can do that is transitioning to statewide bargaining. As we're approaching this cliff and preparing for a benefit for a long term supports and services benefit for all Californians, the only way to do that is to grow the workforce. And that first step is absolutely creating that foundation within statewide bargaining. Thank you.

Just before I finish, and I say this because it's so timely, just yesterday, the White House release their press release on their Executive order. Funding does not have to be solely from the state, and the feds are already giving a nod to say, hey, we are trying to invest here. So I believe it's incredibly imperative and incumbent upon the state to do the same. Thank you.

Ms. Gonzalez.

Thank you. Good afternoon, Mr. Chairman, Members Rebecca Gonzalez with the National Association of Social Workers, California Chapter, speaking on behalf of the Californians for SSI Coalition. This is a statewide coalition of SSI advocates in over 200 organizations across the aging, disability rights, housing, and homeless, anti-hunger, and anti-poverty sectors. We see the suffering that our most vulnerable residents are facing every day, and we seek to ensure that they receive adequate support to live their lives in dignity.

Californians, older adults and people with disabilities on SSI hold jobs, provide caregiving to children and elders, continue to make valuable contributions to society, and have dreams for the future. The high cost of living in California, inflation and recession-era cuts to SSI, SSP have made it difficult for SSI recipients to survive, let alone thrive. Living as an older adult or an individual with a disability with Low income is precarious.

Making sure you have food that meets your health needs and the equipment and services needed to safely live independently can be costly. High rents have the deepest impact on those with the lowest incomes, putting them at higher risk for housing instability and homelessness. Inadequate benefit amounts drive increasing homelessness in the state, including among older adults. As a coalition, we see how important it is to have benefits that are adequate now and into the future.

SSI beneficiaries live in every community and reflect the diversity of our state. As a safety net program, SSI also helps to equalize access for marginalized communities. SSI is a critical benefit for seniors and people with disabilities who have had less access to employment and other opportunities, such as women, especially older women of color, people of color, LGBTQ plus, and immigrants.

This work to ensure adequate benefits has particular meaning from my perspective at NASW, because throughout the profession's history, social workers have sought to ensure that all people have equal access to the resources and opportunities that allow them to meet their basic needs. I'd like to share a quote from a coalition member, an SSI recipient quote I appreciate the raise we got in SSP, but we are still at 90% of the poverty level. The lack of SSP meant that my recent move was expensive.

I am now in San Bernardino County and being in a flood-impacted county didn't help when Calfresh got lowered after the pandemic expansion stopped -end quote. The programs at DSS provide essential support to older adults and individuals with disabilities who receive SSI. Calfresh is our first line of defense against hunger and SSI SSP and CAPI provide monthly income that people can use for rent, food and other basic needs.

The Legislature and the Governor have made significant investments in the past few years to undo the recession error cuts and bring SSI recipients back to the level of support they had before the recession. We need to continue to do this and also make sure that the SSI SSP grant and other benefits are truly adequate for living in California now and into the future.

That is why the coalition is asking in this year's budget to one appropriate a three step increase to bring the SSI SSP grants to 100% of the federal poverty level over three years, which would require 209,000,000 over the next three years and 418,000,000 ongoing. Two update S and B and TNB allotments to have parity with adjustments made in Calfresh.

Californians deserve credit for providing state funded food assistance through S and B and TNB to hold harmless the households who lost Calfresh benefits due to ending the SSI cash out policy. However, with record food inflation and continued hunger among older adults and people with disabilities, we must ensure parity with the SNAP Calfresh Thrifty Food Plan update in 2021 and create a regular update process to prevent future inequity between S and B and TNB benefits and the Calfresh benefits they are meant to replace.

Lastly, revive the special circumstances program. Previously, the state had a program called Special Circumstances for SSI CAPI and IHSS recipients. Reviving the special circumstances program would support SSI recipients with emergency expenses, especially those that could result in hunger or homelessness, such as housing, repairs, replacing furniture and appliances, moving expenses, and unmet shelter needs. California's most vulnerable residents struggle to stay housed, buy food, and survive.

We must remain committed to ensuring that SSI recipients do not struggle with the toxic stress of poverty and have the economic security to live in safe environments. This will help us meet current needs and continue moving us toward a new, inclusive normal in our public benefits program that provides dignity for all. We would also like to thank staff for any proposals, such as the one in the agenda that they recommend to move SSI recipients to more financial stability. Thank you.

We'll begin with Yasmin Pellet. Justice and aging.

Good afternoon, Mr. Chair and Committee Members. Dr. Jackson, thank you for holding this hearing and for inviting me to speak about the crisis of older adult homelessness. My name is Yasmin Pellet. I'm a senior policy advocate at justice and Aging. We're a national legal advocacy organization focused on advancing the rights of Low income older adults. So what do we know about older adults experiencing homelessness? Dr. Kuchel mentioned some of this, but frankly, given the dire circumstances we're in, it bears repeating.

Homelessness amongst older adults is rising dramatically, and this trend will continue unless we take swift steps to address it. Older adults. Older adults over the age of 55 are the fastest growing age group of people experiencing homelessness in California, and we see the steepest increase amongst those over the age of 65. From 2017 to 2022, homelessness amongst those over the age of 65 has almost tripled, growing by more than 163%. Housing, and specifically rent unaffordability, is a key driver in older adult homelessness.

Older adults are more likely to struggle with rent because as they age, they face an increased likelihood that their fixed incomes have not kept up with escalating rent prices or they've depleted their savings, or they've lost a spouse. This results in older renter households aged 75 and older facing the highest cost burdens. Let me repeat that again. Older renter households over the age of 75 face the highest cost burdens.

Can you imagine being 75 years old and being faced with the real possibility of homelessness for the first time in your life? I was going to provide more data and stats, but I think I'd like to provide a personal example. My grandparents live here in Sacramento. They're 82 and 83 years old. They used to live in an apartment, a small apartment in South Sacramento, and they lived there for a year, stably housed. But then their rent increased and then their rent increased again and again.

They benefit from all the programs you're going to hear about today. They have MediCal, they have Medicare, they have a small Social Security income. They get the SSISSP grant, they're on Calfresh, they get their utilities subsidized, they've gotten meals on wheels, they've gone to the food banks. They get every service, all the great services that we invest in. But the rent increases that they were experiencing were the thing that was going to push them over the edge.

And if it wasn't for my parents being able to step in and get them stabilized, I guarantee that they would be homeless. And next week. My grandpa's about to have spine surgery at 83 years old. There is no way that he would be able to access that medical care or recover from a serious surgery like that if he was still in such a precariously situated housing situation. Most people that fall into these circumstances are not as lucky as my grandparents.

They don't have children that can afford to get them housed. And so while California has directed substantial resources to prevent and end homelessness, despite these investments, the problem of older adult homelessness is still increasing. Where the state has focused investments in homelessness on specific populations like transitional aged youth or veterans, we see that tailoring solutions really works, which is why we need a strategy tailored specifically to the concerns of older adults.

Justice and Aging supports CDSS's existing programs like HDAP and Homesafe, which can help some older adults that are connected to other CDSS benefit programs. But HDAP and Homesafe are not specifically meant to reach the larger pool of older adults who are homeless or at risk of homelessness. The problems we face today are bigger than the programs that we have available. And as everyone here has mentioned today, the top goal of California's master plan for aging is to prevent and end homelessness amongst older adults.

So in order to really achieve that goal, we need a comprehensive strategy. So what's one solution? We need to focus on homeless prevention. We need to do everything we can to keep older Californians housed, because once someone is experiencing homelessness, it is much more difficult and more expensive to get them back into permanent, stable housing. Creating a statewide rental assistance program for older adults and people with disabilities is justice and aging's top priority.

This would be a program both for those acutely at risk of homelessness and for those currently experiencing homelessness. We have a $500 million budget request to get a program off the ground. There are several local rental assistance programs in Santa Monica, Stanislaus, San Diego that are targeted to seniors, demonstrating that this is a highly effective homeless prevention strategy.

And so, in addition to the income supports that Rebecca's mentioned, home and community based services that others on the panel have mentioned, ensuring that people have affordable and accessible housing is key to aging in place. Thank you for this opportunity. I'm happy to answer questions at the appropriate time.

Thank you for your testimony. Kathy Senderling Mcdonald with CWDA.

Thank you, Mr. Chair, Chair Ting. Member Jackson Kathy Senderling with CWDA we appreciate the Legislature and administration's ongoing support of the Adult Protective Services program. CWDA and Justice and Aging together co sponsored the proposal during the pandemic to expand the APS services to age 60 and to increase our investments in the Homesafe program. Homesafe will be discussed further, of course, on your agenda and as Dr. Kishell and Ms. Pellet noted, such investments for our older adults are needed and we believe should remain a top priority.

Counties are seeing increasing demands for APS as our population ages and we support continued investment in the program. As you also know, counties administer the in Home Supportive Services program. Specifically, our workers and staff perform in home assessments for IHSS services, assist in enrolling consumers and their providers into the program, perform annual reassessments and process timesheets to ensure timely payments to providers. The key IHSS related issue I'd like to raise today is the critical need to increase administrative funding for the program.

CWDA is seeking 242.2 million General Fund ongoing to ensure the IHSS budget covers the actual costs of county administrative activities. There are two major issues with the current methodology that contribute to this underfunding. First, the methodology underfunds the actual cost of IHSS workers. The updated methodology uses what was already an artificially low wage rate for social work staff that was set in 2000 and 718, despite substantial cost increases since that time.

At this point, about 40% of actual social worker costs are not accounted for, so 60% funded, 40% unfunded. The methodology does also not count all workload. As you heard from the prior panelists, there are times when individuals are processed, found, eligible and approved for services, but they are unable to secure a provider right away, in some cases for a long time. However, counties continue to need to do maintenance work on those cases, reassessments and other activities both on demand and on a regular basis.

In December 2022, about 12% of cases showed in our system as approved but not having any paid hours for them, and so we are not at this time receiving funding for the work that we are required to do for those cases. When administrative costs are underfunded, it affects program services and quality. Caseloads of 300 or 400 consumers per social worker are not uncommon in some counties.

This hampers county's ability to provide timely services, processing applications within the 30 to 45 day timeline as required by DSS rigs, and ensuring that the reassessments occur on time every 12 months required both under state and federal law. It can also result in fiscal sanctions to the state if we don't meet those. It contributes to staff burnout and staff turnover and makes it more difficult for us to recruit staff to fill in vacancies that many counties are experiencing.

We have continued to support expansions in Medi Cal, and as your agenda notes, individuals then are potentially eligible for IHSS, expanding Medi Cal to all undocumented persons, health for all, as well as repealing the asset limit. Both will certainly have an effect in the IHSS program, but the funding gap just grows wider if we're not provided adequate funding to administer the program.

We'd like to just add quickly that CWDA is concerned that the administration's budget proposal does not propose administrative funding for that undocumented expansion and delays that until the middle of 2024, essentially the 2024, 25 fiscal year, a full six months after the expansion will go into effect. We've been told that there's an assumption that HSS expansions, lag, medical expansions. We have asked for data because we don't see that lag.

It's certainly not a six month lag, especially in a population that is aging, where demand is growing for the IHSS program. And we know that advocates and outreach continue for the program because people are entitled to receive the services.

So we don't think that that assumption currently is warranted and would urge both the Administration, as it prepares to, may revise, as well as the Legislature as you think about how to Fund the expansions and IHSS related to the Medi Cal expansions, what those ought to look like. Happy to answer questions and pleased to be able to participate on the panel today. Thank you.

Next we have Jenny Bellow with the LAO.

Good afternoon. Jenny Bellow with the Legislative Analyst Office. Just one quick contextual note. Back in 2018, our office undertook an effort to project the number of aged Californians that would be living here by 2060. And not surprisingly, we found that that population would be more than doubling. One of the findings we made at that time was that the state didn't have a comprehensive plan for the aging population. So fast forward to now.

We do have that master plan on aging, and we really see that as a step in the right direction and something for all of us to use as we consider all of our safety net programs and proposals to really see how they plug into that master plan on aging and how they really help us further our efforts to reaching those goals.

Department of Finance.

Anam Kant, Department of Finance. Nothing further to add, but happy to answer any questions.

Thank you. I'll bring it up to the dais for any members' questions. I will keep it here at the chair. I'm going to invite Director Johnson and Ms. Whitten and Dr. Kushel, back up. And, Kathy, I'll have you stay put, if that's okay.

Thanks.

I'll begin with Director Johnson, if I can. Huge fan of the lowering of the age of APS, as well as home safe that I'd like to understand. What have we learned about the needs of vulnerable adults since we have lowered the eligibility age and we've created homesafe? Are there any lessons learned thus far?

Thank you for that question, chair. Yeah, I think that the components and part of the impetus around that expansion is certainly demonstrating the need that we have, I think to the other panelists points that they've made, that the population specific needs, and as we look at those eligibility determinations, we're seeing that need across the board. I don't know if Deputy Director Ramsey wants to add any more to that.

Oh, sorry. Claire Ramsey, Chief Deputy Director, Department of Social Services I would just add that I think as a Department, we're still determining what the major impacts of that expansion are. A few, though obvious things that have been beneficial. One is that this has allowed all older adults 16 and over to gain access to homesafe if they're eligible for APS services. So that's really immediately increased access to critical housing supports and case management.

We also know that counties are working to ramp up the more extensive case management that was allowed under the expansion. And so that's a gap that had been identified before the expansion, and now we are able to increase access to those services.

But I think what we're really expecting is that we're going to need a little more data to understand the full impacts and kind of what we're seeing and whether there are actually shifts in the types of cases we're seeing, the types of needs for the younger adults, the younger older adults, and whether or not that requires us to make additional shifts or to provide additional support as we continue to move forward and support this additional population.

Wanted to give you an opportunity to respond to some of the concerns from the stakeholders, particularly on the Administration of the Programs, hoping you can just provide some thoughts.

No, I very much appreciate that opportunity, and I think it's something that we've looked at across the board and all programs that we're looking at, what are the existing methodologies that drive those changes over time, how we're looking at having regular cadence to revisiting methodologies more holistically. So really appreciate that we have that continued conversation about, do we have the methodology right that is meeting the needs for those who are administering the program.

Ms. Senderling, Mcdonald I'll take this as a chance. I wanted to dig in a little bit more with the IHSS administrative shortfall and see if there's a baseline need here to make sure we're addressing those funding methodologies. When we have a 40% underfunding of our social workers and we have some who aren't getting any funding at all, does it speak more broadly for us to open up discussions about realignment if we're having such discrepancies between our funding formulas?

That's an excellent question. So to break down a little bit more of the 240,000,000 that I mentioned, the worker cost issue is about 185,000,000 of that, and the authorized but unpaid cases is about 55 million of that. To add those up, and what I think we're seeing in a lot, as Director Johnson noted in a lot of the methodologies, we've revisited them in some recent years, I think that's a CalWORKS is another example of the conversation we're having.

Unfortunately, when it sort of comes time to say, okay, here's the new methodology, which has been about five years since we did that in IHSS, it gets changed, but then it stagnates. There's no built in either relook or increase related to inflation. And what we've seen in the past couple of years, especially have know it's a tremendous increase in actual costs. We know that as the Administration builds its budgets for its departments, for example, they typically do look at cost increases.

And so thinking about how we might be able to piggyback off of those practices and utilize them as one option, relooking to think about how over time we make sure, even if it's not annual, which of course we'd prefer at least every few years, catching it up for the actual cost, and then you don't end up in a situation like with Calfresh, we're 20 plus years out with IHSS, now it's five. With Cal Works, it's several as well.

And it just starts to add up to such huge numbers, it's very hard to catch up. And it's unrealistic to think, oh, I'm going to put all that in one budget year, especially when we know that budgets fluctuate as well. So I think looking together at how we can try to build in some things and whether that be thinking through realignment or thinking through just the methodology in General or some combination depending on the program, we'd be very open to that conversation.

It would be nice not to have to have an argument every year about are you funding us for the actual cost? It does take, I think, time and attention away from policy changes that we'd like to be talking about as well.

Not just are we funding the underlying basic operations of the program, we obviously have to start there because if we can't properly Fund and staff and administer the program utilizing many of Ms. Whiten's Members and other unions as well, primarily at the local level, then people aren't getting the services that they need. So it is really critical.

