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

Welcome to Sub Three Health and Human Services. We'll be, beginning today, we'll just be focusing on one department, which is always nice. Keep it all organized that way. We're going to be working with Department of Healthcare Services on an array of things today. So that means that public comment will only come at the end of issues one through ten. We won't be doing public comment in between. We have two mini panels.

We'll be talking about hearing aids for kids, and then we'll just have a brief update on CalAIM ECM, how that's going, and how we can do better with that. So let's get started. I'll ask for issue one, if I can have the department representative, representatives, Department of Finance, LAO, come on up and, and the stakeholder as well from Children Now. Great. Director, we'll start with you with an overview, brief overview of the department, and then we'll jump into your questions assigned to you for HCAP.

Great. Good morning, members. Michelle Baass, Director of the Department of Health Care Services. The Governor's Budget includes a total of 161.1 billion for the Department of Health Care Services. Of this amount, about 1.3 billion is for state operations. This includes the support for about 4600 positions to support the department's programs and services.

As you know, Medi-Cal is the largest program at the department, but we also administer community mental health and substance use disorder programs, genetically handicapped person programs, the Children's Services program, and primary and rural health programs such as the Indian Health Program, American Indian Maternal Support Services, and the Tribal Emergency Preparedness Program. The budget includes some major proposals and issues, most significantly the managed care organization tax, which we've, I think, will be at a later hearing.

We also included about 1.4 billion total funds in 2023 and 3.4 billion total funds in 24-25 to maintain the expansion of full-scope Medi-Cal coverage to adults, regardless of immigration status, that went into effect on January 1, 2024. Consistent with the previous year's actions, we've also removed the Medi-Cal asset test that also went into effect January 1, 2024, and so the budget includes dollars to fund that. We have 200 million of that 15 million general fund for the Reproductive Health Access Demonstration 1115 waiver.

And then we also have some budget solutions. Some of them will be discussed at this hearing and I imagine others at subsequent hearings. The withdrawal of 900 million for the safety's state safety net reserve fund. A reduction of 193.4 million in Proposition 56 supplemental payments for physician services, delays in funding for the behavioral health bridge, housing, and behavioral health infrastructure continuum program. And then, as will be discussed later today, the transfer of the Medi-Cal drug rebate fund balance to the general fund.

Eliminate the previously proposed buyback of a two-week check. Right. Hold for a fee for service payments at the end of each state fiscal year and the transfer of 14.9 million in unspent Clinic Health Clinic Workforce Stabilization Retention Payment funding to the general fund. And now I will turn it over to Deputy Director Rene Mollow to discuss the hearing aid program.

Thank you so much, Director Boss. And again, I'm Rene Mollow.

Deputy, just a quick question before we dive into that, and I know there are opportunities to later talk about it, the behavioral, the BCHIP, and then the other acronym that I don't know, the Behavioral Housing Bridge Housing. Thank you. I know we've proposed for a delay, and now that Prop One was successful, do we anticipate the need for these two, potentially maybe cutting them, not delaying them, and leaning towards the funds that are going to come out of Prop One?

I think those are kind of potentials for future conversations. What I just discussed is what's proposed in Governor's Budget, and I think, you know, per may revision. I think, you know, opportunities to discuss. We know we need to build out the infrastructure of behavioral health, whether it's bridge housing or facilities, or residential homes. I think part of that will be part of future conversations.

Okay, thank you.

If I could just weigh in on that. I think if we're gonna cut anything, we need to be very strategic about it because I don't think there's any question that we need to follow through on our commitment to voters and to folks that we've already allocated this money, and we know it's getting out. We just need it to be successful. So I if we cut anything, it should be very strategic and not take us anywhere backwards. We need to continue to move forwards on this.

You may proceed.

Okay. Thank you so much. So again, Rene Mollow, Deputy Director, health care benefits and eligibility with the department. So, I'm here to present on the hearing aid coverage program for children that we administer. So as noted in the agenda, we did launch this program in July of 2021 to Fund hearing aid benefits and related services for children ages 0 to 17 who do not otherwise have coverage for these services and supports.

We do support individuals who have family household incomes that are less than 600% of the federal poverty level, and they cannot otherwise be eligible for the Medi-Cal program or be enrolled in the California Children's Services program for hearing aids services. So, effective January 1 of 2023, we did expand our program eligibility to include individuals between the ages of 18 to 20, and then we also provide supplemental coverage for those with coverage, that is, partial coverage up to $1,500 a year for hearing aids.

Again, our covered benefits include hearing aids and assistive devices for listening and surface bone conduction hearing devices, and we also provide hearing supplies and accessories and then hearing-related audiology, and post-evaluation services. So, I'm going to cover all the questions that you had in the agenda in my remarks. So, as of March of this year, we have received 612 total applications, and of those, 353 applications have resulted in enrollment in the program since the beginning of the program.

So today, 422 individuals have been enrolled in the hearing aid coverage program, and of those individuals, we are currently serving 193 individuals. So at a high level, in 21-22 we served 103 individuals. In 22-23, 171 individuals and then in fiscal year 23-24, 148 individuals.

In terms of the covered benefits under the hearing aid program and the associated reimbursement rates, those rates and the procedure codes that are used for the program are the same reimbursement rates and codes that are used under Medi-Cal and the CCS program.

There are no differences in those rates, and so for any associated rate increases that are being proposed as part of the MCO tax proposal, those rates would also apply to those benefits that would be made available to individuals that are enrolled in the program. As of February of this year, we have 68 total providers that have opted into the hearing aid provider locator.

That just means that those are the providers that have agreed to have their information out there publicly for individuals to find them, to have these services provided to them. We are working on pulling data for the number of providers who were added to the program for this year and also note that there are of the providers that are indicated on the locater; they could include individual clinicians and or facilities that may have multiple clinical staff on board.

I do want to note that we do have top pediatric institutions across the state that are also participating in the program. These institutions include the Center for Early Intervention on Deafness in Berkeley, the Children's Hospital of Orange County, Providence Speech and Hearing Center, Rady's Children's Hospital of San Diego, and House Children's Center in Los Angeles. In February of 2024, we had also published an update action plan to highlight some of the key programmatic activities and policy updates in the following areas.

So, we have begun partnering with other state entities to help promote the participation and awareness of the hearing aid program, which includes the placement of hearing aid program information on websites and in evidence of coverage materials as applicable. That outreach has been made to Covered California, Department of Managed Healthcare, Department of Education, Department of Public Health Developmental Services, Social Services, and then also First Five.

So we are working strategically with them to make available our information and then, as appropriate, to participate in associated meetings, webinars, trainings regarding the hearing aid program. We've also completed the translations of the hearing aid related materials into the Medi-Cal Threshold languages, and that information is located on our website for this program. We have also implemented - we will be implementing a streamlined annual eligibility review process to help simplify the enrollment into the program.

So, the review form will be released in the spring of this year to help improve consumer experiences both with the application and the annual eligibility review, and we're also working on refinements for those materials and processes with our stakeholder partners. We're also continuing to conduct outreach to Medi-Cal providers who are not yet participating in the hearing aid program to help support their participation.

We will be using data to help conduct additional provider outreach efforts to help increase the awareness and what we those provider engagements will be on a quarterly basis. Those engagements are noted on our website, and we do have events that occurred in January, one will be in April, July, and October, and then we continue to host quarterly webinars with providers and stakeholders.

And then we do have a small subset of very interested stakeholders that we meet with on a monthly basis to share our progress and to address any concerns that they may have. We're also continuing to monitor our overall enrollment in the program, which has been trending upwards, and so we'll be looking to update projections of enrollment as appropriate to help towards, you know, getting people enrolled in the program who are eligible for the program.

We do recognize that there have been concerns raised regarding the participation of Kaiser, and we have been engaged with Kaiser, both in Southern California and Northern California to discuss processes for helping to refer individuals into hearing aid coverage. In terms of a question about geographic analysis of the hearing aid providers, we have not yet done a geographic analysis of participating hearing aid providers, but our provider locator tool does allow the families to search by zip code for pediatric audiologists.

Of the providers that have opted in to use the locater tool, most are concentrated in Southern California, in Los Angeles and San Diego, as well as in Northern California in the Bay Area. And these are the two areas that we have observed. The largest concentration of individuals that are potentially eligible for our program, and then in terms of the reimbursement rates. I had addressed that earlier, that again we will be using the targeted rate increases for this program.

For the hearing aid program, specifically for the targeted rate increases, they will be targeted at 80% of Medicare for most of the services that are outside of the evaluation and management codes, but for audiology services, they do not have associated Medicare rates because typically we peg our rates to Medicare, so there are not Medicare rates for these services. So, for that purpose, we will be doing review rates for commercial payers and for other governmental programs to establish an 80% Medicare equivalent for these services.

And then again, since we use the existing Medi-Cal codes for hearing aid services, both for Medi-Cal fee for service and for our CCS program, these codes that would be subjected to the rate increases, the targeted rate increases would also apply to the hearing aid coverage program. And this concludes my remarks regarding this program and happy to answer any questions that you may have. Thank you.

Thank you so much. Before we jump into questions, I'll turn now to Children Now, Nora Lynn, to provide her remarks.

Thank you, Senator Menjiavr and subcommittee members, for inviting me to speak today. I am Nora Lynn with Children Now, speaking on behalf of Children Now and our partner, Let California Kids Hear. HACCP was created by the administration nearly three years ago in response to a coverage gap that leaves more than 20,000 deaf and hard-of-hearing children without coverage for hearing aids. Despite millions of dollars allocated to the program, it is barely meeting 2% of the children in need of this coverage.

The lack of progress is alarming and has been described by experts as a developmental emergency for children that has been unfolding for years in the State of California. This legislative body has held many oversight hearings on the HACCP program since its inception, but unfortunately, HACCP is still plagued by several program design flaws. I would like to uplift recommendations we've made to the department around two key issues that we think are needed to better ensure kids can access care. The first is regarding reimbursement.

There are two reimbursement issues that particularly affect younger children. Providers lose money on ear molds, which must be taken more frequently as children grow and need to be refitted for hearing aids, and that providers do not have the support and assistance they need for hearing aid testing for very young children, a best clinical practice that should be a covered service.

We call on DHCS to use their authority and resources available to them to update reimbursement policies for ear molds and testing assistants so that kids in HACCP can be adequately and appropriately served. The second issue I'd like to raise is the fact that too few pediatric audiologists are currently and proactively participating in HACCP, resulting in long appointment wait times. That's why making Kaiser's network of qualified pediatric audiologists available to HACCP is an absolute and long overdue necessity in ensuring timely access.

Given the outsized role that Kaiser plays in the commercial market and now in the Medi-Cal space, it is unacceptable that Kaiser providers are still not participating in HACCP. We would like to see DHCS deliver results based on ongoing conversations with and feedback from Kaiser, which have been taking place for years. The design flaws in this program are further exacerbated by the exorbitant spending on program administration paid to an outside vendor rather than spending on actual hearing aids for kids.

Kids deserve access to care, and we expect the administration to do better. Thank you for your time and attention.

Thank you so much, Nora. Department of Finance, do you have any additional comments to add?

Aditya Voleti, Department of Finance, nothing further to add at this time.

LAO?

Ryan Miller, LAO, nothing to add but available for questions.

Thank you so much. Okay, colleagues, let's jump into some questions here. I really appreciate the detailed answers to each question. Let's dive a little, little bit more into that. I think the first one is bit near. Close to 20,000 kids are eligible for this. And Deputy Director and Director, we're hearing that 193,101,103,171, and 148 are our numbers for the past couple of years. You said 2%. We're meeting close to only 2% of the eligible kids.

And only 68 total providers have agreed to be listed as a provider-eligible. Who will be taking on this? Most of them in urban areas, as what I heard from you, concentrations in LA, the Bay Area. 68 providers doesn't even cover one community in LA. I see this as a complete failure, a complete failure of a program that it's not even meeting where it's in good faith. We're at 50%. We've increased a little bit more.

How do we justify only meeting 2% of the population's needs in this and not have an even bigger urgency? I think action plans are great, but they're just plans like, what are we doing to really say, "Hey, legislators, this is how much we've improved. We have now 200 providers. You know, we've closed the gap from 2% to 50% of kids who have now been treated." Kaiser, one of the biggest providers, is getting to get out scot-free.

And I'm wondering what, you know what, that's another question. So, let's start with this. Like, how can we justify this? In all due respect, I wish I had the governor here, right? He's the one who vetoed this. I mean, put this back on the department to say that this program is better than having every commercial plan cover it. How do we justify this program being successful or still surviving?

So thank you for the question. So, to start off, in terms of the number of providers, the 68 that were referenced are the providers that have opted into the locator tool. That doesn't mean that those are the only providers for participating. One of the things that we had heard during the work that we had been doing to talk with the pediatric community in this space is that a lot of providers were unsure. They were unsure about the volume that they may receive.

So we have been talking with them about what to expect, where we hear challenges that they may have with our program in terms of, you know, administrative burdens or barriers. We are then working to try to address those, to give them clear guidance, but again, when the program was constructed, it was built on the use of the Medi-Cal network and providing these services.

