Assembly Budget Subcommittee No. 2 on Human Services

Good afternoon and welcome. This is the Assembly Budget Subcommitee two on human services. Today we will be discussing issues and programs related to the needs of our older, vulnerable adults in California, focusing on programs administered by the California Department of Aging and the Department of Social Services. Before we invite our first panel to begin, I'll just make a few introductory comments.

Today we will be talking about some proposals that were included in the January Governor's Budget, where we are still waiting for information and analysis of the impacts of those proposed cuts. We first saw these proposals on January 10, and today is April 17. I just want to make sure that we are all clear that if we are missing information about real impacts to real people, we will be in opposition to those cuts.

We need complete information at the time that these proposals are made so that we can make the best and most informed decisions necessary. In today's hearing, we will be talking about our sacred responsibility to our elders. We will hear about how seniors are faring in our California economy and the senior homelessness crisis that is very concerning. These pressures and costs, of course, intersect with the basic income support that the government provides to economically vulnerable, aged, blind and disabled residents in our state.

We know more about disparities, social determinants of health, and end stage poverty than ever before. Therefore, our population, as our population ages and becomes our majority, we need to re engineer our state systems to provide more protection and support to the elders amongst us who need our help. Additionally, one of the biggest challenges in our state is ensuring we can pay essential workers adequate for their work, providing support for our seniors, especially the workers providing care through the IHSS program.

So, as I close, I will pose a vital question. What are we trying to concretely accomplish in the next few years with the master plan of aging? We have a wonderful plan. However, we are lacking enough milestones to ensure that we continue to move forward to meet the needs of today and into the future. I look forward to discussions today on this wide array of critical subjects.

But one thing is clear, if we do not make aggressive progress, this will be the next crisis in the future and we will be at fault for that crisis. We must prevent this crisis from happening because our seniors provided a better world for us today. It's now our time to pay it back. So with that, I also want to make sure that everyone knows that we are going to be starting our panel.

After all of our panels are are done, we will take public comment after those panels. Each person providing public comment will have two minutes each to make their remarks. There will not be any votes happening today. So with that, I'm going to ask our first panel to come forward to take their seats at the witness table. We ask that they please introduce themselves before you speak. And let's try to go in the order listed in the agenda. Our first issue is senior poverty, homelessness, and hunger.

OH. The first one up will be Doctor Margot Kushel. Margot Kushel, who will be with us via Zoom. And then after that, we will go on to our Director of State Income Security, Justice and Aging, Doctor Kushel. Are you in?

I'm here. Can you hear me?

We can hear you.

Wonderful.

You may begin when you're ready.

Sure. Good afternoon, chair Jackson and Members of the Assembly Budget Committee. And thank you for letting me come in virtually today. My name is Doctor Martin Krushel, and I'm a Professor of medicine at the University of California, San Francisco, where I direct the Center for Vulnerable Populations and the UCSF Benioff Home Homelessness and Housing Initiative. I'm a practicing physician and an NIH funded researcher with substantial experience researching homelessness. Today, I want to discuss the state's older adult homeless population, their needs.

Just a minute here. Can we turn the volume up? Sorry, Doctor, it's been a while since we did some zooms. We gotta recalibrate our technology here. Did we turn up the volume?

How's that sound?

Louder.

Can you hear me now?

No, it's on our side. We're trying to figure this out.

Okay. Sorry about this.

All right, why don't you give it a try?

Great. Well, thank you for inviting me here today to discuss the state's older adult homeless population, their needs, and evidence based solutions to support older adults. On a given night. In 2023, more than 181,000 people experienced homelessness in California. While we have 12% of the US population, here in California, we have 28% of the homeless population and half of the unsheltered population. One of the fastest growing groups of people experiencing homelessness are those aged 50 and older.

In the early 1990s, about 11% were 50 and older. And in our recent representative study, the California statewide study of people experiencing homelessness that our team conducted, 48% of single homeless adults are 50 and older. In our state. We anticipate that the proportion of homeless adults aged 65 and older will triple between 2017 and 2030. Homelessness and older adults disproportionately impacts black elders. 31% of older homeless adults in our state identify as black, compared with 6% of older adults in our state.

Among those 50 and older who experienced homelessness, 41% had never experienced homelessness, not even for a night before they turned 50. Those who had been homeless before the age of 50 and continued homelessness after the age of 50 had had devastating childhoods and lived their lives marked by trauma and struggle. Those who first became homeless after 50 had very different stories. They had lived typical lives and had worked physically demanding Low wage jobs throughout their lives until something disrupted them in late life.

They or their spouse lost their job or became ill, their marriage broke up, or their spouse or partner or their parent died, and suddenly they found themselves homeless. Underlying the crisis of older adult homelessness is the lack of housing that is affordable and available to extremely Low income households. In California, we have only 24 units of housing that's affordable and available for every 100 extremely Low income household, a deficit of a million units. Older renter households are those who are most likely to be cost burdened.

Our team found that the median monthly household income of older adults who became homeless in the six months prior to this episode was $920 a month, not nearly enough for them to maintain their housing. Whether new to homelessness or homeless for a long time, those 50 and older have health status more similar to people in their seventies and eighties in the General population. A quarter of older homeless adults in our research in Oakland had indicators of cognitive impairment.

43% in our study across California noted difficulties with one or more activities of daily living, and a third reported mobility problems. Over half reported fair poor health. These are devastating indicators of poor health. This leads me to say, when talking about homelessness, 50 is a new 75. Once homeless, we have found that older adults have difficulty exiting homelessness, and most go on to enter the category of chronic homelessness.

Our research has found that 80% regain housing within a few years, but half of those return once again to homelessness. The one thing that protects them against returning back to homelessness is having a housing subsidy. Homelessness is devastating to health, and older adults experiencing homelessness have a high risk of mortality, 3.5 times that of the General population. Among homeless adults 50 and over, the median age of death is 64. The status quo is simply not acceptable.

To solve older adult homelessness, we must dramatically increase the supply of deeply affordable housing, and we must focus on prevention, keeping those who are at risk of homelessness from becoming homeless and then preventing those who've recently exited from returning to it. We need to align our systems to meet the needs of the older adult population, including those with cognitive mobility and functional problems.

We must be more flexible in how we use Medicaid, home and community based services to provide personal care support so many of our others rely on, and we have to continue to embrace housing first, a flexible solution that acknowledges that housing is central by providing permanent housing options with tailored, supportive, supportive services, including voluntary behavioral health support, to meet the needs of this aging population. And we should center racial equity in all we do.

The aging of this population presents us with stark choices and we can't be complacent and allow our elders to live and die on our streets. Thank you for having me and I'm happy to answer questions later.

Thank you very much. I appreciate that.

Good afternoon. My name is Trinh Phan and I'm with justice and aging and I would like to share some context on who experiences senior poverty, homelessness and hunger. California is aging and by 2030, a quarter of us will be 65 or older. The older adult population is also becoming more ethnically and racially diverse. By 2030, white, non Hispanic older adults will no longer represent the majority of older adults in the state. 15% of California seniors live in poverty.

To talk about the current State of senior poverty, I want to first bring us back to the devastating cuts made to SSI, SSP grants during during the recession, which dropped over a million SSI older adults and individuals with disabilities into poverty. As the housing crisis deepened and rents escalated, many SSI recipients became homeless and even more had to rely on emergency food assistance as a way of life because grants were insufficient to last the month every month.

This put pressure on providers across the human Services network and on local and state government as people had to rely on expensive public safety, medical and nursing home services that wouldn't be needed if grants covered basic needs. We deeply appreciate the Legislature and administration's commitment to rescinding these cuts. The recent grant increases were desperately needed and are finally bringing the grants back.

However, these increases simply bring the inflation adjusted value of the SSI grants to somewhat above where they were after the cuts in 2009 and 2011. Those cuts dropped the individual grant from 100.5% of the federal poverty level down to 91.5%. Inflation pushed people even deeper into poverty year after year, and then these recent increases brought us up to 94%. The current grant is not far from where SSI individuals were in 2011 after the final cut was made for SSI seniors, the recession is still not over.

We need to continue to boost the grants and ensure that public benefits for older adults are truly adequate. Adequate income helps people to get and stay housed in the face of rising housing costs. Unfortunately, SSI grants are still trailing significantly behind housing costs. The fair market rent for a studio apartment is more than 50% of the individual grant. In every county and in 25 counties, the fair market rent is higher than the entire grant. Rent is unaffordable for California seniors across the board.

About six out of 10 older renter households face unaffordable rents for extremely Low income older renters. Nearly eight out of 10 are rent burdened. The housing affordability crisis is also a primary driver of the alarming increase in older adult homelessness, which Doctor Kushel discussed just now. Older adult homelessness is a preventable tragedy, and we should use the tools we have to prevent it. The pandemic caused even more hardship.

While poverty rates generally decreased during the pandemic, seniors were the only age group where the poverty rate increased. Hunger also remains high, as over one in five households in California are experiencing food insecurity today. Food banks continue to face near record demand, and most are still serving one and a half times more community Members than they were pre pandemic, including many SSI older adults and individuals with disabilities. The pandemic is still not over for Low income seniors.

Poverty, homelessness, and hunger are toxic stresses, and even more so for seniors who disproportionately experience these stressors. This includes people of color, individuals with disabilities, women, immigrants, formerly incarcerated individuals, and LGBTQ individuals who often experience the compounded effects of systemic discrimination across their lifespan. We have solutions that work in the form of income benefits like SSI housing assistance and calfresh and other food assistance that work together to lift seniors out of poverty.

We would oppose any cuts or delays to the human services programs that keep Low income seniors and individuals with disabilities afloat. People are barely making it now, and cutting programs that help seniors obtain housing and food would just increase homelessness and hunger. Keep our program strong so that the most vulnerable Californians have the help they need during hard times. And let's continue building public benefits programs that provide dignity for all. Thank you.

Good afternoon, Mister chair. I'm Susan DeMarois, Director of the California Department of Aging. In response to the questions provided to us, we are closely tracking several trends that warrant attention. First, it is well known you've already heard today that by 2031, in four Californians will be aged 60 or older. One fourth of our state's population will soon be age eligible, age eligible for CDA programs and services. And today's population is larger, older and significantly more diverse than 50 years ago, when our Department was first established.

CDA is proud to have just concluded a statewide survey of 4700 LGBTQ older adults offering important insights into the unique needs of this population. Just one example of the diversity that we are seeing today among our aging programs and what we expect to see in the future. What's lesser known is this the 85 plus population is the fastest growing demographic in our state. With advanced age comes higher rates of disability, cognitive impairment, and medical complexity.

As individuals age, they they are more likely to outlive their savings, deplete their assets, and enter into poverty. The master plan for aging centers our work in equity. While poverty rates have declined for all populations, there's been a slight uptick among older adults of significance. Older adults who are Latino, black, or Asian experience poverty at least triple and nearly quadruple the rate of older adults who are white. Master plan for aging goals 1 and 5 address housing availability and affordability.

With adults 50 plus experiencing alarming rates of first time homelessness, this is a priority focus area for MPA stakeholders. CDA recently convened local, state and federal partners to identify strategies and solutions to prevent and end older adult homelessness. Participants identified three themes. First, prevention. A wide array of services are available, but not always well known, coordinated, or tailored to older adults. This includes advocacy, legal aid, housing navigation and assistance completing applications for benefits.

Second, intervention, calaim, enhanced care management, and community supports are proving to be effective interventions for individuals who are precariously housed. Local models that provide temporary rental assistance, as well as home share programs have been successful in keeping older adults housed. Another key intervention for older adults is the critical transition from institutions back to the community when individuals need timely services and intensive support. Third, permanent supportive housing.

The supply of Low income, affordable and supportive senior housing is steadily increasing thanks to investments made by the Governor and the Legislature, though demand with an aging population continues to outstrip supply. Thank you to justice and aging for reporting on the rent burdens that older adults carry. With rents currently averaging $2,750 a month in California, nearly double, or more than double, the SSI benefit of $1,183 $83 a month.

While CDA does not offer housing programs, I can share that one of our local area agencies on aging reports receiving 70 calls per day about housing options. This is consistent with statewide data. There was a 94% increase in older adults accessing homeless services from 2017 to 2023. We are eager to lead California's aging network through the positive changes brought about by Proposition one and the Mental Health Services act to ensure that older adult housing and behavioral health needs are addressed locally.

Locally, when asked what steps are imperative for the state to take, I would say housing is health and food is medicine. Last year, Cdas aging network provided nearly 22 million home delivered grab and go and congregate meals. We partner with Director Johnson's Department of Social Services to provide targeted outreach to enroll older adults in Calfresh. And we've allocated close to $37 million for local nutrition infrastructure projects such as refrigerated trucks, commercial stoves, food pantries, and walk in freezers.

We are grateful to the Governor and the Legislature and our partners at C four A for securing roughly $127 million for nutrition services as part of the modernization of the Older Californians Act. This helps avoid a nutrition cliff when COVID-19 funds expire later this year. In summary, the master plan for Aging is a whole of government, whole of society approach that calls on all of us to prioritize and stabilize vulnerable older Californians.

Good afternoon, chair and Staff Kim Johnson, California Department of Social Services and we'll also go to the questions in the agenda. And you've heard the growth. We have the great privilege to work in partnership across the State of California in administering some programs that are specifically designed to support and serve this population, including those focused on housing in home care, protection from abuse, nutrition, and licensed care.

So I'll go through both some of the trends that we're seeing in those spaces, as well as what efforts we have underway. You heard from Doctor Kaushal, older adults are now the fastest growing segment of the population of individuals experiencing homelessness, and we are seeing need in our programs that serve this population. Housing and disability advocacy program and home safe.

We are seeing an increased demand together, the Administration and Legislature, increased investments in this space, and we're seeing more counties, as well as tribe, tribes and tribal governments participating and providing these services in their communities. We also echo the and are seeing the increased need for affordable housing that supports this population and especially those with disabilities as well.

And part of our solution that we've worked on together in this space is the community Care expansion program, which seeks to expand the number of beds or units to serve individual individuals receiving SSI and SSP and CAPI, and to preserve existing beds serving that population that also, as you heard Doctor Kushal reference the need for some subsidy that also provides an operating subsidy Reserve for those that are participating as a way to stabilize supports to this population.

From our oversight of key programming specifically targeting older adults and adults with disabilities, we observe the deep and diverse level of needs, again across these populations. For example, as you know, we administered project roomkey during the pandemic, which was specifically, specifically designed to support those experiencing homelessness and also at high risk of severe consequences with COVID-19 our evaluation was just recently released in this space and project room key participants were found to need a higher level of medical care than anticipated.

Others needed support with tasks associated with daily living. We were able to be innovative in that initiative to have some in home supportive service support workers in the hotels and spaces that were being provided. That was also very successful. We also note that grantees of the housing, disability and advocacy program report the need for intensive case management services during participation, including multi year disability application processing for participants exceeding what they anticipated when they began.

We also understand older adults and individuals with disabilities often face unique challenges and can be subject to inequities and service delivery that's been referenced here. So not all homeless services were designed and created. Thinking about the particularly the older adult population and those with disabilities in mind. For instance, shelters that close during the day pose challenges for older adults who need a safe place to rest. There's also more work to do to ensure that shelters are accessible to people with more intensive mobility needs.

Some older adults are also facing that unexpected financial circumstance and need to bridge their fixed income and housing and costs. For those older adults, a connection to a housing voucher or subsidy again can be sufficient. Those with more complex needs programs such as our home safe and housing and disability advocacy program are necessary. These programs not only provide support via a wide range of direct financial assistance, but additionally include case managers to help participants navigate services going forward.

I also would just say, in addition to what you just heard from Director Demars, that the integration of housing, health and social services is where we're seeing the most long lasting impacts in terms of services and supports when they are intentionally designed to be working and integrated together. The in home supportive services chair that you referenced at the top of your remarks, the largest home and community based service program in the country.

IHSS is administered, of course, of the partnership with the Department counties providing domestic and personal care services to children and adults with disabilities and older adults to keep them safely in their own homes and communities and avoid institutionalization. The department's going to speak to IHSS a little bit later this afternoon, but we continue to see a year over year increased need and budget year project caseload to be at 691,000 in IHSS. In adult protective services, we're also seeing growing caseload.

In 2021, AP's served approximately 147,000 cases or opened those that many cases in 22-23 that increased to 188,000. So we again seeing increased need as it relates to food and nutrition, which was also referenced by another panelist. Here we see that increased need for food and nutrition programs. According to the 2022 USDA Economic Research Services report, 9.1% of us households with adults aged 65 and older were food insecure at some time during the year.

That's higher than what we've seen in years prior, and again see the 65 and older process numbers increasing over time. Calfresh is the largest nutrition assistance program in the state and plays a critical role in addressing hunger and food security. I want to say there are good news and bright spots in this space. Calfresh participation among older adults has increase 460% between 2014 and 2022, from 215,000 to 991,000 individuals being served. That's tremendous.

That's largely due to the expansion of Calfresh to serve SSI and SSP recipients and our additional efforts like simplifying application processes, avoiding churn in the program, et cetera. We also are very much looking forward to implement the California Food Assistance program, which is being expanded to serve all who are income eligible, regardless of their immigration status, age 55 and older set to operationalize next year.

