Assembly Standing Committee on Health

Additional testimony will also be in person and limited to name, position and organization if you represent one. on consent today, we have the following bills proposed for today's hearing. Any Member of the Committee may remove a bill from consent. Item two, SB 908, Cortese. Item six, SB 1257, Blakespear. Item eight, SB 142,. Atkins. Item nine, SB 1464, Ashby.

Please note that Assemblymember Waldron will not be available today. And with that, we have our first author available, and we will move to our first item, which is item number one, SB 294, Wiener. We will start as a Subcommittee. Thank you for joining us. Please go ahead.

Okay, thank you very much, Madam Chair. I'm here today to present Senate Bill 294, and we'll be taking technical amendments asked for by the Committee, and we also have technical amendments requested by DMHC and CDI.

Colleagues, we know that over the last few years, and first of all, I should say thank you to the Assembly Health Committee for passing a similar version of this bill last year relating to youth mental health. We know that the rate of mental health challenges among our youth has reached crisis levels.

And today, with Senate Bill 294, we have an opportunity to take a tangible step to increase the ability of young people to access mental health treatment.

And specifically, SB 294 requires that all life threatening mental health treatment denials by health plans for folks under the age of 26 automatically trigger an independent medical review, or IMR. For denials by health plans of non-life threatening conditions, it will trigger an automatic grievance process, then followed by an IMR if the grievances.

If the denial is upheld after the grievance. The purpose of this bill is to make sure that people who have insurance can actually get mental health treatment covered for their children. We know that our. Unfortunately, we have a long history of health plans making it all but impossible to access mental health treatment other than in emergency situations.

This Legislature has taken strong steps in recent years around mental health parity and timely access, and I'm really proud of the work that we've been able to do together. SB 294 will build on that work by ensuring that when a denial happens for a young person, that an IMR automatically happens.

We know that when IMRs are requested, they overwhelmingly will reinstate the coverage and overturn the health plan's denial of that mental health treatment. We also know that for people who are requesting IMRs, they overwhelmingly are doing so in English.

So what that means is that there are various populations that simply do not know that they have the ability to do a grievance and then an IMR, or they are just boxed out of that process for one reason or another.

And so this bill will allow us to ensure that everyone has access to the IMR process, which we know will expand access to mental health treatment. So with that, I have two witnesses testifying with me today, Doctor Teresa Frausto, an MD, President of the California Academy of Child and Adolescent Psychiatry, and Colleen Corrigan with Children Now one of our sponsors.

Please go ahead. You'll each have two minutes.

Good afternoon. My name is Doctor Teresa Frausto. I am the President of the California Academy of Child and Adolescent Psychiatry, a statewide umbrella organization that consists of four regional councils of child adolescent psychiatrists.

Youth with mental health conditions, especially children of color, LGBTQ, and socially disadvantaged, often experience overwhelming stigma, shame and discrimination, which leads to marginalization and lack of care. The COVID pandemic only exacerbated mental illness among our youth, and health plans continue to deny care at an alarming rate.

Navigating our healthcare system to access care is already challenging enough without the difficulty of filing a grievance and appealing a denial through the independent medical review process.

As a physician and patient advocate with over 33 years of experience, I have worked in the private sector, county mental health, juvenile detentions and psychiatric hospitals, and have witnessed firsthand the mental health crisis our youth are facing and the importance of these services for our kids.

When health plans say it is not medically necessary or not an emergency, our youth end up in the emergency department, psychiatric hospitals and juvenile detention centers. Mental illness is killing our youth. Suicide is the second leading cause of death in youth between 15 and 24 years old, and suicide rates among our black youth have doubled.

Our providers know that when a child comes to them struggling with anxiety, ADHD, depression, bipolar or any psychotic disorder, they work to understand their illness and prescribe culturally competent care. It is extremely frustrating when their plans deny such care under, often under the guise of medical necessity disputes.

Senate Bill 294 would put the power back in the hands of providers and patients to decide what kind of care is right for them without placing the burden on families to fight the system. For these reasons, I respectfully request your aye vote on this measure. Thank you.

Good afternoon. My name is Colleen Corrigan, and I'm a health policy associate with Children Now. A co-sponsor of the bill along with the County of Santa Clara, our organization has heard from countless parents over the years about the difficulties in navigating the independent medical review process.

While IMRs are an important consumer protection, it's difficult to access for families whose first language is not English and who may not have the health literacy or time to submit a grievance or an IMR.

