Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services
- Caroline Menjivar
Legislator
Alright, we'll get started. Good morning, everyone. Welcome back. Fortunately, we couldn't finish last Thursday, so it's going to be a little different today. We're going to finish where we left off last Thursday.
- Caroline Menjivar
Legislator
So it's basically social, Department of Social Services in the mix of it, bringing back some topics we did talk about Thursday, just some additional questions that you'll see on the agenda.
- Caroline Menjivar
Legislator
We'll go through DSS and then we'll swing back to health and dive deeper into some topics that we want further information on that we started talking about on Thursday. So that's the plan. We're here until, if we need it, until one. And that's how we'll do it.
- Caroline Menjivar
Legislator
We'll stick to what I said last week in terms of public comment. One big topic. We'll do public comment and move forward like that. So we'll start with childcare. Deputy Director, please join us up here. Department of Finance. Jackie, welcome back. And for this, you know, we started talking about the unspent dollars. The number was $19 million.
- Caroline Menjivar
Legislator
I'd also like you know, as the question shows, the $70 million as well. We focus on those two points more than anything.
- Jennifer Troia
Person
Good morning, Chair and Members Jennifer Troia, Chief Deputy Director of the Department of Social Services, diving straight into those questions on childcare. To go back to that subject, the first question that you asked was about that $19 million in projected federal ARPA funds.
- Jennifer Troia
Person
I'll kick us off and then ask my Department of Finance colleagues to add on if they'd like to. ARPA discretionary funds were eligible for uses to support subsidies or slots, but also for other purposes, like professional development rates, expanding the supply of childcare.
- Jennifer Troia
Person
That said, the funds had to be obligated for a specific purpose by September 30, 2023. We as a state did obligate all of the funding, and we did so by the deadline. The $19 million that we are estimating may revert to the Federal Government was obligated to support slots and therefore can only be used for that purpose.
- Jennifer Troia
Person
More specifically, the funds are still obligated. They are in contract actively with General childcare and Alternative Payment Programs.
- Jennifer Troia
Person
What we shared with you about the 1$9 million is based on our most recent assessment of what we expect them to expend out of those contracts, and that is a 99% utilization rate of all of the funding, leaving this $19 million. It's a point in time estimate.
- Jennifer Troia
Person
If the contractors are able to utilize all of the funding, we would not revert any to the Federal Government. It's our best estimate at this point. In time of what they're not likely to utilize because of the time it's been taking for them to ramp up implementation.
- Jennifer Troia
Person
But the money is actively in contract and that's why we are unable to alter the intended uses. So I hope that provides a little bit more clarity. I don't know if others want to add, but.
- Tamara Weber
Person
Tamara Weber, Department of Finance. I think the Deputy Director explained it pretty well, but happy to answer any questions.
- Caroline Menjivar
Legislator
Deputy Director. Okay, so the $90 million, well, just the bigger number was allocated to contracts for expansion of slots. This is an anticipated unspent dollars of the funding that's already been provided to the vendors providers that potentially will not be able to be spent by what time?
- Jennifer Troia
Person
The end of September this year.
- Caroline Menjivar
Legislator
Because of the process to getting slots out to the consumer and so forth.
- Jennifer Troia
Person
Correct. So I would say on the voucher side, the contractors that we have need to have enough staff to process the eligibility. The families need to identify a provider and get that done in time. On the contract side, where we direct contract with centers, they need to have enough staff and facilities.
- Jennifer Troia
Person
And so as we have been ramping up, we have been very successful, as we talked about Thursday, in expanding, but not as quickly as we would have liked because of those logistical issues on the ground of actually getting the expansion.
- Caroline Menjivar
Legislator
Would this then pose an additional number to the 12,000 slots that are on the table potentially be clawed back an additional of this amount?
- Jennifer Troia
Person
This is. I don't know how to think about this in terms of the slots.
- Tamara Weber
Person
Do you want to. Yeah. So this is $19 million that's in contracts for current service level slots. So it's completely independent of any new slots that would be added in 24-24.
- Jennifer Troia
Person
On the APP side. So on the voucher side, they have two years to expend the funding that we have provided to them. It's a two year contract.
- Jennifer Troia
Person
Part of the reason it's complicated, to answer your question, is that some of what we do is shift the funding around so it's not so much a slot issue in the sense that if they ultimately end up utilizing the slots that are there now, we might be using a different color of money.
- Jennifer Troia
Person
The question is, if we run out of time before this color of money expires. On the General childcare side, it's a one year contract.
- Caroline Menjivar
Legislator
Okay, I think I understand that part, but I think I want to go back to the question I just asked. If the $19 million was already allocated, however, was allocated for the different vendors and they can't meet that, doesn't that potentially also decrease the number of slots that they thought they were going to have.
- Jennifer Troia
Person
We have already accounted for the funding that we expect to go unexpended in slots elsewhere. This is funding that we, I think we've already accounted then for that in the total number of slots as well. Is that as well?
- Caroline Menjivar
Legislator
Okay, so $12,000 potentially can include the unspent. $12,000. Not the unspent, the $12,000 we can't. We're proposing up further, providing resources. And then this one, the $19 million that is only allocated for slots, the.
- Jennifer Troia
Person
Slots that we talked about in terms of what we anticipate not being able to Fund that would have otherwise gone newly into contract. Was. It's a different Fund source?
- Caroline Menjivar
Legislator
Yes, it is, but they all Fund for slots.
- Jennifer Troia
Person
They are all funding for slots. That is a different fund source.
- Caroline Menjivar
Legislator
Okay, Jackie, do you have anything on this?
- Jackie Barocio
Person
Jackie Boracio, Legislative Analyst Office. We're in the process of trying to schedule a meeting with the Department to better understand the issues behind why these funds would go unexpended.
- Jackie Barocio
Person
As your agenda noted, last year we were in a similar position where through our conversations with the Department, hundreds of millions of dollars of federal funds were projected to go unspent. Potentially some of those were also in contract.
- Jackie Barocio
Person
I think the way that the Department obligated those dollars, as the Department expressed, is rather than pay quarterly payments or monthly payments, however, those payments are made with a General Fund dollar. Maximize those payments with an ARPA federal dollar. So make those payments 100% until you spend on the federal funds. Then you'll dip into the General Fund.
- Jackie Barocio
Person
The Department is already projecting within the budget that they will do some Fund shifts with $97 million ARPA discretionary. I think some of the questions we have is, are those dollars in contract and are we shifting those dollars or were they never put into contract?
- Jackie Barocio
Person
What is the distinction between our ability to spend that money before September 2024 versus this $19 million? Or is the issue workload, administrative capacity?
- Caroline Menjivar
Legislator
Okay, I know you're looking to schedule that. Meaning, is there anything you can share regarding which kind of funds we're re appropriating or shifting around once that have more flexibility, ones that are about to end?
- Jennifer Troia
Person
We do periodically assess contractor spending levels and identify any adjustments to projected expenditures on that sort of first in, first out basis to make sure that the dollars that expire the soonest are expended first. We, as Jackie noted, are planning to do that similar kind of redistribution in August.
- Jennifer Troia
Person
But we're projecting that even after we do that redistribution, this is the amount that may be left again. The contractors could expend it, but this is what our projections now, based on the trends now show would be remaining even after that shift.
- Caroline Menjivar
Legislator
And do contracts know that that money could potentially be pulled back?
- Jennifer Troia
Person
They know that this funding has this timeline, yes.
- Caroline Menjivar
Legislator
Okay. Okay. All right, let's move on to the second question, please.
- Jennifer Troia
Person
The next question was about previously awarded CCDF funds. So not the one time relief funding, but the regular CCDF funds. And I just want to clarify, I think there may have been confusion. We are not projecting any regular CCDF funds will go unspent.
- Caroline Menjivar
Legislator
Okay.
- Jennifer Troia
Person
That's a three year window for utilizing the funds. We have plenty of time to identify the eligible uses and to utilize them fully.
- Caroline Menjivar
Legislator
Okay, what's the deadline for the utilization of these funds?
- Jennifer Troia
Person
We have a three year plan period for our CCDF state plan. Our new plan is coming now. Do you remember how long we have to liquidate the existing fund?
- Gabrielle Santoro
Person
At a high level. Sorry, Gabby Santoro of Department of Finance at a high level. The regular CCDF award is on a three year rolling basis. Don't have the exact date. Happy to get back to you.
- Caroline Menjivar
Legislator
How much? So we have available funds right there. Can you explain to me why then we can't use this for the slot to the bridge? What is it called? The emergency bridge program.
- Jennifer Troia
Person
Our CCDF plan happens on a three year period. We have all of the funds that are currently in the CCDF plan allocated. We have them identified for eligible uses, which do include slots.
- Caroline Menjivar
Legislator
Got it. Okay, so that's. And when's the third year end? When is the third year? Are we in the first year? Second?
- Jennifer Troia
Person
We're in the third year, but I don't remember what the timeline is exactly in terms of the close out of the expenditures. Our new plan is due July 1, this summer.
- Caroline Menjivar
Legislator
Okay. Okay. And as we enter into this last year of this three year plan, the entire allocation within this Fund is accounted for. Will all be spent before we submit. Not before, but. And then we'll submit the new plan for the three year.
- Jennifer Troia
Person
We don't expect to have anything left unexpended. I think what perhaps was referenced on Thursday was that part in similar vein to what we were talking about earlier. There is some degree to which we can sort of shift things, and when we shift them, sometimes we're able to identify savings. This funding is intended to supplement, not supplants.
- Jennifer Troia
Person
So we can shift in certain ways, but also have to be cognizant of that. And I think there was a question about $70 million as to whether or not there was any additional potential opportunity to shift, and I'll defer to my colleagues at finance if they have anything to add to that.
- Gabrielle Santoro
Person
Gabby Santoro, Department of Finance like Deputy Director Troia said, we are not anticipating any of that $70 million balance. Like we are working to maximize that so it doesn't revert back just for clarity because we are still working on evaluating eligible uses for that balance.
- Gabrielle Santoro
Person
We did not score associated General Fund savings as part of the May revision. However, we are continuing to work that and happy to fold in the Legislature and staff to inform you on our progress about how we maximize that $70 million balance.
- Caroline Menjivar
Legislator
I guess I think I just got, I confused myself. There is a 70 million balance?
- Gabrielle Santoro
Person
So, the only distinction is just that we did not, it is our intent to use that balance and recover General Fund savings. We did not score those savings as part of the May revision so you don't.
- Caroline Menjivar
Legislator
So you have a plan of utilizing it?
- Gabrielle Santoro
Person
Yes, correct.
- Caroline Menjivar
Legislator
Got it. And is within that discussion, the two items that are proposed for delay or cuts, the slots, the expansion of the slots and the emergency bridge program.
- Gabrielle Santoro
Person
We are definitely taking a holistic look at any opportunity to make sure that we're not. We're minimizing reversion of federal funds, including for that $70 million balance. So that would that, you know, looking at the whole picture, that could be a part of the.
- Caroline Menjivar
Legislator
What would bar us from utilizing that, for that? I just, I guess help me understand. If we're proposing cuts and there's an option, what bars us from just automatically doing that instead of proposing cuts to the expansion and proposing cuts to emergency bridge program?
- Gabrielle Santoro
Person
I think part of this is the Administration, as an awardee of federal funds, is working with the Federal Government to make sure that whatever funds or whatever purposes we are using for this balance are eligible. So it's part of the process.
- Gabrielle Santoro
Person
But to your question about how do we evaluate uses, I think that we're looking at anything, any possibility of spending those funds so that they don't revert back.
- Tamara Weber
Person
Yeah. And with respect to the $70 million, that is a one time balance that is not ongoing funding. And when we introduce new slots, we make an ongoing commitment. So that could only get us so far with the slots and we would have to cover the rest with General Fund.
- Caroline Menjivar
Legislator
Is that the same thing for emergency or is that one time support for each individual? Say for each.
- Tamara Weber
Person
The may revision proposes an ongoing reduction of the $35 million for.
- Caroline Menjivar
Legislator
Right. But when we allocate an emergency slot support at that time, do we allocate an ongoing support for emergency, but. Or is it just keyword emergency, It's a one time allocation?
- Gabrielle Santoro
Person
At a high level. In terms of how the program works, we make a voucher available for a year long period. There was a recent amendment to add flexibility to the extent that, like a child in the foster family that's caring for them needs additional time. But in terms of the funding, we make it available.
- Gabrielle Santoro
Person
It's not like a one fund. We just have the overall funding available for those voucher slots, so we're not.
- Caroline Menjivar
Legislator
And $34.8 million ongoing. How many emergency slots, on average, does that cover?
- Jackie Barocio
Person
We did a rough calculation back of the envelope again, as the Department of Finance and the Department of Social Services, as noted, calculating a rough slot number is difficult because programs are funded mainly like funding. But if we were to look at average cost per slot, it's roughly 1700.
- Gabrielle Santoro
Person
I believe.
- Caroline Menjivar
Legislator
Jackie, maybe, you know?
- Jackie Barocio
Person
But I would note that those slots currently are not being used. Our understanding of the administration's reduction is that this is right sizing, but as we pointed out last week, it's right sizing based off of current take up trends.
- Jackie Barocio
Person
To the extent that we're not doing the slot expansion in other programs, which is our understanding as to why maybe bridge slots have come in lower than budgeted, because there was capacity in other programs that may change the take up trends moving forward.
- Caroline Menjivar
Legislator
How much funding will continue in the service? The emergency bridge?
- Krishan Malhotra
Person
Krishan Malhotra Department of Finance under the May revision proposal, the emergency child care bridge program will still have $59 million in total funding.
- Caroline Menjivar
Legislator
Yes, thank you. I wrote that down. Okay, so summarizing, $90 million potentially, we don't know. Vendors could utilize it. And you're saying it's really difficult to automatically take that back to allocate somewhere else because it's already in the vendors.
- Caroline Menjivar
Legislator
$70 million doesn't really exist because you will have a plan or you're working on having a plan, and we're staying engaged in that. We will meet with LAO on the questions that Jackie proposed here on ensuring not a penny gets unspent and stays within childcare seems to be okay. And then the final question.
- Jennifer Troia
Person
I'll defer to my colleagues at finance for that.
- Krishan Malhotra
Person
Krishan Malhotra Department of Finance the approximately $60 million in new federal child care funding anticipated from the Federal Government this summer. Of that $60 million, we currently have an estimate from the Federal Administration of Children and families for that funding. We don't know how much we're actually going to be receiving.
- Krishan Malhotra
Person
It's not standard practice for us to budget funds that we haven't received yet. And so we don't have, you know, direct answers to what's going to happen with those funding, with that funding, until we receive the award letter from the Federal government.
- Caroline Menjivar
Legislator
Couldn't we then use provisional language for childcare slots or anything else if there's a potential for funding coming in?
- Tamara Weber
Person
Tamara Weber, Department of Finance we're willing to entertain any kind of proposal the Legislature wants to make about what to do with the $60 million if and when we actually get the award.
- Caroline Menjivar
Legislator
Okay.
- Jackie Barocio
Person
I would just note that the award letter, they typically come in July and August. Another option could be, which we've seen in other areas, too. When we know we're going to get a federal dollar, we just may not know how much is.
- Jackie Barocio
Person
You could the Legislature could consider as a part of the June package, adopt a placeholder number and then potentially through August cleanup, just correct that number to reflect actuals.
- Caroline Menjivar
Legislator
Thank you, colleagues. Any questions on the childcare issues?
- Susan Talamantes Eggman
Person
Senator, I would just say that I like what you're proposing because then at least we have that placeholder that will remind us that that's out there. Just so it's like what happened to that money.
- Caroline Menjivar
Legislator
Right. Okay. Thank you so much. Moving on to issue number two, Deputy Director, on this one big emphasis on the home visiting program, more than anything on the mental health.
- Caroline Menjivar
Legislator
I just want to know if there's anything that's come out of that conversation on last Thursday about the transition of people in services and what that's going to look like. That's really it. That's what I'm looking for here.
- Jennifer Troia
Person
Okay. Thank you. Jennifer Troia, on behalf of the Department of Social Services, again, with respect to revisiting some of the conversations about CalWORKS and what you just referenced. Starting with the home visiting program and the questions in the agenda, the May revision proposes a total Fund of $58 million for the home visiting program.
- Jennifer Troia
Person
So this reflects a reduction of $47.1 million in 2024-25 and ongoing to adjust funding to utilization and address the budget shortfall. As I think we talked about on Thursday, the home visiting program is currently implemented by 41 counties across the state and serves an average of 3400 families per month for the calendar year 2023.
- Jennifer Troia
Person
You asked about the outcomes of the program. We did conduct an evaluation in 2022 with the University of California, San Francisco. They found that clients experienced the home visiting program to have improved their quality of life and that of their children on a number of fronts. For example, they experienced improved parent child bonds and gained parenting skills.
- Jennifer Troia
Person
They were connected to other services that helped to meet their basic needs. They reported increases in food security and in mental health. Participant families, also, of them, a greater proportion of children receive developmental screenings than for other Medi-Cal recipients and other preventive services.
- Jennifer Troia
Person
As we're still in implementation and uptake fairly early on for this specific CalWORKS home visiting program, we don't yet have information on the longer term improvements and things like financial stability.
- Jennifer Troia
Person
That said, home visiting programs more broadly, including the models we specifically use, are very well researched and that research has documented improvements in infant and maternal health, the prevention of child abuse and infant mortality, early learning and long term academic achievements, and those same referrals and coordinations of services. You also asked about expenditures.
- Jennifer Troia
Person
In 2022-23 we allocated $99.5 million total to the home visiting program. Of that funding, $40.8 million was expended. To date. In the current year, $39.1 million out of the $100.3 million that was allocated has been expended. However, the counties can claim an arrear.
- Jennifer Troia
Person
So we will not know final expenditures for the current year until well into the budget year or even beyond. So that $39.1 million is premature to assume is the current year spending. Our best projection at this time for expenditures for the current year is $64.6 million.
- Jennifer Troia
Person
So to do the math for you, that would leave $35.7 million unspent. The proposed reduction that put forward in the May Revision was based on a point in time utilization rate.
- Jennifer Troia
Person
So given the numbers I just shared, I think you will see that because it's our understanding that counties have done some increasing of the number of families served in the current budget year, the actual utilization could be higher and some families currently receiving services would be discontinued from the program if that was indeed the case.
- Jennifer Troia
Person
We'll continue to analyze that data as it becomes further available.
- Caroline Menjivar
Legislator
Deputy Director, can you remind me, or maybe I got lost in the numbers there. Sure. The cuts are $47.1 million ongoing out of or what would be left ongoing.
- Jennifer Troia
Person
In 20, we allocated 100.3 for 24-25. Sorry, that's the current year in 2425. Do you have it handy? Go for it.
- Unidentified Speaker
Person
Yeah. So we have for 23-24, $103,000,000 allocated and expenditures average $64 million. So of the $47.1 million reduction, we are calculating that $38.7 reflects a true up based on utilization, and the $8.4 million left over is like kind of a baseline baseline cut for this reduction.
- Caroline Menjivar
Legislator
So we're moving forward with 34 ongoing for the program or 8.0 something ongoing for the program.
- Unidentified Speaker
Person
So it's the $104 million minus the $47.1 million reduction.
- Caroline Menjivar
Legislator
So about?
- Unidentified Speaker
Person
64. If my math is
- Caroline Menjivar
Legislator
Different, number over here. But it's around the same.
- Unidentified Speaker
Person
Yeah, yeah.
- Caroline Menjivar
Legislator
Plus or minus
- Unidentified Speaker
Person
Our expenditures are the 104 million.
- Caroline Menjivar
Legislator
Okay, so ongoing. This program will still continue with approximately $58 to $61 million.
- Unidentified Speaker
Person
Correct.
- Jennifer Troia
Person
Your next set of questions was about the mental health and substance substance abuse funding. As a reminder, the may revision proposes to reduce the full amount of that funding on an ongoing basis to assist in closing the projected budget shortfall. You asked about the number of individuals served in the agenda in 2022 to 23.
- Jennifer Troia
Person
A monthly average of 5628 individuals were receiving mental health and substance abuse services through CalWORKS. 5098 of that was mental health services and 530 were substance abuse services. In 2022 to 23, we allocated $126.6 million for these services and $89.4 million of that funding was expended.
- Jennifer Troia
Person
So far in 23-24. $85.1 million of the $126.6 million has been expended that we know of, though this is the same issue in the sense that the current year is not yet closed out and the counties have time to claim even after the current year ends.
- Jennifer Troia
Person
Our best projection at this time is expenditures in the current year of $72.1 million. So the remaining balance would be $54.5 million in the current year. Counties have flexibility designing and implementing these programs.
- Jennifer Troia
Person
As we discussed on Thursday, the focus is to remove barriers to employment and support self sufficiency so we don't track the utilization or outcomes in a more detailed fashion.
- Jennifer Troia
Person
You asked in particular about transitions, and I don't have anything to add to what we shared on Thursday in terms of the work that we would need to do with the counties to make sure that as much as possible, there are warm handoffs on the Medi-Cal.
- Caroline Menjivar
Legislator
Side in particular, and then also because we can assume most likely these people won't cut off services right at July 1, will there be some funding to continue the people who are in services throughout August-September?
- Jennifer Troia
Person
The proposal is to reduce the full amount of funding for the budget year.
- Caroline Menjivar
Legislator
So how then, if we do that, then everybody who's in day two of their 10 day inpatient treatment will be kicked out immediately.
- Jennifer Troia
Person
Hopefully, anyone who's in inpatient treatment is getting served on the Medi-Cal side already because it's a pretty Medi-Cal service. But I realize your larger question, your larger question was about people receiving those services.
- Jennifer Troia
Person
The only thing I can point to, which of course is difficult given the other proposals within the May revision, is that the counties have flexibility within the single allocation to provide services related to employment services. And to the extent that they feel. That these are,
- Caroline Menjivar
Legislator
We're cutting that drastically, Drastically.
- Jennifer Troia
Person
Yes.
- Caroline Menjivar
Legislator
So, I mean, I really do worry that, you know, it takes a while even to transition over to Medi-Cal. They're going to get kicked out of the service, figure out their insurance, and then maybe they'll come back to this service. This seems like it's a cold turkey cut off.
- Caroline Menjivar
Legislator
Doesn't matter what service you're in, you're going to lose everything July 1st without having to ramp up some kind of allocation just to weed people off. I'm really, really worried about that part. Really worried about that part. Ready? They're also worried. You can see it on their faces. They're worried. Okay, we can skip number three.
- Caroline Menjivar
Legislator
The third question. I'm going to move on to issue number three. Oh, I'm just kidding. LAO, any comments on that?
- Sonia Schrager Russo
Person
Sonia Schrager Russo with the Legislative Analyst Office. I would echo some of your questions that you've raised around the operational aspects at the county level. It may put counties in a difficult spot when they're facing bosing allocation reductions and also these proposals to figure out how to fund the folks who are transitioning off.
- Sonia Schrager Russo
Person
Additionally, we hope to engage with the Administration to get a better understanding of their current year projections when it comes to expenditures so we can report back on that.
- Caroline Menjivar
Legislator
Thank you so much. All right, now we can move forward. Do you have any numbers on utilization for the family stabilization program?
- Jennifer Troia
Person
In terms of the numbers of people served, it might take me a second to track that down. In terms of utilization, it is fully utilized. Actually over utilized. All of the funding.
- Caroline Menjivar
Legislator
Okay, please begin. We are now moving into new information that we didn't go over on Thursday. Great.
- Jennifer Troia
Person
The third item on your agenda relates to Child Welfare Services and the May Revision solutions. You asked us first to share an overview of those solutions. The first one is related to caregiver approvals. The May Revision proposes a reduction of $50 million General Fund for caregiver approvals workload in 24-25 and ongoing.
- Jennifer Troia
Person
This funding has been provided annually since 2022. It has been fully fully utilized by the counties. As of March this year, 1923 families with placements were going through the approval process. These are typically relatives. And 2716 pending families were seeking resource family approvals.
- Jennifer Troia
Person
So they did not yet have a child placed in their home but were seeking to become resource families. In terms of the outcomes of this reduction, we do expect that the reduction could result in higher caseloads for county staff who approved caregivers, and therefore there could be delays in the approval of caregivers and the permanency for children.
- Jennifer Troia
Person
The second proposal relates to the permanent foster care rates structure. We have a number of detailed changes to the trailer bill related to that proposal. I will save those for the later item on the agenda. The specific one that relates to the solutions is a trigger. The trigger mechanism is intended to identify whether there are available revenues in the Spring of 2026 in order to trigger on the permanent rate structure. I will turn to our Chief Deputy Director Ramsey for the Bringing Families Home Program.
- Claire Ramsey
Person
Claire Ramsey, Chief Deputy Director for the Department of Social Services. Would you like me to speak to Bringing Families Home again or hold off on that?
- Caroline Menjivar
Legislator
We'll hold off. I realize that we didn't do the public comment for that topic last Thursday, but let's... Deputy Director, let's go back to the rate structure. And Department of Finance, let me, help me. Tell me if I'm wrong here. And I was searching and didn't do... I don't think I did a good job of searching the entire budget on this, but is there anywhere else in the budget that has trigger language for a mandated infrastructure statute?
- Kia Cha
Person
Kia Cha, Department of Finance. We could take that back. I'm not sure if there's any other errors. If there's trigger language being put.
- Caroline Menjivar
Legislator
I don't think there is, and I'm wondering if we can walk through this again. This is the statutory mandate. We're solving, I get it, for budget plus one. This brings no savings whatsoever in putting the word trigger. But it really sends a message that even though this is a statutory mandate, we're going to put trigger language on this and just this. The Department always comes back to Budget Subcommittees, hey, we need to delay this. We need to delay that. We're doing it from almost everything. So I don't understand the need for the word trigger here.
- Kia Cha
Person
Kia Cha, Department of Finance. So I think the intent, we don't want it to delay this effort. The intent is that like the automation TBL and the work to develop guidance and other necessary activities.
- Caroline Menjivar
Legislator
I'm so sorry, ma'am. I said it wrong. You're right. I don't want to delay. I apologize. I'm going to cut you off really quick, so I can fix what I said. Why the need to put anything? We don't have to put delay. Just say, hey, this is going to be implemented in 2026, and for some reason something happens, we come back.
- Kia Cha
Person
Yeah. So the Administration continues to support foster care rate reform. I think given the volatility of General Fund revenues and just the significant size of this investment, we want to be able to monitor and evaluate that General Fund in the out years can support this investment.
- Caroline Menjivar
Legislator
We can still do that without a trigger because this is supposed to be going into play two years from now. We still have time next year to come back and reevaluate. But the trigger language really locks us in and gives, with all due respect, a lot more power to Department of Finance to just say, no, we put trigger language in this, versus having the dialogue to come back next year and say, hey, let's reevaluate with how this program is going and the process. I am not a fan of the word trigger in here. I think if we stick to the trailer bill language on the process and so forth, but no trigger language to this program.
- Kia Cha
Person
Understand. But I would just also note that whether or not... Like whatever the outcome of the determination, we are going to be having that conversation for sure in subcommittees.
- Caroline Menjivar
Legislator
100%.
- Kia Cha
Person
It's not solely a Finance Department decision.
- Caroline Menjivar
Legislator
Right. Right. And I want to have that conversation, but putting the trigger kind of limits it a little bit. It already says if we have funds, we're going to do this, we're going to put it on the trigger. But just leaving it as is, the Department can still come back next year and say, hey, we need to delay this. And that conversation still happens.
- Caroline Menjivar
Legislator
I think it allows for a more transparent conversation instead of putting the word trigger. Like most programs that are coming to the table today are from deals that were made a couple years ago that are being proposed for delay. That's still the opportunity of the Department to do that. I still think the trigger language really locks us in before having that conversation. Senator, anything to add on that?
- Susan Talamantes Eggman
Person
I would just concur, Madam Chair. I think this is a... I'm like a broken record, but in my final year. But it's always a Department, it's always the Human Services Department, Social Services that get the trigger language. And it, it rarely then comes back to us. The trigger is triggered and that's two years down the road.
- Susan Talamantes Eggman
Person
I think it gives that time for the public to give input again. It can be painful, but that's part of transparency and oversight and us actually, the Legislature actually taking our role very seriously and being deliberate about its impact on families. And once you put, I mean, trigger in there, just from a mental health perspective, right. You're triggering somebody, you're telling, it's coming, it's coming, it's coming. So I would concur with you that we can let it go as is, and the Administration come back to us if they need to make changes later, like everything else.
- Caroline Menjivar
Legislator
Yeah, because I think you just reminded me, the continuous coverage for 0-5 is on trigger language. And that keeps just, I mean, of course we can bring up anything to talk about it on Sub 3, but those are just some examples that get triggered, get down at the bottom of the list for priority. So it doesn't take away your opportunity to bring it back. It's just leave it, where we stand, leave as is.
- Caroline Menjivar
Legislator
And I know continue having that conversation with the three parties for the budget at the end, but that's where I'm standing on. Okay. I think those were in on that. I think I... We're going to do public comment now for all child welfare issues, CalWORKs and child welfare, and then move on to IHSS after LAO. I keep forgetting y'all.
- Angela Short
Person
Thank you. Angela Short with the Legislative Analyst Office. I'll start with the trigger since that's what we were just focused on. I think perhaps similarly to some of the comments made by the Chair and Senator Eggman, we also would agree that it does not seem to make sense necessarily to subject implementation of the new rates structure to a trigger. More specifically, this is a quite significant revamping of the foster care rate structure that has been proposed.
- Angela Short
Person
And we already know that the department, stakeholders, counties, service providers will be spending quite a lot of time over the next couple of years, continuing to work out the implementation details of the proposal and preparing to transition to the new rate structure. So we're not sure if having everyone do all of that preparation, all of that work, would make sense if ultimately the decision is deferred to the Department of Finance and implementation may not happen at all.
- Angela Short
Person
Since we already know, again, that this is a very significant proposal that's going to take time, we would agree a prudent approach would seem to be to pass language this budget year that is necessary to allow that implementation preparations to begin, and then in the next year or so, once the Legislature has a better fiscal picture of the state's future revenues, make a determination if a delay needs to occur.
- Angela Short
Person
But ultimately, the trigger language doesn't seem to make sense from our perspective for this proposal. And then briefly, I'll just go back to the proposed 50 million reduction for the resource family caregiver approvals. We would just add to what Chief Deputy Director Troia mentioned.
- Angela Short
Person
Our understanding is that currently the median approval times remain over 100 days, both relative caregivers as well as non-relative resource families. This is above the target 90 day approval timeline. So reducing those funds that counties use to help address the backlog and get those processing times down, we would anticipate will just result in longer times and longer delays for those families. And happy to answer any questions. Thank you.
- Caroline Menjivar
Legislator
Thank you. No questions. Turning over to public comment. So we have the Bring Families Home Program, we have the family care approvals, foster care trigger language, and then the CalWORKs programs.
- Kevin Aslanian
Person
Yeah, we oppose the trigger. And about mental health and substance abuse. Medi-Cal is not the solution to the issue because Medi-Cal has a limited six visits for a year, so often people need more than six visits. So if that's going to be the solution, then those prepaid health plans have to be amended to make this possible. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Eileen Cubanski
Person
Good morning. Eileen Cubanski with the County Welfare Directors Association. Cut me off when you need to. There's a lot. Just the single allocation. I'll just say it is a significant reduction to the single allocation. With the eligibility shortfall that we have of about $400 million, we're looking at what is effectively the entirety of this cut coming out of the employment services component of the single. That's about a 50% reduction to services.
- Eileen Cubanski
Person
There's no doubt that we are going to be cutting people off of the employment services that we have and will not have any room to transition on the mental health substance abuse side either. And that's on top of the ESE cuts and the family stabilization cuts as well. So. And now the Home Visiting Program cuts, too. So we'll be looking potentially at cutting some families off of that. So it is significant and it is deep, and it is deeply concerning to us what that means for the CalWORKs program.
- Eileen Cubanski
Person
Minimally, we're going to need some trailer bill language to absorb even a portion of these cuts that's going to exempt us from work participation requirements and so forth.
- Caroline Menjivar
Legislator
One last thing, because you went over your time already.
- Eileen Cubanski
Person
Oh, I'm sorry. On the caregiver support, on the approvals, we fund about 200 social workers statewide with that money. We spend at least twice that on those. Without that funding, we are undermining core programs, and we have significant concerns remaining about the foster care proposal. None of our concerns were addressed in the trailer bill. Thanks.
- Kelly Brooks-Lindsey
Person
Kelly Brooks on behalf of the urban counties of California and the Rural County Representatives of California, we have deep concerns with the CalWORKS reductions, which is 759 million, 487 million of that is ongoing.
- Kelly Brooks-Lindsey
Person
We're looking at cuts to infrastructure of the program, things that help in family crisis supports, access to mental health and substance use services, job readiness training and employment supports, and county caseworkers. If counties decided to implement the single allocation cut just with layoffs, we'd be laying off 1730 CalWORKS staff statewide.
- Kelly Brooks-Lindsey
Person
Just underscore what Miss Kubanski said about we will need some trailer bill to implement this level of cuts on the caregiver approvals. This is the foundation of our child welfare system to maintain family caregivers for children and youth who have been removed from their parents.
- Kelly Brooks-Lindsey
Person
This will lead to delays and mandated approvals, including of relative caregivers and delays in their ability to be provided a full foster care repayment inclusive of supplemental rates. The $50 million cut is equal to about 203 social workers statewide. Thanks.
- Kimberly Lewis
Person
Good morning. Kim Lewis, representing a Spironetta Foster Family Agency in 35 counties in the state and I just want to echo your comments around the trigger into the permanent rate structure. I think this causes grave concern to the field about the stability of our programs and services who are supporting our foster youth.
- Kimberly Lewis
Person
In addition to the $240 million in cuts that are being proposed in this budget to the child welfare system in general, let alone the loss of the FFA Bridge Funding, that's going to go away.
- Kimberly Lewis
Person
And so how do we expect to have our foster care providers be able to support the vision of this new rate structure if they're not going to be here in two years?
- Kimberly Lewis
Person
So I urge you to reject all the cuts to child welfare system and have an engaging conversation with us around how we're going to solve this problem going forward. Thank you. Thank you.
- Kristin Power
Person
Good morning. Kristen Power with The Alliance for Children's Rights. I want to echo your comments about the trigger language and support the recommendation from the LAOs office.
- Kristin Power
Person
We want to be sure that we are supporting this investment and that the Legislature has oversight into this process and that the overall process is supported and results in what we anticipate is an increase.
- Kristin Power
Person
At the same time, we want to urge the Legislature to reject the cuts to all of the child welfare programs and see where this balance ends us at the end of the day. Thank you.
- Christine Stoner-Mertz
Person
Chair and Members, Chris Stoner-Mertz with The California Alliance of Child and Family Services. We similarly agree that we need to remove that trigger language and bring back the proposal to the Legislature for review in January 2025 so that we're all working together to make sure it's the right proposal.
- Christine Stoner-Mertz
Person
And we want to focus your attention on those cuts to foster family agencies, which are a critical part of this proposal. We must get that 8.8% COLA in place for this July. And then finally, we also reject the cuts to the child welfare system in General. We can't be building on one side and cutting on the other.
- Christine Stoner-Mertz
Person
Thank you so much. Thanks.
- Justin Garrett
Person
Justin Garrett with the California State Association of Counties. We are strongly opposed to the cuts to the CalWORK senior allocation, the various services cuts, the bringing families home program cut, and the caregiver approval cut.
- Justin Garrett
Person
You know, taken together, these cuts will significantly impede county's abilities to perform core administrative functions for these programs, as well as negatively impact the workforce at the county level. On the services side, that will take away key housing supports, job training and other skills and services that families need. And it's critical to the success of these programs.
- Justin Garrett
Person
So we urge you to reject them. Thank you. Thank you.
- Susanna Kniffen
Person
Susanna Kniffen with Children Now, the state has both a moral and legal responsibility to protect children and youth in our foster care system. Today. They need you to protect them from this Administration. Please reject all cuts to our foster care system, particularly the elimination of the family or gym response system.
- Unidentified Speaker
Person
Thank you.
- Catherine Senderling-Mcdonald
Person
Thank you. Madam Chair, Members, Cathy Senderling-Mcdonald for Alameda County. We urge rejection of the FERS elimination, the bringing families home elimination, the elimination of the SILP housing supplement, and the $50 million cut to RFA approval. These cuts would delay reunification for families who are doing everything we ask of them.
- Catherine Senderling-Mcdonald
Person
Would delay approval for relatives who want only to care for the children and their families. It delays stability for those children. It would further traumatize and reduce services to children and youth who've already suffered, through no fault of their own, all of those things. And finally, it would further reduce and threaten an already overburdened workforce. Thank you.
- Unidentified Speaker
Person
Thanks, Cathy.
- Martha Guerrero
Person
Madam Chair Members, Martha Guerrero, representing the Los Angeles County Board of Supervisors, also urge your rejection of the CalWORK single allocation because it would affect 117,000 families, 217,000 children, 70,000 adults in Los Angeles County would be impacted. We also oppose the additional cuts to child, the cuts to child welfare from the January.
- Martha Guerrero
Person
We're looking at the governor's may revision and the serious impact it will have to Los Angeles County and will provide additional impact information.
- Kellie Flores
Person
Thank you. Good morning. Kelly Longo Flores with the California Association of Food Banks. We understand that this is a very challenging budget year, but we ask that the Committee rejects outcuts that will impact California's most vulnerable populations.
- Kellie Flores
Person
Specific specifically, we ask that you reject the double cuts of CalWORKS and safety net withdrawal and any pullback in child care funding. Thank you. Thank you.
- Jeff Neil
Person
Jeff Neil, representing the County of San Diego. We remain concerned with the proposed cuts to the single allocation to the CalWORKS supportive services, especially the proposed cuts to the statutorily acquired eligibility and Employment services program would be almost $30 million just in San Diego, make it unsustainable to continue to operate that program into the future.
- Jeff Neil
Person
Given the significance of the cuts, the county would request that you consider reducing some of the administrative regulatory burden both on counties and on clients. Some of the COVID era Executive orders made changes to suspended intake interviews, annual renewal interviews, semi annual reporting, and good cause latitude for counties that don't participate in employment services.
- Jeff Neil
Person
Lifting some of those administrative burdens would would at least give us some flexibility to operate the programs under these devastating cuts. Thank you. Thank you.
- Emmerald Evans
Person
Good morning, chair. I'm Indravar Emmerald Evans with Grace in Child Poverty California. We would like to deeply oppose and reject cuts to programs serving foster youth, both included in the May revise and the January budget proposal, and then also regarding the foster care rate structure.
- Emmerald Evans
Person
We want to echo concerns by counties and advocates about the unknowns in the methodology behind the tiering system. We urge only minimally necessary action this year for stakeholders to get it right given the permanent reforms being made. We share your concern about the structure of the trigger and then regarding how it works.
- Emmerald Evans
Person
I want to echo our comments from Andrew on Thursday to underscore your comments, chair, that these are deep cuts to core programs and then regarding childcare.
- Emmerald Evans
Person
Lastly, we want to reject the cuts to childcare bridge that would ensure children are placed into foster care in crisis, that are in crisis, have childcare, and we appreciate your hard work to make sure that we maximize all federal funding. Thank you. Thank you.
- Vanessa Cajina
Person
Thank you very much. Vanessa Kahina, on behalf of the Nurse Family Partnership, one of the CalWORKS home visiting programs, deeply concerned with all of the proposed cuts to CalWORKS. Taken together, these would have significant impacts on thousands of families around the state.
- Vanessa Cajina
Person
As we've done an assessment of our network partners in different counties, we can tell you that we believe that there would be 100 families in Riverside County who would be cut off from home visiting services if this cut were to go into effect. We urge you to reject these cuts and thank you so much for your attention.
- Unidentified Speaker
Person
Thank you.
- Heidi Kaiser
Person
Good morning. Heidi Kaiser, representing Child Action. We'd like to align our comments with the ECE coalition, please reject the cuts to the childcare bridge program. Cutting these funds will hurt some of our most vulnerable children. Additionally, pausing any new childcare slots will result in missed opportunities for struggling families to stabilize and hurt their children. Thank you so much.
- Unidentified Speaker
Person
Thank you.
- Nina Buthee
Person
Good morning. Nina Buthee, Executive Director of Every Child California we're very opposed to the cuts to the child care bridge program and also specifically to the General child care slot reduction. Centers have already started transforming classrooms on the promise of these funds.
- Nina Buthee
Person
One of my Members in LA said the expansion funding application was a very long and arduous process. She went through it, got board approval, started shifting classrooms, got licensed, which takes a very, very long time. Of all of the age groups she serves, the longest waiting list is for infants and toddlers.
- Nina Buthee
Person
Without this expansion funding, she will have three empty classrooms unable to serve these children. Let's not let classrooms just sit open because we're cutting this funding. Thank you.
- Unidentified Speaker
Person
Thank you.
- Valerie Denero
Person
Good morning. Valerie Denero with Every Child California and we also align ourselves with the ECE coalition. I echo the comments that have already been made. The ECA coalition we are committed to working with the Legislature and the Governor to adopt other budget solutions.
- Valerie Denero
Person
In particular, we urge you to adopt the timeline for implementing the alternative rate methodology, adoption of the ECE reversion account, and most importantly, the release of the 27,000 CCTR spaces that were already promised to providers that have already gone extremely out of pocket to be ready to go to enroll families July 1.
- Valerie Denero
Person
Thank you for your attention to this matter. Thank you.
- Rebecca Gonzales
Person
Good morning. Rebecca Gonzalez with the Western Center on Law and Poverty. We continue to oppose the deep cuts to CalWORKS, especially the Family stabilization program, subsidized employment program, the draining of the safety net, and then in May, the CalWORKS home visiting program and the mental health and the substance abuse program.
- Rebecca Gonzales
Person
We do believe this runs counter to the state becoming part of the federal pilot program, but we were happy to see in the budget that there was some language put in by the Department requesting language to be a part of this pilot.
- Rebecca Gonzales
Person
And we're also concerned about the cuts to the child welfare, including the childcare slots and the bring families home program. Thank you. Thank you.
- Janice O'Malley
Person
Good morning, chair Members. Janice O'Malley with Ask Me California, you've heard from the folks prior to me that the cuts to child welfare, to CalWORKS will really severely impact the workforce. But I also want to share with you what that actually means.
- Janice O'Malley
Person
One person, even one person who is fired from these positions could really affect the health and safety of children and families especially in small rural areas.
- Janice O'Malley
Person
We represent folks in Humboldt County, and they had to put out an all points bulletin message to their workers to even if they didn't work in the classification of child welfare, they needed to all work together to address the backlogs. And so that means that the workforce is overburdened.
- Janice O'Malley
Person
They're unable to address some of these health and safety issues that are mandated by the state. So we're really concerned about these cuts and hope that I know this is a bad budget year. You have to make really difficult decisions. I don't envy you when you make these decisions.
- Janice O'Malley
Person
But let's think about, like, the real impact of how this will affect families. Thank you.