So again, it was already said, but I also would just point out as we're continuing to have mitigation strategies and resources available to community, the equity is how we are leading. We are being specific to be able to disaggregate what we're seeing by race and other factors as was referenced, to be able to make sure our processes, our outreach strategies are very targeted intentionally on those we need. Happy to answer questions.

Thank you very much. Department of Finance.

Ty Ulrey Department of Finance we have nothing to add here.

LAO.

Good afternoon Juwan Trotter Legislative Analyst, office so, first, we would note that overall, across the Governor's Budget proposal, there's not any new major proposals for older adult programs. With that being said, as we have heard throughout this panel, many of the aging and older adult issues are cross cutting in nature today.

The agenda will give us an opportunity to discuss some initiatives that are already underway, including the master plan of Aging and the California 2030 initiative, that are beginning to address some of these intersecting issues affecting older adults.

Thank you very much. You know, obviously, we know that this is one of those key opportunities now. That as we start to see some red flags, that we have an opportunity to get ahead of it, and we have an opportunity to begin to know what's coming. And so how do we continue to. Move in the right direction every budget. Year, to continue to make sure that we are first preventing more seniors from becoming homeless but then, number two, getting.

Those who are in crisis mode out. To get them stable. Right. What do you think? First of all, you know, my thoughts is, you know, next year we, it's. My personal goal to make sure we actually have some targeted legislation and budget, budget priorities relating specifically to our seniors to be able to get there. And I believe, Director Johnson, you know, I, when I was chair of my previous, the previous Committee, I did a series of listening sessions as well. And my thought is probably to do some listening sessions specifically on seniors for this year and would love for Department of aging to be a part of those listening sessions as well.

And the idea is that if every year we're not moving forward, then it's one more year that we could have prevented that next crisis from happening. And even though we are in a very tough budget cycle, I can't imagine the amount of cost it's going to take if we allow more seniors to become homeless and the medical and disability issues that have to be covered along.

With not just housing, but all those things. That's quite a hole to try to dig ourselves out of. And so it is my goal to make sure that we're trying to prevent that hole. But I'm glad that as we set this context in terms of the State of our seniors and the various things that they are facing, that through these issues, we can also begin to have some more pointed discussions in regards to, number one, what is that next step we should be making? Right. Great master plan.

What's the priority in that plan this year? And what's that priority in that plan next year? Right. We know SSI, SSP still has not recovered from the great recession in terms of the cuts that we made back then and how do we get there in terms of doing those things? How do we incorporate seniors in our guaranteed income programs and things like that. Right.

To give them more flexible money for them to be able to work with so that if they don't qualify for IHSS, that they have actually more disposable income to be able to, for the services themselves. Right.

I mean, all those whole hosts of things about how do we continue to give agency to our seniors and to create a true safety net for our seniors so that, I mean, we should, we should have a system to make sure that it is very hard for seniors to be homeless in our state. Right. Like it's, and obviously, unfortunately, we don't think them of them enough. When we think about all these other big issues in terms of homelessness and things like that, you know, we start.

To feel good about ourselves. And we were getting people housed and, you know, home key, room key, you. Know, those type of things. And then we start hearing reports about seniors. Right. How were we missing that?

So thank you very all very much for setting the tone for today, and we will move on to issue number two. Issue number two, thank you very much. Justice and aging. Thank you much for participating. Doctor Kushel, thank you so much for your insights as well.

Issue number two, a review of the master plan on aging milestones and near term state priorities for aging programs. You may begin when you're ready.

Good afternoon, Mister chair. My name is Sarah Steenhausen. I serve as Deputy Director of the Department of Aging's division of policy, Research, and Equity. Thank you for the opportunity to highlight the Department of Aging's role with facilitating implementation of the master plan for Aging, which I will refer to as the MPA, as well as our near term goals.

What makes the MPA unique and impactful is its ability to serve as a dynamic living document that drives person centered system change through a whole of government and whole of society.

Approach to planning reflecting on the importance of cross sector planning, the Department of Aging's role is to serve as a conduit across state government, local government stakeholders, and private partners, and facilitating progress across the MPA's five bold goals at the start of the MPA's fourth year, we are proud of our accomplishments, and we also recognize that tremendous work lies ahead to build a home and community care system that works for all Californians undergirded by equity, with a focus on underserved and underrepresented populations.

Achieving meaningful change relies on our collective ability to address four key interrelated elements which are the focus of our MPA efforts underway. These four elements are one, streamlining navigation two, enhancing access to programs and services three, supporting our workforce and four, addressing system financing. I will now speak to our efforts underway in these four areas. First, streamlining navigation. It's often difficult for people to find the information they need to make informed choices regarding their needs as they age.

Without a known place to go for information and support, people are often left without meaningful choices, making it more difficult to find what is needed to help them remain at home and in the community. Earlier this month, California kicked off the state's no wrong door leadership council to develop protocols and tools needed to better streamline access to information and support.

Ultimately, through a no wrong door approach, we hope to establish a web portal, a statewide web portal and call center that provides streamlined access to local, regional, and statewide information. This effort will help simplify how people access the information they need to make informed choices as they age. Second, access to program and services. Even if we better streamline how people navigate services, we need to ensure that everyone can access the services they need when they need them.

However, many who are in need of services cannot access them for a range of reasons, including lack of availability of services or long wait lists. To address this, California has launched the home and community based services, gap analysis and multi year roadmap to understand where there are gaps in services across the state, how this compares with our demographics across all of our counties, and to develop a path forward for statewide access to services. Enhanced access to services also includes addressing the housing crisis impacting older adults.

A key to advancing MPA goals is identifying more housing options and addressing homelessness among older adults. As you heard in the testimony from directors Demoris and Johnson, this issue remains front and center of our MPA efforts. Third, supporting the workforce the MPA elevates the importance of supporting California's direct care workforce, including both the paid direct care workers and California's approximate 5 million unpaid family caregivers, both of whom are the linchpin to our service delivery system.

Over the past two years, the state has made unprecedented investments to meet the growing needs of our direct care workforce through several initiatives that seek to build the workforce pipeline, increase the number of direct care workers needed to care for our growing aging population, and implement training and incentives. We will continue to partner with our Cal, HHS and labor and workforce development agencies agency partners, to advance these initiatives. Fourth, and finally, is addressing system financing.

California confronts many challenges in how to finance long term services and supports Medicare does not pay for the day to day help that people need, and most people end up paying out of pocket for these services, which is cost prohibitive and creates a significant financial and social burden for individuals and families as they age.

In response, the Department of Aging is leading a cross agency $5 million LTSS financing initiative, which will first outline the data focused on the current and projected future needs of the older adult population in California.

Second, consider opportunities to leverage Medicare to pay for specified home and community based services for those who who are ineligible for Medi Cal and three, identify a comprehensive set of sustainable policy solution for these solutions for the Legislature and administration's consideration, that report will be presented to the Legislature in June 2026.

In closing, through the MPA's system change framework, we will continue to work in partnership with the Legislature, the state, local governments and stakeholders to address the needs of today's older adults, people with disabilities and caregivers, and build a system for the future. Thank you.

Good afternoon again. Chair and staff Kim Johnson California Department of Social Services we are proud to be a partner with community and other departments in actualizing, over the last three years, the realization of the master plan on Aging, and the Department of Social Services actually has programs in every single goal area that's outlined in page 11 of your agenda.

We've also been active partners in the ongoing workgroups led by the Department of Aging, including the Disability and Aging Community Living Advisory Committee and the Elder and Disability Justice Coordinating Council, in addition to our work with the California Interagency Council on Homelessness. And I want to just tell you right, we have plans and actions and steps and master plan on aging.

We also have them in the Interagency Council on Homelessness, and we have them in what we reference as the DACLAC, the disability and aging community living advisory. So these are opportunities where we are being intentional about integrating, again these components and leveraging each other in terms of the composition of any particular group and their subject matter expertise.

So I'm just going to highlight, given that we have area work in each of the areas and give you an example in each of the goal areas, goal one, housing. And we've been talking about that and certainly in the first panel. Again, I'll just reference the Community care expansion program, $860 million investment to expand and preserve approximately 7000 beds or units to serve Low income older adults and people with disabilities on SSI, SSP and CAPI.

And again, you're gonna hear a little bit more about our latest work and implementing that later in your panels this afternoon. Goal two, health reimagined within the community care licensing Division of Social Services, the Department has undertaken a multi year effort to update our regulations for providing dementia care in licensed residential care facilities for the elderly, or rcfes, in collaboration with, again, our interested partners and provider organizations.

Those regulations are currently in the formal rulemaking process and will be promulgated later this year, and the updated regulations really help ensure that all of the licensed settings are meeting the needs of residents with dementia. Goal three, equity and inclusion, not isolation. Goal three encompasses a number of initiatives, including those focused on elder justice. As of January 1 of 2022, we changed the definition of elder, decreasing the age from 65 to 60 in our adult Protective services program.

The expansion has obviously increased the number then vulnerable individuals served in that program, and in order to meet the needs of that expanded population, we've also been providing training to all social workers working on AP's for decisional interviewing for decisional abilities, essentially a tool that allows the social worker to assess the client's ability to appreciate the benefits and potential consequences of any decision that they're making.

So we've 143 have completed the training, with more than 500 social workers having expressed interest and participating in coming months in goal four for workforce in October of 2022, we implemented the Career Pathways program. You're also going to hear about this later on your agenda this afternoon.

This is a new statewide training program for in home supportive services workers and WPCs workers that's meant to increase the quality of care, assist with recruiting and retaining providers, and provide opportunities for those who would like to advance their career through training. Very well received. As of March of this year, the program has held more than 12,000 classes attended by more than 18,000 providers. And again, you're going to hear more about that shortly. And then finally, in goal five, affording aging.

There's been a continued investment in the SSP grant amounts that you heard in the previous panel, with an increase in January of 2023 of $150 million, resulting in a 10.3% increase, as well as an increase in January of this year of $146 million, resulting in a 9.2% increase. To further support older adults on SSISSP in 2019, again, the Calfresh Calfresh was expanded to SSI recipients and are eligible, and we're doing additional outreach to reach that population.

As of January of this year, the average Calfresh benefit amount for an SSI SSP household is dollar 133 a month. It's additional support going into the family.

Over the coming two years, we will continue to focus on successful implementation of all of the significant one time and ongoing funding for initiatives I just described, as well as continue to support and strengthen our backup provider system for IHSS, the housing and disability and advocacy program, and home safe, as well as, again, as I referenced, the expansion of the California Food Assistance program. We'll also have implemented a new licensing category for medical foster homes for veterans.

That's a new initiative that we also have going forward. So I just wanna say that again, all of our work is led and informed by community. So we're also looking forward to participating with the California Department of Aging later this year to look at from hear from community on where we're focusing going forward. In addition to what I've outlined here this afternoon. Thank you.

Good afternoon, Mister chair and staff. Yasmin Peled, on behalf of Justice in Aging, we were a Member of the MPA stakeholder Advisory Committee during the creation of the plan, and several justice and aging staff sit on the implementation committees. We appreciate the ongoing commitment from the Legislature and the Administration to implementing the MPA, and since the plan was released, we have seen progress and investments in the systems and services that older adults and people with disabilities rely on.

However, now, with the state facing significant budget deficits and being almost halfway through implementation of the MPA, we're at a really critical juncture. In no uncertain terms, we cannot accept any cuts to programs and services for older adults and people with disabilities. As you've heard from the panel before me, the State of older adult poverty, homelessness and hunger is in a really dire situation. Any cuts to these programs is a direct affront to the goals of the MPA and the progress that's been made thus far.

So to answer the question that I was asked, where are we going from here? We urge the Legislature and the Administration to focus on two of the largest issues facing older adults. First is significantly investing in a home care system, and the second is preventing and ending older adult homelessness. Doctor Kushel told you all the facts about older adult homelessness, so I don't have to repeat everything she said.

But I think one fact bears repeating, and Director Johnson also repeated it, that older adults are the fastest growing population of people experiencing homelessness in the state. This is a travesty. And just look at our history. We sent 1 million older adults and people with disabilities into poverty in the last recession. That's deplorable. We cannot be in a situation where that happens again. We cannot be surprised by where we find ourselves now, when those were the cuts that were made in 2009 and 2011.

It's a direction reflection on the policy choices that this state made, and we have to do everything that we can to reverse that. One proven method to prevent homelessness is to provide rent subsidies. This is why justice and aging and our partners have been advocating for a targeted rental assistance program for older adults and people with disabilities who are most at risk of experiencing homelessness.

Despite the budget surplus of the last few years and this clear trend in older adult homelessness, there have been very few targeted investments in preventing and ending older adult homelessness. You'll hear later in the hearing about two programs that actually are targeted to older adults, which is homesafe and HDAP, which the Director has already mentioned. However, the governor's January budget proposes to delay these funds. This is misguided, and we think this will set back these limited but successful programs.

The other crisis the state is experiencing, which will only worsen as our state ages, is that we do not have an accessible, affordable, or comprehensive long term care system. The majority of older adults and people with disabilities want to live at home and in the community, but too many people do not have access to or cannot afford the home and community based care that they want.

We realize that the funding is not available in the current budget year, and the reality is that it won't be available in the next budget year or the budget year after that. If we are not working right now to create a plan that generates revenue in the future to Fund a home care system that really works for all Californians.

Home care and home care financing needs to become a focus of the MPA and for the Legislature and the Administration if we're going to get where we need to be by 2030. We certainly recognize that the budget deficit of this year, and potentially future years, are a major challenge in making the investments that we need. However, we are up against the clock. The demographics of the state are rapidly changing and we need to aggressively invest in the systems that will support older and disabled adults.

Many of the MPA investments were one time state funds or federal funds, and so we must ensure that future investments are ongoing and sustainable for the state in the long term. We started the hearing going down memory lane of the catastrophic cuts in 2009 and 2011. Let's leave that part of history in the past and use the MPA to ensure that California is a state that we can all age well in. Thank you for this opportunity and happy to answer questions at the appropriate time.

Thank you very much. Department of Finance

Tyler Ulrey Department of Finance. Nothing to add.

Lao

Juwan Trotter Legislative. Analyst office we have nothing more to add at this time.

My questions are centered around, particularly when we think about the master plan for aging and even with the programs that DSS provides. What should we hope to accomplish this year on behalf of seniors?

Thank you, Mister chair. That's a wonderful question. I would say that generally speaking, looking at the initiatives that we have underway, we are trying to advance all of those initiatives so that we can bring them to fruition, and that a lot of our efforts right now, they're focused on either delivering in programs and services, analyzing what needs to be done to prepare for the future and three, communicating with the public and policymakers about what is needed.

For example, when we talk about the importance of addressing our long term care system financing, that is critical, as Yasmin noted. And it does take the thoughtful analysis of what the data trends are now and into the future so that we can thoughtfully prepare and outline a comprehensive set of policy solutions. So that is one particular effort that we are focusing very, very much attention on. Second, we are working towards the establishment of this statewide home and community based services.

Gap analysis and roadmap the important part of this gap analysis is the roadmap forward. So I think something, it's very understandable that there's a desire to see the outcomes right now, but what we can't do is throw money at a broken system. So we're trying to figure out what exactly needs to be done to fix the system, and then we have the arguments for how to Fund it. Targeted investments that are needed to shore up the problems with our system.

So those are a few of the examples. I'm happy to provide more specifics across the five gold bold goal areas, if you'd like.

And then chair for the Department of Social Services, as you've heard me say, increase food access. Right. I gave you the number over a longer time horizon, but we are still doing additional work on simplifying applications and access to Calfresh, for example. So seeing increased utilization of Calfresh would be very specifically what I would expect to see. Also, obviously increased access to housing supports through the various housing programs that we provide.

And again, in partnership, in collaboration with the safety net connection, the case management and connection to other services, also the stability of the IHSS workforce and upskilling. Right. That's the whole point of the career pathways program, is both to do additional kind of competency and skills based work for existing providers, bring more in, and also, again, help people who maybe have been in that field move on into their higher level advanced healthcare space.

But also, I would say in terms of what, not only is then the recipient of IHSS receiving kind of a higher level of support, but also with the backup provider system continuing, we're also going to be able to, if that IHSS provider has a need to not be there at any point in time. We have availability and accessible backup providers in a much better way than we have today. So those are some very specific things that we expect to see this year.

You know, when I think about issues dealing with seniors, we also, it reminds me of the debates we always have and how we're trying to address the mental health crisis. What Department of Aging, what you're outlining is kind of how do we assess and build the infrastructure for the long term. Right. But then at the same time, I'm always, I'm always concerned that we're not doing enough to stabilize the current population.

Now, at the same time, and by the time we're done, and I think you said 2026, you'll actually have a report out June of 2026, a report about recommendations and things that we could be doing.

Yes, for the long term care financing issue, but then for our home and community based services, gap analysis will be out next summer, 2025.

Okay. But then in the meantime, we possibly have a growing number of seniors who are now becoming unstable. Right. So the question becomes, can we do both? And what I'm hearing is what seniors need right now are things like rental assistance to stay in their homes now.

And what I'm also hearing is the ability to find places such as how we've been working on room key for those who have already lost their homes or their place of dwelling, that we have a place for them to go that meets their needs and the whole wrap around, meaning with that comes medical services, possibly disability, accessibility issues and those type of things.