For Ms. Whiten. And I do want to give Mr. Mohammed an opportunity to respond if you would like, as well. I want to bring up that statewide collective bargaining was part of the discussions during CCI, and when that initiative stopped, it ceased the effort to have that statewide collective effort. That I'd like to understand from both of you, the funding requirements of that effort. What would it cost for us to do this in 23, 24 or in a multi year schedule?

Can you help to lay that out for us?

Yeah, absolutely. I think so. We're continuing to look at the cost. I think we really want to find a dedicated funding source that can assist with covering those costs, which is why we only initiated the startup costs. That would be helpful in order for us to get the departments up and running a lot of the costs. Again, we don't have a specific number because a lot of it will be due to negotiating at the state level.

Right now, there are some counties that don't have a contract, so you have to think about bringing those providers up. Some of them have to go between wages and health care. So some counties have no health care. So you have to think about the additional cost to the health care benefits. There's other things that would potentially be able to be negotiated at the table, and so that would be additional cost.

So as you guys know, this is a billions of dollar program that we anticipate there will be hundreds of millions of dollars that potentially could go to funding something like this at full implementation, which is why we are open to consideration of a delayed implementation so that we can find funding. We do not have to rely on a General Fund and that we can have a dedicated funding source that we don't have to kind of come back to every year.

And just to echo Ms. Senderling, we definitely come back every year in support of their proposal to increase IHSS admin costs because we do represent those Members as well that do the Administration. So in working with the counties, we definitely want to kind of put our heads together and hopefully with your Committee as well, to figure out an appropriate structure to adequately fund the program.

Mr. Mohammed wanted to give you an opportunity, and we'll just say not all of our counties are created equal.

No, they are not.

I appreciate it. Thank you, sir. Honestly, I think Ms. Whiten said it the best. We're still trying to figure this out. And I think what's most important here is, although the costs are going to be pretty much dependent on what comes out of negotiations in terms of actually setting this up and getting this running, the cost should be, it should be relatively small in comparison. Right. Because we are looking at Administration of those fees. However, there are a lot of moving pieces to it. Right.

And so, yeah, as was stated, we're looking forward to working with you all and the counties as well, just to try and see what it's going to take to make this happen financially.

I will just share a perspective from the ground shared to me by the frontline workers, which is a difficulty in getting the dignity and respect that you deserve while working so hard to keep our community safe and thus feel that it's important for us as a state to make sure that we are prioritizing this needed workforce. And to do that, I believe we're best capable of doing it when we keep that authority here, to make sure that we as a state are collectively bargaining effectively.

I'd like to turn to Dr. Kushel, if, you know, I'm really struck by your comments about older Californians who are becoming homeless. And I want to pull in an issue that we'll discuss later in issue four under SSISP. But we've seen a trend over the last number of years of decreasing participation within this program, while at the same time we're having more and more older Californians who are becoming homeless.

And so I'm hoping you can make some connections or help me to understand how we can have both of those happening at the same time.

I think that's a great question, and I think there are two things at play. One is we used to say that SSI solved homelessness and that is no longer true, that when you look at the median household income of individuals in the six months before they become homeless, it's often at about the SSI level that the cost of housing has just outstripped the benefits. But I think that's not the whole story.

I think one thing that we are really struck by, by our work with older adults who are becoming homeless is how disconnected they are from our systems of care. And we are doing a great job in many ways, but we are missing people and we do a lot of qualitative work. Well, we'll just turn a microphone on and have them tell us about what was going on in their lives before they became homeless.

And we're really struck by how many resources are available that they have not accessed. And I think that there is probably work to be done in figuring out who are we missing? How do we better get to them. I will add, I have been really struck by this conversation because it's not an uncommon pathway for people to be an IHS provider for a family Member. And when that family Member dies or goes into a nursing home, that individual becomes homeless.

And I think about it in two ways. One, what a loss of a workforce. This is someone who knows how to be a caregiver and could be trained to be a caregiver for others, but also how little connection they have that they tell us again and again. And it's a story, when I first heard it, thought it was sort of a one off, but we are hearing it again and again and again, and I think it's an important thing to keep track of.

As a physician, we are seeing folks, and I just wonder if we're not doing a good enough job in our health systems, connecting to our social service systems and other ones.

Director Johnson, hoping you can comment on relatively the same question, but just trying to understand what else can we be doing for outreach to make sure that our older Californians are aware of the services that are available to them?

Absolutely critical. And I often talk about the robust array that California has built is really unlike any other in the country. And so when that totality of the array is connected, we see the outcomes are so much greater. So really appreciate the question and certainly think that there is more outreach we can do. I'll say that we're mindful of this component around SSI.

That's the work we've done together with the community care expansion effort, where we're offering the additional operating subsidy in recognition that, again, the operators in adult and senior care settings often need that additional resource to support the residents that they're caring for, who receive SSI and SSP. And we are finding that to be a promising component that you'll hear more from our Deputy Director of housing and homelessness about later on.

So I think those kinds of interventions about thinking about both, again, how we're getting access to resources. So again, as we design programs like HDAP, which is about getting that connection built in to help navigate and make the connection to the safety net resources, but also how we're looking at the places where SSI and SSP recipients are currently and how we are ensuring that they are successfully housed and staying housed in their settings.

So those are a few interventions that we've deployed but recognized still more to do in terms of making sure we're doing that outreach and connection to the whole.

I may invite Ms. Pellet up just for one last question, if I could. Okay, first off, I'm just going to appreciate your testimony again, it's always important when we can feel and hear the struggle that so many are going through. And so I just want to make sure to appreciate.

Thank you.

Your comment was that APS and HDAP don't fully encompass the older population, and yet we just heard how homesafe does. And so I'm wanting to know how your organization really views homesafe as an opportunity for us to be providing outreach to as many as we can to help to prevent homelessness where possible. Hoping you can comment on, you know.

Again, homesafe and HDAP are doing a good job at their mission. Right. But the issue is much larger than what they're currently going after. And the issue, we need more investment, we need more outreach, we need more overall more and more. And the data they provided today was sort of the uptake numbers and the 85% of people staying housed. That's all great. We applaud that, but we want to see that more. I mean, the numbers, again, I can't remember exactly now. It was, what, 5600 people?

That is a fraction we're talking about. The data is not great on the number of, total number of older adults that are homeless in California, but we're talking about 62/63,000 people from the most recent CalICH data. So 5600 is a great start, but it is far from where we need to be. And so we need to keep investing in the programs that we know are working. We need to build on those models, but we also need to get people housed.

And we know that there are so many people really on the brink there that they're not homeless yet, but they're 1,2,3 months away from a rent increase that totally blows them out of the water. And I think Dr. Kushel has data from her surveys that even shallow subsidies of $100, $200 a month really make a difference for folks.

And I think to bring it back to the conversation about SSISSP, we have to remember that the SSP grant limit was slashed in the last recession, and between then and now the cost of living has dramatically increased. The SSP grant has not kept up with that, even with the restoration that we finally now have. We're restored to the rate of 10 years ago, when so much has changed here and the cost of living, the rent, nothing is the same as 10 years ago.

And so that's part of this misalignment between the reality that people are facing and the benefits that they're getting.

Thank you for that. And I'm going to thank this entire panel for their testimony. I will make a request from the chair. We will make several requests over the course of this hearing related to the topics which are discussed as we go through this afternoon. One that I'd like to make now is regarding the IHSS statewide collective bargaining.

I'd like to ask CDSS and the Department of Finance to assist on a technical assistance basis on the General Fund required, both for state operations and local assistance to realize those goals. Could the Administration work with us to produce something that could give a picture of what this could mean and what policy considerations you would want us to weigh as this is thought through? And on what time basis could this potentially be provided.

Department of Finance? Concerning your question? Yeah, we're happy to take that back and work with your staff to get you updates.

Thank you. We will hold this and all other issues open. We will now move on to panel two.

Good afternoon, Mr. Chair and Members. I'm Susan DeMarois, Director of the California Department of Aging. I'm proud today to be joined by our Chief Deputy Director, Mark Beckley. And Mark and the rest of the California Department of Aging Team deserve tremendous credit for leading our Department through a period of tremendous growth and change over the last several years. Before I launch into the budget, I want to thank the Governor and the Legislature for their critical investments in the COVID-19 pandemic response.

The populations we serve were and continue to be at the greatest risk, older adults, people with disabilities, family caregivers, and communities of color. So we thank you for the resources that enabled the Department and our sister departments to bring critical resources to our communities, PPE, vaccines, boosters, treatments, and life sustaining meals. Thank you so much. I wanted to touch today on two things, the role of the Department and 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 the largest program we oversee, 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 the state independent Living centers and the Long Term Care Ombudsman, led by Blanca Castro. We also collaborate with the Department of Healthcare Services to provide direct services to medical beneficiaries.

CDA oversees 271 community-based adult services, or Cbas Centers. Serving close to 25,000 older and disabled adults, and the multipurpose Senior services program, an intensive in-home case management program with 37 sites. Since June 2019, when Governor Newsom took Executive action to establish California's master plan for aging, the Department has led this whole-of-government approach on behalf of the Administration under the direction of CHHS Agency Secretary Dr. Mark Ghaly.

I want to acknowledge the incredible leadership of the Legislature every step of the way, from inception to implementation to today's hearing and the conversation that we just had. As you heard, goal number one in the master plan for aging is housing for all ages and stages. Thank you for focusing today's hearing on that topic. Goal two is health reimagined. Goal three is inclusion and equity, not isolation. Goal four is caregiving. That works. I appreciate also talking about our direct care workforce and IHSS.

And goal five is affording aging. Working in partnership, the Governor and the Legislature have made historic investments in all five bold goal areas, breaking down silos and cutting across multiple agencies and departments. Together with our stakeholders, robust stakeholder engagement, philanthropy, and the private sector. Dozens of states are now following our example, inspired by California's work. And just last week, a federal master plan for aging was proposed in the US Senate.

The master 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 people, the equivalent of all of Los Angeles County, being 60 or older. Not just 60 and older, but much older. Because the fastest growing demographic in our state is actually 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, the Administration and the Legislature launched 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. We're very committed to being transparent with all of our work.

In closing, I want to lift up just three areas of intense focus in this coming year for the Department. The first is delivering more behavioral health supports to older adults as we strengthen the behavioral health continuum across the lifespan. Coming out of three years of isolation due to the pandemic, extreme weather events that we've seen up and down the state, tragic shootings in Monterey Park and Half Moon Bay. We are committed to ensuring that older adults receive the behavioral health supports that they need.

We were pleased to be in all of your districts I believe, Fresno and the Inland Empire just last week. This week we're heading to Ukiah and we'll conclude in San Francisco. We're meeting with community older adults in the community and community agencies, and we're hearing firsthand the critical need for behavioral health supports. Second, examining the high cost of home care and identifying lts financing options to help the growing missing middle or forgotten middle-income population.

And third, preparing our AAA network for 2030 in order to meet the demands of a growing population that is older, more medically complex, more diverse than ever before in the 50 year history of the Older Americans Act. Thank you very much.

Thank you, Mr. Wakefield, Chief Deputy Georgia, did you have any comments.

Yes, Mr. Chair and Members, I just wanted to lift up maybe five additional areas of importance. We heard a lot today about the importance of the IHSS workforce. We also have initiative underway to address the needs of the non-IHSS workforce. It's through a program that we have called CalGrows. And what Calgrows does is it consists of two components.

One is to create a standardized online training platform with professional coaching, and then second, to create an innovation fund of $89 million, which we recently awarded to 78 community organizations throughout the state. The purpose and goals of CalGrows is to upskill and increase the skills of our direct care non-HSS workers so that they can experience career mobility and have additional career ladders and lattices in their careers. The second initiative I just want to highlight is our digital inclusion initiatives. We have two key initiatives underway.

One is our access to technology for older adults and disabilities program. This provides 46 million to 42 participating counties, and with this funding they can purchase digital devices, surface plans and infrastructure to bridge the digital divide among older adults in their counties. And then we also have the Digital Connections Program, which provides 17,000,270 participating home and community-based providers, including CBAS, MSSP, and Pace Providers. And this is really critical. As we know, during the pandemic, older adults experience high incidence of loneliness and isolation.

So this helps provide a virtual way of getting social inclusion as well as access to telehealth and other services. Next, and we'll talk about this, I'm sure when Mr. Wakefield speaks, is our nutrition infrastructure program. So this program provides $40 million in grant funding to our AAAs, who then will be passing the dollars through to local meal providers such as Meals on Wheels California, to modernize and expand their facilities and equipment to help bridge the senior nutrition and hunger gap that currently exists throughout the state.

In the area of congregate care, CDA is in the process of launching what we call a bridge to recovery project. During the pandemic, as we know, in congregate settings, older adults experienced high incidence of infection, sickness and even death. So under this project, we hope to mitigate the risk of infection through improvements to facility infrastructure, training and staffing. And this project is being done on behalf and in collaboration with CBAS, Adult Day, and Pace Centers.

In all, we hope to serve up 1200 CBAS, ADC, and Pace Sites with $55 million in grant funding. And then finally, I just want to highlight our community services gap analysis and roadmap initiative. So the purpose of this initiative is to increase access to and expand the availability of home and community-based services and programs statewide.

As we know, in various parts of the state, we may have service deserts or service gaps, so we really want to help bridge those gaps and provide services to all Californians. We're collaborating on this project with DHCS. DHCS will be handling the Medi-Cal home and community-based services, and we'll be addressing the non-medical services. So we're in the process of developing this plan and we'll be launching the effort soon. Thank you.

Thank you, Mr. Wakefield.

Hello. Thank you, everybody, for allowing us to zoom in, first and foremost. So, Chair Arambula, we really appreciate it. Members. Dr. Jackson, it was nice to learn that you were also raised by your grandmother, as I was. And I have friends there that I'd like to hang out with, like Susan DeMarois, who's going to be visiting our Meals on Wheels yearly conference next week. So we get to see her as well.

I am President and CEO of Meals on Wheels San Diego County, but I'm also chair of the board of the Meals on Wheels California State Association. So we represent more than 50 senior nutrition programs across the state. So we're direct service providers and we're of all shapes and sizes. Some of us are large and in urban areas, like we are in San Diego covering the entire county, but also providing meals to about 2000 clients a day.

And then there are small organizations that we represent as well that might serve 40 or 50 people. They're very small, they're in remote areas. So we really bring a diversity and ethnic, economic and geographic diversity under our Association's umbrella, and we're really proud of that. So across the state, so we're meal providers. As you know, homebound seniors rely on us predominantly. There are even some congregate sites. But in General, people like meals on Wheel San Diego County.

We show up every day with a meal three, probably three to six days a week. We drop that meal off and we engage with the senior. So in San Diego County alone, we've delivered in one year 645,000 meals to seniors homes, and that equates to over 333,000 individual contacts with homebound seniors just in San Diego County alone. So these are extraordinary numbers. So multiply that across the state, our impact is pretty remarkable. And so what happened during the pandemic? Right.

We all saw within about a month, month and a half, somewhere around 50%, even some people, 100% increase in demand for our services in about a month. And so you can all appreciate this, the sense of having to kind of MacGyver your infrastructure to make things happen. Right? We did that across the state. We were using things that weren't intended for the original purposes to get out there and make it happen because we had to.

And so I think we were all really proud of our accomplishments. And then we lobbied the state, the Governor and Legislator, and you all responded in 2021, with $40,000, $1.0 million of one-time-only infrastructure for senior nutrition programs. Senior programs across the state. So this was fantastic. We applaud you. We're very grateful for all of this. And so there are a few issues that I want to bring to your attention. So these funds, as you know, are managed through our area agencies on aging.

These are exceptional agencies that we very closely, and they've been able to, up until now. Is my connection good? By the way, I see a stall.

You're doing great.

Okay, great. This is a reimbursement model, right? So what happens is you go, you purchase your equipment, and then you get reimbursed. And the issue with that, I think, for us, isn't an issue because we have reserves. We're a larger organization. If you look at smaller organizations across the state, they literally are going to get loans in order to purchase a vehicle, to then get reimbursed once they get that vehicle. Vehicles tend to be the largest item on our ticket list.

So I have here, this is the list of items that we asked for for these infrastructure dollars here in San Diego, about $200,000 worth. And about $140,000 of that happens to be vans and vehicles. And you can't actually pay for something, and you can't get an invoice for a vehicle until it's been produced and there's a VIN number. So we're all trying to get electric vehicles, and unfortunately, that's really not available to a lot of us right now. So these vehicles aren't available.