So it's the same network of providers, not just the 68, but other providers that are participating in our program that can serve these kids.

So we're trying to do all that we can in terms of education, reaching out to the schools, you know, working with pediatric audiologists in this space, also getting some lessons learned from them, areas of best practices and information that would be helpful to the provider community in terms of their participation in the program, in terms of the number of individuals that have been served by the program.

We do understand and recognize that the ramp-up has been slow, but we are also looking at other touchpoints that we can make in terms of educating people and making them aware of these services. So, in working with the Department of Managed Healthcare to Covered California, putting information out on their websites, putting information about this benefit and their coverage of benefit disclosures, we're looking at doing that.

And then also for the newborn screening program through Department of Public Health, as well as through the newborn hearing screen screening program that is administered by the department, also providing additional information and outreach materials that are going out and doing calls to people to make them aware of this program so that we can help to increase the participation in this program.

So we do recognize that those are incremental steps, but we do believe that collectively, with those efforts that we're looking at deploying, it will help to increase the number of individuals that are participating in this program. We're also working with Department of Education to share information and how that information can be disseminated through schools, again, to make people aware about this benefit through the department.

Thank you for that part because I was going to ask, what about Department of Education? Because I don't think originally you said it, but thank you for touching on that point. Do we feel that now there is an urgency because this program has been going on for three, going on four years now, that now we have direct clarity, goals that we can now really flip this program?

I do, but as with any, and I recognize the timing for when the program was established. But one of the things that we have learned just in Medi-Cal, generally speaking, when we create new programs, new benefits ramp up, does take time, even despite our best efforts in educating people, putting information out, an email blast, you know, we put information out in our stakeholder updates on the program and all. It just takes time. It takes time to educate people, to bring people to the table.

We use our advocate voices to help with that communication. But we recognize it's not just one single thing that will help bring people to the table. It's a multitude of different activities that we have to coalesce around to help them increase awareness and participation in the program.

Two more questions, and I'll turn to my colleagues. One is, what are the barriers that Kaiser has shared with you as to why they're not participating? I know you shared recently that some concerns of providers thinking the influx is that the barrier Kaiser has proposed. I mean, they could take care of it; they're big.

Yeah, we know, and we have shared our concerns and our desire to work with them. Part of it is their infrastructure and how they're set up to provide these services and supports. So they have two distinct infrastructures in Northern California versus Southern California.

So we are working with them to try to see where we can offer some administrative relief because of the way of their infrastructures and their billing because part of it has to do with the billing and how are they going to then be able to bill for the services and supports.

We have received commitment. I'll be honest here: we have received commitment from them to work with us on this program, and they do recognize the importance and the role that they play in providing these services and supports, and so that is something that we're continuing to work on. And as we, you know, get further along in that process, we will then make sure that people are aware of next steps as it relates to Kaiser.

But they are committed and willing partners and working with us in terms of trying to overcome with the barriers that they may have between their two organizational structures.

Thank you. And this question, perhaps maybe Department of Finance, or if you have the answers, Deputy Director, is we've allocated a lot of money for this, I'll just throw out a bunch of these numbers, 400,000, 20-21, 15.1 million, 21-22, 14.5 million thereafter, and now we're requesting a couple more millions. But what we've allocated in services, correct me if I'm wrong, doesn't amount to all the money we've allocated for this program. So I'm wondering, where's the rest of the money?

Aditya Voleti, Department of Finance, so we, the Governor's Budget in the Medi-Cal assistant estimate project current year expenditures for this program to be 645,000 general fund and 100, sorry, 1.6 million general fund and budget year for this. And that is an estimate for what we think the usage will be. So if the -

And I'm so sorry, but in previous years, we never got near the amount of - these are 15.1 million, 14.5 million, and we've only served less than 2%, where is the rest of the millions of dollars? Why are we allocating more money to this? Shouldn't we have leftover from the previous year since we didn't use all of it?

So we - sobecause those were just estimates, we do make the allocation, we lower the allocation. Now it's 1.6 million, we lower the allocation based on updated estimates through the budget process. Every Governor's Budget May revise, and then in the Budget Act.

So, were the previous allocations of 15.1 and 14.5 called back? Because they didnt get? And I dont know, LAO, if you have more information, but it seems like the money wasnt completely utilized.

Yeah. If any program comes in like not at the estimate, we do just re-up the estimate when we pass the next Budget Act.

I'm gonna need a little bit more clarification. I give a department 14.5 million, and 2% of it is used; what happens to the rest?

So then, like next year, like, you know, if we, so if we - I don't have the prior year numbers in front of me, but like then the next year we would just, we would right-size the dollars to the -

Why would we need to right size if - why would we need a bit give more money if not all the funds were utilized? So why are we adding more? Yes. Where's the money? It seems like in the bucket there is 15 plus 14. That's 29. 29.6 plus 400,000, $30 million in the bucket for the past three years.

There is. You can't just, like, add up the numbers each of the years. So it's an estimate.

Wait, why not?

Medi-Cal is on a cash basis. So you - so what's available right now in the Governor's Budget, it proposes 1.6 million.

What's available in this program right now.

For the local assistance expenditures: 1.6 million general fund for the budget year.

No, that's what he wants to put in. Right? That's what you want to add.

No, that's like. That's what they have estimated. For the -

Expenditures.

Yeah, for the expenditures.

Right. So, the previous estimates were 15.1 and 14.5. And we didn't scratch the surface there. So what happened to those dollars?

Those dollars are not like, it's now 1.6 million. Those dollars -

I don't think - should I phrase it differently?

Like, they weren't quite.

Is it the difference between the state match and the federal money on Medi-Cal?

No..

That has nothing to do with it. But we budget on a rolling. We budget on a three-year basis.

LAO.

Yeah. Ryan Miller. LAO. Again, maybe if we backed up, I could maybe offer another way of approaching it. The issue that we're actually going to be discussing in the next item is the overall Medi-Cal estimate. And there are dozens of individual items that all add up to one number, and that number corresponds to the appropriation in the budget.

And so every cycle when we have a new estimate for this program, but for, like I said, dozens of others, the administration updates its estimates for caseload and for, you know, per member cost and all kinds of things. And individually, a lot of those estimates will go up and down, but then they all kind of add up into that one overall number.

And so I think that that's a very technical way of explaining, of course, that essentially because of lower utilization, it sounds like the funding wasn't required, and the amount for this program -

It just get absorbed back into the bigger Medi-Cal budget?

I think that's probably a fair way.

So we don't have a bucket just for this program?

No.

Whatever is in use gets clogged. Just essentially get back in the bigger bucket?

Yeah.

Okay. And so for this year, we're only asking to put $1.6 million into the bucket.

Yes.

That's a drastic cut. Why? I mean, that feels like that doesn't give us faith that we're gonna really increase enrollment. And secondly, it seems like the allocation for admin funding of this program is higher than the allocation for actual services of this program. Am I right to say that?

So the - so one of the things to be clear is that, like, just because there's 1.6 million estimated in the Governor's Budget for this program doesn't mean that anyone's going to get turned away or get denied hearing aids. If, for example, the caseload for this program was to triple, quadruple, we would just re-up the estimate. So, no one's going to get denied. This is just an estimate for what we project would be allocated for this program. So it's not a cut, necessarily.

Final, final, final. It says here we're the General Fund expenditure authority of $4 million for the 23-24. 3.7 in 2024. It's okay. I'm good with this. I think I asked the question already. I'm going to turn to my colleagues. Senator Roth.

Well, I apologize for coming late to the process. We had another meeting going on. So, in looking at the DHCS' steps in the future, steps to help patients maximize benefits. And there are six of them. In addition to developing these six steps, have you developed a specific projection on how these six steps are going to help increase participation and maximize benefits? Talking about hearing aids for kids, what's the goal in terms of increased participation? 20%.

You think these six steps will result in a 40% increase in the take rate? Are these really the steps that are going to be required to get to that 40% or 50%? Or is there something else?

So, in looking at the different steps that we have identified, we haven't, like, pegged it to a certain percentage or number; we're going to be measuring that based on what we start to see in terms of utilization.

So it's kind of a bifurcated process, but based upon the actions that we have taken, based upon feedback that we have been receiving from stakeholders, and things that they have asked us to commit to doing, we believe that those things collectively will help to increase the utilization of the program as we do with each cycle in the budget.

We'll be coming back with updated estimates, but part of it will be based upon the utilization that we are seeing and then trends that we project for future forward, in terms of the number of individuals served by the program.

I don't want to be; I'm not being critical. We're talking about hearing aids, so, you know, hearing impaired in young people, and that probably translates into the ability to learn or not at critical ages, particularly the ages we're talking here. And I'm normally in the business world we're normally accustomed to, if we have plan, the plan is tied to something.

That's going to happen at the end of the plan, and then people are graded based on plan objective attainment. And it's sort of hard to apply any of that if we don't have something that's going to, that we think is going to happen based on our actions, but we don't have that.

I mean, I don't have those numbers at the ready. I know we are looking at our utilization patterns right now and we'll be working on making updates to the utilization and what we're expecting to see. So we're looking at as people have been coming into the program, remaining on the program and the time at which they come in based upon what their needs are and using that information to then project future forward.

In terms of what we anticipate to see from utilization, as the Department of Finance had alluded to, there are assumptions and so we'll validate that or check that on a go-forward basis. So, we're making assumptions about what we believe will happen based upon information that we have from utilization participation in the program.

And then as we're looking at the various strategies, we have not, you know as I indicated earlier, we haven't pegged the strategies that say: by us doing x, y, and z, it's now going to net us, so many individuals. But again, the collective effort, we believe, will help to increase the utilization in this program.

For example, by streamlining this and simplifying provider enrollment. I mean, based on your contact with provider and provider organizations. I mean, do we even know that if we simplify it, that there were 20 providers that complained that they didn't do it because it was too complicated, and if we simplified it, they'd sign up so we could say, "Oh, well, if we simplify, we're going to get 20 more providers in the system."

We just, I don't have the magic ball to say what that would be. I mean, we are working as diligently as we can to educate the providers. There are providers that are in our program today that can provide these services based upon their skill sets.

What I think people have been looking at is that provider locator tool that people have now said, "I'm going to put my name out here," because now, when people are looking for these services, I am now putting my name out here to say, you know, come, I can provide services to you. What we had heard previously, why we weren't having so much uptake, is people were unsure what the numbers were.

These are providers. The providers, not people seeking hearing aid?

No, the providers. And just their capacity to serve those individuals.

Again, I'm not being critical. It's a very complicated issue, I'm sure. And I have to defer to you all, who are the experts. I am a little disappointed in Kaiser.

Seems to me, you know, given all that we've gone through with Kaiser, including some massive contract and all of that conversation that you would think they would, Kaiser is an entity with all the people and all the money that flow through that operation that they would be able to figure out how they could do a better job with respect to something that's pretty critical to young people who aren't able to hear.

So I'm hoping that you all can help big Kaiser figure out the answer to this problem.

We are working on it.

I'm sure you are and hopefully they are too. Thank you very much.

Thank you, Madam Chair.

Thank you.

Thank you. And to follow up on Senator Roth's questions. Yeah, it's surprising that Kaiser is, I mean, how at some point do we think about using sticks instead of carrots with Kaiser. As it relates to this, they provide a lot.

We understand, I mean, it's a program that's outside of Medical. But again, we have, you know, talked with them about the importance and their role in the participation in this program. So they are getting the, I'll say the pressure from the Department, but they have been working with us. Part of it is an administrative complexity in terms of the billing. And also we are willing to come to the table to look at opportunities for how that can be structured, streamlined.

But there is information we're going to need from them and it's just having those systems and those abilities for those systems to communicate with us and our billing processes for reimbursement purposes. They have been crystal clear about their desire to want to work with us. It's just the mechanics of how. And so that is what my team is currently working through with them in terms of the how to make this happen.

It seems like they're pretty sophisticated in a lot of the hows. And maybe this Committee could talk with Kaiser as well just to get their perspective on why this is so complicated for them. And then just my notes. You're right. Let's have a conversation with Kaiser so they can explain it to us why it's too hard. You know, the weekend's coming here and I'm thinking the weather's not too bad. I might do a little fishing.

And I just wonder, with a program like this, is there a point where we cut bait where it's not working? And what do those indicators look like to us that would tell us four years in 567? I mean, how long do we do this, right, that this program's not going to work and we shift to another model? That's already been suggested.

Fair question. And one that, you know, for us, our intent here is to try to make this program as successful as we can. So we're not looking at this, that we're going to get to this point and then we're going to stop, you know, throw our hands up. Our goal here is to make the program successful. So that's what we're going to continue to work towards and work in collaboration with the Legislature and our interested parties.

I would push back. My goal isn't here to make this program work. My goal here is to get here hearing aids to kids. So whether it's through this program or something else, you know, I don't care, but I want us to also, we have to accept if this program doesn't work. That's the thing I'm struggling with that. Next year, if we're at the same numbers, are we still gonna say, oh, no, please give us another year. We're gonna try again, it's an action plan 2.0.