- Unidentified Speaker
Person
Thank you.
- Mariam Sossouadouno
Person
Mariam Sossouadouno, Child Care Law Center we urge the Legislature to reject any cuts to the CalWORKS program. Thank you. Thank you.
- Juliet Terry
Person
Good morning, Chairman Menjivar. My name is Juliet Terry. I'm with the Child Care Resource Center, and we're proud partners of the ECE Coalition and align ourselves with all of their sentiments said today.
- Juliet Terry
Person
I just want to start off by saying that during the May revision, drop the governor's sentiments around a choice having to be made between funding childcare rates and funding childcare slots is quite a false choice narrative, and it's very harmful to our families and children who are depending on these programs. We have other choices.
- Juliet Terry
Person
So please consider rejecting the cuts to CalWORKS, rejecting the cuts to the Foster Care Bridge Program, fully funding the child care slots that were allotted. I know in our district alone serve, we already have 18,000 families waiting for childcare. And as well, we do ask the restoration of the General childcare slots as well. Thank you.
- Caroline Menjivar
Legislator
Thank you so much. Moving into IHSS.
- Unidentified Speaker
Person
Madam Chair, before you do, if I may just for your record, answer your question related to family stabilization, it was 44,000 CalWORKS families that received those services in 2022 to 23.
- Caroline Menjivar
Legislator
Thank you so much. I appreciate that.
- Claire Ramsey
Person
Good morning, Madam Chair. Claire Ramsey for the Department. Speaking on your IHSS questions, I will begin with the rescission of the in home supportive services benefit based on immigration status. The May revision proposes the elimination of IHSS for all undocumented recipients affected by the full scope Medi Cal expansions.
- Claire Ramsey
Person
The elimination of IHSS for all undocumented recipients would affect estimates for the caseload impact of SB 75, which is the children 18 and under, and those 19 to 25, 26 to 49 and 50 and older.
- Claire Ramsey
Person
This elimination would result in a reduction of $94.7 million and a workload adjustment of $3,000,400. $304.8 million General Fund in fiscal year 24-25 and ongoing to assist in closing the projected shortfall.
- Claire Ramsey
Person
Based on our case management information and payrolling systems data, which supports both the IHSS and the Waiver Personal Care Services program, this policy will impact approximately 2,968 individuals. We are working closely with the Department of Healthcare Services on this change because they run the Medi-Cal program and we run the IHSS program.
- Claire Ramsey
Person
So we're working to mitigate any negative impacts to currently assisted individuals, including looking at other benefits they may be able to receive under the Medi-Cal program. These could include things like the CalAIM enhanced care management, the CalAIM community supports and other Medi-Cal waivers, including the community based adult services program and the multi service senior program.
- Claire Ramsey
Person
So CBAS and MSSP, in addition to all other Medi-Cal benefits that they will remain eligible for under the expansions. There are, however, no alternatives at the Department of Social Services at the time for this population. We were also asked to speak in question two to our implementation plan.
- Claire Ramsey
Person
The Department would need to take a number of steps to implement this change, including the normal administrative steps we take to issue an all county letter, draft a notice of action messages for recipients, work with DHCS to make sure we have accurate data to ensure no other qualified populations were included in this termination.
- Claire Ramsey
Person
We wouldn't need to make some systems changes as well, but those are absorbable by the Department. We would then have to issue notices with at least 10 days in advance to individuals who would be losing IHSS under this proposal. I'll move next to the elimination of the IHSS permanent backup system.
- Claire Ramsey
Person
The permanent backup system was established on October 12022 to assist IHSS recipients with finding a provider when an urgent or immediate need for IHSS services arises and the regular provider is not available, or when an IHSS recipient is transitioning from out of home care to home based care and they do not yet have a provider.
- Claire Ramsey
Person
Eligible providers are currently allowed to receive up to 80 hours a year and in certain instances up to 160 hours a year, and there is a differential wage paid of $2 for backup provider systems. The May revision proposes the elimination of the program so both the funding going forward and the program itself.
- Claire Ramsey
Person
The reduction would result in $11.6 million in General Fund savings starting in 24-25 and ongoing. In regard to impact, there are no alternatives at the state level to the current backup system. Some counties have operated independently backup systems before these systems were made permanent through the state.
- Claire Ramsey
Person
We anticipate some counties would continue to do that, although we don't know how many and to what extent they would be able to offer backup services ongoing. However, we do plan to work with our counties and public authorities to determine how best to support them and any recipients to make sure their urgent needs are met.
- Claire Ramsey
Person
Regarding utilization utilization currently has been Low in the program.
- Claire Ramsey
Person
We are averaging about 110 providers providing backup services per month for the first four months of 2024, specifically in January 105, February 117, March 114, and April 105, and we do anticipate that there are a lot of IHSS recipients who are able to utilize family, friend and personal networks to provide backup services, which is why this the current backup system is not being more heavily used at this time.
- Claire Ramsey
Person
Lastly, I'll speak to the reduction in the IHSS Career pathways program. The Career Pathways program is the training program that we have talked about several times that is meant to increase quality of care and assist in recruiting and retaining providers into the IHSS program.
- Claire Ramsey
Person
Your agenda correctly indicates that the number of people who have currently been served through the Career pathways program and the number of incentive payments that have been paid out to date. The May revision proposal proposes a one time reversion of $60 million in HCBS funding for IHSS career pathways to help close the projected shortfall.
- Claire Ramsey
Person
The 60 million would be divided between 40 million to the Department of Developmental Services and 20 million to the Department of Healthcare Services Fund assisted living waiver slots, and on the DDS side, it would help Fund rates. Can you say the breakdown again?
- Claire Ramsey
Person
Sure, and I look to my finance colleagues if I've stated anything wrong, but it's 40 million to Department of Developmental Services for rates and 20 million of the 60 million to Department of Healthcare Services for the assisted living waiver and then regard to impacts.
- Claire Ramsey
Person
We will continue offering all the classes we are currently offering through the end of September as planned. There are no changes there. We will continue to allow people to submit for payment and incentives through the middle of November, and they will be able to earn on incentives through the end of October.
- Claire Ramsey
Person
So that will all say the same. As we discussed at the hearing earlier this year, we do anticipate we can spend down the entire $235 million remaining, as we have already spent as of March 31 of this year, $91.6 million in the program.
- Claire Ramsey
Person
So we do not anticipate a negative impact to anyone participating in the program and believe there was money to be able to use for other purposes. I will stop there and happy to answer any questions.
- Caroline Menjivar
Legislator
A year ago, y'all said the same exact thing a couple months ago, y'all said the exact thing. And now again you're saying we have confidence we're gonna spend it. That's three times I've heard it in my time here, and we're not. So I don't have that much confidence in this area that we're gonna spend it all.
- Caroline Menjivar
Legislator
Do we have. I know these are numbers for March. Might be too early to get April numbers. Do we have any April numbers just to see a trend we don't have?
- Claire Ramsey
Person
Excuse me, we don't have April numbers yet, but we anticipate we will likely have them in the coming weeks. We are always month in arrears on payments and we understand the concern by the share about spending fully in this program. This has been a hard program to predict spending and we are doing it in small increments.
- Claire Ramsey
Person
So it requires a lot of providers to take classes to build up the dollar amount. But we did have our highest spending to date in March of 2024 after the doubling of classes. And we do anticipate the trends to continue upward.
- Caroline Menjivar
Legislator
Are we still doubling classes?
- Claire Ramsey
Person
We're not doubling anymore, but we now have a significant number of classes being offered ongoing, and we do expect to continue to see high rates of spending going forward.
- Caroline Menjivar
Legislator
Question for both Department finance and Leo, because this will be after the budget process, what recommendations can we put in here? Or what would the process look like come August, where we don't seem to be on track to utilizing all this Fund?
- Caroline Menjivar
Legislator
And how quickly can we reallocate some of those funds for something else outside of this process?
- Unidentified Speaker
Person
Kiachi, Department of Finance I think that would be something we'd have to work with our DHCS colleagues and the Department of Healthcare Services, since they are the lead agency on the HCBS spending plan.
- Caroline Menjivar
Legislator
Would the departments just determine on their own? I mean, I don't think they're calling all of us to come back and decide.
- Ginni Navarre
Person
Thank you, Madam Chair. Ginni Bella with the Legislative Analyst Office. I think you're raising really great questions about how will we know and how can we keep more lifetime track of this spending. I think hearing this April information will be very helpful in kind of determining how much is left over and what we can do.
- Ginni Navarre
Person
Because to your point, if you are going to redirect more of this money, you would want to know that now so that you can offset other reductions that you may be considering. So something that will be on top of two in terms of April. So we can get back to you once we see those numbers.
- Caroline Menjivar
Legislator
Do we anticipate those on June 1st.
- Claire Ramsey
Person
That's about right. I don't want to promise the date, but that should be about accurate. We should have them early June at the latest. Okay.
- Caroline Menjivar
Legislator
Please do send that over to us as soon as we get that. We definitely want to track this literally day by day, just because, again, and it's no personal nothing, the trend that we've seen, we're not on track. And I do worry that we're not going to utilize all this federal funding.
- Caroline Menjivar
Legislator
And if it doesn't seem like we're looking to expand it, I still want to entertain the idea of just doubling down the amount of money we give out, if that's our utilizing for other things. But I definitely don't want any funding to be left over in this area. Thank you, chair.
- Caroline Menjivar
Legislator
And we have the same commitment to spending all the money. Okay. And then for the immigration benefit benefits for the immigration regard because of your immigration status, how we. I don't know if you've been talking with advocates, but this isn't a public charge. And for those who have complex needs, they can go to CBASes. Right.
- Caroline Menjivar
Legislator
It requires you to be ambulatory and so forth. If this is care for someone who is non ambulatory and their next option is a SNF, a secure nursing facility, that's a public charge. So I'm wondering what we're doing to focus on that specific area.
- Caroline Menjivar
Legislator
Because I agree with you, Calam ECM can help with certain areas, but the most dire, dire need of this care could potentially be locked out of other services, especially on public charge areas.
- Claire Ramsey
Person
Thank you for your question. Undocumented immigrants would have a right to skilled nursing care if they needed it. So I just want to be clear that would be available to them.
- Caroline Menjivar
Legislator
Add a SNF, wouldn't that be a public charge?
- Claire Ramsey
Person
I'm not an immigration expert. zero, yeah, I know your problem.
- Caroline Menjivar
Legislator
But I understand the concern about advocates have shared with me that that would be, in fact, a public charge, so that wouldn't be an option for them.
- Claire Ramsey
Person
I can take that question back. Madam Chair, we are cognizant that people may need to make hard choices if this proposal goes forward and IHSS is terminated again, we would be working closely with Department of Healthcare Services to make sure no one is caught out or without services that they need to live safely in their own home.
- Claire Ramsey
Person
We do recognize that that may be not possible to stay at home given the change in IHSS eligibility.
- Caroline Menjivar
Legislator
This has a 10 day timeframe. You mentioned a notice goes out you have 10 days. This service is over.
- Claire Ramsey
Person
So that's something we could certainly work with the Legislature on. 10 days is our minimum requirement of notice to give to an individual.
- Caroline Menjivar
Legislator
I mean, I appreciate some kind of notice. Right. Other programs we've talked about earlier today, it doesn't seem like there's a notice approach. It's just a cutoff with the 10 day timeframe. Does that mean that there is going to have to be some spending in this area in the upcoming fiscal year?
- Claire Ramsey
Person
I think that is something we will take back as a question, but is going to be a challenge given that there are multiple requirements that have to be met before the action can actually be taken for any individual recipient.
- Caroline Menjivar
Legislator
And you mentioned it's about like 300 something million for the admin.
- Claire Ramsey
Person
Oh, let me correct. There was a caseload adjustment of $304 million, and I don't know if my colleagues at finance want to speak any more to the caseload adjustment.
- Caroline Menjivar
Legislator
Oh, no, no. Okay. I just wanted to see if there's any funding left for those people that are going to be using those 10 days leeway to come off this service into the fiscal year. In the fiscal year.
- Claire Ramsey
Person
We have not budgeted for any funding for this population into the budget year. However, we may want to continue to have legislative discussions around how to work that timing and the funding on that timing.
- Caroline Menjivar
Legislator
If we haven't. Department of Finance, what is the plan then? If we're giving them 10 days, that means they're going to have the service all the way up to the 10th day until they find someone else. So how do we?
- Italy Perez
Person
Italy Perez, Department of Finance. Yeah. In regards to this, we're continuing to engage still with DSS on the implementation of the solution should it make it into the final budget.
- Caroline Menjivar
Legislator
Okay, I feel like we wait till the last minute to discuss everything, huh? Any other questions on IHSS colleagues? LAO? I was going to Forget. Department Finance? Did you have something else to add?
- Italy Perez
Person
Yes, Madam Chair, please. Okay, so we also would like to note that in regards to the IHSS for undocumented expansion services, prior to the various coverage expansion for individuals, regardless of immigration status, this population qualified only for emergency and pregnancy related services. They were not eligible for IHSS.
- Italy Perez
Person
The May revision maintains expanded Medi-Cal coverage for individuals of all ages, including the adults that became eligible for the full scope Medi-Cal effective January 12024. The benefits for this population continues to be eligible for included essential services such as preventative care, dental coverage, optical services, prescription drugs, physical therapy, reproductive health, and doula coverage.
- Italy Perez
Person
And mental and behavioral health services. It continues to be the administration's priority to maintain health coverage for all Medi Cal Members. And in lieu of reducing eligibility, the MAE revision is recommending the solution now to address.
- Italy Perez
Person
That's the second part of the question of how, or yeah, as if the Administration considered the potential higher costs for individuals who lose access to IHSS and if they may rely on institutional care.
- Italy Perez
Person
At this time, we don't have any estimates, but we'll work to make sure we put forth a balanced budget to the Legislature in subsequent years. Thank you. Thank you.
- Juwan Trotter
Person
Juwan? Juwan, yes. Juwan Trotter, Legislative Analyst Office so for us, just overall, we're always monitoring utilization rates and caseloads and always making sure that what's budget is in line with utilization rates for this elimination of the IHSS undoc population for all ages.
- Juwan Trotter
Person
First, we will note that administration has significantly reduced the estimate of what would cause for the IHSS undogging population, reducing it from hundreds of $1.0 million in January to less than $100 million as of the May revise. So we're currently tracking and taking a closer look at these estimates.
- Juwan Trotter
Person
Other primary questions kind of revolve around what's already been discussed regarding the. How it's going to be operationalized going forward, as well as the other resources and benefits that these populations are going to be eligible for.
- Juwan Trotter
Person
And at a higher level, we do have questions around the implications of eliminating Medi-Cal benefits for a specific group of recipients. For example, has this been done anywhere else in Medi-Cal?
- Juwan Trotter
Person
And how is it decided for IHSS benefit to be the component of the program eliminated for the undocumented population if the, if there were other benefits considered? As far as the career pathways, we'll work with the Department on monitoring the April numbers and work with and get back to you on that.
- Juwan Trotter
Person
And then touch, just touching on the elimination of the permit backup provider system. We did note during our evaluation of the January proposal that the utilization rates were lower than expected and there was room to create savings.
- Juwan Trotter
Person
The Department did reduce their estimate before proposing to eliminate a program overall, but we are looking at these update estimates to see if we could reduce, or right size the program further to create significant savings without like completely eliminating the program. And so we'll get back to you on that as well.
- Caroline Menjivar
Legislator
Okay, thank you so much. Public comment on IHSS.
- Caroline Menjivar
Legislator
You will have 45 seconds each.
- Warren Cushman
Person
As soon as I get to it. All right. Hello, Senators. My name is Warren Cushman, Community Resources for Independent Living in Hayward. I took a while, took a bit of a journey to get up here from Hayward. I want to say that the IHSS discussion today around the undocumented population is just shocking.
- Warren Cushman
Person
The fact that we would in our state, consider that, consider cutting off an entire group of folks from IHSS would just be unconscionable. It would be something I can't even fathom. And I absolutely hope that we will not go down that road.
- Warren Cushman
Person
It is a serious breach of trust for people with disabilities, and I hope we don't go there.
- Caroline Menjivar
Legislator
Thank you, sir.
- Kevin Aslanian
Person
Yeah, Kevin Aslanian, Coalition California Welfare Rights Organization, the 10-day notice is a minimum required by federal law. The state Legislature could decide to do 30 days, and there's nothing that prevents you from doing that. And for the record, I would also like to say that we oppose all the CalWorks cuts. I forgot that last time. Thank you.
- Mohamed Rashid
Person
Sorry. Good morning, Madam Chair and Committee Members. My name is Mohamed Rashid. I'm a self-advocate in Stanislaus County. IHSS is a program that supports all people, documented and undocumented with disabilities, to live interdependently in the community.
- Mohamed Rashid
Person
It allows those with family members to still have income in as they provide care for their families while helping to close the gap first. The gap of the shortage for providers, people with disabilities that do not have family to provide care back. That do not provide care back registry relieves the anxiety and removes the burden of providers.
- Mohamed Rashid
Person
It ensures the vital care to be provided there by keeping individuals in their homes and community and out of more expensive care facilities that have limited space and restrictive placement options. Thank you for your time. Have a good day.
- Kim Rothschild
Person
Kim Rothschild, California Association of Public Authorities for IHSS, and we're here to echo the comments from the LAO. We'd like to work with CDSS as well as the Subcommittee on right-sizing the backup provider program so that folks are not completely without care or cut off.
- Kim Rothschild
Person
This could result in more costly services as well as fear and anxiety around not having care and ending up in urgent care or ERs. So with that, we'd like consideration of maintaining some level of funding for this program. Thank you so much.
- Caroline Menjivar
Legislator
Thank you.
- Dan Okenfuss
Person
Good morning. Dan Okenfuss with the California Foundation for Independent Living Centers. Just a few words about what IHSS means for our community, the independent living movement and IHSS that kind of shared the same DNA.
- Dan Okenfuss
Person
It's all about critical needs for people with disabilities to stay out of more expensive nursing facilities and remain productive in their homes and communities. We're already desperate for quality caregivers, which are hard to recruit for these positions. Low wages and high turnover and insufficient hours for the consumers that rely on these IHSS services.
- Dan Okenfuss
Person
The consumers, some of them are often the most vulnerable in our society, suffer when these cuts happen, and live in fear of losing their providers and not being able to find their replacements. And finally, I believe the Deputy Director mentioned that the IHSS benefits based on, she said, 3000 individuals affected. That's 10 times the capacity of this room.
- Caroline Menjivar
Legislator
Thank you.
- Raylen Aguado-Mala
Person
Hello. Raylen Aguado-Mala with the Filipino Workers Center and Courage Home Care Cooperative. We are deeply alarmed that the Governor's May revision includes the elimination of IHSS, benefit for undocumented Californians in Medi-Cal. This elimination also puts a significant economic burden on family caregivers, who may now have to leave the workforce to provide that care uncompensated.
- Raylen Aguado-Mala
Person
Family caregivers are often low-income women of color, and if they must leave the paid workforce to provide care to their aging and disabled family members, this proposal will exacerbate economic disparities. Thank you so much.
- Caroline Menjivar
Legislator
Thank you.
- Rebecca Gonzales
Person
Rebecca Gonzalez with Western Center on Law and Poverty. I want to echo some of the comments about the cuts to the IHSS program, it being a public charge issue about it resulting in more institutional care, which is more expensive, and also it would harm workers who are predominantly women of color.
- Rebecca Gonzales
Person
We believe California should not turn its back on the historic Medi-Cal coverage expansion and treat people differently based on their immigration status. Given the proposed cuts target immigrant and disability communities, we believe these cuts violate the Americans with Disabilities Act and the Supreme Court's decision in Olmstead, the Equal Protection clause of the California Constitution, and California's Government Code section 11135. We are exploring litigation options at this moment. Thank you.
- Caroline Menjivar
Legislator
Thanks, Rebecca.
- Malik Bynum
Person
Oh, geez. I was going to do the power stance, go lower. Good morning, Madam Chair. Malik Bynum with UDW AFSCME Local 3930, representing IHSS providers in 21 counties throughout the state. Also commenting on behalf of my SCIU counterpart, Tiffany Whiten, who represents home care providers in the other 37 counties.
- Malik Bynum
Person
It truly is disappointing to see the expansion of IHSS to undocumented individuals clawed back, as well as the reduced funding for the career pathways program. But even further, the proposed elimination of the IHSS backup provider system in its entirety. These cuts aren't just gonna be harmful to our workers.
- Malik Bynum
Person
This is gonna be devastating for consumers of IHSS and their families across the state.
- Malik Bynum
Person
And, you know, we acknowledge that the budget isn't in good shape for anybody this year, but it is unfair and unjust for us to keep balancing the budget on the backs of our providers, caring for those who need it most, you know, our aging population and those living with disabilities.
- Malik Bynum
Person
So with that, I respectfully urge the Committee and the Legislature to reject these proposals. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Janice O'Malley
Person
Hello again Chair and Members. Janice O'Malley AFSCME in California, just want to align my comments with our AFSCME affiliate, UDW Local 3930, because of the devastating impact to providers and consumers. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Christine Smith
Person
Christine Smith with Health Access California also urging the Legislature to push back on these proposed cuts that unfairly target immigrant communities, including this proposal for people who are undocumented. The proposal undermines the health for program by specifically rolling back existing services for this population.
- Christine Smith
Person
It is essential care, as has been noted, and also removal of this funding could result in further impoverishment and increase the state spending on expensive nursing home care and also, as noted, exposes people who are undocumented to public charge if they were to result in a nursing home.
- Caroline Menjivar
Legislator
Thank you.
- Catherine Senderling-Mcdonald
Person
Thank you Madam Chair and Members, Kathy Senderling-Mcdonald for Alameda County, echoing the comments of the public authorities regarding the backup provider system and urging consideration that this program be maintained due to the importance of it, as well as expressing concerns about the effects of eliminating the services for undocumented recipients of IHSS and also thinking about providing full scope coverage to this group.
- Catherine Senderling-Mcdonald
Person
But yet, carving out this one set of services doesn't actually make a lot of sense in the provision of a robust healthcare system, which is really the point of healthcare for all. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Ronald Coleman Baeza
Person
Good morning. Ronald Coleman Baeza that here on behalf of the California Pan Ethnic Health Network CPEN, we implore that the Legislature reject the Governor's discriminatory proposal to eliminate IHSS services for the undocumented. It is indefensible that Governor Newsom to eliminate these services for a population for no reason but for their immigration status.
- Ronald Coleman Baeza
Person
Segregating which Californians are eligible and who are not eligible is unconscionable. It is 2024. It's California Governor's so called California for all. And this has vile undertones of Prop 187, and it's right out of Donald Trump's playbook. Without IHSS, these individuals will need costly and preventable hospital and nursing home care, and family caregivers will go without pay.
- Ronald Coleman Baeza
Person
This will perpetuate a generational cycle of poverty. We understand the Legislature needs to make very difficult decisions right now, but we ask you to reject this cut and stand up and do not put discriminatory proposals in statute and stand up for equity. Thank you.
- Caroline Menjivar
Legislator
Look, I stood up.
- Jackie Gonzalez
Person
Good morning. Jackie Gonzalez, Policy Director of Immigrant Defense Advocates, I humbly offer my opinion also as an immigration attorney that this would result in a public charge. The State of California has also taken a position on what constitutes a public charge.
- Jackie Gonzalez
Person
On the California Department of Social Services website where I read, "public charge is defined as a noncitizen who's likely to become primarily dependent on the government for support by receiving either cash assistance or being institutionalized for long-term care at a government spent."
- Jackie Gonzalez
Person
So the State of California is aware that this would result in a public charge. I would also like to clarify what public charge means because we're throwing it around.
- Jackie Gonzalez
Person
Public charge could lead to the inadmissibility of someone which would prevent them from becoming a lawful permanent resident, making them eligible for other services that they need in certain circumstances within five years of admission, it can also result in deportation.
- Jackie Gonzalez
Person
And I want to be clear that the United States government has no issue deporting people who are disabled or in a wheelchair or suffer other disabilities. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Vanessa Cajina
Person
Thank you. Vanessa Cajina on behalf of Vision y Compromiso, the statewide network of promotoras and community health workers, in opposition to the IHHS cuts to undocumented Californians.
- Caroline Menjivar
Legislator
Thank you.
- Emerald Evans
Person
Emerald Evans here with End Child Poverty California, we align with SEIU and WCLP against the proposed cuts and delays to IHSS. Regarding the benefit for undocumented individuals, we underscore the deep inequities that this will create and that many of these people who will be impacted will be also children. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Andrea Amavisca
Person
Good morning. Chair and Members Andrea Maviska on behalf of the California Immigrant Policy Center. I want to first echo some of the comments made by the Filipino Workers Center and others regarding who tends to serve as caregivers and the impacts that this would have on immigrant communities.
- Andrea Amavisca
Person
The proposed permanent elimination of IHSS for undocumented Californians unfairly targets immigrant communities and undermines the aim of the Health for All program. This is not a delay or scaling back, this is a full removal of benefits that people are receiving right now.
- Andrea Amavisca
Person
IHSS provides essential care that allows thousands of seniors and persons with disabilities to remain safely in their homes as an alternative to out of home care. Removal of this funding could result in further impoverishment among our most vulnerable community members, as well as increased state spending on expensive nursing care.
- Andrea Amavisca
Person
We respectfully urge the Legislature to reject the proposed cuts to this critical investment. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Russel Dawson-Rawlings
Person
Good morning, Madam Chair and Members of the Committee. My name is Durazo Dawson Rawlings and I am the Community Organizing Manager at California Foundation for Independent Living Centers. And as my colleague and others have testified, these cuts have deep impact.
- Russel Dawson-Rawlings
Person
I want you to see the face of someone who has benefited from having access to programs such as in-home supportive services.
- Russel Dawson-Rawlings
Person
I myself came to California in 2001, and I can also tell you that what these hard decisions look like, waiting for access to a program such as IHSS or being denied access to the program, means those hard decisions include going to our ERs.
- Russel Dawson-Rawlings
Person
I myself had a period where I was ineligible because my benefits had not yet started in California, and those were the decisions I had to make, was going into the ER just to simply get washed up and to make it out of bed in the morning.
- Russel Dawson-Rawlings
Person
So these are the real impacts that you're going to see for undocumented individuals if they lose access to this program. I also really wonder about a 10-day notice period, also because the in-home supportive services program operates on a monthly pay schedule or twice monthly.
- Russel Dawson-Rawlings
Person
So I'm wondering about unpaid wages to people, potentially unfairly, if the program were changed. Yeah, thanks.
- Caroline Menjivar
Legislator
Thank you so much.
- Khalid Rashid
Person
Good morning, everyone. My name is Khalid Rashid. I'm from Stanislaus County. As an IHSS backup provider for my brother, I know what it is to have security to know that my brother will be cared for when my mom needs a break. To know that others don't have that security worries me.
- Khalid Rashid
Person
It also gives me anxiety if I or my mom are not around to provide care for my brother. As a person with a disability myself, to know that when I need care, that I will not have a backup registry to back me up scares me. Primary care providers are already limited.
- Khalid Rashid
Person
To narrow that down even more makes no sense. Disability does not discriminate. We need to have a system that will be ready to care for all documented and undocumented. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Mikyla Dupont
Person
Good morning. My name is Mikyla Dupont. I'm also a resident of Stanislaus County. IHSS provides essential supportive services to individuals with disabilities to allow all to remain in their community. Caregivers are already in shortage in this program, and eliminating the backup system puts elderly and dependent adults at risk for more costly institutional or hospital placement.
- Mikyla Dupont
Person
Continuous care is critical to ensure individuals remain in their homes despite potential gaps in primary care, which allows individuals to also continue accessing their communities and even being able to take an active role in economic development activities and employment. I urge the Legislature to please reject this proposal. Thank you.
- Caroline Menjivar
Legislator
Thanks.
- Ella Roberts
Person
My name is Ella Roberts. I'm a retired state worker. I retired disability, retired in 1999. My husband became very disabled with Parkinson's. I had to take care of him even though I'm disabled myself. We don't need cuts, any cuts to disabled services or IHSS. We were not eligible. I'm a retired clerk. He's a retired lounge keeper.
- Ella Roberts
Person
He just died in January. We made too much. We were not eligible. I'm having to hire people out of my pocket, and I get people who are not trained. It's been a nightmare. I did manage to keep him home until he died. He didn't want to die in a nursing home. No cuts.
- Ella Roberts
Person
Instead, close 15 of the prisons and do something about the oil subsidies.
- Min Chang
Person
Thank you. Hi, I'm Min Chang. I'm CEO for Homebridge. Homebridge is the main provider for career pathways. And to date, we've trained actually over 28,000 caregivers in the State of California across all 58 counties. So we are very proud of it.
- Min Chang
Person
As you know, training is such an important part of actually providing quality care to the clients and the customers that you've heard from. And so we urge you to continue the funding, not only through this calendar year, but through the fiscal year as well. The demand has only been increasing.
- Min Chang
Person
Just as an example, in the month of April, we've had 30,000 people register, so the need is absolutely there. So I encourage you to rethink that as well. If there are questions that we can answer, I am very happy to set up some separate time and answer any questions, also provide some context.
- Min Chang
Person
We work very closely with CDSS, and we look forward to continuing to do that. Thank you. Thank you.
- Erin Siberry
Person
Erin Siberri, also here on behalf of Homebridge, I want to thank you, Madam Chair, and this Committee, for your support of IHSS and for serving our most vulnerable citizens. I also wanted to just weigh in on behalf of career pathways and the increasing demand that we're seeing even in the last few weeks.
- Erin Siberry
Person
And so we have no doubt that the money that Director Ramsey said could be spent, would be spent. And we're also hoping, even though it's a tough year to extend, this program, which is affecting, has capacity to affect over more than half a million Californians. And as the woman before CEO Chang spoke, training is so critical.
- Erin Siberry
Person
Folks are on the front lines of our cognitive and Alzheimer's issues and really need this training and support. Thank you so much.
- Kelly Flores
Person
Kelly Longo Flores with the California Association of Food Banks in strong opposition to the elimination of IHHS benefits based on immigration status. All Californians deserve to live in the least restrictive environment possible. Thank you. Thanks.
- Jessica Lamon
Person
Hello. Jessica Lamon, disability and aging community organizer. I am an employer of home attendants myself, and it has gotten harder and harder to hire attendance.
- Jessica Lamon
Person
Having decent rates, having provider backup, having career pathways are all about having the strong workforce we need to keep us in the community where we can come and be part of things and not in nursing homes. This is actually a life or death matter.
- Jessica Lamon
Person
I do know people who have not been able to get the attendance they need, who have cycled in and out of nursing facilities and have killed themselves because it is so miserable. I am not exaggerating. We cannot make cuts to IHSS.
- Jessica Lamon
Person
When someone asked me why are they proposing cuts to undocumented people, all they could think was that it is, of course, one of the groups that is probably the least able to safely fight for their rights. Ibram Kendi says that every action is either racist or anti-racist, and it's pretty clear which way this proposal goes.
- Jessica Lamon
Person
Please reject all the proposed cuts to IHSS. Thank you.
- Monica Kirkland
Person
Hello, Madam Chair and to the Committee. My name is Monica Kirkland. I am the State Policy Director for Senior Services Coalition of Alameda County. We offer it's about 39 nonprofit and community organizations that offer health and different social supports to about 89 older adults within the county.
- Monica Kirkland
Person
And we strongly urge you to reject the cuts to the IHSS career pathway program. Thank you so much.
- Caroline Menjivar
Legislator
Thank you.
- Yasmin Peled
Person
Good morning. Yasmin Peled on behalf of Justice and Aging, we are strongly opposed to the proposed cut of IHSS for undocumented Californians.
- Yasmin Peled
Person
And really, with all due respect to the Department of Finance, when the Administration and Legislature committed to expanding Medi-Cal to all in California, regardless of immigration status, that meant expanding all of Medi-Cal, which includes in home supportive services.
- Yasmin Peled
Person
So to suggest that just because they can have the rest of the range of Medi-Cal Services, that this is not a detrimental cut is really disingenuous.
- Yasmin Peled
Person
Also alarmed that there didn't seem to be an acknowledgement or an understanding of the public charge consideration when these folks potentially may have to end up in nursing facilities, which is, like everyone has said before me, a much more expensive place to end up. So we are also opposed to the cut to the IHSS backup provider system. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Caroline Menjivar
Legislator
Moving into Calfresh and food programs.
- Jennifer Troia
Person
Thank you, Madam Chair. Jennifer Troia for the Department of Social Services. You've asked us to provide an overview of May Revision solutions related to CalFresh and food programs, so I will begin by doing that. There are three proposals that I will highlight.
- Jennifer Troia
Person
The first is the expansion of the CFAP or the delay of the CFAP expansion or the California Food Assistance Program. As you will probably recall, the Legislature and Governor recently agreed to expand the CFAP program to all Californians aged 55 and older, regardless of immigration status.
- Jennifer Troia
Person
This proposal extends the implementation of that program by two years, so it would move from October 1, 2025 implementation to October 1, 2027 and correspondingly result in General Fund savings. There are no immediate impacts in terms of losses of benefits for people eligible for CFAP who are currently receiving them because, again, the program has not yet...
- Jennifer Troia
Person
The expansion has not yet been implemented. However, of course, we acknowledge that the individuals who would otherwise have been served beginning in 2025 would be waiting to be served until 2027. Prior estimates indicated that around 75,000 people would receive CFAP during the first year of the expansion.
- Jennifer Troia
Person
Those who are currently eligible for the CFAP program, approximately 45,000 individuals, would continue to receive CFAP with no changes. The second proposal to highlight is the Minimum Nutrition Benefit Pilot. This program was enacted as a part of the 2023 budget to assist in closing the projected budget shortfall.
- Jennifer Troia
Person
The proposal is to eliminate the pilot program, which would have issued supplemental state funded CalFresh benefits to raise the minimum benefit from $23 to $50. The pilot program has not yet been implemented, so there are no immediate losses of benefits for individuals who are otherwise receiving them.
- Jennifer Troia
Person
The final proposal to highlight is the Work Incentive Nutrition Supplement Program. This proposal results in an anticipated reduction of $25 million beginning in 2025 and ongoing. The WINS program, or work incentive nutritional supplement, provides a supplemental $10 per month food benefit identified as a form of TANF assistance to CalFresh households who are not receiving CalWORKs.
- Jennifer Troia
Person
In the past, this has allowed us to meet our TANF work participation rate by being able to count those individuals in the calculation for the WPR. Because the recent federal Fiscal Responsibility Act provides enough caseload reduction credit for the state to meet the all families WPR, we no longer need the WINS program to serve that purpose. Having said that the elimination of the WINS will result in the loss of food benefits of $10 per month per household for just over 100,000 Californians.
- Caroline Menjivar
Legislator
We're coming after everything. $10 each. The second one was my baby. This was my initiative last year.
- Susan Talamantes Eggman
Person
We've cut most of the ones I made during my time.
- Caroline Menjivar
Legislator
I should get used to this. Oh, no, I don't want to. Department Finance. What is the... I gotta see if I can save this. Delaying it two years.
- Emily Marshall
Person
Yes. So you want to know the fiscal for delaying two years?
- Caroline Menjivar
Legislator
Yeah. I mean, it won't impact us right now. Right? We can still come back and...
- Emily Marshall
Person
We'll reevaluate in two years, and that's the plan. So implementation would begin October 1, 2027 instead of October 1, 2025. So this was planned to begin implementation in 25-26.
- Caroline Menjivar
Legislator
I'm so sorry. I'm so sorry. I'm talking about the CalFresh minimum.
- Emily Marshall
Person
Oh, Minimum Nutrition Program. This is just a cut of the 15 million one time funding.
- Caroline Menjivar
Legislator
No, no, I know. So what, could we potentially just delay it two years?
- Emily Marshall
Person
We're happy to have discussions with alternatives to a complete cut, but for now, the budget proposes, the May Revision proposes...
- Caroline Menjivar
Legislator
It won't impact us. Right? There's nothing... You're not going to say, oh, no, that's... We'd still have to allocate some money for XYZ. Just want to know if delaying it for two years is a net zero or not sure if I'm looking. Is it going to cost us anything?
- Aanam Khan
Person
Yeah. So Aanam Khan, Department of Finance. If we did delay it for two years, then we would have to account for the 15 million in budget year plus one. So it would have cost in budget year plus one.
- Caroline Menjivar
Legislator
No, two years. So...
- Aanam Khan
Person
Right. Budget year plus two.
- Caroline Menjivar
Legislator
Plus two, which we're not looking at right now. Right. We're just solving for incoming plus one?
- Aanam Khan
Person
Correct. The Administration looked at budget year plus one. Just budget solutions. Yeah.
- Caroline Menjivar
Legislator
So if we're looking at budget plus two, it has no implications.
- Aanam Khan
Person
Well, it has implications in the out years.
- Caroline Menjivar
Legislator
Right. Right.
- Aanam Khan
Person
Right.
- Caroline Menjivar
Legislator
So I'm going to take that as a no. There's no impact for what we're looking to solve of fiscal year?
- Lourdes Morales
Person
Lourdes Morales, Department of Finance. While the Administration's focus was on producing a balanced budget for budget year plus budget year plus one, we do know that there are structural deficits in sort of the out years. And so as we sort of look to make ongoing reductions to the budget, it is to provide solid footing for those out years as well. So as though we are not fully solving, it helps address sort of multi-year deficits that we know would persist should we not take these corrective actions now.
- Caroline Menjivar
Legislator
Can you share with me, if we're solving for two years, does that not solve the structural problems?
- Lourdes Morales
Person
No. So we understand that the revenues and expenditures sort of do not put us on solid footing, sort of under current expenditures through the multi-year period. So that is three years out beyond budget year.
- Caroline Menjivar
Legislator
Okay. All right. Thank you. Any other questions? LAO, any comment on these issues?
- Sonia Schrager Russo
Person
Yes, thank you. Sonia Schrager Russo with the Legislative Analyst Office. As it relates to the first two proposals, so the delay to CFAP expansion and the reduction in the Minimum Benefit Pilot Program, these do in general align with our overall recommendations as an office for the Legislature to consider delays in programs that have not yet been implemented or reductions, again, in programs that have not yet been implemented.
- Sonia Schrager Russo
Person
Given, as was mentioned by the Department, that this will not impact the benefits of individuals currently receiving benefits. However, of course, there are trade offs to these decisions, and given the budget situation, we recommend the Legislature sort of consider those trade offs and the potential future recipients in its many priorities across human services and social services.
- Sonia Schrager Russo
Person
Similarly, as it relates to the WINS program elimination while, as the department has mentioned, the WINS program is unlikely to be needed in the next few years to meet the state WPR requirements, we do have questions about what might occur if, longer term, we did need a program like wins to meet the WPR requirement again, as we see caseload increasing in the coming years.
- Caroline Menjivar
Legislator
Thank you so much. Moving on to the next issue, issue number six.
- Claire Ramsey
Person
Good morning, Chair. Claire Ramsey for the Department of Social Services. I'm here to speak on issue six, the Adult Protective Services and CDSS housing programs. I will start with the cuts to the Adult Protective Services expansion. The Budget Act of 2021 made statutory changes to the Adult Protective Services program to lower the APS eligibility age for older adults from 65 to 60 and adjusted the eligibility age for dependent adults to age 18 to 59. It also expanded the definition of self neglect to include financial mismanagement and housing insecurity.
- Claire Ramsey
Person
It also allowed for additional case management. The current May Revision proposal proposes a decrease in funding for the APS expansion of $40 million ongoing. This would help to assist with the projected budget shortfall. The proposal largely impacts counties and their ability to serve the expanded population, so it is not a direct benefit cut to any individual.
- Claire Ramsey
Person
But we have heard indications from counties that there may be layoffs associated with this reduction. We would flag there are no alternatives for APS for this population, and APS is required to take all calls on a 24 hours hotline and to perform an in person visit to individuals who have called for assistance.
- Claire Ramsey
Person
The growth in APS over the last four years between January 1, 2029 and January 1, 2023 has seen approximately 20% increase overall in services per month and has had an increase in services to individuals 60 to 64. We were also asked about expenditures. Counties do fully expend these funds, which are currently at 70 million dollars.
- Claire Ramsey
Person
If the proposal moves forward, it can become effective July 1, 2024, since it is a reduction in funding and not a change to the AB 135 requirements. And we will work with counties to determine any technical assistance they need to make this shift and to adjust their staffing levels. Happy to answer any questions. I'll move on to the Statewide Training Program. Or would you like me to...
- Caroline Menjivar
Legislator
Yeah, 1 second. Department of Finance, I think we've asked some similar questions about like what unforeseen increases we're gonna see. Across a couple of programs that we've talked about where there's a potential for a lot of layoffs. The future of public health potentially laying off, I think it was like 1000 individuals across statewide.
- Caroline Menjivar
Legislator
Layoffs here, layoffs elsewhere. These are individuals that could potentially request or seek governmental assistance in other programs, increasing our costs. Have we looked into this and seen, coming next year, that our Medi-Cal cases will increase so forth, where our costs will be much more than what the cuts were doing?
- Kia Cha
Person
Kia Cha, Department of Finance. I think what you mentioned is the possibility, but at this time we don't have any estimates. And I think as my colleagues mentioned earlier, we'll make work to make sure we put forth a balanced budget in future years to the Legislature.
- Caroline Menjivar
Legislator
When we do these cuts, is that a variable that we look at?
- Kia Cha
Person
I think that's something that we're still looking at and we can continue to Work with the department...
- Caroline Menjivar
Legislator
In past years, is that a variable that we've looked at? When we propose cuts to programs, is that a variable that we include in our calculation? Not where the world do it, but is that something that's been part of Department of Finance's approach for various things? Or have we ever gone back to the table after years, after years saying, hey, we cut this, this is a direct correlation to now we're seeing an increase in XYZ?
- Kia Cha
Person
I think I can take that question back and get back to your staff.
- Caroline Menjivar
Legislator
Okay. I just... Yeah, I guess...
- Susan Talamantes Eggman
Person
Madam Chair, if I could also. I mean, we're talking about cutting services to IHSS and family support, and at the same time we're going to talk about cutting services to APS and CPS. Right? So those two things have a definite relation, right?
- Susan Talamantes Eggman
Person
I mean, the amount of stress and poverty on a family and the lack of help increases abuse. I mean, the numbers don't lie on that at all. So that's another direct correlation. I wonder if we could look at. As families become more stressed, you're gonna have more abuse and injuries occur to also be able to think about how do we make sure that we're not incurring other really big costs both to our pocketbooks and to are most vulnerable.
- Caroline Menjivar
Legislator
These are preventative in nature, most of these programs, right. These are just to help assist get people back off their feet so they no longer utilize these services. The longer we cut assistance, the longer they'll be on these programs. So I'm just wondering if we've ever done this kind of correlation. That if we, the more we assist in the beginning, the less they'll need support once they get older or down the line.