And then if they are available, some of the smaller agencies are having to go out and get bank loans, pay for them, and then get reimbursed once they get these. So in June of 2022, the California Department on Aging issued an update that maintained that the funding end date was December 31, 2024. And we were excited about that. We had two years, we knew of supply chain issues, et cetera, that were going to keep us from getting those vehicles in a real short period of time.

So we were relieved to know that we had two years of spending time. And then, unfortunately, on December of this last year, or actually, in January, we were notified that we had a year less. So we got an important memo and it said that the entirety of the HCBS spend plan package will expire December 31, 2023. So that's a year less than what we were originally told.

Federal guidance from the Center for Medicare and Medicaid Services allow for states to exercise a one year time extension of the HCBS spend plan at this time. California does not intend to exercise a time extension and plans to end the HCBS spend plan programs on December 31, 2023. So we have a timing issue here.

And so one of the things that I'd like to do is implore the state to apply to the Federal Government for an allowable additional year for the effective expenditure of these funds, or to find alternative funding for the program to maintain the original timeline of its intent. We simply may not be able to get these vehicles. So my example for I was actually granted additional funds from a private entity, $300,000 grant back in September.

And since September I've been trying to get electric vans, and since September I've only been able to get one, and I may get two this summer. So these aren't the infrastructure dollars, but that's just to show you the logistics and the timeline. Other people that I know, smaller agencies, found out that somebody got bumped off the list, they got their spot, so it's decreased their waiting time by about eight months, but they still have to go and get a line of credit to purchase these vehicles.

So I think, simply put, it's highly unlikely, if not impossible, that most nutrition providers are going to be able to make the infrastructure purchases in time to utilize the state funds for this purpose as they were intended. And that is an absolute shame. So we're requesting that the state either ask for an additional year time extension allowed by a CMS or commit now to appropriating General Fund Dollars in the 23-24 budget to offset any of those dollars lost.

And I appreciate your time, and I'm happy to take any questions at the appropriate time. So thank you, everybody.

Thank you. Next we have Michael Costa.

Thank you, chair Arambula and colleagues, for the opportunity to speak today about the impact of cuts in HCBS waiver funding on a number of programs that area agencies on aging provide directly or contract out to our community partners. In addition, we'd like to address the need for additional funding to ensure that the expansion and sustainability of ADRCs necessary to achieve the MPA goal of no wrong door also occur.

I'm Michael Costa, Executive Director of the California Association of Area Agencies on Aging, which represents the 33 AAAS in California serving all 58 counties, 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. Recently, a growing number of AAAs also provide services directly or indirectly to medical recipients through the CalAIM program.

As you know, HCBS waiver funding is planned to end on 12-31 of this year. This will impact a number of programs besides the Nutrition Infrastructure Program that Brent just talked about, and these programs were in fact originally intended to be ongoing. They include fall prevention and home modification programs that involve training, education, and assistance for individuals at risk. 30 out of 33 AAAs participate in these programs, which has very broad appeal. As of December, 3,606 individuals have been assisted through 312 trainings.

Legal services intended to help folks deal with issues such as fraud, landlord-tenant issues, and discrimination that arose during COVID but are ongoing, will also be curtailed. An employment opportunities program, which increased funding for senior unemployment under Title V by increasing slots and enhancing program infrastructure, will be curtailed, as will an intergenerational activities program that is intended to reduce social isolation and build relationships across generations. 28 out of the 33 AAS participate in this program.

Currently, family caregiving funding that augments education, training, and respite care will end, and a state and local leadership grant to build AAA leadership will be ended, as will a social service and healthcare provider network planning and development project, which is really designed to help the AAAS interact more effectively with healthcare going forward.

Given the impact of waiver end on this wide range of programs, we're asking that the Legislature request that the Administration apply for a one year extension of the HCBS waiver for social service programs funded by the waiver. However, we understand that there is a federal maintenance of effort requirement that complicates this request. We look forward to working with the Legislature and the State to ensure that remaining funds are spent in a timely way.

And also, we'd like to request that the state consider pursuing a regulatory fix if such fix exists for the maintenance of effort issue. Of course, if it's a Legislative fix that would be necessary, then that's quite another thing. I want to also stress the importance of providing sufficient funding to support the expansion and ensure the sustainability of aging and disability resource connection programs.

This program is basically designed to help achieve one of the principal goals of the administration's master plan on aging, that of the no wrong door. The vision of ADRCs is to establish trusted sources of information in every community where people, particularly older adults and those living 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. As of 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 also recently learned that an additional seven to nine AAAS across California have withheld applications to become emerging ADRCs due to concerns about adequate funding going forward, and a number of independent living centers, AAA partners in the ADRC program have also withheld applications for the ADRC program to continue development.

As a critical aspect of the master plan's intent to develop a no-wrong door, the allocation must increase. We are asking that the allocation be raised beyond 10 million over two years, with an additional 5.9 million allocated during fiscal year 23-24 and 9.7 million allocated in fiscal year 24-25. We believe that that is the only way that the program can expand throughout California and have any hopes of being a sustainable program. Thank you very much for allowing me to speak.

Next, we have Debbie Toph.

Good afternoon, Chair, Arambula Committee Members, staff and community. My name is Debbie Toth and I'm the President and CEO of Choice in Aging, a 74-year-old nonprofit that has been serving people with disabilities and frail older adults with the goal of ensuring they live with dignity and support in their setting of choice. We have all the acronyms soup at our agency, including Adult Day Healthcare or ADHC, and Community Based Adult Services, or CBAS, the Multipurpose Senior Services Program, or MSSP, California Community Transitions or CCT.

I feel like I could come up with a wrap, but we're not there yet. An intergenerational preschool, mental health, case management, caregiver support, accessible transportation, and budget and policy, education, and advocacy because that is necessary to do all the previously mentioned programs. We do all of this because we have this crazy radical notion that people should be able to age with dignity and maybe even some joy. And we have that opportunity now because of the master plan for aging.

But the master plan for aging is only as good as the money we put into it to make those things a reality. We're hugely grateful to the Legislature. I've been coming here 21 years, and I've never felt like I've been in a pool of friendlies the way I feel like it is now. I mean, it's real. So we're hugely grateful to you, to the Legislature, to the Administration, and in particular to the leadership of the California Department of Aging. We could not have picked better leaders.

We were in the trenches together just two years ago developing the master plan for aging together, and now here she is leading the work. So it's a pretty amazing kismet kind of moment. So know that what I'm talking about today is not about leadership. It's about the problems that we're experiencing. Boots on the ground. So we're going to need partnership continuance with the Administration, and we're going to need the support of the Legislature.

It's going to take everybody to make the master plan for aging truly live and breathe and be effective at what its intent is. So here we go. Here are all the asks. You ready?

All right. Here we go. We're asking for your support in ensuring the $64.1 million bridge to recovery funds that were mentioned for CBAS programs graciously approved for us to make the Adult Day HealthcarePrograms whole and safe, that this funding still come to us. We know that it's been a year and we're still waiting for that funding. And sadly, we've seen foreclosures of adult day healthcare, community based adult services programs. In this time frame.

Yeah.

We can prevent future closures if we act now and Fund and allow the agencies to apply for funding to keep our centers open, centers closed in Marin, Stockton, Contra Costa, and one is pending in a rural area. Sadly, each of these closures were sole providers in the region. There is not another adult day healthcare program that's going to step in and provide those services. We talked about isolation. Guess what's happening to these folks.

Not only are they isolated now, they're not receiving health services, and in rural communities, there are not. And there are sort of resource deserts all throughout our states. And it's just really an incredibly unfortunate thing to happen at a time when the aging population is radically growing. We're removing infrastructure that allows them to continue living in the community. So show me the money. My second ask is for the administrative burden reduction with Emergency Remote services program. You may or may not know about ERS.

It is one of the most incredible things to happen to adult day healthcare in many, many years that allows us flexibility in times of emergency. However, it is hugely burdensome administratively. So at our center, we had one Covid outbreak, which is not bad because we've been back in Center for two years. We're pretty good at this business, but we've radically reduced the number of people we've served. We do social distancing. We require masking. It's all kinds of these things. So we had a Covid outbreak.

We were able to continue to serve people at home, bring them their meals, bring supplies, check in with their physicians, blah, blah, blah, blah, blah. But then we had power outages. So we went two weeks without power, but we had to do 30 hours worth of paperwork to request funding for the services we were providing to our participants. That's nuts. That meant we were up all night on our computers at home trying to get this work done. So ERS is amazing.

Let's get rid of some of that administrative burden, please. All right, so the next ask. We're not done yet. My third ask, this is the third for those of you at home keeping notes. So we have the incredible. We're part of the CalGrows and we're part of Cal-COMPASS. Both of those grants, Choice in Aging is incredibly fortunate to be awarded these grants.

But like you heard from previous speakers, going from a two year grant time frame to a one year grant time frame is not just like we can't spend the money, like you can't get the vehicles, but how do you create sustainability in less than a year? It is really a challenge. If anybody can do it, I will tell you, Michelle at the California Department of Aging is going to help us figure out sustainability in a year.

But Cal Compass is working with the most fragile population, mid to late stage Alzheimer's, and their family caregivers. And how you create a program and create funding streams for sustainability in a year is not a simple task. And you don't want to provide all these services and then pull them away.

And you also don't want to leave the nonprofit organizations that are employing all these people in one year to try and deliver this program, saddled with unemployment claims and all the things that come after and unemploying people that you spent a ton of money, time and resources, training, and bringing on board. So if there's a possibility to extend that another year, I would ask for that if there's not, I would ask for more money and more time.

I don't know where that comes from, but I'm sure you'll find it. I have lots of faith in this Legislature. I really, really do. Okay. And finally, I will say the nail in the coffin for adult day healthcare programs is this rate issue. At a time when minimum wage went up $5 per hour, CBAS rates remained stagnant while insurance costs went up over 50%. Employment costs up, supply costs up, labor costs skyrocketed, supply chain issues. Rates remained stagnant, when the benefit became a managed care benefit.

The state did not put any guardrails on rates. Since 2012, when the settlement protections ended, there has been no rate floor period. MediCal managed care plans can pay whatever they wish. Yet Title 22 regulations mandate that we have a skilled nursing staff. So we have the same staffing in our adult day healthcare programs that they have in skilled nursing facilities.

And we can get paid less per hour than an IHSS caregiver who's not a Doctor, a physical therapist, an occupational therapist, a speech therapist, a registered nurse, a social worker, direct caregiver. And we have caregiving staff issues. So the regulations force this, but the plans aren't forced to pay this. What we're trying to prevent is people going into skilled nursing facilities, and skilled nursing facilities get a rate floor and they get an annual rate increase.

And that has happened every year while adult day health care rates have remained stagnant. The system's broken. It must be addressed. And we can't continue to prioritize and support institutional care rather than community living if we're to meet the true dream of the master plan for aging. I think we've heard some common themes today about fragmentation. Why don't people know? People don't know because we're not mandated parts of the system.

If we were home health or we were skilled nursing facility, everybody would know who we were and when to send people to us and how, if we don't start putting stopgaps in and saying, before you pay for this, you must first exhaust these resources. We will continue to live in a world where nobody knows what exists to help them. So fragmentation is a huge issue. We also need to love our caregiving workforce, and we need to applaud them and laud them and give them some money.

So we're grateful to the Administration for your continued dialogue, you, Administration that way, and partnership, and we look forward to your support as well. Thank you.

Next we have Karol Swartzlander.

Good afternoon. Karol Swartzlander, Executive Director of the California Commission on Aging. The Commission is an independent advisory body established in state statute to serve as the principal advocate for older Californians before the Governor, the Legislature and state agencies. So as you work on the Budget Act of 2023, I'd like to share the Commission's top three priorities for your consideration. First, expanding the workforce serving older adults and increased workforce opportunities for older adults.

The Commission is encouraged and in complete agreement with the increasing efforts to support and expand the workforce that serves older adults, such as CalGrows, with the Department of Aging, and more. And yet, we encourage the Legislature to do more to focus on an untapped resource, older workers the good news is that many of us are living longer, healthier lives. But the financial landscape of retirement years is changing.

For a growing number of Californias, saving sufficient resources to support potentially three decades of retirement is not achievable. And when combined with our current and growing workforce shortages, it leads us to the conclusion that we must see older adults in the light of the value that they bring. We should encourage older adults to retain their current employment while recognizing they may not be able to or want to keep doing the same work or work at the same pace.

We must incentivize employers to incorporate greater flexibility to accommodate older workers. We need to enable older adults to transition into other forms of employment to extend their ability to remain in the workforce. For example, we can promote reentry into the workforce through training such as reskilling and upskilling, providing assistive technology devices and living supports through coordination at the state and local levels.

We now have five generations in the workforce, the silent generation, baby boomers, Gen X, millennials and Gen Z. Each of these generations has different strengths, preferences and work styles, and that are determined by the world in which they grew up, their life stage and their professional experiences. This multigenerational workforce offers a remarkable opportunity to foster intergenerational relationships that promote cooperation and empathy between age groups and help dispel the myths and stereotypes associated with any age group.

Our second priority is addressing older adult homelessness and increasing affordable housing options. I won't belabor that point since you heard so eloquently from the first panel, but I do want to share that the Commission is convening a forum on May 9 in Glendale as part of the C4A, a annual conference, to take a deeper look at older adult homelessness and social models of housing such as assisted living.

And I'm pleased to share that Dr. Kushel, who was so wonderful this morning, is one of our primary speakers. Our third priority is improving behavioral health services for older adults. Behavioral health includes both mental health and our substance abuse issues. In California, older adults are unserved or underserved relative to their needs. For example, in 2020, approximately 27,000 older adults received any type of behavioral health services, even though data projected that at least 700,000 needed services.

We are pleased to hear about the focus of the Department on the Behavioral Health and also that the Mental Health Services Act Oversight and Accountability Commission is partnered with the Department of Aging to issue 10 grants worth up to $20 million to replicate evidence-based and emergency behavior and emerging behavioral health programs for older adults this year.

But we view these grants as only a starting point, and much more urgent action and focus is needed, such as establishing a leadership position for geriatric behavioral health within the Department of Healthcare Services and ensuring that older adults with behavioral health needs are specifically embedded throughout all of the master plan for aging's policies and programs. Thank you for this opportunity.

Next, we have Jackie Barocio with the LAO.

Jackie Barocio with the Legislative Analyst Office. The comments that I just wanted to share is just to provide a brief overview regarding the HCBS spending plan that has come up in this hearing, but may come up in other hearings as it funds initiatives across multiple programs and departments and then just provide an update in terms of where expenditure levels are at today.

So, specifically, just for a background, the HCBS spending plan, it became possible because in 2021, as a part of the American Rescue Plan, the Federal Government temporarily increased the federal match for Medicaid HCBS, or home and community based services, by 10 percentage points. And as a part of the 21-22 budget package, the state decided to fully drawn down those additional funds, which as a result freed up $2.8 billion General funds that otherwise would have been spent on Medicaid HCBS programs.

And as a condition of drawing down these dollars, the Federal Government required states to spend an equal amount of funding to enhance and expand or strengthen HCBS programs. Additionally, the Federal Government required states to comply with an MOE or maintenance of effort, which includes one, not imposing stricter HCBs eligibility rules, two, preserving existing service levels in HCBS programs and three, maintaining HCBs provider payments.

And these MOE requirements are in place for as long as it takes the state to expend all of the additional HCBS funds that we have decided to draw down. And as been mentioned by other panelists, originally the Federal Government gave states until March 31, 2024 to spend those additional HCBS funds. But then in June 2022, the Federal Government did allow states to extend that expenditure deadline to March 31, 2025.

And just two things that I wanted to clarify regarding that expenditure deadline is that, one, our understanding is that for the state to decide to take advantage of that one year extension, it doesn't necessarily require a federal application or an approval. It's really just a state decision that could be done through budget Bill Language, through statute, through the budget process itself. But then also, you may be seeing two different references to expenditure deadlines, March and December.

The distinction between those two dates is the federal deadline is March. However, the State Department expenditures are mainly tracked in December just to allow departments to reconcile cost and submit reimbursement claims for those last three months. So that's why you may see those references. In terms of where we are today. So of the $2.8 billion in HCBS funds that this state has drawn down, as of September 2023, only 282 million has been spent. So that's about 10%.

One of the main reasons as to why the majority of the HCBS funds have not been spent is that of the 26 initiatives that are being funded with these dollars, many of them were new activities, many of them were new expansions and enhancements. So it just took time to plan those out, to ramp them up, and to implement.