We know that Medicare consumers have more protections in place for denials, which include five levels of appeals and automatic review after the adverse determination by a plan. California's youth are equally vulnerable to the mental illness and deserve a fair chance at getting the care that they desperately need.

Children are the most susceptible to the long term effects of undiagnosed and untreated mental illness, which include unnecessary disability, homelessness, inappropriate incarceration, and suicide. SB 294 aims to protect more children from falling through our safety nets. SB 855 was signed into law to ensure mental health parity by requiring plans to cover medically necessary services.

However, data show that health insurance companies still regularly deny claims, and this bill will support the accountability intended by SB 855. In the last four years alone, an average of 78% of youth mental health denials were overturned by the IMR process.

We have no way of estimating how many denials never even make it to the grievance or IMR process because plans are not required to report this data.

When plans don't provide the care that they're supposed to, children and families end up paying out of pocket or seeking care from medical and county public health systems at an enormous cost to the public. Health plans are only denying these treatments because the system allows it.

We need to ask for accountability from plans and how they approve and deny this life saving care. Our team has had years of conversations with health plans advocates and experts to draft legislation that is consumer friendly and consistent with existing law. We must act now to address racial and economic inequities and mental health access. Thank you.

Thank you. Are there any additional witnesses in support? Please state your name, organization and.

Tom Renfree on behalf of the California Association of Alcohol and Drug Program Executives in support. Thank you.

Thank you. Dylan Elliott on behalf of the California State Association of Psychiatrists in Support. Thank you.

Vanessa Cajina on behalf of the California Pan-Ethnic Health Network here in support.

Whitney Francis with the Western Center on Law and Poverty in support.

Good afternoon. Lizzie Cootsona here on behalf of the California Medical Association in support. Thanks.

Katie Van Deynze with health access in California in support.

Meghan Loper on behalf of the California Hospital Association, in support.

Annie Thomas, on behalf of the California Alliance of Child and Family Services, in support.

Tyler Rinde, on behalf of the California Psychological Association in support. Thank you.

Jeff Neil, representing the County of San Diego, also in support.

John Drebinger with the Steinberg Institute in support.

Deputy County Executive David Campos on behalf of the County of Santa Clara, strongly in support. Thank you.

Thank you. Melissa Cortez on behalf of Autism Speaks and the Council of Autism Service Providers in support.

Thank you. Are there any primary witnesses in opposition? Please take a seat. You'll each have two minutes.

Good afternoon, Madam Chair, Members of the Committee, Jedd Hampton, with the California Association of Health Plans here, regrettably, in opposition to SB 294. We would like to thank the author, the sponsors, the staff, the Committee staff.

We've had several conversations about this bill in the last year and a half, so we really appreciate the openness and willingness to hear some of our concerns and see if we could find a path forward on that. But unfortunately, you know, we have not quite found the path forward just yet.

We certainly appreciate the overarching intent of this goal to ensure that our enrollees have timely access to mental health care. However, we are concerned that this bill creates a new bifurcated review process which requires health plans and insurers to automatically review all youth related mental health services when the plan has issued an initial denial, delay or modification.

While many initial denials or modifications can be resolved through a health plans grievance process, we do believe that it is excessive to require that every modification or denial should automatically be submitted for review, regardless of merit or physician or enrollee input.

The current process that's laid out in statute enables a health plan to work together with the provider to ensure that the enrollee gets the care that they need quickly. It's important to acknowledge that the success of these grievance reviews are dependent on the engagement of the individual patient and the physician.

We are concerned that SB 294 expressly prohibits that health plans and insurers are required that the patient or the provider take any action to initiate or to continue the grievance processing procedure, and we believe that without their involvement, this secondary review process could actually result in an increase in unnecessary denials.

We are also concerned about potential impacts that SB 294 would have on the integrity of the current IMR system. Automatically referring denials or modifications into the IMR process, regardless of merit, will most certainly lead to a significant influx of cases sent to IMR, thereby compromising the effectiveness of the system as a whole.

We also have some additional privacy concerns with the bill that I know my colleague will address in her testimony. But we would also want to acknowledge that there's been a considerable amount of work done in this area in the last few years.

In addition to some of the recently implemented regulations around SB 855, health plans are also required to cover services originated from 988 calls care court, as well as the launching of the children and youth Behavioral health initiative, where these mandates require health plans to cover mental health and substance use disorder services without any prior authorization or zero cost shares.