Can we expect, number one, are we, has the Governor already proposed, and maybe this is a question from Department of Finance, I'm not sure is are we proposing anything? Have we already, has the Governor already proposed in the January budget, or do you foresee him proposing anything as we head into the may revise that will help us deal with the issues of housing subsidies and things like that so that we can make sure that we are stabilizing our current population.

Now, I'm glad just very quickly, and you're going to hear about this in just a moment, but the community care expansion program is specifically including an operating subsidy component for those that are residing and living in adult and senior care settings. Right. And our SSI, SSP recipients, too. So it's very, very targeted and specific there. Right. Really acknowledging. We've done quite a bit of research and surveying.

When an adult and senior care setting goes out of business, what were the reasons that caused them to go out of business? Part of that was operating dollars and resources, especially for those serving the SSISSP population. So that was a very intentional ad as a component of community care expansion to address that. It's not universal, but it is certainly meeting the needs of those who participate in that.

And I also just want to underscore the importance of what you just said is we have to focus on the MPA implementation, on meeting the needs of older adults, people with disabilities and caregivers now and into the future. So I appreciate that clarification. We don't have the option of doing one or the other.

So to that extent, we are very proud of the one time or of the investments to date to advance the master plan for aging across the five bold goals, $9.5 billion to ensure that we are supporting older adults, people with disabilities and caregivers. However, we know that a lot more needs to be done, as has been discussed.

So on the issue of rental subsidies, recognize this as a Budget Committee, but there is a policy Bill, SB 37, by Senator Caballero, which is a targeted rental subsidy. And we took amendments to cut it down to be a pilot program in three to five counties. Understanding the budget implications this year and the difficulty of potentially being able to do a statewide program. But that Bill is moving forward this year.

And to speak to CCE, I think we're particularly interested in how CCE can be used to leverage more permanent supportive housing options for older adults and people with disabilities. But I think to your point, people want to stay in their homes. We want to prevent people ending up in homelessness. CCE is great, but it's also about, you know, restoring rcfes, boarding care facilities.

And we don't want sort of older adults who have stable housing but sort of are precariously housed to have to move into a boarding care facility or an RCFE if they could stay in their homes, in their communities with just a couple $100 more in a rental subsidy. So we think it's a both and approach. We need programs like CCE. But I, but rental subsidies are very clearly successful.

There's been some county programs across the state, most notably in San Diego, has a very successful county program in providing rental subsidies to older adults. And so I think when you ask what is something we can do this year concretely, rental subsidies is something that can be concretely done if the state wanted to make that investment.

Are you seeing any red flags when it comes to the Governor's Budget proposal as of January?

I think one of the most alarming delays, cuts, whatever you want to call it, is the home safe and hdap delays, which I know will be discussed later on in the agenda. But I think generally we were pleased that there weren't major cuts like there were in 2009, 2011 to programs that older adults rely on. However, we are really concerned about the May revise. I mean, I won't put it lightly. All the signals coming from everywhere is that there are more cuts coming.

And at some point, older adult programs are going to, you know, are going to be in the discussion. You know, like I said, like I said, like my colleagues said before me, we're just coming out of the recession. Older adult. There are some older adults programs that haven't been fully restored since the recessions. The caregiver resource centers have not been fully restored since the cuts that they received in the last recession.

And so those are really important programs that provide, you know, support to unpaid family caregivers that are doing the real difficult work of taking care of their loved ones. And so if I think about all of the cuts that could be coming. It makes, it keeps me up at night.

You and me both, if I may. oh, sure.

Ty Ulrey, Department of Finance just wanted to reiterate that investments in older Californians and housing for older Californians is absolutely Administration priority, as evidenced in master plan for aging. One other specific program I wanted to throw out there, Director Demoris mentioned enhanced care management and community supports, some programming that is through the Medi Cal program. So for older adults in the Medi Cal program, one of those specific community supports is transitional rent and support with rent that can go for those populations. And that's something that's maintained in the Governor's budget.

I would have my specific ask of the Administration through the Department of Finance is just to making sure that as we he thinks about the may revise that we began to I think I'm hearing loud and clear the idea of making sure that there's ample amount of type of rental assistance or subsidies to be able to keep seniors in their homes currently.

Now, I think seems to be something that we need to just make sure that as we go through this budget process, that we're also just making sure that we're not, that we're fully addressing that the best that we can, of course. But I want to make sure that that is one of the cornerstones of what we're trying to accomplish this year in the budget when it comes to our seniors.

When we think about the master plan, and of course you're going to Department of Aging, you are in an interesting timeline because, of course, as we have the next two years of this Administration, how do we ensure that, number one, that we start to get as detailed as possible in terms of milestones, things we're trying to accomplish? Right. What is our measure of success when it comes to the master plan by the end of the next two years?

Any thoughts about how we can be able to really outline that and making sure that we as a Legislature understand where we might need to go. As. Well as what we can say, you know, how we can say if we've been successful or not? Any thoughts about that?

Yes. Thank you, Mister chair. It's an excellent question. And I should say, I would say that a very key component to our work in advancing the master plan for aging is ensuring accountability. So to your point, we have prioritized the development of a data dashboard for aging, which is on our MPA website. And through that effort, we also have a California aging and disability research partnership comprised of representatives of higher education institutions, the state, as well as philanthropic partners.

That group or that partnership, among other efforts has prioritized the development of key outcome measures that can be developed that are person focused, that will help us understand the impact that the master plan for aging is having on key areas of older adult and people with disabilities, including housing and homelessness, psychological well being, as well as our caregiver support.

So we are developing the kind of approach to that framework, and we'll be advancing that so that in two years we can look at the data and see what it says, as well as the data across the data dashboard for aging that has several indicators per goal, which is not population specific, but more just gives us a sense of our progress in reaching the goal. So that's one key element of accountability. Additionally, our stakeholders hold us accountable in the work we do.

Our six stakeholder advisory committees, including the Impact Advisory Committee, which is kind of our oversight advisory body, really calling attention to the areas that they feel are high priorities. And we ask these stakeholders to work on developing their key recommendations, and every two years they present their key priorities, and then we update the plan every two years.

So this fall, we're holding a big convening here at Sacramento where we hear from our stakeholders and they present their recommendations for the next two years of the master plan. So that keeps the plan alive. And all the while, we're trying to ensure accountability as we advance the plan and in our report to the Legislature every year that we submit.

Okay, thank you very much. Really appreciate this panel and this very, very, very important issue. And let's move on to issue number three, and you may begin when you're ready.

Thank you. Thank you, Mister chair. Good afternoon. Mark Beckley, California Department of Aging Chief Deputy Director I'll be answering the questions under this item. The first question is providing an overview of CDA's budget, and I'll note that the agenda does an excellent job of providing an overview of our budget.

So I won't take time to repeat what's already been stated, but I will note that going into the next budget year, we are seeing a significant decline in our budget due to the expiration of American Rescue plan, as well as home and Committee based spending plan funds. These reductions were anticipated and we've been planning for them with our partners and stakeholders. They predominantly Fund one time projects, so we'll be ramping down these programs and then conducting evaluations for on those.

The second question asks for the current status of our long term care ombudsman program and specifically if the program has the resources to meet its needs. The long term care ombudsman has two principle responsibilities the first is to investigate complaints of abuse and neglect in residential care facilities and to conduct quarterly facility visits to maintain a presence in facilities. I first want to start off by really expressing thanks and gratitude for long term care on Busman.

They have very difficult jobs and very important jobs in protecting the rights of older adults and staff in residential facilities, and they just do a tremendous job in terms of resources. When it comes to investigating complaints of abuse and neglect, they do promptly investigate the most significant complaints promptly. In terms of conducting quarterly visits, that has been an area of challenge for the ombudsman.

We are thankful for legislative augmentation in 2019 of $5 million, which allowed the ombudsman to increase its quarterly visits up to visiting 76% of nursing homes and 53% of residential care facilities for the elderly on a quarterly basis. The challenge really comes in that over the past five years, we've also seen a significant decline in long term care ombudsman volunteers during this time period, they lost approximately half of their workforce, or about 357 volunteers.

The ombudsman is launching a statewide volunteer recruitment campaign beginning in July that will continue through September 2025. So we hope that some of these volunteers can either be brought back or we can recruit new volunteers for the program. I'll now move on to item number three, which is an update on our bridge to recovery program.

The Bridge to Recovery program is a $56 million grant program to provide adult day healthcare, adult day and pay centers to resume and stabilize in person center operations post the COVID pandemic and to enhance their infrastructure for infection control. The funds can be used for a variety of purposes, including wage differentials and retention bonuses for staff, staff training and structural improvements for infection control.

To date, we have awarded 296 grants totaling $20 million, and we do plan on issuing a second round of grant applications in May. There were some logistical challenges in initially launching the program and reviewing and approving the grant applications. We've worked to streamline those processes, so hopefully in round two it'll be a much smoother process for applicants. I'll now move on to item number four, which is to provide an update on the HCBS spending plan.

So, to your point previously about what are we doing now to help older adults in the state? These are some examples of programs. Although these are one time programs, these have provided significant benefits to older adults across the state. So the first program I'd like to highlight is our direct care, workforce and training and stipends program, or what we call Cal Grows. This provides training and stipends to support career pathways for non IHSS direct care workers.

The training is provided online and in person at 76 local provider sites. To date, the program has served 6700 caregivers and has provided a cumulative amount of $2.4 million in stipend payments to these workers, with an average stipend payment of $461. Over the course of the program, more than 25,000 classes have been offered and completed. The second program I'd like to highlight is our Cal Compass pilot program.

Cal Compass is a $5 million program at licensed centers to provide dementia capable services in the community and to prevent institutionalization and advance health equity. There are seven partners participating in this program, and through the end of December, the program has served 848 individuals with Alzheimer's and related disorders, providing 62,563 in person and 3913 remote days of service. And they're also working on a resource guide to sustain these types of programs and models going forward.

And then finally, I'd just like to highlight our work on bridging the digital divide for older adults and persons with disabilities. We have two programs, our access to technology and our digital connections programs. The goal of these programs is to provide digital devices, service plans and trainings to older adults to make them technology capable. The Access to Technology program is a $50 million program. We have 42 counties participating in this program.

The Digital Connections Program is a $17 million program and through this program we have distributed 16,000 devices to different home and community based program participants. As the agenda noted, we have had Low spend rates as of the end of September in a number of our initiatives. The reasons for these Low spend rates really predominantly are for setting up new programs, establishing contracts, and for providers to stand up programs locally.

However, since September we have seen expenditures significantly rise as local providers have implemented their programs, and we expect those expenditures to continue to increase throughout the course of the year. I know for the Nutrition infrastructure program that Director Demara said talked about, some of these are really reliant upon securing new equipment, especially things like vehicles which can take a while to acquire. So we are expecting at the end of this year or two for expenditures in that program to increase significantly. So that's a summary of the different questions asked in the agenda and happy to answer any questions.

Thank you very much. Department of Finance.

Isabella Alioto Department of Finance in response to the agenda question directed at Finance, we are tracking the expenditures for HCBS spending for all of the departments that receive these funds, and at this time we do anticipate that the funds will be fully spent by the deadline.

LAO Juwan Trotter, Legislative Analyst, office so, in terms of the HCBS' spending plan, as we know last year, many of the HCBS programs have been slow to start, though as was noted, we have seen some spending begin to pick up in the last couple months. We still have some questions on whether it is possible to expand all of the lotta funds before the close out of all the programs as know in the agenda. The Joint Legislative Budget Committee is working with the Administration on this issue.

However, the Legislature may want to ask about when the next expenditure updates will become available to ensure spending is happening as expected, and to also provide yourself with the flexibility to adjust spending priorities if necessary.

Thank you very much. Does the Administration expect further changes regarding the HCBS funds to come to us at the May revision.

Isabella Alioto, Department of Finance I believe it is anticipated that we should have updated spending at that point. There are projected expenditures for this program on the DHCS website, on their HCBS page for what they anticipate to spend in each of the coming quarters at the point of May revision. I'm not sure what will be verified numbers and which will still be projected. So I can't say for sure that they will change significantly at that point.

But given that with this program, a lot of the funds go out in like larger batches, it's possible that we don't see it change much up until that point. And later in the year we see more of the funds spent.

Thank you for that. On the long term care ombudsman program, are you familiar with the Fund shift proposal that the Association is raising?

We are, yes.

And what are your thoughts about that? And if even on a technical assistance level.

Right. We don't have a position on that particular stakeholder proposal. We do understand the intent of the proposal and you know why it's being proposed, but yeah, at this time we don't have a position.

In regards to the Ombudsman program. From proposal from the Association I would like to ask if LAO can help us to kind of review the proposal to discuss with CDA and the Department of Healthcare Services so that we can come back to the Subcommitee with feedback on if this Fund shift could even work in the first place. Is it feasible?

And also on the HCBs funding for CDA, I'd like to also ask to review this again in the May revision, may revision and any further changes that are offered. Then we will hold this issue open and move on to the next issue. Really appreciate it. Thank you all very much. Issue number four, review of California 2030 report and related state priorities and you may begin when you're ready.

Hello again, Mister Chair Susan DeMarois, Director of the California Department of Aging. I'd like to start by thanking our stakeholders who dedicated all of last year to the first comprehensive review of California's aging network since its inception 50 years ago. We are grateful to have had the resources, through the HCBS spending plan, to retain consultants who facilitated 270 stakeholder interviews, conducted in depth profiles of all 33 area agencies on aging, and oversaw California's first older adult consumer survey that drew 17,000 responses from all 58 counties.

Late last year, our California 2030 stakeholder Committee put forth a series of recommendations contained in a final report released in January. I'll note that advancing the California 2030 recommendations is one of the Health and Human Service Agency's 2024 program priorities. We are very proud of this work as it is person centered, data driven, and equity focused. It serves as a springboard for action as we all prepare the aging network for a future that looks very different from the past.

More is demanded of our network than ever before, calling for new community partnerships and strong collaboration with counties and health plans. This effort positions California to act on the Administration for Community Living ACL. We call it final federal rule, published in February, the first update to the Older Americans Act in 36 years years. California must be in compliance with this rule by October of 2025. By next July, California must submit its state plan on aging to the ACL.

Our four year roadmap for the aging network as you've stated, we have a demographic imperative to act now. Specifically, CDA is moving forward in five areas. One in consultation with stakeholders, we'll develop a suite of core programs currently offered by all area agencies on aging. For example, this may include senior nutrition caregiver supports, information and assistance, and legal services. We want every Californian, no matter where they live, to know what they can expect, at a minimum, from their local aaa.

Two in consultation with stakeholders, we will adopt performance measures to hold us accountable for program outcomes with limited resources. We need to guarantee that services are reaching older adults with the greatest social and economic needs, as required by federal law. Three, in consultation with stakeholders, revisit the process for determining geographic boundaries and designating local agencies. This pertains to a longstanding right of first refusal for local jurisdictions that was recently reaffirmed by our federal oversight agency.

Many local jurisdictions are seeking to integrate health and human services, and for many, that includes integrating older adults and family caregivers into their systems of care. Four.

In consultation with stakeholders, we will re examine the intrastate funding formula to account for population shifts and to factor in contemporary equity measures and five, in consultation with stakeholders, we will launch a statewide engagement strategy to help consumers more easily identify, navigate, and access services in their local area. Thankfully, we have resources through the end of this year to perform the organizational change management needed to map out the work with timelines and deliverables.

We are grateful also to Senator Roth, who has introduced SB 1249, a legislative vehicle that outlines the 2030, the California 2030 recommendations and statute. CDA is providing technical assistance to the Bill, and we anticipate a regulatory update next year to conform with the new federal rule and any changes that may result from the proposed legislation. At this time, there are no budget requests associated with these efforts. California 2030 is consistent with the master plan for aging.

Currently, MPA initiative number 74 requires CDA to perform this work, and prior MPA initiatives set forth similar expectations. Happy to take any questions that you may have.

Thank you very much. Department of Finance

Tyler Ulrey. Department of Finance nothing to add.

Juwan Trotter Legislative Analyst Office so, as noted, there are no proposals related to this initiative. As such, we will continue to monitor the Cal 2030 initiative as it progresses.

My only request from CDA is just to make sure to ensure that we have close communication amongst our Committee staff as well throughout the process, particularly including Lao, about the continued work that is moving forward, and always able to make myself available on a proactive basis in terms of even before you're launching the new initiatives or things like that, that we're able to have conversations and make sure everyone's aware and help to make sure that everyone is brought along in the process.

And so I hope you'll be willing to do that. And also would like to ask, you know, once this crazy legislative session is over, that we're able to sit down and catch up. I think it's been a while since we've been able to do that. Are you open to that? You going on any vacations or anything I need to be made aware of?

Absolutely. Doctor Jackson, we welcome your involvement and we commit to you and to your staff that will keep you well informed of every step along the way. And we'd love to visit with you in your district where you have a model program, a very strong area agency on aging in your area that we'd love to partner with and bring in your constituents as well.

Thank you very much. Really appreciate it. We'll move on to our next item. Thank you so much. Issue number five, and you may begin when you're ready.

Thank you and good afternoon, Mister chair. My name is Nicole Shimosaka. I'm the Deputy Director of Administrative Services at the California Department of Aging. I will present to you today the three budget change proposals as they were introduced in the Governor's Budget. Our first budget change proposal is regarding the Calfresh Healthy Living program.