Like, I want us to be able to be on the same page that accept our losses because it's not us that are suffering, you know, and put our ego aside and say, hey, we tried it this way, let's try a different way. So I am hopeful, not all advocates are hopeful because they've been in this fight longer than I have. Right. So I am hopeful that we can change, but I want us to have a little bit more teeth on this.

I don't know if there's a deadline for Kaiser participation. I agree with the Senator, we shouldn't, no more bait. And I also kind of want to go back on what Senator Roth said. If we don't have milestones, how do we know we're in the right path? So if we hear from 10 providers say, hey, 10 providers say, I have not joined because I don't have Internet, then we know that for 10 providers, we need to help connect them to Internet.

And we know that next year we'll have 10 more providers. How do we know that? We're scratching off the barriers for us to estimate next year how many providers we'll have. I don't think you're right. We don't have a magic ball, an eight ball, but we should have an understanding of the barriers that are common and easy to overcome. If you share with me one of the big ones is the concern of a huge influx.

Then you talked to 20 providers and you made them feel comfortable that to us should say, those 20 providers are going to be on that list next year. So that's what I want to hear of those action plans having these milestones that we're going to reach. When it comes to the geographic analysis, I know you mentioned we haven't done this, but wouldn't that tell us where we need to put more energy of?

If the 68 or 32 in LA and 36 in the Bay Area, then we should focus our energy in those other areas. I'd like to provide your opportunity to respond on to the two recommendations that Nora mentioned. If you could speak to regarding the pediatric codes around molds, hearing molds, and the support for hearing test assistance. What work we've done that and what barriers still exist.

And then the long list that even of the providers that we have, kids are still waiting on that long list due to, you mentioned, too few pediatrics ideologist.

So in terms of the, so one, thank you for your comments. In terms of, you know, some future forward next steps. In terms of the molds are covered, we have heard the concerns about just the policies, and we understand for the younger kids there's frequencies because as they grow, they have to get, you know, updated molds. Those things are covered.

I think one of the things that we have recognized from feedback we have received is how can we make sure that that is explained explicitly, spelled out in our provider manuals. And then on the other one, it's just a matter of me going, I'd have to go back to look at what codes are in terms of the services that you were referencing, like for the training and all. So we will take, I will take that back.

But the code, you know, like all the things that we cover under the Medi Cal program, they're covered. My understanding from what we have heard from the stakeholders that we have been working with, it's not that anything has not been covered. We do cover them. It's just a matter of if those services and supports are, if they require a prior authorization or not.

But where we had learned in our early efforts, we had learned that there were some procedures that it was not clear that we covered. So we did clarify our coverage policies in terms of all the types of services and supports that are needed for the population to help aid in their hearing. So we have addressed that. But I'll have to just look at the one code that you're referencing in terms of training and if that was added or not.

Nora, I'd like to, because I really appreciate keeping to your three minutes, most panelists don't. So any additional comments? I'd like to hear more about the stakeholder engagement and then also about we estimate a certain amount of caseload due to a lot of barriers that exist. Are there any additional barriers that we did not talk about as to why a family is not enrolling their child into this program?

I think the lack of pediatric audiologists is key, and I would disagree a bit with the coverage of ear molds. For example, we talked to Rady Children's Hospital in San Diego, and I'm going to quote from what they told us in terms of costs. Our February cost analysis for 2022 was just completed, and our breakeven cost for audiology is $141.89 per hour.

For an ear mold, we schedule a half hour to take the impression, a half hour for paperwork, and a half hour for the fitting, meaning that our breakeven cost is $211.34 in services, plus the cost of the impression material, which is about a dollar per impression. So the break even point would be $244.34, and the Medi Cal reimbursement is $27.52. So that is a challenge for the audiologists to participate.

But they're included in the MCO tax. Right. So is this going to match the 244 or just going to get closer to it?

The 80% you mentioned.

It'll get closer.

I don't know that we know exactly what the rate will be compared to what she just mentioned, but it is part of the package.

Yes, and it will be part of what they're going to be doing is also looking at commercial payers and what they're paying, and then other public programs to use that information to then help us to get to an 80% Medicare equivalent for these services.

Okay, my final thought, unless. Senator Roth, you have something.

Well, I'll wait for you. Oh well, how does the. How is the cost of the apparatus itself, the hearing aid, covered? Is that a fair question? We're talking about hearing aids.

Yeah, we cover the hearing aids, so.

That's not what we're talking about here. State pays for the hearing aids.

We pay for the hearing aids. We pay for the molds, we pay for the visits to the providers.

I mean, but is it the full cost of the molds and the full cost of the hearing aids?

Well, I think that's the question at hand. In terms of the reimbursement rates.

Well, you know, and because the reimbursement for service is rendered, the hourly rate, that's a different issue for me. When it's important to the state, we do it right. We make vaccines, shots, medicine, you know, maybe we make hearing aids. I mean, I think we need to decide if this is important to us to make sure kids hear, and then we need to figure out how we reimburse the audiologists who actually have to pay the services. And that's why I was asking.

I was getting a little. I want to make sure this is the equipment apparatus is one issue, and the hourly rate for the audiologist is another. And I guess it is. Okay.

It's an important issue. Obviously, you can tell this is important to us because we have to go back to our districts and we have to. As you may know, I have a state school for the deaf in my district, so it's a pretty big deal.

Understood.

Yeah. One of the more emotional topics to talk about, what I was trying, my blubbering before was trying to ask this one question regarding the allocation for this year, what's proposed in the Governor's Budget? And that is 2.6 million for expected expenditures, but 3.7 million for Administration. How do we justify $1.1 million more for admin than for the actual services?

You say one thing before. Sorry, I just wanted to jump in and just say that it's 1.6 million General Fund for 24-25 for the benefits, not 2.6, I think, which is what you said.

I'm looking at the agenda. Okay. On the agenda on pain. Six, it's. It says $2.6 million for 24-25. Yep. Hearing aid, 2.6 million. It's on straight from medical estimate. Okay, 2.6 and then 3.7 for admin. Okay.

Yeah, yeah, that's fine. Sorry, my mistake.

I got a good team. You gotta trust Scott. And then, so. And then 3.7 for admin. So even if it was 1.6, I'd be worse. Right. So how do we justify more? I always think about, like, overhead should never be more than 10%. So what's going on there?

No. Understood. But in part of the, for the administrative services. So there is a vendor that helps to support this program in terms of the work that they do for the enrollment, the applications, the annual renewals. So those are vendored costs, and so they do have a cost, you know, in terms of caseload that we are paying them for. Their vendor costs did come down from what they were previously, so we did negotiate with a lower reimbursement rate for them.

But their costs are spread based upon the infrastructure that they have to have in place in terms of administering the program, because it's not just, you know, they have teams, you know, as you understand, working on the program.

But there are, to your point, administrative costs in terms of having that team on board, doing the call center, and being available for inquiries, but they do all of the eligibility work for the Department on Behalf of this program, as well as the annual renewals, and then the necessary follow ups for applications that may come in that are incomplete.

I won't contradict that. It's just, you can see how this adds fuel to this topic. Right. It's just, yeah, it's hard. I think it's hard for me to go back to the stakeholders, constituents and say, trust is on this. We're spending more money on vendors than this because you usually don't see this in other programs.

Yeah. But also the expenditures are based upon the utilization and people coming in. So I think to that earlier point made that to the extent.

We won't turn anyone away.

Right.

No one's going to be turned away. So as more people are coming in, more services are being provided, then you're going to see those expenditures increasing.

Okay. Okay. Nora, any final, final thoughts? Okay. Thank you so much for this. I appreciate it. We'll continue to be in touch on this.

Thank you.

Thank you.

Thank you very much.

We're now moving on to issue number two. Talk about the Medical local assistance estimate direct. Are you doing this one?

Yes. So the Medical local assistance estimate includes expenditures of 156.6 billion, 35.9 billion of that is General Fund and 97.6 billion federal funds, and then finally 23.2 billion special funds and reimbursements for the current year. So 23-24 the Governor's Budget projects General Fund spending in Medical will be 190 million less, or about a half a percent less than was approved in the 23 budget act.

This is a net result of some several factors, including additional revenues from the MCO tax recoveries for managed care plans related to lower than previously assumed supplemental payment costs during the public health emergency period and the proposed sweep of the medical drug Rebate Fund Reserve to help address the General Fund shortfall.

These impacts are partially offset by increased caseload costs as more members remain enrolled during the public health emergency, unwinding than previously projected, and then an increase in one time state only claiming retroactive payments to the Federal Government for the upcoming fiscal year 24-25. The budget projects General Fund spending in Medical will decrease by 1.4 billion compared to the 2324.

Main factors driving this change include the full year impact of expanding full scope coverage to eligible individuals aged 26 to 49 without regard to immigration status, typical growth in rates paid to managed care plans and providers, the end of the increased federal matching from the public health emergency period, savings from large one time payments in 23 to 24 that do not continue in 202024-25, and additional kind of swings in caseload and then additional savings from the MCO tax revenue. Happy to answer any questions?

Yeah, I just have two questions on care. We're allocating $65.3 million to the Care act. How is this getting distributed? Or to what is it just evenly through all the counties that have started.

Or it's based on kind of the phasing of the counties and kind of the projected caseload by the counties.

Is this only for the counties have already started, or is this for the phase two?

The second, the budget year dollars would include phase two as well.

Okay. Yeah. And then my other question was regarding do we and do we not credit, but do we assume that part of the drop is in the Medical is due to the redetermination.

Acceptable drop, you would say?

In terms. I mean, we do, you know, caseload is going down, but there's also corresponding increases in caseload as a result of new applications. And so, you know, it's kind of up and down. And so there are changes in our estimates regarding caseload. And so I think we are learning more, and I think.

Is this an acceptable coming drop or are we skewed a little bit?

Pardon me?

So I would say the disenrollment, since the unwinding, the redetermination process has started, we've been at about 20% in disenrollment, you know, plus or minus a little bit here and there. And that is pretty consistent to pre COVID, I will say, the last couple months, where we've automated some of our ex parte rules with regard to some of the federal flexibilities, our disenrollment rate has significantly been reduced about 8-9%.

And so, you know, kind of the redetermination process, individuals hadn't had to do a redetermination or send in their packet for three years. So lots of kind of changes in the processing and kind of the up and down in the caseload. And so I think kind of some of these are some typical caseload ups and downs based even on aid code, in terms of some that are consistently trending up and others are trending down.

Okay. Department of Finance, any additional comment?

No additional comments.

Can you tell me your name, sir?

Sorry, Aditya Valeti, Department of Finance. No additional comments.

Thank you.

Ryan Miller. LAO. I just think we would add on to what Director Baass said that, and she hit on it earlier in her initial comments on the estimate. The caseload now being projected to be quite a bit higher than was previously projected by the Administration in our office, and just kind of repeating some of the numbers that Director Baass mentioned on the redeterminations. Not to lose in the conversation, folks who have been disenrolled from the program.

But I think that our assessment is that the redeterminations process has had much less of an effect on enrollees than we had predicted, certainly last May last November. And so just wanted to kind of offer that. In addition, I think we would just also say that there was a huge deal of uncertainty about how that process would unfold and where there is normally a lot of volatility in the Medical estimate from cycle to cycle and in May, we can often see pretty big differences.

It seems like particularly possible this year that we could see a big swing. So that's something that we'll be keeping our eye on, and we'll provide sort of a final assessment on the estimate to the Legislature after the May revision.

Because it goes through June or July redetermination.

So the unwinding period, June, would be kind of the last.

So we'll have a closer understanding come May revise.

As we continue to get the real numbers.

Yeah. Colleagues, any questions on this? Great. Thank you so much. We're going to hold that item open, move on to issue number three, family health local assistance estimate.

Hi there. Sorry about that. Good morning, Madam Chair and Members of the Committee, Sarah Brooks, Chief Deputy Director from the Department of Healthcare Services for healthcare programs. I'm here to talk with you today about the family health estimate and provide an update on the CHDP transition. All right, so the Governor's Budget projects that spending on family health estimate programs will be very close to what was approved in the 2023 Budget act with no significant changes or new proposals. Happy to answer any questions. All right.

With that, I'll move into the CHDP update. All right. So DHCs issued and posted the final CHCP transition plan on its website on March 29, 2024. We also posted the accompanying declaration required by SB 184, certifying the date that all activities required pursuant to subdivision of Health and Safety Code section 124024 have been completed that was posted as well. DHCs went through an extensive stakeholder process to inform development of the CHTP transition plan.

So we did conduct six different stakeholder convenings and brought together Members of the public, which included counties, members from various stakeholder workgroups and other entities, to engage in different discussions throughout the process. And so we had much discussion along the, along the way, a draft of the transition plan was previously released for public comment from September 27, 2023 through October 11, 2023 and received a large volume of stakeholder input.