So we certainly appreciate the intent that the author has put forth in this bill. However, with these concerns, we are regrettably opposed to the bill, but we are happy to continue the discussions moving forward. Thank you.

Madam Chair Member Steffanie Watkins. On behalf of the Association of California Life and Health Insurance Companies, I'd echo many of my colleagues comments.

We have had a really open dialogue and have shared a lot of the information and the findings we've had with the author and sponsor's office and do hope to continue those conversations if the bill moves forward today, I would just echo what my colleagues said about privacy we are concerned that SB 294 may unintentionally violate patient privacy protections.

Currently, the federal Health Insurance Portability and Accountability act, otherwise known as HIPAA privacy rules, expressly prohibit covered entities from sharing psychotherapy notes without direct consent from the enrollees. Psychotherapy notes may be required for health plans and insurers to adequately assess medical necessity.

Automatically referring cases to IMR and requiring plans and insurers to provide clinical notes without the explicit authorization of the patient puts health plans and insurers in an untenable position of either violating federal HIPAA laws while attempting to adhere to the requirements of this bill.

To that point, the existing IMR process addresses those concerns by requiring an enrollee to expressly consent to IMR. We believe that piece of the process is critical to ensuring the patient fully appreciates the privacy rights the bill is attempting to waive on their behalf.

Regrettably, the way SB 294 proposes to deal with this issue does not get to the court issue. The statute requires plans insurers to coordinate with enrollee and provider to get a signed IMR application along with medical release forms after the plan has already submitted the request to IMR.

While we appreciate the intent of the author and sponsor to address the privacy concerns that have been raised, attempting to obtain a signed release after the information has been submitted does nothing to address the underlying privacy violations this bill creates.

The statute clearly requires plans and insurers to submit as a part of the auto referral all relevant information that informed the health plan insurers to deny, modify, or delay the service. This requirement most certainly would include all the patients medical records, even those would otherwise be prohibited without direct consent.

For these reasons, we are opposed, but do look forward to having continued conversations if the bill moves forward today. Thank you.

Thank you. Any other witnesses in opposition, please step forward.

Thank you, Madam Chair. Jack Yanos, on behalf of America's Health Insurance Plans in regretful opposition. Thank you.

Thank you. I'll bring it back to the Committee for any questions or comments.

So I think, I was discussing this bill with my staff earlier and want to thank you for bringing it forward. And I think the number that they shared with me is that was it, 70% of claims are denied or where does that number come from? Do you know?

Around children?

Yeah. Are you referring to the number of denials that are overturned? 78%. Yeah. 78%, yeah. 78% of youth mental health denials are overturned by IMR. Overturned, yeah.

So, I mean, that, to me, is a glaring breakdown in our system when you have almost 80% of initial denials overturned.

And, you know, I was recently just talking with a parent in my district who has a child who's struggling with suicidal ideations and was really frustrated because they were saying that their healthcare provider or insurance was telling them that they really couldn't provide them the services that they needed until they acted on this, which, as a parent, boggles my mind.

So, I mean, clearly there is a change in the system that needs to happen. We know we're in the middle of a mental health crisis amongst our youth especially. And I'm grateful that you're trying to figure this out.

It sounds like conversations will still go on to make sure that there's protections that are needed around privacy, but this can't continue as it is. Thank you.

Thank you, Senator Wiener, for bringing forward this bill. I also appreciate that you had this go to towards the age of 26 years old. We in California consider adolescents to go to 25 years old.

Those who are in their 20 somethings are just for their first time, kind of often on their own and needing to navigate a very complicated healthcare system. I would like to address, have you address, if possible, the privacy concerns that the opposition raised.

Yeah, absolutely. And we respectfully disagree. So, first of all, folks can withdraw the IMR. They're not forced to go through it. They can withdraw it. In addition, and they're still going to have to participate in the process. And so they'll have every ability, if they don't want their records to go over, for that not to happen.

But it's also the case that in the health insurance determination process, medical records, medical information has to be known, otherwise you can't go through that process. So we respectfully disagree that this is going to somehow be a breach of privacy. And of course, everyone is going to follow federal law at all times.

I tend to agree.

And maybe Children Now may have something to add.