Additionally, as been mentioned, under the Governor's Budget, the Administration is assuming that these HCBS funds will be spent by the original December 2023 deadline, so they are not opting to reflect that one year extension in the budget. However, it's our understanding that the Administration, to the extent we get to December and we still have funds left over, their intent is to then provide an extension for however long is needed to fully expend the dollars at that time.

In terms as the Legislature's hearing, HCBS spending plan activities both in the Department of Aging, but in other departments. Just some key questions that we suggest the Legislature ask the Administration is one, what would need to happen to fully spend these funds for each of these initiatives by December 2023? Because, as I mentioned, there are many programs in which expenditures have not happened yet.

So that means we have eight months left to fully spend these funds to the extent that we don't spend the dollars by December 2023. Getting a better understanding of what will happen then. As I mentioned, the administration's intent, as we understand it, is that we will automatically extend the deadline.

However, it's still unclear to us if at that time would we keep the unspent funds in their original and current program commitments, or would the dollars be shifted to other activities where they could be spent more quickly. And then lastly, even though the expenditure deadline would, in our understanding, be automatically extended, the question is, well, what would be the benefits and trade offs of just making that decision earlier through the budget process rather than at the end of the calendar year?

And one benefit that we see is that this would allow departments to have enough time to modify contracts, communicate with program providers, and modify program designs to reflect this additional time, and then possibly just minimize any potential service gaps or disruptions to the extent that we make the decision to extend. But more time is needed to modify the contract. So then program services have to shut down and then start back up once the new contract is in place. Thank you.

Department of Finance.

Thank you, Chair, Hersh Gupta with the Department of Finance. I just want to address a few of the points related to the HCBS spending plan as well. So as LAO noted, the Governor's Budget does reflect that all dollars for this spending plan will be spent by the current deadline of December 31, 2023 with all accounting reconciled by March 31 2024.

And also, just reflecting on the comments we heard today, I want to also be clear that it's really important to the Administration, too. I mean, these programs were developed in collaboration with the Legislature, and so we really want to see these programs succeed. And to that end, we really are continuing to monitor the implementation progress of each of these programs and are working diligently to expend the funds by the current expenditure deadline.

And just to be, I mean, we are anticipating all these funds will be spent by that deadline. And I know LAO mentions regarding reevaluating that come December. I mean, we're hoping that we're continuing to evaluate that throughout this process. We have some upcoming expenditure data that's more recent than the September 2022 picture, hoping to get that in the next couple of weeks from all the departments.

So any sort of auto extension come December, I think, is something we would definitely preempt through continuous monitoring of this funding prior to that time.

Thank you. With that, I'll bring it up to the dais to see if there's any member's questions. We'll begin with Dr. Jackson.

Thank you very much, Mr. Chair. Obviously, one of the greatest mistakes we can make is not implementing or making permanent some of the innovations, some of the changes we allowed during COVID to make sure that we were filling in gaps, making sure that we were doing things in an equitable way.

What are some things that are due to sunset or have already sunset it, but we actually should be making permanent during the time when it comes to taking care of our seniors, for instance, how we did meals and who we allowed to prepare and deliver meals. Right. All those type of things. What should we be making permanent? And that's for anybody and everyone.

Give me the mic. All right. Debbie Toth with Choice in Aging. Number one, you can allow our older adults and people with disabilities to continue participating in the government legislative activities, every kind of process, electronically. It's absolutely ridiculous that we opened the door and we have so many older adults and so many people with disabilities who are participating on commissions on aging, on planning commissions, on all these different bodies, and they're being told they have to come in person now or they can't.

And by the way, accessible transportation doesn't exist to get them to and from these meetings. So you are forcing isolation if you don't take advantage of this opportunity. That's one. Number two, as it relates to adult day healthcare programs, we were able to serve people who couldn't bear a four hour day. Medi-Cal requires us to have somebody on site for 4 hours a day, people decondition during the pandemic.

And so people that we had been serving at Choice in Aging for 10 years in our adult day healthcare program, five days a week, came back and could not do 4 hours, but they could do two. But that flexibility got taken away. People who cannot do that long or people who have difficulty, because paratransit takes two and a half hours to get to the center because an adult day healthcare program closed. So they have to go to one that's further away.

Are not going to be able to bear a two and a half hour drive, a four hour day and a two and a half hour drive home. Like, there were some flexibilities that we had that have been taken away that we absolutely should have in place, and there should be justification for why that's happening. There has to be a medical assessment. Like, there are things that we can put together to make sure that's the case. We're also now taking away food benefits from people. Right?

So that is going to be radically reduced. And why were we starving people? We are the richest nation. We are the fifth largest economy, or maybe the fourth now. I don't know. That varies, but we absolutely must continue to feed people at the levels we were feeding people. And I want to just shout out to Marco.

Are you talking about the CalFresh? When the Federal Government withdrew, will stopped, giving the actual funds? Is that what you're talking about?

I mean, we're reducing benefits now. We got people up to a certain amount of food benefit, and now we're taking away that food benefit. So how we Fund that, I don't know, but we must. I mean, these are basic sort of things.

I used to say the same thing. I used to be on the other side and say, hey, that's not my job. You figure it out.

I'd be happy to help you figure it out. I think I'd rather work with her than him, though. Just to be clear. If I'm gonna say.

I'm friendliest.

I think that we also learned that there are ways that we can do things that are more person centered in asking people what their wishes are. So, for example, we have a Russian program, Russian and Ukrainian program in our adult day health center. And at the beginning of the pandemic, the coordinator for the program said, there's no way my people are getting on Zoom. Guess what? They zoom every day. So some that come three days a week are zooming in those other two days a week.

We can't Bill for that because that's not allowed because we can't serve people off site anymore. But they're on Zoom all day and they're exercising and they're participating and they're engaging. There are so many lessons learned that we are making go away right now. So I thank you very much for that question. I'm sure if you gave me another hour, I could keep telling you all the things, but those are top of.

Karol Swartzlander. I would like, since she opened the door, I'd like to also echo that we need to keep the Bagley-Keene flexibilities in place. The Commission on Aging is really concerned about the ability of older adults, people with disabilities, people who are too poor to travel, people who are in rural areas participating on state level boards and commissions.

Because requiring in person attendance to establish quorums means that you're creating a barrier to a lot of people who can't participate, who showed they could participate and do participate fully, remotely.

Then my second question is. While we're in this two year cycle as a Legislature, 2023-2024 what must we have accomplished within these two years to stay on track with the master plan and to meet the.

Current needs.

That is a big question. Okay, I looked around for those of you at home to see if anybody else wanted to answer. I think first and foremost, I think working closely with the California Department of Aging is going to be necessary because they're the ones who are watching this play out and overseeing what's happening. So, for example, you heard Director DeMarois mention that there are 95 new initiatives. So we went from 134, 137, something like that.

These 95 are different than what we had before, and that's because they observed, they listened, they learned, and they're course correcting. So it is a living, breathing body of policy. And in order for the Legislature to not have a disconnect between what's happening, I think working closely with the California Department of Aging is going to be very, very important. And I think there's a data dashboard.

There's a tool that we can use that we're using to monitor progress where we don't have really good markers for how to measure, such as accessible transportation. In case you guys have not heard me say that we're developing them and we're asking people with disabilities and we're asking older adults and we're asking caregivers. So I think there's a lot of information that's coming in. I think we have tools. I think we're developing them. My question is, what are we spending? And I asked that question.

Are you paying attention? I asked that question because we have so underinvested in older adult and disability programs and services that what we're investing now cannot be just a flat level is the same as somebody else. We have to invest more. We have to invest more. So when you look at how much money you're investing in something that's broken versus how much money you're investing to keep status quo, you know, you have to do some extra work to fix the broken.

So I think the investment levels need to be higher and make you uncomfortable. You uncomfortable in order. So comparing that, what are we spending now compared to what we were spending before? And are we meeting the mark with what we're spending? We should not have to come back. As the IHSS human said, I'm sorry, I don't have her name in my head.

We should not have to come back every year and beg for funding to keep programs and services running that save taxpayer dollars. One fifth the cost to pay for adult day health care versus a skilled nursing facility. And I'm here begging every year for funding. So I think being able to fix funding streams and look at how you are investing more in community-based solutions over institutional solutions should also be a calculus of success and just being welcoming to us in these rooms. Thank you.

Dr. Jackson. I might add just one point to Debbie's comment. In the 95 new initiatives, because we're now in year 3 and 4, it's like a relay. So all of the initiatives started at the same place, but now the work is being staged and we use three criteria. With these 95 initiatives, everything is grouped. It's either something that we're delivering, so that means it's in progress, it's in place, it's been authorized or funded by the Legislature. We are analyzing.

So there's a lot of work in this 10 year plan that we still have to study, do research, our due diligence, stakeholder engagement, and then the third is communicate. So it's either deliver, analyze, or communicate. We realized, and we heard this today already in your hearing, that many programs and services that exist in our state aren't known to the communities that they're intended to serve.

So a lot of the work of the master plan is also to get the word out on what is available and to meet with communities to hear about where those gaps exist.

If I can, I'd like to add one other thing related to ADRCs. I think we're at a crucial point in the development of ADRCs in terms of having this ceiling, a financial ceiling on the ability to continue to expand, and we have a demand out there. There are a number of AAAs and ILCs that would like to participate in the program, but have real concerns about whether there'll be adequate funding for the program going forward.

So I think in the next two years, it would behoove the state, the Legislature and the state to think of our funding ask, which would really help Fund that expansion and build sustainability for the ADRCs and thus allow the continued movement toward a no wrong door solution. So I do think that's a very important consideration going forward.

Thank you. I would actually agree with both Michael and Debbie on everything they just said, but I also think we need to keep up both the support for the Department and pressure on the Department to continue moving forward.

I've worked in aging and long term services and supports with the state for 22 years now, and we never were able to get off the ground until we had an Administration come in and say, yes, we're going to make this a priority, so we need to continue making it a priority. And all the stakeholders, the Legislature, everyone needs to support the Department in making it happen.

One final thing, Schoolhouse Rocks. You may be too young, I don't know how old you are to know what Schoolhouse Rocks was, but.

I know what you're talking about.

Living on Capitol Hill. So we need that for aging and adult services in the community. So an HCBS, LTSS, Schoolhouse Rocks. And I think if we get it to the children when they're little and everybody up, then we're never going to have questions, are we? Because I can still sing at 53, you know.

Thank you, Mr. Chair.

Bring it back to the chair for a few questions. I'll begin with Director DeMarois and Deputy Director Beckley if I can. I want to give you an opportunity to respond to some of the concerns that we heard from stakeholders. In particular want you to focus comments on the bridge to recovery and the foreclosures that we've seen that really is decreasing access. Hoping you can provide some comments.

Mark Beckley, Chief Deputy Director, California Department of Finance, this takes me back. I used to work for the Department of Finance, as Nicole will remember once in the day. California Department of Aging.

Yeah. So on the bridge recovery and on a lot of the CBAS issues that Ms. Toth raised, absolutely the closure of CBAS sites greatly concerns us. They're definitely a vital part of the HCBS continuum. They have served so many older adults throughout their duration and just provide such a needed vital service. When we look at the rates and the utilization rates over time, we definitely have seen a net decline. So pre-pandemic, the CBAS sites were running at about 70% utilization.

During the pandemic, there was an uptick to about 85%. Now they're down at around 50%. Part of it could be. I mean, there's a myriad of factors that could play into it. Some of it, as I mentioned, concern about just infection entering into a CBAS site post COVID. During COVID there was, as Debbie had mentioned, temporary alternative services, which did allow CBAS sites to provide services remotely, which made access to those sites very easy. However, that was temporary and that was a CMS-approved flexibility.

That flexibility has expired. And as the waiver is currently constructed, CBAS is an in person center service. So we as the state don't have flexibility to change that. It is the way that the waiver has been designed. But we did implement what's called emergency remote services, which do allow the sites to provide remote services in the case of either a personal emergency with an individual or due to, like a state disaster.

We have heard many comments from CADS, which is the Association that represents the CVAS sites, about the administrative burden issues. And we have been working collaboratively with CADS as well as with the DHCS and CDPH to build in additional flexibilities. For instance, now a site only has to submit one application if the site needs to go down, as opposed to individual applications for each participant, and we'll continue to work.

And I'll also note that part of the issues there are also the managed care plans who also have their own policies about ERS approvals. But we're definitely committed to working with sites on those issues. On bridge to recovery. That is a huge priority of ours. It is a huge lift. It's a grant-based program.

We have a consultant that we've been working with, and we've been working really closely with cads as well as the pace and adult aid centers to develop the request for application and the process. We expect by the middle of May to submit letters of intents for centers to apply to be a part of the program. And then the formal application process should follow early June, like within the first or second week of June.

So that program we do expect to launch very shortly, and we hope to get grant awards out by September to the sites. So that's the current timeframe on those issues.

If I may, Thank you. That was excellent Mark. I would just add we're hosting a webinar. Part of our role at the Department of Aging is really to convene our community and to engage stakeholders. We're pointing our CBAS providers to the DHCS CalAIM Path cited opportunity to engage more actively in CalAIM, and examples of that might be enhanced. Care management might be a really good fit for many of the ADHC providers.

So we're providing some abridge to the Department of Healthcare Services to help our community better understand that funding opportunity that is open through May 31.

Along those lines, and it might be a better question for DHCS. It seems that there are significant cost savings from doing CBAS versus institutionalizing our elderly. I believe we heard testimony it was a fifth of the cost. So we haven't had the managed care plans increase rates. Aren't we expecting then for more elder adults to be institutionalized if they're not getting adequate rates? And what can we do to incentivize, encourage, or if I'll use Cal Ames words, advance and innovate with medical to make sure we're meeting the needs of older adults?

Mr. Chair, I would agree with you that that question is best answered by the Department of Healthcare Services.

I'll bring it back. I'm going to want to focus a little bit on the HCBS spending deadline. I'm really moved, and I'll come back to the Department of Finance. Your comments were that you're going to be tracking closely over the next coming months. Are there any deadlines for us that you would make a decision by? How do we stay up to date on the information that you have? You recently stated there's going to be more information coming. When's the plan to share that with the Legislature?

As when I see us spending 10% of funds thus far, it doesn't give me confidence that we'll spend it by the end of the year, that I'd like to understand what options we have that are available, as well as if we are forced to spend it within the year. How are we expecting to operationalize and make sure that we are able to do this?

Sure, So I'll start just by reiterating again a couple of points. So one, the expenditure picture that we have of 10%. Unfortunately, the latest data that we could provide prior to the hearing was just the September 2022 figure. So while it is a small amount, it is both lagging in time. And then also I'll note that a lot of these programs have money that goes out in pretty significant chunks. So that number, the expenditure picture, could change fairly rapidly in a shorter period of time.

So just to kind of provide a little bit more context to that particular figure, as far as providing updates to the Legislature goes, that's something that. For. any changes to the expenditure deadline or anything of that nature, by statute, we're required and absolutely will proactively come to the Legislature to communicate any thoughts about those changes and engage the Legislature in those decisions, for example. And also, we're also required to notify the Legislature of any kind of expenditure changes as well.

So we just had a notification go out to the Joint Legislative Budget Committee in which we actually had all departments provide pretty detailed explanations of exactly how they plan to expend all these funds by the current expenditure deadline. And happy to provide a copy directly to your staff as well for reference. And I think, again, that's something that we're going to continue to update and monitor.

We're getting an updated expenditure picture in the next few weeks here, and we'll be sure to share that with your staff as well. And those are kind of the General deliverables there and hopefully gives a little bit more sense of what we're looking at.

It does, and I'd like to now turn to the Administration, if I can, and based on the concerns that we're hearing from the stakeholders, are we actively considering an extension to this timeline? Would love to get your thoughts on that.

So on behalf of the Department of Aging, we're one of several departments and a list of many initiatives, and we're adhering to the December 31, 2023 deadline. And those are the contracts that we have in place with our awardees for the different programs that we oversee.

Just so we have a little clarity and understanding. And I'm not trying to continue on it, but is it the MOE for the other departments that are constraining our ability to seek an extension? Because the testimony here was pretty powerful for me, and so I'm trying to rationalize why we're continuing with this timeline. I'm looking to see if there are other departments that are also receiving this HCBS waiver that may inhibiting us and if so, what is that?