Within this request, CDA has asked for $2 million in reimbursement authority to support one permanent position, and increased local assistance funding ongoing, which would provide increased monitoring services, program site capacity, increased client counts, and enhanced curricula for the Calfresh Healthy Living program. This program targets Low income adults aged 60 and older.

The source of this funding is from the USDA Food and Nutrition Services section of the federal budget, the Calfresh Healthy Living program provides older adults with education and training about healthy living and good nutrition and how to make healthy food choices on a limited budget. 20 area agencies on aging participate in the program, providing services to residents in 37 counties. CDA will provide the increased funding to our AAA partners with a goal of increasing the number of people participating in the program by 5%.

The AAA's will also leverage this funding to increase services to diverse and underserved populations in the state, including communities of color, immigrant communities, LGBTQ communities, tribal organizations, and veterans. The additional position requested will provide additional monitoring and technical assistance to the participating AAA's. Currently, the program is budgeted at $6.1 million and serves 130,000 unduplicated clients. The second budget change proposal that we have is regarding our health insurance counseling and advocacy program.

CDA oversees this program, also known as HICAP, which is administered statewide by 26 area agencies on aging. HICAP offers Medicare and related health insurance counseling and education and provides services to approximately 51,000 Medicare beneficiaries annually. The HICAP service delivery model is dependent upon the ability to recruit, retain and train volunteer counselors. Volunteers make up 74% of the overall high cap counselor workforce. Between fiscal years 2017 to 18 and fiscal years 2122 the number of Medicare beneficiaries residing in California increased by approximately 7%.

However, during that same timeframe, in large part due to the operational challenges of the COVID-19 pandemic, the high cap penetration rate decreased by 22%. In addition, the number of active high cap counselors, many of which are older adult volunteers, also decreased 20%. In response to these trends, beginning in July of 21, CDA was provided with two year funding authority from the High Cap special Fund to support the HICAP program. The local funding enables each of the 26 HICaps to have one full time volunteer coordinator position.

This position is vital to the program since high cap volunteers do constitute 74% of the high cap workforce. The volunteer counselors are responsible for recruiting, training, and acting as a resource to the high cap clients. The three requested limited term positions are needed to update and refresh high cap training materials, monitor local programs, and perform program research and analysis to determine customer trends and needs. At this time, we are requesting to extend the limited term high cap positions and local funding for additional year.

Our third and final BCP is regarding the office of the long term Care Patient Representative program. This is a technical budget request to provide sustainability and permanence to the model that we have built for the program.

Given the success of the state patient representative model, CDA proposes redirect funding from local assistance to state operations to continue to support six patient representative positions, one patient representative manager and one analyst that was needed to respond to General inquiries from facilities, support, technical and administrative needs of the office and provide technical support and program oversight of the IT solution that was created called the California Patient Representative Information System. There are currently eight limited term positions in the office.

CDA requests, position authority and technical budget adjustments for these positions. There will be no impact to the local partners because initially, as the program was structured, there were funds created in the local assistance that was intended for local patient representative service contracts. However, after two rounds of requests for applications, there was only two responsive bidders in LA and Orange County. They were both awarded contracts and that will continue.

The remaining balance has been used to Fund these eight state operations position, state operation positions, and we're just asking to move that funding permanently to sustain this model. That is all.

Tyler Ulrey, Department of Finance nothing to add.

Juwan Trotter Legislative Analyst Office we have nothing to add.

We just have one request for LAO to help us take another look at the high cap BCP and help us with drafting some straightforward budget Bill Language that will help us with facilitating oversight over how high cap is operating and the HICAP Fund condition is LAO amenable to helping us with that. And we're also asking Administration if you'll please work with Lao as they are, as they request the various information to help us with that process.

Not a problem. Absolutely.

Okay. Thank you all very much. We'll move on to issue number six. We are jamming, y'all. We are jamming. You might be able to catch an episode or two when you get home if we keep going.

Good afternoon, Chair Jackson. Claire Ramsey, Chief Deputy Director for the Department of Social Services, here to speak about the Social Security income state supplementary payment program called the SSI, SSP program. The agenda does a great job going over highlights of the program, so I'll just flag that the program Governor's Budget has the 2324 adjusted budget for our SSI SSP program at $11.3 billion, which reflects a small decrease of $116.9 million in total funds for the Budget Act of 2023.

And we have a projected budget in 24-25 of $11.5 billion, with a net increase of $112.5 million compared to our budget act of 2023 current spending. We anticipate that the 23-24 caseload will be slightly above 1.1 million recipients and that the 24-25 caseload will be slightly below 1.1 million recipients, and we'll speak to that a little as we answer your questions. Our current SSI rate for an individual is as of January 2023 is $1,133.73 and $1,927.62 for a couple as of January 2024.

Because of our increases that were discussed earlier, we are at $1,182.94 for an individual and $2,022.83 as of January 2024 for a couple. Now we'll move to your questions. We were asked about the current grant levels, as I just read them out, that individuals right now are at 94% of the poverty level, as was mentioned in an earlier panel, and couples are at 119% of the federal poverty level. We also were asked about a comparison to the average rental cost.

We do not actually track information related to fair market rent in California. However, we appreciate the information that was provided in the agenda and have no reason to think that it is inaccurate that in some counties rent is far higher than our SSI grant and that in most counties it is not enough to rent an apartment alone, without other income, or without a roommate. We were asked to discuss the SSI SSP Moe standard.

We did provide the Legislature with our analysis, but it was only earlier this week. So I'm just going to touch a few points that were lifted up in that analysis and as the chair and others have more time to look at it, if we have additional questions, we're happy to talk about that further.

But as I said, we completed our analysis on the technical and administrative impacts required to pivot from the Social Security SSP supplementary payment level method, which is the current method we use to the total expenditures method. The analysis was sent to the Assembly on Monday, April 15 to summarize what was included. California can change its SSP payment standard.

To make this change, the state must comply with all SSA requirements, including notifying the Social Security Administration at least six months in advance, and it must align with a federal benefit increase. Since this typically happens on January 1 of every year, California would likely have to notify SSA no later than June 30 of the year preceding the change. Want to clarify that this change, either leaving it the same or changing it, does not impact a recipient's grant amount.

Those will continue as they were discussed, but it may impact the state General Fund. So just flagging that the total expenditures method requires us to keep the amount total that we spend on SSP consistent from the previous year, even as caseloads decrease. And if they do decrease, we're next asked actually about that exact point whether or not and why SSI SSP caseloads are declining slightly and whether there were issues related to applications or retention.

We don't have data on applications and retention because the program is directly administered through SSA and people apply and are determined eligible by the Social Security Administration. However, our caseload does suggest steady and slight decline over time, and we think this is largely due to the asset limit in the SSI program, which has remained at $2,000 for an individual and $3,000 for a couple and has not changed since 1989.

We also do think it's possible that the COVID pandemic where SSA offices were closed for more than two years to the public may have also impacted applications, but we don't have data on that. Final I'll just say that we don't actually have denial rates again because of the Administration through the Social Security and so don't have data to answer your last question in the agenda. Thank you.

Good afternoon. My name is Rebecca Gonzalez and I'm with the Western Center on Law and Poverty and I'm speaking on behalf of the Californians for SSI Coalition. This is a statewide coalition of SSI advocates and over 200 organizations across the aging, disability rights, housing and homeless, anti hunger and anti poverty sectors. We see the suffering that our most vulnerable residents are facing every day, and we seek to ensure they receive adequate support to live their lives in dignity.

We are deeply grateful that the governor's proposed budget did not propose cuts to the grants and that the commitment was kept to maintain the grant increase that took effect on January 12024. Despite recent increases to the grant, the high cost of living in California, inflation and recession error cuts have resulted in the individual grant only being at 94% of the federal poverty level.

Californians, older adults, and people with disabilities on SSI hold jobs, provide caregiving to children and elders, continue to make valuable contributions to society, and have dreams for the future. Living as an older adult or an individual with a disability with Low income is precarious. Making sure you have food that meets your health needs and the equipment and services needed to safely live independently can be costly.

High rents have the deepest impacts on those with the lowest incomes, putting them at higher risk for housing instability and homelessness. As mentioned previously, a recent study by the California Budget and Policy Center points out that the fair market rent for a studio apartment exceeds all exceeds one half of the current individual SSI SSP grant of $1,183 in all counties and is higher than the entire grant in 25 counties.

And this is rent alone, and the analysis does not include other basic needs like food and health care costs to better understand housing affordability for SSI recipients. We support the suggestion for DSS to include this type of analysis of SSI SSP grants compared to fair market rent. As part of their regular work. SSI beneficiaries live in every community and reflect the diversity of our state. As a safety net program, SSI also helps to equalize access for marginalized communities.

SSI is a critical benefit for seniors and people with disabilities who have had less access to employment and other opportunities such as women, especially older women of color, people of color, LGBTQ plus people, and immigrants. I'd like to share a quote from a coalition Member and an SSI recipient. I appreciate the raise we got in SSP, but we are still at 94% of the poverty level. The lack of SSP meant that my recent move was expensive.

I am now in San Benito county and being in a flood impacted county didn't help when Calfresh got lowered after them pandemic expansion stopped. Californians for SSI is here to stay. We are still in need and we want our voices heard. As the state looks toward the future and as our fiscal situation improves, it is imperative that this population has adequate resources for their daily needs.

To get there, we must appropriate a three step increase to bring the SSI SSP grant to 100% of the poverty level over three years. Two, bring back the cost of living increase yearly in order to prevent the grants from eroding over time and three, revive the special Circumstances program, which was a program for SSI, CAPI and IHSS recipients.

This program supported these recipients with emergency expenses, especially those that can result in hunger or homelessness, such as housing repairs, replacing major furniture and appliances, moving expenses, and unmet shelter needs. California's most vulnerable residents struggle to stay housed, buy food and survive. We must remain committed to ensuring that SSI recipients do not struggle with the toxic stress of poverty and have the economic security to live in safe environments.

This will help us meet current needs and continue moving us toward a new, inclusive normal in our public benefits programs that provides dignity for all. Thank you.

Department of Finance.

Idalys Perez Department of Finance nothing further to add.

Juwan Trotter Legislative Analyst Office so first noting that the Governor's Budget includes no new proposals for SSISSB. However, as was mentioned, the Department has recently released a memo outlined the process required to switch from the state's MOE from a current payment level method to the total expenditures method. At this time, we are in the process of reviewing this memo. So we'll provide updates at the May revision.

Thank you very much. Can the Administration talk through the considerations that are in the report per the trailer Bill last year on the SSP MOE?

Yes, we can. Thank you for the question was mentioned. The ability to change the payment method is within our decision making power. We do not have to ask permission to do it. However, the considerations really are whether or not the state wants to take the decision to shift the amount of funding for SSP and take that out of basically their hands on a year to year basis.

Because going to the total expenditures method would mean we are required to stay at the preceding years overall spending amount each next fiscal year. So basically what it does is it removes the option to decrease or increase or, excuse me, I should say decrease the General Fund spending on SSP. And as I mentioned, General Fund spending decreases in SSP do not necessarily equal grant decreases for individuals. Instead, they may be tied more closely to caseload.

And if caseload decreases, General Fund expenditures may decline while still keeping grant amounts at the same rate they are currently. So again, it's just a question of whether the state wants to change its flexibility and how it shifts and how it looks at the total amount it spends in General funds for SSP.

Thank you very much. Obviously, SSI, SSP is critical, and certainly we have to begin to get to the point where we are covering those costs of living. That's one of the particular reasons also why seniors are falling into homelessness and other things. And so it's my hope that we can begin to address that. I'm hopeful that we can see it in the May revise if possible, but at least be able to make sure we have a plan on how to get there. Right?

We've got to get there and we cannot balance our budget based upon, on the backs of our children and our seniors. We that this is our sacred responsibility that we have, particularly with the state. We are not a quality state if we're not taking care of our children and our seniors. And so we have got to make those movements forward to make sure that we can actually be a state we can be proud of once we have a chance to, to fully review the report.

Just want to alert the Administration that we may want to pursue this change in the payment standard. We ask that the LAO is also to help us with a review of the report that was just received. And if we do decide to pursue a change in law, we will circulate language for everyone's consideration as well. From a legislative purview, we would review this language as no cost.

So if the Department of Finance and Administration have a different view, we ask for you to let us know in writing and explain your perspective. In addition, I want to ask for the Administration to consider including a display like what is in the agenda on page 7 and 8 for the DSS estimates binder, which are released at January 10 with the Governor's Budget and at May with the May revision. This was a very helpful, very helpful display that was put together.

And this is the kind of information about how the SSI SSP grants line up against fair market rent in the counties. It's certainly critical for us to have a real understanding for the condition of the grant levels. Basically, we want to make sure we know what we're looking at, how we're looking at it, and how does this really reflect what's happening in the real world. Right.

And so we certainly have a great model, and it's our hope that we will continue to produce those types of models so that we can fully understand the impacts that we are making, both, whether they're good or bad or neutral. It has proven to us to be very helpful. So thank you very much for this. Obviously, more to come as we go into the may revise, and certainly we look forward to hearing from our advocates as well once the may revise comes.

And I certainly know that my door is open to be able to continue to have those discussions. And so we will hold this issue item open and we'll move on to the next issue. Thank you so much. Issue number seven in home supportive services.

And Miss Ramsey may start when you're ready.

Well, there was a change. It's all right. It's all right. My name is Leora Filosena. I am the Deputy Director of the.

So you're not Claire?

No, I'm not Claire, unfortunately.

She's really good, though.

oh, okay.

Yeah.

We had a last minute shift.

Okay, my bad.

No, no worries. No worries at all.

You may start when you're ready, though.

All right. Thank you so much. Good afternoon, chair and Committee Members. My name is Leora Felicina. I'm the Deputy Director of the adult programs division at the California Department of Social Services. Agenda did a great job of giving an overview of IHSS, so I will just kind of jump into the budget aspect in the interest of time. Glad to answer any questions.

So the 24-25 Governor's Budget proposes a total of $22.4 billion in fiscal year 2324 and $24.3 billion 24-25, which is an increase of approximately 1.9 billion. The increase is due to the expansion of the full scope Medi Cal to undocumented adults, the sunset of enhanced federal Medicaid funding and growth, and projected caseload cost per hour and hours per case.

I did wanna make sure I mentioned that there are no budget solutions related to the IHSS program, and I will just go ahead and move on to the next item, which is streamlined eligibility for minor recipients and providing update there. We issued an ACL on December 212023 and the counties had a 60 day implementation timeframe which ended at the end of February 2021.

Our understanding is that the counties have begun working with these impacted cases as they are being reassessed and or at the request of advocates and parents of the recipients. We will know more as changes are made and we are able to see in the data that there are minor cases with no providers who are now receiving services and going on to the next agenda item, I'll just keep on moving.

For AB 102 and the requirement to explore regional and statewide collective bargaining for IHSS providers, we held three initial level setting meetings with the workgroup to provide an introduction to the IHSS program, the county MOE, and the current collective bargaining process. We brought on two consultants to assist with the workgroup. High Road alliance will help us with facility facilitation, and the UC Berkeley Labor center will assist us with research related to the workgroup.

The formal workgroup meetings actually begin this Friday, April 19, and will continue monthly through August as we explore the various topics as laid out in statute and required to be submitted in a report to the Legislature by the Department. The workgroup Members will receive information after each meeting that documents the conversations, the topics covered. At each meeting, workgroup Members will have an opportunity to provide feedback and ensure any conversations, issues or concerns are documented.

These iterative documents will be used by the Department to draft the report to the Legislature with the goal of being transparent with the workgroup with regards to the information that will be included in that report to the Legislature. Nature and so for the next item is an update of the implementation of electronic visit verification.

So, to comply with updated CMS direction, effective July 1, 2023 all non live in IHSS and WPCs providers are required to electronically check in and out for each recipient they work for at the start and end of each workday and have their geolocation captured only if they identify themselves as being in the recipient's home at either one of those times.

It's important to note, too, I want to make sure that providers geolocation is not captured when they identify themselves as being in the community, and that's guidance provided to us from CMS. Currently, the adoption rate we're seeing is between 55 and 60. We continue to focus on compliance through providing training, outreach and notices to non live in providers who identify who are not using the EVV system but should be. There are no penalties for IHSS providers for making errors, for getting or not using the system.

We're really focused on compliance and getting folks to do the requirement, the federal requirement, so that we can do what we need to do with regards to that. We did begin the certification process with CMS in January of 2024. We're still working through that process, but there have been no expressed concerns from CMS with regards to our evv solution thus far. So we feel pretty confident that our compliance and will be certified here pretty soon. I know. Next I will move on to the IHSF backup provider system.

The pressure.

Gosh, and you guys have so many questions, so you know, and they're great questions.

Now you wish Miss Ramsey was here instead of you.

All right, so for the backup provider system, after reviewing the data of the backup system, it seems as though the utilization rate is a little bit lower than we anticipated. So in response, what we did was we issued a survey out to our county and public authority partner to try to determine if there were any possible barriers to access or if there were challenges with the current system. The survey ended at the end of February. We got 31 responses, so that was very good.

Some of the preliminary takeaways were that there were difficulties with finding enough providers to provide backup services due to existing provider availability, distance, language barriers, and occasional recipient refusals. That happens every once in a while.

