Assembly Budget Subcommittee No. 1 on Health

Good evening. We're going to call this Committee, Budget Subcommittee Number One on Health to order, start by calling roll.

[Roll Call]

So, just to refresh everyone's memory, the January budget included over $5.4 billion in total solutions in Subcommitee Number One, most of which reflected the early action proposal to expand the scope of the MCO tax and to capture projected MCO revenue funding. However, the May revision included many new, complex and difficult proposals that directly impact California's health.

With over $15 billion in savings over four fiscal years, the proposal assumes $11.2 billion of the savings resulting from 35 different reduction or complete elimination proposals, with many having a direct impact on current level of services. Last Wednesday, May 15, the Subcommittee held a very thorough evaluation of these proposals.

Today we will mainly focus on the voices of the community and stakeholders. But before we open it up to public comment, if there are any remaining questions that those of us on the Committee have, we will begin with those. Assemblymember Bonta.

Thank you chair. I first want to just talk about the MCO revenue solutions. We're being asked in a matter of a couple of weeks to make some very difficult decisions about cuts that I believe will have devastating impacts.

And while we can accept needing to make these tough decisions, we don't want to have to make those decisions without understanding that we have an opportunity to perhaps lessen the impact. The Administration has presented a two year budget, but the budget will be adopted by June 15 is only for one year.

With some of these high priority initiatives, we should consider pursuing some delays so we can still balance the budget for this year and not completely give up on these important initiatives. We know that rates really matter for access to care. I don't want us to just completely give up at this point, and we do have some choices.

So with that, I wanted to be able to dive into some of the impacts on the reductions on provider and on the reductions we'll have on provider participation in medi Cal and access to care related to those cuts. So on the MCO tax, we've essentially rolled back completely the rate reimbursements, which is very significant.

I don't know if there's any opportunity to be able to again ask whether there's an opportunity to do a proportional amount or some other thing that might not have us have to cut entirely those rate reimbursements.

Now, the Legislature wasn't involved significantly in those initial negotiations, but it's pretty daunting to consider having that complete clawback of those rate reimbursements is there any new information that can be provided to us?

Is there anyone from the Department of Finance that is here that can address Assemblymember Bonta's question?

Thank you. Assemblymember Andrew Duffy, Department of Finance, my colleagues are still making their way over. Would just note that a number of tough decisions had to be made in this budget, and no way do the decisions reflect the administration's or reflect the value of these proposals. But given the significant budget problem, we were dealing with significant solutions.

I could ask a specific question if it would be helpful to you. Can you describe what you expected the augmentations around the rate increases would have done to encourage providers to take on MediCal beneficiaries and to improve access to care? And what then, in the absence, it would happen if the impact is limited?

Is there anyone from Department of Finance or DHCs who can speak on the MCO tax proposal?

Specifically, what is the impact of eliminating these augmentations on access to care? Have any projections?

We don't have projections on the impact to access. I will note that the 2024 rate increases will remain in effect and those get primary care, maternity care, and non specialty mental health services to 87.5% of Medicare. So lifting up those services that we prioritize as part of last year's budget.

And there's no way for us to do any kind of additional tracking to care in the meantime to track the.

Difference in utilization and provider participation. Since the rate increases went into effect in January, we're not able to capture that type of information because we pay, essentially, we pay the plans, we then pay the providers. And so I'm not aware of any way we can really track how provider participation changed since January.

So I think that there is a way in which you can track it because you can look at the number of providers who are currently accepting MediCal outside of the three subspecialties. Right.

Because what we're talking about is the other providers who were going to be pulled into the MCO tax in 2025 now not being pulled into that. And so I think what Assemblymember Bonta is asking is, since we're not pulling those others in that we had talked about, what is going to be the impact?

Because we understand that although it is extremely important to look at our primary care providers, to look at our behavioral health providers, to look at those who are providing maternity care, they are not the only ones within the healthcare system.

And I've said this before, if you're a primary care provider and you tell your patient that they need to go see a cardiologist.

You have been made somewhat whole through the MCO tax as a primary care provider, but the cardiologist has not, and therefore access to that cardiologist for your MediCal patient is still significantly limited and reduced.

And ultimately, like the patient is not going to get any better because we have not extended that to other more specialty provider services. So I think her question is, what can we expect to see? What did you project would happen with these providers leaving the MediCal system since they're not being reimbursed?

What would be the impact on health? You can guess, make an educated guess. Based on the low numbers of MediCal participation that we currently have.

We don't have forecast in terms of provider participation that would have been, would have grown or existing providers who would have taken on more MediCal members as a result of the 2025 rate increase as well. We don't have that level of information.

I'll just restate that, I think it's very problematic that we have no ability to actually understand the projections or the impact that not being able to receive the augmentation around the reimbursement rates will have. And sweeping back and clawing back the entirety of the MCO tax, including the rate reimbursements, is beyond problematic.

I'll move on the behavioral health throughput. So an area that we have for a very long time kind of not had the kind of capacity that we should have around addressing our behavioral health system needs and ensuring that Californians don't languish in the emergency room.

We, through the MCO package, we're finally going to be able to make some progress on that, but now we aren't going to have those resources. What is the alternative? Is there an alternative solution proposed by the Administration with this elimination to ensure that we still have some capacity and is Prop One at all engaged?

So I would say definitely Proposition One and just be chipped in General, building out the continuum of community based care, including places where individuals who may be in a hospital could be discharged to. We also have our BH connect waiver that's before the Federal Government that really works on improving transitions and discharges from our acute settings.

And so those proposals, I think, you know, are helpful in this space and would, would have been complimentary and still kind of serve the same purpose in terms of really trying to really ensure individuals are served in the most appropriate setting, really the least restrictive, the least institution setting for our members.

Good to know that there's going to be something to be able to lean on there. The May revision included still on the MCO augmentation. The May revision is proposing $115 million of MCO funds directed towards children's hospitals over the next three fiscal years.

To date, the Legislature hasn't really received any explanation or justification for this funding, this new funding. Beyond that, it's intended to improve access to quality health care for children with serious diseases, certainly something that I know is very important. And also it was a new line item without much explanation.

Can you provide some additional explanation about why this appeared?

So this new directed payment is in recognition that our children's hospital really take the really high specialized high acuity children and recognizing kind of the exceptional costs for that care.

And so this is a directed payment that would be based on utilization for at children's hospitals, really to reflect the cost, again, of that exceptional care and, you know, high cost care for these high acuity patients.

Is there any reason why it wasn't a part of the original negotiation?

So children's hospitals would have received part of the 2025 rate increases. They would have been eligible for the community outpatient procedures and also the emergency bucket as well. So they were part of the 2025 rate increase as part of the 25 proposals.

So we essentially kind of carve them out of the clawback. I'll move on to looking at the programs related to health enrollment navigators. I raised this at the last hearing. The fact that we are going to be reducing the level of access makes those positions even more critical.

Are there any, is there any opportunity to really think about the navigators and the provision of outreach, any other programs or initiatives that we believe will be able to provide some resource for the health enrollment navigators as we consider to making those cuts?

So I think we have our coverage ambassadors program where we have about 6000 individuals who signed up since kind of the beginning of the unwinding period.

And these are community based organizations, providers, different entities that the state has been working with really to uplift the importance of the redetermination process, the expansion, and so really using this cohort, our ambassadors, to really help individuals enroll, help individuals understand their coverage options and really trying to take advantage of that group with this reduction.

I'll move on to a related area community health workers. We know that this is another area where we need to desperately look for alternatives. It's a very critical issue. We spent hours in March discussing this critical issue at a community health workers promotoras and representatives hearing.

I'm very interested to understand and know what the alternatives are associated with that. Is it possible at all to delay as opposed to completely eliminate the major investment that we've made there?