I believe we received over 1000 comments and incorporated those into the stakeholder transition plan and updated it. So it took some time for us to update it, but certainly wanted to go through all those different comments and make sure we took them into account. So those comments, in addition to the feedback compiled throughout the workgroup meetings, informed updates to the transition plan itself. In addition to issuing the CHDB transition plan.

DHCS has and continues to issue targeted guidance to the counties related to transitioning CHDP program functions and standing up the healthcare program for children in foster care. So also known as HCPCFC, the best acronym ever. So I wanted to talk to you a little bit about that. So we have some guidance out right now for comment with the counties, including two different documents related to HCPCFC.

In addition, we have issued guidance to the counties starting back in December 14, I believe it was 2023, that provided guidance to the counties that really issued direction to them in terms of what they should do once the CHTP transition occurred, which will be at the end of June 30, 2024 of this year.

So really have worked closely with the counties to provide direction to them in terms of what they should do with the end of the CHTP transition, noting that the transition plan itself is really a document that provides guidance to the public, but also to the Legislature itself about kind of the overall direction that the Department is going in. But recognizing that we've issued guidance to the counties as well along the way and had many discussions with them during the process.

So happy to answer any questions, if you may have some. I know that this has been an issue of topic. No questions.

Appreciate it. Yeah.

All right, thank you.

We're gonna hold the item open and move on to issue number four.

Sorry.

Brings us up to our, our next mini panel.

All right, so we're gonna talk a little bit about.

I'm gonna wait the rest of the.

Okay, thank you. Sorry about that.

Chair comes up. So we're going to do a legislative oversight panel on CalAIM, enhanced care management and community support. We're going to be led by our Department, then we'll dive into the panel discussion. I'll have.

We have joining us today, and I'll have you introduce your names, but we have someone from the Local Health Plans of California, El Proyecto del Barrio, and from Western Center on Law and Poverty. You may begin.

All right, good afternoon again. Sarah Brooks with the Department of Health Care Services. I am the Chief Deputy Director for healthcare programs. I'm going to go through all of the different questions. There were a number of questions, I believe eight with a lot of A, B, C, D, E, F, Gs included. So I may take a moment to get through my comments here, but I will answer all of your questions in the dialogue that I do present today.

So again, thank you for the opportunity to talk with you a little bit about Enhanced Care Management, or ECM, as I may reference it today, and community supports. So I'll speak about ECM to start. So as of quarter three, 2023 we had 123,100 unique members that had received ECM in the prior 12-month period. Further, in Quarter Three, 2023 which is July through September of 2023, there were 1301 total ECM providers in the state.

Finally, in Guarter Rhree, 2023 the top three groups enrolled as ECM providers were other qualified provider or entity, which is always kind of like the catch-all. So to describe who those entities are, they're really kind of community-based organizations, federally qualified health centers, and then behavioral health entities. So that really made up the majority of or most of the providers themselves.

To be eligible for ECM, members must be enrolled in a Medi-Cal managed care plan or an MCP, as I may refer to them today. I'll use those interchangeably, likely during the presentation, and meet at least one of the following nine ECM populations of focused definitions.

So I'll run through these pretty quickly, as they are a long list. Individuals experiencing homelessness, individuals at risk for avoidable hospitalization or ED utilization, individuals with SMI and or SUD needs individuals transitioning from incarceration adults living in the community, and at risk for long-term care institutionalization. That's a good one.

Adult nursing facility residents transitioning to the community children and youth enrolled in CCS or CCS Whole Child Model with additional needs beyond the CCS condition, children and youth involved in child welfare, welfare, and birth equity populations. For further information about these populations of focus, I would refer you to our ECM Policy Guide, which is posted on the DHCS website. MCPs must use the eligibility criteria provided by DHCS to evaluate members and may not impose additional eligibility requirements for authorization of ECM.

There are several pathways to obtain ECM authorization, so three specifically. Plans can query their own, data providers can refer a member to the plan, and members can self-refer themselves to the plan as well. MCPs may broaden criteria to include members who may not fit the eligibility criteria, but they can't narrow it. So they can expand and add additional individuals, but they can't narrow and... they cannot narrow it.

DHCS does have statutory authority to determine additional ECM populations of focus, but I think I want to note that at this time, we're really focusing on the nine populations of focus that we have to ensure that they are being successful. Noting that we want to, we are noting that we want to prioritize and see what happens with them. You know, we have issued recently, and I'll talk about this in a little bit, data specific to ECM and also community supports.

And so looking at that data closely to ensure that we're tracking it and making sure that things are working in the manner that they should be. An example, and so I'll talk a little bit about community supports now. So there's been continued growth in the number of community supports offered by MCPs since the launch, and we're really excited about that. As of January 2024, 23 counties had all 14 available, compared with the end of 2022, when only three counties had all 14 community supports available.

For context, the total number of Medi-Cal members who received community support services in the last 12 months is 94,144. This is based on the most recent available time period of data. For context, the total number of Medi-Cal members who received community support services in 2022 was only 36,391. So a significant increase for us. From Quarter Two, 2022 to Quarter Three, 2023. I apologize, throwing out all these quarters and numbers.

The most common community support services received were housing transition and navigation services, housing tenancy and sustaining services, and medically tailored meals or medically supportive foods. And have numbers to back that up if you're interested to hear a little bit more about those. From Quarter Two or in that same time period, the least common community support services were nursing facility transition diversion to assisted living facilities, community transition services, nursing facility transition to a home, and then environmentally accessibility adaptions.

So those were the ones that we didn't see as much of. Noting, however, that ECM long-term care populations of focus went live in January of 23. So we may see more uptake of these less common community support services as that population of focus becomes more established. Some important things to note for community support specifically. So, a member does not have to be enrolled in ECM to receive a community support.

So wanted to make sure that that was clear. However, they must meet criteria for each community support that they do receive. A key goal of community supports is to allow members to obtain care in the least restrictive setting possible and to keep them in the community as medically appropriate. So that's an important goal of the Department. MCPs must expedite certain community support services, including recuperative care, short-term post-hospitalization housing, sobering centers, and medically tailored meals being offered after discharge from an acute care setting.

So, you know, just wanted to flag that. As we have looked at and worked on community supports, we've looked at what are some things that we need to put in place to make them more effective. And so we identified that there are some community supports that need to happen immediately upfront because they are more effective in that manner. So, for example, if you send somebody home from the emergency room without food for a week, that's not effective.

So we need to make sure that we get the food, medically tailored meals, for example, in place immediately. And so that's an example of that happening. Some.

And ERs can do that?

For example, in this case, the health plan would come in and they would. So this would be the responsible of the health plan. That would be the responsibility of the health plan when they're ordering the community support or putting the community support in place. Yeah.

Okay.

Some MCPs have implemented presumptive authorizations. So that's exciting for us to see is that they've put in place that you can kind of get straight through and get the community support without having to have an authorization in place.

We've seen that happening in Los Angeles. For example, similar to ECM, MCPs may determine eligibility for members for community supports. As part of their authorization process, MCPs are to ensure documentation that the community support service is medically appropriate for that member as recommended by the provider using their professional judgment. The process may be incorporated into the MCP's utilization management process or may include provider-level documentation in an individual's care plan or other record.

So, to talk a little bit about network sufficiency, there continue to be opportunities for improvement for both ECM and community supports and network sufficiency. However, it is important to note that it takes time to build expertise and capacity in the delivery system. We do see that whole-person care and health homes programs counties had a significant head start in network capacity development.

This is reflected in the data which shows slower uptake for non-whole-person care and health home program counties and with new populations of focus. So, for example, with the justice-involved or children and youth populations where we see that networks are slower to uptake with those populations of focus because they're new and they weren't in existence necessarily those health homes in whole-person care counties.

Building capacity at the delivery system level to really support community-based organizations and providers to work with Medi-Cal takes time and investment. That is the reason we have made available incentive payment program or the Incentive Payment Program through managed care plans and path funding availability directly to providers and CBOs. And I'm going to talk a little bit about what that is and what that opportunity is for providers and such in just a minute.

Under PATH, there is funding for infrastructure and capacity building under the cited initiative, and there is technical assistance for CBOs and providers interested in becoming providers or expanding capacity. Additionally, there continue to be opportunities to improve member and provide awareness about ECM and community supports to improve rates of referrals for these critical services. The DHCS, ECM, and community supports action plan has been actively streamlining referral and authorization processes to help improve Member and provider referrals.

So we have an action plan that we've put in place that really kind of streamlines and aligns things across community supports. And so that, for example, when I talked before about looking at what's happening in Los Angeles with the prior authorizations, or looking at the direct medically tailored meals, having direct services happening immediately, that's an example of what's happening in the action plan that we've put forth for our health plan.

So, talking a little bit about outreach, I said I'd talk a little bit about some of the outreach that we're doing. So DHCS has a multipronged approach... has a multipronged approach for sharing guidance, providing outreach, and offering TA to providers.

This includes the development of guidance, documents, toolkits, and other resources available on the DHCS website hosting various informational webinars on ECM and community support with topics including specific POFs or populations of focus, community supports, billing and reporting requirements, and best practices from MCPs and their contracted providers. We have several initiatives intended to help build up the capacity and infrastructure on the ground for our of our on-the-ground partners to successfully participate in the Medi-Cal delivery system.

So one of those is PATH or Providing Access and Transforming Health, which includes three different parts that I'll talk about. One is collaborative planning and implementation, also known as CPI. This is local workshops that provide a forum for providers, MCPs, and other stakeholders to identify and address implementation gaps at the local level.

Another is the TA Marketplace, which is really a one-stop kind of site of various off-the-shelf projects and curated vendors that can provide customized TA to contracted or prospective ECM community support providers. And the third is CITED, capacity and infrastructure transition, expansion, and development. That's what the CITED stands for, which is direct funding to build capacity and infrastructure to provide ECM and community supports.

DHCS we do expect managed care plans to also work with their contractor provider networks to train providers on ECM and community support. So we do expect that they work regularly with their networks. Through IPP, MCPs report on measures tied to provider education on ECM and community supports availability, eligibility requirements, service definitions, and member engagement. Many health plans have developed flyers, training, and other resources to support their network providers and to share awareness of services with members.

MCPs include provider-facing resources on their websites to support referrals and understand eligibility requirements. They also include information on ECM and community supports on their member-facing websites, with guidance on how to reach out to their MCP or PCP for more information. Finally, DHCS teams interface with multiple advocacy groups to help them better understand ECM and community supports and hence kind of communicate this to their constituents. So we really rely on stakeholder groups.

They're on the ground and are able to communicate that information out, and so we really rely on those partnerships to get the word out for us. And as I described before, this remains an area of opportunity for DHCS in actively working with our health plans to improve member and provider education, as well as to streamline referral and authorization processes to move to a state where most referrals come from community-based resources. To talk about outcomes and data. So data tells the story, right?

Currently, the data DHCS is tracking focuses on access and use of ECM and community supports. We're able to access utilization of ECM for specific populations of focus, which by definition are high-needs beneficiaries. DHCS also has an internal ECM and community supports dashboard that analyzes data from the quarterly implementation monitoring reports. So we utilize that to monitor trends and to look at what's happening with the program. The public version of this was released earlier this week. I believe maybe it was just yesterday.

Yeah, so just yesterday we released new data and is available on our website. It shows data through Quarter Three, 2023, and provides a variety of cuts, including by population of focus, community support services by planning county where data are available. Were also deepening our monitoring and program evaluation for ECM by defining key performance indicators and quality outcomes so that we can assess the quality of ECM being provided in addition to utilization. So lessons learned. That's always important.

So what can we take away from this, and what can we take moving forward as we move into, as we continue with the program? So DHCS is interested in making community support services as a statewide benefit in future waiver periods as we've talked about. Practically speaking, this means that managed care plans will be required to cover community supports as a benefit in the same way that they cover ECM. So ECM is an entitlement today for all members. Today, community supports are voluntary as you know.

Moving to this future state will depend on how robust our delivery system is in meeting the needs of our community. Availability and capacity of each community's support and the relevant provider network does vary. As mentioned earlier, we have seen wide availability and uptake of the housing suite of community support services. So we've seen a big uptake in those services. We've also seen offering of medical respite as a community support service.

As of January, we have 53 of 58 counties offering medical respite available in their county, which is just great news. We're really proud of that. We'll monitor and support implementation efforts to increase use of those providers and ensure members who need those services can access them in a timely manner. These are lessons learned from implementation, but we're not waiting in the next waiver until the next waiver period to apply those lessons learned as we are taking a continuous improvement approach.

So, as I said, we're kind of taking lessons learned and applying them as we go. As part of our continuous improvement approach, we consider stakeholder input and data. In terms of the stakeholder input, we listen to our stakeholders and adjust when appropriate. In 2023, the Department took the opportunity to engage, and I believe my Director was a part of this, to conduct listening tours and survey providers. We heard accounts from multiple stakeholder conversations about implementation challenges that had to do with unnecessary barriers.