There was also a request for us to provide some materials that counties can use to inform providers at orientations and things of that nature, to kind of let them know that they have a there's an opportunity there for them, and as well as materials that can be provided, provided to recipients at reassessments. We are working on all of that.

We're still reviewing the survey data, but we will continue to work with our county and public authority partners to shore up the program and figure out how we can get more people utilizing it. So that is a priority for us. And then finally for Medi Cal Redeterminations, we've really made a concerted effort to minimize the impact of Medi Cal Redeterminations on IHSS recipients.

We continue to work with the hcs and our stakeholder partners, counties, everybody, to promote public information, education and outreach to remind IHSS recipients to complete their annual Medi caligibility renewals. And we do this through emails, letters, social media and banners on our electronic services portal, which is used by most recipients to approve timesheets for their providers.

Additionally, we work with our county partners and provide them monthly files, data files that include a list of all recipients who are required to complete that Medi Cal redetermination the following month. So this will allow counties to identify the folks that need personal assistance, and they also have an opportunity to do their own outreach to that population. So far, we're seeing the number of terminated cases for no medical falling far below levels seen prior to the pandemic.

So the monthly average that we've seen is about 232 recipients losing their being terminated for no Medi Cal. The monthly average prior to the pandemic was 1300 individuals per month losing their Medi Cal for not doing the redetermination process. So the activities that we been doing seem to have a lot of benefits.

We feel very positive, but we also are continuing to monitor the data that's the other piece, and work with the HCs or county partners to identify if there's any issues that arise so that we can respond accordingly and minimize any impacts to IHSS recipients. And so that concludes all of my requested updates. I'm happy to answer any questions that you may have.

Eileen Kubanski with the County Welfare Directors Association IHSS is a key strategy in helping older Californians access home based care to live safely in their homes and communities, avoiding costly institutionalization and premature death. The demand for IHSS services continues to grow, as your agenda has so thoroughly noted, both due to the aging of the state's population, but also due to the expansions recently in the Medi Cal program and the elimination of the Medi Cal asset test.

County human services agencies remain committed to stand and serve the needs of this population. Our social workers work with consumers to determine eligibility for IHSS services, to assess their service needs and their hours of service, and perform reassessments. We help consumers navigate the IHSS and Medi Cal systems, we provide case management services, and we generally help ensure the well being of IHSS recipients.

And as you heard, Leora, you know, there's always issues that come up where we're working very closely with our state partners to ensure that we're meeting the unique needs of IHSS consumers during different state situations, the Medi Cal unwinding disasters, and so forth. But sufficient administrative funding is probably our biggest barrier right now for county agencies to retain and build a workforce to process these new applications and reassessments in an accurate, consistent and timely manner and be responsive to client needs.

Unfortunately, the current state budgeting methodology for funding county IHSS Administration has known shortcomings. It doesn't Fund the actual costs of IHSS social workers and it doesn't count all of the required IHSS administrative workload. And these methodological gaps have led to a significant shortfall in state funding. In fact, in 22-23 counties invested $51 million of their own funds to cover the shortfall in state funding.

But as county realignment revenues stagnate, our ability to compensate for the state shortfall with our local investments is going to shrink and disappear, and that's going to exacerbate the following problems. It's going to contribute to higher worker caseloads in many counties, which in turn contributes to counties inability to recruit and retain staff and meet the needs of an increasing elderly and vulnerable population.

Caseloads of 304100 consumers per social worker are not in common in some counties and LA County IHSS workers testified to caseloads of up to 500 cases per worker in the earlier Senate hearing this year. These caseloads levels are unacceptably high. This will hamper counties ability to timely and accurately administer the program and respond to needs of recipients and providers.

As of February 202420 counties were actually already subject to quality assurance action plans for non compliance with timeliness, requirements for application or reassessment processing, or both and our performance is continuing to deteriorate.

We're grateful to Assembly Member McKinner and our staff for championing a budget request that we have for $51 million General Fund on a one time basis to county human services agencies for IHSS Administration in 2425 and trailer Bill Language that would require DSS to work with us county human services agencies and county worker representatives to update the existing IHSS Administration budget methodology periodically and beginning in the 25th, 26th fiscal year.

This trailer Bill Language is consistent with the current statutory approach that's been adopted for updating our other major county administrative allocations, including CalWORKS eligibility funding and Calfresh admin. And we believe that an approach of regularly updating the budget methodology will help keep IHSS admin funding sufficient to ensure that sufficient services, essential services, can continue to be delivered. We thank you for your support of this vital program, and I'm here to answer any questions you might have.

Thank you very much. Department of Finance zero oh, you're up next.

Thank you. Kim Rothschild, the California Association of Public Authorities for IHSS I want to echo all the comments of my colleagues from CWDA as well as cdss. And aside from being the employer of record, the public authority's main core function is to provide a comprehensive provider registry, including the backup registry. And so with that, they connect the caregivers with the consumers. They also investigate the background of potential providers. They enroll and orient the new providers.

They provide skilled training for consumers and providers, and they seek input and guidance from the IHSS advisory committees, which, as we know, this is a consumer driven program. So that's really important. We thank the Governor and the Legislature for supporting our admin funding. But as Eileen mentioned, this is critical because as caseload continues to increase, the staffing needs to keep up with the caseload on both the public authority side as well as the welfare Director side.

PAS work hard, but as I mentioned, with limited staff to find and retain enough providers to meet the demand, especially on the backup program. We just want to ensure that they're staffed and that we're able to support the needs of the Californians that are calling in on these programs. So typically, we've talked about the backup provider program.

The cases that are coming in are urgent and necessary, and it's not uncommon to find PA staff working later into the evening or taking calls on a weekend in order to meet those needs and do what it takes to provide a provider for that consumer need. And so we're hearing that there's 68 hours per case.

The estimated methodologies estimated one to 2 hours so I just wanted to share with you that we wish it was one to 2 hours, but it's taking a significant amount of time and we're working diligently to make sure that that person is not stranded or in a situation where their safety is of concern. So those are some of the things that the public authorities are working hard as mandated with a backup provider program. Additionally, wanted to echo the appreciation.

We know that retention is really important, the care for the providers and the care for not only the consumers, but being able to connect people with the training is really important. So retention with career pathways has been instrumental and so we appreciate that, especially with the dementia population. This is not an area where people know how to recognize the signs or how to care for their loved ones with this particular challenging illness.

So those are areas where we're appreciative and we hope that there's continued support along those paths. IHSS is the most cost effective way to really keep people out of the institutional care settings. We've talked about being homeless, we've talked about all the necessary issues surrounding populations, and so this is such a vital program that we're here just to ask for continued support, not to cut those services and provide the administrative funding for both the welfare Director side and the public authority side.

So we thank you for your time and are here to answer any questions.

Department of Finance.

Idalys Perez Department of Finance nothing further to add.

Juwan Trotter Legislative Analyst officer so while there are no new major proposals for IHSS in the budget, there are a few things. We are continuing to monitor and expect some updates for May revision. Firstly, we are always monitoring the caseload for this program and checking the administration's estimates against the most recent actual claims for the program. And as the agenda notes, we have noted some a decline in the percentage of authorized cases who are submitting timesheets and claiming hours.

We've seen this drop from 91% of authorized cases being claimed pre COVID to about 88% post COVID. Second, we are continuing to monitor the various expansions and updates to Medi Cal which have implications for how many people are eligible for in homes and board of services as shown on the agenda.

These include the repeal of the Medi Cal asset limit, the continued expansion of full scope Medi Cal to undocument individuals regardless of immigration status, and the resumption of the Medi Cal redetermination process which was suspended during the COVID-19 public health emergency. Lastly, we are continuing to monitor the implementation and utilization of the more recent IHSS initiatives, including the permanent backup provider system, the elimination of the minor recipient provider eligibility requirements, and the recent increases to paid sick leave.

Given the significant budget problem, we are looking at these new initiatives and caseload trends through a lens of determining whether or not actual costs are coming in in line with the budgeted expenditure levels. In cases where costs are coming in lower than budgeted. Right. Sizing the budget with actual expenditures could result in budgetary savings. We will continue to monitor the actual data as it becomes available and hope to report back at may revision.

Thank you very much. Obviously, the Legislature is very, and this Committee feels is very important in terms of the statewide bargaining report, is there any issues that may prohibit it from coming to the Legislature on time?

We do not anticipate any. We are working, we will work as hard as we can to get it through everybody it needs to get through so it gets there on time.

Okay, appreciate that. And then also, you know, redetermination is a big problem with many programs, not just this one. What else can we be doing to keep our seniors stable during the redetermination process? Obviously, we have. I do note that we've seen a decrease in terms the, of amount of those who are getting kicked off of their services. However, you said 200.

200, yes, 200.

What else can we be doing to make sure that, number one, are we doing the redetermining process more than we need to? Are we doing it beyond the minimum requirements right now?

So from the IHSS perspective, we really don't have any control over the redetermination process. We're actually a service of Medi Cal, which is kind of where IHSS falls into this and where our recipients are impacted. The counties, we've been working with counties. So we already have a process where if somebody loses their Medi Cal, they automatically go into the IHSS residual program.

So we lose the federal dollars associated to those cases, but they keep their benefits while the counties are able to work with those individuals to get them back on the program. So we do everything we can for them not to lose their benefits from that perspective. And I think that as we've kind of moved along and there are, that's been for us a very, not necessarily a positive, but it has been a proactive approach to keeping people on their benefits.

What's the percentage of those who end up in the residual program that end up getting placed back on Medi Cal?

That's a good question. I would not know that, since it's a medi Cal. That's something that happens on the medi Cal side of the house, not the IHSs side of the house. So what we have is automation. So how we find out somebody loses their medi Cal is we get a notification from DHCs through our payrolling system, the counties, then the social workers are alerted, and then they start to work with those individuals from the IHSS side to help them get back on their.

On their medi Cal. So for us, we kind of get everything, everything happens for us in arrears. We're not really at the front part of that. This is the first time, I think, since we've, since Medi Cal redeterminations have been happening that we actually provide and get a file ahead of time for counties to know who's going to be up for their renewal for the following month. This is a new process for all of us.

I think that we can see that with some proactive approaches that we've been taking with everybody is in partnership, you know, community based organizations, counties, public authorities, ourselves, DHCs. We see that when we make a concerted effort, we actually get great results.

So we went from, you know, and we don't want anybody to lose their benefits, but going from 1300 down to 200 in a program of 750,000 people is not a bad, you know, it's something that I feel very proud of, that we actually work together to make a difference in this process, and it actually worked, and we're seeing those benefits and our recipients are seeing those benefits.

Miss Cubanski, if you can see if you can get some answers to that question as well. I'm not sure what the counties are thinking in terms of those who are getting kicked off of Medi Cal into the backup program. How many of those actually make it back?

Actually make it back? Yeah, we'll see if we've access any of that data through the two systems. Churn is absolutely an issue. Yes. And so the work that the state that we've been doing with the state, in terms of being more proactive and knowing in advance who is up for redetermination does help prevent that churn that we see when folks lose their medi caligibility, for whatever reason, come back onto the program. That's definitely been reduced with these efforts.

Thank you all very much. Look forward to the May revision on these subjects, and we will hold this issue open, and we'll move on to issue number eight, IHSS career pathways.

Good afternoon, Assembly Member Jackson. Claire Ramsey, Chief Deputy Director at the Department of Social Services. Here to speak on IHSS career pathways, and you will get to see a lot of me over the next several panels. So glad you got miss Deputy Director.

First, as you have heard a little bit about in earlier panels, the IHSS Career Pathways program is a program that was stood up under the home and community based services spending plan that helps train IHSS and waiver personal care services wpcs providers to increase the quality of care, to assist with recruiting and retaining providers, and to provide opportunities for career advancements to providers through training.

We have five pathways, a General health and safety pathway, adult education, cognitive impairments and behavioral health, complex physical care needs, and transitioning to in home care and community based living. We were able to bring two vendors on board to provide these trainings and to work with several of our counties. We launched classes in October of 2022 with our county classes available statewide, and then in January 2023 added more classes through those two additional vendors who are Homebridge and the Center for Caregiver Advancement.

We added additional classes in March of 2023 and then in January of 2024, doubled the number of classes again. As of March 312024 more than 18,000 providers have completed at least one training class and our experience is that, excuse me, providers are taking numerous training courses and are benefiting from a variety of classes. We have worked continuously with our training vendors and they have been very receptive to continually increasing classes to meet the demand, which has been very high.

As of the beginning of this year, we have seen a significant increase in claims. From the beginning of January through the middle of February, we have received more than 40,000 claims for both training times and for incentive payments, again seeing an increase with those increased classes. And we do reach out to providers on a regular basis through a number of different methods.

As part of those 18,000 providers over the course of our running the program, we've received more than 440,000 claims for training time, and we have received approximately 19,500 incentive one payments, which are for completing 15 hours of training in any pathway. 2255 incentive two incentives that's for the 15 hours plus one month of work for a recipient, and now 860 of our incentive threes, which are 15 hours plus working for the same recipient for six months.

We anticipate that we will continue to see higher levels of claims now that we have more classes available and now that people are meeting the goals of hitting the marks for incentives and that they will be able to claim them. We did have a question related to the current spending of 41 million out of the full 295 million.

We will be able to provide additional information at May revise, but we are currently monitoring class attendance, training and incentive claims to help us update our projections based on actuals and we should have enough data, as I said by may revise to identify whether there will be remaining funds. However, we are working hard to make sure we expend all funds within this program.

We also want to just note that we are continuing to pay claims and do see a little bit of lag between when people actually take the classes and when they submit their claims because people are not required to immediately take claims, so we may have people continually increasing their claims as we get closer to the end date. I did also want to speak a little bit to that end date and clarify something in the agenda.

First, we did issue an all county letter 2402 to announce and define the parameters of our extension of career pathways that came with the passage of our last budget act. We have executed contracts with training vendors and informed counties and public authorities that we want to extend classes through the end of September 302024. That is, as late as we could run classes and meet our closed down deadline for all spending being completed by December 312024.

But we are allowing people to claim incentives through the end of October of 2024 and then claims are due by November 15 of this year so that we can pay out all claims and have all funds liquidated by December 31 to meet the timeline required by the HCBS spending plan. With that, I'll pause and happy to take any questions about the program.

Good afternoon Mister chair and Members. Tiffany Whiten with SEIU California on behalf of our over 700,000 workers across the state, but in particular over 400,000 long term care workers, the majority of which are IHSS providers. The home care workforce, including the IHSS workforce, consists proportionately of women of color and immigrant workers who have historically been excluded from basic worker protections and been subject to poor job quality. It is a workforce that has been too long unseen and underappreciated.

This underscores the importance of the IHSS Careers Pathways program, a paid and incentivized training program for IHSS and WPCs providers helping to advance racial, gender and linguistic equity by reframing and repositioning the workforce as one to be invested in one to be invested in one to be valued and treated with dignity.

The program aims to provide high quality, accessible training to IHSS and WPCs providers statewide to stabilize the workforce and encourage the recruitment and retention of providers to improve the quality of care of consumers and to provide opportunities for career advancement in home and healthcare.

The CPP aligns with the California Master Plan on Aging's 2324 initiatives, which we heard a little bit about earlier today, to diversify the pipeline of direct care workers by testing and scaling emerging models, to explore opportunities to expand career pathways for direct care workers and to develop an inventory of evidence based training, career ladder, and certification programs that are accessible, person centered, and culturally and linguistically responsive.

The IHSS Career pathways program responds specifically to the industry's lack of opportunities for training and career advancement for IHSS providers. There's no formal career ladders exist within IHSS, and providers seeking career advancement have to look outside of IHSS to other professions and industries. As the program continues to expand to care for more populations in need, we must work to stabilize and uplift the workforce by formalizing training opportunities and building out career pathways within IHSS, which is exactly what the CPP has been working towards.

The benefits of training are far reaching as providers are empowered with knowledge on foundational and specialized skills. Through the CPP, consumers can benefit immensely from an improved care experience. The CPP provides a remarkable and historic amount of funding for training the home care workforce, which in return will enhance the delivery system and provide improved care for the consumers of the program. We implore the state to do everything it can to utilize every dollar allocated to the program and make good on the intent of the program.

I testified last year on the same issue and only 2.7 million of the 297 million was spent. We were told the dollars would definitely be utilized in the initial timeframe by March 2024. The program was not on track to utilize the funding in that timeframe, so we requested an extension, which is the current March 2025 deadline.

But with only 41 million being spent to date and an anticipated 120 million spent overall, it seems like we are again not on track to realize the total funding and thus the true intent of the program.

While we appreciate all that goes into making the program work, signing contracts with the vendors, increasing the amount of classes and processing of claims, stopping this program prematurely because we couldn't use all the funding in the program is given is contradictory to the goals of the master plan on aging and the intent of the program. We'd like to continue to work in partnership with this Committee.

DSS in particular, Director Johnson and her staff have been amazing to work with and definitely have been open to our conversations, DoF and DHCs to ensure that providers are given the opportunity to sharpen their craft, increase their knowledge, and ultimately better serve their consumers. We are committed to exploring the barriers of the program and how we can mitigate them.