So if the Department of Health Care Services, there is no reduction to the community health worker benefit that is maintained and so no reduction as part of May Revision, I believe there might be changes at Department of Healthcare access and Information, but not at DHC.

Can anyone speak to.

I'm sorry, can you repeat the question please?

Question is, around the community healthcare workers, we spent a lot of time looking at workforce needs and given the fact that we need to ensure more frontline, culturally concordant care, is it possible to consider delaying the major investments as opposed to eliminating them entirely?

Yeah. Matt Aguilera Department of Finance so in the workforce area, we are proposing ongoing reductions just due to the out year funding issues we're trying to solve for budget year and budget year one.

And you know, the thinking is that once that puts the state back in a better position, then we could consider, you know, adding back some of these services through the budget process and subject to competing priorities through the budget process. But that's kind of the approach.

So it gives the state additional flexibility taking that approach.

Given the fact that, it's very challenging to kind of not move forward with the infrastructure that's already been developed when you cut these programs. Reason for delay versus elimination or elimination versus delay? And is delay at all an option?

Yeah, I think statewide, from the community health workers perspective, it is a benefit on the Medi-Cal side. So there are investments in leveraging of federal funds happening on the Medi-Cal side?

Well, on that, there is an assumption essentially that, well, that's actually. So if there isn't the coverage, though, with the federal funding, then if the Federal Government makes any changes in funding, then we just will not be able to fund those programs.

So on the Medi-Cal side, it remains a benefit in the Medi-Cal program delivered by our managed care plans. And then it's also proposed to be a benefit under BH connect for our county behavioral health plan. So there's no change to it being a benefit in the Medi-Cal space.

Okay, Covered California, I'm switching topics. Okay, moving on to Covered California. So we are essentially, we made, may revise, assumes that the Arp federal subsidies will be extended and therefore proposes to sweep most of the Covered California Healthcare Affordability Reserve Fund for General Fund relief. What happens if the Federal Government does not extend the federal subsidies?

Is there any opportunity to structure in a trigger or a default in the event that the federal subsidy ends up not being at the level that we expected?

Matt Aguilera, Department of Finance, yes. So you have identified a risk that's inherent in the budget. The state has been fortunate that the Federal Government has extended this in the past. And so, you know, we're trying to make sure that that extension continues into the future.

The funds, the $62 million that is proposed as a loan comes out of the Reserve. So that, you know, I think that's not gonna hinder us too much in terms of whether or not the Federal Government extends their subsidies since it comes out of the Reserve.

Also, the enabling control section for these various statewide loans allows the General Fund to repay the money in the event that it's needed for ongoing program activities.

So there's essentially some potential mitigation.

Yeah, there's a safeguard.

Okay. I wanted to move on to public health, so we. Do you have any kind of. Is it going to be you?

Okay, can you provide any impact analysis of the proposed $300 million cut described and describe what activities are being conducted at the state and local level now that this, with this funding, will no longer be available.

You jumped right in. Give me a minute. Sorry. Just an overview of the proposal or.

Specifically the impact analysis. I don't want the proposal. Sure. So the proposal is to cut $300 million? Yeah. Have you conducted an impact analysis to fully understand what it will mean for us to not have the public health resources that we need?

Yeah, we're working through a little more detail on that. However, I can say that obviously $100 million was. Sorry. Brandon Nunes, Chief Deputy Director for operations at the Department of Public Health. So $100 million was provided for state operations, $200 million for local assistance.

On the local assistance side, we know that 70% of that funding was required to be spent on personnel. And so from the personnel perspective, the local health jurisdictions were planning to use that funding to support about 1350 positions, of which 82% or 1100 roughly are filled with the funding that they received.

At the state level, we were looking to Fund roughly 400 positions with that funding, of which about 78%, or about 320 positions are filled. Obviously, kind of at the local level. It's going to vary jurisdiction by jurisdiction as far as impact.

But local health jurisdiction funding was meant to support staff, including epidemiologists, public health physicians and nurses, laboratorians, policy and program analysts, community healthcare workers, administrative support and leadership and management within the local health jurisdictions. And obviously, those personnel.

We're going to be supporting some core public health functions in the areas of chronic disease prevention, communications, emergency preparedness, maternal, child and all this, and health, public health labs and vital records. So it kind of ran the gamut of different public health areas based on the plans that the local health jurisdiction submitted.

On our side, from the state operations perspective, again, we filled roughly 317 of the 404 positions, and a lot of that, again, was. Was for staff that were related to emergency preparedness. We stood up a regional public health office that had a lot of communications with local health jurisdictions. We bolstered some emergency preparedness activities.

We stood up our Office of policy and Planning with these funds, which provided the State of the State of Public Health Report to the Legislature last year, or, sorry, this year. And so broadly, the impact is kind of these areas that I kind of outlined as far as where staff are located.

Again, the vast majority of the funding was for staffing at the local level. Again, approximately 70%. I'll leave it there and see if Doctor Aragon wants to take any comments.

Yes, Tomas Aragon, CDPH Director and state public health officer. What I want to do is just spend a few minutes. I know it's been a long day, and everyone's really exhausted. So I want to try to frame the future public health initiative in a way that I think will make it a little bit easier to understand.

And one thing I want us to start off by saying is that we know California is a large, diverse, complex state. Almost 40 million people were bigger than most countries. And so the future public health initiative was really to begin to shore up and strengthen our basic public health infrastructure.

So when we started looking into this, we worked with national experts who have decades of research that really trying to figure out what are the core essential services that public health should be offering and that everybody should benefit from those core services.

And so if you recognize the way public health evolves, we're always reacting to disasters, and then we get a shot of funding that tends to be very, very categorical. So we based based on this research and national model, it's what's called public health foundational services.

And it's really to make sure that we have that core infrastructure, and it's about promoting a culture of health, well being and thriving for all in California. And we focus on that concept of protection, prevention, and promotion, building resilience, responding and recovery, and, of course, making sure that what we do is effective, efficient, ethical, and equitable.

So those core services are broken up into two areas. The first area is called foundational capabilities, cross cutting infrastructure to support all the activity that we're doing. So when you look at the cuts, you'll see them happening in some of these eight different areas. I'm just gonna list them. I'm not gonna go.

You've heard some of the specifics. Assessment and surveillance. Okay, like, right now, we're focused on Avian, Avian influenza and moving through cattle community partnerships. Development is number two. Number three is equity and health equity. Number four is organizational competencies. That's workforce development, development, data science, data modernization.

It becoming more effective in our operations, policy developments and support CDPH. This is the first time CDPH has had a office of policy and planning for a state as large as California. Accountability and performance measure management is number six. Emergency preparers and respond is number seven. And then communications and public education is number eight.

So those are foundational core capabilities that every Health Department in the country should have, especially a state such as California. Then there are what are called foundational areas, and those are areas that you're already familiar with. They're very categorical, communicable disease control, chronic disease and injury prevention, environmental, public health, maternal, child and family health.

And then the other area that we're moving into is mental health and substance use. So what I want folks to recognize is that this core infrastructure are like the roots of a tree.

You can't see them most of the time, but it really determines the ability for us to do what you do see, which are those foundational areas that I just mentioned. So, remember, this is core, core infrastructure. And I like to tell people it's a little bit more like public safety because we're not delivering individual fee for services.

We don't get to get reimbursement. We respond to anything that happens in California. Everyone in California is who we represent with an emphasis, of course, on equity and vulnerable populations. But that's part of the challenge of public health, is that we have to be.

We're working every single day, we're responding to events every single day, and we're preparing and exercising for big events that we know are going to come and have been coming for decades now. So I want to just give you that framework just to understand a little bit. So let me end there and see if there's other questions.

And we have other staff here from the director's office that can also answer questions.

I just, first of all, want to thank you, Doctor Aragon, for being here. Very happy to see you walk through the door.