- Caroline Menjivar
Legislator
So whatever can be brought back on that. For APS or for like, in general, a lot of programs, you know, I've heard, well, these are programs that just started and so forth. I feel like we never give, we're not never. I feel like we're not giving programs enough time or we provide them for a couple years, and they're like, well, we only did it for two years, so it's not really a core service. People aren't really used to it.
- Caroline Menjivar
Legislator
But the impacts in those short years are so, so are fantastic that I can only imagine how much more we can really help people if we let these programs grow and we're not cutting them at the root. And the APS, you can imagine with the influx individuals who are going to be coming of age into this third part of their life, we need all the types of services around this demographic. The expansion was for a good reason. I mean, we do these things after evidence based practices, after stakeholder discussions, after XYZ.
- Caroline Menjivar
Legislator
We put so much effort into expanding these programs because we know there's a need and then we cut them off. Essentially, I feel like negates all the work that we've done leading up to these kind of expansions. Nothing else to say on that. LAO, any comments on these issues?
- Juwan Trotter
Person
Juwan Trotter, Legislative Analyst Office. So first we would just highlight what was said about how the counties have historically fully spent their annual APS allocation, and thus any cuts will likely result in real reductions in services.
- Juwan Trotter
Person
Also, we would note that although the APS expansion did lower eligibility age for APS from 65 to 60, it's our understanding that reductions in funding will potentially impact the availability of services for all age groups, not just those expanded.
- Caroline Menjivar
Legislator
Because it's the same pot, right? So we don't know who it's going to impact. It can impact anybody. Would you like to add anything else? You don't have to. I just...
- Sonia Schrager Russo
Person
No further comment to add. Thank you.
- Caroline Menjivar
Legislator
Okay. I'm gonna hold the item open and move on to issue number seven.
- Claire Ramsey
Person
Excuse me. I just wanted to check if you wanted me to speak to the APS training elimination?
- Caroline Menjivar
Legislator
Yes. Yes.
- Claire Ramsey
Person
Second item. Thank you. Quickly just add that the Adult Protective Services Training Program is a state function that is mandated to select and award grants to private, nonprofit, or public entities for the purpose of establishing a statewide APS workforce development and training program, as well as providing training to other individuals who are serving APS clients, including, but not limited to, public administrators, public guardians, and public conservators.
- Claire Ramsey
Person
The May Revision proposes the elimination of the APS contract for training curriculum. The elimination of the contract would result in a reduction of $4.9 million General Fund beginning in 2024 and continuing ongoing to assist in closing the projected shortfall. The APS training budget would revert to $176,000 per year, which was its amount before the expanded money was provided. And we do anticipate, as impacts, there will be significantly less training provided and classes offering and availability in the number of classes available to APS social workers. And the state will have to amend or end contracts with current APS training providers.
- Caroline Menjivar
Legislator
The contracts already started?
- Claire Ramsey
Person
Correct. There are yearly contracts. So we are currently in contract with CSU San Diego and in the process of executing contracts with CSU Sacramento and CSU Fresno for these training dollars, although they are already providing the services. So...
- Caroline Menjivar
Legislator
Okay. Is there, like, a fee to get out of these contracts we're gonna have to pay?
- Claire Ramsey
Person
No, we don't anticipate that, but there will be time to amend contracts.
- Caroline Menjivar
Legislator
Juwan, you good? Are we okay? Okay, now we're going to go on to issue seven. Thank you.
- Eliana Kaimowitz
Person
There we go. Good morning, Madam Chair. Eliana Kamowitz here for the Department of Social Services. I will be speaking on item number seven, the rapid response immigration item. As we all know, the Federal Government is responsible for immigration policy and migrant processing.
- Eliana Kaimowitz
Person
However, at large falls to local and state government to address the post processing needs of new arrivals. The CDSS funded nonprofit partners welcome, provide shelter and administer services to hundreds of vulnerable migrants who would otherwise be released by federal authorities directly into border communities.
- Eliana Kaimowitz
Person
Just last month, on April 15, the Governor signed Assembly Bill 106, which re appropriated 79.4 million General Fund from the 2021 and 2022 budget acts to continue to support the southern border humanitarian efforts.
- Eliana Kaimowitz
Person
The May revision proposes to reduce the rapid Response Reappropriation Authority included in this legislation by 29 million General Fund to assist in closing the budget shortfall.
- Eliana Kaimowitz
Person
The reduction won't impact the services currently being supported in San Diego and other parts of the border as early action funding would support services in the budget year FY 2425, we expect there will be sufficient current year savings in border operations to restore the 29 million, and the Administration will continue to assess the details of these potential savings based on current projections and operational needs.
- Eliana Kaimowitz
Person
Happy to take any questions.
- Caroline Menjivar
Legislator
So you expect current funding should be enough for the next fiscal year? Okay, Eliot, want to comment on this?
- Unidentified Speaker
Person
True on charter Legislative Analyst Office. I guess our only initial question would be if there's any new funds provided by the Federal Government and if so, how much?
- Eliana Kaimowitz
Person
Since January, there were additional funds provided by the Federal Government. And this federal fiscal year are organizations in San Diego and Riverside County received a little bit over $45 million in shelter service program. FEMA federal funds for a total of 93 million over the last two fiscal years.
- Caroline Menjivar
Legislator
And it could be used for this kind of program?
- Eliana Kaimowitz
Person
Yes.
- Caroline Menjivar
Legislator
Is this the only kind of program it can be used for?
- Eliana Kaimowitz
Person
Yes. It's for sheltering services across the border.
- Caroline Menjivar
Legislator
Okay. Because if I remember correctly, there weren't any other kind of funding to help offset the other two programs we talked about. Right. The other two programs. Temporary, the TPS. That's correct.
- Eliana Kaimowitz
Person
CSU, immigration. Those are separate because those are legal services. And this is sheltering federal funding for sheltering. Okay.
- Caroline Menjivar
Legislator
You know, sharing with my colleagues, I was like, this hearing's going long is because everything's being proposed for cuts. That's why it's. That's why it's a lot. It's a lot. Thank you so much. We're gonna go on to issue number eight. Thank you. We can go fairly quickly on this one.
- Yang Lee
Person
That's the plan? Yang Lee with Department of Social Services. So for the first couple of issues are just caseload adjustments and changes that are happening to our major programs. I mean, the agenda does a pretty good job aligning some of those case law just in surgery.
- Yang Lee
Person
So I'm not going to go into too much details of that unless the chair wants me to do so. Otherwise, I'll just skip ahead and start talking about the budget change proposals instead.
- Caroline Menjivar
Legislator
If you could just a little bit on the provisional language for the federal CalWORKS calips program. Sure. Again, reiterating, we don't anticipate all these cuts are hurting our ability to participate.
- Yang Lee
Person
In this pilot program at the moment. We don't anticipate that because the Federal Government's going to be making the determination. I don't think they're going to be looking what the state's going to do on that side. But I don't know, too, because I'm not the Federal Government of what they're going to be looking at. But.
- Yang Lee
Person
Jen lizard no. Okay. But on that one, really simple, just the extent that we are accepted to be part of the pilot, we're just going to need some resources to implement that. And that gives us an opportunity to make those adjustments during the current year when the Legislature is not available.
- Caroline Menjivar
Legislator
Can you remind us of the timeline for this whole thing? Sure.
- Yang Lee
Person
So spring and early summer Administration, the Federal Government will release a guidance application for the pilot around the summer. The state will be selected, states will be selected to participate, and then October 1 is when we anticipate that the pilot will launch and data will be collected to start the process.
- Caroline Menjivar
Legislator
Do we, I think I asked this or anticipate any other funding sources necessary?
- Yang Lee
Person
I'm not tracking any, but there could always be that when we start doing assessments, once we get the more information from the feds.
- Caroline Menjivar
Legislator
Okay. The 2.4 million, this is administrative, that's.
- Yang Lee
Person
Automation costs that we're anticipating would be needed to do some automation work. There's going to be some resources for staff to do some of the work and also some resources for the counties also.
- Caroline Menjivar
Legislator
Okay. Thank you.
- Yang Lee
Person
So I'll start with some of the bcps that we have included in May revision, and I'll just cover some of those and then some of the other detailed stuff. Okay. So the first one is just the maintenance of the CEcRIS system.
- Yang Lee
Person
We're requesting to make permanent positions, make permanent four limiter positions to continue to maintain and operate the system. These resources were provided two years ago. This is very, it will be very helpful to allow to ensure that the county is reimbursed timely. So like I said, with any system you need people to maintain and operate it.
- Yang Lee
Person
The second one is just the summer electronic benefit. Well, which is now referred to as Sunbuck. That's a program that we're referring to now.
- Yang Lee
Person
That's the federal change in that name for requesting $2.5 million in the budget year for six permanent and two limited resources position to cover the ends up funding to cover some consulting work related to the it component.
- Yang Lee
Person
So this resources will provide state level administrative, technical experts and to do some of the policy work around the implementation of the Sombec program. The next one is the child welfare training funds. This is more of just a shift between funding between two different budget items.
- Yang Lee
Person
We're taking money that's right now being allocated and paid for through some consultant services with a vendor. We're going to bring some of that in house instead. And we're going to hire two position to do some of those training. And then the last.
- Yang Lee
Person
No, sorry, the second to the last BCP, it's a guardian background checks, maintenance and operations. This is the current system that the state is the department's using for background check. Currently the cost has come a little bit higher as anything else that we've seen. Costs are going up.
- Yang Lee
Person
So we're asking for $312,000 for the next two fiscal years and then $612 and starting 2627 to cover the cost of the maintenance and operation for the current guardian background system. The last BCp is the preschool development grant program. This is just federal dollars that we're asking and reimbursement authority for social services.
- Yang Lee
Person
So 328 reimbursement for social services $1.3 million federal funds for agency for us to continue to expand and implement the preschool development grant planning program. The FRA we cover that is just budget Bill Language. The next one is the ABOD, the budget Bill Language.
- Yang Lee
Person
We're also asking for language to be included in the budget Bill that would allow Department of Finance to increase our department's authority extent that we are determined to no longer be eligible for the waiver. So ABAD currently California is under statewide waiver the aboard time limit pending release of relevant unemployment data.
- Yang Lee
Person
California will be conducting analysis to determine if the state will be eligible for another waiver beginning in November 1.
- Yang Lee
Person
To the extent that we're not because the employment data are coming in would so that we're not longer in meeting the waiver, we'll have to implement the time limit and that requires resources to do so, so we're putting language into consent that that happens.
- Yang Lee
Person
And starting as fiscal year, there's an opportunity for us to get resources to do that. ABA five CalWORKS grant increases pretty simple. Every year we do an assessment of what the real local realignment dollars are. Right now we're projecting that there's going to be a 0.3% increase in the CalWORKS map that would in itself bring.
- Yang Lee
Person
That's estimated to cost around $10.5 million. This is all paid for by realignment, the child poverty and family supplemental support account that would bring our non exempt net level up to $1,171. Sorry, sorry. From 1171 to 1175 per month for a family of three. The next one is emulation of comparable disqualification.
- Yang Lee
Person
Here we have a proposal which includes trailer Bill to eliminate the comparable disqualification for the CFAP program and to make it align with the Calfresh program. Comparable disqualification refers to the policy whereby a state may choose to choose to disqualify Calfresh Member if the household Member is disqualified from another means test program such as CalWORKS.
- Yang Lee
Person
And so we Calfresh receives approval from FNS to eliminate the comparable disqualification beginning April 12024 as part of our annual state options report process. Because of that, we want to align that with Californ CFAT, too. So we're just making that shift here, making that change with this proposal.
- Yang Lee
Person
The next proposal is the national standard for missing and exploited children reporting requirement, or the May revision includes 1.2 million. 432 Journal Fund ongoing for new federal reporting and communication requirements this is signing into law and federal law this past January.
- Yang Lee
Person
Under current law, federal agencies, federal title four EE agencies are required to maintain regular communications with law enforcement agencies in an effort to provide safety recovery of missing youth. This funding will go to the county so that they can implement that process. And then, of course, we have the La County welfare stabilization funding.
- Yang Lee
Person
This is more of a technical adjustment that we're just making because we're no longer proposing that as part of the solution. Right? Foster rate reform. I think for the most part, we talked about that earlier, so I'm not going to delay into those details. We also have another proposal for re appropriation.
- Yang Lee
Person
This has to do with BH Connect. We got $2.6 million that we want to have additional year to spend so that we could continue supporting of the child family teams for families maintenance cases associated with implementation of BH Connect and then FFPSA reappropriation. This is very technical.
- Yang Lee
Person
For the most part, we just want to make a correction to a budget item that's in the budget Bill. The last couple things are just chapter legislation. These are just funding that are provided to implement various chapter legislation that impacts the Department.
- Yang Lee
Person
We have approximately, there's quite a few, but overall, the department's requesting $46.4 million, 24.7 General Fund to implement various chapters legislation. Some big ones are.
- Yang Lee
Person
I'm not going to go into all of the details, but some of the big ones are implementing, providing additional pay, sick leave for IHS providers, going from 24 hours a year to 40 hours a year, implementing some books, program, things of that nature.
- Yang Lee
Person
There's a lot in there, but these are just chapters legislation that the Legislature and the Governor agreed, too, as part of the 23 legislative process. So that's pretty much the information there. I'm happy to talk more about the details of some of these chapter legislation, if that's the desire.
- Caroline Menjivar
Legislator
No, we're okay. Department panelists, I just have kind of like the same question I had last week regarding. Well, the governor's proposing about an 8% cut across departments for staff, but we continue to see staff requests that essentially could potentially offset the 8%.
- Caroline Menjivar
Legislator
So I'm not seeing how we're going to save all these savings if we're asking for more staff.
- Unidentified Speaker
Person
Oh, no, I'm calling Department of Finance. So are you referring to the vacant position savings?
- Caroline Menjivar
Legislator
No, that's a 10,000 vacant positions.
- Unidentified Speaker
Person
The statewide reductions?
- Caroline Menjivar
Legislator
Yes.
- Unidentified Speaker
Person
Yeah. So the may revision is assuming a cross board reduction to state operations by 7.9% for all agencies and departments. The plan reduction involves all categories, so it's including personnel, operating costs, and contracting. We're planning to work with agencies and departments in the fall on the appropriate budget reductions. And this is just to address the structural deficit facing the state.
- Unidentified Speaker
Person
The post cuts, we think are necessary to address the budget deficit and encouraging the Department to operate more efficiently in a way that will maintain core operations and affected levels of service. And then, as the Governor mentioned in the May revision press conference, we're targeting 3 billion in government efficiencies.
- Caroline Menjivar
Legislator
But how can we do that if we're requesting for more staff? How are we going to be working more efficiently? If I'm seeing all these different departments asking for more staff?
- Unidentified Speaker
Person
It will offset the 8% cut. Right. So I think we took that into consideration when determining the statewide cuts.
- Caroline Menjivar
Legislator
Oh, I thought you turned it off. Because we're turning it off now. You're like, don't turn to me. Okay. So that consideration, the 8%, is still going to be seen, even though what you're saying, what I'm hearing is that we're asking for more stuff. Correct. Okay. LAO, any comment on this?
- Angela Short
Person
Angela Short with the Legislative Analyst Office. We're still reviewing the details of these various proposals, but very much in line with the chair's comments.
- Angela Short
Person
Something that we will be looking into is, given the administration's proposed 7.95%, kind of global, across the board state operations reduction proposal, how do these new funding requests interact with that overall reduction goal? Is something that we'll be working with the Administration to better understand in the coming days. Thank you.
- Caroline Menjivar
Legislator
And then I'd also like to know, and this is not specifically on this topic, but the 10,000, I think I brought it up, where they lie amongst HHS departments. If they impede any chaptered legislation, then one of the questions our colleagues had was like, are any of the 10,000 vacant positions?
- Caroline Menjivar
Legislator
Were they supposed to have been working on some chaptered legislation? Would that further impede the implementation of said chapter legislation? Okay, any questions? Okay, moving on to issue number nine, let's talk about some trailer built languages.
- Jennifer Troia
Person
Thank you, Madam Chair and Members Jennifer Troia, on behalf of the Department of Social Services, the first item of trailer Bill is the one that I will actually spend a little bit of time going through the detail of, if that is all right. And then on the others, I think we can move fairly quickly.
- Jennifer Troia
Person
That first item of trailer Bill is adjustments to our proposed permanent rate reform structure for the foster care system. As you may recall, we already talked about the trigger language with respect to this proposal, but the overall proposal is a large set of changes to the overall structure of the Foster Care Rate Reforms.
- Jennifer Troia
Person
Subsequent to the governor's proposal in the January budget and the hearings that we previously had on this topic, we held more than 15 public meetings with more than 500 individuals. We received extensive public comments in writing and verbally. In those meetings, we are submitting responsive revisions to the trailer Bill.
- Jennifer Troia
Person
In light of all of those comments that we received in those extensive public engagements, I will highlight the most significant of those changes for you, and I'm happy to answer any questions about the additional details.
- Jennifer Troia
Person
There were three components of the or three main components of the proposal, strength building program, immediate needs, and then a sort of catch all bucket of everything else. So, with respect to the strengths building program, we previously had a lot of conversation about the supervised independent living programs and how those rates were structured.
- Jennifer Troia
Person
Our proposal in the May revision is to make an adjustment to the trailer Bill Language so that the strengths building funding will be given directly to the youth who reside in supervised independent living placements. They will not go through the third party financial manager for the receipt of those funds. It will be built into the silp rate.
- Jennifer Troia
Person
As a result, the total of the silp rate would become $2,288 and it would go directly to the non minor dependent.
- Jennifer Troia
Person
Non minor dependents would also be empowered so outside of Silps, but in other placements, to develop their own strength building plan and to make decisions to expenditure the strength building funds in a manner that supports their transition to a successful adulthood.
- Jennifer Troia
Person
We also, in response to feedback that we received from stakeholders, made an adjustment so that any unspent funds in a child or non minor dependent strengths building account will remain available to them for the remainder of the fiscal year if they have transitioned to permanency.
- Jennifer Troia
Person
So if they reunify with their parent or are adopted or enter into guardianship, they will still continue to be able to expend those strengths building funds. We removed background check language that was causing some confusion.
- Jennifer Troia
Person
Our intent was simply to reference the existing law, and our reference to that created some confusion about whether we were creating a new standard. We were not, and so we've just deleted that.
- Jennifer Troia
Person
To make it clearer, we also clarified that strengths building funds are not to be considered income or resources for the purposes of eligibility for any other local, state, or federal benefit or assistance program to the extent allowable under federal law.
- Jennifer Troia
Person
With respect to the immediate needs program, the biggest change was to set essentially a default so that those funds, if a child or youth is placed in a strTp, they would receive.
- Jennifer Troia
Person
The sTRTP would be the default provider of those immediate needs services unless the county affirmatively determined that it was not in the child's best interest for the sTRTP to receive those immediate needs funds. So that would create some greater certainty for those TRTP providers of the availability of those immediate needs funds.
- Jennifer Troia
Person
And the final thing that I'll highlight is that the immediate needs program plan will be required to be jointly submitted to CDSS by the local child welfare agency as well as the local mental health plan to increase the collaboration and coordination required at the local level.
- Jennifer Troia
Person
So I'll pause there on the rate reform and see if you have questions on that.
- Caroline Menjivar
Legislator
And then, you know, I still am very excited for what this reform is going to bring, and we're hearing the excitement from youth and caregivers. I know not everyone else is super happy, but at the end of the day, if the youth who are in these programs are happy about this, the caregivers are happy about this.
- Caroline Menjivar
Legislator
This is a really big start. And I know we have two years to continue to hash out the trailer, continue to hash out the program and so forth.
- Caroline Menjivar
Legislator
My ask, and I don't do this to the advocates, is that we need to come together and we need to make sure we're supporting the Department and pushing this forward, because what I don't want is for there to be some installment, some barriers and pizzas from continuing to push forward this trailer Bill Language on this program that is going to be historic for our youth.
- Caroline Menjivar
Legislator
And I think, again, we'll have time to come back and see what else we can do.
- Caroline Menjivar
Legislator
But for right now, this is a big first step and we'll continue working with the counties and providers, but we need to be united for now in pushing this first step forward before we don't have a first step that we can push forward. So that would be my ask to the advocates on that.
- Caroline Menjivar
Legislator
And then going back to the trigger language, I just want to ask another question on this. By putting a trigger, are we scoring a save because we're doing an infrastructure, right? Are we doing this to score a save earth? Yeah, score a save savings.
- Kia Cha
Person
Kita Department of Finance so yes, in the out years. We are not capturing those costs in the out years until the trigger determination is made. Okay.
- Caroline Menjivar
Legislator
So that's what I'm worried about. We're scoring a save on something that's a statutory mandate. And I'm thinking about the DDS rate reforms. I'm thinking about what we're going through right now and like that, I think is very unfair. But I really appreciate you answering the question. Thank you.
- Caroline Menjivar
Legislator
I just think it's very unfair for us to do this to this population, scoring a save on something that we have to do. Okay. Any other questions on the trailer Bill Language for the rate reform foster care rate reform?
- Shannon Grove
Legislator
I just want to confirm that the trigger language for 2026 doesn't automatically let us roll this program out. It's based on funds available for 2026. Is that true or not?
- Kia Cha
Person
Yes. So in the spring of 2026, the intent is for finance to make a determination to make sure that there's sufficient General Fund revenues to support in the multi year over the multi year.
- Angela Short
Person
Eliot, comment on yes, thank you. Regarding the amended trailer Bill Language, based on our initial read, we did want to acknowledge it does seem that many amendments are made directly in response to the significant stakeholder feedback that has been provided to the Department over the past couple of months.
- Angela Short
Person
And we do also understand that the Department will be continuing to work with stakeholders to address some issues that do remain outstanding. For example, we understand there are still some questions related to the child and adolescent needs and strengths cans, assessment usage, the latent class analysis or the methodology to establish the tiers, and some other issues.
- Angela Short
Person
So while there do remain outstanding questions, the amendments do again seek to directly address many elements of stakeholder feedback that has been provided. So we'll be continuing to track the evolution of the language in the next couple of months.
- Caroline Menjivar
Legislator
Thank you. And then can you share anything regarding the admin cost for providers and what we're seeing and how conversations are going in that realm where providers feel it's just not enough?
- Jennifer Troia
Person
We have not proposed any changes to the governor's proposal from January with respect to the admin costs. Conversations are still happening. We absolutely are hearing from providers and do understand what their concerns are.
- Jennifer Troia
Person
I think they are both concerned with the total of the admin funding and also with the desire for a COLA to be applied to those funds. We have not provided either of those in the proposal at this time, but do understand the concerns that are being raised.
- Caroline Menjivar
Legislator
Does the Department see it in a different light? Where we feel where the Department feels like this will get providers through, this is enough.
- Jennifer Troia
Person
Our proposal represents what we believe is necessary to implement the rates okay, okay.
- Claire Ramsey
Person
Claire Ramsey for the Department on the second trailer Bill Language for information sharing for small family childcare homes this is a non fiscal TBL proposal that would allow small family child care home names, license numbers, zip codes and telephone numbers to be shared on California's consumer education website for child care.
- Claire Ramsey
Person
Currently myChildcareplan.org.current law limits that sharing and California is looking to bring itself into alignment with federal law that requires this information to be made available. We do have concerns if we don't come into compliance, we may have penalties assessed in out years. Next, I will speak to the facility inclusion for community care expansion preservation program.
- Claire Ramsey
Person
This is also a non fiscal TBL to allow cdss to accept a legally enforceable agreement in lieu of a deed restriction for facilities awarding excuse me, facilities awarded funding for operating subsidy payments in the community care expansion preservation program.
- Claire Ramsey
Person
The requirement for deed restrictions has posed a significant barrier for participation in the operating subsidy payments for CC because we're finding that people often lease the properties they use to run the facilities and their landlords are not looking to make deed restrictions just to confirm that the term of any legally enforceable agreement would cover the full term of any operating subsidy proposals provided to that facility.
- Jennifer Troia
Person
The next item is with respect to federal reporting and communication requirements when there are missing or exploited children. The TBL proposal relates to federal reporting and communication requirements, which were signed into law in January 2023.
- Jennifer Troia
Person
The federal law requires us as a title iv e agency to maintain regular communication with law enforcement agencies in efforts to provide safe recovery of missing youth. These are additional recording requirements that will bring us into federal compliance and also enhance the overall partnership between county child welfare agencies and law enforcement.
- Jennifer Troia
Person
The next item is related to specialized care increments. Specialized care increments provide a supplemental payment to family home providers when they need to pay for the additional care and supervision when there are behavioral or emotional or physical requirements of the needs of a foster child.
- Jennifer Troia
Person
This proposal would allow tribes who have a title iv e agreement with the state to create their own Sci rate setting system. It would also explicitly clarify that children under county jurisdiction who are placed in a tribally approved home may receive the county's SCI where Applicable.
- Jennifer Troia
Person
So overall, it is providing additional specialized care increment resources to tribal children. The next proposal relates to the resource Family approval program and the emergency caregiver funding which we've previously discussed for other purposes.
- Jennifer Troia
Person
The resource family approval program was implemented to create a streamlined approval process for relative and non relative caregivers under the jurisdiction of county child welfare systems and to increase the use of home based and family centered placement options.
- Jennifer Troia
Person
There's currently a disconnect in the statute in the sense that the RFA statute requires the approving agency to complete the process within 90 days where emergency caregiver funding can be provided for up to 120 days. The RFA timeframes have continued to decrease but not ever hit the 90 day mark.
- Jennifer Troia
Person
So this trailer Bill is bringing those two statutes into alignment at the 120 day timeframe. The next trailer Bill is related to the state and federal kinship guardianship Assistance payment program.
- Jennifer Troia
Person
This is an alignment to bring the state into a place where we can allow young people who are aging out of the foster care system to have a better transition into adulthood by not requiring them to spend spend down resources.
- Jennifer Troia
Person
So the current law provides that children and non minors receiving kin gap can only retain cash savings, including interest up to $10,000 and specified personal property limits. This is a holdover from prior federal law.
- Jennifer Troia
Person
The Federal Government no longer requires it, and so there is no reason for the state to create such a restriction and there's no fiscal impact to us of allowing these young people to retain those resources and transition better into adulthood. The next one is related to the excellence in family finding, engagement and support program.
- Jennifer Troia
Person
One of the requirements of this program is that counties that opt into the program need to have full time staff fully dedicated to this resource. What we have found in implementation is that for the 20 small counties and for some tribes, there is not a sufficient caseload to justify a full time staff person.
- Jennifer Troia
Person
And so in those exceptional circumstances, we want to have the flexibility to make sure that they are still meeting the intent of the program, but are able to do so perhaps with someone on a part time basis. The next trailer Bill is related to snap or Calfresh reimbursement when there are instances of stolen benefits.
- Jennifer Troia
Person
So the may revision is proposing to codify how we reimburse electronically stolen Calfresh benefits and to bring us into alignment in terms of when the versus the Federal Government is footing the Bill for that replacement of benefits.
- Jennifer Troia
Person
The proposal would halt the state funded replacements if federal funding is available, and would also create better alignment between the state and federal policies that ultimately are more generous to how much is replaced for the recipient. We originally implemented our state replacement prior to any availability of federal funding.
- Jennifer Troia
Person
So these programs sort of came into being at different times and we are bringing them into alignment through this trail.
- Caroline Menjivar
Legislator
I know a lot of the advocates have pushed for streamlining the process of getting the funds back, you know, 10 days. I know we worked to get to 10 days, 10 business days, and still advocates think that's still a long time.
- Caroline Menjivar
Legislator
I'm interested in seeing if we could put some stronger language in this Tbl regarding, you know, as soon as possible or just, I think 10 days. Just, we're going to wait till the 10 days. So interested in seeing some language regarding codifying a faster approach to getting the funds out.
- Jennifer Troia
Person
I believe the way that the statute frames are right now is that it's a prompt replacement and we have implemented that to be the 10 day standard. Does it say prompt? Okay, it does appreciate your point though, and happy to talk with you further and to work with your staff on any proposals that you might have.
- Unidentified Speaker
Person
Okay, thank you.
- Jennifer Troia
Person
The next piece of trailer Bill is related to the tribal Nutrition Assistance program.
- Jennifer Troia
Person
The trailer Bill would remove references to the federal distribution program on Indian reservations from the statute that authorized TNAP to make sure that the TNAP program could be more available without requiring tribal Members to choose between FD, PIR or Calfresh in order to benefit from TNAP.
- Jennifer Troia
Person
The next one is related to the CalWORKS intensive case management hourly increase. Pause. This was a January budget proposal. This is the trailer Bill Language that would effectuate the proposal. The next trailer Bill is the California Food Assistance program, or CFAP elimination of comparable disqualification. My colleague Mister Lee already referenced some of this.
- Jennifer Troia
Person
We have currently a policy of disqualifying or sanctioning individuals in Calfresh if they received a sanction in Cal Works. We are not required by the Federal Government to impose such a sanction, and we've received approval in the Calfresh program to no longer do so.
- Jennifer Troia
Person
But the CFAP statute remains on the books, and so we need to adjust the CFAP statute to align with calfresh in order to not sanction the Calfresh recipients.
- Caroline Menjivar
Legislator
Madam, one question. Is this. Remind me, I know we talked about this earlier in the year regarding some additional state sanctions that the Federal Government doesn't have. Is this what you were talking about, removing that?
- Jennifer Troia
Person
No. I believe what you were referencing in the earlier hearings was with respect to the pilot and the advocate's advocacy for saying that the state should not in the CalWORKS program sanction any more than is minimally federally required. This is about carrying a calwork sanction over into calfresh.
- Caroline Menjivar
Legislator
Okay. Senator Grove.
- Shannon Grove
Legislator
I have a question on the CalWORKS intensive case management hourly increase. Pause. How many people, or have you guys determined how many people would be affected by that for delaying that?
- Jennifer Troia
Person
I don't have that number in front of me. I do know that the case management hours are reduced, but there is still intensive case management. It's just going to be, instead of increasing from 8.75 hours to 10 hours, it will remain at 8.75 hours. So we will still be serving all of the same people.
- Jennifer Troia
Person
I don't know what the total caseload is off the top of my head, but we will still serve all of that.
- Shannon Grove
Legislator
Can you find out how much the number of hours is not being served? Because my office receives calls all the time for help to develop, to get a case manager because they're waiting months for one. And so I'd like to know how many people aren't being served.
- Shannon Grove
Legislator
That's why we asked to have the increase in the first place, so that people that were struggling with those benefits, working with a bureaucratic agency would be able to have their benefits brought forward on the case management problems that they had. And that's why we asked for it to be increased.
- Shannon Grove
Legislator
And if you're not going to increase it, I want to know how many people are still going to be waiting in line and for how long and what. Give me a dashboard. We will provide you the information on the caseload for that program that are served by them.
- Jennifer Troia
Person
The next piece of trailer Bill relates to the family reunification cash assistance for families who were receiving cowworks when their children were removed. On the child welfare side, this is recognizing an implementation delay.
- Jennifer Troia
Person
Typically we include in changes to the CalWORKS program language that indicates it will take effect at a certain time or when automation is complete, whichever is later. We did not include that language in this statute and do need to do so, and so this is making that adjustment.
- Jennifer Troia
Person
Part of that is also because the all county letter to implement the policy was released in November of 2023 and what we have heard from Calsaws is that the implementation for the change will not be completed until January 2025 and the counties are not able to do a manual workaround given the complexity involved prior to that time.
- Jennifer Troia
Person
So this is changing the timeline just to match what is actually feasible in implementation.
- Claire Ramsey
Person
Next we have the data sharing to quantify the impacts of the safety net on the whole californian. This is another non fiscal TBL proposal that would allow CDSS to receive data and report on outcomes related to housing stability for participants in various human services program, including our CDSS housing programs.
- Claire Ramsey
Person
Specifically, this would give us access to person level data from the housing data integration system, hdis that the BCSH agency runs. We believe the statutory authority will provide everything the Department needs in order to access that data and to move forward with additional ability to analyze outcomes.
- Jennifer Troia
Person
The next proposal relates to the CFAT program and to the overissuance, collection retention rates. This was actually a January proposal which you have already heard. We are literally just changing a code section reference within that trailer Bill because we identified an error.
- Claire Ramsey
Person
The next is the IHSS permanent backup provider system. This is the TBL to effectuate the elimination of the IHSS backup provider system.
- Caroline Menjivar
Legislator
The following item similarly and the wins and the undocumented. Do we have trailer Bill Language yet? Like the actual.
- Unidentified Speaker
Person
So regarding CFAP. Yeah, that trailer bullet language. The technical correction is forthcoming for the win. That also has not been posted yet.
- Kia Cha
Person
And the undocumented IHS. The undocumented IHSS is still pending, so we're working on that and that will be posted as soon as we have it ready.
- Shannon Grove
Legislator
So I'm just a follow up question. So we're going to be voting on this Tuesday and Wednesday, right? Is that correct?
- Caroline Menjivar
Legislator
TBD, because I still have a lot of health to go over and TBD.
- Shannon Grove
Legislator
So my understanding is that we're going to take up the votes on this next Tuesday and Wednesday and we don't have maybe and we don't have language for those three. Like it's just pending out there. When is somebody going to provide us the language so we know what we're voting on?
- Shannon Grove
Legislator
Or is that the, I don't know, Modus Operandi? I guess that's what I feel like.
- Shannon Grove
Legislator
I feel like that every year a budget is submitted, somebody puts a little sticky note on a white paper that says, you're going to cut all these people's benefits and the most poorest or most vulnerable Members of our society, and then you meet with them and you can say, zero, we met with all these providers.
- Shannon Grove
Legislator
We had 15 meetings and met with over 500 providers. And instead of cutting their benefits at this level, you only cut them at this level. And they're very grateful and thanking you guys for doing so, but they still have a cut. And then we don't even get the language.
- Shannon Grove
Legislator
So somebody tell me when we're going to get the language. Respectfully, sorry. Go ahead. Anybody?
- Unidentified Speaker
Person
Yeah. So in regards to the CFAP and wins program, we're working on the language as we speak. So hoping to get to you as soon as possible.
- Shannon Grove
Legislator
What does that mean? Does that mean this week or next week or.
- Unidentified Speaker
Person
Yes, I would hope by this week.
- Unidentified Speaker
Person
Okay.
- Kia Cha
Person
And then for the chair.
- Shannon Grove
Legislator
Go ahead. Yes, ma'am. Sorry, go ahead.
- Kia Cha
Person
I was just going to add for the IHSS undocumented solution. We're also expecting to get that hopefully wrapped up this week for you guys as well.
- Shannon Grove
Legislator
How many pages do you think is in there? Like, are we going to have time to read it? Is it 100? Less? Five.
- Unidentified Speaker
Person
In regards to the CFAP and the winds, the CFAP is a technical correction, so it won't be more than one line. The winds we haven't seen yet, so that should be pending. But it shouldn't be hundreds. You haven't seen it yet, so we're working on that currently. Who's working on it? The Administration.
- Unidentified Speaker
Person
So the Department, along with the Department of Finance. And have you seen it? I have not at this time.
- Caroline Menjivar
Legislator
Okay. No, I'm there with you. I'm there with you. I'm there with you. Okay, we can proceed.
- Jennifer Troia
Person
I believe we are done because there's nothing to share. Right.
- Claire Ramsey
Person
Last thing I wanted to just flag for the chair and Members on the IHSS undocumented, there is CDSS trailer Bill Language that will be posted, which is very brief because it's a single code section being amended. However, there is amendments needed from the Department of Healthcare Services as well, and those are in process as well.
- Claire Ramsey
Person
So we'll have all that together.
- Caroline Menjivar
Legislator
Okay, thank you. Moving on back to Department of aging. zero, Lao, is there anything you wanted to share? That. No? Okay. Sorry, Angela, what's going on? You know what? I don't know. I feel like you're usually on this side. Yes, I'm always this way.
- Unidentified Speaker
Person
Go ahead, please.
- Mark Beckley
Person
All right. Good morning, chair Members. Mark Beckley, Chief Deputy Director for the California Department of Aging. There are two questions on the agenda for us.
- Mark Beckley
Person
I'll take the first question, and I'd like to take the second question embedded within the first item, which is, how did the demand for meals, cost of meals, including congregate options like meals on wheels, change during the pandemic? And during the pandemic, we saw a couple of significant events occur.
- Mark Beckley
Person
One is, and this actually kind of just followed along with a trend that had been existing in the program for so long, is a switch from congregate meals to home delivered meals. Home delivered, obviously, because our congregate sites had closed down and people were interested in receiving meals at home. The AAA's also provided grab and go meals.
- Mark Beckley
Person
But this does seem to be a change that our customers are interested in. And under the new federal final rule, there is more flexibility to switch funding from congregate to home delivered meals.
- Mark Beckley
Person
The second thing that occurred during the pandemic is, you know, and we're very proud of this and proud of our AAA partners is we've served more people through our meal programs than we ever have before. As I testified previously, over the past five years, we have served 100,000 more meal participants and provided 3 million more meals.
- Mark Beckley
Person
So this is just tremendous progress, and we definitely hope to build upon that progress in the future. Regarding the question regarding impacts. So I'd like to kind of break down the impacts based on different funding sources. So currently, the AAA's receive two additional one time funding sources, ARPA funds, which is at 77 million.
- Mark Beckley
Person
If you divide that over the three years of ARPA, that comes out to be $25.6 million a year. And then HCBS relief funds, which is $20 million over two years, combined, that's 36 million. That's roughly the figure that the AAA's had requested, the 37 million on an annual basis.
- Mark Beckley
Person
So that's the gap that was really intended to be closed with this funding. There was additional funding received in the current year, unexpected but very welcome funding in the amount of $15 million from the Administration of community living to provide a baseline augmentation to nutrition funding.
- Mark Beckley
Person
So if you take that 20 million and subtract it from the 36, that gives you a problem of 21 million that the AAA's were seeking to solve with the older California act funding, that roughly equates to about 9.5% reduction in spending capacity by the AAA's on nutrition services. There are some important caveats there.
- Mark Beckley
Person
The first is we have not closed the books on ARPA or HCVS yet because those funding sources still have additional time to run. So we won't know until probably late next year in terms of how much money they actually spent and how many people they served with that funding.
- Mark Beckley
Person
And then they also have flexibility in terms of the number of meals that they serve to participants. So they all operate a combination of both home delivered and congregate meal services. So depending on that mixture, it could result in a different number of populations being served with their funding.
- Mark Beckley
Person
So I think, you know, to really quantify the impact, we've been and will continue to work with the AAA's to really understand local impacts. As I mentioned in last Thursday's hearing, we do have $53 million in what we call older California modernization funding that is currently dedicated to provide supportive services such as legal caregiving, care management services.
- Mark Beckley
Person
We're going to provide flexibility to the AAA's to use that funding for nutrition programs so they can make the decision locally. If they use that funding on nutrition services, that could bridge the gap for the next two years. Because like I say, the problem's 21,000,053 divided over the two years is about $25 and $26 million a year.
- Mark Beckley
Person
So that would be available to them. In addition, they did receive the first compliment of Older Californians Act Modernization nutrition funding of 15 million in the current year. That funding will also still be available to them to spend until March of 2026.
- Mark Beckley
Person
So to the extent that they haven't fully spent their allocation the current year, they could continue to spend down that funding source. So in a nutshell, that's really the definition of the problem.
- Caroline Menjivar
Legislator
Will we see a different impact in different AAA's depending on geographics?
- Mark Beckley
Person
In terms of geographics, you may, like I say, I don't know if it's so much geographic as much as it is based on their local assessments of needs, whether you have, you know, greater populations who need home delivered meals versus congregate meals. But I would imagine that the impacts would vary according to AAA's.
- Caroline Menjivar
Legislator
Okay, but at the bottom line, it's the 9.5% reduction overall, right? That's across all AAA's or it's just.
- Mark Beckley
Person
That's top line. So if you look at the amount of funding that's been appropriated in the current year, four AAA's, and you take out the 21 million, it's about a 9.5% reduction.
- Caroline Menjivar
Legislator
Okay, can we move into. And we can move into that second point.
- Mark Beckley
Person
Okay, so I think. Okay, so the second issue, older adult behavioral health so in the current year, we have spent $325,000 to date and just kind of explain how the funding is being used. Older adult behavioral health ethnic media campaign really had two components to it.
- Mark Beckley
Person
The first is conducting research, surveys, focus groups for 11 different ethnic communities. And the point of these, of this research is to identify the needs of these populations, and then two, to understand good messaging.
- Mark Beckley
Person
So what is it that they would need to know or hear about to make them more aware of mental health services in their areas and be willing to accept those services. So that was the first stage, is research.
- Mark Beckley
Person
And then the other component to it is translating our aging program resource guide in 17 different languages. So that was really the work envisioned.
- Mark Beckley
Person
And we believe that if we could accomplish this first phase of work, that's really going to make the second phase of work very effective, which is a paid media campaign to really conduct active outreach to these populations, again, increasing awareness of the services, but also reducing stigmas so that they're not, you know, unwilling to receive services once they are aware of them.
- Mark Beckley
Person
So that, that's the, that's the work that we currently have underway with our contractor and that we'd like to continue.
- Caroline Menjivar
Legislator
$312,000 out of the 10.5 million.
- Mark Beckley
Person
I'm sorry, $25,000.
- Caroline Menjivar
Legislator
$325,000. Correct. Out of the $10.5 million. Correct. So let's, let's get, let's get a little real here. I understand this. Yes, bring awareness to services, but we're slashing a lot of services. So what are we bringing awareness to in a year where we're really looking to scrape dollars to fund core services? This is not one of them.
- Caroline Menjivar
Legislator
And I know we're potentially in a contract with said vendors, but I think we just heard under APS, we're looking to cut and end contracts for APS social services, social worker training.
- Caroline Menjivar
Legislator
So Department or Department of Finance, if we're cutting contracts in other areas, this is another contract we should cut because this is $9 million more, $9.5 million we can save to. And if we're looking at older adults, save for APS expansion, save for APS training social workers.
- Caroline Menjivar
Legislator
I don't see how this is a priority, a media campaign over actual core services or actually services to the community. This is not something I will be inclined to support. In looking at how we triage things.
- Shannon Grove
Legislator
I echo the chair's comments. I think it's about priorities.
- Shannon Grove
Legislator
Again, the same thing I said to the last panel, you guys always start with cutting senior services, developmentally disabled healthcare service to the most vulnerable Members of our community and then you offer something up that 50% or less of what they're getting but not as much as you intended or that you put forward on the cut.
- Shannon Grove
Legislator
I still want to understand the methodology of how that happens. Like why do you start there? Why don't you start at, I don't know, $30 million for the healthcare board that does pricing. Why don't you start? I mean, I realize it's federal and bond dollars, but we're spending hundreds of millions of dollars on the high speed rail.
- Shannon Grove
Legislator
Why not delay that for 60, 90, 100 days or whatever and make sure that the most vulnerable people in our society have food? Food is sort of a necessity. Waiting for the next 50 years for the high speed rail shouldn't be top priority. And I realize they're separate dollars, but again, there's a lot of money.