We truly believe that the CPP is a valuable resource that should be a formal tool embedded in the IHSS program, not only for this short time, but ongoing. So it is imperative that we get it right and we utilize all the funding provided we have the infrastructure in place, which I would argue is the most challenging with vendors that have been doing an outstanding job and we have providers that are more than willing to engage, not only now, but on an ongoing basis.

So to conclude, I will offer up some possibilities for your consideration. If the state is unable to get an extension on the timeframe, we suggest having classes go until the end of December, which gives an opportunity for more providers to engage and the state to process claims until March 1 deadline of next year.

We would also highly encourage and recommend looking into rolling the remaining funds that are unspent into different parts of the HCBS spending plan in order to free up some General Fund Dollars that we then can use outside of the existing timeframe to continue the program. I understand the sensitive nature we are all existing within due to the budget.

However, this program is already up and running and the benefits not only advance the workforce, but can save lives with providers being trained appropriately and also save the state money. Thank you for the opportunity to speak with you today. And I just made it. I heard it. It was good.

I hope everyone was taking notes. That's how you did it.

Thank you Mister chair. Thank you.

Department of Finance Department of Finance.

Idalys Perez Department of Finance nothing further to add at this time.

Juwan Trotter Legislative Analyst Office start the clock.

Don't worry, don't worry.

I'll come in under. So yeah, no. Similar to our conversations around the ACBS spending plan earlier, this program was slow to ramp up, but has reported increased spending over the past few months. With that being said, like the other ACBS programs, we do have some questions on whether it is possible to expend, although a lot of funds before the close out of the program. To that point, the Legislature may want to consider the updated expenditure figures that will be provided by the Department at May revise.

Okay, thank you very much. DSS, can you, what can we, what can be done to address the issues raised by SEIU on this issue?

Yes, thank you. We really appreciate all the work that. We have done, as Tiffany referenced in partnership together with the unions and with the vendors to really roll the classes out and to get the word out, we'll all agree the demand has really been there for the classes. There are often wait lists for the classes and hence why we doubled classes in January, because we saw that there was such high demand for classes and we wanted to make sure people had an opportunity to take the classes.

We also are trying to make sure people understand what's available. We are communicating, as I said, on a regular basis with our providers so that they know what classes are available, what incentives are available, and to make sure they understand that they can get paid for their time spent in training and that they can get earned toward incentives. We also do think that that has had the desired effect of increasing claims.

As I mentioned, we have seen the highest number of claims come through at the beginning of 2024 and are closely monitoring that and anticipate continuing to see a high rate of claiming as people are now earning their incentives. We also are committed to maximizing the potential for this program and getting every dollar spent.

And so if there are other things that Legislature would like to see us do to ensure that we are understanding the possibilities and working with the unions to continue to get the word out so that people can take as much training as possible, we are happy to also take back any, any information that we've gained today and work with the unions to discuss.

Is it feasible to extend the program to December?

That's something we'd have to take back right now as it's set up. We don't see a pathway to doing that because we have to have all funds expended and liquidated by December 31 of this year. We don't have trailing months beyond that, which is why we have pushed classes to what we think is the furthest that we can do in end of September while still getting all claims paid and all claims submitted.

The larger question of whether or not the HCBs spending plan could have liquidated funds in 2025 is a question beyond our Department and is really a question both for Department of Finance and for DHCs, who is overseeing the entire HCBs space.

Obviously, this is a very rare opportunity to provide this type of funding, not only funding, but also training for professionals. If you're amenable to it, I would like to ask for a meeting to be scheduled by the Administration with the major stakeholders, my office, legislative staff, including Lao, for for the career pathways program, as soon as possible, just to continue to have a thoughtful discussion about the concerns raised and explore possible avenues, especially as we head into the May revise. Are you amenable to that?

Yes. We're happy to work with you to discuss this further.

All right, looking forward to scheduling that meeting. Also, I have sent a budget, a proposal to both DSS and Department of Finance related to IHSS wage increases for Riverside and San Diego, county, who have already reached the 10% participation cap. Are you aware of that proposal that I've submitted?

Yes, I am, Doctor Jackson, and we're evaluating that proposal.

And when do you anticipate giving us feedback on that?

Let me check back with my team, but I believe we're looking to have feedback around the time of the May revision. But let me confirm that with our team.

Okay, I appreciate that. That's all the questions I have on this issue, and we will hold this issue open and we will move on to the next item. Thank you so very much.

Thank you. Claire Ramsey, Department of Social Services Chief Deputy Director, here to speak to you today about two of our housing programs, the Housing Disability Advocacy program, which I'll refer to as HDAP, and our home Safe program. As you heard earlier, these two programs are particularly targeted to serving older adults and people with disabilities. HDAP works to serve people who are apparently eligible for disability benefits, to connect them both with disability benefits and housing supports.

And our home Safe program is connected in with our adult Protective Services program program and serves people who are eligible or likely eligible for AP's or who are in receipt of services consistent with tribal law and custom and who are at risk of experiencing homelessness. I want to give you a few statistics about our program to give you some updates. As of June 302023 Homesafe has served 8756 people and provided 3555 instances of housing related financial assistance. Additionally, we have connected more than 2000 people with our local coordinated entry system.

In terms of housing outcomes, we have seen approximately 47% of our participants exit to permanent housing in fiscal year 2223 and as a report done by UCSF Doctor Kushel's center on Housing Excuse me Benioff Homelessness and Housing Initiative, they did an evaluation of home safe a preliminary evaluation in December of 2021 where they noted a number of successful outcomes, including retention for 85% of their participants of housing six months after exit from the program and important fostering of strong connections between AP's and the local care continuum and our social services partners for HDAP.

It was established in 2016 and since the inception of the program, which really kicked off serving people in 27 excuse me 2017-18 and as of June 30, 2023 has served excuse me has permanently housed 3345 people has helped submit 9318 disability applications of which we have seen 1881 applications approved. We have a 68% approval rate within this program, which is far higher than than the national average of 35% approval.

In terms of outcomes at exit, we have seen 41% of our participants in HDAP in 2023 exit to permanent housing and homelessness exits to homelessness have been the least common housing destination for our participants. Further, we have seen that six months after exiting the program, 84% have retained housing again. These programs have also helped foster connections between housing providers, social service providers, and medical services for our recipients.

We had a question about whether or not there was a baseline county match, excuse me, what the effect of the baseline county match has had on the Administration of these programs.

We have had reports back to us from counties and tribal entities that match requirements can make it more difficult for communities to operate the programs, and we have heard feedback that exemption of local match requirements for our current one time funds has been critical in abling counties and tribal entities to participate and rapidly grow their programs. Now, I'll turn to the questions 2 and 3 related to delays in our programs.

I want to clarify that our intent behind these proposals is not to do any harm or to in any way affect negatively our program participants. Our idea here is to smooth out our funding and give an extra year through re appropriation into the fiscal year 25-26 for both home safe with $65 million and HDAP with $50 million.

To implement these proposed delays, we would be extending those timelines for spending on the 22-23 funds for an additional year such that they now have a new expenditure deadline of June 30,2026. We are not proposing to withhold or pause any of our funding in 2025, and we do not are not asking programs to pause or to hold funding, but instead letting them know that they would have additional time to spend.

We have based these proposals on point in time information we had for the January budget, and if we will be reviewing updated data for may revise and if there are updates to be made, those will be reflected in May revision. I will pause there, but happy to take any questions.

Go ahead. Hello. My name is Susie Smith, and I'm Deputy Director for Policy Planning and Public Affairs and San Francisco Human Services Agency. And I'm here to talk about HDAP and a little bit of what the one year delay, the impact that could have on our program. So HDAP, as mentioned, it serves people experiencing homelessness who are disabled, so highest vulnerable population, and its goals are to stabilize folks in permanent supportive housing and secure SSI.

It's proven to be a very effective strategy in addressing homelessness among disabled folks, but it is a multi year strategy. The SSI application takes on average about 18 months, can be up to two years, depending on how many levels of review someone has to go for in terms of repeal. And there's also an important element where we help connect people to medical care that builds the case for the SSI application, and that, again, takes some time.

So in San Francisco, the expanded, the one time expanded funding allowed us to do a couple things. One, we expanded the number of people we could serve up to 150 additional participants through our partnership with Bay Legal, who does the SSI advocacy. And we actually developed a whole new program model where we now have a multidisciplinary team of social workers, eligibility workers, housing assessors that go from shelter to shelter across the city, and they enroll people in benefits.

So Calfresh Medi Cal SSI applications, they do housing assessments for coordinated entry and also enroll them in IHSS. So it's really a model where we're going directly to the people and avoiding someone having to make an appointment and then miss that appointment and then not get the services that they need. And that's what the expanded funding enabled us to do to really pay for that level of care, direct care.

And in terms of some of the impacts that it's had, we've served 235 cases and we have a 71% approval rating for SSI. As mentioned, that's far higher than the national average, which is only 31% for SSI approval. And we have been able to house. Hold on. Let me see how 70% of the folks that enter the program as well and the remaining people are in the housing process. All of the HDAP participants are prioritized for housing, so they go through coordinated entry prior.

So we know that these are folks that are going to get access to housing and will have a subsidy at the other end because unfortunately, we saw the SSI award levels. When you look at housing, you need to have a subsidy at the other end. Just because you get SSI does not mean you can be able to pay for housing in places like San Francisco and most places across the state.

So again, the MDD provides direct outreach, making it easier for people to enroll increases the likelihood of success. Wanted to share one success story with you. And then I have a slide just on the impact of the one year delay. So through our multidisciplinary team, Bay Area legal aid met a 43 year old man at a navigation center. This client had been assaulted multiple times and he's lived in both shelters and on and off the streets. Due to his traumatic brain injuries.

He was one of the highest utilizers of SF General Hospital emergency room care. Communicating with him was extremely difficult. As a result, though, of working with the Bay Legal team, which is both social workers and attorneys, the client now has a positive relationship with his Doctor, who he sees monthly, and he drops in the clinic when he's feeling poorly. He's seen a neurologist and he gets regular speech therapy.

Because of this positive relationship that he was able to attain with his Doctor and the supportive services of HDAP, his use of the ER dramatically decreased. So when we look at sort of other systems impacts, these kinds of interventions are able to be able to reduce costs in the long term. In April 2023, he was awarded SSI benefits and in June 23, he moved into a quiet, permanent supportive housing building where on site supportive services is provided.

So what is the big deal of delaying funding for a year? What is the impact? And so for us, the delay in funding would result in a reduction for next year in about $2.8 million. This would result in a two thirds cut in our Bay Legal contract, and we would have to stop new enrollment because we planned for the ability to carry those funds forward already.

So without having to be able to carry forward that 2.8 million, we would have to stop enrollment, about 70 people would not be served. 30% to 40% of existing clients would be in jeopardy of losing legal representation and the social work support, about 30% to 40% of current case work would be unfunded. So it really does have a direct impact because it's a multi year program and we're planning for that funding. It creates a lot of uncertainty for our nonprofits.

Bay Legal ramped up quickly when we had the additional funding hired social workers, hired attorneys, if we had to scale back, they would not be. We can't kind of turn on and off a spigot of funding for our providers, so they would not be able to ramp back up. We know that just, I know I'm end of my time, but we understand that CWJ is working with cdss to determine whether and how a delay would be operationalized and what amount of funding could be delayed.

And there may be some reallocation from counties that are underspending to counties that are able to spend the money and plan for it. So, you know, we just ask that that careful consideration is made and that we look at counties that are able to effectively spend the funding and be able to, and have planned for those additional funds to be able to take into consideration as we make the final decisions. Happy to answer any questions.

Good afternoon, Mister chair and Members. I'm Kelly Carpenter. I'm the Program Manager for Nevada County Adult Protective Services. I was invited to share our home safe program from a small county perspective. Nevada county is a rural county with a population of approximately 103,037% of the population over the age of 65. Nevada county was part of the original 2019 Home Safe pilot program and we received $50,000.

At that time, we developed specific home safe criteria, checklists, program intake flowcharts, training staff, and we attended our local community partners to share this new program. We mostly collaborated with our homeless outreach team, our aging and disability resource center, law enforcement, the local hospital 211, and our social services Department. We all worked together and braided our funding where we could. Our aging and disability resource center was by far our greatest partner.

We managed the Home Safe program in house with our current staff of two social workers. Home safe has been a game changer. Being able to make needed community referrals and to retain housing and have the available funds to assist our clients is truly meaningful support. Prior to home safe, our AP's social workers were able to give community referrals to potentially improve their situation, but oftentimes clients didn't have those resources to pursue the referrals during the course of our home safe funding streams.

Our county experienced significant winter storms two years in a row and managed through COVID. The Homesafe program allowed us to serve 253 AP's clients. We assisted 128 clients with either new housing or saved their existing housing. We assisted 125 clients with housing related wraparound support services, housing rehab, hazard removal, mobile home roofs that collapse due to snow loads, hoarding cleanups, just to name a few, for our clients to remain safely in their home. We received approximately $558,000 over the course of the home safe allocations.

Average cost spent per client was $2,200. Average Aave served was 65 years old with that being 58% were female and 42% were male. I would like to comment on the flexibility of the home safe program and how valuable that was. Oftentimes, older adults and adults with disabilities come with multiple aging challenges that need to be taken into consideration when looking for housing or to save their housing. Walkers, incontinence, hearing issues, vision issues, cognitive impairment, and wheelchairs all add additional barriers.

Home safe flexibility allowed interim housing while waiting for longer term housing because oftentimes our older adults can't go to our homeless shelter due to incontinence issues, they just don't have the available staff to provide this level of needed care. We were also able to assist our local hospital with paying for transitioning clients from the hospital to needed board and cares so the hospitals didn't absorb all of that financial burden. I wanted to circle back to the term meaningful support and share two home safe success stories.

We had an elderly client in their eighties living with an adult child who struggled with mental illness, was taking advantage of them financially and had hoarded the house waist high, deep in empty beer cans and trash. The older adult experienced a mental break and pushed the elderly parent down to the ground, poured a gallon of vodka on them and attempted to light them on fire. Thankfully, the client was able to reach their cell phone and called 911. The client's adult child was arrested at the scene.

Prior to home safe, we would have been able to offer referrals for victim witness support and sliding scale counseling with home safe funds. We were also able to pay the back rent to secure their housing, change the locks on the home, and arrange for a hoarding cleanup. Our second story, success story is of a local family owned mobile home park that was purchased by an outside company.

The new company came in and raised all the rents, changed the electrical billing address which immediately voided all of the residents Low income pg and e discount programs without the residents knowledge and increase their propane costs. With the assistance of our aging and disability resource staff and our home safe funds, we assisted 11 elderly clients, save their housing and avoid eviction. Home Safe is a flexible program that has allowed us to meet the individual needs of our clients. The money has enabled our county to provide truly, truly meaningful support. Thank you.

Thank you very much. Department of Finance.

Idalys Perez Department of Finance we would like to clarify that the Administration's proposal aligns expenditure authority with expenditure trends and provides an additional year for expenditure. The proposals do not reduce funding for grantees and are not intended to have an impact on programs and service delivery. We note that these funds are one time and as such allocations are limited on the natural some grantees will spend down their allocations more quickly than others.

For those grantees, funding will not last at the end of the period of those available funds. However, this issue is not driven by the administration's proposal.

Lao.

Juwan Trotter Legislative Analyst officer so in going through these delays in the proposed budget, one of our key questions was and so is what do these proposed delays leave behind for expenditure in the budget year? Or questioning goes along the lines of do they leave enough funding behind to allow the programs to continue at the current level? Will the service levels need to be reduced to reflect a reduction in funding, and will the impacts be similar on a county by county level?

As was noted, not all the funding for these programs have been spent to date, and it is our understanding that there may be funding available from previous budget allocations to be utilized in budget year. Though this may be this may vary on a county by county basis. We also acknowledge that the reduction amount is a point in time figure based on current expenditure levels for the program and that these figures will be revisited again and may revision as such.

That might be a good time for the Legislature to better understand the budget year funding levels, specifically on a county by county level level.

DSS is it your understanding that the proposed delays will not cause applicants to be rejected or current consumers to be cut off from the services that they need?

Yeah, thank you for that question. I just want to reiterate that it is our intent that none of those things happen. However, we do understand in working with our individual counties that different counties are experiencing different situations when it comes to whether or not they think they can continue the program. And as was just mentioned, that some counties are concerned that they will have to modify their delivery of services to individuals.

So, as was mentioned, we are working closely with the counties and the county Welfare Directors Association to look both at how individual counties will be impacted and to see if there is redistribution of funds that can be made between counties to ensure that counties can continue at the service levels that they are currently providing. And we are also making sure counties understand that the mechanism to enact these delays would be reallocation.

And again, as Department of Finance pointed out, to basically smooth out the pathway so that they can continue to administer their programs and plan thoughtfully for spending across the coming years.

This Committee wants to just reiterate that we are.

Continuing to reject any proposals that will cause clients to not remain stable or any opportunities. We do not want to close the door on any opportunities to bring people. Out of a State of crisis as well. These programs are starting to materialize, to have some more detail to them, and I appreciate the detail. Moving forward is going to be very important.

This Committee and this Legislature, in terms of the Assembly, is committed to a just process, which means that without an analysis of the impact that decisions are made, we do not consider that a just process. We must make sure that we are making thoughtful decisions. There is no doubt cuts will need to be made.