Can you explain to us, and for the people who are watching, what would happen with these proposed cuts to our public health infrastructure, to the, to the roots that you're referring to that really stand up our public health county, throughout our counties and our state?

Well, it's. It provides the future public health initiatives, funds, core public health infrastructure. These parts that just fall through the cracks. It's not just at the state level, it's also at the local level. So it would really, it would inhibit some of the work that we're doing.

Office of Policy and Planning we need to be strategic in how we plan to address public health, how we plan for the future, how we help select the evidence that's going to be not just effective, but most cost effective, so we can save resources. We need to work with the locals.

Oftentimes, problems cross boundaries, cross jurisdictions, which is more common than not. And we need to be. We're the ones that come in and organize outbreak investigations that are multi jurisdictionals. We work very closely with federal health officials and the CDC, HHS to really organize what's happening nationally and to what's happening here locally.

So it would have an impact on that core infrastructure. We do have those categorical things that, you know, that are funded in other ways, like the WIC program, home visiting, radiation health.

We have a whole team that just focuses on radiation, but it's really these things that are cross cutting and supportive of all of this which would be impacted.

So essentially you're saying that the roots are going to be a bit attenuated across the entirety of the public health system.

It would be impacting us at the state level in operations, and it also would be impacting the locals as well. So imagine for every, every Health Department is going to be different depending on their community and the problems that they face, and so they're going to have different infrastructure gaps.

And so every local health Department took the funding that they got and focused on how do they fill their infrastructure gaps?

And we did the same thing at the state level, and then we worked closely together, again, working from these foundational capabilities as really our roadmap, roadmap for how to make sure that we deliver core public health services.

Are there any non personnel initiatives that are funded by the combined $300 million allocation that are going to be essentially defunded or we're not going to be able to move forward with?

Um yeah, do you have some examples?

I'd ask. I know that, like I mentioned, that roughly seven, again, I'll just say at the top that roughly 70% of the funding is meant to be for staffing, particularly at the local health jurisdiction level.

I know at the state level, we do have some contracts that are supporting our operations, I imagine, and I'm sure there are some contracts as well that are supporting the local health jurisdictions in that remaining 30%. I don't know if there are some that pop to mind.

Yeah, I'll mention one while Susan Fanelli and some other staff come up. So one of the examples, when Proposition One passed, we did not ask for additional money. We said, we have this future of public health initiative. We have an office of Policy and Planning.

And so we started to do all our planning without existing funding and existing staff. So that was a key example.

Yeah. And Christine Siador, Assistant Director of the CDPH, we do have contracts, like Tomas said, regarding behavioral health, with UC Berkeley to do our landscape analysis, to plan for Prop One. And so there are other contracts, the whole evaluation of future public health, we do have a contract for that to make sure that we are being effective.

And really, when you ask the question what would be the major impact? I think that for me, I would just say that it will reduce our preparedness and response capability.

And I'll just add to that, having been through the whole of the COVID response and working through that for many years, I think it would put us back to where we were at the beginning of the pandemic and that we would not have the surveillance, the modeling, all of these teams that we put together.

We wouldn't have our recovery section and our emergency preparedness office and center. So I think it would really, for all of those areas that were involved in response, this is really solidifying the gaps. Our communications team that before this was really just reacting to media.

And now we know we have a whole marketing and different types of communication efforts that need to be part of our.

And that also means that as we're dealing with Avian flu, dengue fever, food recalls, measles, mpox silicosis, tuberculosis, valley fever.

Several of the folks working on that are funded through the, are going to.

Essentially be compromised as we deal with those.

Madam Chair, I wanted to add a couple points for the record. So, yeah, as you know, these investments were made during better, relatively speaking, better financial times. And the funds that were provided were intended to enhance the services that existed at that time. But I did want to note that the may revision maintains $4.8 billion total funds.

That includes $1.7 billion and roughly 5000 positions for state operations and $3.1 billion for local assistance. That's total funds for all of public health activities. So this goes beyond just this specific program that we're talking about here, but it does provide some context.

So there would be additional resources in the budget even if we were to do away with this program. I had a couple other points I wanted you to be aware of. So for the state operations component specifically, we would work with the Department to implement the various reductions in the fall.

We would look towards prioritizing administrative work and finding efficiencies, using existing vacancies to absorb impacted staff and reclassify positions as needed. And so we do not anticipate that the layoffs would result on the local aspect. We don't have as much visibility into the local resources and how they spend their funds.

So, you know, that would be subject to the local process there. And a couple other points. So the budget also maintains $1.4 billion for the Center for Infectious Diseases, of which $214.6 million is General Fund and $945.2 million would go to the local health departments.

And in addition, we have $26.9 million for the surveillance and public health information reporting and exchange system, which is used to process lab data and help state and local officials address outbreaking infectious disease. Thank you.

Can I just ask, Doctor Aragon, as a general principle in public health, when there is decreased access to preventative care, as we've understood, is likely going to be what happens with the reduction of the reimbursement rates, what generally happens from a public health perspective for the spread of communicable diseases?

Yeah. So primary prevention is a core public health approach. It's much more effective and much less expensive to prevent diseases from happening. Every HIV infection that occurs ends up being hundreds of millions of dollars. Sorry, hundreds of thousands of dollars per individual, their lifetime cost.

When we prevent an HIV infection, we save the health system and we save and communities money and suffering. So primary prevention is core. And you saw that also with COVID So vaccine programs are an example of primary prevention.

It's much easier to keep people healthy than it is to take care of them after they've suffered an illness that might result, for example, in long Covid and ongoing cost.

Thank you. Thank you. So question for the Department of Finance. You just mentioned funding and other parts of the Department of Public Health. So understanding the importance of this program.

And, you know, when we had the hearing on Wednesday, we heard from the LAO that, you know, our public health departments weren't even at par prior to the initiation of COVID And so this program and this funding just kind of brings them kind of to where they should be understanding the significance and the fact that what happened is going to happen again.

Why is it that the decision was made to cut this funding instead of looking in other areas, since you say there's funding funding in other places? What was the rationale behind cutting this program, which is extremely important to the future health of Californians and the ability for us to respond to the next pandemic?

I think, you know, it's consistent with some of the testimony you've heard elsewhere, which is that, you know, we tried to focus on one time investments or areas where funds had not yet gone out or programs started up. And so, you know, this, and also tried to maintain the core services and Medi-Cal and elsewhere.

And so, you know, we look, we tried to look under every pillow and mattress, as you suggested, I believe. And these are just some of the choices that are necessary to get to the types of numbers that we need to solve the budget problem.

Yeah. And understand that we are in a significant budget deficit. Did you happen to sit down with the Department of Public Health and say, hey, we need to make some cuts? Where would you suggest we do them? Or was this just kind of something that the Department of Finance decided on its own.

We work collaboratively and, you know, the Administration is working together to come up with the best solutions that we could find. But as has also been indicated, we're open to, you know, other or better ideas that any others put on the table.

We're willing to consider that and we look forward to working with the Legislature on the rest of the budget process.

Doctor Aragon, are there any. You don't have to answer right now, but you know, this particular program is extremely important.

And if, you know, if anyone was listening to the hearing we had last Wednesday, we had a very lengthy discussion about it and the importance of, of being ready for and prepared for what is to come in the future.

Have you all thought of any other areas in your Department where we could go back and say, here's $300 million that can be taken from this over here so we can maintain this program?

Yeah, most of our, we've looked, we've looked for other things that have come up where we've run short. For example, when the cancer registry, there were shortages, finding even those small amounts of money are really tight because the vast majority of our funding is categorical. So it's just, it's very difficult to move money, move money around.

I don't know if Susan has anything else to add.

No. Or Brandon. Most of our money is federal or special Fund. So it wouldn't alleviate the General Fund.