So we did take away from those listening sessions and took real-time action and implemented changes based on that into our program. And for example, that action plan that I talked about came out of the...came out of that listening tour, and we made modifications to the program as a result that we believe have helped with increases in both the networks and the enrollment into the programs.

So I've spoken quite a bit today already, and I'm sure that you may have questions and there are others here to speak as well. So with that, I will end. Thank you for the opportunity to speak with you today.

I appreciate that. Yes, a lot of great information, though. We're gonna hold questions until we hear from everybody. So I'd like to move on to our next panelist, Katie Andrew. Well, I said I was gonna have you introduce yourself, but I can pronounce that one.

Okay. Oh, it's on. Great. Well, then I will skip introducing myself. In the interest of time, I'll just quickly say local health plans of California represents 17 mission-driven, not-for-profit, community-based plans that deliver equitable and accessible healthcare to over 70% of the 15 million Medi-Cal members throughout the state. Since the launch of the Enhanced Care Management and community supports benefit, local plans have been at the front lines of implementation, identifying provider partners, assessing gaps, troubleshooting barriers, and, where possible, streamlining processes.

Local plans have fully embraced Calaim and the ECM and community supports benefits and believe in the value and know the impact that comprehensive supports and services offered through these benefits can make, not only to their members' health and well-being, but in helping to pull them, put them, excuse me, on a better life trajectory. Overall, the implementation of the ECM and community supports benefits has been very positive. Local plans, again, understand the importance of the benefits to improving health outcomes and reducing disparities for their members.

But of course, the implementation of new benefits is never without challenges. Launching these services and building the networks to support them is a significant lift. However, over time and as the benefits mature, the state and Medi-Cal members alike will begin to realize their full impact. That said, the progress over the last 21 months or so since implementation began is promising. Very promising. And as was highlighted by my DHCS colleague here, the numbers sort of speak for themselves.

You see in the last quarter a significant increase in the unique members being served by both benefits, and so we're really encouraged by that. And I'll just also say that for local plans, in terms of community supports, most of our plans are offering 10 of the 14 community supports available, and many are offering all. So we are seeing an increase in the community supports being offered across the board.

In terms of provider network and building that capacity, plans often have started with leveraging existing relationships, such as those established through the Health Homes Project and whole-person care pilots as you already heard. Those were low-hanging fruit to build those relationships and put those contracts in place. So for investments in supportive services like medically tailored meals, recuperative care, nursing home transitions, housing investments, there were also relationships that are already in place there for those services as well.

And that was usually coming out of standalone pilots or investments that local plans were doing on their own. To expand the network beyond existing relationships, plans began to identify providers already serving ECM-eligible members and populations of focus including FGHCs, county behavioral health, and others. Local plans also began connecting with community providers, delivering community support-like services, which I already spoke to a little bit. Once potential providers are identified, local plans provide education and training.

Make sure that consistent meetings are happening with providers, outreach, and training as well for those who may be interested in contracting, sort of give them a lay of the land. In this work, the ability for local plans to leverage incentive payment program dollars, as we've heard, was incredibly critical to support network development and to developing the infrastructure and building out the capacity of providers for these services. So, for example, developing data exchange capabilities, funding for staffing, etcetera.

In addition, the Housing and Homelessness Incentive Program funding has helped address local housing and homelessness needs by working closely with county partners to provide housing services, technical enhancements, and infrastructure. These funds have also allowed local plans to make creative investments in permanent supportive housing, give equity grants to smaller nonprofits, and create system change grants. Building out the ECM and community supports provider networks, however, has not been without limitations or challenges.

So one example of that is workforce shortages, and this has impacted providers' capacity to contract... or the volume of Medi-Cal members that these providers can serve. There are also geographic constraints, so particularly in very rural areas where there are very few providers or CBOs, that can be a challenge. New providers that have never contracted with Medi-Cal managed care often grapple with the new processes as well.

So to move beyond those challenges, new providers require support, technical assistance, and guidance around strategies for braiding funding, developing infrastructure, and increasing capacity. And many of our local plans are engaged in those activities to support them. And despite these challenges, however, plans remain committed to troubleshooting barriers and providing technical assistance to providers with the goal of continuing to grow and expand their networks and to provide quality care and supports to members.

In terms of identifying populations of focus and determining eligibility for these benefits, plans are often relying on available data such as claims and utilization data, demographic data, social determinants of health data as it's available, screenings and member assessments, and gaps in care reports. This data is used to identify members that are within specific populations of focus and assess members' risk level. Based on that assessment, local plans then connect them with needed services and the appropriate level of care management for Members. Yeah, I am.

Thank you very much. So let me just quickly touch on outreach to members and providers. So local plans have used several methods to educate Members, traditional methods like updating ember handbooks, sending out letters, and information on plan websites, and through member portals.

Similarly, members or plans have also done a lot of outreach to providers by disseminating information, doing webinars trainings, that sort of thing, providing information through portals, and also a lot of partnership with community-based organizations as well, meeting members where they are and working through organizations that are already serving them to make sure that they're receiving information that way as well.

Final thoughts?

Final thoughts. So I'll just say that while local plans have experienced some challenges in the implementation, expansion of ECM, and community supports, plans continue to expand their provider networks, continue to see an uptake in the benefits, and have witnessed the real-life impact of these benefits on their members' health and well being. The implementation of new benefits takes time.

Takes time to educate members and providers about the availability of new benefits, to build trust and capacity with nontraditional providers, and to find ways to streamline processes. And as local plans continue this work, we will continue to work with DHCS and providers to provide technical assistance.

Thank you.

Support resources.

Thank you. Thank you.

Of course. Thank you.

Thank you. Okay, we're gonna be moving on. And before that, just wanna make sure there isn't the representative from Sacramento Native American Health Center in the audience. Okay. Just want to clarify. No worries. Okay, we're gonna move on to Ruth from El Proyecto del Barrio. Yeah, get closer.

All right.

You might want to put. Yeah.

Yes. My name is Ruth Lopez Novador.

And, Ruth, I'm actually going to have the microphone be right maybe to your side so we can hear you better.

Okay. To my side?

Yeah.

Is that okay? All right.

There we go. Perfect.

All right. Thank you, Honorable Caroline Menjivar, for inviting us to this session. My name is Ruth Lopez Novador, and I'm representing Corinne Sanchez, Esquire, President, CEO of El Proyecto del Barrio. Currently, unfortunately, El Projecto is still not a CalAIM participant. We have performed CalAIM-like services, but have not heard a response from the plans for our request to participate since '23. Excuse me, 22. December of '22. So, excuse me, January of '23. Pardon me.'

El Proyecto was founded in 1971 to provide substance abuse services with behavioral health counseling, bilingually, biculturally, Spanish, for the poorest neighborhoods in the San Fernando Valley. For over 50 years, our behavioral health program has provided counseling and referral services to men and women, including specialized services for women who are pregnant, postpartum, and parenting. El Proyecto, for over 30 years, has provided primary healthcare job training and placement, and childcare services for the underserved communities of the San Fernando Valley.

It was a lack of available medical services for the Latina expectant mother users that prompted El Proyecto to become a federally qualified health clinic and recognized as a patient-centered medical home by the NCQA, which provides care through an extended managed care network to the San Fernando and San Gabriel Valleys. We are here to share our experience with CalAIM, ECM, and provide some insight of the experience of a smaller FQHC in the community that's been established for 50 years.

El Proyecto del Barrio's leadership took immediate action to inform, train, and plan for what appeared to be a number of substantive changes resulting from the CalAIM initiative. The board of directors welcomed and adopted the promise and challenge of the CalAIM initiative presented by DHCS. Our El Proyecto President made it clear that all training available should be made to executives and appropriate management to prepare for the collaboration of some of our non-clinic services with the health plans as per the CalAIM initiative.

This is in full compliance with our mission and our greatest experience base. 50 years. Needless to say, thanks to the agencies of California Primary Care Association and the Community Clinic Association of Los Angeles County, momentum began at the beginning of 2023 or 2022. Momentum began with multiple trainings for APM, CalAIM, ECM, EPT, et cetera. And during the training, we were working on the recommended timelines to send LOIs and applications.

We managed to not only send APM application, but managed LOI, but got a response, and were ultimately invited to participate, but we declined for specific reasons. However, all of this was a little bit surprising when we got to the first quarter and wanted to see what our status was with the LOIs, with the plans, with the key plan that we wanted to work with, and we were told we can't be reached.

We used a very well-known consultant to help us because at that quarter in 2023, ha, our attention shifted immediately for transition projects to financial operational challenges due to imperative and urgent needed outreach to our members regarding redetermination, MHLA transition, Molina vs. Health Net transitions, health net and transitions. So I'm going through this for a reason. Mid-year there was still no response from the first ECM LOI, and several attempts were made to reach the plan for status, to no avail.

Parties that we were familiar with through contracting did not know who to refer us to and we submitted another LOI to another plan and have received no response. And we are following them up regularly and we use the same consultant for that one, and I don't think it's on the part of the consultant. Finally, a year and a half year later, because of a connection through another party that's already in ECM participation.

We were connected to the director of this first applicant or the first LOI request and confirm that we are finally completing the application, which will take 90 days to find out if we are accepted, minimum of 90 days, to CalAIM ECM program or not. So I have to apologize. Honorable Caroline Menjivar when you came and asked are we involved in ECM? I thought for sure that we would be involved if we're not involved now because we had an LOI since last year. Why did the delay happen?

Even after speaking with several participants and advisors and the plans themselves, there is no clear answer. However, comments around competing priorities.

Finding appropriate staffing and the development of competing priorities all came up. This report does not put blame on anyone, but only highlights the need for when there are multiple change projects, there will be gaps and unintended consequences. If you could start wrapping up, please. Therefore, the proposals from California Primary Care Association for providing consistency throughout the county in terms of application for ECM and financing issues is supported, fully supported, by El Proyecto Del Barrio.

Overall, Senator Menjivar, we are proud of the work that you're doing to push this forward, and we can't wait to be a part of it completely. Thank you for allowing El Proyecto Del Barrio to serve by sharing our experience with you. Thank you so much.

Linda Good Morning.

Linda Wei with Western center on Law and Poverty. Enhanced care management and community supports can be life changing for Medical Members. However, our legal aid advocates report challenges accessing both enhanced care management and community supports. Although the number of people receiving both services has steadily increased, and we're pleased to see that only about 1% of Medi Cal Members have received enhanced care management over the past two years, about 160,000, and it's about 100,000 for community supports.

Clients report difficulty accessing and being assessed for enhanced care management, which differs from community support in that it is a benefit, not a plan option, for any Member who qualifies. In addition, enhanced care management authorization timelines can take longer than the mandated five days. At the same time, there have been some quality of care concerns.

Clients with enhanced care management often are unaware of who their ECM provider is, a sign that the anticipated level of meaningful engagement in this intense and mostly in person service is not consistently happening. Clients also report that their ECM provider are not trained to provide the intended service that is coordinating care among different providers. We appreciate that the Department is seeking to increase standardization for community supports, but our advocate report plans still narrow eligibility criteria or impose additional limits.

For instance, we have clients who request housing deposits but are told that they must first request and receive housing navigation services, and once they've gone through that process, the housing deposits and the housing deposits are approved, the housing unit is often no longer available. We've also heard housing support service providers share that the rates are inadequate in that they don't actually cover the cost of care. In some instances, they've just stopped offering certain services like housing deposits citing reimbursement issues.

Of the data available, there is continuing evidence that limited English proficient and Latinx populations are disproportionately underutilizing both enhanced care management and community supports. Unfortunately, we don't have timely access to disaggregated data on ECM enrollment and providers. Specifically, the most recent data, which we're very pleased to see yesterday, is through September 2023.

And so we would recommend this data be updated more timely and be disaggregated by populations of focus provided demographic information, which we think is a factor in member outreach and utilization, as well as indicator of dual status, that is, individuals who are both eligible for Medical and Medicare. We have no way of determining dual eligible utilization and if their method of enrollment is affecting access, so that additional breakdown would be helpful.

The Department has shared its goal to make all communities supports a statewide Medical Benefit, with housing support services and medically tailored supportive food being the farthest along, requiring the state move forward with seeking federal approval to make these services a benefit. Housing support services in particular, has been shown to improve health outcomes and are particularly important considering the rise in homelessness, especially among those experiencing homelessness with a disability.

And finally, we would recommend the Department articulate some specific, measurable targets to hold plans accountable and publicly report the progress on these targets. And these measures should include providers, specifically trusted community partners who have experience in providing services, as well as the number of unique members receiving enhanced care management and community supports, which the Department has started to do, so thank you.

You're such a pro at this. You've been a panelist so many times. You know, you stick to the timeframe. Department of Finance. Would you like to add anything?

Tyler Ulrey, Department of Finance. We have nothing to add.

Nothing? Okay, great. So let's start. First question. Do we have a response as to why El Proyecto del Barrio hasn't heard back on their application to be providers?

Hi there. Sarah Brooks with the Department of Healthcare Services. So we were frantic, not frantically, but if we were looking into whether or not we could identify what the issue or concern was. And we'll need to follow up on that and we'll follow up with you directly.