Yeah, I think the only thing I would add to that is regarding psychotherapy notes, which were called out. We've spoken to many HIPAA attorneys, and it's clear that psychotherapy notes are not required for the initial grievance decision. And even if they were, they'd be separate from the medical records that are shared during the grievance process.

And the IMR application that needs to be completed within the 30 days does confer consent for sharing medical records. So it really, contrary to the points, involves providers and enrollees at every step. Thank you.

I think that ends the general comment. Do I have a motion? Oh, we don't have a quorum yet, so apologize for that. But I did want to clarify that there are not any technical amendments being accepted by this Committee, but that you plan to have those technical amendments reviewed by the Appropriations Committee.

Correct. We will be submitting them as author amendments, and the Appropriations Committee, should this Committee advance the bill.

Thank you so much. I appreciate the presentation.

Thank you. Respectfully ask for an aye vote.

We are going to move on now to Item Number Four by our star Senator Durazo, SB 1132, who will also be presenting Item Numbers Three and Five. You could start, Senator Durazo, with your bill: SB 1132.

Okay. Thank you, Madam Chair and Members. SB 1132 clarifies the authority of county health officers to enter and inspect private detention facilities operating in our state. Today, there are six private facilities that operate in a gray area under our health and safety codes, as public health oversight laws do not explicitly cover private detention facilities.

These private detention facilities are operated by for-profit companies that often fail to meet minimum standards of health, safety, and sanitation. Recent reports from these facilities continue to document a pattern of poor conditions, inadequate health care, and unsafe work conditions.

This bill will ensure that private detention facilities are clearly covered under our health and safety laws, and therefore, our county health officials can ensure minimum standards in these facilities. With me to testify in support is Andrea Amavisca from the California Immigrant Policy Center. Thank you, Madam Chair.

Thank you. You'll have two minutes.

Good afternoon, Madam Chair and Members. My name is--

Please put your microphone on.

Thank you. Good afternoon, Madam Chair and Members. My name is Andrea Amavisca, and I'm the Government Affairs Manager at the California Immigrant Policy Center, co-sponsor of this bill. California holds the third largest immigration detention population in the country.

All six ICE detention facilities in the state are run by for-profit, private prison companies, making them prone to a lack of accountability. These facilities have a horrific track record when it comes to the health, safety, and human rights. Detention facilities can pose a public health risk to individuals detained inside, individuals who work inside, as well as families who visit or live near these facilities.

The Los Angeles Times has reported on investigations by Cal/OSHA that found willful and serious health and safety violations in private detention facilities, citing unsafe conditions for individuals detained, including a lack of protective equipment and proper training while cleaning the facility for less than one dollar per day.

A 2021 report by the California Department of Justice found that the Adelanto Detention Facility in San Bernardino County had used a chemical agent known as HDQ neutral to sanitize surfaces which many individuals detained at this facility reported was so toxic they experienced headaches, nausea, nosebleeds, fainting, breathing issues, and more.

These are just a few of the many examples of unsafe conditions and public health violations that occur in these facilities and part of the urgent need for a public health solution to this problem. SB 1132 clarifies that county health officials can inspect the health and sanitary conditions of private detention facilities when deemed necessary and appropriate.

The bill does not impose an annual inspection. The bill has received support from over 50 organizations, including the Health Officers Association of California, and has received no opposition. I respectfully request your aye vote. Thank you.

Thank you. Are there any other witnesses in support?

Kat DeBurgh, with the Health Officers Association of California, in support.

Vanessa Cajina, on behalf of the California Pan-Ethnic Health Network, here in support.

Hello. Molly Robson with Planned Parenthood Affiliates of California, in support.

Jackie Gonzalez, proud co-sponsor from Immigrant Defense Advocates, in strong support. Thank you.

Are there any primary witnesses in opposition? Any other witnesses in the room? Seeing none, I will bring it back to the committee for any questions or comments. Dr. Arambula.

Thank you, Madam Chair. I had the honor of being able to work on a private detention facility when our Attorney General asked me to carry a bill as he was moving on to his office, and wanted to thank the author for bringing this forward as it's important to make sure that we're providing the human beings who are in those detention facilities with the dignity and respect that they deserve. Thank you, Madam Chair. I'll make a motion when the time is appropriate.

Thank you. I also want to thank the author for bringing forward this bill, Senator Durazo. We need to make sure that our detention facilities are situated in a way that people can be treated humanely. They shouldn't exist at all, but they do. And with that, when it's appropriate, we will move this bill forward. Can you--

Thank you, Madam Chair.