- Shannon Grove
Legislator
Like the advertising campaign, like the chair just said, why are we spending money to get people to sign up for services that you are cutting. You can respond, why are we spending millions of dollars? Why are we doing that?
- Tyler Ulrey
Person
Ty Ulrey, Department of Finance our understanding is that for the 10.5 million unspent for these, for this program, for the older adult behavioral health, that these dollars are encumbered. They're promised in contracts to locals on the ground. So we felt it was important to maintain those contracts.
- Shannon Grove
Legislator
Right. So I'm sorry, those. Sorry.
- Caroline Menjivar
Legislator
Matching those comments, that's an excuse. I mean, we're climbing back $12. 12,000 slots of childcare, of awarded letters, but we can do that. Those are encumbered. So I've asked if we're going to do some approach. For one, we're going to do it for all.
- Shannon Grove
Legislator
I want to see a copy of the contracts too. There's got to be an outclause. You don't have a 30 day cancellation notice or a fee buyout thing that maybe we pay, you know, 1% or whatever it is. What do the contracts say? Is there a cancellation notice? Does either party have the right to cancel?
- Shannon Grove
Legislator
And if so, what are the terms?
- Tyler Ulrey
Person
I'm unaware at the moment of the specifics of the terms of the contracts, but we'd be happy to take that.
- Caroline Menjivar
Legislator
Back for you because again, what we went over on APS adopt protective services, there's already contracts out for the training for social workers and the Department said that they're getting out of them, they're going to be ending the contracts amending. So I know we can do that for other areas.
- Caroline Menjivar
Legislator
It just seems like we're picking and choosing which ones we're going to get out of versus others.
- Caroline Menjivar
Legislator
This is so much money that we can use for actual services that if there is a clause, there's always most likely a clause right to get out, a penalty we pay for that offsets the savings that we can get from this. A median campaign.
- Caroline Menjivar
Legislator
We're telling Californians we're cutting actual caseworkers for Adult Protective Services, but we're going to give you ads on Instagram. That's nowhere near how we should triage what should be cut and saved in this year.
- Shannon Grove
Legislator
And to follow up on that, there was a piece of legislation passed last year that signed into law, went through both houses, signed into law to increase healthcare workers to, I don't know, 20 dollars an hour, 25 dollars an hour, whatever it was. And the state, state is reneging on that.
- Shannon Grove
Legislator
Not reneging, but they realize they can't afford it, so they're not doing it. So they're just automatically arbitrarily sweeping and saying we're not going to do that for state workers. So even if there isn't a clause in the contract, but there should be in the private world, I have state contracts.
- Shannon Grove
Legislator
I know there's a clause in there for termination and the right to terminate. I want a copy of the contracts.
- Shannon Grove
Legislator
And I also want to know if the Administration is willing to just null and void those contracts just like they did with the increase in the wages which they were able to do for whatever reason with not having. I mean, where's a PAGA attorney when you need one? But it's not happening. So what's the way out?
- Shannon Grove
Legislator
Because I side with the chair on this, that, you know, if you're not going to deliver food to people who need it and can't afford to buy food, especially with the cost of food, like she said, why are you posting ads on Instagram and paying that?
- Caroline Menjivar
Legislator
I don't want to undervalue. I know it's probably not ads on Instagram, but it is at the end of day still a social media campaign. I don't know if you'd like to share anything.
- Mark Beckley
Person
It is. I mean, and I think the only thing I'd add when we talk about providing services to customers, what we're really seeing this at least first phase of work doing is setting the stage for leveraging the Proposition One money, to really implement a robust campaign for these communities.
- Mark Beckley
Person
So it was really more of a stepwise process, if you will. So we do think at the end of the day this will, you know, deliver valuable services that are funded. This is really just the first part of the process.
- Shannon Grove
Legislator
I know. I have one more question, Madam Chair. How many seniors are on Instagram? I just made that up. I don't know if it's just how. Many are on social media, 65 and older, that we provide food. I think it's just media, right?
- Mark Beckley
Person
Could be TV, TV ads, right? Yeah. Print media. And when we do conduct media campaigns, we make sure that we do it in a lot of different modalities. Definitely not just the Internet, but also through TV, radio ads, print ads.
- Shannon Grove
Legislator
I'd like a lot of that as well. Like, what do we spend on print ads? Media ads. Television ads, radio ads, and social media.
- Mark Beckley
Person
For the older adult population. The older adult population, I can see. And we're not the only Department, of course, who runs those kind of programs, but it's yours.
- Caroline Menjivar
Legislator
Okay, I understand. Like, you know, the first step, leverage how we're gonna expand on top one. But again, when we're looking to triage, this shouldn't be one that we're giving a lifeline to at all. Aleo, any comments?
- Juwan Trotter
Person
Juwan Trotter, Legislative Analyst Office so we're gonna continue to look through these numbers that we've been given throughout this time, but also take a closer look at the media campaign contracts moving forward.
- Caroline Menjivar
Legislator
Okay, thank you so much.
- Shannon Grove
Legislator
Elia, do you have that language? Do you have all that language?
- Juwan Trotter
Person
I'm sorry? Language for.
- Shannon Grove
Legislator
Do you have the trailer Bill Language, or do you have all this language on the contracts and stuff? Do you have that in your possession now?
- Juwan Trotter
Person
Not at this time.
- Shannon Grove
Legislator
Okay. But you're gonna get it and look through it.
- Juwan Trotter
Person
But we'll ask for it.
- Shannon Grove
Legislator
You'll ask for it. Will you give us for.
- Mark Beckley
Person
Well, we'll be happy to share the information. And then there are termination clauses in all of our contracts. Just so you know, the contracts are always subject to Better Act Appropriation.
- Caroline Menjivar
Legislator
So thank you. Thank you.
- Mark Beckley
Person
Absolutely.
- Caroline Menjivar
Legislator
Moving on to DDS or moving back to DDS. So we're bringing these back up just to continue that conversation that we had. I'm mostly interested. We don't have to go through the whole thing. Mostly interested on any potential updates we have from our last conversation.
- Carla Castaneda
Person
Thank you, Madam Chair. Carla Castaneda with Department of Developmental Services. And we do have a handful of updates, not all of them.
- Caroline Menjivar
Legislator
Right.
- Carla Castaneda
Person
The first issue, one that you had asked for on the mayor revision was on the complex needs homes and if any of that could be retrieved or any of the appropriation, what has been spent to date. So with the execution of the contract.
- Carla Castaneda
Person
We did pay the Fairview management company the $10 million to then address the development at Fairview. So we don't, we're still looking at the technical feasibility of any return and we'll continue to monitor the $500,000 that was attributable for staffing and bringing those on board.
- Caroline Menjivar
Legislator
So we paid Fairview the $10.5 million already.
- Carla Castaneda
Person
$10 million,
- Caroline Menjivar
Legislator
For?
- Carla Castaneda
Person
For the development of the home. So that would include any of the demolition because statute doesn't want any of the existing structures and we are looking to incorporate those near to adjacent to harbor village to minimize any issues with utilities and other.
- Caroline Menjivar
Legislator
Okay, check has gone out. And then on the $500,000?
- Carla Castaneda
Person
That we will likely still have remaining funds. We're just still reconciling on that because it does depend on ramping up for staff.
- Caroline Menjivar
Legislator
And that's the potential unspent. But you're looking for 23-24.
- Caroline Menjivar
Legislator
Correct.
- Caroline Menjivar
Legislator
Okay. All right. And then let's move on. Oh. So no work has been completed yet.
- Carla Castaneda
Person
We've identified two potential locations. So a lot of the work was assessing some of what's available in prior assessments of the sites, any pollution or the buildings on the locations.
- Caroline Menjivar
Legislator
So the 1$0 million that was given to Fairview was given as a lump sum?
- Caroline Menjivar
Legislator
Yes. Correct.
- Caroline Menjivar
Legislator
Without construction or anything done?
- Carla Castaneda
Person
Correct. And when we are doing housing development, we typically put that full amount aside so that it's available as the projects continue.
- Caroline Menjivar
Legislator
Okay. I did that with my contractor. It was bad news. Didn't finish a project and then I never got my money back. But that's neither here nor there. Bathroom upgrade. Okay. So 2023-24 we got nothing. Potentially $500,000 that you're going to roll over into this year.
- Carla Castaneda
Person
There is no additional authority for those dollars. So they would only be available through this fiscal year. And if not encumbered, then those would be los, reverted.
- Caroline Menjivar
Legislator
To the General Fund?
- Carla Castaneda
Person
Mhm. Correct.
- Caroline Menjivar
Legislator
So they can potentially be reverted to the General Fund.
- Carla Castaneda
Person
A portion of that could be.
- Caroline Menjivar
Legislator
So we have a month and a half to spend it.
- Carla Castaneda
Person
We still have to reconcile, not that it would be spent because these were for the staff resources. So whether that is hiring in progress, or preparing
- Caroline Menjivar
Legislator
But we don't have to do much of that right now right?
- Carla Castaneda
Person
Correct.
- Caroline Menjivar
Legislator
Okay. So potentially, we could have the full $500,000 unspent.
- Carla Castaneda
Person
I don't have more details on that.
- Shannon Grove
Legislator
Does this include the 8% vacancy?
- Caroline Menjivar
Legislator
No.
- Shannon Grove
Legislator
It does not.
- Caroline Menjivar
Legislator
No, No. This is, no.
- Shannon Grove
Legislator
Okay, go ahead. Sorry.
- Caroline Menjivar
Legislator
Mm-mm, right, this has nothing to do
- Chris O'Neill
Person
Chris O'Neill, Department of Finance. That's correct, Madam Chair.
- Caroline Menjivar
Legislator
Okay, when are we looking at. Look, I know $500,000 is nothing, right? Pocket change for the State of California. But you know what I'm doing? I'm looking at everything. Couch cushions. When are we gonna admit to ourselves, like, hey, this is really gonna go unspent? Do we have an internal timeline?
- Chris O'Neill
Person
Chris O'Neill, Department of Finance. I don't think there's an internal timeline for that. I think when it came to this program in developing the May revision, our assumptions had lined up at the time.
- Chris O'Neill
Person
You know, certainly, you know, if there were an action taken by the Legislature for that 500, you know, we obviously will take a look at that number too, but, yeah.
- Caroline Menjivar
Legislator
Okay. Okay. Let's move on to Porterville.
- Carla Castaneda
Person
During the, this was more about the population and the historical trend of that population. So the first quarter of 2024, we've had an average census, an average monthly census of 176 individuals. Over the last five years, that annual average has ranged from a high of 208 in 2019 to a low of 187 in 2023.
- Caroline Menjivar
Legislator
177.
- Carla Castaneda
Person
187.
- Caroline Menjivar
Legislator
208 in 2019.
- Carla Castaneda
Person
Correct. And 187 in 2023, so going by calendar year.
- Caroline Menjivar
Legislator
How many do we have right now?
- Carla Castaneda
Person
Currently it is, I believe it's 176.
- Caroline Menjivar
Legislator
Okay. We do see a trend down.
- Carla Castaneda
Person
It does go up and down throughout the year. So these annual averages do have that appearance, we do acknowledge that during any given month, you might have higher, closer to the cap. So, of course, the budget allows that capacity flexibility for when there are referrals from the courts to Porterville.
- Caroline Menjivar
Legislator
Okay.
- Chris O'Neill
Person
And Madam Chair, Chris O'Neill in the Department of Finance, just to clarify, too, just Porterville is unique in that a large segment of the population served there are individuals deemed incompetent to stand trial, just like who the state hospitals serve. And so the services there are highly dependent upon kind of variabilities with the court system as well.
- Chris O'Neill
Person
And so, I think it's instructive to look at those averages and kind of see the ups and downs and the points and times do fluctuate. But at this point, that's the 211 cap. The Administration would see that as a reasonable landing spot. I mean, to maintain that that's what's currently allowed in statute and that's where we think maintaining that number is important.
- Caroline Menjivar
Legislator
And how many employees do we have working there?
- Carla Castaneda
Person
I will double check for you. I believe it's close to 1400 for the full facility. That includes level of care and operations.
- Caroline Menjivar
Legislator
The 20 million would be for how many positions?
- Carla Castaneda
Person
I don't have that with me.
- Chris O'Neill
Person
We would need to call. I think we would need to make a determination. I'm not, and I'm not and I'm not sure the feasibility just because, I mean, obviously positions are different, salary ranges and things like that, but we could take that back and try to unpack that more memorable.
- Caroline Menjivar
Legislator
I'm so sorry, It's Chris.
- Chris O'Neill
Person
It is, yes.
- Caroline Menjivar
Legislator
So, Chris, we're asking for $20 million for staff. Right? But we don't know staff?
- Carla Castaneda
Person
No. Actually, what we were doing was capturing savings in the current year. So based on vacancy. So as my colleague was.
- Caroline Menjivar
Legislator
We're reverting that.
- Carla Castaneda
Person
In the current year.
- Chris O'Neill
Person
Correct. Just acknowledging hiring challenges at Porterville. When we developed the Governor's Budget, we, the Administration determined it was a reasonable assumption to score 20 million in savings. Look, we were going, we were partway through the current year, made that kind of assessment. And so we brought down what we thought would be projected expenditures at Porterville for staffing.
- Chris O'Neill
Person
I think we would maintain that fully budgeting Porterville, budgeting Porterville for full staffing in budget year is still the appropriate way forward. And then I would say, I don't know if we would go through the same exercise again for Porterville specifically, because obviously there's some other global things happening in the budget as well. With the reductions in assessing vacancies more globally, across state government as well, it kind of complicates the picture going forward.
- Caroline Menjivar
Legislator
So going with, yes, hiring difficulties, challenges probably are going to persist, right? We feel confident you were going to use a full 20 million to bring in the people that we need.
- Carla Castaneda
Person
To support the population at any given time, we would be looking at the permanent staff that are hired, voluntary overtime or mandatory overtime in addition to contracted support. So we're kind of more looking for the supporting what we've had as an average, plus that room for admissions as their referrals happen.
- Carla Castaneda
Person
I think the other clarification I wanted to add sort of for context for planning for the unknown admission referrals is being able to address the acuity of individuals when they come into our facilities. So they may not fall into, they may need more individual support, which could result in like one on one supervision or additional staff.
- Caroline Menjivar
Legislator
I mean, we have a lot of diversion programs. And even this year, the Legislature has introduced a number of bills to divert from going into state hospitals or kind of other establishments like this. I do see our numbers to decrease as we continue and we'll see that trend.
- Caroline Menjivar
Legislator
Team here, I'm still, I don't know if the full 20 million, and I recognize we need to have a good ratio, we talked about this last year, but what if we're not using the full 20 million?
- Caroline Menjivar
Legislator
I'm not saying that you don't need the full, but given the trend of decreasing amount of clients here, also the difficulty on onboarding, the difficulty in finding people to work in this space and looking at how we can approach these areas, perhaps a lower amount of dollars here seems more appropriate, throwing that back out as we continue the conversation on this topic.
- Caroline Menjivar
Legislator
Questions on Porterville?
- Shannon Grove
Legislator
Yes.
- Caroline Menjivar
Legislator
Go ahead, Senator.
- Shannon Grove
Legislator
So a follow up on the 20 million. First, there's 1400 employees and at a max capacity, it's 211 people that are served. I realize they're behind the fence people. I realize they're not, you know, they're a different type of person other than in a regular developmental center. But that's like almost seven employees per individual. So if you had to tell me what those seven employees did per individual, what would they do?
- Carla Castaneda
Person
I think a large part of it is the multiple shifts because it is a 24 hours facility. So the level of care staff would be covering all shifts. The three shifts during the day, that includes Office of Protective Services would be supporting three shifts for individuals.
- Carla Castaneda
Person
On the administrative side, it's more like the traditional operations of a department with the staff who are doing the procurement, doing the human resource work.
- Shannon Grove
Legislator
So on the 20 million to follow up on the chairs question, and you don't know how many positions that is $20 million. How many positions does that get us for $20 million?
- Chris O'Neill
Person
Senator Grove, when we scored those savings, we weren't tying necessarily to the number of authorized positions, just acknowledging that there was probably some savings related to hiring challenges. And so
- Shannon Grove
Legislator
So do you have the formula how you scored that savings, $20 million? Or is that just like a number you threw? Like, I don't know, where did the $20 million come from? Like, who determined what that was like? We're going to save $20 million on Porterville, or we're going to spend $20 million on Porterville? Not save.
- Shannon Grove
Legislator
We're going to spend $20 million on Porterville to hire new people with the Governor's Budget that says he's taking 8% of vacant positions to reduce employee compensation costs. So we're taking 8% across the board for people that we employ now, but we're going to spend $20 million to hire. We don't know how many people for what positions. It's just $20 million. Like, how'd you come up with the $20 million and how many positions is that?
- Chris O'Neill
Person
Senator, I couldn't describe a number of positions to that number. I think looking at Porterville's budget and totality, which I can pull that number for you, but just knowing the hiring challenges and the vacancy rates that are dealt with, it was a, we determined it was a reasonable estimate of Governor's Budget to put forward.
- Shannon Grove
Legislator
What basis? Like, it's just, I mean, I have a household income. If I know what my budget is and I can't go, "I'm gonna save $5,000 this month". How? I don't know. Just $5,000 or I'm gonna spend an additional $5,000 or where am I gonna get the money? So how did you come up with $20 million? And you're saying it's based on their total budget. Well, what does that mean?
- Caroline Menjivar
Legislator
And before you answer, I think to that point, I think that's why the 20 million seems a little arbitrary. That's why I'm like, I know you need to hire some people. Let's bring that dollar amount lower, because we're potentially going to still come across the same barriers that we came across a year ago.
- Caroline Menjivar
Legislator
And having more will still help in Porterville. And you can come back again, the full 20 million upfront where potentially you'll say, hey, we didn't use it. And then I'm like, well, we cut these other services and we could have used it for that is what we're hoping to accomplish. We have 45 minutes left, and I have to get through public comment for human services. So we're going to
- Shannon Grove
Legislator
I'm sorry, but my last follow up comment is that you're cutting 6% or 8% in vacant positions, but you're asking for 20 million for positions. And Porterville's in my district, I'm not trying to stop jobs in my district.
- Shannon Grove
Legislator
I'm just trying to say you have to come up with a number that's going to be adequate for the people that you're going to hire, and not just throw $20 million at the program at the very beginning, when other services are being cut.
- Chris O'Neill
Person
Understood, Senator. Thank you.
- Caroline Menjivar
Legislator
Okay, the last issue on number three really quick, we looked at just having a number, a low number. I know, 10 million, approximately. If we're thinking we're going to spend a little bit more than that, then we should have, like a very conservative number that we should save from this automatically included in the June revise as we move forward. Anything else on that, Chris?
- Chris O'Neill
Person
Senator Menjivar, we don't have updates to the numbers that are cited in the agenda or that were previously provided to staff.
- Caroline Menjivar
Legislator
Okay.
- Shannon Grove
Legislator
So is Porterville understaffed now and that's why you need these positions?
- Carla Castaneda
Person
I think I got confused with the issues crossing. Have we moved on to the workforce?
- Chris O'Neill
Person
Senator had a question for.
- Carla Castaneda
Person
Okay, so for staffing, for the individuals that are there, we will use. We don't have enough permanent staff, but what we do is there's voluntary overtime, mandatory overtime, and supplemented with registry contacts to support the individuals that are admitted.
- Shannon Grove
Legislator
And the budget we have for them right now does not cover that.
- Carla Castaneda
Person
The proposed governor's budgeting does support the 211 capacity.
- Shannon Grove
Legislator
And we're not at 211, though.
- Caroline Menjivar
Legislator
No, we're at 176.
- Carla Castaneda
Person
Correct. But the capacity also allows for whether you have the one on one supervision or as you admit individuals to address that.
- Shannon Grove
Legislator
So we're at 176 capacity. Your funding, you want funding for 211, but we're in 176. What's the savings difference from the 176 to the 211?
- Carla Castaneda
Person
I don't have that with me.
- Caroline Menjivar
Legislator
On DSP, on the tuition, so moving on to the third one. On the tuition and the stipend program, could you just ask answer in the middle of the question? Could the program, the tuition, be limited in a similar way to the administration's proposed limitation of the internship program? Just giving out to the ones that already are in the program and taking back the, taking out the remaining funding?
- Chris O'Neill
Person
I think on a technical aspect, that's an action the Legislature could take. Yeah.
- Caroline Menjivar
Legislator
And then on the sidebends, we still don't have a number.
- Chris O'Neill
Person
I think as a Department previously, sure. There's a 90 day lag in understanding. So that the figure, the $10 million figure that was previously provided to staff is, we don't have an update.
- Caroline Menjivar
Legislator
Okay, an update. We're still looking at this because we could potentially still see a savings on that as well, whether it's as low as 3 million, 2 million out of the 10 million?
- Chris O'Neill
Person
Yeah. The 10 is the best figure that we can provide staff at this point, Legislature at this point.
- Shannon Grove
Legislator
And keep in mind, we're voting on this next week.
- Chris O'Neill
Person
Understood, Senator.
- Caroline Menjivar
Legislator
LAO, any comments on this?
- Karina Hendren
Person
Karina Hendren, LAO, nothing to add at this time.
- Caroline Menjivar
Legislator
Okay, we're gonna move on to
- Chris O'Neill
Person
Senator Menjivar, sorry just, we wanted to make one clarification in the agenda. The agenda noted stopping new enrollments in the internship program, and we just wanted to make sure we were clear that there's a nuance here of we're honoring the existing commitments, but we don't have total visibility into placements that may be pending out there.
- Chris O'Neill
Person
And so that was the assumption. That's what the 2.5 reflects, is that kind of assumption. So, I just wanted to make sure we were.
- Caroline Menjivar
Legislator
We don't know if some are onboarding right now.
- Chris O'Neill
Person
In current year, correct. Yeah. So that's
- Caroline Menjivar
Legislator
So they could potentially be cut off without even starting? Or
- Chris O'Neill
Person
The intent of scoring the 20 million savings was to make sure we could capture those. Yes, exactly. We just want to make sure you weren't seeing this is a hard cut off of the number that we provided last week. There was a little bit of nuance there. So we just wanted to clarify that to the Committee.
- Caroline Menjivar
Legislator
Thank you. Move on to issue number two.
- Carla Castaneda
Person
Thank you, Madam Chair, for an update on the CERMS and UFSM modernization projects. In January, we submitted the stage two alternative analysis to the Department of Technology for review. During that market research this last year, we did identify that there are potential systems available that would allow us to combine the two projects.
- Carla Castaneda
Person
So we have done that, and we are working on identifying the requirements for the request for proposal that would be published next year. Part of that will depend on if there are any changes during the review of CDT for that stage two reporting documentation. And then we do have a quarterly update requirement for the Legislature, so that is in progress. That will give you more details.
- Carla Castaneda
Person
For the next question, you were asking about the funding level, and so this is another one where we can get back to you because we are looking at the expenditures in the current year still.
- Caroline Menjivar
Legislator
On the positions?
- Carla Castaneda
Person
Yes.
- Carla Castaneda
Person
As I understand it, the question is specifically of the current budget funding for the project. Is there any remaining funds that might be reappropriated or used in subsequent year?
- Caroline Menjivar
Legislator
Yes, we don't know yet.
- Carla Castaneda
Person
Right. Correct. Regarding the federal funding, though, we have met with CMS representatives and with Department of Healthcare Services, so those conversations continue.
- Carla Castaneda
Person
We have a consultant to help us who's familiar with the process for getting the federal approval. Those documents are still in the planning phase in those conversations, so we don't have a good timing of yet what that approval might look like, the timeframe for that too
- Caroline Menjivar
Legislator
If we provide, if we do provisional language, can we score any savings in the upcoming fiscal year? Because we have a good, hopefully CMS will fund a good portion of this, right? So what happens then to those, those dollars? And then two, can we, if we do provisional, can we save? Provisional language, can we save?
- Carla Castaneda
Person
Okay, thanks. Sorry about that. So, yes, they will. When they are approved. If approved, it would provide up to 90% matching funds for the planning and development, which is the stage we're in for the maintenance and operation would be a 75% match going forward. We just don't have a sense of when they would approve that.
- Chris O'Neill
Person
I think. Senator Menjivar, we would just, we would note that, I mean, the federal funding conversations are occurring and so it's not 100% given, but we're optimistic, and so I just wanted to make that point.
- Caroline Menjivar
Legislator
And if we do provisional, that still protects us to use up to all what is needed, but not all, if we have the funding come in. And in that scenario, what happens with the funding that we don't need to end, we don't end up using?
- Chris O'Neill
Person
So if the provisional language were to say, you can use up to the standard, if federal funding were to become available during budget year and federal funding would offset, is that the question?
- Caroline Menjivar
Legislator
Yes.
- Chris O'Neill
Person
We could look at provisional language and the revision doesn't include that language, but I think it's similar to what we proposed in the other BCP for the reimbursement system project, where we are appropriate. I guess I'm pointing to that as an example where we're waiting on a pending CDT report to come.
- Chris O'Neill
Person
And so we have, the request is for up to the semantic General Fund, and to the extent that the report from Department of Technology comes back and says it's lower than that, then we would lower DDS as General Fund authority for that project accordingly.
- Caroline Menjivar
Legislator
Okay.
- Chris O'Neill
Person
And then at that point there would be, there would be General Fund savings. But we wouldn't be. But it would happen. It would happen during the next fiscal year. Correct.
- Caroline Menjivar
Legislator
Okay, thank you. We can move on to the, LAO any comments on this? Okay, moving on to our last issue on OICR. Welcome back.
- Katherine Lucero
Person
So I'll go ahead and begin. Thank you, Senator Manjavar and your Subcommitee and staff for the thorough review of the trailer Bill Language and my to come speak with you today. My name is Katherine Lucero and I am the Director of the Office of Youth and Community Restoration.
- Katherine Lucero
Person
I'm joined by Joseph Donaldson from Doff Health and human services team as well as Ellison Hewitt from the Doff Corjan team. I also want to acknowledge Katie Howard is here from BSCC and is available to answer any questions, and I do want to thank her team for being available throughout this transition process.
- Katherine Lucero
Person
Before I walk through, I'd like to before I provide a walkthrough of the proposed language, I'll tackle the second part of question one first to describe each grant that is proposed to be shifted to OYCR. It is confusing at times, so I would like to lay that out very clearly.
- Katherine Lucero
Person
Chapter 337, statute of 2020, SB 823 requires juvenile justice grant Administration functions at the BSCC to be moved to OYCR by January 12025. The 2024 to 25 may revision provides for the transfer of all the remaining juvenile grants from BSCC to OYCR as of January 12025.
- Katherine Lucero
Person
It is proposed that OYCR will oversee five different juvenile justice grants. Number one, the juvenile justice realignment block grants that was established through 823. It's a non competitive funding that's always been housed with us. However, we are proposing to change the funding formula grant revision to January 10, 2025 so it was previously due 2024.
- Katherine Lucero
Person
Number two, the Juvenile Justice Crime Prevention act. That grant is currently housed with the BSCC. With the proposed trailer Bill that we're reviewing today would be moved to us by January 1, 2025. This is a non competitive grant that provides state funding for counties to implement programs aimed at reducing youth crime and delinquency.
- Katherine Lucero
Person
This is a separate grant from the youthful offender block grant that I will discuss in a minute, but as of 2016, counties combine the reporting of the JJCPA and the YOBG. Expenditure and data reports are submitted yearly. Number three, the youthful offender block grant.
- Katherine Lucero
Person
This grant is currently housed with the BSCC and with a proposed trailer Bill would be moved to us by January 1, 2025. This is a non competitive grant that enhances county probation, mental health, and substance abuse departments to provide services to youthful offenders.
- Katherine Lucero
Person
This is a separate grant than the JJCPA, but as of 2016, counties combine the reporting, expenditure, and data reports are submitted yearly. Number four is the juvenile reentry grant. This grant is currently housed with the BSCC and will be moved pursuant to this trailer Bill by January 1, 2025.
- Katherine Lucero
Person
This grant addresses local programs needs for persons discharged from custody of DJJ. It was, as you know, proposed to sunset. But the trailer Bill Language that we are reviewing today specifically addresses the fact that now we have secure youth treatment facilities, a term that did not exist previously.
- Katherine Lucero
Person
This new language allows for the eligibility of the youth from the SYTF upon reentry and after DJJ closed. And then you're already familiar with the Title II grant. We've discussed that many times. That is a competitive grant for counties, CBOs, city governments, county governments, and that is a three year cycle of grants.
- Katherine Lucero
Person
With regard to the trailer Bill walkthrough, I would like to note that the bulk of the trailer Bill replaces the board of state and community corrections with OYCR. As you will hear, perhaps at some point, the intent was just really, and I mean from DOF, the intent really was just to literally move the grants copy and paste.
- Katherine Lucero
Person
Yes, exactly. So that was done. In addition to the BSCC, OYCR language swap out, there are a number of places where we do introduce secure youth treatment facility into the language. The first is the amendment to WIC 1981 on page of the 16 page TBL.
- Katherine Lucero
Person
This allows the eligibility, as indicated earlier, of the juvenile reentry grant to go to those kids. Now on page 10, the amendment to W and I code 1982 includes edits to the auditing functions and edits to the ability to withhold funding if data is not submitted.
- Katherine Lucero
Person
However, the Administration does note that the removal of these provisions was not intentional, and we will work with the Legislature to incorporate the provisions within the other amendments proposed to this code section edits in WIC 1984 are technical cleanup. Now I'll address the edits to WIC 2200 H.
- Katherine Lucero
Person
This language added I quote 'and the methodology of grant allocations shall be consistent with those incorporated into the 2011 public safety realignment fiscal structure'. OYCR recognizes that the shift of these grant responsibilities is significant to our county partners.
- Katherine Lucero
Person
By this language, we reaffirm to counties that OYCR will follow the original intent, formulas, and statutes associated with these grant allocations. Only the state agency will change. It has always been the intent, and the language allows for a meeting of the minds on this concept in black and white.
- Katherine Lucero
Person
I believe I've addressed the four questions, but I am certainly available, and my team is available to answer any other.
- Caroline Menjivar
Legislator
Follow up questions on the thank you so much for the regarding the point that the whole point was to transfer over, you're going to be making some technical changes to that to ensure that OYCR is still collecting data from the counties, which is really great.
- Caroline Menjivar
Legislator
On the 2200 H language I know we've talked about in the subcommittee, you know, the need down the line as we move forward to look at this methodology and gives us the opportunity to change it. We're not asking right now to change it. I get that.
- Caroline Menjivar
Legislator
But this also locks our arms, our hands into never, ever changing it. So I'm wondering and excluding that, that gives us the opportunity to come down the line to have those conversations, gather with stakeholders and looking at changing the methodology, because this really locks us in.
- Caroline Menjivar
Legislator
Do you see this as locking us in forever, this methodology and never allowing to readjust?
- Katherine Lucero
Person
Well, I don't see it saying you're never allowed to readjust, which I think is the plain language of the law. And this really affirms what the law already is. There was never an intent for us to do anything than apply the law as previously promulgated. So I don't see it as tying hands.
- Katherine Lucero
Person
I would certainly offer my colleagues to comment, but every year, you know, different governors, different legislators, they have the opportunity to make changes as needed. But I'm happy to hear from others on this.
- Allison Hewitt
Person
Allison Hewitt. Allison Hewitt. Allison Hewitt, Department of Finance. I don't necessarily have anything to add to Director Lucero's comments. There's no proposal from the Administration to change any of the realignment formulas that have existed in statute, other than a technical update to the juvenile reentry grant at this time. I wouldn't see that the.
- Allison Hewitt
Person
Not a lawyer or a judge as Director Lucero has been. I wouldn't see that adding that language would prevent any future conversations. To that end, then why add the language? Because there's a big transition happening right now.
- Allison Hewitt
Person
BSCC has been administering these programs for well over a decade, so I think this gives the county some certainty that the formulas, at least as they are in statute, now, remain the same while this transition occurs. To the extent there were future proposals to amend the realignment statutes, I think you'd be potentially amending the same code sections.
- Allison Hewitt
Person
But in either case, I think this is. This provides some certainty for right now.
- Caroline Menjivar
Legislator
That if we ever come back to the table and trying to change that, their Department is going to point and say, hey, in this TBL, it says the methodology won't change. So making it even harder for us to come back.
- Allison Hewitt
Person
I think it would be hard. I think my two cent is it's going to be hard to rewrite any of the formulas that were written into 2011 realignment for a number of reasons, including Proposition 30, that said. This code section could easily be modified in any future vehicle.
- Caroline Menjivar
Legislator
Prop One is realigning a whole different things and reallocating funding to go down to counties to adjust to our Prop 30. So it's doable because Prop One is a whole new, different mandate and we're allocating funding for that. So I don't think that's an enough reason to not do it.
- Caroline Menjivar
Legislator
I just, I do think having it strictly in the TBL will prevent us years from now to even. It will make it harder for us to move around methodology, because having something from 2011 the same and stagnant till 2040, 2035 means that we're not growing as we see things growing and changing and so forth.
- Caroline Menjivar
Legislator
I'm not saying again that we want to change the methodology right now. I want to be able to continue to have that conversation.
- Caroline Menjivar
Legislator
I do think this locks us into preventing that conversation from happening because the Department will come back and say, well, it's in that tbo you passed three years ago, four years ago, so just, there's no need to be a response to that. But that's where, that's how I'm looking at it. LAO.
- Orlando Sanchez Zavala
Person
Our comments reflect the trailer Bill language just heard. As you heard, we raised these inadvertent deletions to both the Administration and your staff, and the Administration has communicated that they're willing to change that and update those.
- Orlando Sanchez Zavala
Person
But those pertain to the juvenile reentry grant and that there's certain data that these grants require that are reported to the state that was deleted. And there's also some provisions that would allow the OYCR to audit this data that the state receives.
- Orlando Sanchez Zavala
Person
And again, that wasn't included, but we've raised those in the Administration notes that they're willing to modify that language. The second issue I want to raise is the grants we just heard now is, is missing. Like one notable BSCC grant that is administered. This is the juvenile probation camp funding. This is for camps and ranches.
- Orlando Sanchez Zavala
Person
There's some data that the BSCC currently collects on the population, and then this then is given to the Department of Finance, who then decides how counties get allocated this funding. The grants that were just gone through did not mention that one, so just want to raise that for the Committee. Thank you.
- Orlando Sanchez Zavala
Person
And Orlando Sanchez with the LAO, sir. Thanks, Orlando.
- Caroline Menjivar
Legislator
Director, was that on purpose?
- Katherine Lucero
Person
Yes. My understanding is the BSCC is going to maintain purview over the actual facility, the title 15 inspections, that kind of thing. So it's directly in their purview. Go ahead.
- Drew Soderborg
Person
Drew Soderborg, Legislative Analyst Office yeah, the only context I just wanted to add real quick is that that grant is really driven by data that's collected by BSCC, and that data collection function has always been intended to stay with BSCC.
- Drew Soderborg
Person
There hasn't been a proposal to transfer it to OYCR, and so since it's pretty much just collecting that data and plugging it into a formula, that's why that change hasn't been proposed yet, is my understanding.
- Allison Hewitt
Person
Allison Hewitt, Department of Finance. I think unlike the other three grants, the Campton ranch and funding is distinctly not a grant program. So there's BSCC Administration, but it's not a grant.
- Allison Hewitt
Person
It's a direct allocation based on the number of facilities that counties operate, number of camps and ranches, and that data is already collected by BSCC on the natural in conjunction with their title 15 responsibilities. There's nothing functionally to transfer at this point.
- Unidentified Speaker
Person
Senator Grove, did you still have a question?
- Shannon Grove
Legislator
I do. Is the purpose of this transfer under your Department Director? Is it because BSCC is more public safety, focused on juvenile justice issues, that where they're hardened criminals based on the crime that they committed and why they're there, and OYCR is more of a mental health approach?
- Shannon Grove
Legislator
What's the reason for the transfer?
- Katherine Lucero
Person
Well, as you know, Senator, it was contained within SB 823 when it was originally promulgated, and my understanding of the reason is because OYCR is specializing in juvenile justice data policy, best practices, evidence based practices, and having all of this information available to us, and we are overseeing the plans that will be delivered under JJCPA, YOBG.
- Katherine Lucero
Person
We're going to be able to really mine this information and give the Legislature back some really good information about the realignment itself and how youth are doing in the 58 counties. So this really has become our, our specialty is the juvenile justice population.
- Katherine Lucero
Person
Not to say that BSCC doesn't still have oversight over the actual facilities and making sure that the kids are safe in those facilities. We're much more involved in programs, mental health, substance use, and want to know how those outcomes are going. And so now all of this will be in one place with us.
- Shannon Grove
Legislator
And does BSCC not provide you that information?
- Katherine Lucero
Person
They could. They could, absolutely, but we will be the ones now that the counties will provide it to. We could go back and we could look at the plans that are posted, we could look at the data that's collected, but we would like to make this uniform underneath OYCR.
- Unidentified Speaker
Person
Okay.
- Caroline Menjivar
Legislator
Great. No further questions. Thank you. Okay, thank you. Opening it up for public comment for the remaining items that we have not had public comment on. Give me 1 second before you begin. Let me know when they're ready.
- Warren Cushman
Person
You ready? Okay. Please proceed. Okay. Warren Cushman for Community Resources for Independent Living in Hayward. Three quick things. First of all, just pointing out that when you look at older adult programs, you're also looking at people with disabilities. Also, we are interested in food security. So that's another piece, including Cal fresh.
- Warren Cushman
Person
And then the only other thing I'll say is it's nice to hear Democrats and Republicans at least expounding on each other's positions once in a while. Thank you. Thank you.
- Russell Rawlings
Person
And good afternoon, Madam Chair and Members of the Committee. Russell Dawson Rawlings, community organizing manager at California Foundation for Independent Living Centers. And I reiterate what my colleague just mentioned. Many of the AP's cuts do directly affect people with disabilities of all ages. So it's important to consider that when looking at these.
- Russell Rawlings
Person
Also, it's really important to understand that all of these cuts threaten our state's compliance with the spirit of the Olmstead decision, allowing people with disabilities the access to the community living options.
- Russell Rawlings
Person
And every cut that you make that takes away those community based options costs the state extra money in money spent in skilled nursing facilities and other institutionalized settings. So it's really important to look at these as cost savings by keeping these cuts or keeping budgets whole. Thank you.
- Caroline Menjivar
Legislator
Thank you. You'll have 45 seconds. If you go over, we're cutting it off at one, so you might not let the other one speak.
- Yesenia Ortiz
Person
Hola, buenas tardes. Mi nombre es Yesenia Ortiz del condado de Marin, miembro de paren voices. Ah, por favor, necesitamos que luchen por el presupuesto final que incluia financiamiento para nuestros suicidios de cuidado infantil y las promesas para las proveedoras tambien que rechacen el doble corte para calvos aumento de ingresos estatales-
- Caroline Menjivar
Legislator
Gracias. -
- Yesenia Ortiz
Person
Okay. Gracias.
- Unidentified Speaker
Person
Hi. Good afternoon, Madam Chair. I apologize that we have repressed. You know, we are driving from Marin County, was traffic and there, like, taking their day off just to be here. So I would really appreciate if you can hear their words. They already take their day to be here.
- Unidentified Speaker
Person
And, you know, we are here to reject the cuts to colorworks. We are here to ask for the 20,000 slots for childcare. But also, like, we know that the Governor put, like, almost 20 billion in the rainy day fund. But it is raining for our families already.
- Unidentified Speaker
Person
They are struggling, and it is hard for them to be here. I brought a picture of over 100 Members that we have just in Marin County. Two weeks ago, we brought, like, 500 families over here with their children to advocate for what it is needed. You said our families, they need to have those services.
- Unidentified Speaker
Person
We cannot spend the money on other things like media or like administrative, like salaries when they are struggling. You know what it is to pause your dreams just because somebody says that we don't have the funds to do that, our families there are waiting. That's why we are here.
- Unidentified Speaker
Person
And I would really appreciate if you can listen to our parents that they are taking the day off.
- Caroline Menjivar
Legislator
Thank you. Next.
- Unidentified Speaker
Person
Hola, buenas tardes, mi nombre es Mari-
- Caroline Menjivar
Legislator
Pero tambien hay una linea por eso.
- Unidentified Speaker
Person
Por eso el condado de Marín estoy aquí para pedirle al gobernador que cumpla su promesa para el cuidado infantil, porque las familias no pueden esperar, hay muchas necesidades en la comunidad. El cual necesitamos de su ayuda para que ellas puedan salir adelante como yo estuve en la lista de espera por tres años y es bien triste poner tus sueños en pausa, por eso necesitamos que más familias tengan cuidado infantil. Gracias al cuidado infantil, he podido sacar a mi familia adelante. He podido trabajar porque necesitamos que luchen por un presupuesto final que incluya financiamiento para los subsidios del cuidado infantil prometidas para las familias comprometerse a reembolsar el costo de real de la necesidad es para los proveedores que rechacen el doble corte de calvos. Gracias.
- Caroline Menjivar
Legislator
Gracias.
- Rebecca Gonzales
Person
Good afternoon. Rebecca Gonzales with the Western Center on Law and Poverty. I'm here to talk about a few issues. We oppose cuts to nutrition programs such as the California Food Assistance Program. This program is important for our immigrant communities. Combined with IHSS cuts, this devastating blow.
- Rebecca Gonzales
Person
Also concerned about the elimination of the CalFresh Minimum Benefit Pilot Program and also the WINS program. As you know, food costs are going up and these cuts will only result in more hunger. Also opposed reductions to CDSS Housing and Homelessness programs. When a time our houselessness, crisis is at rising levels and it really concerns everyone.
- Rebecca Gonzales
Person
That includes the Bringing Families Home program, which targets families in the child welfare system, home safe program, for those in AP's housing and disability advocacy program.
- Caroline Menjivar
Legislator
Thank you, Rebecca.
- Rebecca Gonzales
Person
Thank you.
- Emmerald Evans
Person
Emmerald Evans with End Child Poverty California on the CalFresh minimum pilot. We are a proud co sponsor of your baby chair and we are appreciating your leadership. The new data from the Urban Institute released today highlights that Calfresh benefits are inadequate to cover the cost of every one of the 58 counties across the state.
- Emmerald Evans
Person
And this cannot be permanently cut as we are ready to support any next steps necessary on WINS. Thank you for underscoring that this will create a new hunger cliff. We should be increasing the WINS to provide more than $10 a month.
- Emmerald Evans
Person
We strenuously oppose removing WINS from the statute and agree with LAO to guard against changes to the WPR, which we know the US House wants to do. And we align with the food for our coalition against the CFAP delay for issue eight.
- Emmerald Evans
Person
Thank you for your question and we respectfully disagree the DSS that the cuts do undermine the FRA pilots. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Dan Okenfuss
Person
Good afternoon. Dan Okenfuss once again with the California Foundation for Independent Living Centers. We oppose the cuts to the 65 million from the Home Safe program and the 50 million from the Housing and Disability Advocacy program. Honestly, without this program, thousands of at risks currently, house older and dependent adults will now become newly homeless.