Yeah, so that's exactly the challenge here. It's really weighing the needs of these stakeholders to expend the funds by the deadline and actually execute the goals of the programs that we set up against this maintenance of effort requirement. And just to back up a little bit, that maintenance of effort requirement actually applies to all Medicaid HCBS programs.

And what it does is that in addition to restricting the state's ability to kind of make changes to those programs, it also has resulted in significant delays in federal approval for a variety of other state requests pending with CMS. And so I think the challenge there is, especially as needs are quickly evolving with the PHE unwinding and things like that. I mean, there are a lot of key changes and initiatives that we need to make sure we get quick approval from CMS on.

And so I think balancing that with a need to get these programs to the finish line is really what we're struggling with here. And again, I think that's why while this is the decision that governs budget, we're continuing to monitor the implementation progress and really want to make sure that the programs are successful and expend everything by the deadline.

With that, I will thank very much this panel and hold this issue open. And I would like to make one request from the Chair, if I can, and that is for more detailed information from the Department of Aging and DOF by Friday, May 5, about how it intends to spend those funds. It sounded as if you had submitted it to JLBC and just want to make sure this Committee receives it as well. Sure.

Happy to do that.

Thank you. With that, we will move on to issue three regarding the In-Home Supportive Services programs, including the Career Pathways program, the phase in of undocumented immigrants aged 50 years and above, and the restarting of medical redeterminations.

We will have three presenters on issue three, and we will begin with Leora Filosena, adult programs division deputy director, California Department of Social Services.

Thank you, Mr. Chair and Committee Members. My name is Leora Filosena. I am the deputy director of the adult programs division at the California Department of Social Services. I oversee the in home supportive services program, the cash assistance program for immigrants, the state side of SSISP, and adult protective services. I'm just going to ask the question. Did you just want me to jump into the questions? Perfect.

All right, so the first question was, with regards to career pathways, please provide an update on the IHSS career pathways program and how does CDSs intend to ensure that all HCBS Funds will be spent within the administration's timeline? And will there be a proposal to extend the program expenditure deadlines? So Career Pathways is a new program we're really excited about. We were able to get it off the ground.

It's for IHSs and WPCs providers that's meant to increase the quality of care, assist with recruiting and retaining providers, and provide opportunity for career advancement through training. Providers can complete classes in five different pathways.

They were limited, but they were available in English and Spanish in most cases. In January 2023, more classes were launched by two new vendors, Homebridge and the Centers for Caregiving Advancement.

There's a general health and safety pathway, adult education, as well as three specialized pathways which include cognitive impairments and behavioral health, complex physical care needs and transitioning to in home care and community based living. In order for us to get the program off the ground, we did in nine months, we completed two procurements to bring on training vendors.

We brought on vendors to create career lattices and provide coaching services to assist providers who are interested in furthering their career in the healthcare field. Classes launched in October of 2022, our county partners stepped up and provided those classes.

More classes have been added to the course catalog as of March 2023. For the period of January through March 2023, we had a total of 1,949 class sessions offered in multiple languages, mostly online.

Depending on the class and the vendor, providers were able to take classes and can still take classes in English, Spanish, Armenian, Cantonese, Mandarin, Russian, Vietnamese and Korean. We have approximate capacity at this point for 16 to 18,000 providers to attend training classes each month.

We're seeing attendance at approximately 50% to 70% of that, which is what we've heard is normal for training. So roughly 8 to 11,000 providers are currently attending training. Classes fill up every time we put them out there, there's a lot of interest. Our vendors do run waitlists for each class so that if they get a cancellation, they're able to reach out to people and give them the opportunity to attend.

With about 8000 to 11,000 folks attending training each month, we anticipate that at least between 96-120,000 providers will be able to complete at least one class, based on what we're seeing today. As classes continued and based on current attendance rates, we believe that we will expend the funds based on what we see today. Additionally, we are starting to receive claims for incentive payments.

So originally we were just receiving some claims for actual just training time, but we are starting to see the incentive payments come through, particularly for completing one pathway. There are two other pathways, as you guys heard earlier.

One is with regards to working for somebody for one month, so it's completing a pathway and then working for somebody for a minimum of 40 hours. We're starting to see those now and people will be eligible to claim the six month incentive starting at the end of this month.

So we do anticipate seeing those start to flow in. And of course, we will continue to be looking at actual expenditures as we kind of go through this process. For the second question with regards to career pathways, the question was how many providers does CDSs expect to go through the trainings and receive incentive payments, and how is CDSs winding down the program in a way that ensures providers are aware of the deadlines they must meet in order to be eligible for various training incentive payments.

So right now, based on what we're seeing, we are estimating roughly 15%, or about 107,000 IHSS providers will complete one career pathway. In addition, we're estimating 44,000 providers will receive a second career pathways stipend, meaning they complete two pathways, so each one of those qualifies them for a $500 incentive payment.

Based on what we're seeing, 60,000 will receive a stipend for one month of employment and 26,000 will receive a stipend for the six months of employment. So that's what we're anticipating right now.

In sheer numbers, as of April 11 of 2023, we have received over 26,000 claims for payment. Most of them are training for training time, but we are seeing, like I said, the request for incentive payments. So we're going to continue to work diligently to make sure that those payments go out and each one is a manual process where we work with the training vendors, make sure we are validating attendance and then issuing the payment out the door.

So we are making sure that we are getting people paid as quickly as possible. We continue to communicate with providers. So as classes come out, we're letting folks know. We have set up a website on the CDSs website for people to come that gives them all of the information that they need with regards to course catalogs, how to receive incentive payments, all of that. In addition, we recognize that we have to let people know right of when those deadlines are.

So those will be our normal proactive communications that we use today. We do a lot of emailing to our providers, lots of banner messages on the electronic services portal. We'll be doing social media posts, all of that, all of our normal activities, to be as proactive as we can to let people know when they need to do things, how quickly they need to get them in, how to submit their incentive payments.

We've done the best we can to make everything accessible, everything easy to use, and we'll continue to do that. We also have provided coaching for people to provide that information to them as well. So if people are struggling with accessing the program, they can contact the coaching services and get help there, not only for accessing the program and getting paid, but also if they're interested in featuring their career in the healthcare field.

So those coaches also work on giving them the information with regards to career lattices and whatnot. And we are always committed and continue to be committed to ensuring providers receive the wages and the incentives they earn in this program. And we also want to make sure we're proactively encouraging IHSS providers to take advantage of the opportunities offered as part of this program. So we continue to work on that.

So then the third question, and this is kind of shifting over to a different topic, is please provide an update on the phase in of undocumented immigrants age 50 and above. And so we have recently begun to see undocumented immigrants age 50 and above enter into the IHSS caseload.

So we are starting to see that as paid cases receiving services. This timing validates our previous assumptions about the lag between the expansion of full service medi Cal and the subsequent increase in IHSS cases. And we are continuing to monitor the rate and the cost of the phase in of the new case law. So this is something that we are looking at very proactively.

LOA, Ms. Bellow thank you.

Mr. Chair. Jenny Bellow with the Legislative Analyst Office. There are no major new proposals in the Governor's Budget for in home supportive services for 23-24. But there are a few issues that we continue to monitor and expect some updates on at the time of the May Revision.

The first one is related to enhanced federal funding for IHSS, and this is not the enhanced federal funding that you heard about with the HCBs spending plan, but instead it is enhanced federal funding that was related to the public health emergency that was for all of Medicaid and also for IHSS. So it was a 6.2% increase of the FMAP that we started receiving back in January of 2020.

So we've been receiving that enhanced federal funding that has been offsetting General Fund costs in the program for several years now. The Governor's Budget assumes that that enhanced federal funding will end in the current year and therefore General Fund costs will increase in the budget year.

Since the development of the Governor's Budget, we've learned that there will be some additional enhanced federal funding in part of the budget year. So we expect to see some General Fund savings when we see the May Revision.

Another issue we're continuing to monitor, and we always do, is the caseload. So we're continuing to watch the IHSS actual caseload numbers coming in and comparing those to the administration's estimates. One trend that emerged during the pandemic was really related to the percentage of authorized IHSS cases that are paid cases in any given month.

Historically, that number has been at an average of about 91%. So of those authorized cases, on average, we see 91% getting paid. During the pandemic, though, we saw that number drop to 88%. But more recently, the more recent caseload numbers really look like it's starting to creep up again closer to that pre pandemic level.

So we'll be continuing to monitor those numbers and hope to report back in May and look at that comparison. And then finally, we are monitoring the implementation of enacted new initiatives such as permanent provider, backup provider for sick leave, and also the career pathways.

And hopefully we'll have some additional new data we can share at the time of the May Revision as well.

Department of Finance?

Yeah, and I'll call in Department of Finance. Nothing further, but happy to answer any questions.

Bring it up to the dais to see if any members have questions. I will keep it here at the chair. I'm going to focus if I can. Deputy Director, earlier we heard about a need for 240 million in General Fund Fund the baseline Calfresh County Administration costs, and I'm hoping you can respond to the IHSS County Administration issues if possible.

Sure. We are aware of the proposal. We are definitely taking a look at all of that, and we'll continue to have those conversations as we move forward with not only counties but also our counterparts to see what can be done or whatnot. So we do continue to explore that.

I'm going to ask next about the Career Pathways program. What are we learning thus far about its effectiveness and whether it should or could continue past the one time investments that we make? And what's your thoughts on the stability of the provider workforce overall in IHSS?

Sure. So I think that we're in the process right now. It's a little bit early for us. We're looking at data and seeing kind of what the impacts are for IHSS providers. We are currently working on an interim report to the Legislature that's due in May. So there will be some information there definitely, with regards to how the program is working.

We are looking at doing focus groups with people who've attended training and also trying to follow that up with recipients as well to see if there have been some changes, if what we believe the program does, it actually does. So we will definitely more to come on that for sure. As far as the HSS provider population, we do see that that is something that we have to absolutely focus on. So it comes as no surprise.

We talked a lot about the Master Plan for Aging and how this population is growing, and we definitely see that there are some pressures there. So we will continue to look at how we can bring more providers into the program and see how we can look at bettering their experience as an IHSS provider, but also thinking about all the things that we also have to focus on. And in ensuring quality of care, ensuring that people have dignity in their care.

And so we're definitely focusing on all of those efforts at this point.

In your testimony, you said you believe they will expand the current funds by the end of the year, but we heard a stark contrast from stakeholders earlier, and I'm asking how we rectify both statements.

Sure. So I think for Career Pathways in particular, it was a slow ramp up. So because it required procurements, it required contracting, it required a lot of things, we were able to meet the statutory deadline to implement with county classes, but we had limited offerings.

So really what we've done is we have done a lot of ramping up of classes. And so based on the attendance rates that we're seeing today, the number of courses that are available, the number of people who are attending.

We feel pretty confident that we're going to be able to expend those funds, particularly focusing on proactive communication to our providers as well, to make sure that they're aware that this program is out there and what they need to do to get those payments.

We'll just emphasize, I believe your total number was 96 to 100,000 will take one class. Earlier from SEIU, they stated they had 600,000 providers and UDW has 135,000.

Yes. So we're estimating about 15% of IHSS providers will take a class, at least one. So that's about 107,000 folks. As far as the numbers, I was trying to go back and look at what I have and we've received about 20, a little over 28,000 claims at this point. So based on that as well, looking at the number, just to give you kind of an idea of the number.

So we ramped up the trainings from more than 5000 course hours in October to December to over 23,000 course hours in January of 2023. We have increased that number again in March and as of April 2023, we've actually offered over 9000 classes.

So we continue to ramp up and the demand is definitely there. So we feel pretty confident that we're going to expend the funds based on that.

Again, it's another rationale for why I was asking about one time funding. If we've covered 15% and there's still 85% who could benefit from the program, it seems there's an opportunity for us to consider looking to extend this type of funding going forward. I'm going to move to redeterminations if I can, within IHSS and I'm going to get nuanced. Sorry about it.

No, it's okay.

We passed a medical asset limit test adjustment that will go into effect in January 1 of the upcoming year. And yet we're going to be redetermining for some as of now with the current medical asset test that may throw those who are on IHSS off when their medical is being redetermined. That I'd like to understand what options are available to us to consider.

Is there an opportunity, as we've done on the health side, to deprioritize certain populations if we are expecting changes to come in the upcoming year?

So as far as the medical, I believe that DHCS did receive a waiver on the medical asset limits. So we are a service of medical. So the way it works for us is that if somebody loses their medical, that data comes to IHSS, and then those individuals would be put on the IHSS residual program, while the counties, and nine times out of 10, the county's first priority is to get them on their medical. Right. So they go through all that process.

So what we're doing, and I just want to also point out it impacts about 33% of IHSS caseloads, so 67% are SSI. So those individuals go through a different process. Their medical is hooked to their SSI, so they don't actually go through the redetermination. Now, 33% is not an insignificant number.

So I'm not saying that that is by far insignificant, no. But what we are doing is really some proactive. So we consider ourselves ambassadors as part of the DHCS team, putting information out there.

So we've worked with DHCs to create some IHSs specific messaging that they're going to be pushing out, and we will also be pushing out through our normal communication channels, through emails and banner messages, social media. We'll be doing all of that to proactively keep people on.

So we're hoping with a lot of that, we're not resting on our laurels, as they say. It's such an old saying. We do, and are continuing to be proactive about ensuring that people don't lose their medical.

I think our concern, as it was on the health side, is as we're doing these redeterminations, we've been telling people for months not to fill out forms, and now if they miss one form, there's the chance that they may get thrown off their medical.

And for this particularly vulnerable population, we'd like to be kept abreast of what currently is going on about the current State of affairs and how those redeterminations are going so we can be as protective as we can for this vulnerable population.

We have been working with DHCS and we have a couple of strategies. I think probably one that's really going to benefit us is we're going to be getting data from DHCS with the folks that are having to go through redeterminations on a monthly basis.

So our plan is to share that information with the counties, because the counties also have mechanisms themselves. They do blast text blasts, emails. If it's a smaller county, they'll actually contact people individually and remind them to do their paperwork.

So definitely we're putting that message everywhere. We know every IHSS recipient has to approve a timesheet, either through the electronic services portal or telephone timesheet system. So we're putting messaging there as well so that they hear it when they log on or they see it when they log on that says, you're going to get your packet in the mail, definitely fill it out and return it. It's really important.

So we're really doing everything that we can human possible within our infrastructure, within the different communication mechanisms that we have to make sure that people are aware that this is extremely important. We don't want people to lose their benefits.

Last question on it. It would seem that very little would change with their financial picture since the public health emergency and now that it's just a real concern if we're redetermining those who are on IHSS that they've lost their coverage. And so is there a failsafe or a chance for us to ensure that prior to termination that we have ensured that we've done everything?

It sounds like you're stating the counties will do that and we'll make sure to do outreach, but what's our backstop to make sure we don't have harm happen?

Thank you for that question. So because we're a service of medical, right. All of that stuff happens on the medical side of the house. So when IHSS, when we get information that comes from DHCS that says somebody loses their medical, they go into the residual program.

So they won't actually lose their benefits. They will still continue to get their benefits, but it will be funded, state only funds. We kind of lose that federal share. So that's where the county step in.

Once that person becomes residual, then the county then gets a notification, hey, this person lost medical and then they will go and do some outreach and try to get that person back on their medical. And so that's usually the way the process works and that's how we anticipate it should work now.

So folks won't necessarily lose their benefits or IHSS services. They'll go into the residual program and then the counties will do the work necessary.

They will lose their medical potentially, and if they're disabled and elderly and in need of those services, I think that's why I'm trying to make sure that we do all we can to be as protective as we can. With that, we will conclude this panel. I will, thank you very much. I will ask for some detailed information, if I can, on how the Administration intends to spend its portion of the HCBS Funds.

As I spoke about earlier, and in particular the IHSS Career Pathways, I just want to make sure that we have as much information if we potentially need to be asking for an extension.

Second, I'd like to ask for that written analysis, if I can, about the IHSS recipients who are expected to be subject to the resumption of medical redeterminations and any specific strategies. We have to retain full scope medical coverage for those who remain eligible.

In addition to any specific metrics the Department will be tracking to understand the impacts and how and when this information will be shared with the Legislature. We'd like to ask the Administration for that. Are you amenable to that?

We'll do our best.

Thank you. I will thank this whole panel, and we will move on to issue four. Issue four is regarding supplemental security income and state supplementary payment program status and the Housing Disability Advocacy Program implementation update, including HDAP, proposed technical changes, Trailer Bill Language. We will have four presenters on issue four, and we will begin with Danielle Morris.