And I would add that identifying General Fund in our budget is difficult, particularly because even some of the General Fund itself is categorical. Of the dollars that Mister Aguilera mentioned is left of the 470, roughly three quarters of that is local assistance dollars.

And then very specific funding goes for things like home visiting in our maternal child and other. Listen. Health programs, our black and white health program has received additional funding over the last year's budgets.

And then a lot of things in STD prevention and lab support, which is kind of where the bulk of our state, so even the state operations funding that remains is less than $100 million.

Okay, well, I would recommend that maybe you go back and look again and see if there's anything, even if it doesn't add up to $300 million, understanding, you know, where the Department of Finance and the Governor is, if you're able to find some resources, it would be easier to ensure that we're able to maintain this very critical program.

I would like to move on to healthcare workforce training.

Thank you very much.

Thank you. Thank you so much for coming. So last Wednesday we had a conversation about the healthcare workforce training cuts that you proposed, and I specifically requested knowledge as to whether or not any current residents would lose their slots based on what has been proposed. Do we have an answer for me today?

Yes, Madam Chair. Madam Chair and assemblywoman Bonta, Elizabeth Landsberg with the Department of Healthcare Access and Information. Yes. So we did make calls, spent a lot of the day, Thursday and Friday reaching out to residency programs. So we have several different pots of funds, so I'll just go through them.

Some of the song Brown residency program funds are for support of existing slots. Some are for expansion slots. The funds that we did award in March of this year are for residents who just were matched and are starting in 2024.

So as you well know, there is a contract obligation between the residency program and the resident who's been matched. But we, the programs that we spoke to indicate that Song-Brown Financing is a key funding source and that they would have a difficult time continuing some of their programs without this core funding.

So we have, in addition, there's Song-Brown primary care residency program, new primary care residencies. So the budget two years ago included $50 million for new residency programs, and we have awarded $41 million of that and started payments for those new residency programs.

There is a two and a half year process to get accreditation, so we have awarded a quarter of those funds, and additional funds are to be made once accreditation and other milestones are reached.

So again, different types of funding, but all of the programs indicated that there would be significant impact if these funds were withdrawn once given that these awards have been made.

Okay. So let's make this very clear for me. If you're a first year resident, current resident in one of these programs, and this cut occurs, is there funding to allow that resident to do their second and third year at that location in that residency program, or would that residential need to find a new program?

None of the programs that we. So we spoke to seven or eight programs that we were able to reach on Friday. Again, they indicated that there would be general difficulties in backfilling these funds.

And I don't have a specific example of this hospital or this teaching health center would be unable to continue for the second and third year of their Residency program.

but there is a chance that they would not be able to continue with their current residents.

Yeah. Scott Christman with HCAI. Yes. The issue would be in each institution whether the sponsoring institution had additional dollars to backfill. So it's really a case by case basis.

So there is a chance.

There is a chance

That some of these residents who have finished all of their training, have come to California to do their residency, would not be able to complete their residency, or would have to scramble at the last minute to get into another program outside of California.

That's correct.

Okay. Additionally, we have cause this is what June?

May.

May Gosh. So match day has passed, and we have already matched and committed to some recently graduated fourth year med students who plan on coming here and starting their residency as of July 1st.

For those residents, there's a chance that they may not be able to come because of this budget proposal.

Correct, Madam Chair.

So the Department of Finance, when the thought process went into this particular recommendation, what was your thought as to what these young doctors future providers would do if they now have no residency slot and all of the other ones are filled?

Matt Aguilera, Department of Finance. The workforce package is a one time investment over multiple years. So it falls under that one time investments look.

But that doesn't answer my question. I understand that it's in a particular one time funding thing, but these are commitments that we've made to individuals who are now here or coming to our state to train that we may not have the funds based on the proposal.

So when you were in the process of proposing this cut, what was the thought process as to where these individuals would go?

I think that's a good question that you raise, and it's certainly one of the impacts of this proposal.

I think, like all the various budget solutions, these create real life circumstances, as you're all aware and based on the testimony, and, you know, in the event that some one time monies are having to be pulled back, then, you know, folks are having to come up with Alternate Fund sources.

In the case of some of the residencies, we heard that the state money is a portion, but not all of the funds supporting those efforts.

Right. But it's a significant portion, clearly, because you need it to, to become whole. And so if you remove a part of it, then you're no longer whole and you're not able to continue the commitment that you and we as a state had made.

But there was no thought process of, oh, we've got these now, young early physicians who really wouldn't be able to usually do anything because, I mean, slots are filled.

They'd have to sit out for a year doing nothing and hoping that they would be able to scramble into another spot next year if somebody happens to drop out of their residency program somewhere else. There wasn't any thought or behind that potential?

No, I would not characterize it as, there was no thought because I think we were very thoughtful. We looked for all the possibilities and obviously if there were easier choices out there, then we certainly would be bringing them forth. But this is an impact for this area as you've identified.

Well, when I say no thought, what would we do? What would we offer these individuals? Last week, it didn't even seem like anybody had the answer. So had we not even considered that as a reality with this particular cut?

I don't think, you know, we didn't view it at that level of detail, although we realized that there are impacts to having to pull back one time funds due to the budget situation.

Okay. Were any issues of liability considered with this particular cut?

It strikes me that if we are, have already made offers, people have come, have an expectation of being able to receive these state funds in order to be able to complete their residencies, that there's a basic, I think, offer and acceptance in there and a liability that we could potentially expose ourselves to with these cuts.

I know in terms of state contracts, as has been indicated in prior testimony as well, you know, the contracts typically have clauses that are subject to availability of resources. So I don't know if the Director could...

Correct Assemblywoman, so there is, I'm told there's, we have contract language with extenuating budget circumstances. So I think we are concerned about the real life impact on these individuals.

So, that's the Song Brown Program, and as you know, we additionally have 19 individuals for whom we've agreed to give loan repayments for those are physicians under the Stephen Thompson Loan Repayment Program, as well as some pipeline and pathway programs to which we've obligated funds.

And so, for those individuals that we had already stated, we're going to repay your loan, or, you know, some of these other programs, it would just stop.

Correct.

Okay. All right. We'll move on to another issue. Thank you.

Thank you.

I'd like to, if possible, move on to the Behavioral Health Continuum Infrastructure and the Behavioral Health Bridge Housing funding. In our agenda today, the Behavioral Health Continuum Infrastructure Program was initially provided $2.2 billion, is my understanding. The May Revision proposes a total cut of 450.7 million and leaves 1.75 billion of the initial 2.2 billion remaining.

The Governor announced last week the program guidance for the 4.4 billion in Prop. One bond funding for the BHCIP round one and round two funding.

Can you, the Administration, explain the rationale of maintaining 1.75 billion of the initial General Fund allocation when we have 4.4 billion coming down the pike through Prop. One bond funding?

So, that, the 1.75 billion, has been awarded. Those were rounds one through five that have been awarded. Some projects have started, some have already providing services. So that's those dollars.

So, they've already awarded specs? Okay. Is the Administration considering? Well, I guess if they've already been awarded, they can't be reallocated. Fair to say.

I mean, projects have started.

Yeah, got it. Today's agenda also details the Behavioral Health Bridge Housing has overall proposed reduction of 250 million of the initial 1.5 billion allocated.

This program also has a proposed 90 million in Behavioral Health Services Act funding for 25-26. Can the Administration explain why the May Revision only proposes 90 million of the BHSA funding to backfill this program?

Guadalupe Manriquez, Department of Finance. So, the 90 million for the Behavioral Health Bridge Housing is the amount available from the MHSF revenue. So that 90 million is the amount that the reserve balance can sustain.

So, in theory, you could reallocate that.

So, that 90 million, because our proposal was to maintain.

132.

Yep. So, if the, if we want to maintain the same level of funding in budget year one for Behavioral Health Bridge Housing, the trade-off is that it would be additional General Fund in lieu of Mental Health Services.