- Dan Okenfuss
Person
We already know that the adults are the state's fastest growing group of first time homeless who will be adding to the number of unhoused and institutionalized older adults without home safe. Thank you very much.
- Caroline Menjivar
Legislator
Thank you.
- Yasmin Peled
Person
Good afternoon. Yasmin Peled on behalf of Justice in Aging on issue six of CDSS housing programs were opposed to the proposed cut. Older adults are the fastest growing population of people experiencing homelessness. Nearly half of homeless Californians are over the age of 50.
- Yasmin Peled
Person
This is a travesty and the state does not have an adequate plan to address this issue, by eliminating Home Safe and reducing funding for HDAP, the only two state programs that specifically address older adult homelessness. How can we say this is a priority for the state when there is no programmatic investment?
- Yasmin Peled
Person
Additionally, we're opposed to the CFAP delay and the minimum nutrition benefit pilot cut. We're opposed to the other AP's funding cuts. And finally, under CDA, we're opposed to the reduction of funding for the older Californians act senior nutrition programs. There's not an adequate backfill for these programs.
- Caroline Menjivar
Legislator
Thank you, thank you can only have 30 seconds or else not everyone's going to be able to speak. 30 seconds.
- Eileen Cubanski
Person
Eileen Cubanski with the County Welfare Directors Association in opposition to the AP's cuts, it is about 200 workers statewide and the training in particular. Once that infrastructure is gone, it's gone. And regarding the foster care rates, completely agree.
- Eileen Cubanski
Person
We want to keep the momentum going and think there is a middle ground where we can keep it going and address all the concerns. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Tiffany Whiten
Person
Madam Chair and Members. Tiffany Whiten with SEIU California oppose the AP's cuts as well as the CalFresh cuts, and we also reject the proposed cuts to the DSS administered immigrant legal services. And then with respect to the foster care rates, definitely have concerns around admin funding and having enough workforce.
- Tiffany Whiten
Person
There's so many cuts all over the place. We want to make sure that we have adequate workforce to attend to all the needs. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Mariam Sossouadouno
Person
Mariam Sossouadouno, Child Care Law Center. Childcare is essential for thriving families and justice and communities. Thousands of families continue to languish on waiting lists and they need affordable childcare now. We urge the Budget Committee to reject the cuts and pauses to 81,000 spaces and cuts to spaces of emergency bridge programs.
- Mariam Sossouadouno
Person
We urge legislators to identify other sources of revenue and reserves instead of taking away critical services from families with the least resources. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Justin Garrett
Person
Justin Garrett, California State Association of Counties in opposition to the AP's cuts, we have strong concerns about what this means for both the county workforce and services that older adults need. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Chris Stoner-Mertz
Person
Chris Stoner-Merts with the California Alliance of Child and Family Services on the TBL for foster care rates. We are very concerned about how this is going to impact the provider community. We are not just talking about Administration. These are core services, social workers, other supports, transportation to family, etcetera. We absolutely support the strengths building for youth.
- Chris Stoner-Mertz
Person
We support the caregiver supports as well. But we cannot have a safety net if we're going to decimate the programs that support them.
- Caroline Menjivar
Legislator
Thank you.
- Shawna Morris
Person
Hi, I'm Shawna Morris with Casa Pacifica Centers for Family and Children. We take care of foster kids today. We lost $1 million last year doing it. We will lose another $1 million this year. If you cut our rates, we will close those programs. We had 237 referrals in the last six months.
- Shawna Morris
Person
We were able to treat four of them in our program. Please do not cut these programs. Your children, our children's lives depend on it. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Kellie Flores
Person
Kellie Longo Flores from the California Association of Food Banks. We ask you to reject the elimination of the CalFresh minimum benefits pilot, which this would have raised the minimum benefit from just $23 to $50 a month. Reject the CFAP delays and reject the cuts to the WINS program.
- Kellie Flores
Person
We know $10 doesn't sound like a lot, but to many Californians, every little bit helps. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Mark LeBeau
Person
Jimmy Sunwe. I'm Doctor Mark LeBeau, CEO of California Rural Indian Health Board. On behalf of the 68 fairly recognized tribes and the CRIHB membership urge Committee to support trailer bills, specialized care, increment eligibility and family finding engagement and support program. And finally, the Tribal Nutrition Assistance Program. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Kathleen Mossburg
Person
Chair and Members, Kathy Mossberg, on behalf of the Area Agencies on Aging as well as Meals on Wheels, California, both in strong opposition to the cut to senior nutrition. We already know this will leave us serving 60% less meals than what we served in the pandemic.
- Kathleen Mossburg
Person
We already know we have an unmet need of approximately 370 meals per year that we're not getting at seniors who need food. So this would be a tremendous cut we urge you to reject. Thank you.
- Caroline Menjivar
Legislator
Thank you,
- Unidentified Speaker
Person
Madam Chair and Members. [Name]. On behalf of Disability Rights California. We are opposed to, as previously mentioned, cuts to IHSS, specifically to the immigrant population, the elimination of the backup provider system-
- Caroline Menjivar
Legislator
We already took public comment for IHSS.
- Unidentified Speaker
Person
-and also for the immigration and equity programs, AP's and HSTAP.
- Unidentified Speaker
Person
We just want to highlight a constant theme that we're seeing that the budget is being balanced on the backs of the most vulnerable and in this case, the immigrant community, which is why we wanted to mention the cuts to IHSS. Once again, we want to just raise the legal liabilities. Thank you so much.
- Jared Call
Person
Good afternoon, Madam Chair and Members, Jared Call with Nourish California urging you to reject the CalFresh cuts, particularly the proposed delay to CFAP. These are older adults who've literally waited forever for food assistance implementation. I know we're saying it will be paused for two years. We know every planning and automation is happening now and has been happening.
- Jared Call
Person
We know if we pause it, it'll be that much harder to get it started. We all know that it'll fall further down the queue. So urging you to please work with us to find a way to keep it going.
- Caroline Menjivar
Legislator
Thank you.
- Andrea Amavisca
Person
Good afternoon, Chair and Members, Andrea Amavisca on behalf of the California Immigrant Policy Center, I echo the comments made by my colleague at Nourish, California regarding the proposed delay to the CFAP expansion.
- Andrea Amavisca
Person
Additionally, we urged the Legislature to reject the governor's proposed cuts to the TPS Immigration Services Program, the CSU Immigration Legal Services project, as well as a discontinuation of funding for the Children's Holistic Immigration Representation project.
- Andrea Amavisca
Person
These services are a lifeline for immigrant families across our state and can mean the difference between a young person losing a parent or family Member to deportation or attaining higher education and economic mobility. Call on the Governor and Legislature to fully fund these programs. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Unidentified Speaker
Person
Thank you. Thank you so much to Chair Menjivar and Senator Eggman for your really insightful comments, that cuts to services actually lead to an increase in the need for services. Whether or not the Governor wants to acknowledge it, please reject all cuts to food programs. AP's the behavioral health services for older adults incredibly important.
- Unidentified Speaker
Person
And especially reject all cuts to housing programs. We've been criminalizing unhoused people with mental health disabilities. We need all housing support possible. Please show that older adults and disabled people are valued members of our society. Thank you for fighting for us.
- Caroline Menjivar
Legislator
Thank you.
- Jackie Gonzalez
Person
Jackie Gonzalez, Policy Director, Immigrant Defense Advocates here to oppose the governor's cuts to TPS, CHRP and the CSUs. Since I last testified before this Committee, our future presidential candidate has threatened the deportation of immigrant communities, a militarized deportation. How we turn the tap off today, I don't know. I don't know.
- Jackie Gonzalez
Person
But if in six months, I hope that we find a way to turn it back on. It shouldn't be cut off. The zero tolerance policy of the Trump Administration separated 5,000 children. 2,000 of them have not been reunited with their parents. Still to this day.
- Caroline Menjivar
Legislator
Thank you.
- Nika Maslin
Person
Hi, my name is Nika Maslin and I'm here with the Mesa Verde group on behalf of the Central American Resource center, immigrant legal defense CARECEN. We're urging the Committee to reject the governor's proposed cut to immigration legal services and request that the Committee Fully Fund Immigration Legal services. Thank you. Thank you.
- Khalid Rashid
Person
Good afternoon. My name is Khalid Rashid. I'm from Stanislaus County, California. Food assistance, Calfresh and AP's programs support all and are needed. We need to prioritize services that will keep our communities healthy. Slashing funding impacts on local level on a local level, our communities are big and are growing.
- Khalid Rashid
Person
We need to help the agencies that support on a local level with the funds that are needed. Thank you for all your passion and support. I can really feel your understanding of what is needed in the community, which is why I urge you to reject the proposals.
- Khalid Rashid
Person
We can't play with matters of health and create instability with vital health needs. Thank you. Thank you.
- Monica Kirkland
Person
Hello, Monica Kirkland, state policy Director for Senior Services Coalition of Alameda County we urge you to reject the elimination of the home safe funding and to protect the vulnerable older adults that are impacted by it. A lot of them need that support. We in our county have a lot of people that have been impacted by that.
- Monica Kirkland
Person
Also to reject the adult protective services expansion and that results in the immediate loss of staff. And then we also reject the older California acts modernization funding to protect the older adults who rely on the supports of this funding. And also we reject the elimination of the older behavioral program in the Department of Aging. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Makaila Dupont
Person
Hello. Makaila Dupont, resident of St. Regarding AP's and the related proposals, AP's needs investment in staff and skills to continue responding to the ever shifting needs of our most vulnerable population to address a related budget item.
- Makaila Dupont
Person
With housing insecurity becoming an increasing concern for the General population, this is even more magnified for individuals with disabilities who are already experiencing homelessness.
- Makaila Dupont
Person
The Housing and Disability advocacy program, or HDAP, provides critical community based resources that support the person where they are and help establish sustainable income that helps ensure success of long term housing related the home safe program similarly provides critical community supports targeting case management, financial assistance and more. For those reasons, I urge that we reject those proposals.
- Caroline Menjivar
Legislator
Thank you.
- Nina Weiler-Harwell
Person
Good afternoon, Nina Harwell with Arp California on behalf of our 3.2 million Members, I want to tee up a couple of things. 2021 our vital Voices survey found that 87% of voters over 45 want to remain in their homes and communities as they age.
- Nina Weiler-Harwell
Person
The state is talking a lot about California for all, but the cuts I'm going to address actually run counter to that. So Arp is deeply disappointed in the cuts to nutrition programs at CDA, to the cuts to AP's and the cuts to home safe. Thank you.
- Kathy Sunderling
Person
Thank you. Kathy Sunderling McDonnell for Alameda County regarding the adult protective services cuts, we do urge you to reject these cuts regarding the expansion this wasn't just for the age, it was also for additional case management. Alameda County was able to hire 10 additional staff.
- Kathy Sunderling
Person
They were already losing ground because of the increase in demand and complexity, and this would further set them behind. They currently have 73 cases per worker, and this would only increase that to an untenable level.
- Kathy Sunderling
Person
Additionally, implementing SB 43, the Conservatorship Reform Act, as well as the CarE act, will be impossible if the training services are cut as proposed. And finally home safe. It's a huge disruption to stop those services. Thank you.
- Amy Westling
Person
Amy Wessling, Association of Regional Center Agencies want to express our gratitude to the chair Members and especially your staff for digging through the couch cushions and looking for every dime.
- Amy Westling
Person
And we encourage that if any dime is found, that it is retained in the system where it's found, particularly in the Developmental Services system related to the provider rate delays. Thank you so much. Thank you.
- Tara Gamboa-Eastman
Person
Tara Gamboa Eastman with the Steinberg Institute respectfully requesting you to reject the cuts to the behavioral health workforce investments. We are in a behavioral health crisis and also face a behavioral health workforce shortage. The Steinberg Institute estimates we need 370,000 workforce.
- Caroline Menjivar
Legislator
I don't think we're doing any behavior. We're on the human services side. We haven't done the health side. Apologies.
- Ronald Coleman Baeza
Person
Good afternoon. Ronald Coleman Baeza here. On behalf of the California Pan Ethnic Health Network CPEHN, just urge you to reject the delay of the CFAB benefits to undocumented seniors. Thank you.
- Caroline Menjivar
Legislator
Thank you. We will need to take a recess. It's a rough schedule for us right now. We have to go to session and prepare, so we're going to take a recess and come back after session to finish the health side. So it's going to be a long day.
- Caroline Menjivar
Legislator
Budget sub three number health on health and human services has adjourned. Has taken a recess. Adjourn for now.
- Caroline Menjivar
Legislator
It's been a long day. Here we go. Let's close this out. The Assembly is having their hearing at the same time, so we're gonna maybe go out of order. We're just gonna take people as they come here and then move that way. So I'm not sure if for the first issue on Semcis, we have someone here. Perfect.
- Caroline Menjivar
Legislator
Department finance. LAO, join the party. Please begin, sir.
- Craig Johnson
Person
Good evening, Madam Chair and Members of the Committee. My name is Craig Johnson and I represent the California Emergency Medical Services Authority. And as listed in the agenda, we're here to provide an overview of the central registry replacement and the California EMS Information System re procurement. Also, we're here with our partners at OTSI.
- Craig Johnson
Person
So EMSA partnered with OTCI to manage the planning and implementation the central registry project and conduct the CEMS reprocurement.
- Craig Johnson
Person
So this proposal requests re-appropriation of 3.0 million General Fund and provisional language authorizing encumbrance or expenditure until June 30 of 2026 for reprocurement activities of the California Emergency Medical Services information system and planning and implementation of the California Emergency Medical Services Central Registry replacement Project.
- Craig Johnson
Person
EMSA has statutory and regulatory requirements related to the collection and evaluation of EMS data, licensing, certification, investigatory, and legal disciplinary actions as described in the California Code of Regulations, title 22, division nine Regulations, and the Health and Safety Code. The request supports two key activities.
- Craig Johnson
Person
One, continued planning efforts of the central Registry project, which will replace the current legacy registry system and help ensure EMSA meets its statutory and regulatory requirements related to the collection and evaluation of EMS personnel certification, licensure and training data and two, re-procurement activities of the California EMS Information System, CEMS, which is a critical system of patient care data, need to begin in July 2024 due to the length of the state's procurement cycle.
- Craig Johnson
Person
So this proposal requests these resources so that EMSA continues to meet their statutory and regulatory responsibilities to provide the tools necessary for emergency services providers to care for patients at their most vulnerable moments in life. And then if there are questions, happy to take them.
- Craig Johnson
Person
Or I can turn it over to my colleague Micah Muth here, who is from the Office of Technology Solutions and Integration, to provide more details.
- Micah Muth
Person
Thank you, Madam Chair, Senator Eggman, happy to be here tonight, and thank you very much for your time. I know you've had a very long day, so I just wanted to add a little bit to what my colleague from EMSA stated. You had asked the other day, why now? Why are these resources important now?
- Micah Muth
Person
And so let me just emphasize a little bit about the central registry itself. So this is the only system the state has to track and maintain EMS personnel data and associated records from a safety standards and compliance perspective.
- Micah Muth
Person
And the current system is essentially, it's on its last leg, so it no longer meets the state's technical and data integration standards. It requires many manual workarounds. And, and essentially, this system is not only critical for EMSA at the state level, but also for those local governmental entities and Californians that rely so heavily on the solution.
- Micah Muth
Person
And I'll just give you an example of what I mean by that. So there's 69 certifying entities, EMS, employers, local and state authorities, and the public that leverage that solution to verify EMS personnel certification and licensure, basically employment history, both current status as well as historical status.
- Micah Muth
Person
And there are hundreds of thousands of EMS personnel records and associated information and data within that solution that are maintained and accessible as statutorily required. So that's on the licensure and certification piece, but on the training program side, because the solution is also meant for authorized and required training around public safety.
- Micah Muth
Person
There's 90,000 daycare providers, there's 135,000 school bus drivers, there's almost 14,000 peace officers that leverage or use that solution to identify what training programs are required to authorize around public safety, CPR, and so on.
- Micah Muth
Person
And so this solution is critical, and these resources are critical for the continued planning and project efforts, not only for the central registry, but as we mentioned, the CEMS reprocurement activities. That baseline contract does expire. We need time to reprocure and both get a contract in place before the current one expires. When does it expire?
- Micah Muth
Person
So the CEMS, the current baseline contract actually expires. I think it's September of 2024. We have a baseline contract, but we have two optional extensions within there of one year each. And EMSA has funding a request in their fall BCP for those two optional years to take it out to 2026.
- Micah Muth
Person
That's the time period in which we're going to need in order to execute a new contract because we know that the state's procurement process takes some time. What do you mean your fall BCP? Sorry, EMSA, BCP that they put forward in the fallout. I'll defer to my colleagues at Department of Finance or EMSA to provide more.
- Unidentified Speaker
Person
January budget? Yeah, there was a BCP approved in the fall for that contract or to Fund the two options. Talking about last year? No, in the fall for budget year 2425 but for a Governor's Budget, it was already approved.
- Caroline Menjivar
Legislator
Okay. And so the systems right now are doing it. The contracts can expire. The funding needs to extend the contract to get into a new system.
- Samantha Lui
Person
So in the fall, we approved a separate BCP Fund those two optional years of the contract. So that's done.
- Samantha Lui
Person
And part of this reappropriation is to Fund the reprocurement process for once those two optional years are done, then there will be a new vendor or a new agreement in place if it's the same vendor, because that procurement process does take so long.
- Samantha Lui
Person
We want there to be a seamless transition so there's no gap in service in between.
- Caroline Menjivar
Legislator
So this is for a contract that will expire in two years?
- Samantha Lui
Person
Yes, that's correct.
- Caroline Menjivar
Legislator
And you want the funding now to. Begin the procurement process because it would. Take potentially two years?
- Unidentified Speaker
Person
Yes. Do you guys want to speak to that?
- Unidentified Speaker
Person
Yeah. So reprocurement efforts within the state through, they typically take anywhere from a year to two years. And we would like some time to transition between the two.
- Unidentified Speaker
Person
Well, if there is a new vendor, we would like time for transition between those, just given how critical this solution is, and that's pretty standard with any type of repocurement and transition.
- Caroline Menjivar
Legislator
The funding that was allocated in 2021 was for a different program, and now we are preparing for another one.
- Unidentified Speaker
Person
You're referring to the Budget Act of 2021? Correct. So that. So if we go back to 2021, that was originally around the California EMS data resource system. So there's $10 million originally appropriated to that. That was about data integration, and that basically. And Budget act of 2022, we were authorized to expand through June of 2024.
- Unidentified Speaker
Person
So that's now. And in 2023, there was new legislation around the California Health and Human Services Agency's data exchange framework, essentially negating the need for the original intent of the CDERS project, because that was envisioned as a separate health information exchange.
- Unidentified Speaker
Person
And with the data exchange framework negating that need, that was withdrawn from the project approval lifecycle from an IT perspective. But the need to integrate data across all of these planned current and future it solutions still exists.
- Unidentified Speaker
Person
So from the time period of the Budget Act, 2023 and beyond, or I should say 2023, when that was decided to pull it from the PAL process, that became the data Infrastructure solution initiative.
- Unidentified Speaker
Person
And so that is a separate activity that relates directly to these efforts because that will pull and use data from these two solutions, as well as other planned and current solutions in them.
- Samantha Lui
Person
I do want to add that it is a re appropriation and not a new BCP, because that CDERS system, that kind of evolved into the data infrastructure solution. It was envisioned as a system to kind of be a single information hub that connects these other three systems. So the central registry, CEMS, EPULST, but.
- Samantha Lui
Person
It never came off the ground. Right CDERS. Well, it evolved into the data infrastructure solution and EMSA was able to actually data platform in current year.
- Samantha Lui
Person
So this year to kind of establish the infrastructure for that and kind of envisioned, I think it kind of evolved in terms of what they landed on, in terms of the type of data infrastructure that was needed. And so they've procured that.
- Samantha Lui
Person
It's a smaller system than what was originally envisioned, but it's still, you know, all of these different data systems are kind of integrated. And so this is helping to continue that. What was originally envisioned in 2021 with that $10 million to connect all of these different systems. And so that's why we're continuing those pieces of it.
- Samantha Lui
Person
So there's the, and also just to distinguish this 3 million or the 2.964 million, it's divided between the CEMS free procurement that we were just discussing and the updating or replacement of the central registry. So those are two different systems. Again, it's all part of this kind of integrated web of data, a data platform.
- Samantha Lui
Person
And Michael had explained how the central registry is outdated. So that's what that project is, to update it so that it can actually be functional and have accurate data. And then the chemsis is the reprocurement side.
- Caroline Menjivar
Legislator
LAO any additional comment on this?
- Will Owens
Person
Will Owens with the Legislative Analyst Office. Nothing further to add but available for questions.
- Caroline Menjivar
Legislator
Okay, thank you so much.
- Susan Talamantes Eggman
Person
Madam Chair. If I could just say maybe to the Department of Finance. Why does it take two years to do procurement? For who? Can anybody answer that for me?
- Unidentified Speaker
Person
That's how government works. I'd be happy to take that off and follow up with your staff.
- Susan Talamantes Eggman
Person
Okay. I was just at a press conference the other day with the Governor where he was talking about, I think it was a no place like home act that was passed by voters and it took us three years to get out the RFPs. Three years to get out the RFPs. That's without a cent going out.
- Susan Talamantes Eggman
Person
That's something the voters voted on. And we were able to streamline that process with Prop One. We got our 1st 3 billion going out next month, I think so. I'm just thinking if we can do that with one thing, it seems to me we should be able to do it with other things.
- Susan Talamantes Eggman
Person
I mean, 10 million, time is money. Time is money and we're at a time when we don't have much money. So we should work as best we can to compress the time.
- Caroline Menjivar
Legislator
Thank you, Senator. Thank you. HKI? Anyone here from HKI? HKI is in the Assembly. We're gonna skip HKI. DHCS is in the Assembly.
- Unidentified Speaker
Person
DPH is here. So we can probably.
- Caroline Menjivar
Legislator
So we're gonna move on to DPH? Yes. Doctor Aragon. Were you in the Navy?
- Unidentified Speaker
Person
No, not me. I was a marine reservist. My son is a naval officer.
- Caroline Menjivar
Legislator
You were in the marines? Reservists have to be nice to you now. zero, my goodness.
- Unidentified Speaker
Person
That was many, many years ago.
- Caroline Menjivar
Legislator
So we're gonna fix this, right? Marines get
- Tomas Aragon
Person
absolutely
- Caroline Menjivar
Legislator
stuff done.
- Tomas Aragon
Person
That's the plan.
- Caroline Menjivar
Legislator
Okay. Thank you so much, Doctor, for coming. We're gonna start with issue one on eight. We're gonna start on issue the other. Issue one on the future of public health and have a more in depth conversation. Do we have all the panelists up here?
- Caroline Menjivar
Legislator
My two panelists, my two. We're all here? I think so. Hope so. Okay, Doctor, I'm going to have you kick us off on future public health, and then we'll turn to. To representatives from two different counties just to talk about that. I would also add in the agenda there's a variety of different.
- Caroline Menjivar
Legislator
There's a breakdown of how different counties are utilizing the funding, the flexibility associated to that. If you're awake at one or 02:00 in the morning looking for something to read, you can continue reading this, Doctor.
- Tomas Aragon
Person
Thank you very. Thank you very much. And first of all, I do want to thank the Senate for its visionary leadership and foresight and commitment to public health. So California is a large, complex, and diverse state. We are larger than most countries, with a population close to 40 million. We're an international destination and hub for travelers.
- Tomas Aragon
Person
So what happens globally affects us. In California, we have existing, emerging and re-emerging public health threats. You know about them. Std's. We had HIV, SARS, H1N1 one pandemic in 2009, COVID, MPOX, antimicrobial resistance. And now we're currently dealing with H5N1 highly pathogenic Avian influenza.
- Tomas Aragon
Person
In cattle, we have mental crisis with mental health, substance use, obesity and chronic diseases, and the need to support maternal, child, adolescent and family health. So we know that public health has struggled in the past around the country, having funding for core public health services.
- Tomas Aragon
Person
When we developed the Future Public Health initiative, we met with stakeholders, we met with experts, we met with the locals. We work with national organizations that have been conducting decades of research on what is core public health infrastructure that is needed for health departments across the country.
- Tomas Aragon
Person
One of the challenges is that we respond, and so we end up focusing on categorical solutions, and then we have all these gaps that we have to fill. So the way the experts organize this framework is very basic. And they talked about foundational capabilities.
- Tomas Aragon
Person
And I want you to think of foundational capabilities as really the roots of a tree. You can't see it, but those foundational capabilities is what makes the tree strong. It's what allows it to respond, to be resilient to the public health threats that it faces.
- Tomas Aragon
Person
The core foundational capabilities that we use to design the future public health included assessment and surveillance, community partnership development, equity and health equity, organizational competencies like workforce development, IT, data science, data modernization and other operations, policy development and support.
- Tomas Aragon
Person
And one thing I do want to point out is for the biggest state in the country, future public health initiative allowed us to. To stand up our first Office of Policy and Planning ever, which is incredibly, incredibly important. The 6th one is accountability and performance management.
- Tomas Aragon
Person
Seven, emergency preparedness and response, and then, of course, communications and public education. So those foundational capabilities, again, are the roots of a tree. We don't see it. I think people should really think of public health more like core infrastructure. In some ways, we're more like public safety because we respect to whatever threat happens.
- Tomas Aragon
Person
We don't get to choose. We can't say, oh, no, we don't do that. No, we respond to. We respond to everything. And then, of course, there are the foundational areas that you know about communicable disease control, chronic disease and injury prevention, environmental public health, mental health and substance use, maternal, child and family health.
- Tomas Aragon
Person
So that's what the future of public health initiative is. It is core public health infrastructure to make us whole so that we can be responsive currently every day, but also to emerging threats. And in some ways, when we started, you asked me about my military background. In some ways, there is an analogy to the military.
- Tomas Aragon
Person
The military is constantly exercising and practicing, and that's what we're doing every day when we're responding to daily public health threats and we're fine tuning our systems, our surveillance, working with hospitals, working with communities, working with local health jurisdictions. So when bigger issues happen, we are prepared to respond in an effective and efficient way.
- Tomas Aragon
Person
And that can only happen when we have our staff, we're whole, and we're training, and we have the kind of funding that gives us the flexibility to respond to whatever happens. Most of the funding that we currently have is categorical, and it comes from other sources.
- Tomas Aragon
Person
I'm going to go ahead and end there and just end off by saying that in public health, we promote a culture of health, well being and thriving for all. In California, we focus on protection, prevention, and promotion of health. Communities being resilient, us responding, and then communities recovering.
- Tomas Aragon
Person
And then we're also focused on being effective, efficient, ethical, and equitable. So I'm going to go ahead and end there and let the rest of the panel continue. Thank you.
- Caroline Menjivar
Legislator
Doctor, do you think we'll still be able to meet those categories you mentioned with the drastic cuts?
- Tomas Aragon
Person
It will hinder us. And so one concrete example for me is just, for example, one thing that really excited me about the funding was to have for the first time, an Office of Policy and Planning to provide for you the first State of public health report. And we're just getting started.
- Tomas Aragon
Person
We want to be able to be up on the latest science, to be able to find the public health interventions that are not just going to be the most effective, but which are going to be the most cost effective.
- Tomas Aragon
Person
And it enables us to develop these strong partnerships with our academics so that we can really promote better public health for all of California.
- Tomas Aragon
Person
And so Policy and Planning is sort of a concrete one because you can't run, it's really difficult to run an organization without having a strategic approach for a state that's as big and as diverse as we are. And then, of course, our emergency prepares and response really critical. We're taking regional approaches to how we do public health.
- Tomas Aragon
Person
We're developing 24/7 capability to always be ready.
- Tomas Aragon
Person
And so there are, our staff will be able to provide additional examples, but it will impact us because those things, if our Office of Policy and Planning goes away, that's a big, that's going to be a big, big loss for us, and it will be a lot a loss for California.
- Caroline Menjivar
Legislator
Do we know with the proposed cuts, if that office would go away?
- Tomas Aragon
Person
Pardon?
- Caroline Menjivar
Legislator
would that new office is that at risk of being, of going?
- Tomas Aragon
Person
That's all part of the future of public health. For the future of public health is we focused on foundational capabilities and planning and policy development is a core foundational capability. And it was a gap area. Gap area for us. The local health jurisdictions did the same thing.
- Tomas Aragon
Person
They looked at what is core public health capabilities that every county should have. They looked at their gaps, and that's what they filled.
- Caroline Menjivar
Legislator
And then we won't be able to continue to meet that gap at the.
- Tomas Aragon
Person
State level and also at the local level.
- Caroline Menjivar
Legislator
Okay, Senator Eggman and then Senator Robert thank you.
- Susan Talamantes Eggman
Person
Thank you, Doctor Aragon. So, you know, we all have to make some very hard cuts. I think this is a lot for public health, especially just coming out of a pandemic.
- Susan Talamantes Eggman
Person
And I think the year after, we thought we were going to be able to get some relief, and we were put off a little while and we finally got some, and then now it's going away. But I.
- Susan Talamantes Eggman
Person
But I'm concerned if some of the things that we've already invested in, we end up wasting money, walking away from money into things we've already begun. If we just. If we can identify things that will, that we've already invested in, that's going to cost us.
- Susan Talamantes Eggman
Person
And just like money gone or things that we can, that have not started yet, that perhaps makes more sense in the reductions.
- Tomas Aragon
Person
Yes, I agree with your assessment. It does take a long time to build up the system systems and to develop the proficiencies in operating them and learning how to do it. So that would definitely impact us. Yes.
- Caroline Menjivar
Legislator
Senator Roth.
- Richard Roth
Person
You know, I asked this question when we last visited this subject, and as my colleague referenced, 27 plus $1.0 billion is a lot of cuts. When you cut $27 billion out of any operation, you're probably going to cut some of the nice to have stuff.
- Richard Roth
Person
Some of the policy and analysis teams that are really, we argue, are critical to have, but not boots on the ground. If you have a pandemic or some other natural disaster that would involve public health, I don't think.
- Richard Roth
Person
And the question I asked last time was, what level of cuts is the public health system able to sustain or take and still have enough gas in the tank to ramp up quickly in the event of another pandemic or some other public health crisis?
- Richard Roth
Person
And that may be very difficult to answer, but those of you who are in the business can probably answer it better than we can.
- Tomas Aragon
Person
Yeah. So there's a couple of answers. That one is the first one.
- Tomas Aragon
Person
So part of our policy and planning is that analytical capability, because we have, there's always new science, new data that's coming in, and we're trying to figure out what is the best science to use, what is the most effective intervention, what is the most cost effective approach.
- Tomas Aragon
Person
And so we want to focus on implementing those things that we think are going to make a difference. And so that does help us. That's big. I'll give you another. We'll give you a concrete example that happened at the national level. So when H1, sorry. When SARS Cov two, the COVID pandemic happened.
- Tomas Aragon
Person
We had a vaccine within one year. Why were we able to get a vaccine in one year? Because we had more than 10 years of investment in vaccine research. That's the difference it makes.
- Tomas Aragon
Person
There's no way we would have been able to deploy a vaccine that fast if we had not been investing in developing that science and knowledge.
- Caroline Menjivar
Legislator
I'm a little confused.
- Tomas Aragon
Person
That's the way.
- Caroline Menjivar
Legislator
What I hear from you is just why we shouldn't cut this. That's what I keep hearing, like, the importance of investing in all this. So what I want to know is giving everything you were saying, giving everything we're saying, then why are we cutting this?
- Caroline Menjivar
Legislator
You're sharing all the wonderful things that this future of public health does, what helps us prevent the capacity foundation for it. So then why are we cutting it? So then we can be in that situation again in a couple years.
- Caroline Menjivar
Legislator
If something else happens, like what do we, what is left in place to do all the beautiful things that you mentioned public health does?
- Tomas Aragon
Person
We would lose. We would almost come back to where we were prior to the pandemic.
- Richard Roth
Person
Madam Chair, may I ask you a question?
- Caroline Menjivar
Legislator
Senator, of course.
- Richard Roth
Person
I didn't mean to. So I guess when you have to cut, and I don't think there's any doubt that we have to cut. And so we're having to measure you against childcare, against the developmentally disabled, against hearing aids for kids.
- Richard Roth
Person
We're having to measure you against a whole variety of other things. And you obviously are a valued partner in keeping Californians healthy all up and down the state.
- Richard Roth
Person
But when you look at your entire operation, and we're trying to plan for some residual, keep some residual capability in place so we can respond at some level to the next pandemic rather quickly, is some of this capability that can be contracted out rather quickly, as opposed to how do you train and hire, track and trace people, folks, to do vaccines?
- Richard Roth
Person
Some of the other things that you do, I think you do in the public health sector, is there not a difference between the manpower that you need in the field and some of the analysis work that others do?
- Tomas Aragon
Person
Yeah. So this funds really core. This is funding core, minimal infrastructure. And so, for example, we know right now we have an epidemic of syphilis and gonorrhea. And even with our current workforce, even with these investments, we're still not able to keep up.
- Tomas Aragon
Person
If a pandemic were to happen again, it would be like what happened with COVID It's an all state response. We would have to have additional resources at that time immobilized beyond public health because we mobilized. We mobilized. We mobilized. It was an all of government, all of society response to the COVID pandemic.
- Tomas Aragon
Person
I'll tell you one of the ways that I think about it, because I know this is a challenge, having been through cuts before in the past, not here, but at a different institution, at a different local level.
- Tomas Aragon
Person
And I try to encourage people to look at public health as core infrastructure and more like public safety, because we're not providing direct services. Mostly, we're in the background providing core public health services. So think of it like infrastructure. Think about, for example, IT. You don't, you don't generally compare it to the direct service.
- Tomas Aragon
Person
Direct services, because they're two very different functions. And we can't say, we don't usually say, zero, we're just going to cut it because it doesn't provide.
- Richard Roth
Person
But I'll tell you this. If you're in a city and you have to cut, you might cut community whatever. You're not going to cut the black and whites on the street.
- Tomas Aragon
Person
Correct.
- Richard Roth
Person
And I guess that's what I'm asking you.
- Tomas Aragon
Person
Yes.
- Richard Roth
Person
What are your black and whites that are very difficult to train, very difficult to recruit, very difficult to hire that you need to keep in the face of some draconian cuts that are probably going to touch just about every Department agency in the State of California? California.
- Tomas Aragon
Person
Yeah, we would. Right now, the proposed cut would eliminate the future of public health initiative, which funds core infrastructure operations at the state level and at the local level as well.
- Rita Nguyen
Person
And, Senator, if I might add, Rita new, an assistant public health officer. This gets one of your questions from last week as well. I think you had asked a lot about the local boots on the ground impact.
- Rita Nguyen
Person
And to make it clear, part of the future of public health investment, $100 million is for state operations, but $200 million goes to our local colleagues, the boop's on the ground, including the community health workers, the folks who are out there forming trust and bonding relationships with community at the state level.
- Rita Nguyen
Person
It also funds our newly formed regional public health office. And so that office provides technical assistance to the various regions to support the local health departments in whatever they may want to do, whether it be EPI with data or support their communications campaign. So they are closely linked.
- Richard Roth
Person
Thank you. Thank you Madam Chair.
- Susan Talamantes Eggman
Person
Madam Chair, if I could follow up on that question. Thank you. So in this. So wouldn't it make more sense, and I'm asking because you. I mean, this is your document.
- Susan Talamantes Eggman
Person
I mean, I know it's coming from the Department of Finance, but would it make sense then to try to maintain the funding that goes to the locals, then where, that's where the boots on the ground are, where we have the syphilis outbreak. Want to stop the syphilis outbreak. Makes sense. Versus some of the state planning part. Right.
- Susan Talamantes Eggman
Person
If it's all talk about all being lumped into one, but can we separate those out to be able to maintain the services on the ground versus the planning for later?
- Tomas Aragon
Person
Yeah, you're asking a really good question. I think the role the state operations play is really vital because many things that happen are cross jurisdictional.
- Susan Talamantes Eggman
Person
Doctor, I'm not saying they're not vital, but you're arguing to us to cut everything. I mean, we're talking about doing a lot of cuts and we're saying, help us. I prioritize your cuts.
- Tomas Aragon
Person
Yeah. So we were. Yes, we put documents together to talk about the impact. We didn't get into sort of comparing within what future public health, what we would cut out. And I don't want to. I don't want to.
- Tomas Aragon
Person
I do want to acknowledge that both the state role and the local role are incredibly important and they complement each other and we work really closely together and, you know, like, the state works with the CDC and we work with locals and we're that linkage that enables us to take regional approaches to take care of things that happen across jurisdictional lines.
- Nina Hong
Person
Department of Finance I do want to, like, note that these investments were made during relatively better fiscal years. So due to the budget situation, we're proposing to reduce the funding on this. And we do want to also note that the may revision does maintain $4.8 billion in total funds for DPH.
- Nina Hong
Person
And these funds will help the entities to continue to provide public health services to the extent that the base funding allows for. And we also do maintain other funding, such as the SaPHIRE system, $26.9 million to continue lab data for reportable health conditions, and $1.4 billion in Budget year for the Center for Infectious Diseases.
- Caroline Menjivar
Legislator
Let's hear from our two guests who came in today. First, Public Health Director from Riverside County.
- Kim Saruwatari
Person
Good evening. Chair and Members Kim Saruwatari, Director of Public Health for Riverside County and the immediate past President of CHIA. Thank you for having this discussion about the impacts of eliminating public health funding on our Department, departments and communities and allowing me to share the impacts in Riverside County.
- Kim Saruwatari
Person
Future of public health funding has allowed us the much needed flexibility to hire staff in areas of highest priority and to meet the needs of our most vulnerable communities. In my county, we filled 104 out of 107 positions. Last week, you asked CDPH leadership if these positions would go away and if California's preparedness would be impacted.
- Kim Saruwatari
Person
In Riverside County, we would likely lay off at least 90 staff and our ability to perform core public health functions will be greatly diminished. In Riverside County, our communities are benefiting greatly. With these funds, we hired nurses for our mobile immunization teams.
- Kim Saruwatari
Person
In the last four months, we've administered over 1100 vaccinations at schools, community centers, skilled nursing facilities. Without this funding, these teams would be eliminated and our already low vaccinations rates would fall even more given the surge of vaccine preventable diseases such as measles. These vaccination clinics are extremely important in protecting our residents.
- Kim Saruwatari
Person
The disease investigators supported by this funding have investigated potential contacts to confirmed cases of measles, each of which requires monitoring for up to 21 days.
- Kim Saruwatari
Person
We also fund our enhanced disease detection and Investigation team who identified an outbreak of leak genellosis in a senior apartment complex before traditional surveillance methods, allowing us to intervene earlier and protect this highly vulnerable population. These funds support half of our public health lab team.
- Kim Saruwatari
Person
Without these staff, turnaround times for critical testing such as tuberculosis and bacteriology would take significantly longer. Infectious diseases can easily and quickly cause outbreaks in the community if testing is not perform timely, particularly in high density population settings like daycares, detention facilities, skilled nursing facilities, and school settings.
- Kim Saruwatari
Person
In 2019, I came before the Senate Health Committee and sounded the alarm that our local health departments were woefully understaffed and unprepared to respond to a long term, large scale public health emergency, let alone meet the day to day needs of our population. Unfortunately, our worst fears came came true during and after the pandemic.
- Kim Saruwatari
Person
Our Department has responded to Monkeypox, a resurgence in measles, high rates of congenital syphilis, and were actively preparing for H5H1 AB, and influenza.
- Kim Saruwatari
Person
In light of last week's evacuation due to a potential anthrax threat, I would highlight that qualified public health labs test for this agent and if positive, public health would also play a critical role in treating those exposed. This is yet another reason why public health needs to be prepared.
- Kim Saruwatari
Person
Please do not repeat the same mistake that we made in 2019 and decades before. If we devastate our workforce again, we will stifle our ability to hire and the progress that we've made. Our communities will suffer and lives will be lost. Thank you.
- Caroline Menjivar
Legislator
Thank you so much. Now I'll turn over to Yolo County Public health officer.
- Aimee Sisson
Person
Yeah. Good evening. I'm Doctor Aimee Sisson, Public Health Officer for Yolo County and President elect of the California Conference of Local Health officers, speaking on behalf of the Health Officers Association of California. Thank you for this opportunity to discuss the devastating impact the proposed cuts to future of public health funding would have on California's 61 local health departments.
- Aimee Sisson
Person
While these funds may be called the future of public health, they drive public health now. Since 2022, California's local health departments have hired over 1100 new staff using future of public health funds based on the promise of ongoing funding. Without these monies, newly hired staff will lose their jobs and critical work will go undone In Yolo County
- Aimee Sisson
Person
this represents 10% of our public health workforce. Future of public health dollars aren't being used to fund bells and whistles. To answer your question, Senator Roth, these aren't nice-to-haves. These are must-haves. Local health departments use these monies to provide basic public health services to our communities.
- Aimee Sisson
Person
No other entity can provide these core public health services, not the healthcare system, not community based organizations, not academic institutions. Much of the public health funding Yolo County receives from the state and Federal Governments is earmarked for a specific disease, leaving us with little flexible funding to meet the needs across communities.
- Aimee Sisson
Person
Future of public health funds are wonderful because they allow Yolo County to apply the monies as we see fit to achieve our locally determined priorities and objectives.
- Aimee Sisson
Person
With our allocation of these funds, Yolo County is creating better health outcomes for those most impacted by racial, ethnic and economic disparities, slowing the spread of infectious diseases, and increasing opportunities for residents to be healthy.
- Aimee Sisson
Person
With future of public health funds, Yolo County hired personnel to administer our wellness vending machine program, which provides free supplies like Covid tests, masks, mosquito repellent and condoms to prevent the spread of communicable diseases.
- Aimee Sisson
Person
With future of public health funds, Yolo County hired a farm worker health coordinator to survey Yolo's large population of migrant farmworkers in order to identify and meet their health and social service needs.
- Aimee Sisson
Person
With future of public health funds, Yolo County supports outreach staff and data scientists to work with community Members to identify health needs and then collaborate with community partners to address these needs. Now is the time to stay committed to funding local health departments, not to cut funding. Decades of underfunding left us understaffed and underprepared for a pandemic.
- Aimee Sisson
Person
Limited term federal funding bolstered our ability to address Covid-19 but that funding is not nearly all spent. Without future public health dollars, local health departments won't have the necessary resources to address rising cases of measles, tuberculosis and sexually transmitted infections.
- Aimee Sisson
Person
Nor will we have the resources to adequately respond to Avian Influenza, a virus the CDC describes as having pandemic potential. Avian influenza, also known as bird flu, has already made the leap from birds to dairy cows in the United States States and to at least one dairy worker.
- Aimee Sisson
Person
Without future of public health funding, local health departments will be less able to protect workers in the dairy industry from Avian Influenza. We will be limited in our ability to provide testing, symptom checks, and contact tracing.
- Aimee Sisson
Person
Without such preventive measures, the virus will have opportunities to spread and potentially mutate to become transmissible, not just from cow to human, but from human to humans. It has been said that those who do not learn from the past are condemned to repeat it.