Hello? Is this on? Okay, hopefully you can hear me. Good afternoon, Mr. Chair and Assembly Members. Thank you for having me today. My name is Danielle Morris and I'm the chief over the Fiscal Appeals and Benefit Programs branch in the adult programs division of the California Department of Social Services, and I'm here to present the SSI/SSP questions that came our way.

So, the first one was related to grant levels for the supplemental Security income and state supplementary payment SSISSP against federal poverty levels and how these grants compare to average rental costs in most California counties.

So, as of January 2023, the federal poverty guidelines are $1,215 per month for individuals and $1643.33 for couples. The most common SSI/SSP maximum grant amounts are $1,133.73 for individuals, which equates to 93.3% below the federal poverty guidelines.

And then for couples, it is $1927.62 for couples, which is 117% above the federal poverty guidelines. In terms of the grant levels compared to average rental costs within California, we have not done a comparative analysis to be able to see the rental levels versus other housing assistance that these individuals would qualify for, but we do recognize the high cost of rent throughout California and the barriers it creates specifically for the lower income populations.

Onto the second question, what has been the history of the adjustments for SSI/SSP grants, and what year are the current grant levels commiserate in history? Dollar for dollar. So we do have two reference documents that are within our 2023-24 Governor's Budget, which specifically cover number one, the California SSI/SSP history of maximum payment standards for aged, disabled individuals and couples.

This displays a historical look at SSI/SSP grants as well as the adjustments for the SSI and SSP COLAs that have taken place up until January of 2023. We also have a second document which covers the estimated SSP payment standards if the COLA had been applied based on January of 2029, when the cuts were applied.

This displays the projected General Fund cost of what the payment levels would have been in January of 2023 if the state cost of living adjustments had been provided annually to SSP grants beginning in January of 2029 and each year thereafter.

So there's many different categories which individuals could qualify under. But looking at our most popular payment standard, there's a difference about of $134 of where we're lower than where we would have been if the COLAs were applied each year since January of 2029.

So we do recognize that. And then, looking at the third question here, could the state pivot to a total expenditure method regarding SSI/SSP grants, which would prevent a reduction of grant levels below the state expenditures in the prior year to reflect California's values?

So, since the maintenance of effort has been a requirement of California since the 1980s, we have chosen the payment levels method where the state may not lower its supplementary payment levels for any payment categories below their March of 1983 levels.

38 other states also choose this method. From our research, California could make this change to the total expenditure method. However, we don't currently have a proposal on the table or know what details this would on what kind of impact it would have on an administrative perspective, and we don't have anything moving forward at the moment to make this change. And then the fourth question for SSI/SSP here is related to the caseload declining slightly.

Are there issues with applications and retention of SSI/SSP benefits, or are there any other reasons for this dynamic? So the SSI/SSP caseload has been declining for a number of years even prior to the pandemic. Looking back at fiscal year 14-15, when we started to see a decline, the pandemic has impacted a number of SSI applicants.

The number of applications decreased sharply in 2020 and remained Low in 2021 due to a number of pandemic related effects, including SSA offices closing and applicants needing to utilize technology to apply for these benefits, which created additional barriers.

In 2022 and 2023, the number of applications is projected to increase and as compared to 2000 and 22,021, it'll reach levels that are more consistent with the long term expected trends and remain roughly that thereafter.

In terms of why it continues to be a decrease, we think there's a multitude of different factors, which is hard to really determine what's leading to that. But two of the main factors we believe increases to this decline is due to income and resource limits for this population, and thresholds which are set for them. Specifically speaking to the asset limits, those have been the same amounts since 1989, and they're set at $2,000 for individuals and $3,000 for couples.

Hanna Azemati.

Hi, thank you so much for the opportunity to present here today. My name is Hanna Azemati, Deputy Director for the Housing and homelessness division at the Department of Social Services. I'll be speaking to HDAP in this issue number four, but I'll also be speaking to our other programs in later issues. So I know you heard a lot today about the need amongst older adults, especially those at risk of and experiencing homelessness.

So I'm just going to go straight into talking about the programs that we do have, rather than discussing the level of need further. So the agenda provided a really strong overview of the HDAP. So I'm going to highlight a couple of points before answering your question, specifically.

The last two years, as you know, have provided us with significant investment in our programs and have allowed for tremendous statewide expansion. The increased funding has allowed HDAP, in particular, to expand to 57 counties and two tribal programs.

Many of these local programs are continuing to ramp up program implementation and expansion in order to effectively scale their programs in response to these historic investments. Based on prior pilot implementation timelines, we anticipate and are seeing that these new and expanding programs require six to 18 months to fully scale up and implement.

To support the expansion and the growth of our program statewide, we've launched comprehensive Technical Assistance initiative in partnership with the Change Well Project, which has allowed us to be very tailored in our response to the needs of local communities and stakeholders and in providing that support, I'm going to speak to HDAP's outcomes, which I know is a point of interest.

Since its inception in 2018, the program has served more than 500 clients and helped permanently house more than 2800 people six months after exiting the program.

Those that have been housed of those that have been housed, 80% retain housing. And in fiscal year 2021 to 2022, grantees reported that HDAP had a 78% approval rate for disposed disability benefit applications, with 65% of applications approved at the first point of evaluation.

By comparison, the average rate of approval solely for initial applications for Social Security disability benefits specifically was 39% in California in 2020. So we're making significant improvements upon the average rate.

But additionally, I will note that applicants for SSI and SSDI that experience homelessness are estimated to have as low as 10 to 15% initial application approval rate. So considering the population we're serving, it's an even greater impact.

Grantees have credited HDAP with improving cross collaboration among social service agencies, disability benefit advocates and housing providers for a more holistic approach to service delivery, which we believe is another really important impact that this program is having.

You've also asked about the challenges that are arising as we're implementing HDAP, and I'm going to highlight a few of these, and I'll note that these to a large extent apply across all of our housing and homelessness programs, so I'm not going to repeat them later on. But the first I want to highlight is a lack of safe, affordable and permanent housing options.

All communities are up against a deficit of affordable housing stock, and you heard the story earlier today that was so moving of one of the speaker's grandparents facing this challenge. Specifically, rising housing costs can make it challenging to identify housing that is sustainable for individuals with disabilities, even once they secure disability benefits. Many local staff are new to the housing and homelessness field. That is a second challenge I want to highlight.

So because we're working with social service departments that previously didn't have the tools we're offering them to help their clients that are at risk of homelessness or experiencing homelessness, it means that they, as the staff, have to be getting up to speed on the homelessness system at large and what the best practices and approaches are that work.

So our technical assistance has been a really critical factor in that. The third barrier that we've been experiencing is capacity constraints amongst third party contractors and providers.

The huge surge in need, accompanied by the huge surge in investment which we're so grateful for, has meant that we're really running up against capacity to actually run and implement these programs. And so that's been something that we're continuing to invest in and trying to problem solve around. And again, technical assistance has been super helpful investment to that end as well. And then finally, a lack of robust cross cutting data.

Notoriously, data on homelessness is highly decentralized, variable in quality, and limited to data on individuals and families that access homelessness. With the point and count data aside, which has its own problems.

But for HDAP in particular, finding ways to really be able to access and improve the integration of data is critical to coordinate across disability benefit advocacy and housing services and follow up on clients' performance, or outcomes after they exit the programs. So now to the HDAP proposed technical changes.

So, as summarizes in the agenda we're proposing trade alone Bill Language to make two technical statutory changes to HDAP related statute. The first is to extend 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 appropriated in fiscal year 2022 to 2023.

And the second is to clarify the department's obligation and authority to develop regulations corresponding to the entirety of the HDAP statute, rather than just the changes that were enacted by AB 135 by July 1, 2024. These technical changes will support streamlined implementation of HDAP using the one time funds included in the Budget Act of 2022. Thank you very much. I'm happy to answer any questions.

Ms. Bella with the LOA.

Thank you, Mr. Chair. Just one technical note on the SSI/SSP program. As you know, there is a grant increase proposed for the January of 2024, and the budget includes 146 million for that. And that amount is certain. The amount that it will increase grants is an estimate. So it's an estimated 8.6% increase in grants that could be afforded by that 146 million.

And in the past, when we've done grants this way, the Department of Finance and the Administration has worked together, as we get closer to the implementation of the grant increase, to figure out exactly how much of an increase we can afford with the funding, and they report back to the Legislature, we get it in the fall and we get a chance to look at that estimate and that's been laid out in Trailer Bill in the past.

We would just note that this grant increase is not proposed at this time to come with any Trailer Bill. So you may want to consider whether you wish to enact some Trailer Bill that really lays out the parameters of that calculation and includes an opportunity for the Legislature to see that calculation prior to the implementation of the grant increase and then on the HDAP technical TBL changes. We don't have any concerns.

Thank you. Ms. Khan with the Department of Finance.

Yeah, Aanam Khan, Department of Finance. Nothing further. Happy to answer any questions.

Thank you. I'll bring it up to the dais for any members questions. I will keep it here then for a second, if I can. I'd like to dig into the question that I asked, and I believe this question is going to be for you, Ms. Morris.

Earlier I had asked Dr. Kushel regarding the decreasing participation within SSI/SSP and simultaneously the rising older homelessness that we're seeing. I'm hoping you can provide some comments on how we ensure that those who have needs are having those needs met?

Yes, absolutely. I think from what was said earlier as well, it's a complex issue that we don't exactly know why we continue to see the decrease, especially with the rising age of our population, our aging population, as it is rising, but it is something that we continue to track and we look for ways to support this population and advocate them, not just on the state side, but the federal side as well. So we continue to look into it.

If I can. It was your testimony earlier that the payments can't go below our 1983 levels, and you also stated that it was the predominantly the income and threshold levels that were keeping people off of the program. And so I'm now going to come back to, if I can, about the total expenditure method versus the payment methodology and ask what would we anticipate if we were to go through an expenditure method? Wouldn't we expect more people to continue to be on the program?

And if so, why aren't we trying to come up with creative strategies to ensure we can have as many people participate as possible?

And under a stand your perspective, we've been going with this option since we had to choose an option to go with back in the 1980s. So we don't really know from an administrative perspective what it would look like if we changed or engaged with our federal partners on what kind of implications that would have for the Administration. So we'll continue to have those conversations and look into the request.

You said there were 38 states that similarly do what California is doing. Can we look at what those 12 other states are and allow us to determine if we're more aligned ideologically with those states, as I believe it will be an important discussion for us to have. With that, I will thank very much this panel, and we will hold issue four open.

Issue five is regarding the budget review and oversight of the community care licensing overview and updates. We will have three presenters on issue five, beginning with Kevin Gaines, community care Licensing Division Deputy Director for CDSS.

Mr. Chair, Committee Members, thank you and good afternoon. My is Kevin Gaines, Department of Social Services Deputy Director for community Care Licensing Division. As you mentioned, I'll provide a quick overview. I know we're getting to the end of the afternoon, but I'll also give you an update on our inspections operations.

So the mission of the Community Care Licensing Division, CCL, I'll refer to it from now on, 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. We have four primary program clusters. One is our childcare program. We have a residential cluster which includes children's residential and a larger adult and senior programs section. And we also have a home care services which is our newest program.

Just to give you some basic numbers, and a lot of this is covered in the agenda. Thank you very much. We have 1566 authorized staff that are operating out of 18 locations throughout the state, covering 32 facility types and providing licensing and oversight services to about 70,000 facilities that serve about 1.3 million people in California. The core work that we're performing.

Is happening out in those regional locations with direct contact with prospective and existing licensees in three big buckets of work. First is applications, second is complaint investigations and third is periodic inspections. And I'll cover some General numbers on those really quickly. As for facility inspections, during the last fiscal year we completed 28,000 case management visits, which are follow ons concluding after the conclusion of a complaint or an inspection, with findings that need further follow up. We performed about 13,000 of those.

We investigated 14,000 complaints and processed about 5600 applications. So a little more detail about applications inspections investigations during fiscal year 2122 we received approximately 5700 applications for licensure in those 32 facility types. In General, we have to make a final determination to approve or deny one of those applications within a specified time frame, which is going to vary by the facility type.

But on average we're working with a set of requirements between them about 60 days after a complete application has been submitted, and we more often than not get incomplete applications. The average application processing times, as it turns out, based on those programs, about 100 days for childcare, about 140 days for children's residential, and approximately 170 days for adult and senior care facilities.

As far as complaints go, the number of complaints that we receive each month over the past fiscal year has continued to be greater than the number of complaints that we approve or finish each month. This is pretty much the increase, the total number of complaints that are pending over 90 days. So we're having some issues there. But in order to ensure health and safety, all complaint investigations, regardless of priority level. And we have four priority levels.

First being like immediate threats to health and safety and going in lower triage from there. But regardless of priority level, they're required to be initiated within 10 days. And over the last fiscal year, my division has met this requirement 99% of the time. As far as what we are seeing and observing in these complaints that come to us, we have the top three. I'll list those for you. About 37% of the complaints that we receive have to do with personal rights violations.

About 20% are categorized as neglect or lack of supervision, and about 7% are coded as physical plant issues. An electric socket that needs a cover, for example. So those are the top categories of complaints that we receive. Finally, I'll cover some of our inspection information. So back in 2021, we started using a new tool to assess the relative health of facilities.

We call it a care tool, and I've reported on the status of our implementation of this care tool throughout these program categories over the last couple of years. Until March 1 of this year, adult and senior care program focused its annual inspections on Covid-19 their care tool has 12 domains to it. One of those domains has to do with infection control. We concentrated our efforts on inspecting with the infection control domain.

These focused inspections were due to the high risk settings of dolphin senior care facilities and had the maximum effect of mitigating and preventing the spread of Covid-19 the adult and senior program has completed its transition to a full care tool as of March 1. So now they're using the full 12 domains, and so we expect that completion times will get slightly longer as we acclimate to the tool and interact with the full tool with our licensees and administrators.

The childcare program is using the full set of care tools for all their pre licensing and their annual inspections, and we're working on a creation of a single licensing tool to align with statutory requirements. The movement to one single category of childcare facility, Children's residential, is using its full set of care tools for annual inspections and has been for a couple of years. They have 12 different facility categories and 11 facility categories for pre licensing inspections.

The children's residential program is in the process of developing care tools for their remaining smaller facility categories, but they're rolling along fairly well. For calendar year 2022, the adult and senior Care program has an annual inspection, an annual mandate, and in 2022 completed about 85% of that mandate. Childcare has a mandate to inspect all facilities for over three years of time, but we have an internal goal to get to 100%. In calendar year 2022, childcare has inspected 45% of its facilities.

Not our personal goal, but we're ahead of our statutory goal. And finally, children's residential has a biennial inspection requirement and has completed so far has completed about 55% of that goal. So we're ahead of schedule. That's the end of our status and overview. I'll take any questions that you want.

Ms. Short with the LAO thank you.

Good afternoon, chair and Members. Angela Short with the Legislative Analyst Office. Nothing to add for this overview, but happy to help with any questions.

Hi, Diana Dominguez with Department of Finance. No further comments.

I'll bring it up to the dais to see if any Members have questions. I'll keep it here just for a second. Sure. I was drawn to the number of days it takes to authorize the application. It seems like it's 100 days for both childcare and adult senior facilities.

Actually, for adult and senior it's a lot longer. It's about 170 days is what we're averaging, which is tough.

Is that our goal or no? How do we make inroads?

We'd like to get more efficient with that, and we're looking at different ways to do that. We've established over the last couple of years a centralized application bureau that will help process the documentation portions. There is a pre licensing portion that has to be conducted in the field by licensing program analysts.

And between those two, we're hoping to get some level of efficiency again, more than the same licensing program analysts that are conducting complaints and making case management visits and performing annual inspections are also doing those applications, in large part, at least touching them, particularly in adult and senior care. So we're hoping to get some greater efficiencies. It's going to take us some more work.

I'm trying to make sure you have the resources to address it appropriately, and you may not be able to ask for it. But I'm trying to make sure that we acknowledge how much childcare plays as a central rationale for getting people back to work.

And as we're in the current situation where we don't have enough facilities, I hope we are better able to license the facilities that would like to come online in a more rapid pace and would like to understand if there's anything we, as a Legislature could do to improve that timeline so we could get more of these online and happy to follow up offline rather than today.

Understood.