Why would it not be part of the fast-track Prop. One bond funding?

For Behavioral Health Bridge Housing.

So, bridge housing isn't part of the bond structure, it is part of potentially once Proposition One, the revisions to the local categories of funding, when there's the 30% housing intervention dollars, which starts July 2026, this would be an eligible use of dollars for those types of services, such as rental subsidies, operating subsidies, et cetera.

In July 2026?

Correct.

So, is it possible to defer $90 million for future budget year plus one so that we're essentially backfilling with the Prop. One?

Those are local dollars that we don't control. The state does not control those dollars.

Okay. Oh, dear. Okay. Those are all my questions.

All right. So, I want to thank all of the departments and Department of Finance for coming again today. You know, the understanding that this is a very, very tough budget year and decisions had to be made.

Some of the decisions that were made are very concerning about, like we said last week, the priorities of our state, but also where we are going to go as far as the health and well-being of the residents of California.

Understanding that you were trying to keep some of those core services available, but like I said last week, you can keep those. And yet people still don't have access because they don't have providers to go to.

We've done so much in a short period of time in terms of building up our Public Health Department, not only at a state level, but a local level so that we can be prepared for what we're seeing now and what we will see to come.

And so, to pull back some of those dollars would really put us in a very dangerous position, to be quite honest with you, especially given the size of our state, the number of residents that we have here, and the need to act quickly on a variety of different things that are coming our way.

Very concerned, of course, like we talked about last week with the proposal to eliminate the Indian Health Grant. Still don't understand the rationale behind that when we know that we're looking at vulnerable communities, where that would lead us if we remove that grant, and where we would leave that population.

And, you know, so we have a lot of things that we need to clearly, from a legislative standpoint, look through, reevaluate and see what we agree with and what we don't agree with.

I am very concerned, of course, with the promises that we made to our future physicians and the fact that we were now proposing to put them in a very precarious situation where they will not be able to continue to be trained here despite them keeping up their end of the bargain, that we would pull this away from them at such a critical time.

But at this point, I'm going to open it up to public comment to hear from some of the stakeholders who have hopefully had more of a chance to kind of digest some of the proposals and also listen to the hearing from last week. So, we have a lot of people who want to speak, which is great.

We are going to give everyone one minute for your public comment. So, once again, we're going to give everyone one minute and we can begin.

Thank you, Chair and Members. Mark Farouk with the California Hospital Association speaking briefly, asking the Committee to reject the Administration's current MCO proposal. As policymakers and practitioners, you have heard for years about the need to adjust Medi-Cal reimbursement rates and what that means for access.

The target rate increases as part of the MCO deal reached last year are there to provide credit critical and foundational services to Medi-Cal patients. Madam Chair as well as Madam Chair, thank you for your continued inquiry into this issue.

We have deep concerns, as many of you have expressed and would echo the comments that you've made, as well as your questions about this proposal would ask that you reject that proposal. Thank you.

Thank you.

I'm Doctor Mark LeBeau, CEO of the California Rural Indian Health Board. CRIHB has a membership of 68 fully recognized tribes and 20 tribal health programs throughout California. We recommend the Subcommittee reject the Department of Health Care Services proposal to eliminate the Indian Health Program, which was established in 1975.

Tribal and additional American Indian communities endure significant health dispensation disparities and comprise one of the most vulnerable populations in the state. We are recovering from multigenerational trauma and post-traumatic stress imposed on us by colonial forces. Our clinics are chronically underfunded by the federal Indian health service and are reliant upon the state for resources.

In light of this, tribes again urged the Subcommittee to reject Department of Healthcare Services proposal to terminate the Indian Health Program. Thank you.

Thank you.

Thank you. Stephanie Weldon, United Indian Health Services. I too, ask that you reject the cuts proposed to the Indian Healthcare Program for all the reasons stated prior to. But in addition, the Department has failed to consult with tribes on this program. It's not a new program.

The Department is responsible under the Governor's executive order, as well as last year's bill that requires consultation with the government to government with tribes. We have a lot of needs. Our tribe supports traditional healing as well as behavioral health recruitment and retention. The counties are funded, yet they do not serve our people, especially in behavioral health.

We are working with DHCS. However, we still have a lack of access to culturally responsive behavioral health services this is the one funding source that allows us to provide increased access and culturally responsive behavioral health. We talk a lot about equity, but tribes are not mentioned in that.

And so by cutting this program, equity is merely just a word and a stamp. Thank you.

Thank you.

Good evening. Thank you. Stacey Hiramoto with REMHDCO, the Racial and Ethnic Mental Health Disparities Coalition, also representing the Community Partners of the California Reducing Disparities Project. First, I want to support the remarks of Mark LeBeau and the speaker after him. We are very concerned about the cuts to the Indian Health Program, too.

But I also want to commend you for, in your analysis, pointing out the CYBHI, the Children and Youth Behavioral Health Initiative cuts. One of the cuts in particular, the awards have already been handed out and this is the public education campaign in Department of Public Health.

So, we really are concerned because those are going to some of our partners, the community-based organizations that are the safety net, also the one under DHCS. Thank you. The reduction of programs to scale community-defined evidence practices. CDEPs are the services that are preferred and are very effective with BIPOC and LGBTQ communities.

And a recent study showed that for every dollar spent, you save $5 the state does on these programs. So, thank you very much.

Thank you.

Thank you very much. Vanessa Cajina, on behalf of the California Academy of Family Physicians, in great appreciation of your remarks on the song Brown program. Under HCAI, we are extremely concerned about what it would do to current cohorts in the upcoming years about where they might be able to practice. We do Song Brown.

We do this investment as a state. We've done it for decades because primary care is not funded adequately at the residency and training level. We are in a primary care crisis, and we urge you to reject that cut. We are also disappointed in the MCO tax proposal to sweep those savings.

An ounce of primary care is worth a pound of delivery down the system. So, we urge you to reject that cut as well. And then on behalf of Vision and Compromiso, the statewide network of promotores and community health workers.

The investment in community health workers has been an equity building investment for a population of people who have historically been systematically excluded from the healthcare professions in California. We urge you to reject that cut. Thank you very much.

Thank you.

Good evening. Michelle Gibbons with the County Health Executives Association of California, representing local health departments. Thank you for the concerns raised around the public health funding. We don't qualify in any of the categories that the Department of Finance raised in terms of how they chose this cut. It's not. It's ongoing.

It's, you know, so we don't qualify in those buckets. We'll go back to as prepared as we were in 2020, which just was not sufficient. We also are still trying to figure out what the funding is for Cal Connect, how much, how long, and if this is going to retain all the capabilities.

So, we hope that there'll be ongoing dialogue around that. Syndromic Surveillance trailer bill just posted today. We are digesting, but want to make sure that we retain our local systems. Appreciate the movement on CHDP. Want to see all the funding going over to the healthcare program for children in foster care. Thank you.

Thank you.

Good evening. Geoff Neil, first, on behalf of San Diego County, look forward to working with the Committee and the state on language around the incompetent to stand trial, making sure at the very least, that the money, that the penalty money that is to be returned is done so maybe in statute with a specific deadline for when that money would come back to fulfill that promise.

And then also on behalf of San Diego, Contra Costa and Lake counties, urge you to reject the devastating cuts to public health. Thank you.

Thank you.

Good afternoon, Madam Chair Member. Martha Guerrero, representing the Los Angeles County Board of Supervisors for two reasons. For the Child Health and Disability Prevention Program, we request that all the funding go to the Health Care Program for Children in Foster Care transition. And so also, we are currently analyzing the May Revision proposals.

We have serious concerns with the Health and Human Services and will be provided immediately with the budget impact as soon as we are able to present it to you. Thank you.

Thank you.