I didn't know. You know, we probably know because I.

Thought, I mean, we do need information also from. This is the plan, right? Is the plan. The letter of interest is with the plan, not with the Department. And so we need to understand the communication between the plan, which plans, and the clinic. So it is, you know, we're trying to find out in front of you.

We'll get you information.

Yeah, happy to. Yeah, we're happy to look into it.

What is the. I mean, ideal timeframe? Like, you submit an intention loi, and then what's the timeframe. Maybe the plans answer that, because the LOI goes to the plan.

Sorry. Yes. So the timeline should be within 30 days, I believe, or not, for the LOI. Excuse me? For the LOI, I believe that is 90 days, if I'm not mistaken. Should I?

Yeah, I think that the LOI. The timelines likely vary between health plans. You know, there is a different application process for each health plan, but certainly they need to be reasonable. And so we're happy to follow up with you all with specifics on the timelines, if that would be helpful.

Thank you. Katie, a question for you. Which community supports are harder to provide?

Yeah. So it varies by regional. So it is really dependent on the region. I would say that the housing supports are for some, those are community supports that are easier to provide in some areas, but very, very challenging in others. Sobering centers is another one that has come up as a challenging.

What was that one?

Sobering centers. Yes.

And that's just because of capacity and access issues. So again, it really is dependent on the county and the region that we're talking about.

On the housing challenges in some areas. Is there a common geographic theme to them? Is it harder in rural areas, coastal areas?

Yeah, I would say it's more difficult in rural.

Is it the lack of placement?

That's right, yes.

Okay. And the sobering centers, just lack of existence of them? Okay.

Thank you. And I apologize, I forgot your title.

Yes, ma'am.

Oh, that's okay. Sarah Brooks. I'm the Chief Deputy Director for healthcare programs and fairly new. Thank you.

Okay. One of the earlier questions you answered was regarding the flexibility. Local plan plans cannot remove target populations. They can add, so can the Department. But you're really focused on the nine. I was trying to count. I counted six, so maybe I missed three other ones.

Sure. Let me.

And while you do that, the reason why I'm asking, at least in my district, I've been approached regarding, and I brought briefly, you know, survivors of crime, violent crimes, specifically domestic violence survivors. I could potentially say they could be at risk of homelessness. Right. Because that's the hardest, most difficult time is when you leave, and sometimes you don't leave because you don't have a place to go live. I'm wondering if there's. It sounds like there's flexibility.

What would be the process if we wanted to add another target population? Or are we. And it sounded like we just want to really focus on the populations now and maybe come back to that question later down the line.

Yeah, no, I think. Excellent question. And I will get you, the nine. So I don't have to read through them all again. They're back and forth with you. But we, and just to be clear, we have nine right now we have the authority to add an additional. And when I said that the plans have, the plans can add. Yeah, the plans can additional, add additional.

I think when I was, but anyway, to answer your question, to be clear, so we are really focused right now on our nine populations of focus. I think we want to make sure that CalAIM and community supports, ECM are working in the way that they need to be working. We're tracking and monitoring them closely.

I think recognizing that the population that you're flagging is important and a significantly important population, but that we do touch on that population, as you kind of referenced actually specifically in our populations of focus that we have today. So I think really focusing today on kind of the, the program that we have and that we've implemented to make sure that it's successful. And then as we see the successes that we have, you know, later on down the line, looking to potentially add additional populations of focus.

Okay. Okay. Thank you. I've heard from some FQHCs who are providers. You talked regarding guidelines. You talked about the guidelines that come out. Some concerns from FQHC, see, is that benefits rolled out about two years ago, but the guidelines came out just in February. Of some guidelines came out just in February. Now MCPs are asking for money back because rules weren't followed to the guidelines.

It's kind of like you didn't follow the rules to a guideline that just came out and that their FQHCs are having to now pay back some of the funding that they were given when they had no idea they weren't following a guideline that hadn't come out yet. And I hope I explained that in a way that was digestible. Have you heard this concern?

I have not been made aware of that concern. Certainly it's something that we would want to look into and further explore.

You know, did some guidelines come out just in February?

Well, what I would say is that we are constantly refining our policy guidance that we put out. As I mentioned, our action plan that we put out. We are constantly, as we listen to stakeholders, as we gather additional information, as we monitor, and look at, and oversee the program, we're constantly refining our guidelines and our guidance that we put out to the plans. But it's never our intent to change or cause some sort of recoupment of some sort.

Certainly, we of will follow up on what you're stating and look into it.

Okay, local plans. Do you have anything to say on this? Have you seen any plans? Go back and ask for funding back?

That would be something I'd have to also look into, but happy to do that and bring it back.

I would really like, yeah, I can get a follow up on this, and I'd be more than happy to share some of the FQHCs that have.

That would be great. Very helpful.

We'll send that information to you. And then I just want to bring up what I brought up last time, Director, in the behavior side of this hearing was regarding new benefits coming out and just honing in on that. New benefits coming out. A client goes to a center and so forth and says, hey, I'm eligible for this. Where's my benefit to this? And then the center not being up to speed providing and so forth.

Just want to reiterate that I know we can't always, we want to, you know, get that out there, but try to work as much where we can align what we get out there as a headline, and it's ready to go down on the ground as well. Okay, I'll turn to my colleagues right now, Senator Eggman.

I just had a few questions. Well, one, just a distinction. One of the things that we heard when we were doing cure court and some of our other and Prop one with 326, was the idea that some counties, the smaller counties, wouldn't need as much funding for housing because it wasn't as big an issue. Now, I hear you saying the smaller counties are the ones who are having issues with being able to place people on housing. So if I could understand that discrepancy. Because you think LA County, right, would be a harder place to be able to find enough housing?

Oh, I think housing is a problem across the state. I'm sorry. I'm trying to look at you and talk into the microphone at the same time.

You're on TV, so I can see you.

Okay. Yes. I mean, housing is an issue across the state. So again, I think I can't say that small counties do or do not across the board have issues with housing. But, you know, it just really depends on the county and the availability of housing, obviously. So I'm sorry that I'm not able to provide more of a direct answer, but I appreciate the question and happy to look into it more if we.

Could, just because that's diametrically opposed to what we've heard before or I've heard before anyway. And then the other thing, just if we look at the counties still not providing some of the services. They're the small ones. So what are we doing? There's some of the small ones. What are we doing to help them? Right. Everything's like, it's Butte, Colusa Del Norte, blah, blah, blah. How are we assisting them and being able to build out there?

I will just say as Sarah moves like microphone as part of the path, the infrastructure dollars, we are kind of prioritizing. Some of the rural counties where we see the community supports uptake is not there. The plan hasn't elected to implement that yet. So trying to look at where in the state we know we need to build some of the capacity and use some of the path dollars to build that out.

All right. And we're still looking at counties being able to do some collaborative things together in some of the smaller. Okay. Okay, thank you.

Two things. Also voicing some of the things that I hear from the community. So the plans provide a list of eligible members to call, to enroll and so forth. And there's a lot of difficulty in incorrect contact information on there. What kind of TA is being provided to be able to find the individuals to enroll them? And some cultural things are also coming up with a lot of our minority groups regarding the distrust. Why, this is a scam.

You know, a lot of elder populations like, no, this is a scam. And then also the no, talk to my child, to my children to enroll me in there. I'd like to, one, are they eligible to talk to? Is a provider eligible to talk to a child first to talk about programs or just have to be with the actual beneficiary? And two, what are we doing to update some of these contact lists to actually find the individual?

So with respect to your question about contact information, this is an issue that the Department is focused on at this time. We recognize that it is an area of concern and something that we are committed to working to improve. You know, it's something that the plans and the Department have been partnering on. We have our, we have a, oh, I'm trying to remember the name of the initiative. I apologize. It's slipping my head.

But we have an initiative at the Department that's focused on this issue, and it's really focused on looking at where are the opportunities for us to kind of look to improve contact information. As you know, our population sometimes moves and changes addresses and phone numbers frequently. And so we want to make sure that we have the most up to date information as is possible so that we're focused on that is what I wanted to say. And Michelle may want to add to that.

I would also just add as part of the redetermination process, before that process started, we made a very focused effort in terms of the first messaging was update your contact information, make sure the county your application. That is correct, because we wanted to get the redetermination packets to the individuals. And so it's been kind of a focus, an intense focus, actually, over the last 14 months or so.

And then as part of our population health management service, you know, ultimately having the ability for a member to update their own information, I mean, that's the ultimate goal. So it's kind of the opportunity just to do that live, and that gets kind of spread throughout kind of all the systems to take that into account. But it is something that we are really focusing on.

And then just with regard to, I think, in terms of just understanding of what the benefits are out there, we have a medi Cal Member advisory group. And one of the things that really trying to get their kind of take on how do we better communicate some of these opportunities and benefits to our members? You know, we talked to them about our community supports, and many of them had not heard of those benefits and that they had access to this.

So we're trying to find all the ways we can to even think creatively of how do we directly engage with our members. Often, you know, the plans do that. We have our direct mailings. But what are the ways we can, in a simple way as well, not like in our technical speak, communicate what's available. And so it is something that's top of mind for us because we want to ensure that our Members have access to these services.

And can only healthcare entities be providers, community supports and.

Oh, no. So all kinds of entities can be providers for. So we have community based organizations. So there are all kinds of any. I mean, the list can go on and on in terms of the types of entities that are considered community based organizations, these are on the ground providers that are offering services to our Members.

And this is actually the, one of the kind of the challenges. Right. Is that they do have to kind of become Medical providers. Right. In terms of understanding the Medical system. And they're not the traditional partners that we've been working with for decades. Right. And so how do we, and that's the intent of some of the path dollars, is to build out their capacity to become, because there are federal rules that have to be followed.

So they do have to kind of have some of the infrastructure needed to participate in Medical.

I'd like to turn back to what Linda mentioned regarding some potentially in some health plans creating additional steps, in relation to the housing benefit where oh have to do this step first, and then you'll get to that one. I don't know if the local plans could speak to other Department.

Sure so my understanding, having reached out to our plans prior to this hearing, is that. So that was the first that I have heard of that. We follow the eligibility that's set by the state, and in some cases, we can maybe there's some flexibility in terms of expanding upon that, but not narrowing. And so I'm happy to look into that, and I'm happy to touch base with Linda if you have a specific example.

Where do we direct these kind of grievances and complaints? Like.

Yeah, Directly to. I mean, the Department wants this information. This is how we can understand kind of the issues and what needs to be considered and addressed.

I was going to say, Linda, we all know each other, but please, yeah, reach out to me, Linda. Step authorization should not be in place and so if there are examples that you have, please reach out and provide them to us so that we can look into them directly.

And is there a max dollar amount for every community service?

That's a great question. So a max dollar amount for every community service. So it would need to be. So what would need to be provided would need to work within our actuarial soundness, which is, I know, a very technical term, but I think what we would need to do is follow up with you on that question, if that's okay specifically.

I'm wondering, like, I feel like this. I mean, the housing assistance, right. Not just the navigation, but like the down payment.

I think that the deposit, I think there may be a dollar amount, but that's the only one. I think in terms of the 14, that would really be specific to a kind of a cap. And we would have to follow up on that.

And then the environmental modifications, what does that entail?

Oh, it might be like for asthma modifications, like if there's mold or you might need to, new air conditioning unit of some sort that might help with air circulation in the home because of the child's.

And it's the least amount of community supports we're seeing utilized. Huh?

At this time, yes.

If I may provide a specific example, and this is from Inland Empire health plan that was shared with me recently. A woman was hit by a car, became paralyzed as part of the home modification community support. They actually went into the home and added different guardrails move the level of the sink, the sink level so that it was appropriate for a wheelchair. But that's kind of what that is envisioned by that type of benefit.

Okay, that's really great. I just feel like there's so many great things in here and not a lot of people know this exist. And I mean, this would solve so many issues. And I know you shared a lot of your things, webinars. What are we doing? I mean, what creative things are we really doing to share this?

Yeah, so, I mean, there are a few examples of plans also working through community health workers as well to help spread the word. So there's a lot of different methods. Working with community based organizations is huge for our plans. And then of course, you know, there's the traditional communications, but we're trying to think outside of the box in terms of how to reach members and let them know about these benefits. And to hear that folks might think that this is a scam is really a concern.

And so finding ways to make sure that they feel that it's authentic and real is something that our plans are really, really focused on and dedicated to doing. And so I think part of it is just time. Part of it is working through our providers and who are already working in the community to really spread the word. And sometimes that might take longer than we like unfortunately.

Senator Eggman, just to add, as somebody who's worked in a lot of treatment programs, the best way to get news out is to have a client have that news and tell everyone else that they have something and somebody else is going to want that same thing. So as much as you can use not just providers but actual recipients and clients, to be able to then go out and spread that word in creative kinds of ways, I think is a good way to go, too.

Yeah, and I appreciate that. And, you know, just in talking with our plans, it was really, there are plenty of examples, success examples, where they have their lives and their health and well being have really been impacted by these benefits. So figuring out ways to lift up those stories is important. I agree.