So I don't want to, if you have some hope, I don't want to give you too much hope right now, but I do want to reiterate that the cuts that will be made will be done knowing exactly what we're doing and not, and making sure that people are not hurt, that don't need to be hurt.

And so just want to continue. And the only way we can do this is to have thoughtful discussions, share information openly, and making sure that we are really analyzing things as opposed to just making quick decisions. Because when quick decisions are made, equity does not exist. And we will make sure that we're grounded in equitable decision making. I want to hold on. Let me make sure I don't have any more. Yep. I did my job.

We will hold this item open. And I look forward to more detail and obviously with discussions, particularly what Lao was addressing, that for some counties, there might be some unused funds that justifies. A delay or reversion or whatever. As you know, we just got finished doing some reversions of unutilized funds from previous years for different programs. But in other county, in other counties.

It may not, it may actually do some harm. So our hope is that through the may revision that we start to see those type of county specific type decision making as opposed to cookie cutter approaches again so that we can make sure that we have some just decision making. Thank you so much for your time. We will move on to item number, issue number 10.

Claire Ramsey, Department of State.

oh, Claire.

oh, yeah. You're going to see me through the end here from the Department of Social Services Chief Deputy Director here to speak about our community care expansion program. As you heard earlier, our community care expansion program was established in 2021 and has received one time funds totaling $860 million available over multiple years. There are two component parts to CCE, the capital expansion program and the preservation program.

So our capital expansion program provides 570 million of that 860 million to acquire, construct and rehabilitate adult and senior care facilities of a variety of type, which I'll speak to in a minute, that serve applicants and recipients of SSISSP and our cash assistance program for immigrants, also known as CAPI, who are at risk or experiencing homelessness. The second preservation program has awarded $247 million to immediately preserve and prevent the closure of existing licensed residential, adult and senior care facilities.

Our overall goal with this program is to expand and preserve a total of 7000 beds or units throughout the state. We were asked about match requirements. CCE does have match requirements. It is based on the applicants, the type of applicant in that program. So for the expansion program, applicants who are tribal applicants are required to provide a 5% match. Cities, counties and nonprofits a 10% match and for profit or private organizations must provide a 25% match.

For our preservation program, which includes ability to provide funds to licensed facilities for capital improvements. For the capital improvements portion of those dollars, we require a 10% match. There is no match, though, on the operating subsidy portion of our preservation program. We've been asked to speak to what we've achieved so far and we do want to highlight that we had some updated numbers to provide you for awards granted.

Of the $570 million for the expansion program, we have already awarded $464 million to date that will support 55 projects across the state to expand capacity to an additional 2465 beds or units. We have an additional $106 million to award in CCE expansion funds and expect to finalize those awards by the end of the month. The one caveat there is we are working.

We have a tribal set aside and are working with tribal applicants who sometimes require additional technical assistance and additional time to make sure that they are supported in their applications. We were also asked about the sort of benefit of our operating subsidies. We have found these to be a unique aspect to our program, but a particularly crucial aspect. Many facilities are struggling when they serve our SSI SSP recipients and our CAPI recipients to cover all of their operating costs.

And so awarding operating subsidies, whether it is through the expansion program which some of our awardees have received, or through the preservation program to make sure we preserve available capacity, has been instrumental and we have heard stories that people are feeling that this will allow them to continue their program much longer and into the future. I did want to mention, because it was referenced before, about the types of facilities we are funding.

We are funding a variety of facilities and non facility types through the expansion dollars. So we are funding adult residential facilities. We have funded residential care facilities for the elderly, or rcfes. We have also supported a number of permanent supportive housing units as part of the CCE funding and we have had both recuperative care, respite care and other recovery and sober living.

So we have a mix of units and beds within the portfolio that we are supporting through these awards so we can hopefully meet people where they're at and provide a continuum of available units and beds for this population. We've also been asked about the preservation programs and any updates on how that's preventing closures. As I mentioned, we've awarded 247 million in preservation to 34 participating counties. We have heard that this money, as I said, is much needed and is excited to get out into the community.

We have counties that have already gotten into contract. 12 counties are in contract with at least one facility and many more are coming online during the spring and summer. We are seeing positive trends in our adult residential facilities and in our senior care facilities. This will be my last point. Between the last quarter of 2021 and the last quarter of 2023, we have seen an increase of 6% in our adult residential facilities and a 3.7% in the overall capacity.

Since 2021 and 2023 in our senior care facilities, we've seen it increase of 13% in our total facilities and a 2.5% in our overall capacity. And with that, I'm happy to answer any questions.

Department of Finance.

Idalys Perez Department of Finance nothing further to add.

Juwan Trotter Lao we have nothing else to add.

I want to go back to issue number nine. I apologize. I actually did not do my job and so I just wanted to make sure that I alert the Administration that we may want to pursue the change regarding county match for the base housing and homelessness programs administered by DDS DSS.

If we do, we will circulate language. For the Administration considerations. Of course, we would view this language as no cost. So if the Department of Finance and Administration have a different view, we ask. That you let us know in writing. And explain your perspective now that I cleaned up my mess. Issue number 10 similar to the questions we've had on HDAP and home safe, is there an amount of unspent funds. In CCE that would be safely delayed. With no adverse consequences for services or people in need of adult residential support?

So, as you know, we do not have a proposal in our January budget to delay any funding within CCE. I do want to mention that we are very close and in our final stages of approving and releasing the final CCE awards.

We do not anticipate at this time that there will be available funds and that we will continue to be able to meet our goal of 7000 preserved or expanded beds between the combination of our expansion funding and finalizing those awards and the awards we've already made to counties as part of our preservation dollars.

Thank you very much. Just want to make sure that we are clear that as close as we continue to have to make tough decisions, if there, if there at any time we believe that there is going to be any unspent funds in this particular. Program, we. It is our intention to. Make that as a part of budget solutions as we await for the governor's may revise. Thank you so much. We will move on to issue number 11. You are still here?

I sure am. Claire Ramsey, Department of Social Services Chief Deputy Director I've been asked to provide a brief overview of our adult protective services program planning and development for data warehouse. BCP California was allocated approximately $1.4 million by the federal Administration for community living in the Elder Justice act to support the state's AP's program.

To that end, the Department would like authority to use those federal dollars to Fund two positions to support and build our data warehouse, which will be housed at CCE and will help to make sure that we are receiving and collecting all the data necessary to meet our federal requirements to have case level data. Currently, we can collect we collect aggregated data, but not case level data. We do have an exemption at this moment from collecting case level data, but we are not guaranteed to continue.

When we were asked about how it will improve our understanding, it's anticipated that our data warehouse system will be completed in January of 2026 and we plan to work with the counties and CWDAs to develop those requirements and define those business processes.

Having case level data and timely data will help inform our impact and outreach, our AP's worker training and we'll make sure that AP's is responsive to abuse allocations in a timely, effective and equitable manner for clients, we wanted to provide a practical example in response to your question. One example would be we will be able to better track recidivism in our program. Recidivism means a client who has been referred to AP's more than once in 12 months on a new case.

And so right now, although we do track that aggregate data, we actually don't know at a case level who is being impacted by recidivism within this program and whether or not we could do a better job identifying communities, geographical locations where recidivism is happening. People who are more at risk of being abused repeatedly and having repeated AP's referrals.

And with this data warehouse we will be able to look at that at a case level and basically see whether we can target our approach and make sure that we are equitably providing support to our older adults who may be experiencing abuse and neglect. Happy to answer any questions on this proposal.

Department of Finance.

Idalys Perez Department of Finance nothing further to add at this moment.

Juwan Trotter Lao we have nothing more to add at this time.

Is the Administration amenable to budget Bill Language to assist with tracking and oversight for the data warehouse and information about adult protective services?

We're happy to take that request back and work with you to look at language about what might be possible.

Thank you for that. I would like to ask Lao for help with a drafting budget Bill Language to first preview with my office and Subcommitee staff and then we would ask for your assistance with circulating that with the Administration to prepare us for action at the May revise.

Thank you so much. We will hold this issue open and move on to our next and final issue, issue number 12. Who's up next? oh, guess what?

Hello again. Claire Ramsey for the Department of Social Services. Happy to speak to to you today about our community care licensing you division and recognizing there are not any proposals on the table for you to consider, but do want to provide some information so you have some insight into a very large division that is mission is to promote the health, safety and quality of life of each person in community care through the Administration of an effective and collaborative regulatory enforcement system.

CCL is comprised of four licensing programs and three support branches and we are those three. Excuse me, those four programs are adult and senior care program, our child care program, our children's residential program and our home care services program. We have 34 different facility types. We license 69,646 facilities and serve $1,450,48,000 Californians through our facilities. We also have a home care services bureau that has registered more than 1900 home care organizations. The division has 1571 authorized positions.

I was asked to speak about the budget we have in 2324 we have $78.42 million in General funds, $157.8 million in federal funds, $23.8 million in our technical assistance Fund, 2.1 million in our certification Fund, 2.7 million in our Child health and Safety Fund, 7.3 million in our home care Fund and 2.8 million for our continuing care provider Fund which is continuously appropriated.

We use all those dollars on our 1571 authorized staff who serve in 18 different locations across the state, conducting more than 34,000 facility inspections a year, 15,000 case management visits and disposal and investigation of more than 17,000 complaints per year. We also process approximately 7000 applications for licensure a year. We are working on two large it systems projects and we process more than 250,000 criminal background checks a year to ensure safety in our facilities.

I was also asked to speak on two of our programs, first about our guardian background check and the $4 million that was allocated in last year's budget. Currently, we are receiving on average 20,000 applications per month for background checks and we are able to process approximately 22,000 applications per month. We currently have 2277 cases backlogged past 120 days. This represents already a 24% decrease from our January 2024 numbers where we had a little over 3000 cases 120 days.

Just to show you the progress we are making on reducing our backlog, we think this is due in large part to the $4 million where we were able to hire additional staff to support both the backlog processing and to increase our capacity to answer phones and emails from applicants and licensees.

We also think it is contributed by a Bill that was passed thank you to the Legislature, AB 1720, which significantly increased the number of simplified exemptions we could do, which are happening much more quickly than our normal standard exemptions. We were able to provide our second quarterly update on our backlog numbers last week and anticipate providing the next quarter numbers later this spring. Just want to also speak to our Guardian project and our new system. We have completed all critical development in Guardian July 2023.

So our guardian system is currently stable and we are getting better functionality at it and people are learning to use it and work with it better. We also have a business excuse me, we're in the PAL process, stage two for our replacement system and we are information gathering and almost complete with that piece of that and then we are going to be drafting high level business requirements in preparation for our RFI. Lastly, I was asked to speak to the Home Care Fund and actions we've taken.

The 2023 budget provided the Home Care Services Bureau with the opportunity to transition to a branch. We have completed that transition in July of 2023. We were given funding to hire for 15 new positions. We have hired 12 and are in the hiring process for the remaining three and anticipate we will be completed hiring within the coming months.

The point of the additional positions was so that we could investigate unlicensed home care and issue civil penalties and also bring more people into licensure and into compliance, which will also generate more revenue for our home care Fund. We are continuing to meet with our community partners and stakeholders to build our working relationship and to make sure that we have developing. We are developing our regulations and internal policies and procedures to support the new branch, and we anticipate having our quarterly report.

We had already submitted our first quarterly report and our second one is coming due this spring, and we anticipate having it to you in the coming weeks. Happy to take any questions.

Department of Finance.

Idalys Perez Department of Finance nothing further to add at this moment.

Juwan Trotter, Lao we have nothing more to add at this time on.

The complaint investigation timelines. Can you please share how these have improved or not in the past few years?

Yes, so I do want to preface complaint investigation timelines by acknowledging that the pandemic had a significant impact on our ability to investigate and close complaints. So we do have a requirement that we must go out to an in person visit within 10 days. We meet that obligation 99% of the time. We are going out and starting inspections and making sure no one is in danger. The inspection timeline, though, is related to full closure of a complaint.

We are working diligently to bring those numbers down, but we have seen that that is going to be a little bit of a slow process. We continue to have complaints, a little over 5000 complaints that are backlogged more than 90 days and have been pending. The bulk of those are in our adult and senior care program, which was the most heavily impacted by COVID, and that backlog is directly tied to COVID. We are working diligently to reduce it and have made progress in reducing it.

It is just a slow movement forward, but we are taking that responsibility seriously and will continue to work that number.

What does it take to be able to continue to make quicker progress?

We work within the resources we have, and that means to meet our three major obligations, which are processing applications, doing inspections of facilities, and then processing complaints. We are trying to balance those three things out so that we are effectively doing and meeting all our obligations in all three. When we need to work down more complaints, we balance that out with our ability to do applications timely and to complete inspections as required. So I would say that is how we do it.

We work within our means and balance those responsibilities.

Got it. This was a helpful background for community care licensing. We will hold this issue open. Want to thank you so much. I guess you're leaving now.

I'll be in the back listening to public comment. Thank you.

This ends the panel presentation portion of our hearing for today.

With that, we will move on to public comment.

Hello, Mister chair. My name is Gavi Lopez-Loomis. I'm an IHSS provider for Nevada county caring for my autistic son, Listat. And we appreciate your comments and respectfully request the Committee's support to carry out the home care contracts that are currently limited by the 10% cap. Thank you very much.

Thank you. Name and affiliation, please.

Good morning. I'm Naomi Rodriguez. Oh, sorry. Good morning, Mister Chairman. My name is Naomi Rodriguez, an IHSS provider for Butte County caring for my mother in law, Elisa Rodriguez.

We appreciate your comments and respectfully request the community support to carry out our home care contract that are currently limited by the 10% cap. Thank you.

Thank you very much. Name and affiliation, please.

Good afternoon, Mister chair and Members. My name is Farnoosh Makhmalb, Pilaser county caring for my client. We appreciate your comments and respectfully request the Committee's support to carry out the home care contracts that are currently limited by the 10% cap. Thank you.

Thank you very much. Name and affiliation, please.

Hi, yes, my name is Chantel Turner. I am a in home care provider for Stanislaus County. I take care of Willie Grays. I would like for you to look into upgrading the wages of our paid so that we can take care of our families more better.

Thank you very much. Name, affiliation, please.

Good afternoon, Mister chair. My name is Brandy Litt and I work for in home supportive health through Stanislaus County. I am on the General provider list, meaning I don't care for one individual person.

I am sent to where the need is the greatest. I am asking today to support the increase of wage. Fast food workers make more than in home supportive health, and to me that is a major issue. So I'd like for you to see where there is room in the budget to increase our wages so we can provide better. Thank you

Thank you so much. Name and affiliation, please.

Peter Hadsell, advocacy volunteer for AARP California. Here today on behalf of AARP California, and it's 3.2 million Members, we have three points we'd like to make for the Committee. The first is a plea, really, to avoid budget cuts that affect older, vulnerable Californians. I think we've heard that refrain, so. But we really want to emphasize that. AARP appreciates the progress that's been made implementing the master plan for aging. We would hate to see that stall or go backwards,

even worse, due to untargeted or poorly targeted budget cuts. AARP's polled as members, 87% prefer to continue to receive services and remain living in their homes as they age. Many find it difficult to navigate the caregiving system and depend on caregivers, many of whom are supported by the programs you've heard today. For that reason, we make a strong plea to avoid any budget cuts affecting seniors. Then we want to go on record of supporting the stakeholder request for the Ombudsman program.

The Ombudsman program provides critical services. You've heard a lot also how underfunded it is and how much it's draining volunteers. The current level. It cannot perform its duties and this is a critical function. So we would strongly urge the Committee to avoid to, pardon me, to support the augmentation in that area. I'd like to defer to my colleague on our third point.

Danita Stromgren. On behalf of AARP California, we also support the IHSS General Fund bridge funding proposal by CWDA and the California State Association of Counties to address the staffing challenges of the in Home Supportive Services program. Current staffing shortages delay timely access to the IHSS services for older adults and persons with disabilities, putting them at risk of institutionalization.

We support IHSS because this essential program makes it possible for 754,000 Californians to continue to live in their homes and communities as they age, and it also allows family caregivers to receive payment for caring for their loved ones. 72% of IHSS providers are, in fact, family Members, and it offers them the choice of getting paid for their work as opposed to having to choose between work and caring for their loved ones. IHSS is also a key strategy in the master plan for aging, and we urge your support for this proposal. Thank you.

Hi, my name is Nancy Volpert. I'm with Homebridge and I wanted to just take a moment in full support of SEIU's proposal around finding a way to build on the investment that's been made in career pathways program. We are, as noted by both Director Johnson and Director Damaris and their teams, CPP is the first in the country model.

It has high demand, it is replicable in other states, and it is providing critical education and support to IHSS workers who are on the front line of keeping our oldest Californians supported and safe at home and living in the community settings in which they thrive. Thank you for your willingness to pull us together to try to find a solution that will protect this program and the education that we provide to IHS providers across the state. Thank you.

Thank you. Name and affiliation, please.

Hi chair, Gabby Davidson with the California Association of Food Banks and Member of the Californians for SSI Coalition. Firstly, we just want to thank the Legislator for the SSP grant increase that took place in January and that there's no proposed cuts this year.

Additionally, as mentioned in issue 1 and 6, we must go further to support the over 1 million Californians who rely on SSP, many of who are struggling with housing and food insecurity by raising the SSP grant levels and reviving the special circumstances program when opportunities allow. Thank you.