- Aimee Sisson
Person
Let's learn from the COVID-19 pandemic and ensure that our local health departments are adequately funded for the present and the future. And I would be remiss if I did not mention how closely local health departments and the California Department of Public Health collaborate to protect our communities. A cut to CDPH's funding negatively impacts local health departments.
- Aimee Sisson
Person
As a local health officer, I regularly consult with CDPH subject matter experts about wastewater, measles exposures, rabies prevention, just to name a few. Public health is a team sport, and locals and CDPH are on the same team. Local health departments benefit when CDPH has the funding it needs. Thank you.
- Caroline Menjivar
Legislator
Thank you so much. You mentioned some items that potentially get some federal funding and other source funding, but this brings flexibility. Are there certain topics you can think of that perhaps don't get, really, the financial support that would be at higher risk of ending or being cut?
- Aimee Sisson
Person
I mean, we have some areas, like chronic disease, for example, which are the leading cause of death in California and in the United States that receive no categorical funding from the state or the Federal Government. So these are areas that we can focus on and address with our future of public health funds.
- Aimee Sisson
Person
Without those flexible funds, we don't have any funding to address chronic disease, for example.
- Richard Roth
Person
Senator Roth.
- Richard Roth
Person
Well, I guess I get the answer to my question, I guess, is on page 27, it looks like about $200 million flows to the local departments out of $300 million that's been being cut.
- Aimee Sisson
Person
That is correct.
- Richard Roth
Person
You know, I guess you don't have to help us make. You don't have to make our job easier, but it certainly doesn't make our job easier when everybody comes in and says, you know, we need the whole bucket, because everybody says they want the whole bucket.
- Richard Roth
Person
And so the danger in doing that, of course, is that if in fact, we have to make cuts. We may make cuts in the wrong area. So when you all leave, you'll have to think through that and see if that's the right way to leave us.
- Aimee Sisson
Person
If I may respond to that, I would just, you know, point out that many of the other proposed cuts are not to ongoing funding, they're to one time funding, whereas the future of public health.
- Caroline Menjivar
Legislator
I would say that's totally incorrect in my subcomittee. Almost all of them in my Subcommitee are ongoing cuts. That's the problem. This is another one that is ongoing CalWORKS, foster care kids. So it's the problem that I'm dealing with here.
- Richard Roth
Person
We do love public health. Don't get me wrong. It's absolutely critical. I hope that you took that away from my questions. We can't eliminate our capability, that is, in our local jurisdictions, to respond to public health crises immediately and effectively so.
- Caroline Menjivar
Legislator
You can say that for other subcommittees outside of this one, they're not.
- Unidentified Speaker
Person
Fair. To the boots on the ground, because I don't want to leave with the sense that we aren't boots on the ground. Many of the things that we do are boots on the ground. We have a regional public health office that works very closely providing EPI support to our local jurisdictions, communication support to them.
- Unidentified Speaker
Person
We also have our data and surveillance teams that provide ongoing analysis of the data for all of these events day to day and during emergencies. We have our recovery team and some of our Center for preparedness and response that are funded here. So the Office of Policy and Planning isn't a critical thing to us.
- Unidentified Speaker
Person
It is only one small part of what we have funded here include our lab, you know, laboratories. It includes across the whole gamut of public health, trying to backfill those places where we knew, like communications, where our, prior to the pandemic, our communications team was really about responding to the media.
- Unidentified Speaker
Person
And we found that that was wholly inadequate in terms of the new role of social media and all of the things we need to combat as we move forward. So I just, just want to make sure, and if you ask us what our priority would be, it would be the positions we've already filled.
- Unidentified Speaker
Person
So we filled 317 out of the 404. And so if we had to give something up, I think it would be to maintain the positions we piloted
- Caroline Menjivar
Legislator
In the admins area, in the departments area.
- Unidentified Speaker
Person
In the state operations side. We proposed 404 positions. We've hired 317, or roughly 320, I would say by
- Caroline Menjivar
Legislator
Because those were also those positions would be cut.
- Unidentified Speaker
Person
Those-our 404 positions would be cut.
- Caroline Menjivar
Legislator
Under would be the 317 that have already been onboarded. Okay, go ahead.
- Richard Roth
Person
Well, we don't want to double impact you. Didn't the Administration require a certain level of cut across the board?
- Unidentified Speaker
Person
I'll let finance respond. But there's a proposed 8% cut.
- Caroline Menjivar
Legislator
And that's on top of all these that would cut on. Yes.
- Nick Mills
Person
Nick Mills, Department of Finance, confirmed that there's an 8% ongoing reduction, but we're still working out the details and working with departments on what that will look like. And I just also wanted to flag that Director Fanelli's proposal is not included in the May revision budget.
- Nick Mills
Person
But we understand that the Legislature may have feedback and different priorities proposal.
- Caroline Menjivar
Legislator
Right. The other programs, ma'am, I didn't catch your name. Other programs that you mentioned, would they be able to continue with these cuts? The example you gave as to, hey, we're also boots on the ground.
- Unidentified Speaker
Person
Those are part of what's proposed to be eliminated.
- Caroline Menjivar
Legislator
Okay. Okay.
- Unidentified Speaker
Person
We're just trying to make sure you understand the impact.
- Caroline Menjivar
Legislator
Oh, no, we. I mean, I'm a little confused. This is a very different approach to what I'm used to here. You know, most of the time, we're not on the same page. I agree. This is a huge impact. Huge impact on public health. I said last week, silicosis is huge in my district, and the spikes.
- Caroline Menjivar
Legislator
Men are dying at the age of 26 for this. I mean, you talked about wastewater mosquitoes in my district. That's a huge area. And always almost in communities of color that already have a bunch of layered on health issues. Right. Diabetes. You can't get over diabetes if all these other public health issues, you know, are happening.
- Caroline Menjivar
Legislator
You gave us the State of. What was it? The State of public health, the State of Public Health, and all the things we talked about. Senator Egmont mentioned STIs. I have a Bill related to, because I know young people are increasing in our STI cases almost amount to 50% in California, and we're not preventative.
- Caroline Menjivar
Legislator
One of you shared, when your program gives away condoms and so forth, we're nowhere near what we need to do in preventing STI's. HPV is on the rise. So I'm there with you. Maybe we should all tell Department of Finance how we. How we feel about this. No, I think this would really, really.
- Caroline Menjivar
Legislator
I mean, we set a foundation, and we're just gonna wipe it away. And then, you know, just like you were here in 2019, asking for this 2020 happened, and we know what happened after that. So we want to be prepared 100%. No one thought the pandemic was going to happen and it happened.
- Caroline Menjivar
Legislator
Covid happened, came out of that field. So I want to make sure that our state is prepared for whatever else comes next. Elio, any closing remarks here for this topic?
- Will Owens
Person
Yes, Will Owens with the LAO. So I want to highlight here that, you know, I think there is an opportunity for the Legislature. You know, it doesn't necessarily, as Senator Roth mentioned, have to be a full elimination of the program or completely funding the program. The Legislature does have options.
- Will Owens
Person
For example, given, as you've heard today here, the broad impacts that the elimination of this funding would have on the public health system.
- Will Owens
Person
This could be an instance where the Legislature works to find other one-time or temporary solutions elsewhere in the budget to maybe give some more time to fully work through what some of these impacts might be to continue funding this for short term.
- Will Owens
Person
You know, given the issues and ongoing deficits in the budget, understanding that ongoing reductions across the budget are necessary, this could be an instance where maybe a temporary solution until we fully, the Legislature can fully kind of wrap, get its arms around the impacts of this cuts could be warranted.
- Will Owens
Person
Additionally, like I said, this doesn't necessarily have to be a complete elimination or a fully funding as is.
- Will Owens
Person
The Legislature could work to kind of maintain funding for certain priorities, such as reducing health disparities within this funding or to kind of focus on already hired public health workforce, as has been discussed, from the $100 million that's going to the Department of Public Health, a lot of that is for personnel.
- Will Owens
Person
Around 80%, as the Department has said, has already been hired. And then at the local level, $200 million going to local health jurisdictions, the same thing. Around 80% of the proposed hires have been made from that $200 million.
- Will Owens
Person
So prioritizing already hired public health workforce could be a middle ground between full elimination and continued funding at current levels. Happy to answer questions.
- Caroline Menjivar
Legislator
Thank you, Will. Any further questions on this? Thank you so much for the conversation. We're going to do issue two, adapter.
- Caroline Menjivar
Legislator
Don't have to focus on the first question. We went over the overview last week. Just any update, number two, and then an update to the conversation we had last week, please.
- Adrian Barraza
Person
Absolutely. Good evening, everyone. Adrian Barraza, Deputy Director with the Center for Infectious Diseases. So the second question that you posed was, how will the Administration monitor expenditures and cash flow in ADAP to ensure the program does not suffer from funding shortfalls as a result of these loans?
- Adrian Barraza
Person
So we actually obtain a weekly fund balance statement from our accounting office to give us, really, a near real time look into what the current rebate fund balance is at any given time.
- Adrian Barraza
Person
We'll need to work very closely with the Department of Finance to assess whether the loan can be broken up into smaller pieces and how we potentially sequence that drive, essentially, by what that cash balance sheet is showing us.
- Adrian Barraza
Person
One other thing to know is in the November estimate, we had projected a fund balance at the end of the fiscal year of approximately 176 million. The updated projection in the May revise is closer to 106 million. So about $70 million difference there. So we'll just want to make sure that we are working with the Department of Finance to establish
- Adrian Barraza
Person
70 million less projected, projected at the end of the fiscal year. So we'll want to make sure that we're working closely with the Department of Finance to establish any necessary triggers to ensure that we have the funding for continuity of services.
- Caroline Menjivar
Legislator
70 million less?
- Caroline Menjivar
Legislator
Will we be able to still have the funding for the further investments?
- Erika Li
Person
Yeah, and I'm actually tracking 126 million on my end, but we can work through that with the Department, make sure we were landing on the same number. And that accounts for a prior year adjustment that wasn't recorded in the Governor's Budget, as well as the 23 million early action package. So that is already set aside.
- Caroline Menjivar
Legislator
So 126 after we do the loan and the 23 million for future investments. Correct? Okay. Yeah.
- Erika Li
Person
And then there's a few adjustments in there for small changes in revenues from the ADAP estimate. So that's what the difference comes from.
- Caroline Menjivar
Legislator
Okay. Can we do number three?
- Adrian Barraza
Person
Sure. So question three, please describe the additional investments set aside during early action and the administration's assessment of funding sources for these investments. So let me first start with a brief overview of the federal and state spending restrictions.
- Adrian Barraza
Person
So federal law essentially provides that rebates received on drug purchase from federal funds must be used for Ryan White services, which include activities for individuals living with HIV, and that is that they have a priority for services that are ADAP activities.
- Caroline Menjivar
Legislator
Can you repeat that one again?
- Adrian Barraza
Person
The whole. State thing, costs related to products.
- Adrian Barraza
Person
State law provides that monies in the ADAP rebate fund must be used exclusively to cover costs related to the purchase of drugs and services provided through ADAP,our PREP assistance program and PREP and PEP navigation and retention services.
- Adrian Barraza
Person
So our PREP assistance program.
- Adrian Barraza
Person
Related to the purchase of drugs and services provided through ADAP, PREP and PEP retention and navigation. And I'm happy to walk through each of the proposed initiatives and then kind of give you our General assessment of each. Perfect.
- Adrian Barraza
Person
So the $5 million for that would go towards SB 954 essentially would require an amendment to health and safety code for us to implement the ADAP and PEEPapp eligibility increase because the state law.
- Caroline Menjivar
Legislator
Says only costs related to drugs and services.
- Adrian Barraza
Person
So Administration of the AIDS Drug Assistance program, procurement of medication.
- Caroline Menjivar
Legislator
Administrating the whole program?
- Adrian Barraza
Person
Correct. Specific to ADAP Administration, prep app Administration, or PREP and Pep navigation and retention.
- Caroline Menjivar
Legislator
ADAP Administration. What does that mean?
- Adrian Barraza
Person
Correct.
- Adrian Barraza
Person
Correct.
- Caroline Menjivar
Legislator
That goes to. That can go to like CBO's and so forth?
- Adrian Barraza
Person
Okay. The second initiative is increase of the eligibility criteria from 500% of the federal poverty level to 600% of the federal poverty level. So that would not be permitted currently under health and safety code. We would need to amend health and safety code to increase eligibility criteria to 600% of the federal poverty level.
- Adrian Barraza
Person
The third proposal is harm reduction clearinghouse increase. This would not be an eligible use of the ADAP rebate fund under current law. Implementing this change would require many health and safety code to modify the language.
- Adrian Barraza
Person
Additionally, due to restrictions in federal law, this proposal could only be funded with a subset of rebate funds within the rebate fund, specifically rebate that's not generated off of federal dollars.
- Adrian Barraza
Person
And lastly, related to this item, the harm reduction clearinghouse has historically been funded by State General Fund and the ADAP rebate fund itself should not be used supplant other resources. And that's both the designation and federal and state law, which require ADAP to be the payer of last resort.
- Caroline Menjivar
Legislator
How do we then get around that with the loan?
- Adrian Barraza
Person
So in terms of structuring this as a component of the loan, yes.
- Caroline Menjivar
Legislator
So if it's a payer of last resort, if it's to use federal law to be within the federal and state law, how do we get around that for General Fund loans?
- Adrian Barraza
Person
So that's something that we've actively been exploring with our legal office. I'm not sure if Department of Finance wants to come.
- Caroline Menjivar
Legislator
We've done it already. This will be the second 3rd time, so I don't think in the past what how many years? It seems like it's legal. I just want to make sure the reasons you're giving me for these things, it seems like the loan could fall into the same reason why we can't do that.
- Erika Li
Person
Dept of Financing. So the loan is coming from the Reserve balance. So it's not actually spending money out of that ADAP Fund, it's just borrowing. And then we will be returning the money when the General Fund situation is either better or the program has needs for the funds.
- Erika Li
Person
It's not part of the proposal right now, but
- Caroline Menjivar
Legislator
So can't we do the same thing? Can we borrow for the things that, that you said aren't eligible? If we, wouldn't that be the same thing?
- Caroline Menjivar
Legislator
I get that. But it wouldn't be violating state or federal restrictions?
- Adrian Barraza
Person
We would need to definitely take that back to our legal team to assess.
- Caroline Menjivar
Legislator
because we're taking a loan that has nothing to do with the state and federal requirements of this Fund to offset the General Fund that has nothing to do with what it's intended for.
- Adrian Barraza
Person
Absolutely
- Caroline Menjivar
Legislator
Okay. I think it's apples to apples. I would really like to know if it's not.
- Adrian Barraza
Person
Yeah, we can certainly take that back..
- Caroline Menjivar
Legislator
But then the future, the further investments, some of them were being told they don't qualify because they're not following what the Fund is intended for. But the loan is not following what the Fund is intended for.
- Caroline Menjivar
Legislator
Okay. Okay. I would really like a response in their next time that we connect, which is I think Monday or sooner would be better, but if not, we'll come back on Monday. Okay. Was there another item on that list that doesn't qualify?
- Adrian Barraza
Person
Three more items. Well, the health insurance premium payment cap increase, that is an allowable use. That one's fine. The TGI wellness and equity Fund.
- Adrian Barraza
Person
Functionally, this is an activity that falls within our Office of Health Equity and it would not be an appropriate use of the ADAP rebate Fund since the activities are not related to HIV prevention care treatment and then the needs assessment is an allowable use.
- Adrian Barraza
Person
So there was $400,000.01 time that was requested to do a gap assessment of client navigation and retention services.
- Caroline Menjivar
Legislator
Okay, are those all the items?
- Adrian Barraza
Person
Those are all the items.
- Caroline Menjivar
Legislator
Any questions? Okay, if we can get some clarification on that it will be helpful? Okay, LAO, any comment on this? Okay, well, thank you so much.
- Caroline Menjivar
Legislator
Moving on to issue number three, CYBHI, the reason why I'm bringing back this topic, to be honest, transparency here is the public comment we received after this was a little overwhelming and I'd like to dive into more of the, the value of these programs and how successful the implementation, how many, how it's being utilized. Go ahead.
- Maria Ochoa
Person
Maria Otoa with CDPH, and I'll cover the first item. So, which gives a little bit more detail.
- Maria Ochoa
Person
So as a component of the urgent needs, urgent needs and emergent issues in the CYBHI package, the 2022 Budget act included 25 million General Fund in 22/23 and 20 million in 23/24 and 5 million in 24/25 for the California Department of Public Health to implement a youth suicide reporting and crisis response pilot program.
- Maria Ochoa
Person
Of the 50 million, 15 million was allocated to CDPH's Center for Infectious Diseases to modify state systems to make suicide a reportable event. CID staff thoroughly explored the feasibility of including suicide as a reportable condition and explored using the California Reportable disease information exchange for data reporting and for using Cal connect in the crisis response process.
- Maria Ochoa
Person
CDPH determined that suicide and suicide attempts do not meet definitions of reportable communicable disease or condition. Because suicide and suicide attempts fall under behavioral health rather than communicable disease, this effort has not been able to move forward. Therefore, there's 15 million in unspent funds.
- Maria Ochoa
Person
So, of importance, of the 50 million, 35 million was allocated to CDPH's Office of Suicide Prevention to develop local reporting and response systems. Implementation of this local pilot is underway in 10 counties, Alameda, El Dorado, Humboldt, Kern, Los Angeles, Riverside, Sacramento, San Diego, San Joaquin, and Solano counties.
- Maria Ochoa
Person
The funding was not reduced or eliminated from the May revision. Learnings from this local pilot program will be used by the Office of Suicide Prevention to provide technical assistance and support for local systems change efforts in the future.
- Maria Ochoa
Person
Counties are developing and testing models for making youth suicide and attempted suicide reportable events that initiate rapid and comprehensive responses within schools and community settings. The goal of the pilot program is to strengthen reporting and crisis response systems so that healing can begin and further suicides and attempts can be prevented.
- Caroline Menjivar
Legislator
So 10 counties were going to participate in this pilot. They got funding, but then we weren't able to collect this data. And what are they using the funding now? I misunderstood.
- Maria Ochoa
Person
Yeah. So there was 15 million in unspent funds that was going to go to modify state systems. So that was separate. That was going to our Center for infectious disease. Our office of Suicide Prevention has received 35 million, and they're working with the locals to collect data on suicide reporting.
- Caroline Menjivar
Legislator
So they're going to be doing that?
- Caroline Menjivar
Legislator
So this is still going to get reported?
- Caroline Menjivar
Legislator
Yes. Okay. I don't think I got that last.
- Maria Ochoa
Person
Yes. I was not clear last time. Sorry. That's why I wanted to bring that up this time.
- Maria Ochoa
Person
Yes.
- Caroline Menjivar
Legislator
Still going to get some data?
- Maria Ochoa
Person
Yes. This is separate monies. The 15 million was unspent for something else.
- Caroline Menjivar
Legislator
So we're still going to be able to collect this information from a different office? We're just not going to do it under this. It falls better on that office because.
- Maria Ochoa
Person
We're collecting it at the local level. The money of the 15 million that was unspent was going to be to modify a state system to collect the data, but we're still collecting it at the local level.
- Caroline Menjivar
Legislator
Okay. But we're getting better news. Okay. This time. Okay, colleagues, any question on the first part? Huh? No. No. Okay, you can go into the second point.
- Maria Ochoa
Person
That I will have to get back to you.
- Maria Ochoa
Person
When will the pilot end for us to see this data?
- Unidentified Speaker
Person
Can you hear me? Okay. The CYBHI public education change campaign. The proposed reduction is a 73.8 million from 100 million campaign to address stigma and improve mental health literacy.
- Caroline Menjivar
Legislator
Wait, I'm sorry. Is that number correct? Wait, how much is a reduction?
- Unidentified Speaker
Person
The proposed reduction of 73.8 million from the 100 million campaign to address stigma and improve mental health literacy. This is the OHI portion.
- Caroline Menjivar
Legislator
Could you break down those numbers? Because I might only have. Yeah, could you just break it out per what year we're pullin out of the 73 you mentioned, that was a.
- Unidentified Speaker
Person
The total campaign, or I should say the total. That was a five year from 2021 to 2026. Okay, and what years are you pulling that from? So the reduction was from year budget year 24/25 and then 25/26.
- Nick Mills
Person
Nick Mills, Department of Finance. So the Administration proposes to revert 28.8 million from fiscal year 23-24, 40 million from fiscal year 24/25 and 5 million from 25/26 and maintains 26.2 million.
- Caroline Menjivar
Legislator
Thank you. I think I was missing the 28.8. That's current savings in this year?
- Nick Mills
Person
Yes, correct.
- Caroline Menjivar
Legislator
Lack of utilization?
- Nick Mills
Person
We worked with the Department to identify these unspent funds, so that's correct.
- Caroline Menjivar
Legislator
Okay. And we're leaving 2.8 million annually for the remaining three years?
- Nick Mills
Person
We are remaining. We are leaving $26.2 million that's available until the end of this fiscal year for encumbrance or expenditure.
- Caroline Menjivar
Legislator
Oh, so this won't be ongoing, it's just to close out the program? 26.2.
- Nick Mills
Person
That's correct.
- Caroline Menjivar
Legislator
Okay, Senator.
- Unidentified Speaker
Person
Yes, before the end of the June, the close of the fiscal year.
- Unidentified Speaker
Person
Affirmative.
- Susan Talamantes Eggman
Person
Affirmative. Okay. So it's been slow to move. So. And I, speaking as the chair of the LGBTQ caucus, we heard a lot about this. Right. This is the one reducing disparities. No, we're not there. Okay. Yes, we are. That it has been slow to get out, and so that's one of the reasons it's been underutilized.
- Susan Talamantes Eggman
Person
As I understand this money has been slow to move. Is that correct?
- Susan Talamantes Eggman
Person
But we're going to try to get out as much as we can before. Is that what we're saying?
- Unidentified Speaker
Person
Yes, we are. We have a vendor, and we should spend up the 26.2 before the end of the fiscal year. Okay.
- Susan Talamantes Eggman
Person
So we're going to prioritize getting it out.
- Unidentified Speaker
Person
Right. But that would be. That would come at. With the local level campaigns. There would be, I guess, $10 million that were promised to local level cbos that will not be covered because they're not budgeted.
- Unidentified Speaker
Person
Yes.
- Caroline Menjivar
Legislator
Doing what?
- Caroline Menjivar
Legislator
Okay, so 26.2 million to be spent in the next month and a half.
- Unidentified Speaker
Person
These are grants. Local level grants.
- Caroline Menjivar
Legislator
For work they already did?
- Unidentified Speaker
Person
Working. Well, the local level campaigns, they've already received or will receive two payments, so
- Caroline Menjivar
Legislator
Work that they will do.
- Unidentified Speaker
Person
As best they can. But they will be losing out. There would be $10 million that we publicly announced at the beginning of, I think, March. They will not receive the entire funding amount.
- Caroline Menjivar
Legislator
So work they already did?
- Caroline Menjivar
Legislator
Oh, they will do. In the month and a half? Oh they can use that dund past our fiscal year. Yes. Okay. We just have to get that out before our fiscal year. But these CBO's can utilize that fund to continue the campaign.
- Caroline Menjivar
Legislator
They won't receive the full 26.2?
- Unidentified Speaker
Person
They won't receive. The local levels were promised 25 million. 25 million, I believe 15 this year. Okay. And an additional 10 million was supposed to be awarded after July 1.
- Susan Talamantes Eggman
Person
And that's what we're cutting out?
- Caroline Menjivar
Legislator
Yes. We're cutting out that 10 million that was supposed to go out in July 1.
- Unidentified Speaker
Person
Affirmative.
- Susan Talamantes Eggman
Person
But the 25's going?
- Caroline Menjivar
Legislator
Okay.
- Caroline Menjivar
Legislator
But the 26.2 is still.
- Caroline Menjivar
Legislator
So we're just cutting the 10 million?
- Unidentified Speaker
Person
The 26.2 is what we are budgeted for this year.
- Unidentified Speaker
Person
Yes. The awards that would happen July 1. Okay.
- Nick Mills
Person
Nick Mills, Department of Finance. There are several components of the public education and change campaign. The Director is responding, is talking about the local level campaigns that are going to 28 community based organizations, but there's also a statewide campaign, and some of that 26.2 million is going to support that as well.
- Caroline Menjivar
Legislator
Okay. So this funding goes into a statewide campaign and a local wide campaign?
- Nick Mills
Person
Sure. So 25 million was announced for the 28 CBO's a couple months ago. 15 million was supposed to go out in 23/24 and still is.
- Nick Mills
Person
There are several components of this program.
- Caroline Menjivar
Legislator
So that's why we have different numbers, because I'm getting, I guess, a little lost in the numbers.
- Nick Mills
Person
But then 10 million was supposed to go out in 24/25 and that will not be received.
- Caroline Menjivar
Legislator
Got it. So we announced this a couple months ago that we're doing it even though we're in the midst of this budget discussion, and now we're saying, never mind.
- Nick Mills
Person
At the time of May revision, this was the best information we had.
- Caroline Menjivar
Legislator
The statewide campaign the media will be eliminated.
- Caroline Menjivar
Legislator
Okay. Okay. So bottom line, some CBO or CBOS will get some funding to continue as best as they can this campaign.
- Caroline Menjivar
Legislator
And we're cutting that vendor?
- Unidentified Speaker
Person
Completely. There will be no statewide campaign.
- Caroline Menjivar
Legislator
The statewide campaign would be eliminate?
- Unidentified Speaker
Person
Yes.
- Unidentified Speaker
Person
We have a vendor who's working. Yes.
- Caroline Menjivar
Legislator
Did it ever get off the ground?
- Caroline Menjivar
Legislator
Is it because it's expiring or we have to sever that contract earlier? We are cutting the.
- Unidentified Speaker
Person
Because of the funding.
- Unidentified Speaker
Person
Because there was no funding for the remaining year.
- Caroline Menjivar
Legislator
Okay. Is it we're cutting or we're getting out earlier than our contract.
- Caroline Menjivar
Legislator
Okay. We're getting out earlier. Okay. What was the success rate or, like, how. Any data that you're able to share with us on in the past from 21, how this campaign went? How many people did we reach.
- Caroline Menjivar
Legislator
Or our level.
- Unidentified Speaker
Person
For the state level now that they. We have not started the state level campaign. We haven't started on that.
- Unidentified Speaker
Person
For the local level campaigns?
- Caroline Menjivar
Legislator
Oh we never started. And we're cutting it.
- Unidentified Speaker
Person
Yes.
- Unidentified Speaker
Person
We started the campaign. It started formative research on the campaign.
- Unidentified Speaker
Person
Yes.
- Caroline Menjivar
Legislator
So we paid a vendor to do nothing. Cause we won't be able to start it. Got it. And we're essentially.
- Caroline Menjivar
Legislator
Yes. Okay. But we hired a vendor.
- Unidentified Speaker
Person
To start working on it. And it was supposed to launch in October of this year.
- Caroline Menjivar
Legislator
To do what?
- Caroline Menjivar
Legislator
Of this year.
- Unidentified Speaker
Person
Yes.
- Caroline Menjivar
Legislator
Okay.
- Richard Roth
Person
How much have you already spent?
- Caroline Menjivar
Legislator
Department finance.
- Unidentified Speaker
Person
Yeah. I have to get back to you.
- Nick Mills
Person
I will have to get back to you, too. I don't have the exact amount for the state level campaign, but this is.
- Caroline Menjivar
Legislator
Where my concern is on a lot of these things. We want all these different money, and I'm like, could we just hold off? Can we just Fund it for a year? Can we do less that money? Less of that money request? Because it takes us a long time to start off campaigns and so forth.
- Caroline Menjivar
Legislator
There are opportunities for us to cut contracts right now because we're doing it in some way in some programs we're cutting contracts and then other contracts we're not. It just seems like when we're talking about census, I believe, like we allocated funding for the legacy system, Cedar, that didn't pan out.
- Caroline Menjivar
Legislator
So we're coming back to a different one. So I just want to make sure at least this year, everything we're requesting for is appropriate in a way that we know it's going to be allocated all the way.
- Caroline Menjivar
Legislator
Knowing our one to two year procurement process, knowing how long it takes us to get money out the door, knowing how long it takes us to stand up a program like us being very sensitive of the dollar amount we're requesting for every single program, because then this happens where we cut programs before they even start.
- Maria Ochoa
Person
Yes. Can I circle back to one thing? You asked when the pilot program would end, and it's June of 2025. Thank you so much.
- Caroline Menjivar
Legislator
Okay. And then on the local level programs, are we going to be able to continue, be able to provide any technical assistance? It's not budgeted. Okay. So we're just giving out the money and they're going to do what they do. We're not collecting any data. At the end, we won't know if this program was successful.
- Unidentified Speaker
Person
There's no funding beyond the, the year. So that includes the entire, I guess, staff that would check on the night staff.
- Caroline Menjivar
Legislator
Will, any additional comment? No. Okay. Any. Okay. Thank you. Issue four California Cancer Registry.
- Maria Ochoa
Person
Maria Ochoa CDPH so the May revision reflects an increase of 271,000 in the General Fund and one position to support additional activities required by the California Cancer Registry as mandated by Senate Bill 344.
- Maria Ochoa
Person
The one position being requested is needed to develop and promulgate regulation, package and support operational functions to meet the statutory amendment resulting from the 2023 legislation. SB 344 changed requirements for electronic pathology reporting cancer diagnoses, resulting in a need for a statewide quality control and follow up with providers that have deficiencies.
- Maria Ochoa
Person
This work is separate and distinct from the current Administration and operation of the registry. The regulations package will enhance data quality and timeliness to optimize the use of cancer data and promote health equity, and the position is needed ongoing to manage the data. CDPH would like to clarify, and this came up again last week, that the California Cancer registry cannot be closed as it is mandated by statute.
- Maria Ochoa
Person
As of the May Revise, the registry is expecting a decline in funding, which would diminish the registry's utility to detect disparities such as race and ethnicity, and the timeliness of getting data out to inform overall cancer control statewide. But the registry will continue.
- Maria Ochoa
Person
CDPH is continuing to look for opportunities to redirect funding to meet the 800,000 shortfall in fiscal year 24-25. If redirection is not possible, the shortfall will be passed to contractors performing the essential registry functions in fiscal year 24-25.
- Maria Ochoa
Person
CDPH is pursuing additional CCR efficiencies and has engaged in lean transformation and collaboration with the CDPH lien Transformation Office and is looking for administrative efficiencies based on recent adoption of a federal data management system and we should see savings in fiscal year 25-26.
- Caroline Menjivar
Legislator
You mentioned if we don't find or meet the $800,000 shortfall that we're going to file the contracts to continue it.
- Maria Ochoa
Person
So we have contractors that perform some of the essential functions of the registry and so we would be cutting some of their funding.
- Caroline Menjivar
Legislator
Okay, so it's not that we go to them to continue correct. The goal here is to 100% try to find a way to make the registry whole so I can continue .
- Maria Ochoa
Person
Correct, It will still continue. The quality of data just might not be as good.
- Caroline Menjivar
Legislator
Because we can potentially just stop collecting some kind of data.
- Maria Ochoa
Person
If there's deficiencies with the data, we might not have the resources to correct the deficiencies.
- Caroline Menjivar
Legislator
And would that be the only thing that's at risk if we don't Fund or is collecting data?
- Maria Ochoa
Person
Also the data collection and then the timeliness of how quickly we're able to get the data out. Okay. But this position is to add more data, to be able to collect additional data. So there was requirements with SB 344 to collect for electronic pathology, and we need to follow up if there's deficiencies with the data that's submitted.
- Maria Ochoa
Person
So this position will help with the regulation package, and then they'll also help manage the data that's coming in once the regulations are in place.
- Caroline Menjivar
Legislator
Okay, so this specific data would be collected even if we don't Fund the 800,000? Okay. Just every other type of data is at risk.
- Maria Ochoa
Person
Mark, I brought a subject matter expert today.
- Mark Damesyn
Person
Mark, thank you. Mark Damesyn, CDPH Director of the California Cancer Registry. Sorry, can you hear? So, in responding to your question, as Maria said, the issue is that with the cuts, that would happen without. If we're not able to find additional funding, we will see less ability to have a data set, to build a data set which can be used to promote health equity. That's sort of what the end result is, and go ahead.
- Caroline Menjivar
Legislator
But this data will be able to collect all of this SB 344 data to meet all the requirements.
- Mark Damesyn
Person
SB 344 merely is looking to improve the quality of the data that is already coming in. And that's what this funding that is being requested is in order to enhance the quality of that data so that those most in need, really kind of, those with the highest risk of disparities, will be included in the data. They'll be represented accurately and we'll be able to really serve them the best we can.
- Caroline Menjivar
Legislator
Final summarization, see if I understand this. If we don't Fund at $800,000, we're at risk, like you said, sir, of not being able to meet to address equity and XYZ.
- Mark Damesyn
Person
That, yes, that. I think, simple as that. We have less ability to promote equity, promote equity in our population, and we are really a model for the whole nation.
- Caroline Menjivar
Legislator
Okay. So at risk of being able to promote equity. Equity of not being able to not. Being able to promote equity, the funding to address, to Fund SB 344 is to help increase our promotion of equity as well.
- Mark Damesyn
Person
Yes. For a specific part of the data, as Maria mentioned, it's the electronic pathology data, which really comes in earlier than the rest of the data. The value there is that's been in place since 2019.
- Mark Damesyn
Person
And what we found is that the data quality is not what we need in order to make sure that we're able to use this advantage to serve those most in need. And so this is what that second part is for the SB 344 funding.
- Caroline Menjivar
Legislator
Is it correct, then, to assume that even if we pass through this first phase, where the funding for SB 344 passes through the first phase of equity, it still has to go through the second part that we potentially won't be able to Fund.
- Caroline Menjivar
Legislator
So what is the point of doing part one if we won't be able to do part two if we don't Fund the registry?
- Mark Damesyn
Person
The registry will remain no matter what.
- Caroline Menjivar
Legislator
But we won't be able to catch inequities or mistakes.
- Mark Damesyn
Person
Inequality.
- Maria Ochoa
Person
If I could hop in here, and I think we're looking at other. We're looking at other administrative efficiencies. So that's what I was saying earlier. So we hope to see, you know, we found some, like, duplication with some of our contractors and the data that they collect. So we're working with them, and we hope to see efficiencies within fiscal year 24-25. So, hopefully, we will not. We can make the cancer registry whole.
- Caroline Menjivar
Legislator
By those administrative efficiencies, one without the other. That's where, bottom line, you can't one without the other. And it's hard to approve a BCP without knowing if the cancer registry is going to be made whole.
- Mark Damesyn
Person
Whether or not the Cancer Registry is made whole, if I may add, it will continue and it remains to be one of the best. The best registry, I would say, even.
- Caroline Menjivar
Legislator
Without it getting fully funded, we are still.
- Mark Damesyn
Person
We are still, yes, we are still maybe one of the only states that has the whole state covered by the NCIS using our data, and that provides other data quality. So, yes, even with the larger shortfall that we're looking at, the enhancement of our electronic pathology data does provide important value.
- Caroline Menjivar
Legislator
Okay, thank you. Any other questions? Would you like to add something?
- Nick Mills
Person
Nick Mills, Department of Finance. I just wanted to note two things. The state does not typically backfill for declining tobacco tax funds, for program supported by tobacco taxes. And number two, some of California Cancer Registries, contractors, regional cancer registries, they use these state funds as a match to draw down federal grant funds from the National Institutes of Health Surveillance, epidemiology, and end results program, also known as SEER.
- Nick Mills
Person
However, these matching funds are not required to come from the state, and the organizations which house these regional registries could also choose to provide matching funds.
- Caroline Menjivar
Legislator
Who can choose to provide matching funds?
- Nick Mills
Person
Regional cancer registries, I believe. University of Southern California, UCSF, and I can't remember the third. UC Davis. UC Davis and Pha.
- Caroline Menjivar
Legislator
Are we asking them.
- Mark Damesyn
Person
Are we asking them to support? Zero, they already do. And. And, yes, but no, Nick makes a good point. And, yes, I think it's, you know, it stands on his own. Okay.
- Caroline Menjivar
Legislator
Thank you very much. Thank you. Okay, so now we're going to flip back to the front here. Okay. Now we're going to move on to HCAI. Four issues again. Welcome back.
- Elizabeth Landsberg
Person
Good evening, Madam Chair and Members. Elizabeth Landsberg with HCAI, the Department of Health Care Access and Information. The agenda asks us to provide an overview of the proposed reversions and reductions. Did you want me to go through those?
- Caroline Menjivar
Legislator
Not all, necessarily. I think I really want to focus on what we talked about last week, the concerns of those that have been already awarded and what that looks like and taking them back.
- Caroline Menjivar
Legislator
I know we talked about the residency, but another thing I can't remember if we talked about are loan repayments on anybody who declared, yes, I'm going to work in that area at the promise of a loan repayment. And now we're saying, never mind. So those are the two major things. And any other program that is in that scenario.
- Elizabeth Landsberg
Person
Yes, Madam Chair, happy to cover the areas where funds have been obligated and are proposed for cuts under this very difficult budget. So, again, the Committee asked HCAI whether medical students who had just matched earlier this spring would have their residencies put at risk by these cuts.
- Elizabeth Landsberg
Person
And so, we did call some of these programs to whom we had made awards, and they did advise that the funding we had awarded is for residents who just got a match and are set to start their residencies this summer. We would note that a match residency program, there's a.
- Elizabeth Landsberg
Person
You know, they're contractually bound to complete the year, which offers some protection to the resident who would not likely find another match in the cycle, as was known. However, it is possible that contracts could be breached if the residency program couldn't backfill the loss of Song Brown funding from the state.
- Elizabeth Landsberg
Person
So, for most primary care residency programs, the Song Brown funding does represent core support to retain faculty, which is required to maintain program accreditation.
- Caroline Menjivar
Legislator
Senator Roth.
- Richard Roth
Person
You know, I've spent a lot of time working on this area in the 12 years I've been up here with my colleague to my right, with Doctor Richard Pan when he was here, and trying to build up our residency funding. And I have to thank the Administration for doing it because we don't do that, but the Administration does.
- Richard Roth
Person
But in the course of being involved in having others set up medical schools and watching the impact and watching residency programs be set up, I do know this. There are more physicians seeking residency programs than there are residency programs to put them into.
- Richard Roth
Person
And so, if a physician loses a match, first of all, they match. And if a physician drops out at that point, I think the odds of the physician finding a residency program are pretty slim.
- Richard Roth
Person
And as you all know, because you're in the business, if the physician does not find a residency program, the physician can't practice medicine in the State of California because a physician without a completed residency program can't get a contract to provide services. He's probably not going to be hired by anybody who has a contract to provide services.
- Richard Roth
Person
And I guess they are a claims representative for some health plan somewhere, and we just can't have that. We don't have enough of these people. They say we need 4,100, whether it's 4,100 more or 6,100 more, we don't have enough of them.
- Richard Roth
Person
And so, realize this isn't your decision, really, but we're going to have to elevate it to the people that can fix this problem because I don't think there's any more residency money out there.
- Elizabeth Landsberg
Person
There are a number of sources for residency programs, of course, Medicare funds, residency programs, and Prop. 56 dollars flows through the California Medicine Scholarship.
- Richard Roth
Person
I know all of that, Madam Director. Also know is there more people pushing into the pipeline than there are slots that are funded.
- Elizabeth Landsberg
Person
Duly noted. It's a very difficult budget year.
- Richard Roth
Person
I will tell you this. I will not vote for a budget that cuts a residency program out of a position that is matched, just like I will not vote for, and I want the people upstairs to hear this.
- Richard Roth
Person
I will not vote for a budget that cuts a psychiatrist who is recruited into a state hospital on the premise of loan repayment out of that loan repayment. That is simply not the honorable thing to do. Not that you're dishonorable, but the honor of the state is at stake here.
- Richard Roth
Person
We'll have to figure it out and find it someplace else because that just can't work. I do appreciate all that you, this is tough for you, just as it's tough for us. Sorry, Madam Chair. That's just what I.
- Caroline Menjivar
Legislator
No, don't you. No apologies, Senator. I think, I think that's the sentiment across the ones that have been, and this is like in the child care, we talked about this. Slots that have been awarded, the award letters have gone out. On programs that award letters have gone out.
- Caroline Menjivar
Legislator
Those are the most, even more difficult ones because you're right, their residency is to start in, like a couple of months and to then immediately say, hey, never mind, that's really difficult. I'm at a time where Prop. One is going to need so many more people to be involved in this.
- Caroline Menjivar
Legislator
CalAIM needs way more healthcare workers involved in this, in those kind of projects. So, you'll notice that we understand, we're not here saying we want all of this back. We're being very strategic and saying, like, these two, in particular, are even harder to swallow because of the impact, because it's already been allocated, people already got award letters.
- Caroline Menjivar
Legislator
People are already accounting for this, made life decisions based on these, of going, hey, I might move away from my family because I'm going to go to a specific location just so I can get my loan repayment. And what if they're stuck there?
- Caroline Menjivar
Legislator
I appreciate you checking into those schools, but I think they made it a little worse getting the information that this is starting in summer. Have these individuals, have the schools made these residents? I think it was 19 you mentioned.
- Elizabeth Landsberg
Person
So, in addition to the Song Brown funds. Yes, Madam Chair, there are 19 for whom HCAI has made physician loan repayment awards. 19 individuals.
- Caroline Menjivar
Legislator
So, the loan repayments, 19 individuals?
- Elizabeth Landsberg
Person
Yes.
- Caroline Menjivar
Legislator
Who were told their loans were going to be repaid.
- Elizabeth Landsberg
Person
Correct. A portion of their loans would be repaid for working in a medically underserved area.
- Caroline Menjivar
Legislator
And they already started working in that area?
- Elizabeth Landsberg
Person
I believe, given that we just made awards, that they're likely finishing their residency programs. We did not reach out to the individuals. I don't believe.
- Caroline Menjivar
Legislator
Okay. And then the other, how many people in the psychiatrist? No. Yes. The loan repayment for psychiatrists.
- Elizabeth Landsberg
Person
The loan repayment for psychiatrists. We have not made awards.
- Caroline Menjivar
Legislator
No awards. So, it seems like the only program that has made awards is the residency Song Brown Residency ones.
- Elizabeth Landsberg
Person
Song Brown Residency. Song Brown Nursing, the loan, the physician loan repayment, and then two of our pipeline and pathway programs. So, the California Medicine Scholars Program was expecting 2.8 million for the next four years. And CMSP has advised us that the program would effectively be terminated without state support.
- Elizabeth Landsberg
Person
So, this is a community college to medical school pathway program.
- Unidentified Speaker
Person
That's already begun?
- Elizabeth Landsberg
Person
Yes. Yes, it has begun. So, they have two cohorts. Yes.
- Caroline Menjivar
Legislator
What would happen to the cohorts?