I think the one thing I would just add is similar to what my colleague earlier said is that uptick is slower. As I talked about my talking points, we saw in health homes, counties and whole person care counties where there was already infrastructure, that we've seen more growth in terms of individuals accessing these services. We'll continue to see more uptick. We've seen the numbers grow. We'll continue to see the numbers grow. We're excited about that.

But I think, yeah, the more that we can get the word out, the better.

Is there any downfall to a provider participating in this? Are there any? Why wouldn't we? Why wouldn't a potential, no right?

I don't think there's any downfall. We welcome all the providers we can.

Opportunity for any of the panelists to speak, share any last final thoughts before we close out. Colleagues, thank you so much. I appreciate you joining us. Proyecto El Barrio. We'll get you an answer. Moving on to issue number five. This is funding transition to state operations for CalAIM, MLTSS and DNSMP integration. Say that 10 times.

Good afternoon, I'm Lori Walker. I'm the chief financial officer for the Department of Health Care Services. The Department is proposing a technical adjustment to transfer $6.6 million $3.3 million General fund from local assistance to state operations with no net General fund impact. The fundings for an existing contract to support a CalAIM stakeholder engagement, project management and technical assistance related to policies for older adults and people with disabilities.

Additionally, these resources continue to assist the Department in the preparation for the 2026 statewide expansion of many Betty plans. Moving the funding to state operations allows the Department to continue to move towards consistent treatment of similar technical assistance contracts. Happy to answer questions.

Department of Finance.

Hi, Isabella Alioto, Department of Finance. I have nothing to add at this time.

Okay.

Karina Hendren LAO. We've reviewed the BCP and have no concerns.

Have you had any chair memorize every single name? I feel like I'm failing with Department of Finance and LAO. No, it's okay. There's a lot of us. Okay, we're gonna hold the item open and move on to issue number six. Managed care capitation payment system support.

Thank you. The department's requesting five permanent positions, an expenditure authority of $926,000 $233,000 General Fund budget year to meet the significant growth in demand of information technology system changes, the increased complexity of invoices for managed care plan services, and higher demands for data and cost transparency.

These resources will operate and support critical applications, including the capitation payment management system we lovingly call Capman and the electronic accounting management interface system we call EMI, the managed care plan Member population substantially to approximately $13.7 million or million people based on our November estimate, resulting in more capitation payments being processed by both Capman and EMI compared to historical trends.

These critical systems process approximately $80 billion in payments, and the payment methodology and calculations in these systems have become more complex due to the growth in managed care and the complexity of the actual payment calculations. The number of system support requests for Capman and EMI increases significantly every year, and denial of these resources could impact the department's ability to correctly process accurate payments to managed care plans, correct historical payment issues and resolve system data errors, impacting the ability to meet federal and state audit requirements and reporting happy to answer any questions.

Do you use this system for MCO payments once?

Yes.

Since this is going to be one of like the first times we're going to be doing this, do we have this will be enough for that capacity.

This capacity is actually helping with a backlog capacity that we have. So we will likely might have future plans for resource needs in the future, but for right now, just these resources are helping to resolve a backlog of issues.

Any further comment, Department of Finance.

Do have a lot of Department of Finance.

Aditya Voleti, nothing further to add at this time. Thank you.

Jason Constanturos, Legislative Analyst Office we have not raised concerns with this proposal. As you can see on page 30 of your agenda, there is a General Fund cost associated with it. Our office has a general recommendation to the Legislature that apply a higher standard this year for any new proposals. As you can see, the cost is just a little over $200,000 annually and the budget problems and the tens of billions of dollars.

So this one proposal doesn't have that big of an impact on the budget problem. I also wanted to note you asked about the MCO tax proposal and how there's also added administrative costs there. There is a separate budget change proposal that is not on the agenda today, but likely will be when you talk about the MCO tax that adds more staffing associated with that. So there is a proposal for additional administrative costs associated with that.

Okay, thank you so much. Thank you. No further questions. We're going to hold the item open and move on to issue number seven. Medical Drug rebate Special Fund Reserve shipped thank you.

The Department proposes to transfer reserve balances in the Medical Drug Rebate Fund of 135.1 million in the current year, 27.6 million in budget year to the General Fund. This transfer is intended to help address the state's General Fund shortfall. Under normal conditions, the vast majority of deposits into the Medical drug rebate Fund are transferred annually into the General Fund. Typically, only a small percentage of the fund remains as a reserve.

The Governor's Budget proposes to instead allow all rebate collections to be transferred to the General Fund. When the budget conditions improve. The Department would propose to allow to go back to having a reserve in the drug rebate Fund.

Any additional comment?

Aditya Voleti, Department of Finance we noticed on the agenda that there was a question on why this was not a loan as opposed to just transferring the fund balance. To answer that question, a General Fund loan out of this Fund doesn't make a lot of structural sense because the Medical drug rebate Fund serves as a pass through to General Fund already. So all of the funds in it would have just gone to the General Fund. Yeah.

We haven't given that. In light of the budget problem, we find this proposal to be reasonable.

Thanks, Jason. So just for my understanding, this always goes to the General Fund, except we leave a little bit in the fund. This time we're just not leaving anything in the Fund and it's not going to impact any programs.

Yes, we typically maintain a small reserve. About 220 million is where we've landed in historic in the past couple of years as a reserve. This we just will not have going forward.

And then this is a Fund that will continue to get.

Continues. Yeah, we continue to collect drug rebates.

Further questions? Holding the item open. Moving on to issue number eight, clinic workforce stabilization pain. This is a TBL.

The Budget Act of 2022 provided 70 million General Fund for workforce stabilization payments to clinics with any unspent funds to be transferred to the Department of Healthcare access and information to be used for workforce purposes. The clinic workforce stabilization payments were provided to more than 56,000 clinic healthcare workforce employees or workers between April and August of 2023. To help assist with the state's General Fund shortfall, the Department proposes via trailer Bill Language to forego the transfer of the 14.9 million in unspent funds.

Department of Finance.

Andrew Hewitt Department of Finance. Nothing further to add.

Jason.

We also found this proposal reasonable in light of the budget problem.

Of course, in light of the budget problem, reasonable. I think. I think the clinics get sometimes bullied by the Administration at times. And I know, you know, given the history of this and the fight that was entailed and them getting a little piece of their pie and then now because we took so long, it's getting clawed back. It's unfortunate, of course, we got to do what we need to do.

But I am, I think this tees up to my, to the conversation and the MCO tax, I just wanted to air those concerns, but.

Foreshadowing.

Foreshadowing. Yeah. Senator.

I'm just, maybe somebody said it and I was asleep. Why was the money unspent given the fact that we have a workforce shortage and we're talking about PA postgraduate workforce training slots, health center residency programs, nurse practitioner, postgraduate workforce training slots. Is there nobody to take them?

So this particular program was for direct payments to clinic workforces, retention payments, kind of what we did with skilled nursing facility and hospital payments, you know, to recognize their contributions during COVID These were direct payments to the workforce and the money that was not used because we did projections in terms of how much was used. And so we used close to 55 million of it.

And so the remaining 14.9 million was not used for these payments because we closed our books on this in November of 2023 after all the reconciliation. And that was the leftover amount. And so proposing to use it in terms of General funds solution instead of to Department of Healthcare access and Information.

So everybody who needed the money got paid, received it.

Yes, for this particular program.

Great. We're gonna hold the item open and move on to our last issue by the Department. Eliminate two week check rate hold buy back. The funniest thing ever. What a loophole, y'all.

Thank you. The Department proposes to eliminate a previously approved two week check rate hold buyback, resulting in General Fund savings of 532.5 million in fiscal year 24-25. As you recall, the 2022 Budget act included funding to buy back an existing two week hold on fee for service Medical payments each June until the following fiscal year. The 2023 budget delayed the buyback until 2024 should the General Fund conditions and prove the Department be willing to revisit this issue at a future time?

Department finance. Any further comment?

Andrew Hewitt, Department of Finance. Nothing further to add.

Thank you, LAO.

Karina Hendren, LAO, given the budget problem, we find the proposed solution is warranted.

Yes, we're going to hold the item open, and that concludes our Department conversations. I would ask if you want stick around, Department, so we can hear these proposals. Issue 10 is on proposals for investment. I have two for presentation. Not, we have. We have one for presentation and one for not for presentation or two for not for presentation. The ones we will would not be hearing today are. But on the agenda is the multi year continuous Medical enrollment for young children, zero to five, as well as the Medical coverage for dental implants

Okay, great. Then you do have three minutes.

But the Committee has noted that these have been received. We will be hearing, however, for presentation Medical outreach and enrollment for older adults project. Whoever is giving that presentation may come up to the well. Yes, I'll be nice today. It's usually three minutes per person. I don't know if both of you are speaking.

I'm just hear to answer.

With this reauthorization, we aim to expand our current 11 counties, Alameda, Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, Santa Clara, Solano, and Napa County, into additional counties encompassing Sacramento, Fresno, San Joaquin, Stanislaus, El Dorado, San Francisco, and Ventura for a total scope of 18 counties. Currently, this program focuses on providing outreach, enrollment, retention, and utilization services for older adults and dual eligible seniors and elderly, disabled, blind, and those in poverty.

In the past year alone, we have connected with 218,000 individuals through outreach at local community events and organized partnerships with the community. We sent over 1.2 million texts and 6.6 million video ads to the elderly. By the end of year one on this project, it has expected that 21,000 people will be enrolled. According to DHCS OMII, there are 102,000 dual-eligible individuals residing within the County of Orange, which is the county that I represent. This translates to 19.7% of Orange County's population.

This does not include the additional older adults that are exclusively eligible for Medi-Cal. In my county, only 45% of the older adult population is eligible for Medicare only, meaning over half of the older adults in my community are living in poverty and are in need of these services. This reauthorization aims to continue our current services and expand them into additional counties, providing cost-effective assistance to over 100,000 vulnerable dual eligibles and older adults, with over 500,000 individuals receiving enrollment, navigation, utilization services, and support.

This expansion is crucial considering the 1.6 million dual eligibles in the state and increasing number of Californians turning 65 daily. Navigating the complex Medi-Cal system, particularly for the elderly, disabled, blind, and those in poverty is challenging. In Los Angeles alone, there are over 165 Medi-Cal and Medicare combinations available. Therefore, the crucial work of assisting the most vulnerable in accessing and utilizing these benefits cannot be overstated.

The budget request seeks an allocation of 10 million annually for four years from the proposed Fiscal Year 24-25 state budget General Fund and aims to draw down an equal match in federal funding totaling 40 million General Fund and 80 million total funds. This significant investment has already been made in establishing the infrastructure for this project. Reinvesting in phase two will allow us to build upon the benefits of the existing project framework and better serve those who are most vulnerable.

Thank you for allowing me to present today. I want to thank Senator Dodd for championing this request.

Thank you so much. Director, have we been funding it? Is this the last year that we're not funding this program anymore? Or maybe you have this answer.

Yes. My name is Mark Diel. I'm with California Coverage and Health Initiatives. I'm the CEO. This has been a two-year funded project, and the funding ends on June 30 of this year, 2024.

Was it intended to only be a two-year program?

The goal was to continue the program, but it wasn't in the DHCS budget. We submitted a budget request, and we were able to get it funded for two years to get us started and see how the program went. It's been much more successful than we originally anticipated, and the reason that we want to add additional counties is because we're having other counties ask us to expand these services to those counties, too.

Okay. Assembly Member.

So would you stop the service to the counties you're already in?

No, no, we just expand to additional counties.

So you have enough funding, right? You would have enough funding to continue doing the work you're doing.

With this request.

Oh, so without this request it would stop everything?

Everything ends June 30 without additional funding.

Why would we set up a program with one-time money? What was the anticipation? What was the game plan? Somebody else was going to fund it?

Well, there is a small amount of funding that comes through any commissionable revenue that's drawn down for the dual eligible special needs and other Medicare Advantage enrollments to continue funding this project. Again, it's not nearly at the level of funding that it takes to staff it and provide the services in the community.

The reason, I mean, I must have been asleep for 12 years. I mean, on the Budget Committee, typically, when we are talking about one-time money, we're not talking about funding a program for core services where the need for the services continues.

This is for outreach and enrollment. Right. So the idea is there was a population out there that wasn't enrolled, and so then you spend the amount of time getting them enrolled, and then you wouldn't need the program anymore.

So. Oh, I see. So we've enrolled everybody that needs to be enrolled in Riverside County and Orange County.

There's a lot more need than funding available. Even with this funding, we're talking about enrolling 107,000 people. We'll probably assist closer to a million people navigating their coverage. But there's 1.6 million dual eligibles in the state right now, and the number's growing. So it's- this serves a fraction of the total population that needs services, but it's a significant amount, and we're serving the most vulnerable residents in each of these communities.

To enroll them. Dual enroll.

Yeah. So helping with the Medi-Cal and Medicare coverage.

And because they currently aren't enrolled to either?