Thank you. Name and affiliation, please.

Good afternoon. Yasmin Peled on behalf of justice and aging, we support the Californians for SSI Coalition asks to increase the SSP grants and provide an ongoing COLA and to revive the special circumstances program.

We also support the California Long Term Care Ombudsman Association's proposal. We oppose any delays to the home safe and HDAP programs that limit or cut off access to these services, and we align our comments with the chair about mitigating harm. And finally, we support SEIU's proposal on the IHSS career pathways program. Thank you.

Good afternoon. Linda Wei with Western center on Law and Poverty related to item seven, we appreciate the large unwinding lift and dramatic drop in IHSS terminations compared to pre pandemic levels.

To the chair's question of what the state can do to maintain coverage, we recommend the state, specifically the Department of Healthcare Services, make permanent all allowable federal flexibilities, which is set to expire at the end of this year. This could result in cost savings as more IHSS consumers will keep their Medi Cal and not move into state only IHSS residual program.

We've seen a dramatic improvement in the automatic ex parte renewals for people 65 and older and people with disabilities from less than 1% to over 60% beginning last December when the flexibilities were implemented. This is a massive improvement that we believe contributed to the dramatic drop in medi Cal enrollment related to issue eight. We support SeIus IHSS career pathway request and share the concerns related to the delay of HDAP and home safe. Thank you.

Thank you. Name affiliation, please.

Good afternoon Mister chair Malik Bynum on behalf of UDW AFSCME Local 3930 over on behalf of over 171,000 home care and child care providers across the state. First off, just want to echo the remarks by my SEIU counterpart Tiffany Ryan as it relates to the career pathways program.

We would hate to see such a critical program cut short prematurely, and we would urge everybody in this room as well as departments to look at how we can reshift some of that funding to really utilize that in the career pathways program.

And of course, just like our Members that you saw before you, we appreciate your leadership and championship of our budget proposal and trailer Bill Language to really look at how we can ensure that those counties that are at the 10% cap, San Diego and Riverside, can fulfill those contracts into 2025. Thank you.

Thank you very much. Name affiliation please?

Tiffany Whiten with SEIU California support and echo the comments made by my counterparts at UDW for the 10% cap. Also support the long term care Ombudsman proposal, and finally, support for the IHSs admin proposal brought by CWDA and CSAC and just underscore the importance for updating the methodology. Thank you.

Thank you very much. Name and affiliation, please.

Good afternoon, Doctor Jackson. Blanca Castro, state long term Care ombudsman. While I reside in the Department of Aging, we are an independent entity. And so I'm here strongly supporting the request from the California Long Term Care Ombudsman Association to increase funding on already existing special funds. I just have two points to make. We have 615 people in California that are certified, and we handled over 43,000 complaints by people that live in long term care facilities just in 2023 that continues to grow. And the top three complaints, physical abuse, unattended care and transfer, discharge and evictions. Thank you very much for your time.

Thank you. Let's schedule some time to chat. Please reach out to my office.

I am. I had every intention.

Okay.

Good afternoon, Doctor Jackson. My name is Jason Sullivan-Halpern and I'm the Director of long term Care Ombudsman Association, and I just wanted to add to what Blanca said. We have 50 aging and disability advocacy organizations in support of this request. We've introduced it concurrently in the Senate as well, presented it to Senate Budget Subcommitee on Health and Human Services on March 7. And as Blanca said, these are requests for existing reserves from two special funds that already Fund our programs.

One of the special funds is legislatively capped at 10 million, but it's been regularly ending each year with about 14 million in that account. And the other, which provides our programs with $400,000 annually, is beginning the next budget year with $130 million in reserves. So we feel confident that there is some funding there that could support the ombudsman programs.

We're going to be working with the Department of Finance, Legislative Analyst's office and CDPH on the, on the logistics, and we do plan on introducing a budget trailer Bill for your consideration in the near future. And I would just encourage the Subcommitee to keep talking to us about this. And, you know, we understand it's a difficult budget year.

We want to do our best to find a source of funding that's not going to impact the General Fund, that's going to be able to let these programs meet their basic mandates, which are to make quarterly, unannounced visits to long term care facilities. As Deputy Director Beckley said, we're not visiting 100% of those facilities quarterly. And in terms of the volunteers, we have lost 50% of our volunteers and the state does have some money to recruit more.

But none of that funding is going to go towards training the volunteers. And these volunteers have to complete 36 hours of training to even begin volunteering for the program. So we'd like to work through some of these details with the Subcommitee and encourage you to consider our request around the time of the May revision. Thank you.

Thank you very much. Name and affiliation, please.

Hi, my name is Rachel Tate. I'm with wise and healthy aging's long term care ombudsman program. We have the programs for the city and County of Los Angeles as well as the County of San Bernardino. So we are more than one third of the state. In Los Angeles City and county alone, we have more than 1900 skilled nursing and assisted living facilities.

We currently have 3000 open cases to work on, 516 of those came in since the first day of this month. We are rapidly doing everything we can to address the needs of residents in long term care facilities, but the funding has not kept pace with the cost of running this program. In the last year, we have eliminated one regional office and four positions in order to attempt to break even this year.

That causes an equitability issue for residents in our county not being able to receive the services that they so desperately need and deserve. While I have been sitting here, I have had a constituent request from a Member related to a 97 year old woman who has been given a rent increase that prices her out of her assisted living facility. And my advocates need to get out there to stave off homelessness for a 97 year old woman. We desperately need this funding in order to provide services for California's most most vulnerable residents.

Thank you. Name and affiliation, please.

Hi, Karen Jones, long term care ombudsman services of San Luis Obispo county. I'm also a board Member for Calcoa, the State Ombudsman Association, and I have so much I'd like to say, but I'm pretty sure all the people behind me would throw me out if I kept going for hours. So what I will say is-

At your own risk.

Yeah, I'm not doing it. I won't. I promise. What I would say is, you've heard from Rachel about the need in so many of the counties, and there is an equitability problem for a lot of facility residents. In some counties they've been able to find other reserves, other resources, and they're able to get to those complaints and facility visits more regularly. And in some counties they cannot. And it is terribly unfair to anyone living in a long term care facility to lack the resources of the ombudsman program.

The funds that we're asking for from this proposal do not affect the General Fund, they don't affect the deficit, and they're not available to other organizations. This truly is a unique opportunity, even in a desperately terrible financial year, to build up a program that's really underfunded and needs the funding so that we can serve the folks that we want to serve or that we are required to serve. This is not money for the ombudsman program. This is money for long term care facility residents and, and it's a benefit to them. So we would really appreciate your vote on that and thank you.

Thank you. Name and affiliation please.

Melissa Flaherty Stanislaus Ombudsman Program I am the ombudsman coordinator for Stanislaw County oversight of 17 skilled nursing facilities and 98 assisted living long term care facilities totaling over 4000 beds with numerous adult residential care facilities and adult day programs.

We all know that the senior population is growing and by not considering the proposed budget increase for long term care programs will greatly become a shortfall. In regards to the importance role of the Ombudsman program in California and the residents that depend on our services. Ombudsman representatives, staff and volunteers become residents eyes ears while having face to face community establishing relationships where Ombudsman become trusted persons who residents can depend on.

Asking you to respectfully consider the proposed budget increase for the long term care ombudsman will help the elders and dependent adults with a variety of backgrounds and creeds to know that we all can help them living a healthy and fulfilling life as deserved. So let's start the process now by moving forward, letting your constituents know. Living in long term care. Long term care ombudsman communities are important part of our community and not forgotten. Thank you.

Thank you very much. Name and affiliation, please?

Hello, my name is Jacqueline Flores, and I'm here on behalf of California advocates for nursing home reform, also known as Canner, in support of the budget request for California's long term care ombudsman programs. For over 40 years, Canner has advocated to improve quality of care and life for long term care facility residents and ombudsman have been alongside throughout the years with their direct advocacy. Ombudsman uphold the rights of California's most vulnerable population, and the funding has not kept up with the state's growing aging population.

As a former ombudsman, I personally can attest to the importance this funding would bring to the long term care ombudsman program. It is the state's responsibility to protect a vulnerable population, our older, independent adults in long term care. And approving this budget request would do so much for a vital program. Thank you.

Thank you very much. Name and affiliation, please.

Hello, my name is Monica Kirkland. I am the state policy Director for senior Services Coalition of Alameda County.

And it is a coalition that is made up of about 40 organizations and it's nonprofit, community based organizations. And we offer social supports and health to older adults within our county. And because of that, we do have some growing concerns based on the fluctuation in the revenue at the current time and the growing possible or the potential for the growing deficit.

And also the Legislative Analyst Office suggestion to, suggestion for the California older Californians act programs to, as a suggestion to cut some of those funding because it does impact us. And so we are a bit alarmed by that. And so a lot of the programs that are administered by the CDA are really highly effective in improving the health outcomes and preventing crisis. They also help represent lifelines for a lot of these older adults who are economically insecure and also isolated.

And they address the stressors that can really destabilize, stabilize an individual or family, and lead to displacement and homelessness. And so it is just critical at this time, as we've already heard, I know from many that have already spoken, that since the last recession, you know, we still haven't recovered from that. And so any cuts, even in those programs, we just, it's already on a strain system.

And so we're just asking for you to protect the funding that already has been allocated because we can't lose those programs. Thank you so much for your time.

Thank you very much. Name and affiliation, please?

Good afternoon. I'm Wendy Peterson with the Senior Services Coalition of Alameda County, and I think it's important to say that Calaim is actually not doing very well by older adults right now, maybe in the future.

But right now there are significant issues in older adults being able to access those services in Calaim for housing supports and such. And also, not every older adult who is in crisis, homeless or at risk of homelessness is eligible for Medi Cal, and that's what makes home safe and HDAP so critical in our county. These services have been game changers. You've heard it from Nevada county. It's true In Alameda County.

They work with older adults who are so complex that none of the other systems have the expertise to be able to figure out how to get them stable. We need these programs. We're extremely concerned about the impact of the delay. Our colleagues in our social services agency in Alameda County are not yet clear on what the impact of delayed funding would be. We appreciate the Department of Social Services and their interest in being able to smooth things out. We're concerned about the particular impact in our county and whether that would lead to a decrease in services or a reduction in staff, because these needs are not going to be going away. Thank you.

Thank you. Name and affiliation, please.

Hello, my name is Brenna Lamuska and I am here on behalf of home match. We are a nonprofit home sharing program. We are specifically concerned with aging in place and homelessness prevention.

The CDA has undergone significant cuts in the past years, and currently the services are not meeting the needs of the growing senior population. For instance, our program specifically has exploded in the last year. Many seniors looking to stay in their homes that they have been in for 40/50 years plus, they can no longer afford to do so. Many of our participants utilize the programs you've heard about today, and we are a very small program.

We heavily rely on referrals to these programs that you have heard today. As we know, insecurity in one facet, such as safety or food security, affects others, such as housing, and vice versa. So I asked the Members of this Committee to make a commitment to protect the funding for home and community based supportive services for older adults. Thank you for your time.

Thank you very much. Name and affiliation, please.

Hi. Good afternoon, Mister chair and Members. My name is Cynthia Gomez, Deputy Director of state policy and advocacy for the Coalition for Human Immigrant Rights, CHIRLA. As the panelists highlighted earlier today, seniors of color disproportionately face poverty as they age. With regards to this, it's really important to highlight how undocumented seniors in particular are susceptible to poverty. Recent expansions to programs like Calfresh are incredibly helpful to undocumented seniors.

However, undocumented seniors are still lacking access to a critical program, the Cash assistance program for immigrants, CAPI, California's version of SSI for aging, and qualified immigrants who lack access to federal SSI. Without immigration reform at the federal level, undocumented seniors are aging into poverty and uncertainty. We understand that California faces a budget deficit, and during a time of economic uncertainty, vulnerable populations face even greater need.

And it's imperative that we support our undocumented community and their access to programs that serve as a lifeline to prevent poverty in senior populations. Thank you.

Thank you very much. Name and affiliation please.

Hello, my name is Kaylee. I'm with the California Association for Adult Day Services. I'm also a provider with three programs in Southern California and our newest program that we opened last month in Northern California. I'm here today to speak on the bridge to recovery grant program.

As a grantee, the process was complicated and convoluted, and even though the funds were appropriated two years ago in the 21-22 budget process, the funds have just started being released through a reimbursement process. And while we recognize that it was difficult to get the grant off the ground, we wanted to come together as a provider community to continue to work collaboratively with the California Department of Aging, who have been really good partners throughout the process.

We look forward to using both the funds that were allocated in round one and will be continued to do so in round two for workforce development wage differentials and to build facility resilience as COVID-19 still exists and is still a risk factor for many of our population, who are the most medically complex and vulnerable older adults and persons with disabilities.

And we respectfully ask today that the funds continue to be protected within the budget so that round two, with expanded categories of different purchases and workforce development efforts can be continued to provide providers with the financial support that they need to continue to operate their programs, which do continue to be at risk because of historically Low reimbursement rates. But we look forward to using the bridge recovery program to at least bridge the gap and help bolster the programs for the time being. Thank you.

Thank you very much. Name and affiliation, please.

Hello, my name is Zu Xi Song, the business owner from four CB's ADHD centers in Southern California. Our centers serve Low income older adults with chronic disease and disabilities. They are mainly Hispanic and Asian populations. Our centers were approved for round one BTR partial funding. The bridge application process itself was extremely complicated. As a result, funds were late.

We urgently require additional support as the current medical reimbursement rate are insufficient to support operations and to serve our vulnerable participants. Our staff are essential direct healthcare workers. However, most of our staff are underpaid. We desperately need funding to recruit registered nurses, program aides, transportation aides, and the medical social workers, and also like transportation aides to serve our participants with specialized medical needs. We're here to ask to protect the bridge found and encourage a speedier process for the bridge found round two. Thank you very much for your time.

Thank you, name and affiliation please.

Hi, good afternoon. Lydia Misalides and I'm with the California Association for Adult Day Services. So first, I want to thank all of you for your support this appropriation of bridge to recovery funds that is so needed, and here to support what you've heard from our providers who desperately need these funds, and a reminder that providers, participants, and caregivers remain in an extended pandemic recovery mode and desperately need these funds for staff and safety.

So last, I just want to say, as sponsors, I've learned a lot. We never imagined that it would take this long to get these funds out into the hands of our community providers who serve our most frail Members of our communities. But I'm going to express optimism that round two, as you heard from our Department of Aging, will be improved, and we will make sure that we give them feedback in a very timely way if we see things that have not been improved over round one.

So again, our ask today is to just assure that these funds that are going to be appropriated in round two are protected. And thank you very much again for your support of these programs and most importantly, our participants and caregivers. Thank you.

Thank you very much. Name and affiliation please.

Hey there. Emily Mathis with the Center for Caregiver Advancement. We're a training partner of the Careers Pathways program, and we're here to urge the Committee to explore all funding options to protect the IHSS career Pathways program.

Evidence shows that quality training for home care workers results in a 46% reduction in recipient hospitalizations. That makes this program a benefit to both providers and those they care for. The success of this program has been uplifted as part of the MPA, and ending it would be a true disservice to the state's caregiving workforce.

We appreciate the commitment from the chair to meet with the Department and stakeholders to ensure that the program goals are fully actualized and ensure that these undervalued workers are not robbed of this historical workforce opportunity. Thank you.

Thank you. Name and affiliation please.

Hi, I'm Robert Cole. I'm part of the CA for SSI Co. A lot of people on SSI are either at risk of becoming homeless, live in substandard housing, or are homeless right now.

Possible solutions, rental assistance with the rent or rental deposit when they go to a new place to live, build more housing and also now again, let me get on homelessness 9281 people experience homelessness according to point and time count back in 2022. Cities, counties and state have to do a lot better job and reduce it's homelessness. Thank you.

Thank you very much. Name and affiliation please.

Martha Guerrero, representing the Los Angeles County Board of Supervisors. Thank you for your patience and listening. Today we are here in support of the IHSS bridge funding and the county admin budget methodology that CWDA is sponsoring and presented today. As we know that in the IHSS program is contributing to higher caseloads in the county, potentially reaching per caseworker, about 560 to 600 consumers that they have to do an assessment. So the current state methodology undercounts the true number of individuals assisted by the IHSS program because it does not include the workload associated with processing an application.

So if that application does not lead to someone actually receiving services, sometimes as well, an average assessment takes from two to two and a half hours for each individual. So the current methodology does not count the number of individuals who are approved for services and only counts those that are unable to secure providers. So for these reasons, I urge your support for this. Thank you.

Thank you very much. Name and affiliation please.

Mister Chairman, my name is Peter Anderson. I'm with the California Commission on Aging and the Commission strongly supports all the efforts on by the Department to maintain current programs and hopefully the same funding levels. And also the Commission is proud to sponsor SB 1249, which the Director previously referred to. This Bill builds on the existing work of the master plan on Aging and also the 2030 program to develop tactics and strategies to prepare California's aging network for the future. And finally, just an acknowledgement of the quality work as usual by your staff. Thank you.

Thank you very much. Want to, seeing no additional people for public comment. Would like to thank Committee staff, would like to thank Department of Finance, LAO, thank our sergeants as well. Thank you for everyone who has participated and we will be adjourned.