Thank you, Madam Chair, Assembly Member Bonta. Cathy Senderling-McDonald for Alameda County. As I previously testified, this will affect 40 staff, 39 staff who have either already been hired or are being recruited.

And as we think about the impacts across the breadth of the services that the public health departments provide, I think we all know that the foundation was very shaky before the pandemic and this agreement came about the funding, because we saw during the pandemic both the value and the imperative of better preparedness, not just for a pandemic or the next public health crisis which will come, but for all of those underlying foundational issues as you heard from the Public Health Director.

That was a really good move. And so, we're urging you to work with us in partnership, as we know you hope to, to not turn back that clock. Thank you.

Thank you.

Good evening. Molly Robson with Planned Parenthood affiliates of California. At Planned Parenthood Health Centers, more than 85% of our patients have insurance coverage through Medi-Cal. And so, because of that, we ask you to reject the May Revision proposal to roll back the much-needed investments in the healthcare system through the MCO tax.

We need to maintain investments in the Medi-Cal system to help stabilize California safety net providers like Planned Parenthood to meet the needs of patients in California and make a sustainable, meaningful impact on healthcare delivery in California, including in sexual and reproductive healthcare. Thank you.

Thank you.

Cher Gonzalez on behalf of my clients, the Association of Northern California Oncologists, otherwise known as ANCO, as well as the Medical Oncology Association of Southern California, otherwise known as MOASC. My clients are deeply concerned about the May Revisions proposed elimination for the reimbursement rate increases to specialty care because we know for a fact that timely access to cancer care is directly linked to survivability.

We therefore urge this Subcommittee to do whatever it can do to make sure that those reimbursement rate increases go forward and you reject the May Revision proposal to eliminate those rate increases to specialty care. Thank you.

Thank you.

Good evening, Madam Chair and Members Jolie Onadair, with the California State Association of Counties, representing all 58 counties, just here to urge you to reject the proposal to fully eliminate the future public health funding. I think, as the State Department of Public Health mentioned, this would certainly impact their ability to prepare and respond.

We would have a very similar impact at the local level as well. Thank you.

Thank you.

Good evening, Madam Chair and fellow Committee Members. This is my first time doing a public comment, so please bear with me. My name is Jeneba Lahai, and I'm the Executive Director of Yolo County Children's Alliance.

On behalf of my agency serving communities in Yolo County and the Medi-Cal for Adult Older Adults Coalition, I am here to respectfully request your support and approval for the reauthorization of the Medi-Cal for Older Adults Program for Fiscal Year 24-25 and your opposition to the Governor's May Revision proposal to eliminate the Medi-Cal Health Navigators projects as part of the state budget.

Support for these two critical programs will allow for the continuation of vital work, which is happening in my county, in some cases life-saving, to provide comprehensive healthcare coverage and services to California's most vulnerable residents. We thank you for your time and consideration of our incredibly important requests. Thank you.

Thank you.

Kelly Brooks, speaking on two different items. First, on behalf of the California Association of Public Hospitals, and Health, we are opposed to the MCO tax proposal. Public health care systems are the core of California's healthcare net, providing 35% of all Medi-Cal and uninsured hospital care.

Due to low Medi-Cal rates and historical underfunding in these systems, they're facing a $4 billion deficit as they stretch to meet an unprecedented demand for services. They're very disappointed that the MCO tax will not be available to address Medi-Cal provider rates.

Second, on behalf of the Urban Counties of California and the boards of supervisors of Riverside, Ventura, and Santa Cruz counties opposed to the elimination of funding for future of public health. In Ventura County, with a population of 850,000, they had one epidemiologist prior to the pandemic. They've used the funding to invest in epidemiology.

They've launched a communicable disease program to combat the transmission of infectious diseases and elevate prevention and control practices in medical and non-medical settings. In Santa Cruz, they've used the funds to update community health assessments, rebuild core infrastructure, expand epidemiology activities, support workforce development and training, particularly trauma-informed and equity-based trainings.

We urge you to do what you can to help reduce the impact of that cut.

Hi, Sarah Dukett, on behalf of the Rural County Representatives of California, urging you to reject the elimination of the local public health dollars. With the decades of underinvestment in public health, combined with the real barriers and challenges for access to care in rural and remote communities, this will be absolutely devastating.

Thank you.

And when you take the scope of the cuts proposed in the state budget, along with the softening revenues locally, the rural counties just will not have the local dollars to continue to fund these positions. So, we urge you to reject those cuts. Thank you.

Thank you.

Good evening. Thank you. Madam Chair, my name is Elba Gonzalez Mares. I'm the Executive Director of a nonprofit organization called Community Health Initiative. Jeneba just spoke. She's one of my colleagues. Our organization serves individuals in Los Angeles, Santa Clara, Solano, and Napa. We proudly have served over 40,000 individuals.

These are folks who are vulnerable in poverty, who are aged, blind and disabled, and depend a lot on these essential services that we were speaking about today.

Also, I'm here to speak on behalf of my fellow colleagues who didn't make it here to today's budget hearing to talk about the just in support of our coalition of California and the Medi Cal for Older Adults work. Your support to prove the reauthorization can impact our projected assistance of 107,000 vulnerable older adults.

We have done really great work and built some fantastic infrastructure that really wasn't particularly there for our Medi-Cal older adults. And then now, so to please request your support and opposition of the other important infrastructure that's been built. That was shown in the Governor's revision of eliminating the Medi-Cal Health Navigators Project.

So these two critical programs are. It's part of that lives changing, essential creates equity, it creates that support and meet folks where they're needed in order to access one of the most important things as part of their lives, which is access to healthcare.

Thank you so much.

Thank you.

Hi, my name is Mark Diehl. I'm with California Coverage and Health Initiatives, and I'm just here to echo the comments of Elba and Jeneba. We really appreciate the opportunity to speak. Thank you, Madam Chair. We want to keep the funding for Medi-Cal for Older Adults in the state budget.

It's helping our most vulnerable older adults, people who are aged, blind, disabled and living in poverty. We also want to oppose the elimination of the Medi-Cal Navigator Program. We're one of the grant recipients, we partner with 12 local agencies to get those services out in local communities, and they're really critical.

They turn Medi-Cal into a program to actually get healthcare services for people. People come to our offices because they don't know where to go. They have confusion about their health insurance. About 90% of the clients that we serve in our offices are insured in Medi-Cal, but they don't know how to use it.

They don't know where to get healthcare services, so they're functionally uninsured. We're making sure that the insurance that you're paying for, the coverage that you're paying for, actually can be utilized. So, thank you for the opportunity.

Thank you.

Good evening. Chair Weber and Committee Members Chris Stoner Mertz with the California Alliance of Child and Family Services. We are very concerned about some of the cuts to programs that directly impact the children and youth in California.

In particular, we ask that you reject the proposed cuts to youth suicide reporting and crisis response for the Department of Public Health, the HCAI Workforce grants, which are so critical to support our behavioral health work workforce. And we are deeply concerned about the cuts to round six of the CYBHI Community-Defined Evidence Program Grants.

These in particular are important to many youth in our communities that need access to non-traditional supports and services. We all know we're facing a youth mental health crisis. Now we have a budget crisis, but we can't give up on them. Thanks.

Thank you.

Good evening. Linda Nguy with Western Center on Law and Poverty. We opposed the devastating cuts to the safety net program and urge the Legislature and Administration to consider revenue solutions.

We're disappointed the Share of Cost Reform was not included, which means certain seniors and persons with disabilities are expected to live off of $600 a month and so really do urge creative solutions.

Also disappointed that multi-year continuous eligibility for children was not included and appreciate the conversation around enrollment navigators, both help people keep their coverage at a time when eligible people are being terminated. Considering the equity implications, we also oppose the cuts to the Indian Health Grants and Medi-Cal, community health workers in HCAI and the public health cuts

Related to Covered California, we're concerned with the proposal to draw healthcare affordability reserve and individual, individual mandate penalty transfer. Instead think those funds should go to a mayor exchange that will open Covered California to individuals regardless of immigration status. Thank you.