Some people will be enrolled in just Medicare and not know that they should also have Medi-Cal because if they have Medi-Cal, they get additional benefits. They have no out-of-pocket costs.

Correct.

RIght? And it's people that are elderly, blind, disabled, living in poverty. There are also people that miss key opportunities to enroll in Medicare because they have Medi-Cal, and then they end up with lifetime premium penalties because they're missing key milemarkers to get those enrolled. Then, some people, of course, are uninsured. Some people are only insured in one program and just stay that way.

The Department, I don't know if you could share some of the Department's vision on how we're addressing missing a lot of individuals in getting enrolled, what other projects we may have, or programs that exist that are helping address individuals that are not enrolled in Medi-Cal. Is there anything that comes to mind, Director?

We have a lot of outreach.

I would just like just the general outreach and communication, kind of broadly, even just the Navigator Program. Those were also kind of short investments, not ongoing dollars that we included as part of kind of the redetermination process, the undocumented expansion, some kind of one-time big pushes. And I think this was a similar.

Okay.

Just so I'm clear, how much money would it take to continue your program in the existing counties, if there are people yet to be reached? Is it- did you tell me that? And I just.

No, I think they're asking.

There was more counties.

More counties. But it-

Current and additional.

Yeah. How much? Yeah.

So my question, I mean, the whole thing ends, right? So, how much money do you need to continue your effort in the counties you're in for getting an expansion?

If we didn't do an expansion, the same level of funding that we currently have. So 6 million General Fund, 6 million match a year. So, 12 million a year.

Got it. Just want to make sure that's on the record. Sort of an interesting budget year for expansions of anything, but sure. Thank you, Madam Chair.

LAO, would you like to add anything to this?

Karina Hendren, LAO. Just wanted to note, since this proposal was not included in the Governor's Budget, we have not analyzed it, but we are available to assist the committee if any questions arise during its review.

I'm hoping you have something to say. If you came up here, you could have waved away.

Make it good, brother. Make it good.

I see you like that one over there.

Chair, if I may. Andrew Stewart, Department of Finance. For the record, these proposals are not included in the Governor's Budget, but the Administration is aware of these issues. We are continuing to evaluate these proposals and look forward to working with the Legislature on these issues as we move forward throughout the spring process.

Okay. I knew that. Thank you so much. Thank you for presenting.

Thank you.

All right. That concludes all our presentations. Moving on to public comment. You made it. Have a good weekend. You may proceed.

Thank you, Nora Lynn, with Children Now. On issue three, we have been working in coalition with groups to determine our thoughts on the CHDP Transition Plan that was just released last Friday. We are still reviewing the plan and remain concerned about the compressed timeline, specifically that local health jurisdictions have three months to effectively close out CHDP and establish HCPCFC as a standalone program.

Between this plan and other recent guidance issued at the end of March to establish HCPCFC as a standalone program, we respectfully request this committee to allow our groups time to fully review the transition plan and HCPCFC guidance documents and to collect feedback from our members. We would appreciate the opportunity to share our thoughts after we have sufficient time to review and collect this feedback.

And last, under issue 10, under proposals for investment, the multi-year continuous coverage proposal, we wanted to express our support for the coalition proposal. Thank you.

Thank you so much.

Good afternoon. Linda Nguy with Western Center on Law and Poverty. In regards to issue 10, we request timely implementation of both share of cost reform so that seniors and persons with disability are able to access needed Medi-Cal services, as well as multi-year continuous enrollment so that children can keep their needed health coverage at a critical time in their development, which is especially timely in light of the high procedural termination rate. We also support funding, outreach, and enrollment for older adults and dental implants. Thank you.

Thank you, Linda.

Nicole Wordelman, on behalf of the Children's Partnership. Also in support of Item 10, the continuous enrollment in Medi-Cal for children between zero and five. More than half of California's children under the age of five are enrolled in Medi-Cal, and through the 2022 Budget, California was one of the first states to vote to implement Medi-Cal enrollment continuous coverage.

We're waiting for the green light from the Department of Finance to implement the policy, but since then, Oregon, Washington, Massachusetts, New Mexico, North Carolina, New York, Arizona, Hawaii, and Pennsylvania have also adopted the policy. Since the end of the public health emergency, when everyone had continuous coverage between June and January 2024, 284,000 children were dropped from Medi-Cal, largely due to administrative hurdles. Continuous coverage is especially impactful for children of color.

Almost three-fourths of Medi-Cal children are children of color, and Medi-Cal is the primary source of coverage for California, Latinx, and Black children, therefore, can play a pivotal role in advancing equity by ensuring that BIPOC children can have a healthy start, beginning with ensuring their health coverage is stable and continuous. To meet the January 2025 planned start date, this needs to be implemented as soon as possible and funded in this year's budget.

Thank you. Director Baass, I know we talked about this last year. Is funding the only issue with this program? I think, remember, if my memory serves me right, we had to submit a letter, a waiver to trigger it. Yes. Where are we at with this? I guess.

So it will require an 1115 waiver to the Federal Government, and we went through the public comment period just to be ready to do so. But, I mean, it's all contingent on funding available in the budget to pay for it.

Is that the only thing holding us back?

And then we will have to do system changes as well. But the kind of the 1115 waiver process-

We submitted the waiver already?

We're ready to go. We did the public comment period, so we will be ready to go, and that process is-

Because we can submit the waiver without having funding, right? Because then we can figure the funding part. Or does submitting the waiver contingent on having the funding?

Well, generally, I mean, from a federal perspective, they want to know what we will be implementing. But, you know, we could submit. I would have to check with my Medicaid Director in terms of- but we did, like, the waiver process is ready to go. That is not the kind of a barrier in the process.

Because we're supposed to start this next year?

That is- that is what the statute says if the finance provides that there's expenditure authority.

Okay, so what happens if maybe- if we don't have expenditure authority? We are allowed to bypass the statute of the start time of January 2025?

Right. If we don't have dollars to pay for the policy, then we would not be able to implement it.

How are we getting? So there's a loophole for us to get away, to get around. I'm hearing yes.

If we don't have dollars.

It's subject to Appropriations. Got it. So it's not a hard- Got it. Thank you so much. That's a correct term I was looking for.

I didn't mean to answer the director's questions. Kathy Mossberg, on behalf of the First Five Association on this issue, is incredibly supportive. Appreciate the leadership of your Committee, your Subcommittee, and the legislature generally. Yes, that is our concern. We know that the stakeholder process has occurred. We're very concerned about the waiver not going to the feds. You know, we have things coming up in November that we're concerned about how another Administration will look on this. We know other states have done this. We know a number of children, to the point raised by my partners here, that over 270,000 kids have fallen off. We know how important zero to five is, and this is incredibly cost-saving and is a very smart policy. We encourage you to support. Thank you.

Thank you.

Good afternoon, Madam Chair and members. Jolie Onodera with the California State Association of Counties, on behalf of all 58 counties. I am here in support of issue 10, the proposals for investment, the presentation you just heard for continued funding for the Medi-Cal outreach and enrollment for older adults project. Thank you.

Thank you so much.

Madam Chair and Budget Committee members, thank you for the opportunity to speak on the continuation of Medi-Cal for older adults. I want to also thank Senator Dodd for championing this request. I'm Elba Gonzalez-Mares. I'm the Executive Director of Community Health Initiative. Our organization provides services in the areas of Los Angeles, Napa, Solano, and Santa Clara counties. And we are here, we're there to support the elderly, disabled line, and those in poverty. I'm here in that request to consider the recommendation to reinvest in the current program and the expansion of the program for additional counties where there's much additional need.

This provides cost-effective assistance for over 107,000 vulnerable dual eligibles and older adults. This expansion is crucial considering the 1.6 million dual-eligible individuals in the state and the increasing number of Californians turning 65. We appreciate your consideration to build upon the existing project and better serve those who are most vulnerable. Thank you.

Thank you.

Kelly Brooks, on behalf of the County Health Executives Association of California. We have comments on two items. First, we have concerns about the CHDP transition to the healthcare program for children in foster care. The transition plan was released just last Friday. Local programs will need time to digest the plan and may need additional times to successfully transition and stand up a standalone HCPCFC program. We look forward to engaging with the Legislature and Administration to ensure a seamless transition.

Second, regarding CalAIM implementation, we want to highlight that there was no path funding opportunity for the population health management strategy. Specifically, we are requesting that unexpended public health workforce funds be re-appropriated to support the population needs assessment required of public health departments and managed care plans. Local health departments do not have dedicated funds to support this new work with Medi-Cal managed care plans. Thank you, and we look forward to working with the Administration and Legislature.

Thank you.

Hi, good afternoon. Beth Malinowski with SEIU California. Chair and members, want to start by acknowledging DHC's timely administration of the clinic workforce stabilization fund. I have some questions raised about the fund. Just want to acknowledge that we are supportive of the Administration's proposal to utilize the unspent funds to address general fund shortfalls. Moving on to issue four, I just appreciate the dedicated time today on CalAIM.

Did want to acknowledge the ongoing dialogue between DHCS, county behavioral health programs, and community-based behavioral health providers regarding CalAIM Behavioral Health Payment Reform. There were some challenges around the rate setting. There are some immediate solutions that have come forward, interim solutions that have been put in place. We appreciate that and look forward to working with the Department on kind of longer-term solutions in that area.

Lastly, do want to just second acknowledge the comments made by my colleagues at Children Now and CHIAC with regards to the CHDP transition. As acknowledged, we are actively reviewing the transition plan that just came out. When this was set in motion in FY 21-22, we always hoped that it would come back to this body before the transition plan moved forward in July 1 and just welcome additional space and time to dialogue on any concerns we have regarding that transition plan and continuing dialogue with the Administration as well on that. So thank you.

Thank you.

Good afternoon, Madam Chair and Members. I'm sorry. Jessica Moran of the California Dental Association here to give comment on issue number 10. It was not up for presentation, but the Medi-Cal expansion for adult implants. Just wanted to make comment that we applaud the sponsors for bringing this issue up and their focus on improving the Medi-Cal dental program, but without additional budgetary investments to make sure that the reimbursement rate is adequate, we do have concerns about what an expansion would look like without ensuring proper access to care.

Additionally, we'd like to urge the Subcommittee to explore other important and currently lacking benefits that could be addressed before we expand to implants. There are still basic preventive and treatments that could be better served to Medi-Cal adults before they to help them maintain their existing teeth before needing to get to the point of an implant. So looking forward to working with the Subcommittee on this issue.

Do you know- I'm trying to find a price tag for this. I don't know if anyone in your group has-

We do not have a price tag. I don't know if DHCS has a price tag available. No

Okay. No. No worries. Thank you.

Okay. Thank you.

Good afternoon, Chair and Members. Katie Layton, on behalf of the Children's Specialty Care Coalition. I just wanted to echo some of the comments that were already made on the zero to five continuous coverage proposal and just express our support, strong support for that as well, so that young children can have access to stable coverage without the worry of interruption throughout these critical developmental years. Also on Medi-Cal enrollment, we're concerned about the high volume of procedural disenrollments that have taken place since redeterminations resumed last year.

This has affected thousands of children, including a drop in enrollment for the California Children's Services program. So we just would urge the state to do everything possible to ensure that those who are eligible for Medi-Cal and CCS maintain their coverage. Lastly, just want to thank you for the conversation today and your continued attention to the hearing aid program as well as enhanced care management.

We know that the building out of the network of pediatric providers for ECM has been challenging, but we thank the Department for their ongoing attention to this issue and just encourage continued problem-solving on how to streamline the process for those that may be interested in providing ECM services to children and youth. Thank you.

Thank you.

Hello, Madam Chair. Hello, Senator Roth. Christina Boss Hamilton here on behalf of the Association for Adult Day Services. And I've come several times to other hearings talking about the issues with CBAS, community-based adult services, how the industry is barely staying afloat due to artificially low reimbursement rates.

And we have provided to the Committee a proposal to basically create a minimum floor of what HMO reimbursement rates to CBAS can be, because right now we have four plans that never restored the 10% rate cut from back during the Great Recession. So an already low reimbursement rate of $76 a day. Some plans, I'm sorry, some CBAS centers are getting $68 a day so that it's even less for them to be able to provide these services.

So we just are looking for, like a floor, you cannot pay less than the Medi-Cal fee for service rate just to bring some stability to this very industry in crisis. And thank you for visiting a facility.

Last week.

In your district. Yeah, absolutely. They were so happy to see you.

We'll be talking more about this topic during our April 18 meeting.

Perfect. Thank you so much.

Okay. I'm the last one, so I'll keep it short and sweet. Madam Chair and esteemed Members of the Committee, my name is Alexis Heaton, and I am with California Coverage and Health Initiatives on behalf of the Medi-Cal for Older Adults Coalition, representing the coalition, and our request for reauthorization. We thank you for your time and your consideration.

Thank you. Record. I'll put a plaque back here. You know? Try to break my record. Well, no, I see no other public comment. Thank you so much for joining us today. That concludes Budget Subcommittee Number Three on Health and Human Services.