- Elizabeth Landsberg
Person
So this. We talked briefly about this program last week. So this program provides support for folks who've come from community colleges into medical school.
- Elizabeth Landsberg
Person
So, they receive personalized transfer guidance, MCAT support, application assistance, research and clinical internship opportunities, targeted advising from community college counselors. Many get internships in clinical research, so it's support to help those students succeed in medical school.
- Richard Roth
Person
So, this is the getting into the medical school piece from community college? Talking about the MCAT, we're talking about having internships in labs, so they get experience that looks good on medical school applications and all that, right?
- Elizabeth Landsberg
Person
Correct.
- Richard Roth
Person
Madam Chair, may I ask one more question?
- Richard Roth
Person
On the Song Brown Nurse Program, I'm less familiar with that, obviously. What does that do? Does that provide loan money to the nurses or because?
- Caroline Menjivar
Legislator
Yeah, of course.
- Elizabeth Landsberg
Person
No, that's also to the organization to fund nursing. Nursing training programs.
- Richard Roth
Person
Oh, I see.
- Richard Roth
Person
Even though they don't have residency programs, it's to provide the basic training program.
- Elizabeth Landsberg
Person
Yes.
- Elizabeth Landsberg
Person
Correct. Many is for ADN nursing programs.
- Richard Roth
Person
Gotcha.
- Elizabeth Landsberg
Person
Does it go to public programs or private programs?
- Elizabeth Landsberg
Person
The Song Brown Nursing? Some of each.
- Caroline Menjivar
Legislator
Yes.
- Joseph Donaldson
Person
Madam Chair, if I might add? Joseph Donaldson Department finance. So, talking about both Song Brown as well as talking about the Song Brown Nursing component, would just note that based within the proposal, within the May Revise that Song Brown residencies.
- Joseph Donaldson
Person
While there are reductions to these current year and prior year dollars that had been obligated at this time, the program is not completely eliminated. The program still maintains 31.3 million and 24-25 and ongoing. So, while we understand that there are concerns about this money, this program is not completely eliminated based on the proposal.
- Joseph Donaldson
Person
Also, in regards to nursing, I know within this proposal, there are various nursing reductions, but I just really wanted to reiterate that even within the state budget as a whole, under Prop. 98, under the Community College Program, understandably that it's not under HCAI's budget, there's still $300 million beginning in 24-25 and allotments of 60 million per year.
- Joseph Donaldson
Person
So, just want to highlight that while there are some difficult solutions built in May Revise, there are dollars still maintained and continued within the state budget, as well as some other investments we talked about in the previous hearings connected to Prop. One. So, just really want to reiterate that while there are really tough reductions within this May Revise. There are other funds within the state budget that are still trying to maintain that commitment.
- Caroline Menjivar
Legislator
But the 31.3 for the residency. That's for 25-26.
- Joseph Donaldson
Person
Sorry.
- Caroline Menjivar
Legislator
It starts in, would continue in 25-26.
- Joseph Donaldson
Person
No, the funding would. The funding slotted for 24-25 and ongoing. That funding is not impacted by the solution. It's just the funding from these prior and current year dollars that while they had been obligated, they were not encumbered at the time of developing.
- Caroline Menjivar
Legislator
I think you have this incorrect because it says 10 million. So, reduction of General Fund expenditure authority of 10 million in 24-25.
- Joseph Donaldson
Person
Sorry, repeat that one more time.
- Caroline Menjivar
Legislator
Reduction of expenditure authority in 24-25 of 10 million.
- Joseph Donaldson
Person
So, this is where there's various fundings for Song Brown. So, there is the ongoing funding of this 31.3 million that I know that it's not touched within the '22 Budget Act. There are augmentations made to Song Brown.
- Joseph Donaldson
Person
There was one for, I believe it was for nursing and Director, correct me if I'm wrong, it was for primary residencies as well. So, there's two amounts. There was a total of 25 million in total for these two programs.
- Joseph Donaldson
Person
So, the 10 million you're referring to was a one-time augmentation that was included in the '22 Budget Act. Not this 31 ongoing for Song Brown.
- Susan Talamantes Eggman
Person
But what's the 31 million for if we're not going to keep our word to the 19 residency slots and the loan payback.
- Joseph Donaldson
Person
Under the May Revise, that was not identified as part of the solution. We only identified obligated but unencumbered dollars. So, the 31. While I understand that concern of kind of an ongoing commitment, that funding is not currently included within the May Revise.
- Caroline Menjivar
Legislator
We might need some clarification because our understanding is that people have been awarded and reclined the awards back.
- Susan Talamantes Eggman
Person
Are you saying that's not true?
- Caroline Menjivar
Legislator
You're saying that's not true?
- Joseph Donaldson
Person
No, I'm sorry. I'm trying to clarify that there's funding. There's funding that was obligated, that is proposed as a reduction. However, there's still funding within HCAI's budget related to Song Brown.
- Joseph Donaldson
Person
So, you have extra money in Song Brown. Let me just tell you what I need to see, because I'm not a finance person. What I need to see is the people that have been matched in the case of residencies, and normally they don't match them unless there's enough money in the pipeline to cover whatever the length of the residency program is.
- Richard Roth
Person
Three years for internal medicine or primary care physician, you know, whatever it is. Seven years for psychiatry, I don't remember. But there's a length of time attached to each of them, and they don't take people in unless there's money to cover them.
- Richard Roth
Person
So, if what you're saying is there's extra money in the pot, notwithstanding these cuts that are going to be able to cover the people that are matched.
- Elizabeth Landsberg
Person
I think our colleague at Department of Finance is referring to ongoing funding for Song Brown, which does exist. I was happy to cover all the remaining funds.
- Richard Roth
Person
But that's. Here's my. I mean. Then I'm really. I don't, I don't understand it.
- Richard Roth
Person
So, not that we need to belabor it tonight, but I think you can, somebody can tell me who's matched and if there are 50 of them, how much money is blocked against that, regardless of who has it, and then I guess they'll stop matching physicians if you cut the budget and don't award any more money.
- Elizabeth Landsberg
Person
So, there are $90 million in Song Brown funds for both primary care residency, nursing, and nurse practitioner PAs that HCAI has obligated that are proposed under this difficult budget to be cut. And in addition, there is ongoing funding for future years to maintain a base level of funding for Song Brown. And I've heard the Senator's concern, sir.
- Richard Roth
Person
That means people will be out of a slot.
- Unidentified Speaker
Person
Yes.
- Elizabeth Landsberg
Person
Correct, correct.
- Richard Roth
Person
Right?
- Susan Talamantes Eggman
Person
31 million's a red. Just a look over here.
- Richard Roth
Person
We'll have to work this out. I mean, you understand our concerns, Madam Director, and it's not you, I mean, somebody upstairs. So, we'll have to figure it out.
- Susan Talamantes Eggman
Person
I just don't think there's any circumstance where the state should go back on its word. You're talking about people breaking contracts and we're proposing to do the same thing.
- Caroline Menjivar
Legislator
Right. But I feel like we're getting two different responses here. Okay.
- Jason Constantouros
Person
LAO Jason Constantouros. Maybe just to help sort of clarify this a little bit more. So, the Song Brown program has ongoing and one-time funding. The Administration is proposing to rescind most of that one-time funding that was for Song Brown.
- Jason Constantouros
Person
They're also proposing to revert in the ongoing amount the amounts that were for prior year and current year, but not the budget year and ongoing. So, when you hear about many of the funds are obligated, it's because they were appropriated in previous budgets and they're proposing to revert those.
- Jason Constantouros
Person
The budget assumes, though, that beginning in 24-25 there would still be that ongoing amount for Song Brown. So that's what the Administration is trying to convey in that answer.
- Jason Constantouros
Person
So, the key issue really for the Legislature here is that sort of amounts that were in the current year and sort of previous years before that. And as we noted in our sort of previous hearing, we think it's reasonable for the Legislature to revisit limited-term spending. That's a key strategy we recommend the Legislature pursue.
- Jason Constantouros
Person
This does raise a more specific trade-off, as you've all noted, because some of these funds that were in previous years and in the current year were obligated, and according to additional information from the Department, that amount is about 125 million. And this solution in the budget year is about 600 million.
- Jason Constantouros
Person
So, it is a key part of the solution that's assumed at May Revision. So, this is something, you know, the Legislature could treat as a higher priority for finding alternatives. We've been working with the Department to identify alternatives, too, but it is a key part of the solution, too.
- Jason Constantouros
Person
So, it is one of those areas that could require a more one for one.
- Caroline Menjivar
Legislator
125 million of the programs that we're talking about is part of the.
- Jason Constantouros
Person
Yeah, of the, of the proposed reduction. According to the Department, 125 million has been obligated. So that's the, that's the amount that.
- Caroline Menjivar
Legislator
Oh, 125 has been obligated.
- Jason Constantouros
Person
That's how, that's my read of their, the information they provided over the weekend.
- Caroline Menjivar
Legislator
Where people already got award letter. Congratulations, you've been selected. Yes.
- Richard Roth
Person
Yes. You see my point. I mean, we're, our job in this Committee and in the other subcommittees that I've been on and, and the Big Budget Committee is to deal with the numbers. But what I want to make sure we deal with here are the people, and I understand cutting a program before somebody's in it.
- Richard Roth
Person
I get that. I understand cutting nursing slots before some nurse candidate is sitting in one. But I don't understand cutting a slot that somebody's in unless we have explored every other alternative. And you've heard, I don't think I'm wrong. We can get the experts in here.
- Richard Roth
Person
But I'm fairly certain that when a nurse will probably find another slot, but an MD physician who needs a residency program will probably not find another residency program in the United States of America.
- Richard Roth
Person
So, I think at some point we need to talk about the people, and you can help us understand the numbers because obviously, I gather the ongoing funding is not sufficient to supplant the money that we're going to, the one-time money that we're going to chop out of the budget. LAO?
- Jason Constantouros
Person
I think I'd have to think about that one a little bit. But generally, it's, my understanding is the proposed reduction here is greater than that ongoing amount in the budget year. And there's a bit of a timing issue when money is appropriated.
- Jason Constantouros
Person
There is other, as the Administration noted there is other funding for GME, but it is of a lesser amount than in previous years across Song Brown and also the UC program. So, there's ongoing funding still at play, but it's.
- Richard Roth
Person
Unless it's changed. UC uses that money inside its own medical centers, right? The $75 million?
- Elizabeth Landsberg
Person
No, it's broadly distributed. It's through an application process.
- Jason Constantouros
Person
It's a competitive grant program similar to Song Brown, but also includes emergency care. And that amount has been 40 million. But the May Revision.
- Richard Roth
Person
Just you understand. So, I know you understand. There are medical schools that graduate undergraduate physicians every single year. And when they graduate, they all pile. The Director knows because she runs this. They all pile into the pipeline.
- Richard Roth
Person
And if you have somebody who's already made it out of the pipeline into a match program, that person or those people are outliers. How do they get back in to compete with the folks that just came out of medical school? And my understanding is it is very, very difficult.
- Richard Roth
Person
So, I'm going to shut my lips right now because it's getting late and we can talk about this some other time, but we'll have to get together on this one.
- Caroline Menjivar
Legislator
125 million that have been obligated. How many souls is that? How many people?
- Elizabeth Landsberg
Person
We're happy to follow up with the exact number, Madam Chair.
- Caroline Menjivar
Legislator
Please do. And then one last question on the Song Brown Nursing. Is that for clinical spots? Because I know nurses and student nurses are having difficulty placing in hospitals for their clinical. Is that for that?
- Elizabeth Landsberg
Person
So, we have separate initiatives around the clinical placement. This is for the training programs.
- Caroline Menjivar
Legislator
Just wanted to confirm. Okay. Any additional comments, Jason?
- Jason Constantouros
Person
No, those are my comments.
- Elizabeth Landsberg
Person
So, the agenda also asks what programs would remain after May Revision reductions. Did you still want me to cover that, Madam Chair? Okay, so if the May Revision reductions were adopted, HCAI would still have 26.7 million remaining in one one-time General Fund.
- Elizabeth Landsberg
Person
The bulk of that 208 million is from CYBHI and will be used to Fund employer support, grants, contracts with CSU and community colleges to start the new program, scholarships, and apprenticeships for our certified wellness coaches. Most of these funds are currently available, and we intend to spend them in the budget year or shortly thereafter.
- Elizabeth Landsberg
Person
There is also funding for reproductive health for some of our pipeline programs, 15 million this year for community health workers, promotores, and tribal representatives, and some additional funds.
- Caroline Menjivar
Legislator
When will the wellness coaches start?
- Elizabeth Landsberg
Person
We do, in California, have, as of last Monday, 133 certified wellness coaches. So.
- Caroline Menjivar
Legislator
In our schools?
- Elizabeth Landsberg
Person
They. There's an. If they get an associate's degree in social work or psychology.
- Elizabeth Landsberg
Person
There are a few programs that they can get now and then do their clinical hours to become certified wellness coaches. And we have a couple thousand people in the pipeline, and then we're poised to grant employer support grants and scholarships.
- Caroline Menjivar
Legislator
Okay. And where can they work?
- Elizabeth Landsberg
Person
They can work in schools or community-based organizations.
- Caroline Menjivar
Legislator
Okay.
- Elizabeth Landsberg
Person
Yeah. Additionally, in addition to that 267 million in one-time funds, HCAI would maintain roughly 50 million per year in ongoing local assistance funds from budget year forward.
- Elizabeth Landsberg
Person
So, that includes the 31 or 33 million annually for Song Brown primary care residencies and then a number of programs where the existing workforce pays licensure fees, and that helps fund loan repayment and scholarship programs for a wide range of primary care and behavioral health professions.
- Elizabeth Landsberg
Person
So, those are the bulk of the funds that we would maintain under the May Revision.
- Caroline Menjivar
Legislator
Okay. Additional comment? Okay. Thank you so much for that.
- Elizabeth Landsberg
Person
Thank you.
- Caroline Menjivar
Legislator
We're going to move on to DHCS. We're not going to move on to DHCS. Okay. We're going to do the issue where it's both DHCS and DPH, CDPH. If you're following along in the agenda, we're on page 22, first issue. And DHCS. So, I brought this issue back.
- Caroline Menjivar
Legislator
You know, from last week, you heard some of my concerns. Just because this Committee, a couple months ago, we heard regarding the difficulty of collecting SOGI data from a Bill that came out in like 2020-2021, Senator Weiner's Bill.
- Caroline Menjivar
Legislator
And it took us such a long time to figure out, to find out that the data wasn't being collected. We had appropriated funds for that. We were then told that approximately seven to nine forms out of the 200 and something forms were the only ones collecting this data due to privacy issue
- Caroline Menjivar
Legislator
We now have AB 1163 that is very similar to what that Bill was looking to do, collecting all this data. I want to make sure that all these allocation of funds, because it's not just your two departments. I think two other departments are getting funding just for this Bill.
- Caroline Menjivar
Legislator
What I don't want is that we allocate the funding, you come to us next year or two years and say, we weren't able to collect this data because of privacy issues. So, that's just forming this conversation.
- Rita Nguyen
Person
Thank you, Madam Chairperson. Rita Nguyen from the California Department of Public Health. I'm the Assistant Health Officer. I'm happy to jump in to address your concerns head on. And thank you for that feedback from the last hearing. We really welcome this opportunity to engage with you further on those concerns.
- Rita Nguyen
Person
We have reached out to the LGBT Legislative Caucus to have more in-depth, regular conversations. So, one point of clarity I just want to really emphasize is that sometimes the phrasing of privacy concerns is used as a shorthand to really capture all the complexity related to collecting, analyzing, and displaying SOGI data.
- Rita Nguyen
Person
But to be very direct and clear, the challenges with sharing SOGI data, collecting and sharing, is primarily driven by the lack of data coming to us. So, to your point, we'll follow up with this in numbers as well. But of the forms that we did evaluate at our department, 65 of them were already collecting SOGI data.
- Rita Nguyen
Person
The vast majority of the reasons why we aren't able to get the form. So, about 50% of our forms are actually from third=party forms that we actually have no control over.
- Rita Nguyen
Person
If you add that with the federal forms, that's closer to 60% of our forms are actually either from the feds or from some other third-party entity that we don't have control over how they collect their SOGI data.
- Rita Nguyen
Person
And so, actually, per the statute, AB 959, the original Bill that you referenced, those are actually exempt for that reason, because we can't control it. And so, again, I'm happy to dive in further at the LGBT Caucus meetings. I recognize that today's hearing is focused on the budget proposal for 1163.
- Rita Nguyen
Person
Happy to discuss that there so that you may focus your time, but just wanted to clarify that it's not privacy. The state and local laws around privacy aren't particularly unique to SOGI, for the most part.
- Rita Nguyen
Person
And again, it's due to the limited data we can collect, and there's great risk of us then analyzing data on such a limited scale and making policy and program decisions on poor data. And we have found that to be the case.
- Caroline Menjivar
Legislator
I appreciate that, because I think we, for a long time, we were just being told privacy issues. Further explanation does help.
- Rita Nguyen
Person
I think. I think part of the problem is the shorthand to explain the complexity of it, but again, happy to explain that further.
- Caroline Menjivar
Legislator
So, how do some of those barriers, are those going to bleed into the implementation of this bill?
- Rita Nguyen
Person
So, the challenges with our inability to control forms that are not ours will continue to be a problem. What we've even seen when it comes to race and ethnicity data. So, there's a lot of existing rules and laws that mandate the reporting of race and ethnicity data, for example.
- Rita Nguyen
Person
But we still, in some cases, ranging from STDs to Hep C, are only really able to report race and ethnicity somewhere between 80% to 70% of the time. So, the short answer is yes. In the domains that we can't control, that will continue to be a problem in terms of the data that we do receive.
- Caroline Menjivar
Legislator
Okay. Are we adjusting? Two things. Are we adjusting both our expectations to meet those, to meet that framework? And two, are we adjusting also the request for these individuals, knowing that perhaps we're not going to be able to collect the data from every single entity, forum, and so forth?
- Rita Nguyen
Person
So, of the forums we have, I'm trying to, I don't have the exact numbers in front of me. There's a smaller subset that we do control. Actually, 21 of them. I do have this in front of me. 21 are forms that we can control.
- Rita Nguyen
Person
And so, it will be easier for us to pursue the systems changes, which is what this BCP is about, is fixing not just the forums, but the system.
- Rita Nguyen
Person
More ideally, we have seamless integrated data systems that can actually enable us to be agile and really adapt as we change the ways that we collect any number of data related to SOGI or related to other demographics like race and ethnicity and disaggregation.
- Rita Nguyen
Person
But yes, we are well positioned to at least change the things within our control and the systems that are within our control with this BCP.
- Caroline Menjivar
Legislator
Okay, did we need to do any system changes for the previous data collection?
- Romeo Amian
Person
Hi, Madam Chair. Romeo Amian, Assistant Deputy Director for the Center for Health Statistics and Informatics. Yes, we did. So, we did make those changes, and we are, we do have the analysis of these forms and are looking to make those changes with this Bill that's coming.
- Caroline Menjivar
Legislator
Okay. So, those data changes, those system changes we made still doesn't meet the needs to meet this Bill.
- Romeo Amian
Person
Some areas correct.
- Caroline Menjivar
Legislator
Got it. Okay. And our expectations are we can control 21 forms, at least from your Department. So, as we later on, come back and look at this data, we should have some, we should have a good, we should have good data, at least from 21 forms.
- Rita Nguyen
Person
The challenge.
- Caroline Menjivar
Legislator
Voluntary.
- Rita Nguyen
Person
Right. So, it's based off of self-identification, and then the training and the environment in which it's asked will then influence whether or not individuals are wanting to volunteer that information.
- Rita Nguyen
Person
And, you know, we're very thoughtful and purposeful about the way that we collect, analyze, and display data as not to leave people to make erroneous conclusions based on limited data.
- Rita Nguyen
Person
So, I will preface it with, we can't control how much data we will get to then be able to display and have policymakers make sound decisions off of that. But this is sort of the arc of progress for SOGI.
- Rita Nguyen
Person
Equity and justice is that we are slowly improving our systems to get to a place where we can collect it, and with time and with effort and education of healthcare providers and of community Members of how do we ask these questions in trauma informed ways will then get us to a place where we will have better data. Is always the hope that we have to start somewhere.
- Caroline Menjivar
Legislator
Okay. And then. I see. I'm just reading your PCP further. Okay. Okay.
- Lindy Harrington
Person
Hi, Lindy Harrington, Assistant State Medicaid Director. Similar to the Department of Public Health, our concern is not around privacy, but we do continue to have concerns around the federal permissibility of this addition, as federal rules require that the application be streamlined and only include questions necessary to determine program eligibility.
- Lindy Harrington
Person
Today, DHCs already collects a limited set of optional gender identity and sexual orientation responses approved previously by the Centers for Medicare and Medicaid Services on the Medi Cal application.
- Lindy Harrington
Person
The enactment of this Bill will add intersexuality to the Medi Cal application, which would require us to go back to the Federal Government for review and approval to ensure compliance to federal Medicaid law.
- Lindy Harrington
Person
Adding those additional gender identity categories beyond the minimum approved by CMS could lead to an application that is considered no longer streamlined, which would then jeopardize federal funding if we were to add those to our application. So we will need to.
- Lindy Harrington
Person
We will need to seek federal technical assistance as it relates to collecting intersexuality data, storing and exchanging that health care data, because the current categories do not align with gender identity subcategories in the United States. Core data for interoperability code set, which is the primary federal standard for storing and exchanging healthcare data.
- Lindy Harrington
Person
So we do have some concerns that would not be eliminated with this funding, but that funding is what would be required in order to add them to the application.
- Caroline Menjivar
Legislator
Okay. Thank you. I appreciate that. Detailed insight into this. And we want. We don't have a BCP yet for this, is that correct?
- Lindy Harrington
Person
I believe it is coming as part of a group of enacted legislation.
- Tyler Ulrey
Person
Ty Ulrey, Department of Finance. Yeah. That BCP is pending and should be posted shortly. Okay.
- Caroline Menjivar
Legislator
The funding. Do you need that to...
- Lindy Harrington
Person
So the funding is required to support the. To Fund the systems costs through Calsaas benefits, Cal and calhears to add and collect that data as part of the Medi Cal application and an IT contracting resource within the Department to support that work. Okay.
- Caroline Menjivar
Legislator
And then we. We don't know when that work will start because we still have to go to the Federal Government for approval and technical assistance. Correct. Got it. Okay. And that might take a while. It could. It could. Okay. Any further questions? Okay. Okay. LAO, any will, any additional comment on this?
- Will Owens
Person
Will Owens with the LAO. Nothing further to add but available to answer any questions.
- Caroline Menjivar
Legislator
Okay. Thank you so much for those responses.
- Caroline Menjivar
Legislator
Yes. DHCS. All right, first issue, MCO before I think you mentioned, or the gentleman that left. Are we getting all the BCPs for DHCS all at once? Because I don't think we have a single one uploaded yet. We're gonna cram it all in before we vote.
- Laura Ayala
Person
Yeah, we'll go read it right after this hearing. But they're coming. We're working on them. Okay. They're coming shortly.
- Caroline Menjivar
Legislator
We're voting next week. Oh, boy. Okay. MCO tax. We talked about this last week. The theme here, I'm pulling things back to have further conversations on some. The stickier issues that are proposed in the May revise. Again, going back. You know, I've been. Obviously, you've seen.
- Caroline Menjivar
Legislator
You've seen me up here talk about the MCO tax for a year and a half now, from the excitement to the frustration, to the excitement, the frustration to now confusion, honestly. Confusion because of all the things we talked about in the realm of MCO tax. And maybe I should ask my counterpart on the Assembly.
- Caroline Menjivar
Legislator
Maybe that's where they talked about the children's hospital directed payment. This just never came up. It just wasn't part of the conversation. I don't know. No, I never heard a single thing from public comment that this was the thing that we needed to dive into. So that's where I'm at, confusion as to where we got to this.
- Caroline Menjivar
Legislator
You know, Director, you know, I was like, 200 million for all these things. This is what I. This is what I'm, I want. Was a big fan of hospitals getting increases, providers getting increases, planned parenthood, our Reproductive Clinics getting increases. Like, all of those were phenomenal investments. And then including the ones that I wanted from new friends.
- Caroline Menjivar
Legislator
Right. So this is where we're at where. If you could just, again, walk us through where we got to that point, why everything was just completely dismantled. Probably going to hear it's because we need to balance the budget, but let's get into it again.
- Unidentified Speaker
Person
Sure. So as part of the May revision, the budget proposes to preserve the targeted rate increases that went into effect January 1, 2024. That is, for primary care, maternity care, and non specialty mental health, to 87.5% of Medicare. And then it preserves one time investments of the $200 million for the distressed hospital loan.
- Unidentified Speaker
Person
And the small rural hospital Fund as well, proposes to eliminate the 2025 rate increases.
- Unidentified Speaker
Person
We went through kind of the discussion of all of those categories and then proposes to essentially use those dollars and the remaining reserves from the Medi Cal provider payment, provide a Reserve Fund to support the General Fund as part of the 2025 term sheet or the 2025 rate increases, there were investments for our hospitals.
- Unidentified Speaker
Person
Our children hospitals were part of the outpatient and community procedures and also the emergency Department buckets as well. But as part of May revision, proposing 115 million directed payment funded by the managed care tax for children's hospitals.
- Unidentified Speaker
Person
Recognizing that they provide highly specialized, high acuity care to the most sickest and vulnerable children in the state, and recognizing kind of the infrastructure needed to support that high acuity is exceptional. It's above kind of the normal cost of the way our rates are funded. So proposing to do a supplemental payment for our children's hospitals.
- Unidentified Speaker
Person
It's a directed payment through our managed care plans for these hospitals.
- Caroline Menjivar
Legislator
Which providers will get the increases?
- Caroline Menjivar
Legislator
No. Is it all?
- Unidentified Speaker
Person
The children's hospitals.
- Unidentified Speaker
Person
Yes, and it would be based on utilization. So that's how the directed payment program would work.
- Caroline Menjivar
Legislator
Okay, this is first time I'm hearing this phrase. Can you just walk me through, like, what? The directed payment. What's that?
- Unidentified Speaker
Person
Sure. So it's kind of a term of art. Under federal regulation, we are only able to direct managed care plans, pay payments under a set of specific exemptions, and one of those is to do a directed payment to a set of providers with certain criteria.
- Unidentified Speaker
Person
And so we just speak about those as directed payments because that's kind of how they're listed in the federal reg. So we have a set of those. So if you think about.
- Unidentified Speaker
Person
If you're familiar with, like, the enhanced payment program for designated public hospitals or the quality and improvement program or incentive program for public hospitals, the private hospital directed payment program under those are all various directed payments that we do, which are supplemental payments to hospitals under the managed care program.
- Unidentified Speaker
Person
So this would be creating one for the children's hospitals.
- Caroline Menjivar
Legislator
Okay, Senator Roth
- Richard Roth
Person
I should know this, but I don't. If I knew it, I don't remember it. Do our children's hospitals employ physicians or are those, is it like a normal hospital where their practice groups in contract.
- Unidentified Speaker
Person
I believe they do not. It's like a normal hospital. They're like normal.
- Richard Roth
Person
And so is the money, this money, the. I guess there's 115 million in federal funds, but the other 115 million, what's it go to do at the hospital? Is it paying the hospital for inpatient services, or is it going to pay providers, the specialty pediatricians, that are providing services in the hospitals?
- Unidentified Speaker
Person
These dollars go to support the hospital, the facility itself. So it's the infrastructure, the building, the tools, the technology, equipment. Exactly.
- Richard Roth
Person
Not the payment to the specialty. Exactly.
- Caroline Menjivar
Legislator
And in the conversations where we talked about the MCO to increase rates, get as close as possible to Medicare and so forth, was this the area that most needed jolt up in rate increases and reimbursement rate increases?
- Unidentified Speaker
Person
I would say our community outpatient rates are pretty Low with regard to the outpatient procedures are pretty Low compared to where we were at with Medicare. In terms of the buckets of dollars, it was one of the lowest areas, children's hospital or community outpatient. So that's just a hospital line item that was in the previous term sheet.
- Susan Talamantes Eggman
Person
Okay. So why then, I guess to focus on this in specific.
- Unidentified Speaker
Person
So just again, recognizing that kind of their exceptional kind of, you know, outlier costs for caring for some of the sickest and most vulnerable, to be able to maintain that network and that possibility in the state, for hospitals to maintain the ability to serve children with really high needs, high acuity.
- Susan Talamantes Eggman
Person
We didn't hear a lot of it throughout this time.
- Richard Roth
Person
But the high cost associated, that's associated with a children's hospital is the cost associated with the capital facility itself and not the cost of somebody paying pediatric specialty physicians and somebody paying the highly skilled pediatric nursing staff and all the other allied health professions that are associated with the complicated needs of this particular population.
- Richard Roth
Person
So it's the capital facility where we're putting our money.
- Unidentified Speaker
Person
I would say it's probably a combination of both, but this proposal is related to the facility cost and infrastructure.
- Caroline Menjivar
Legislator
How many provider codes are we increasing with this proposed?
- Unidentified Speaker
Person
I don't have that. We would be looking to establish, again, some additional details to work out with our various public children's hospital partners, but it would be more specific to like per visit increases that we would be providing. So it wouldn't necessarily, I don't have the number of specific codes that would be under that utilization.
- Caroline Menjivar
Legislator
Okay. And I can't remember if I asked this question. In trying to see how, I know this was part of the original sheet. They were going to be, they were embedded because they had the ERs and so forth, how we're looking to balance supporting rural hospitals and helping bring access to areas that don't have access.
- Caroline Menjivar
Legislator
Is this funding going to be allocated in a way that is depending on where each hospital is, like geographically?
- Unidentified Speaker
Person
So I think those are some of the details that we will continue to work with the children's hospitals to finalize that distribution methodology, but it would go to all of the hospitals based on utilization and other factors could be taken in.
- Caroline Menjivar
Legislator
Are we, I mean, we're triaging everything, right. And we're always hearing another, what are they called maternity wards? Yeah. Right. Maternity wards. Labor and delivery? Yeah. Labor and delivery continue to close. Another one. Another one closing. Another one closing. And we're seeing hospitals fall under more and more and more.
- Caroline Menjivar
Legislator
You know, we're opening our doors to so many as we should to so many people coming from other states for reproductive care. And here in California, where the need is going to be greater and greater, you just heard that the HCIS proposal, department's, Department finance proposing cutting slots for residents and so forth.
- Caroline Menjivar
Legislator
If we keep adding all of it up, we're going to be deeper and deeper in the hole. This is so specific to one thing that I'm having trouble understanding how this is really going to meet the equity. This is me saying, I mean, I'm always here talking about defending our children and kids. Right.
- Caroline Menjivar
Legislator
I'm always at the front line of that. But in this specific, I don't think we're meeting the part of the goal of the MCO tax on meeting the equity or reaching equity.
- Caroline Menjivar
Legislator
I'm really interested in having kids in rural areas, having places to go, pregnant people in rural areas, having places to go, people from everywhere having reproductive justice and increasing that.
- Caroline Menjivar
Legislator
I don't know if I've gotten to a point where this makes sense to me, where this area, for what we're allocating of the MCO tax after it was proposed to be completely dismantled, makes sense.
- Unidentified Speaker
Person
I would also point to one of the other activities that we have proposed as part of May revision.
- Unidentified Speaker
Person
Yeah, remind me of that one is an increase to our public hospitals, including our district and municipal public hospitals, which would allow increases to programs where they provide an intergovernmental transfer, so they provide the non federal share, which we then match with federal dollars and increase payments under those other directed payments.
- Unidentified Speaker
Person
I was talking about increase payments to those hospitals to help with bringing in additional revenue and funding to those hospitals.
- Unidentified Speaker
Person
Public hospitals were here last week commenting that, you know, they were taken out of the MCO tax, so they are getting some support.
- Unidentified Speaker
Person
So it's not as. It's not through the MCO tax, but it's utilizing financing mechanisms that we have available for those public hospitals where they have the ability to provide funding to us that we can then match with federal money to bring in additional revenue to the system. So basically bringing in additional federal revenue to the system.
- Unidentified Speaker
Person
So we've been increasing those programs above the baseline that we have in order to bring in additional revenue that does not require the MCO tax.
- Richard Roth
Person
Senator Roth
- Richard Roth
Person
By the way, is this ongoing funding for the children's hospital?
- Unidentified Speaker
Person
Yes. It is. It is supposed to be ongoing.
- Richard Roth
Person
You know, we have a shortage of a year. We have a shortage of children's hospital beds. I mean, we don't have any pediatric beds for the most part, in any of our acute care General hospital hospitals for financial reasons, decisions that those hospitals and hospital administrators make.
- Richard Roth
Person
So it is important to maintain our children's hospitals. And without knowing where the money is going to go on an annual basis, I'm just wondering what I also know, having just had the conversation about medical residencies, is there is a dire shortage of specialty pediatricians of all kinds up and down the state.
- Richard Roth
Person
And I'm just wondering in some coordinated way with the children's hospital folks if they could help you, help us figure out what's the best mix of the use of this money, because it's one thing to keep a facility and have it to be a great facility, but not have enough specialty pediatricians to staff it.
- Richard Roth
Person
So that's just my comment on it. Sort of hard for me to tell.
- Susan Talamantes Eggman
Person
Senator Eggman. Yeah. Just along the same lines. Like, I don't know that I'm even sure. How many, how many children's hospitals are there in California? I believe there are 10. And the money's going to be equally distributed between all of them?
- Unidentified Speaker
Person
Well, it'll be based on utilization as well. Medi-Cal utilization.
- Susan Talamantes Eggman
Person
It feels like this has been dropped on us out of the blue. It hasn't been part of our dialogues and conversation. I just, I mean, I love kids.
- Susan Talamantes Eggman
Person
I have a kid, but I don't know how it gets elevated to 100 million ongoing every year out of this, when we're, I think you were here for part of this morning. When the cuts are ugly, affects people's lives, childcare, I mean, real stuff.
- Laura Ayala
Person
So I don't like it. Laura Ayala, Department of Finance. I just wanted to flag that the MC, the May revision does maintain the 300 million for General hospitals for a district hospital loan program. Yeah. In the current year. So that has almost all been spent and then going back to also providers, General medical providers.
- Laura Ayala
Person
We, yes, the investment for the children's hospital, 115 million MCO tax, but we still have the Prop 56 supplemental payments to physicians and other providers, which is a billion in current year and 800 million.
- Caroline Menjivar
Legislator
We're offsetting some of those funds with MCO tax, right? Yes, because we're back funding. We're back and we're offsetting the lack of fund.
- Laura Ayala
Person
Yeah. Yeah. We're maintaining Prop 56 supplemental payments.
- Caroline Menjivar
Legislator
So you can imagine how that's like a slap in the face for at least physicians, right? The Prop 56, dollars is there to increase rates. And when it dips, instead of getting more from the MCO tax, we're going to pull it into offsetting the lack of funds in Prop 56 just seems like a stop stop.
- Richard Roth
Person
One of the things that I remember noting when I spoke to, I don't know, there were 150 or 200 pediatricians the other day up here was that, as I recall now, the specialty pediatrician reimbursement rates and resulting income is less than what the pediatrician in normal non specialty pediatrician makes in practice. I don't know.
- Richard Roth
Person
You all would know the rates better than I. But if that's the case, then maybe that requires a little attention, too. We clearly don't have enough of them.
- Unidentified Speaker
Person
We find specialists to actually be paid higher than General. And in the 87.5% increase that we are maintaining, while it is focused on primary care, especially mental health and maternity care, those codes that can be also billed by specialists, the specialists are getting that 87.5% free for those codes as well.
- Unidentified Speaker
Person
It would just be the additional specialty specific codes. So specialists are able to receive for things like their E and M visits and those. So when they're billing those codes, they will be getting the 87.5%. It's not only primary care providers.
- Unidentified Speaker
Person
So for that list of codes that went live on January 1, 2024 specialty providers that also Bill those codes are receiving that increase. So I do just want to make sure folks are tracking that as well.
- Richard Roth
Person
And perhaps I was wrong in my reading on the specialty pediatricians, but the 115 million or whatever it is, 230 million, is that capable of being utilized to backfill hospitals for reimbursement rate deficiencies for inpatient care.
- Unidentified Speaker
Person
So we will be looking to do, it will likely be a directed payment that will be across their inpatient and outpatient services.
- Richard Roth
Person
Oh, so you'll tell them how to use the money?
- Unidentified Speaker
Person
Correct. We won't tell them how to use the money. That is how we will set the reimbursement structure will be across for both inpatient and outpatient. The 115 will go to both inpatient and outpatient.
- Caroline Menjivar
Legislator
It goes directly?
- Unidentified Speaker
Person
It will go through the managed care plan to the hospitals. But we have the ability to direct the managed care plans, how they pay the hospitals utilizing those funds.
- Caroline Menjivar
Legislator
And that's one of the specialties under it being a direct payment, right?
- Unidentified Speaker
Person
Correct.
- Caroline Menjivar
Legislator
Because you're able to directly say that. So, Director, you know, bottom line is, like, this was like a curveball for us. This just came out of left field.
- Caroline Menjivar
Legislator
And I literally was going to say what Senator Eggman said in the past year and a half, even more so in the past 6, 5 months, five months, we've had various conversations, great panels on this. And out of all that, this was a takeaway from the Administration.
- Caroline Menjivar
Legislator
I think that's where we feel like we put so much energy into discussing bringing the needs of what we thought was a really robust coalition, both on those who were already included versus who wanted, just feel like nothing came across in appearance and a whole other thing was proposed to us.
- Caroline Menjivar
Legislator
So that's the sentiment I think we're feeling here. LAO, any additional, Jason, any additional comments?
- Jason Constantouros
Person
Can you hear me? Great. Jason Constantouros, LAO. So just as a reminder, you have two solutions in this issue. You have their increase in the tax and then the pulling back of the previous package for the tax increase. Our message is similar to what you've heard us say in the past. In concept, it's reasonable.
- Jason Constantouros
Person
There is still some information that the Legislature needs, including the proposed trailer Bill, but also what the tax rates would be, and additional analysis from the Administration demonstrating that increase in tax would meet federal rules. The Administration indicates that it is intending to get that part of it passed in time to submit to the Federal Government.
- Jason Constantouros
Person
So it could start in April. So that's all the more reason why this information would be good to have soon, so that the Legislature can fully assess that part of it.
- Jason Constantouros
Person
In terms of the second part of the solution, which is pulling back the MCO tax package, generally, we think it's a reasonable place to look at, you know, given that the package that was enacted in last year's budget, at the time that was enacted, it was not, you know, the magnitude of the budget problem was not fully known to the Legislature at the time.
- Jason Constantouros
Person
That said, we also understand that the Legislature has an interest in this area. You know, generally, you know, Medi-Cal beneficiaries do face greater barriers facing access and quality in healthcare relative to the General population, and rate increases generally are associated with improvements to access to care.
- Jason Constantouros
Person
So it's understandable that the Legislature would still want to pursue certain augmentations here. If that is the case, we recommend keeping a couple of principles in mind.
- Jason Constantouros
Person
First, we recommend focusing on augmentations that are relatively simple, that expand existing programs, or where the effects are relatively known, for example, increasing rates as a percent of Medicare or applying an inflationary adjustment.
- Jason Constantouros
Person
We caution against trying to do notably new programs or sort of major new things where the, and that's because when that happens, typically the effects of that are less certain. And in an environment of constrained budgeting, that's sort of a key issue for the Legislature.
- Jason Constantouros
Person
We also think that's a good way to think about the proposed directed payment for children's hospitals. This is a new proposal. We're still getting more information about it. So this is an area the Legislature want to seriously consider as it's sort of weighing its final package.
- Jason Constantouros
Person
Also want to, just as a technical point, there was some question about what is a directed payment. So a directed payment is just a payment that's directed through the managed care system. Normally, when the state increases rates, it increases rates in the fee for service system. But in the managed care system, things work a little differently.
- Jason Constantouros
Person
And so typically the way a directed payment would work. My understanding how this might work in this case is it's like a supplemental payment. It would be an additional payment beyond what managed care plans normally pay in their sort of base rates.
- Jason Constantouros
Person
Other supplemental payment programs like Prop 56, that also has a directed payment component so that there are supplemental payments in the managed care system, too. And then finally, we also just want to keep in mind that, you know, that we recommend the Legislature keep the budget problem in mind.
- Jason Constantouros
Person
This is a major part of the governor's proposed budget solution. So this would be an area where if the Legislature considers pursuing more augmentations than what's proposed, it would necessitate a dollar for dollar reduction elsewhere in the budget. Thank you.
- Caroline Menjivar
Legislator
Thank you so much. Thank you. We're actually going to take MCO public comment now.
- Stuart Thompson
Person
Madam Chair and Members, Stuart Thompson, on behalf of the California Medical Association, while we certainly understand this is a very tough budget situation, we are very disappointed. The May revision to the MCO proposal, I know it's late, so I'm just going to touch upon a few highlights, a few points brought up during this hearing.
- Stuart Thompson
Person
Just say the average residency slot costs about 150,000. That's a kind of rough back of the kind of napkin math, but depends on the program and the region. And so if you're looking at just Prop 56 reductions, which is 13.5 million, that is the not being proposed to be backfilled by the MCO.
- Stuart Thompson
Person
Just the rates are proposed to be backfill. On the Prop. 56 side, that's about 90 slots. The 75 million that the Legislature approved last year represents about 500 new slots. So that gives you kind of an idea of the numbers of as far as kind of resident physicians that we're looking at.
- Stuart Thompson
Person
I just want to highlight that when the agreement that was reached last year, the budget was definitely kept in mind. 60% of the MCO revenue in that proposal went to the General Fund. And actually, on a year over year increase, was actually the most that the was ever devoted to General Fund.
- Stuart Thompson
Person
So we ask that we restore the cuts. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Mark Farouk
Person
If you could keep it to a minute, please, Madam Chair and Committee Members, Mark Farouk, on behalf of the California Hospital Association, echoing many of the comments of my colleague from CMA who spoke before me just quickly.
- Mark Farouk
Person
You all know in the hearings that you've had how foundational the targeted rate increases are to maintain access and improve equity in the medi Cal space. We would respectfully ask that you reject the administration's proposal related to the MCO. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Vanessa Gehina
Person
Thank you very much. Vanessa Gehina, on behalf of the California Academy of Family Physicians, would concur our remarks with my colleague from the California Medical Association, and that family medicine is the best way to get to primary care. And by going back on these rate promises, we're going to have some problems going into the future. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Molly Robson
Person
Good evening. Molly Robson, with Planned Parenthood affiliates of California. At Planned Parenthood health centers in California, over 85% of our patients are Medi-Cal patients. And so the MCO tax and the investments in the Medi-Cal system were a really big deal for Planned Parenthood and for improving healthcare delivery across the system.
- Molly Robson
Person
So we would respectfully ask that you reject the May revision proposals and reinstate the funds for the MCO as originally agreed to.