With that, I will thank very much. This panel and we will move on to issue 16 is regarding the Home Care Fund stabilization, BCP and the trailer Bill Language. We will have three presenters on issue six, and we will begin with Kimberly Lewis, who is the community care licensing division assistant Deputy Director for CDSS.

Yes, thank you. Good afternoon, chair and Members. I'm Kimberly Lewis. I'm assistant Deputy Director with Community Care Licensing Division of the Department of Social Services, and today I was asked to provide an overview of this proposal as well as the trailer Bill Language, which was recently added. So the Committee agenda does provide a lot of great information and I just want to really address some additional information. High level the Home Care program was initially established in 2016 as a 100% fee funded program.

The structure was created under assumptions about program revenues and operational expenses that seem to prove incorrect as we move forward. Due to the lower than projected revenue from unlicensed home care organizations, a critical shortage of personnel to conduct inspections within the program, and increased legal expenses, the home care program is not currently sustainable as a fully fee funded program. The proposal does seek statutory changes to stabilize the funding with General Fund for fiscal year 2324 and also 2425.

It also is seeking to defer General Fund loan repayment in 2324 in the amount of 711,000, and this proposal also seeks to add 15 positions. Nine of the requested positions that is being requested is to add an additional enforcement unit that would allow us to conduct more inspections as well as complaint investigations for unlicensed operations. And the positions will also include a policy unit which will allow us to do policy work and to maintain the program and to move all of the information along.

Data indicates that far fewer hcos sought licensure from what was projected. So at program implementation, 1217 hcos applied for licensure rather than the expected 2000. This led to a revenue shortfall of approximately $4 million for the program and currently there are 1844 licensed hcos and it is estimated that there are a total of 1100 hcos that are operating without a license. With the additional enforcement unit, there will be an increase in regular inspections as well as those unlicensed complaint investigations.

Also, with the trailer Bill Language that we are adding, we're adding three different areas. We would like to remove the requirement for hcos to resubmit duplicative application information at the time of license renewal, which is biannually and we also are seeking to add exclusion authority. This exclusion authority would prevent registered home care aides and home care organization licensees, staff, and governing body Members that have engaged in serious violations and egregious conduct from reapplying for registration or licensure, and also from working in home care organizations.

Part of this trailer Bill Language is we will also be submitting a report to the Legislature by January 10, and with the additional positions that we're receiving, they will be looking at a way to look at the solvency of the Home Care Fund and also looking at recommendations on a fee structure that allows the program to be self sustaining or to request any additional resource needs. And again, that was by January 102025.

So this proposal is necessary to ensure the stability of the program, which ensures that older and disabled Californians receive a high standard of care while being able to age in place and remain in their own home. So, any questions?

LAO?

Thank you. Yes, we've reviewed the proposal and find it to be reasonable and responsive to a clear need within the program. In particular, given the challenges the program has experienced over the past several years, we find the requested positions to increase the inspections and enforcement make sense and could help address the high number of unlicensed organizations that you just heard about from the Department.

Additionally, the administration's plan to reevaluate the home care fee structure we find will be important to ensuring ultimately the Fund can become self sustaining as is envisioned, which, as you heard currently it is not able to meet that goal. Additionally, the interim solution of pausing the General Fund loan repayment seems reasonable to that goal. Thank you.

Department of Finance.

Diana Dominguez, Department of Finance. Nothing to add, but happy to answer any questions.

I'll bring it up to the dais. I'll keep it here with the chair. This seems more than reasonable considering the 1100 unlicensed facilities and the rising backlog of cases. But I'd like to understand. You stated you're going to come back on January 10. How do we as a Legislature stay up to date on how we're making inroads and updates? Will you be able to report back to us so that we can understand if future changes similarly need to be made?

Yes, we will be able to report. Our final report is due on January 10, and part of it is with these additional positions, we will be utilizing those positions to do a lot of this work that's required. So it's kind of getting everybody on board and then looking at the information.

I'd like to ask the Lao if I can on this, can you help us to draft some potential BBL with reasonable reporting back on outcomes for our collective consideration? If this BCP is approved, I'd like to just make sure we're staying on top of this and believe we're going to need to follow up with some metrics. With that, we will hold this issue open and move on to issue seven.

Thank you.

Issue seven is regarding the governor's proposal to reinforce the caregiver background check system and the background check resources BCP. We will have three presenters on this panel. We will begin with Greg Oliva, who's the community care licensing division assistant Deputy Director at CDSS.

Good afternoon, Mr. Chair, Members and staff. Greg Oliva, assistant Deputy Director, community care licensing for central operations in community care licensing. The Committee did an excellent write up on the proposal and the background, so if you're fine, I'll just jump into the questions. Okay, so the first question is, what are the reasons for and extent of the current backlog for background checks? So the current backlog was created as a result of the following factors. Since Guardian implementation, Guardian is the name of the system.

The new database has experienced system inefficiencies and technical challenges. For example, the system is task based and not case based, so we have had to create more manual processes for the exemption cases themselves. We also have had limited ability to customize features which created challenges given the volume of criminal background check applications we receive. We also deployed the system in the middle of the COVID pandemic, which limited our ability to redirect resources and to keep up with the volume of the cases.

Finally, we had challenges with imported data which resulted in problems like duplicate cases which took additional work to resolve, further impacting our ability to keep up with the volume of the cases. So these factors have resulted in the following processing delays which caused significant backlogs and led to a high volume of public telephone and email inquiries. A little information on the extent of the current backlog. So as of April 1 of this year, the total number of applications pending initial review.

So those ones we've not touched is approximately 1900. The total number of applications in process, which includes standard exemptions and arrest only cases, is approximately 12,300. About three quarters of those are the standard exemptions. So a little over 9000 of those are standard exemptions. And then the total number of applications pending manual closure. So this is due to an applicant not responding for our request for additional information or a denial is about 4000. So they're essentially closed.

But just as a procedural issue, we haven't closed them yet and they're part of our backlog. We have been working really hard to reduce the backlog and ensure we have a workable criminal background check system. And I can highlight some of the things and the efforts that we're doing in the responses to the next two questions. So unless you have questions to number one, just. There we go. Okay. Is an interim solution needed to timely process background checks until a new background system is operational?

So the Department considers guardian as the interim solution. The BCP resources will ensure that we continue to have a functional background system while allowing us to plan for a replacement system to better meet the needs of our stakeholders as well as the Department. Additionally, we are currently implementing a number of important software development items to the Guardian system to improve its existing performance.

These are aimed at both internal efficiencies for our staff who work the system, as well as external processes for applicants who submit into the system. Two sets of that development have already been completed and the rest of those development changes in our current contract we expect to have deployed by July 2023. I'll move on to the third question. What are the potential outcomes for programs and services if an interim solution is not adopted?

So, as I've stated, we see Guardian as the interim solution and we're focusing on three areas. We've been increasing the number of overall staff hours dedicated to reducing the backlog by redirecting staff, offering overtime to current staff and hiring temporary staff to work on case processing. As I'd mentioned previously, we're also implementing a number of important software development changes to improve the system performance. And finally, we are leveraging the changes enacted in AB 1720.

Thank you, Legislature, which allows us a greater number of cases to go through the simplified background check process rather than the standard, which is a very significant time difference. Currently, the guardian system is processing 96% of background checks within approximately seven to 10 days after we receive information from the Department of Justice. This includes both automatically cleared cases where there's no criminal record for the applicant, as well as simplified exemptions where there are relatively minor crimes associated with that applicant.

Those are my responses to the questions. Happy to answer any of your questions.

Ms. Short with the LAO.

Yes, thank you. We recognize, as you just heard, there is quite a backlog currently within the Guardian system that is having some real significant impacts for those individuals who are seeking clearances as well as for the facilities that are hoping to hire those individuals and then ultimately for the users served by these facilities. So clearly there is a need for some level of intervention or interim solution.

Regarding specifically the department's BCP, which includes 300,000 annually for three years as an interim measure to help address this current backlog and other challenges that we just heard about, we suggest the Legislature may wish to ask the Department to provide some additional information around the anticipated outcomes of those funds in terms of reducing the backlog. For example, is the expectation that with those funds, we'll see the backlog reduced by 10%, by 50%?

Do we expect to see that average processing times for exemption cases will improve, et cetera? And we think knowing this would just help clarify legislative expectations in terms of the interim solution and improvements we can see. Thank you.

Department of Finance.

Diana Dominguez. Department of Finance. Nothing further to add at this time.

Bringing it back up to the dais seeking members'questions. I'll keep it here at the chair. I'm going to follow up, assistant Deputy Director, if I can. What are our expectations with these funds? What do we anticipate will happen in terms of both the backlog and timeline for approval?

So the funds are really to begin to do a couple of things right. It's to maintain the existence of that interim solution, which is guardian. There's three years of maintenance and operation funding to keep the system moving forward while we begin the stage two alternatives, analysis of the project approval lifecycle. So those are the $600,000 in consultants funds to support that effort.

So that's really kind of looking into the future, right, of maintaining the system and beginning the process to look into the potential building of a new system.

I'll just jump in here, though, just for a second, because if we're maintaining, aren't we going to get more of the same? And wasn't the same the rationale for why we have such a backlog? And your comment was, this is the interim solution, but if more of the same got us here, is this really the interim that we should be hoping for?

So I think we've actually made pretty significant success recently in terms of, I'd mentioned as some of the challenges deploying during the pandemic, not having the ability to redirect some of the system functionality wasn't what we had expected it to be in terms of requiring when we initially deployed it. We thought there might just need to be small configurations, there needs to be actual customization to it to make the kind of changes, to make it a better case management system.

But we're getting better at working the system. And I would just go back to, I provided some of the backlog data earlier so I had stated that our current number of applications that are pending initial review is at 1900. So as of February it was at 4800. So we've actually reduced that by 60%.

I'm not saying that it's perfect or that our efforts are perfect, but we're through some of the software development changes that we still have several sets of deployments for those to improve the system functionality, as well as the hiring of some temporary staff. It's taken a while to get those staff on board. We've hired nine of the 12 staff. They have to be trained, they have to be onboarded before they can really begin processing cases.

But we anticipate that we're going to make steady progress with the current system. And because the process to actually build new it systems within the state is arduous, it's important and it's important to do it correctly. But that's a very time consuming process.

That what our goal is to continue to make process slowly chipping away at our backlogs and getting to a place where we're actually not having a lot of overtime, we're not having a lot of redirections of staff, but we're using our existing resources to timely meet the needs of the communities that need these applications processed.

Your words right there were to slowly chip away at this, and so I will point what the stakeholders have stated. The advocates have proposed $2 million in General funds to hire staff to address it. Can you comment on what effect that $2 million would have in terms of the backlog and timeline in comparison to the proposal that's before us right now?

The Department doesn't have a position on that particular proposal, but putting additional staff toward case processing, obviously. Sorry, I don't mean to say obviously, but putting more staff toward it does chip away and would very likely continue to reduce that backlog.

Sounds like we might get there a little faster from what you're saying.

That's certainly our interest.

Dr. Jackson, I used to be a custodian of records for the DOJ system.

And what do we call the DOJ system?

I would have to get back to you on that.

Live Scan or.

Live scan? I'm sorry, I thought you were thinking of something different.

All right, so we choosing not to use that, but we are trying to build it seems. Why is the state so bad at building technology?

Sir, live scan is a system that individuals. So an individual goes in, applies for a job, get an offer, they go get live scanned at a location throughout the state. Those results go to DOJ. DOJ has 14 days to get us the information needed to see if there's a hit on their criminal record. So live scan is used. Yes, but it doesn't start necessarily with us. But what the,

Eventually it gets to you.

Yes, the results of the live scan populate within our guardian system and that's when our clock starts and that's when we start picking up the process.

Got it. So you're asking for funds to continue to work on guardian.

To continue to maintain it, to continue to maintain just the simple maintenance and operation.

Okay.

Because without that system there's no ability to approve the checks to give clearances to individuals so that they can go and get those jobs.

And obviously what we're doing is not sufficient from what we're expecting people to do out in the field. Right. And we seem to be, what I see here is an additional 600,000 for two-year limited-term funding to initiate planning activities to develop a replacement to the guardian system. Right. So we're anticipating that it'll take two years to figure out how to replace this thing?

It could take longer than that, sir. So the funding would support the second stage of the process, doesn't it? In addition to laying a roadmap for stages 3 and 4. So there's four stages to the project approval lifecycle.

Why is this so hard?

I can't answer that question.

I may just interject and offer that the state hasn't had a good track record of always choosing the best technology to invest in and looking towards PAL has been a better method for us to spend the time to make sure we're selecting the right product from the start.

And stage two is the alternatives analysis. So we look at market research, we look at a request for inquiry that we send out to the vendor community to see what. And in that inquiry we're stating our business requirements and folks are coming back to us, our vendors are coming back to us and sharing what is possible on their part to deliver that sort of system.

Thank you.

With that we will thank very much this panel and we will now move on to issue eight.

Thank you.

Issue eight is regarding the community care expansion and Homesafe implementation updates, including Homesafe program, technical cleanup, trailer bill language. We will have three presenters on issue eight, and we will begin with Hannah Asmati, Housing and Homelessness Division Deputy Director for CDSS.

Hi again, Hannah Azamati, Deputy Director for Housing and Homelessness Division with CDSS. So here again, the agenda provided a really great overview of community care expansion and the Homesafe program. So I'm going to just start with a brief overview update on CCE and Homesafe, and then as part of that, try to answer the questions that were in the agenda as well, including highlighting outcomes. And then I'll discuss implementation challenges facing those programs and how our technical assistance is being employed to overcome those challenges.

And then finally, I'll provide an overview of the TBL for Homesafe. So the Community Care Expansion program, which is managed by DSS, provides capital funding and operational subsidies to preserve and expand assisted living settings that can serve people who are homeless or at risk of homelessness. The 2021 budget appropriated $805,000,000 in funding for the CCE expansion and preservation programs, and in 2022 the budget appropriated an additional 55 million to fund operating subsidy payments for licensed facilities through the CCE preservation program.

The investment in CCE forms a key part of the state's strategic multiagency effort to increase the state's portfolio of housing options while reducing the inflow to the homelessness response system and preventing unnecessary institutionalization. For the CCE Capital expansion project, $570,000,000 has been made available through a joint RFA with the Department of Healthcare Services Behavioral Health Infrastructure, a continuum infrastructure project, which was published in January of 2022.

As Director Kim Johnson noted earlier, as of February of 2023, CDSS has announced a total of 207,000,000 in awards to 32 projects for capital expansion across the state, and we continue to review applications, and we'll be posting new awards on our dashboard online. Now to the CCE preservation project.

So to date, we have awarded a total of just under $50,000,000 in noncompetitive allocations to 35 counties to preserve existing licensed residential, adult, and senior care facilities that serve residents on SSI, SSP, and CAPI, including those at risk of homelessness or experiencing homelessness. This funding enables counties to prevent closure of licensed residential facilities by supporting critical facility upgrades and repairs that are needed to stay compliant with licensing standards and also to cover operating deficits.

Through both the expansion and the preservation programs, CCE aims to preserve and expand 7000 beds and units in total throughout the state. I'll now talk about the Homesafe program. So the Homesafe program provides housing and supports to those in the adult protective services system. These individuals can be considered amongst the most vulnerable populations in the state.

Grantees operating local home safe programs utilize a range of strategies to support homelessness prevention and housing stability for APS clients, including case management, financial assistance, legal services, deep cleaning to maintain safe housing, as well as mobility-related modifications to the Home Eviction Prevention and landlord mediation. Both the Budget Act of 2021 and the Budget Act of 2022 appropriated 92.5 million in match-exempt funding available over multiple years.

58 counties are participating as of fiscal year 2021 to 2022, which is an increase of 33 counties from the pilot ending in 2021. So with this significant expansion, as I noted with HDAP as well earlier, local communities are continuing to ramp up program implementation and scaling their programs to maintain effectiveness and impact in response to these historic investments. And as also noted earlier, we expect that to take about six to 18 months from when counties are ramping up programs first.

I'd now like to highlight some of the outcomes that we've seen with Homesafe. Since its inception in 2018, the program has served more than 5600 people, and six months after exiting the program, those that were placed in housing or in housing, 85% of those have retained that housing. Grantees have also reported being able to provide housing supports through Homesafe that are critical to the safety of seniors and adults with disabilities, but were previously not available to APS apartments.