Thank you. We will move on now to Item Number Three: SB 1131: Gonzalez, presented by Durazo.

Thank you, Madam Chair. On behalf of Senator Gonzalez, I'm here to present SB 1131, which will ensure access to essential family planning services for low-income Californians across the state.

Since 1997, California has been providing family planning services like contraception, pregnancy testing, STI, and HIV testing to low-income individuals at no cost through the family planning, access, care and treatment program, also known as Family PACT.

In order for a health clinic to provide these services in their community, the clinic must first be certified by a designated healthcare professional. Despite a healthcare workforce shortage, the state continues to limit who can certify clinics for Family PACT services to only physicians, certified midwives, or certified nurse practitioners.

This Bill will address the shortcoming by clarifying that one a site certifier can be any clinician that oversees Family PACT services at the site and that a provider that certifies a site for Family PACT services shall have at least six months to complete program orientation after enrollment and that the DHCS must offer trainings virtually and on a monthly basis.

Finally, to ensure continuity with the existing law, SB 1131 clarifies that Medi-Cal does not have to disenroll Family PACT providers as a result of actions taken by other states based on conduct that is not considered unprofessional conduct in California. Testifying in support of this measure today, I have Kelby Lind with Planned Parenthood Affiliates of California.

Thank you.

Thank you. You'll have two minutes.

Thank you. Good afternoon, Chair Bonta and Members, my name is Kelby Lind and I am the Vice President of regulatory affairs at Planned Parenthood Affiliates of California, representing seven affiliates who provide comprehensive sexual and reproductive healthcare on behalf of the Family PACT program throughout California.

We are proud co-sponsors of SB 1131, and I want to begin by thanking the author for her dedication and leadership on family planning services. Planned Parenthood is the state's largest Family PACT provider with half a million annual visits tthrough the program.

Family PACT provides critical coverage for Californians who need affordable family planning services, particularly patients who have confidentiality concerns or whose family income exceeds the Medi-Cal limit.

Planned Parenthood supports the intended purpose of the Family PACT site certifier program to ensure that all family pact providers are up to date on the policies and benefits of the Family PACT program.

However, there is a need for clarification and updates so that the program reflects how Family PACT providers provide care and facilitates their ability to provide the necessary oversight as required.

We share the state's goals of improving and maintaining program integrity, ensuring clinical quality and compliance with Family PACT standards, and maintaining access to time-sensitive family planning services for patients. Planned Parenthood prioritizes providing the highest quality of care to all patients, including Family PACT patients.

This Bill will clarify and streamline the Family PACT program, improve requirements to sustain and expand the program for future years, and reduce healthcare disparities for Family PACT patients across the state. The Family PACT program is critical to Planned Parenthood's patient population, and that is why PPAC is a proud cosponsor of 1131, and we respectfully urge your aye vote today. Thank you.

Thank you. Any other additional witnesses in support? Are there any witnesses in opposition? Seeing none, we'll bring it back to the Committee for comment or questions. No comments or questions from the Committee.

Senator Durazo, thank you for bringing this forward on behalf of Senator Gonzalez and ensuring that we have yet another tool in our toolbox to make sure that we are providing adequate family planning services in the State of California.

Thank you.

With that, we will move on to Item Number Five: SB 1213 by Atkins, presented by Durazo.

Thank you, Madam Chair, and final one. I'm here to present, on behalf of Senator Atkins, this bill, which would expand access to breast and cervical cancer screenings, diagnostic services, and treatment for lower income Californians.

This bill will increase the income eligibility threshold for the Every Woman Counts Program and Breast and Cervical Cancer Treatment Program from 200 percent of the federal poverty level, which is 30,000 dollars per year for an individual, to 300 percent of the federal poverty level, which is 45,180 dollars per year.

These programs provide free breast and cervical cancer screenings and treatment to eligible Californians, ensuring that women can access timely, quality care. Currently, many lower income women who are uninsured or underinsured with an income above 200 percent of the federal poverty level are unable to afford to purchase insurance.

For those with insurance, premiums and out-of-pocket expenses can still cost over 10,000 dollars per year. Women may choose to skip important screenings or delay care if diagnosed with breast or cervical cancer due to high cost. Of course, that increases the risk of late stage cancer and cancer death.