- Darby Kernan
Person
Thank you, Madam Chair. Darby Kernan. On behalf of the local health plans, we are very concerned with the MCO proposal. Using all the funds for General Fund backfill, the loss of this much needed funding for provider rates that would improve both the quality and access to Medi-Cal program will be profound.
- Darby Kernan
Person
We ask you to reject this proposal. Thank you. Thank you.
- Connie Delgado
Person
Good evening, Madam Chair and Members. Connie Delgado, on behalf of the district hospital leadership forum, these are the 33 district and municipal hospitals in the state offer care in some of the most rural and remote locations in California, serving the underserved populations of the state.
- Connie Delgado
Person
Deeply disappointed to see the sweep of the MCO funds at a time where hospital individuals would like to provide more services to Medi Cal beneficiaries and see this as a very difficult decision. We know it's a tough budget year. We respectfully ask that you reject this proposal. Thank you.
- Timothy Madden
Person
Thank you, Madam Chair Members. Tim Madden, representing the California chapter of the American College of Emergency Physicians, we respectfully request you reject the MCO proposal, emergency physicians emergency departments will have a disproportionate impact as a result of not only this cut, but many of the other cuts that you've been discussing.
- Timothy Madden
Person
As a result of those people will end up in the emergency Department. And once again, the emergency Department treats all people coming in, not just Medi-Cal Enrollees.
- Timothy Madden
Person
So we would ask to the extent, if there's any compromise, you keep that in mind in terms of buttressing up the emergency Department to ensure they can handle the flow of people that will come. Thank you.
- Caroline Menjivar
Legislator
Thank you. Okay. Moving on to issue two on this one, I know what I'd like to learn more about is the utilization of this. Yeah, we can start there.
- Unidentified Speaker
Person
The Administration proposes to eliminate the optional adult acupuncture benefit in Medi-Cal effective January 1, 2025 with this estimated reduced General Fund cost of 5.4 million in the budget year and 13.1 million ongoing in 2023, approximately 66,000 Members had approximately 416,000 visits. That resulted in about 650 claims. So multiple visits can be many.
- Unidentified Speaker
Person
Multiple claims can occur during one visit. So that was the utilization in 2023.
- Caroline Menjivar
Legislator
So we took out chiro a couple years ago and we're taking out acupuncture, and we want everyone to be on drugs because this is very preventative in nature. I mean, I've used acupuncture and chrio for my back issues for years. One, because they say I'm too young for surgery, but two, so I can stay out of surgery.
- Caroline Menjivar
Legislator
Right. So again, going back to the same theme of, you know, we're cutting so many preventative things that we might see increased and other things. Right. Because they'll start going more, longer stays X,Y, Z. But one of my main concerns here is that Covered California has this as a benefit. Right. Like this is.
- Unidentified Speaker
Person
It is part of their essential health benefit.
- Caroline Menjivar
Legislator
So we're cutting it just from the most poor. So Medi-Cal recipients won't have acupuncture, but those, because it's part of our benchmark. Right. Upper California commercial pay will have acupuncture. So it's just another example of, like, we're really going after, like, the poorest of the poor.
- Caroline Menjivar
Legislator
So outside of you telling me because it's a balance or budget, I'm wondering if there's another reason why we're cutting acupuncture. Is it? Yes.
- Paula Tang
Person
Paula Fonacier-Tang with the Department of Finance. So as you have stated, the overall goal was to maintain certain core programs and benefits, such as Medi-Cal eligibility and benefits. I can't speak to the specifics of the deliberative process as to why this benefit was chosen over others. But again, this represents the administration's recommendations.
- Paula Tang
Person
These are proposals that reflect a goal of preserving those core benefits in the elimination of this benefit is just a proposal to help solve for the General Fund shortfall
- Caroline Menjivar
Legislator
With chiro it still hasn't gone back. I don't know if this is cut, if we will ever bring this back as a benefit to Medi-Cal. Don't seem to have a good trend on bringing this back. I'm trying to see all the other services here.
- Unidentified Speaker
Person
Yes. So this was one of the benefits that was cut in 2009 as part of and then was brought back. Okay, so it was brought back. It was brought up back in 2016. Acupuncture. It is an optional benefit under Medicaid rules. And so that again, looking to preserve those core benefits,
- Caroline Menjivar
Legislator
I wouldn't want Sophie's choice over here. What do you cut? I brought this back just because this was one of the more harder ones on the May revise, just to say we're still tracking this one.
- Caroline Menjivar
Legislator
This is still a very hard one for us to accept, again, just because it's preventative in nature and it really just helps alleviate before it gets worse. Right. Any other question on this? Jason, do you have anything to add on this? Okay, we're going to move on to issue three. It's late. It is late.
- Unidentified Speaker
Person
The Administration proposes to eliminate the Indian health program reduced General Fund cost of 23 million annually. The Indian health program grant recipients include 27 Indian healthcare providers, 20 tribal and southern, seven urban Indian organizations. The funds also support four traditional Indian health grant recipients located throughout the state.
- Unidentified Speaker
Person
To date, grant recipients have used the awards to support clinic infrastructure and improve access to care through hiring new primary care providers.
- Unidentified Speaker
Person
Right sizing providers salaries to competitive levels, supporting recruitment and retention efforts, hiring consultants to assist with finding candidates for hard to fellow primary care provider positions, training for existing providers and staff to improve quality care and increasing access. Traditional healing services.
- Caroline Menjivar
Legislator
This one's way harder than the previous one. This one's a really, really hard one. There's about like 20. It's a long list of things that are keeping me up during this budget process, and this one's a really rough one. I just feel like, you know, we're talking about cutting things like IHSS for undocumented.
- Caroline Menjivar
Legislator
You know, we're cutting all of these services for Indian health program where we had cut it years ago. Right. We brought it back for just a couple of years saying. And people probably were really excited and now we're cutting it again. These are like really the most vulnerable populations.
- Caroline Menjivar
Legislator
We know the data around our tribal families and siblings out there. You know, we're always looking to close the gap, and this is going to put us even further, further, further back. What if any Director, like what other programs can supplement, can address, can meet some of these needs that exist? Is there anything maybe not at the same level.
- Unidentified Speaker
Person
In terms of an alternative funding source for these types of services? I can't think of anything that we have underway today. Just do note that reducing disparities for this population is kind of part of our comprehensive quality strategy. So we are very carefully watching the data.
- Unidentified Speaker
Person
I would also say we have just January went live with our enhanced care management for birthing equity and kind of really a focus on this population. And so trying to think of other ways in the global Medi-cal system to support really addressing the disparities of health outcomes.
- Caroline Menjivar
Legislator
Can we meet that by cutting this? Will we fall short of that, of that goal?
- Unidentified Speaker
Person
I will say this is definitely helpful in addressing the unique needs of these communities and really the additional support to achieve better health outcomes.
- Caroline Menjivar
Legislator
Hmm. Yeah. No, I mean, big sigh. Because just, I mean, these are things that are just so chronic and generational. If we don't help one generation, it gets transferred over to the next and we're in this never ending vicious cycle of never stopping it in one generation because it's not ongoing. It's not. Yeah. It's just not consistent.
- Caroline Menjivar
Legislator
And the overall theme here is that whenever we have a budget problem, we go after our most vulnerable and then we pay in the out years. It's just a really horrible message we send to Californians- that you will always be on the chopping block. If you are considered most vulnerable, you're always first to go. Nothing else.
- Caroline Menjivar
Legislator
Would you like to add anything Will?
- Will Owens
Person
Nothing further to add. Available for questions.
- Caroline Menjivar
Legislator
Emotionally, physically tired.
- Susan Talamantes Eggman
Person
You wonder how the elimination of a whole program rises right to the like, oh, here's 23 million. And I know it's tough, I know we're looking everywhere, but it just seems like the whole elimination is severe. When other years we talk about 23 million as budget dust. Right.
- Susan Talamantes Eggman
Person
But for this program, it's the whole, it's the program, is it?
- Caroline Menjivar
Legislator
Because for the past couple years, California has really, really dove into human services, health services and said we're going to really invest. That's why there's all these cuts, because all the money for the past couple years were invested in this area. Is that...
- Laura Ayala
Person
Laura Ayala Department of Finance? I would say that a good way to frame it, the Medi-Cal budget is the largest General Fund budget outside of Prop 98. There were significant, unprecedented investments when we had funding, and now we're facing, obviously the Administration was previously committed to making these investments. We made a lot.
- Laura Ayala
Person
And unfortunately, now we're having to make these really tough decisions and searching under the couch cushions. And it is a large budget and has a lot of one-time funding and discretionary funding.
- Susan Talamantes Eggman
Person
To that point Ms. Ayala, I would say that we work to restore the cuts that we had made previously in these last few years with some augmentation. And now we're going to go right back to where we found ourselves.
- Laura Ayala
Person
And the Administration remains committed to, you know, these services and these investments and to helping with access and coverage. But yeah, it's not a position we want to be in.
- Caroline Menjivar
Legislator
I think it's hard to be committed to something and letting it go. I think anyone who encountered a breakup doesn't hear like, I'm still committed to you, but I'm breaking up with you. That's what I'm taking from this. We can't be committed to the programs that we're cutting because we're letting them go. Okay, issue four.
- Unidentified Speaker
Person
The Administration proposes to reduce a $2 million augmentation that was made in the 2021 Budget Act related to free and charitable clinics. This supports free clinics that are, there are about 33 in the state. And these dollars are allocated to the Association, who then allocates these dollars to the clinics.
- Caroline Menjivar
Legislator
To what Association?
- Unidentified Speaker
Person
The California Association of Free and Charitable Clinics.
- Caroline Menjivar
Legislator
Do we have any reports on... we don't have any reports. We don't know how this fund is being utilized, if it's successful?
- Unidentified Speaker
Person
No. As part of the '21 Budget Act, it was a legislative proposal to just award the dollars to the Association, who then distributed the dollars to the clinics.
- Caroline Menjivar
Legislator
We should definitely collect data on every single dollar we sent out. But I can only speak to one personal experience. Well, personal example, because of my district, and I've been. I visited them, and these two physicians volunteered, put on a free clinic, and they're like, we're swamped. We are swamped.
- Caroline Menjivar
Legislator
Every single time we're open, there's endless amount of people that come in. I know where each and each couple years, we inch towards, you know, healthcare for all in variety of ways, but there's still a lot of people that don't have it right. $2 million, Department of Finance. $2 million. That's, I think this is the smallest one.
- Laura Ayala
Person
Laura Ayala Department of Finance while I can't give you details about the proposals in other areas, I'll tell you that this is not the smallest.
- Caroline Menjivar
Legislator
Oh, boy.
- Laura Ayala
Person
It's a great problem.
- Caroline Menjivar
Legislator
So that's why, you know, with the BCPs, I'm getting on some extra staffing and so forth, it's gonna be really hard for me to approve those when, like, these are, these cuts are happening.
- Caroline Menjivar
Legislator
Because if we're trying to be, like, slim everything, right, try to protect as much, and I'm hearing, okay, that not everyone's gonna get the same amount as they're used to. Everyone's gonna have to trim down. But I can't trim, but then ask for more in other areas. That's where it's hard.
- Caroline Menjivar
Legislator
It doesn't seem like everyone's having an equal trim. Like, if we really want to do an equal trim, then I can't see proposals for more staff. That's the part. I can't. If some staff is more than this, like, you know, in the 200, 200 million for this and so forth, some are in the thousands.
- Caroline Menjivar
Legislator
But that's the part. Bring these issues back, just to know that these are the ones that are on the target list for most difficulty insight into what we're looking at. And just to say it's going to be really hard to vote for BCPs that are asking for more funding hen we're cutting. Any additional comment. LAO? Great.
- Caroline Menjivar
Legislator
Issue number five.
- Unidentified Speaker
Person
The Department created the naloxone distribution project in 2018 to combat opioid overdose-related deaths in California through the provision of free naloxone to eligible California entities. To date, NDP has distributed more than 4 million naloxone kits and has received more than 268,000 reported overdose reversals. We've spent approximately 206 million to purchase naloxone for distribution through this program.
- Unidentified Speaker
Person
For fiscal year 24-25 we project about 54 million utilizing opioid settlement dollars.
- Unidentified Speaker
Person
Based on kind of the May revision proposal of a reduction of 35 million in General Fund, an augmentation of 8 million opioid settlement funds, and some current year expenditure authority, we feel like we will be fully funded to support the program in the budget year.
- Caroline Menjivar
Legislator
Do we know how much is in the fund? We should know.
- Nate Williams
Person
Which are you looking for the current year ending balance or are you looking for the budget year?
- Caroline Menjivar
Legislator
Budget year?
- Caroline Menjivar
Legislator
Yeah.
- Nate Williams
Person
Okay.
- Nate Williams
Person
Yeah. Typically, what we do with the OSF. Sorry. Nate Williams, Department of Finance. We are, we essentially try and spend about the maximum that we can. So typically we don't leave much of a reserve balance in the OSF. I will say that I think we have approximately $2 million that would be not accounted for in the. In the OSF expenditure plan.
- Caroline Menjivar
Legislator
Good.
- Nate Williams
Person
Yeah.
- Caroline Menjivar
Legislator
So the reason why I brought this one back is because I still have, I don't fully understand why we're funding that and not making ho. And I don't think it's under your Department. It's not.
- Unidentified Speaker
Person
Department of Public Health.
- Caroline Menjivar
Legislator
It is. So that's the only reason why I'm bringing this one, just to share that I still, still am trying to figure out why we can't remove some work. Well, this is a proposal. I get it, we're having conversations.
- Caroline Menjivar
Legislator
But just sharing that, I still think we should decrease this amount and provide some funding for the harm reduction. Harm reduction portion.
- Nate Williams
Person
Nate Williams, Department of Finance. So I think what we were trying to do with this is both the CDPH program that you were referencing and NDP took a reduction at Governor's Budget, and then the NDP actually took an additional reduction at May revision of General Fund of $35.5 million. So us-
- Caroline Menjivar
Legislator
Right now?
- Nate Williams
Person
Yeah. So the NDP is taking a $35.5 million reduction in General Fund ongoing. And so this augmentation of approximately 8 million is really to try and right-size the budget years appropriation to approximately the same number of units that we would have been able to supply with our Governor's Budget calculation given that the decrease in price.
- Nate Williams
Person
So we don't have to fully gain back the full 35.5 million now that there's a decreased cost.
- Caroline Menjivar
Legislator
Yeah, I understand. Working cheaper costs with CalRX. Phenomenal. So there's a proposal, I think I missed that. Maybe I'm just tired. 35 million?
- Nate Williams
Person
Yes. So it's actually tied up. So there's a $61 million reduction for medication assisted treatment programs. And then also included in that is 35.5 million. So in that 61, 35.5 million.
- Caroline Menjivar
Legislator
And the 8.3 are just to offset.
- Nate Williams
Person
That's to try and get us back to our Governor's Budget numbers. Correct.
- Caroline Menjivar
Legislator
Got it. Why would we reduce and then add in the same May revise?
- Nate Williams
Person
I mean, I guess you could kind of think of it as a fund shift. We didn't necessarily call it that, but that's kind of what we're doing, is we're reducing the 35.5 because it was tied up with the medication-assisted treatment. It was kind of its own BCP.
- Nate Williams
Person
I don't know that we necessarily talk about it that way, but that's essentially what's happening.
- Caroline Menjivar
Legislator
Okay. Thank you. LAO. Great. I think you just have one last. We're done. Yeah, we're done here. Thank you. Director, one last thing, Covered California. We don't have to go through the whole thing again, just want to know if there is any additional thoughts on what we talked about last week.
- Joseph Donaldson
Person
Joseph Donaldson, Department of Finance. So, specifically, to your first question on this rationale of the ongoing transfer that we propose at May Revise of 109 million beginning in 25-26. So, it's more connected to the overall structure of the Administration's proposal to the budget.
- Joseph Donaldson
Person
So while May Revise is proposing a balanced budget for both budget year and budget year one, we're also acknowledging that there are structural problems in out years as well.
- Joseph Donaldson
Person
So while the May Revise is addressing the budget year and budget year one, this ongoing transfer allows the state to be hopefully in good financial footing going forward, so that potentially more solutions may not be needed in the future.
- Joseph Donaldson
Person
If, you know, when we cross that bridge, so to speak. But noting that, which we noted in previous hearings, that not only with this proposed solution as well as the other two solutions, these don't impact or reduce current service programs through Covered California.
- Joseph Donaldson
Person
So just wanted to reiterate that even with these solutions, we're not reducing or impacting the affordability programs offered by Covered California.
- Caroline Menjivar
Legislator
Right. We're just not increasing if more people come in who are eligible, we won't have the ability to.
- Joseph Donaldson
Person
I might defer to my colleague at Covered California for just kind of the program design on this. I will kind of first begin that I know when we develop some of these for specifically the cost sharing affordability program that has 165 million still maintained. Yes, 165 million still maintained that
- Joseph Donaldson
Person
when this was developed, Covered California used a very conservative model to ensure that it was staying within the confines of this appropriation. My colleague could probably go into more depth on this, but when we developed it, that was the intent.
- Katie Ravel
Person
Hi there. Katie Ravel, Director of Policy Eligibility and Research at Covered California. We are in the first year of running the program this year with 82.5 million, and it will double for next year. So, we will have more experience in the coming months about our conservative approach.
- Katie Ravel
Person
We did build in some cushion for enrollment above and beyond even our highest projections, which potentially also gives us some cushion as benefit costs increase. So those are two factors that we
- Caroline Menjivar
Legislator
So we're not using all of this 165?
- Katie Ravel
Person
We are projected for our 2025 year to be able to service up to 1.3 million enrollees in those plans that we're going to put on the shelf in 2025. We currently have 1.1 million in our silver plan, so we could grow by 200,000 as we do our advertising.
- Katie Ravel
Person
If we don't grow by that amount, then there's some cushion going forward as benefit costs increase.
- Caroline Menjivar
Legislator
So we're, right now, we're serving 1.1 million.
- Katie Ravel
Person
Right now at our 82.5, we're serving a little over 700,000. That will double as we go forward when the funding doubles. Yes.
- Caroline Menjivar
Legislator
And then we still have approximately room to grow 200,000.
- Katie Ravel
Person
We do, yes.
- Caroline Menjivar
Legislator
Past that.
- Katie Ravel
Person
That's right.
- Caroline Menjivar
Legislator
Okay. Thank you so much for that.
- Katie Ravel
Person
You're welcome.
- Caroline Menjivar
Legislator
Because we still, there's still a lot of unknown, I'm still with the mindset that I know we need it for next year. I'm not disputing that. But just the indefinite ongoing part is I'm still stuck on and concerned about, it doesn't remove your ability to come back to the table and ask for it again and again.
- Caroline Menjivar
Legislator
That's where I'm at. I know there's a structural issue. You can still come back next year and ask for it for the following following year. But still, I haven't changed my mind on that part.
- Joseph Donaldson
Person
Yeah. So, understandable that that is a concern. And obviously, as we've noted with all these solutions, these are proposals we're working to work on alternatives.
- Joseph Donaldson
Person
I think it's important to note that, and we noted this in a previous hearing, that for 24-25 there is a fund balance for the Healthcare Affordability Reserve Fund of about 14.5 million, and that's about 30 million in budget year one.
- Joseph Donaldson
Person
When we start looking at these out year projections, based on where we see revenues and where we start seeing some of these loan repayments start getting factored in, even with the proposed ongoing shift, the fund still would have a rather robust fund reserve.
- Joseph Donaldson
Person
So even with the proposals that we have in place of not only the 62 million loan, the delayed repayment of the 600 million loan, as well as the ongoing revenue transfer, we see that based on current revenue projections, the available fund balances for the HCARF is still rather sizable.
- Joseph Donaldson
Person
So if the concern is that we're short changing ourselves in the future to address the now, I don't know if that would be the correct kind of representation of the fund, but acknowledging that there could be a difference of opinions between ongoing and
- Caroline Menjivar
Legislator
But we would still fall short. Whether it's robust or not, we would still fall short if for some reason the federal government gets unfriendly with us, we still wouldn't be able to meet our obligation to cover all those beneficiaries.
- Joseph Donaldson
Person
I think based on, I would want to consult my colleague from Covered California, based on the current level of subsidies offered by the federal government, part of these enhanced benefits, it is a rather sizable amount that would be a rather big cost pressure on the state, whether through the HCARF or through the General Fund.
- Joseph Donaldson
Person
You know, that would have to be a discussion of if we would consider doing a backfill to what degree and what level. But based on this proposal, we did acknowledge that it was assuming the Federal Government would expand beyond 25-26. We understand that there is uncertainty and to a degree, potentially risk.
- Joseph Donaldson
Person
But in order to kind of realize savings available to address the General Fund shortfall while also not impacting current programs offered by Covered California, that was the proposal put forward at the May Revise.
- Caroline Menjivar
Legislator
Okay. Any additional comment?
- Ryan Miller
Person
Yeah, Ryan Miller, LAO, I'll try to keep it brief, just acknowledging the hour and where we are. To your question about you know backfilling the potential loss of the enhanced subsidies, I think that would be pretty difficult and especially in the current budget climate that we find ourselves in. Well, you know, one additional thought I wanted to offer.
- Ryan Miller
Person
You know, we had said in last, in the hearing last time on this matter that, you know, we thought that it could be premature because it would put the Legislature in a difficult position if that problem did materialize. You know, just to offer
- Ryan Miller
Person
with regard to a lot of these, especially the ongoing kind of actions that we're considering, I think that there are a lot of different ways to think about the nature of those, you know, with regard to the enhanced federal subsidies on the exchange.
- Ryan Miller
Person
One way to think about the potential loss of that, while it would have definitely serious consequences for those who get for affordability on the exchange, it would return that to sort of a 2019 service level.
- Ryan Miller
Person
I think there have been other issues discussed in the Committee where, you know, arguably an ongoing reduction that's been proposed in the May Revision may actually cut something either deeper than that or, say, in the case of the local public health issue, would go back on something that seems to have brought a serious level up to where it should have been at that time.
- Ryan Miller
Person
So, yeah, I'll just. I guess I'll just leave it with that. But we're available for questions, too.
- Caroline Menjivar
Legislator
Thank you so much. Appreciate it. That concludes our issues. We're now going to move into public comment for all issues we talked on health outside of MCO tags. Okay, so 30 seconds. Not a lot. 30 seconds.
- Caroline Menjivar
Legislator
Thank you so much, appreciate it. That concludes our issues, we're not going to move into public comment.
- Brandon Tate
Person
Madam Chair, Senator. Brandon Tate with the Youth Health Equity Coalition. I wanted to try to fill in some of the gaps of information you did not get to your questions tonight. So there are four aspects to the public education campaign. The statewide, the local, the technical assistance for the local, and a dedicated LGBT effort. What's happening is that we're getting confused that even though some of the CBOs might receive some of the funding, the statewide campaign was actually creating the infrastructure to ensure that the messages were effective and evidence based. You ask what has happened on the statewide campaign so far?
- Brandon Tate
Person
Contract didn't start until January, so in only four months, they've engaged 1645 youth and parents across the state, and they've stood up community advisory boards with 86 youth and parents who've been hired to serve on those. Some of those are the ones you saw last week. Those are youth that would be dismissed.
- Emma Snuggs
Person
Osiyo. My name is Emma Snuggs. I'm a citizen of the Cherokee Nation and Executive Director of the Tribal Peoples Empowerment Project. My project is actually a part of DHCS's Naloxone Distribution Project. I got into this work after my brother passed away with a fentanyl overdose two years ago. You know, just for the record, you know, our communities have the highest rate of opioid related overdose, the lowest life expectancy, 2.3 times more likely to die of diabetes than white counterparts. Have, the highest rate of suicide, and one in three native women report being raped in their lifetimes. I know that people have shared crucial losses.
- Caroline Menjivar
Legislator
Last thought.
- Emma Snuggs
Person
A cut of this magnitude will result in the loss of life in my community. Thank you.
- Vanessa Cajina
Person
Thank you very much. Vanessa Cajina, on behalf of Visión y Compromiso, in opposition to the cuts to the HCAI workforce reductions for community health workers, promotores and representatives, that was an equity investment in historically underrepresented excluded population. Also, on behalf of the California Academy of Family Physicians, in opposition to the $10 million cut to Song-Brown Loan Repayment. Song-Brown Residency Placement, excuse me, and really appreciate the comments of the Committee on that. We do believe that that cut could lead to people being enrolled and having to leave their residency. Thank you.
- Caroline Menjivar
Legislator
Thank you.
- Luis Cortez
Person
Hi, I'm Luis Cortez. I'm with the LGBT Youth Center. Dear Madam Chair and Committee Members, today I'm here to advocate against the proposed budget cuts for the youth mental health programs, specifically at the Office of Health Equity. Earlier today, you spoke about you need to advocate and fight for our children. You also mentioned that you advocated for children to have a place to go.
- Luis Cortez
Person
The proposed budget cuts, in particular the ones for the youth mental health programs at the Office of Health Equity, will eliminate the opportunity for LGBTQ youth to have a place to land, get resources, affirmation, mental health care, and learn how to accept themselves. This cuts will force us to close our outreach program at our newly launched satellite location in El Dorado, Placer, and YOLO counties. We receive calls daily asking for help and resources. These kids have nowhere else to go.
- Caroline Menjivar
Legislator
Thank you.
- Luis Cortez
Person
Thank you so much.
- Emily McClintick
Person
Good evening, everyone. Emily McClintock with the Public Health Institute here to voice my concerns about the proposed cuts to the Children and Youth Behavioral Health Initiative public education change campaign. As was mentioned, 28 CBOs were already promised 25 million of funding for their work in local level campaigns and will now receive a portion of that with no technical assistance nor opportunity for the state to evaluate the effectiveness of this work. Cutting off the funds and support to CBOs on June 30,2024 will jeopardize this critical work. So we're asking you to help us follow through on these local level projects and maintain originally promised funds and support to these CBOs. Thank you.
- Caroline Menjivar
Legislator
Thank you. Welcome back.
- Mark LeBeau
Person
Thank you, Madam Chair. Dr. Mark LeBeau, CEO of CRIHB. We work with 68 federally recognized tribes throughout California and 20 tribal health programs. Here today to recommend Subcommitee reject the Department of Health Care Services' proposal to eliminate the Indian Health Program, which was established in 1975.
- Mark LeBeau
Person
Tribal and additional American Indian communities endure significant health disparities and comprise one of the most vulnerable populations in the state. We're recovering from multigenerational trauma, post traumatic stress imposed on us by colonial forces. Our clinics are chronically underfunded by the Federal Indian Health Service, and we're relying upon the state for resources.
- Mark LeBeau
Person
In light of this, tribes again urged Subcommitee to reject Department of Health Care Services' proposal to terminate the Indian health program. Thank you.
- Stephanie Weldon
Person
Hello. Stephanie Weldon with United Indian Health Services. I am also a Yurok tribal member and cuts to the Indian health program will impact me and my community, children and grandchildren. This funding funds traditional healers as well as the recruitment of our providers so much needed.
- Stephanie Weldon
Person
The also important part here is that our people are not getting adequate behavioral health services through counties, both culturally appropriate and accessible, who are the most vulnerable is this nation's first people.
- Stephanie Weldon
Person
And if the Department had concerns or was worried about this program, they did not engage in true government to government consultation as they're expected and required to do so with tribes to talk about the program needs. We fought really hard to get this program refunded. Thank you.
- Stacie Hiramoto
Person
Stacie Hiramoto with REMHDCO, the Racial and Ethnic Mental Health Disparities Coalition, also representing partners of the California Reducing Disparities Project. I want to support and commend the remarks of Mark LeBeau and Stephanie Weldon. We are very upset about these cuts to the Indian Health Program. We think it's very unfair.
- Stacie Hiramoto
Person
But on the other hand, in a way, we're not surprised. When it comes to the CYBHI Children and Youth Behavioral Health Initiative, you were trying to understand all the people last week. They look at it like people last hired, first fired. That's what people of color are used to.
- Stacie Hiramoto
Person
And the CYBHI, the, the grants that are getting cut are the ones that would serve the BIPOC and LGBTQ communities best. It's the one of the public education change campaign. Did you notice? They were all people of color. Anyway, thank you.
- Kyra Ross
Person
Good evening. Kiara Ross, on behalf of the City of Pasadena, Public Health Department, one of three city health departments in the state, in opposition, or I guess asking you to reject the proposed cuts to the local public health funding for the City of Pasadena, this would be devastating. We'd lose eight staff.
- Kyra Ross
Person
These are some of our very top staff who last year were able to stop transmission of dengue fever. But also for our homeless, we have navigation services that we would have to cut that have actually gotten dozens of people off the street and into supportive housing. So thank you.
- Catherine Senderling-Mcdonald
Person
Cathy Senderling-McDonald for the County of Alameda, also urging rejection of the public health funding for the local level. As I noted last week at the hearing, 39 staff are hired with this funding in Alameda County.
- Catherine Senderling-Mcdonald
Person
If the pandemic showed us anything, it's that public health is valuable, critical, and it's imperative that we not turn back the clock and go back to where we were before, barely making ends meet and barely keeping above water. Thank you.
- Dylan Elliott
Person
Thank you. Dylan Elliott on behalf of the counties of Kern, Fresno, Madera, Napa, Humboldt, Solano, San Joaquin and Tulare, all strongly opposed to the future of public health funds. Urge your rejection. Those are important first line public health defense monies. Thank you.
- Christine Smith
Person
Christine Smith, Health Access California. We urge the Legislature to push back on the governor's proposal to sweep $109 million ongoing from the health care Affordability Reserve Fund starting next year. This fund collects revenue from California's uninsured and has been preserved for Covered California to make insurance more affordable and accessible.
- Christine Smith
Person
Our understanding when penalty funds were secured last year was that any funds taken were supposed to be loans and only when absolutely necessary, and then returned for its original purpose.
- Christine Smith
Person
So we urge the Legislature to instead support Health4All Coalition's request to use a small portion of these funds to open Covered California to Californians who are undocumented and earn too much to qualify for Medi-Cal. Thank you.
- Chloe Steck
Person
Good evening. Chloe Steck with the California Immigrant Policy Center. I want to echo all of the comments made by my colleague at Health Access California. Ultimately, we want to urge the Legislature to protect funding that will in turn protect the most vulnerable communities in our state. We in this room are their voices.
- Chloe Steck
Person
Preserving the HCAR funding will be crucial in defending the health and dignity of every californian, regardless of immigration status. Thank you.
- Kathleen Mossburg
Person
Chair and Members, Kathy Mossburg, on behalf of the Public Health Institute. Want to align our comments with those of our colleagues regarding or expressing our opposition to the future of public health cuts and also appreciate the conversation on the cancer registry. We really do want to get to the bottom of this here.
- Kathleen Mossburg
Person
I think without minimal funding, we are at risk of losing our federal seer dollars. And so we really hope to work with the Legislature, as we've done for the last decade, to minimally fund the California registry so we don't lose those funds and we would say reject the positions unless we do get that minimal funding.
- Kathleen Mossburg
Person
Appreciate your time.
- Adrienne Shilton
Person
Good evening. Adrienne Shilton with the California Alliance of Child and Family Services. We continue to be concerned with the walking back of investments in children's behavioral health and the infrastructure specifically that's needed to support these programs, our workforce.
- Adrienne Shilton
Person
So we're opposed to the proposed cuts under our Department of Health Care Access and Information for the healthcare workforce initiatives as was stated. We need more workers, not less. We have a crisis of care in our state. We do not have enough providers now, and we have CalAIM. We have Proposition 1, as was stated.
- Adrienne Shilton
Person
So we urge you to reject those cuts. And we also continue to be opposed to the proposed elimination of the $15 million program at Department of Public Health for use, suicide reporting and crisis response. Thank you.
- Jolie Onodera
Person
Good evening, Madam Chair. Jolie Onodera with the California State Association of Counties, representing all 58 counties, also here on behalf of the Urban Counties of California and the Rural County Representatives of California. Appreciate the discussion on the proposal to eliminate funding for the future of public health.
- Jolie Onodera
Person
Would just like to align my comments with those of the Riverside County Public health director and the Yolo County health officer regarding the serious impacts of those, of those cuts on workforce preparedness and response. Thank you.
- Caroline Menjivar
Legislator
Thank you so much.
- Jeff Neil
Person
On behalf-- Jeff Neil, on behalf of the counties of Lake Contra Costa and San Diego, also urging you to reject the cuts to the future of public health. In Lake County, just the proposal has already had an effect. They pulled a listing for an epidemiologist. They'll lose five other positions as well.
- Jeff Neil
Person
In San Diego County, they'll lose 91 positions. 57 of those positions are represented. Aside from all the catastrophic, you know, resulting losses to pandemics, it's everything from the person whose job it is to do brain removal for animals in rabies investigations, doing the beach water testing right now, obviously, the problem with the Tijuana River, and Narcan program for the community, all would be affected. Thank you.
- Tara Gamboa-Eastman
Person
Tara Gamboa-Eastman with the Steinberg Institute, in respectful opposition to the $500 million in workforce investments. Thank you.
- Ronald Coleman Baeza
Person
Good evening. Ronald Coleman Baeza here on behalf of the California Pan Ethnic Health Network, CPEHN. We urge you to reject the cuts at HCAI to CHWs. This is the first time this population has been allocated funding for training and certification. Now this promise and recognition of their work is at threat.
- Ronald Coleman Baeza
Person
Mostly women, mostly people of color, mostly Latinas, wondering how we'll actually meet the state's goals of getting 15,000 CHWs in place by 2028. And so just urge you to reject it. On the Indian Health Program, this population has been colonized, marginalized and isolated. It's contributed to deep disparities.
- Ronald Coleman Baeza
Person
We must have the Indian Health Program in place moving forward. Public health cuts, we're very disappointed about these cuts. We urge the Legislature to also reject the public health cuts. This is also a cut to low income communities of color. For the first time ever, we saw public health departments locally go and work and build bridges with community. Thank you.
- Linda Nguy
Person
Good evening. Linda Nguy with Western Center on Law and Poverty. Considering the equity implications, we oppose the cuts to the Indian health grants in Medi-Cal, which is vital to addressing disparities that persist due to a history of colonization, as well as the community health worker cuts within HCAI and public health cuts related to Covered California.
- Linda Nguy
Person
We align our comments with Health4All Coalition to not sweep the funds and instead fund a mirror exchange for undocumented individuals regardless of immigration status. Thank you.
- Ryan Souza
Person
Good evening. Ryan Souza on behalf of the San Francisco AIDS Foundation and APLA Health speaking to the ADAP fund issue. We just want to appreciate the commitment and attention to addressing both the fund balance and the program modernizations.
- Ryan Souza
Person
We believe that all the modernizations using the ADAP fund are appropriate and can be achieved with typical and minor statutory changes. Second, as it relates to the TGI Wellness and Equity Fund, there was a slight clarification there that it's actually for people living with HIV and AIDS on the TGI individuals.
- Ryan Souza
Person
And then so on behalf of San Francisco AIDS Foundation, APLA Health and End the Epidemics Coalition, we look forward to working together to finalize this action. Thank you.
- Michelle Gibbons
Person
Good evening. Michelle Gibbons with the County Health Executives Association of California, representing local health departments across the state, urging your rejection of the public health cuts proposed in the governor's May Revise. Thank you for including the examples in the agenda.
- Michelle Gibbons
Person
I have a ton more that I can share around skilled nursing facilities and infection prevention, around public health nurses going into communities with outbreaks and really addressing disparities. I will spare you all of the details and just would ask that you all reject those cuts. Thank you.
- Beth Malinowski
Person
Good evening Chair. Beth Malinowski with SEIU California, aligning my comments with those of CHEAC and other members of the California Can't Wait Coalition that have been here this evening. Really appreciate the additional dialogue on the public health cuts today. I want to really acknowledge some of the words of Dr. Aragon earlier. He's referenced how these future public health funding cuts are the roots for public health system.
- Beth Malinowski
Person
When we think of public health as a core service, we think about how to actually help stand up our whole economy, keeps our schools open, and just really ask that we consider that as we move forward in this budget process and the difficult conversation we have. We hope you can reject this cut. Thank you.
- Jonathan Clay
Person
Good evening, Madam Chair. Jonathan Clay here on behalf of USC Keck School Medicine of school. It's late tonight. We're here in support of the cancer registry and trying to find that base level funding. As my colleague mentioned earlier, without that base level funding, we do actually risk losing federal dollars.
- Jonathan Clay
Person
I also want to just raise, like, if, why are we even looking at a PY when we can't even fund the base level of funding? So for that, we urge that you guys try and find that base level funding. Thank you.
- Virginia Hedrick
Person
Hi. Virginia Hedrick, I'm the Executive Director of the California Consortium for Urban Indian Health, and we work on behalf of programs like the Sacramento Native American Health Center. And we urge you to sustain the 23 million for the state Indian Health Program.
- Virginia Hedrick
Person
SNAHC is an FQHC that provides primary care, dental, behavioral health in a medically underserved area, often referred to as a health profession shortage area. Chairman, to your earlier point, SNAHC and other tribal health programs have already been issued award letters for the 24-25 fiscal year.
- Virginia Hedrick
Person
You've already highlighted many of the disparities, and I just want to note, in 2021, the life expectancy for American Indians was just over just 65 years. That means at my age of nearly 40, my five children would have just over 20 years left with me. Again, I urge you to sustain the state Indian Health Program.
- Caroline Menjivar
Legislator
Thank you so much.
- Calvin Hedrick
Person
Calvin Hedrick. I am Mountain Maidu, and I am the Director of Organizing for the California Native Vote Project, and I strongly oppose the elimination of the California State Indian Health Program. I've worked with youth for over 20 years and worked in tribal communities for over 25 years. And what we're talking about here is an already underfunded Indian health programs throughout the State of California. And this money filled gaps, but not all of the gaps.
- Calvin Hedrick
Person
And so what that means when we're talking about some of these statistics is that some of our students that I work with will no longer get those mental health services or won't get them. And they are already community young native people who have the highest suicide rates of anybody in the country.
- Calvin Hedrick
Person
So I strongly urge you to preserve this crucial program.
- Unidentified Speaker
Person
I'm a member of the Seminole Nation of Oklahoma and Muskogee Creek, and I am 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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
With our population having significantly lower life expectancies, our youth having the highest rates of suicides, 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 cause thousands of patients to lose access to essential care that would not be available if not for the provided funding.
- Caroline Menjivar
Legislator
Thank you.
- Camiko Hostler
Person
Hey, I'm Kameiko Hostler. My name is Kameiko Hostler. I come from the village of Ta'kimilding on the Hoopa Valley Reservation. Currently, I work for the California Native Vote Project as a youth organizer. I'm here to address the proposed elimination of $23 million in funding for state Indian Health Program.
- Camiko Hostler
Person
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. IHP is not just a budget line item, it is a lifeline.
- Camiko Hostler
Person
It provides essential medical care, behavioral health services, and culturally specific programming. With the Native American youth facing suicide rates over twice the national average, IHP's role is indispensable. It directly addresses these severe mental health challenges, offering critical support that saves life.
- Camiko Hostler
Person
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 exasperates existing health disparities, undermines any claimed commitment to truth and healing. I challenge you to uphold your promises and commitments and reject the proposal. Thank you.
- Bryana Clark
Person
My name is Bryana Clark and I'm a member of the Hopland Band of Pomo Indians and I'm urging the rejection to cuts for the Indian health services. Suicide rates are at crisis levels and are higher than any other ethnicity within the country.
- Bryana Clark
Person
Eliminating the funding directly contributes to barriers within the healthcare system in providing access to mental health and behavioral services. The leading causes of death within our communities are heart disease, cancer and diabetes, all of which can be maintained if caught early and used preventative care.
- Bryana Clark
Person
IHS provides healthcare in a way that is different than general and privatized healthcare and where they often fail, it provides healthcare that is personalized, culturally sensitive, and assists in fostering self determination within our communities. Today, questions were raised about how to cut funding selectively, as we can't have the whole bucket.
- Bryana Clark
Person
However, for our communities, cutting the pre-existing funding for IHS would be extremely detrimental to the overall baseline of our health.
- Nicole Wordelman
Person
Nicole Wordelman on behalf of The Children's Partnership. Deeply disappointed in the lack of funding for zero to five continuous Medi-Cal coverage, urging funding of that, but also urging that the Legislature direct DHCS to submit the federal waiver with or without the funding.
- Nicole Wordelman
Person
In addition, we're in opposition to the public health cuts, as is Orange County and San Bernardino County. And The Children's Partnership is also opposing the healthcare navigation cuts. Thanks.
- Caroline Menjivar
Legislator
Thank you.
- Donald Lyman
Person
I'm Dr. Donald Lyman, who represents the California Academy of Preventive Medicine. We're the docs who try and keep people away from doctors and hospitals. And I was also the senior civil service physician in what is now the Department of Public Health for about 40 years. We're here to support the future of public health funding and funding for the cancer registry.
- Donald Lyman
Person
While I was in the Department, we had an endless series of issues which were assigned to me that had no other parking place inside the Administration. So we had hazardous waste dump sites, we had AIDS, we had tobacco control, we had opiates.
- Donald Lyman
Person
And when Covid arrived, there was really no capacity to deal with something that big, that awful. I had retired at that point, but I watched the system break. This future of public health is the funding to supply that. Thank you.
- Bruce Palmer
Person
Madam Chair, Bruce Palmer, representing the California Association of Public Health Lab Directors, strongly opposed to these cuts. The scientific capability to identify and control the spread of disease is maintained by these 28 public health labs throughout the state.
- Bruce Palmer
Person
The cuts are going to take away a great deal of the advantage of that scientific expertise that's efficient and is so essential to controlling the spread of disease. We appreciate your hearing. I think you asked some great questions and we're hopeful that some kind of resolution to this issue can be developed. Thank you.
- Gabriella Kohondig
Person
My name is Gabriella Kohondig. I'm a youth program manager for the Native American Health Center in San Francisco. I deeply oppose the elimination of the state Indian health program.
- Gabriella Kohondig
Person
This program has been imperative to the support of urban indigenous communities and helping them thrive and fight against massive health disparities and colonization's impacts across generations and cultivated life saving preventative measures against systemic, social and economic discrimination. Not upholding the legal obligations to native populations will affect present and future generations.
- Gabriella Kohondig
Person
This program elimination would be devastating to native communities across California. Thank you.
- Tracey Lebeau
Person
Hello. My name is Tracey LeBeau, enrolled member of the Pit River Tribe. I have worked in Indian healthcare for 33 years, rural Indian healthcare. I have seen many, many changes throughout the years. Madam Chair, you mentioned earlier about being excited when we got the money. Now you ready to take it away?
- Tracey Lebeau
Person
I have seen where our families have traveled many, many miles just to see, just to get provide quality health care outside of our service area. I ask not to cut the Indian healthcare. We need that funding. Thank you.
- Caroline Menjivar
Legislator
Thank you so much. Thank you for closing us out. Seeing no other public comment. That concludes our seven hour and 25 minute subcommitee for today. Budget Subcommitee No. 3 on Health and Human Services is concluded.
Bill BUD 5180