So again, giving them tools that they previously didn't have to address the foundational challenges of housing that they were facing. Under issue four, I highlighted some of the local and statewide barriers for HDAP which apply to Homesafe. So I'm just going to add by sharing some of the unique barriers that are facing CCE implementation. The first is bridging local partnerships. That's really critical to the successful implementation of CCE.

The second is rising construction and labor costs, so rising costs make it really hard for proposed projects to adequately estimate project costs.

This is especially the case for the capital expansion side, and then finally for small nonprofits and tribes, it can be hard to find the time, resources and also the technical expertise needed to produce competitive applications without significant support. So, and I spoke earlier about our partnership with Changewell Project, which is providing support to our grantees with really extensive and responsive services and technical assistance to address challenges and needs.

For CCE, our investment in technical assistance has also been really critical to mitigate each of the challenges that I mentioned, but also ensure effective and thoughtful implementation. So, for instance, I noted the challenge in developing strong applications for small operators, nonprofits, and tribes. Well, we have included as part of our technical assistance one-on-one technical assistance that includes up to 20.

We've had almost 1700 pre-application consultations, which really help applicants as they're crafting their applications in the very early stages, be able to get the support needed and have the contacts to our technical assistance at hand to be able to produce strong applications.

And then throughout the application process, when we note missing or incomplete or unclear information and applications, rather than reject an application as you would in a competitive, typical competitive procurement, we're really investing time to clarify information, provide support to get applicants across the finish line, especially those that we know need extra support. So we believe that this type of tailored, hands on TA can really help small and diverse facility operators.

And that's so important because we think they know their communities the best and therefore are going to produce the best outcomes for their communities. So we really want to make sure they can successfully participate in the opportunity that CCE presents here. So finally, I'd like to just provide an overview of the home safe trailer bill language. Again, great summary. So, just highlighting four changes being requested. The first is to clarify tribal eligibility language in the tribal Homesafe programs.

As you know, our tribes do not administer adult protective services and instead have unique, locally responsive elder adult services programs and systems. And so the requirement to serve only those who would otherwise be eligible for APS doesn't quite translate. And so we need to adjust that. Second, we're adding the definition of senior, which means the same as the term elder as codified in the APS program, and is inclusive of persons within the age range established by tribal law and custom for tribal programs.

And then third, we're adding appropriate cross-references to codified definitions used in the APS program to define dependent adult and elder. And then finally, we're extending the sunset date for the grantee match exemption for the one-time funds from June 30, 2024 to June 30, 2025 again to align with the expenditure timeline of the one-time funds appropriated as part of the Budget Act of 2022.

These changes are important for us to be able to equitably serve our tribal members through home safe and also reach eligible older adults and dependent adults who are being served by the APS program. So thank you very much and happy to answer questions.

Ms. Bella, LAO.

Thank you Mr. Chair. Ginni Bella with the LAO, we've reviewed the trailer bill language, and we have no concerns to raise.

Department of Finance

Panani Kazi. Department of Finance. No comments at this time.

Bring it up to the dais. See if any members have questions. Assemblymember Ramos.

Thank you, Mr. Chair. And on the tribal component and the outreach, have you been making sure that the community comes forward and gives their input as far as elders and definitions moving forward and how to reach some of the most vulnerable areas? And is there a component that's measuring the data and how the outreach is happening and making sure that it is reaching those that drastically need it?

Yes. In fact, what we have done is actually five of our seven programs are open to tribal entities to be able to operate those. The other two are CalWorks-related programs.

And for three of our programs, we actually have a set aside that we have created for tribes to be able to participate exclusively in those, and then as part of both creating that set aside the adjustments needed for tribes to be able to participate and the sort of structure for how we would allocate those dollars and award them. We've actually conducted significant and very in-depth engagement with tribal entities and tribes, including one-on-one meetings and biweekly office hours.

But beyond that, also formal tribal consultation in coordination with our office of tribal affairs, and so have been able to really shape and plan our approach for how we're reaching tribes through that direct engagement. As we've been working through that.

Do you believe that the funding that's currently there is adequate?

So we actually doubled the tribal set aside with that in mind. Initially, we had allocated $17.5 million across the three programs, HDAP, Homesafe, and Bringing Families Home, that were part of that set-aside. And upon seeing the tremendous interest from tribes, we had responses from 24 tribes and five letters of interest that far exceeded that amount. We doubled that amount to 35 million, and we'll be making those awards quite soon.

Well, thank you. And we'll keep monitoring that because I think there still is a need to even double that. And the outreach to the tribes and seeing those coming forward just shows the need that's still needed here in California with California's first people.

Absolutely.

Thank you.

We're recognizing the opportunity to just first even help establish these programs to begin with, and then in future years, ramp up that capacity and service delivery.

Thank you. And if there's anything that my office or myself can do to help that further along, by all means reach out.

Thank you.

And along those lines, I'm hopeful that you can keep us up to date about the need versus where the funding is. I appreciate the direction that we're moving in, as well as all of the outreach that the administration is doing. It's about time for us to take care of all people who reside within our state and am appreciative of the administration for all of its efforts to take care of the original stewards of our land.

With that, we will thank very much this panel and move on to issue nine.

Thank you. And I think I'm staying up.

Great. Issue nine is regarding the housing investment power and duties technical changes TBL, and we will begin with Ms. Azemati.

Hanna Azemati, Deputy Director for Housing and Homelessness at CDSS. So I'm going to highlight three changes being requested as part of the housing investment power duties, technical changes TBL. The first is that the technical change clarifies that CDSS is authorized to expend an additional 10.5 million in general funds of the total funds that were included in the 2022 Budget Act for our housing and homelessness programs on each data tracking as well as technical assistance.

So this would really get us to align with the parallel investments that were made through the 2021 Budget Act, which are the same, essentially. So we think these investments are really critical to maximize the impact of our spending on the direct service delivery provided through the programs. Second, the TBL authorizes CDSS to modify or waive at its discretion any CDSS housing and homelessness program requirements that conflict with tribal law or custom in line with equity-focused best practices established within the Housing and Community Development Department.

And then finally, the TBL authorizes CDSS to implement program guidance through the all-county letter process. These changes are really important for our programs because they ensure that we can continue to administer equitable, data-driven housing and homelessness programs to maximum effect.

LAO?

Thank you, Mr. Chair. No issues to raise at this time.

Department of Finance?

No comments at this time.

Bring it back up to the dais. I'm just going to make sure I heard it correctly. These are not for the current authority, these are for the additional funds. Is that correct?

I'm sorry, can you clarify?

It's the first question that we have on the agenda.

Yeah. Okay. Yes. So it is to authorize an additional 10.5 million. That's right. So it's 10.5 for each for the data side and then 10.5 for the technical assistance. And that's exactly what was done for Budget Act of 2021.

That was unclear to us initially, and so we will need to be considering that as that goes forward, but look forward to those discussions.

Sure. Happy to talk further.

We will now move on. We will thank that panel and move on to issue 10 regarding the governor's proposal on the master plan of Aging phase three, infrastructure and capacity BCP. We will have three presenters on this panel, and we will begin with Mark Beckley, Chief Deputy Director for the California Department of Aging.

Good afternoon again. Mark Beckley, Chief Deputy Director, California Department of Aging. Got the department right this time. I'll be talking about the MPA phase three budget change proposal. The assembly agenda did an excellent job of summarizing the proposal, so I'll limit my comments to how this proposal interfaces with the master plan for aging and implementing our initiatives, as well as the equity considerations also raised in the questions.

So the MPA phase three proposal requests 10 positions and 1.7 million General Fund to provide needed information technology resources to continue to implement the master plan for aging. Specifically, we're requesting two IT project managers that will oversee three key projects to implement the MPA.

These include the migration of the MPA data dashboard from CDPH to CDA the establishment of a statewide learning management system that will be used by CDA as well as our local aging network stakeholders the implementation of an enterprise client relationship management system, which we call our CRM system.

We'll get all of our partners on one common platform so that we can really look at the data on a statewide holistic basis, and then finally the development of a customer facing web portal, which we think will really be instrumental in enabling people to easily access services and supports in their areas. Right now, you have to call multiple different phone numbers. If you have one website that contains all of your local resources, that'd be much more efficient.

The proposal also requests to establish additional it security database and system administration staff to store and adequately safeguard data acquired for the master plan of aging. CDA is in the process of acquiring additional data sets over and beyond what we'd normally collect, including data on homelessness, housing, transportation, health caregiving, and several other areas so that we can better understand the needs, service gaps, and opportunities for older adults throughout California.

As we continue to acquire these data sets, it's essential that we have adequate storage and security so that we're adequately protecting the additional data that we're collecting. The request also requests three IT contract analyst positions so that they can help us continue to contract for services and equipment to implement our initiatives. So to put the BCP in context, these are really foundational resources that our IT Department needs to set us up to do additional data and research on the MPA going forward.

I'll also note that in the current year, we hired our first ever executive level chief information officer position, an enterprise data architect position that will oversee the architecture of all of our systems and infrastructure going forward, and a chief data officer that will guide our data strategies going forward and with really an enterprise view of systems. And then we also established research staff in CDA.

In the current year, thanks to the legislature, we hired our first ever chief data management officer, and he's in the process of hiring his team of staff. And again, what they're going to do is they're really going to leverage all of the additional data and data sets that we're acquiring that our data team will be assisting us with and really delving into the data and research to really understand, again, gaps, opportunities and needs for older adults throughout the state.

They're going to be working really closely with a newly established consortium of academic, state, and local research experts called the California Aging and Disability Research Partnership. And we also hired our first ever equity officer. So as we're looking at data, data sets, we're going to be doing it all through an equity lens to make sure that we're serving all Californians.

And then the other piece of work that they're going to be doing is identifying performance metrics and outcomes for each of our data sets in all the key domains of areas of service that providing to older Californians. So lots of great work that we have underway with data and research. I'll also just mention three key efforts that we have underway right now, which is really to look at senior nutrition. Are we providing these services effectively? How many people are we serving?

What's the diversity of populations that we're serving? We're doing a similar study on our direct care workforce as well. And we'll also be launching an LGBTQ study to better understand the needs of the state's older adult LGBTQ populations. So that's an overview of the BCB.

LAO.

Thank you, Mr. Chair. We're still in the process of conducting our review of this proposal, but we don't have any particular concerns to raise at this time.

Department of Finance.

Andrew Duffy, finance. Nothing further to add. Here to answer any questions.

Bring it up to the dais. We'll start with Dr. Jackson.

Obviously, when we talk about equity, we are seeing some profound disproportionality, especially when it comes to African Americans who are experiencing homelessness, represented over 30% of homeless folks, especially in terms of our seniors. Right. But make a very small percentage of the population. And so as we begin to build out equity components now, this is also a hard population to get to, to communicate services, to right, to build trust with. And so what is the vision in terms of reaching that?

I think, you know, our AAAs, especially during the pandemic, with the infusion of new federal COVID relief funds, they're able to rapidly expand their service and really invest in culturally competent and appropriate services. So I think they've been doing a great job in terms of creating new messaging, working with communities to really make inroads, translate materials in maybe languages they hadn't had the opportunity to do previously.

But I know that there's been a lot of work done locally to really expand out into different populations and to really be intentional about equity initiatives. So that's some of the work they've done to date at the state level. That's going to continue to be a focus.

Like I say, any of our research efforts where we're seeing where there's gaps in service, or where we're seeing certain populations that are underrepresented, that's really going to be a key focus of ours, is to understand what the barrier is so that we can develop strategies to really get at those populations. And it might be just lack of awareness about the services that we offer, how to contact us, but it could also be just communicating appropriately and being intentional about offering the services proactively.

Do you anticipate specific strategies being developed for specific populations?

Yes, absolutely. Again, if we see service gaps for certain populations at the state level, that's something that we'll be working with our local providers and partners to address.

Um, IT? You gonna be okay?

You know, I can say I feel good. We have a wonderful CIO that we hired this year, as well as really skilled it staff. We're really familiar with the project approval lifecycle process, and so I think that it. There is a stagegate process. It does take time, and as chair ambula said, there's good reasons for it.

We want to make sure that we are making wise selections of our IT systems, and we're not investing in systems that might either be a dead end or might not be the appropriate solutions. So it makes sense to think these solutions through. But like I say, I think we've got a really good team of support to help us, guide us skillfully through the process.

Let them know I'll be praying for them.

And I should also note that we really work closely with our stakeholders. I mean, what's important to us when we're thinking about IT systems or launching systems is that we engage with our local providers and also to the extent that we can involve our participants in the testing and thoughts about data systems, like does it make sense to them? Would they use these systems? So yeah.

I'd like to ask, as the agenda states, that we have budget bill language presented by the department that will allow us to understand how you plan on capturing and implementing the BCP and how that will effectively allow us to further our equity goals. I'd like to understand and track that if possible. With that, we will hold this item open and thank very much this panel as well as all of our panelists today.

If there are no additional members comments or questions, we will now begin public commentary. We will move on to issue 11 regarding health insurance counseling and advocacy program modernization, BCP. We will have three presenters and begin with Nicole Shimosaka, Deputy Director of Administration Services, California Department of Aging.

Thank you. Thank you Chair and thank you members, Here today to present on our health insurance counseling and advocacy program, also known as HICAP, which is administered statewide by 26 area agencies on aging. HICAP offers Medicare and related health insurance counseling and education and provides services to approximately 51,000 Medicare beneficiaries annually. The high cap service delivery model is dependent upon the ability to recruit, retain and train volunteer counselors. Volunteers constitute 74% of the overall HICAP counselor workforce.

In July 2021, CDA was provided with two years of funding authority from the HICAP special fund. This funding was to support one full time volunteer coordinator at each local HICAP and then three limited term positions at CDA to oversee the HICAP funding and financial reporting, training and research and data. This request is a one year extension of these positions.

The recruitment and training of HICAP volunteers is critical to delivering HICAP services statewide, as volunteers do make up that 74% of the overall HICAP workforce, and over the past six years, we've seen the HICAP counselor workforce decline by 26%. At the same time, we've seen the number of clients counseled drop by almost 30%. Currently, the HICAP program serves less than 1% of Medicare recipients throughout the state.

The resources requested in this BCP will continue to help local HICAP programs recruit and train new volunteers, and the state staff will provide the needed support to local programs for training, research and budgeting. At this time, we are just requesting the limited term positions as we have an active effort underway to develop a strategic plan to modernize and expand HICAP services. We've contracted with a consultant to help us conduct a swot analysis and develop goals and objectives for the program going forward.

Some of the key strategies that we are looking at including increasing the public awareness of HICAP services through increased marketing and outreach, enhancing the HICAP tools and informational resources, and continually updating the HICAP training for changes and increasing complexity in Medicare advantage, long term care insurance and other plan offerings. We'll be working with a coalition of stakeholders to inform and finalize this plan. The approval of this BCP request will have a direct impact on local HICAP providers and the older adults that they serve.

Prior to the first BCP in July 2021, 58% of local HICAP service providers reported insufficient staffing to manage existing workload, which continues to grow with the increasing number of Medicare beneficiaries and increased complexity of Medicare and long term services and support programs. Additionally, many local HICAP programs only had a part time volunteer coordinator and no other dedicated staff. The number of annual clients dropped from 66,000 in fiscal year 2016-17 to 51,000 in 21-22 without appropriate volunteer staffing to deliver services.

HICAPs are limited in the amount of services they can provide for Medicare counseling information, legal referral and assistance, and informal advocacy needed to navigate the complex Medicare system, which includes, but is not limited to, Medicare parts A and B, Medicare Part D, prescription drug plans, Medicare Advantage plans, Medicare supplemental insurance and long term care insurance plans, which could result in the lack of coverage, increased out of cost pocket to some of California's most unstable consumers, and a lack of critical services.

We are only requesting a one year extension since the HICAP modernization and outreach efforts are underway. We are requesting this extension to allow for sustained resourcing while we continue to work with the administration and other stakeholders to finalize the blueprint for HICAPs modernization efforts. There are currently several counties that continue to report challenges with reestablishing their pre COVID volunteer ranks. King, Solano, Plumas, San Bernardino, Riverside and imperial are all reporting penetration rates below the statewide average.

This request provides a pivotal foundation for local HICAP modernization efforts and to continue addressing volunteer recruitment and retention issues to expand services throughout the state.

LAO?

We have no concerns with this proposal.

Department of Finance?

Nothing further.

Bring it up to the members seeing no questions. We will thank very much this panel.

Thank you.