Madam Chair, Miss Bonta. Tim Madden, representing the California Chapter of the American College of Emergency Physicians. We ask that you reject the MCO proposal to shift the provider rates. Miss Bonta, you asked what was the, what would be the impact of eliminating these provider rates in terms of the number of physicians participating?

Thank you.

And for emergency physicians, 42% of the patients that we see are in the Medi-Cal population, larger than what the statewide coverage is from Medi -al, which is roughly a third. In our view, that is the direct result of a lack of access to services.

By shifting these funds away to, away from providers, we think that's only going to increase. Physicians are not going to participate in the program when they can barely cover the cost for seeing the patients. So, we think that's a good way to keep an eye on what the impact of this proposal will be.

Specifically for emergency physicians, the number of emergency physicians we have to cover the emergency department is largely dependent on the revenue we receive from the Medi-Cal population. By not allowing us to increase that reimbursement, a shift may have one emergency physician, whereas with the provider rate increase, we might be able to have two emergency physicians cover a shift.

That's good for everyone because I know you understand the emergency department treats everyone. We don't have a special place that's just for Medi-Cal, and everyone goes to a different part of the emergency department. We're all trying to access services through the same front door. So, we would ask.

Thank you.

Thanks.

Madam Chair, Assembly Member Bonta, thank you for the hearing. Christian. Thank you for the sauciest revised agenda yet to be present. Darby Kernan, on behalf of Public Health Institute, we want to express our opposition to the public health cuts.

We agree with the questions and the line of questioning you did today and support the direction the Committee is looking in. In addition, on behalf of the local health plans, we oppose the MCO tax proposal using all the funds for the General Fund backfill. The loss of this much needed funding for provider rates will be a problem for everyone. Thank you.

Thank you.

Good evening, Chair and Members. Beth Malinowski with SEIU California. Want to thank you for the additional critique and commentary tonight in the public health item with CHEAC and our county colleagues. Really stand in alignment with our full California can't wait coalition and asking for you all to reject the tremendous cuts here to our public health infrastructure.

Appreciated Doctor Aragon's reference to this funding being the roots of our public health system. I want to take it maybe a step further and say, when I think of the future of public health funding, it is not just the roots of public health, but also the roots of our economy as a whole.

We saw in the pandemic that when we don't properly fund public health, our whole economy shuts down, our schools shut down. None of us want to see that happen again. So really stand with you and trying to think about any way we can approach this item so that we maintain this investment. Thank you so much.

Thank you.

Good evening. Ryan Souza, on behalf of community health works in Sacramento, formerly Sacramento Covered. We just want to urge this Committee to reject the cuts to the Community Health Worker Training Program and Medi-Cal Navigators Program. Currently, Community Health Works employs about 130 community health workers and they're set to expand.

But with these cuts, that all comes into question, and they need a mechanism to expand training and certification specifically for community health workers with lived experience. Thank you.

Thank you.

Good evening, Madam Chair and Committee Members. Emily McClintick. I'm with the Public Health Institute and here to voice my concerns about the proposed cuts to the Children and Youth Behavioral Health Initiative Public Education Change Campaign. The local level component of this project was launched in March of this year with 28 selected community-based organizations already onboarded.

It's important to note that these projects are already in motion, and the 28 CBOs are currently working with youth, parents, caregivers and community service providers to address mental and behavioral health with our most vulnerable. Eliminating these funds will jeopardize that critical work and waste the effort efforts that have already gone into this project.

These youth-led campaigns will reduce stigma around help-seeking behaviors and open pathways for improved community understanding for the challenges youth are facing. We know that public education and reducing stigma improve help-seeking among youth. So, please help us to follow through with supporting youth mental and behavioral health across California by maintaining these funds. Thank you.

Thank you.

Thank you, Madam Chair and Members. Brandon Tate with the Youth Mental Health Equity Coalition.

First, I want to thank you for the additional work you've done, and it was obvious in the analysis on the agenda and your additional hearing today that you are hearing us about how important this issue is in terms of the elimination of the youth mental health programs at the Office of Health Equity in the CYBHI campaigns.

These programs provide critical support for our most vulnerable youth, including LGBTQ youth, Black youth, Latino youth across the state. Many of the CBOs that are doing this work are already funded.

And it's disappointing to see that while the Governor's proposed budget leaves in place things like an app that we're not sure, with hundreds of millions of dollars being invested that we're not even sure teens will use, while at the same time cutting local programs that we know are proven to be effective.

We hope that you'll reject these cuts and look for more equitable ways to share the burden and not doing so at the Office of Health Equity. Thank you.

Thank you.

Osceol. My name is Emma Snuggs. I'm a Cherokee Nation citizen, as well as the Executive Director of the Tribal People's Empowerment Project and a departmental scholar in American Indian Studies from UCLA. I know you have a lot of difficult decisions ahead of you.

I've been here and listened to everyone and the important issues that folks have presented to you all day. But I'd like to share with you that we have the highest rate of opioid-related overdose in our community. We have the lowest life expectancy.

Members of my community are 2.3 times more likely to die of diabetes than their white counterparts, have the highest rate of suicide. And lastly, one in three Native American women report being raped in our lifetimes.

I also lost my own brother two years ago to a fentanyl overdose, and I work tirelessly to both educate on opioid reversal tools. We pass out Narcan and fentanyl test kits to members of my community, and I'll leave you with this.

There is a lot to lose for everyone who's approached you today, but in my community, a budget cut of this magnitude will result in the loss of life. Thank you very much.

Thank you.

Hi. Good afternoon. My name is Luis Cortese. I'm with the LGBT Youth Center here in Sacramento. I'm here to advocate against the budget cuts proposed, in particular the Youth Mental Health Program at the Office of Health Equity.

As you know, LGBTQ youth are one of the highest, have the highest rate of suicide of most populations, and not only these budget cuts will not only force us to cut our programs, if you, particularly our satellite programs that are in Yolo, Placer, and El Dorado country, county, which are the only ones of its kind, but we also have to lay off our clinicians and cut down our free mental health services and which, you know, we, and we have, where we have around 70% success rate in having people off medication, having a thriving and happy life.

The budget cuts will be extremely instrumental to us, and we hope that y'all reject these, these cuts. Thank you so much.

Thank you.

Good evening. Ronald Coleman Baeza here on behalf of the California Pan-Ethnic Health Network, CPEHN. First and foremost, really urge you to reject the cuts to the Indian Health Program. You know, certainly, this community has been colonized, isolated, and marginalized over the years.

This program is extremely important to make sure that they can deal with the challenges that are coming up in their community, specifically related to health, in the ways that their communities wants them to. And so please do not eliminate the program. We're also very concerned about the public health cuts.

You know, certainly for the first time over the last couple of years, we've seen public health dollars going into our communities with local public health actually resource. They're building bridges with community organizations, talking to communities, working with communities to be able to make sure that those needs are met.

This is not something we've seen before because of the lack of funding that public health departments have had, and we need to make sure that we keep that work going. This is not just a cut to public health workers and infrastructure. It's also a cut to low-income communities of color.

Additionally, we're very disappointed with the cut to HCAI and also the Health Navigators Program. We really appreciate the Chair, the Assembly Member Bonta's comments, particularly as it relates to both CHW funding for workforce at HCAI, but also the elimination of the navigator funding. These two programs are extremely important, particularly with CHWs.

You know, the implementation of the benefit has not rolled out as robustly as we would like to see. The workforce training dollars were extremely important to make sure that we could ramp up that benefit. If those dollars are eliminated, we're going to have trouble rolling that benefit out the door moving forward. Thank you.

Thank you.