As California moves towards universal health coverage, expanding these programs will ensure that California remains a leader in health care accessibility and will help us continue to reduce cancer deaths. I respectfully ask for your aye vote, and we have some witnesses here.

Madam Chair and Members, Autumn Ogden-Smith with the American Cancer Society Cancer Action Network, proud co-sponsor. Ask for your aye vote. Here to answer any questions. Thank you.

And I'm Courtney Quinn. I'm the Executive Director for the Albie Aware Breast Cancer Foundation. We're the largest nonprofit organization dedicated solely to breast cancer in the greater Sacramento area. We're the first point of contact for a lot of people in the greater Sacramento area when they find a lump or need a mammogram.

And as a breast cancer survivor, I have the honor to share a couple of stories of individuals who have been supported through Every Woman Counts in the BCCTP Program and how they are creating cancer survivors. The first is we received a phone call from an individual who had never had a mammogram, and she didn't have insurance, and I shared about the Every Woman Counts Program, and I stated the income eligibility. And she had a huge sigh, and she says, 'I make 100 dollars more a month than the eligibility. So does that mean I can't get a mammogram?'

And I told her because she lived in the greater Sacramento area, our organization would provide her the support. So then a second individual is a small business owner who had emergency insurance only. She found a lump, her business was struggling and she could barely pay the emergency insurance premiums alone, and she was eligible for Every Woman Counts, ended up being diagnosed with breast cancer. A cancer survivor today through this program, and I'm now going to turn over the time to my colleague here from Susan G. Komen.

Thank you, Madam Chair and Committee Members, for the opportunity to comment. Conor Sweeney with the Susan G. Komen Foundation. We're a nationwide breast cancer nonprofit and a proud co-sponsor of this bill. I mainly just want to echo the words of Courtney, here, and encourage you to support this bill today.

I believe that the work of Every Woman Counts and the Breast and Cervical Cancer Treatment Program align very strongly with the goals of this committee. The results they deliver can be measured in cancers detected and lives saved. Breast and cervical cancer impacts every community and every district in California, and the folks at EWC work very hard to identify the gaps where more attention is needed. They take special care to work with clinics and providers that serve hard-to-reach populations. And in doing so, they are continuing to drive health equity in California.

And they're mitigating the devastating medical, emotional, financial impacts of breast and cervical cancer on low-income, underserved individuals. So the goal of this bill is to extend those critical life-saving services to more Californians, specifically to those with annual incomes up to 45,180 dollars as opposed to the current limit of 30,120 dollars.

As you just heard from Courtney, individuals within this income range still do have difficulty securing affordable health coverage options, so access to these programs would mean that they may not have to make extremely difficult financial decisions or even put their lives at risk by postponing or delaying screening. So with that, we respectfully ask for your aye vote, and I'm also happy to answer any questions. Thanks.

Thank you. Any other witnesses in support, please come forward. State your name, organization, and position.

Kelly Brooks, on behalf of the County Health Executives Association of California, here in support.

Good afternoon. Mark Farouk, on behalf of the California Hospital Association, in support.

Whitney Francis with the Western Center on Law and Poverty, in support.

Vanessa Cajina, on behalf of the California Academy of Family Physicians and the California Pan-Ethnic Health Network, here in support.

Dylan Elliott, on behalf of the California Medical Association, in support.

Christine Smith, Health Access California, in support.

Molly Robson, Planned Parenthood Affiliates of California, in support.

Ryan Spencer with the American College of OB/GYNs, District Nine, in support.

Tim Madden, representing the California Society of Plastic Surgeons, in support.

Chris Myers with the California School Employees Association, in support.

Jennifer Snyder with Capitol Advocacy, on behalf of City of Hope, National Medical Center, and also the California Life Sciences, in support.

Moira Topp, on behalf of Biocom California, in support.

Marvin Pineda, on behalf of the California Primary Care Association, in support.

Fred Note. We're representing Stanford Health Care, in support. Thank you.

Thank you, Senator Durazo. We have established quorum at 2:08, so we're just going to call the roll.

[Roll Call].

We have a quorum. Thank you. Any witnesses in opposition? Moved by Aguiar-Curry, seconded by Dr. Arambula. Any other comments or questions from the committee? Seeing none, thank you for presenting this bill on behalf of Senator Atkins. With that--

Secretary, please call the roll.

Thank you, Members.

Motion is: do pass to Appropriations. [Roll Call].