Now Virginia Hedrick. I'm Executive Director of the California Consortium for Urban Indian Health and a Member of the Yurok Tribe, and urge you to oppose the elimination of the Sate Indian Health Program.

Since its elimination in 2009, American Indians and Alaska natives have lost eight years of life expectancy and also reject the Administration's position that difficult decisions had to be made. I don't accept that as a rationale for the elimination of this budget and agree with former comments made that continued years of lives will be lost.

Thank you.

Hasasaka Nikiyam Kakong Calvin Hedrick, I am a Mountain Maidu and I'm also the Director of Organizing for the California Native Vote Project, and I'm here to express my strong opposition to the elimination of the California State Indian Health Program.

This vital program provides essential healthcare services to our Native American communities, addressing unique healthcare disparities and cultural needs that mainstream services often overlook. Eliminating this program would disproportionately, excuse me, impact our communities, who continually fall below the nationwide averages and leading to worsened health outcomes and further marginalization. It's not just about healthcare.

It's about upholding commitments to our Native American populations and ensuring we have the equitable access to the services our communities deserve. And we definitely, we definitely have seen in our community, when we cut things like this, things get taken away and there is loss of life.

And so I just, I really hope that you can reconsider and preserve this program. Thank you.

Thank you.

Good evening. My name is Gabriella Kohondig and I am a youth program manager for the San Francisco Community Wellness Department for the Native American Health Center. I help run a youth program, and so I see that the impact these programs have on so many youth and families in SF.

I deeply oppose the elimination of the State Indian Health Program, and the consequences of this funding cut would be devastating to Native communities across California. Thank you.

Thank you.

Hello, my name is Kimiko Hostler. I am a youth organizer with the California Native Vote Project, and I come from the village of Talk Milden on the Hoopa Valley Reservation in Humboldt County.

I'm here to address the May Revision, which proposes eliminating $23 million in funding for the State Indian Health Program. This cut would completely defund the IHP, jeopardizing 27 critical health programs across California. The State of California has promised support for Native Americans through initiatives like the Truth and Healing Council.

However, eliminating IHP funding blatantly contradicts these commitments, turning promises into empty words, as we California Indians have historically experienced from the state government. The IHP is not a budget line item. It is a lifeline. It provides essential medical care, behavioral health services, and culturally specific programming.

With Native American youth facing suicide rates over twice the national average, the IHP's role is indispensable. It directly addresses these severe mental health challenges, offering critical support that saves lives. Cutting this funding is not just a financial decision, it is a direct assault on the health and well-being of thousands of Native Americans.

It exacerbates existing health disparities and undermines any claimed commitments to truth and healing. I challenge you to uphold your promises and commitments, rejecting the proposed elimination of IHP funding and standing with us to support the essential services, and prove that your words are more than just rhetoric. Thank you.

Thank you.

Istango Sequoia Ko Munjo Kif Kudos I'm a Member of the Seminole Nation of Oklahoma and Muscogee Creek, and I'm also a community organizer with the California Native Vote Project. I strongly urge the decision to reconsider eliminating the 23 million in funding from the State Indian Health Program.

The funding provides so many vital services, including medical care, behavioral health, and culturally specific programs, that myself, my family and a large majority of American Indian community members across the state positively benefit from.

With our population having significantly lower life expectancies, our youth having the highest rates of suicide, and many other health disparities, this cut will leave such a devastating impact on the health services that are available for the community and will cost thousands of patients to lose access to essential care that would not be available if not for the provided funding.

It is imperative that the decision-makers understand the grave consequences of this funding cut. The 23 million is not just a budget line, it represents lifelines for many individuals who rely on these services for their health and well-being.

Eliminating this funding would further increase the health inequities faced by our community and undermine the previous efforts to improve our overall health outcomes. Therefore, I strongly urge you to maintain this crucial funding to ensure that the American Indian community continues to receive the support and care we desperately need and deserve.

Thank you.

Good afternoon. John Drebinger with the Steinberg Institute. We urge you to consider rejecting the cuts to behavioral health workforce investments in the May Revise. As you know, we're in a behavioral health crisis that's only exacerbated by our workforce shortage and our inability to meet existing demand.

Steinberg Institute estimates that we need 375,000 new behavioral health providers over the next 10 years in order to meet that demand. So, cutting at this time could have a year's long impact on our ability to do so.

Specifically, the $120 million cut to Social Work Expansion Program could fund 3,000 social worker stipends, but our estimates say that we need 32,000 over the next year. So, as you can see, these workforce cuts could have a year's long impact in our ability to expand our capacity. Thank you for your consideration.

Thank you.

Roger Adraashkai Higanina. I'm a Member of the Ho Chunk Nation and I'm here to oppose the cuts that are of the $23 million that are post cuts for the Indian Health Program. As you've heard before, we're facing a fentanyl crisis here. People are dying. Not only that, we got diabetes problems and we have other behavioral health problems.

I oppose those cuts because we need actually more help and not less. Thank you.

Thank you.

Pamela Lopez with Key Street Consulting on behalf of the Tule River Tribe and the Tule River Indian Health Clinic. We also oppose the zeroing out of the IHP programs. We wish you all strength and fortitude for the difficult decisions that lie ahead and that you have to make.

I'll simply point out that there are nearly 2000 people living on the Tule River reservation. If their health clinic closes, their next closest opportunity to get basic things like Narcan for fentanyl overdoses and basic prenatal health treatment is over 45 minutes away down a windy mountain road for a lot of people who don't have cars.

Thank you.

Madam Chair and Members, Stuart Thompson on behalf of California Medical Association, we want to thank you for the opportunity to present about the importance of using a portion of the MCO funds towards provider rates and other investments in the Medi-Cal system. We're asking you to reject the proposed cuts in the May Revision. Thank you.

Thank you.

Nicole Wordelman. On behalf of Orange County, San Bernardino County and the Children's Partnership, in opposition to the public health cuts, it has built infrastructure over the last couple of years that cannot be easily replaced.

In addition, on behalf of the Children's Partnership wanted to oppose the Health Navigator cuts which provide children and their families access to healthcare they would not otherwise receive.

Clifton Wilson. On behalf of the counties of Kern, Fresno, Madera, Napa, Humboldt, Solano, San Joaquin, and Tulare, all in strong opposition to the May Revision's proposed cuts of an entire $300 million to the future of public health investments, including the 200 million dedicated to local health department workforce and infrastructure, and 52.5 million in the current fiscal year.

Thank you.

These funds enable county health and human service agencies to serve as the first line of defense against the growing public health threats in our communities and the retention of these funds is nothing short of critical. We urge the rejection of these cuts and thank you for your scrutiny and consideration.

Thank you.

Good evening. My name is Mike Duncan. I'm the Executive Director of Native Dads Network. We're a nonprofit organization here in Sacramento, California, that runs a statewide program that serves tribal communities throughout the State of California. And really happy to be here tonight just to urge the cut of the Indian Health Programs.

This is something that, working with so many different tribes, we witness firsthand the impacts of the fentanyl and other mental health issues, behavioral health issues that, that our community really needs support in. So, these cuts really would really hurt, you know, for our communities.

So, I just really urge that you don't cut the Indian Health Programs. Thank you.

Thank you.

Halito. My name is Alfred Gaskins. I'm from the Choctaw Tribe of Oklahoma. And I wanted to say that I personally go to the Sacramento Native American Health Center almost once a week for their cultural programs, because a lot of urban natives don't have access to traditional knowledge. And we get it through programs like these.

And when you defund them, it's going to disappear. And that really affects our mental health, and that causes the suicide rates to shoot up. And I really, really suggest opposing this Bill.

Thank you.

Yakoki.

Well, I would like to thank, once again, all of the departments who joined us for this hearing today. Really want to thank all those who came out and gave public testimony during the public comment section. And with that, this Committee meeting is adjourned. Thank you.