That measures out 10 to zero. We'll move on now to item number seven, SB 1289, Roth. Hello, Chair. Please proceed whenever you're ready.

Thank you, Madam Chair, Members of the Committee. First, let me note I accept the amendment noted in the Committee analysis. As you note, the bill requires the DHSC to collect data and develop standards for call centers operated by the counties to assist people with their Medi-Cal redetermination and determinations.

Federal and state law require that people be able to apply for Medi-Cal, ask questions, and turn in information for their Medi-Cal determinations over the phone. However, as unfortunately, the wait times faced by many Medi-Cal recipients to reach county workers by phone, in some cases are long, sometimes too long.

Some people report waiting for hours, some report never getting through at all, and others report calling in only to have the system hang up on them.

This bill will require counties to submit certain data regarding call center wait times and will require DHCS to establish standards so that people on Medi-Cal may obtain the assistance that they need.

I have carefully reviewed the policy comments noted in the analysis and commit to working to stakeholders with respect to the issues that committee staff and Madam Chair, you've indicated.

Thank you, Chair Roth. You have primary witnesses in support.

Hello. Whitney Francis, health policy fellow with the Western Center on Law and Poverty, proud co-sponsor of SB 1289, which would provide greater oversight and accountability to county call centers to ensure eligible people are able to keep their Medi-Cal coverage.

For years, people receiving or applying for Medi-Cal and their representatives have struggled to access county workers by phone due to long wait times, call disconnects, and language access barriers. During COVID, it got worse due to staffing issues that remain to this day.

People are still struggling to reach county workers by phone, and when they can't, it often means their Medi-Cal gets cut off.

A recent survey of Medi-Cal members who lost coverage found that of those that had returned their renewal packets, 35% said they couldn't get through when they tried to call to figure out what was happening with their Medi-Cal coverage. Even in counties with shorter wait times, actual processing times can be much longer.

Meanwhile, Californians are losing their health care coverage. California can and should do better. This bill would require the Department to collect and publicly report county call center metrics. This provides the Department with an opportunity to better understand barriers and county specific issues which will ultimately help resolve systemic gaps and issues.

Healthcare coverage for millions is literally on the line. We urge your aye vote on this Bill that passed unanimously out of the Senate with no no votes. Thank you.

Good afternoon. My name is Kevin Aslan. I'm with the Coalition of California Welfare Rights Organizations. We're involved in this Bill because call centers has been a major problem with beneficiaries of Medi-Cal and other public benefit programs.

Department of Healthcare Services has been doing a survey about procedural denials because a lot of people get denied benefits because of the procedure. It's not that they're ineligible, it's just that they all meet the county business practices. During, six months ending with April, 31% of the people had no idea that they had to do this annual redetermination.

45% of the people never got the forms to complete and sent back. 32% of the people said that they were not able to get through the lines and deal with the call center. And we do. And most of the people who are victimized by this system are Hispanics.

Finally, I would say that LADPSS does surveys and we get with the Public Records Act request, we get information, and 30% of the people, more are denied because of not being able to get to the system. Thank you. Sorry. Take time.

Thank you. Are there any other witnesses in support? Please come forward.

Me again. Molly Robson with Planned Parenthood Affiliates of California in support.

Nicole Wordelman on behalf of the Children's Partnership in support.

Colleen Corrigan on behalf of Children Now in support.

Thank you. Are there any witnesses in opposition? Thank you. You'll have two minutes.

Good afternoon. Amanda Kirchner on behalf of the County Welfare Directors Association. We are currently in an opposed unless amended position and want to thank the author for the amendments he's already taken and has committed to take in the future. Our opposition really stems from a couple of different things.

First of all, we want to make sure that any of the standards that are created are created as part of a collaborative approach where counties have input. We want to make sure we're a part of the process, and I believe some of the language reflects that we will be included in that stakeholder process.

Additionally, we want to make sure that we have funding to meet those standards. Right now, we have a hiring crisis for our county workforce, as you are all very well aware of, and that goes through many of our public sector vacancies.

We want to make sure anything that's created is something that we can actually meet, especially as these are new standards and not things that we currently have in place. Additionally, I want to make sure that any of the standards reflected are available for us under our IT concerns.

So, all of our counties use our CalSAWS systems, but not all of the counties use the phone applications through CalSAWS. Some of them use additional IT vendors, and so not everybody has the same functionality.

We want to make sure that the metrics that are asked for are things that are available for us to collect or that funding is provided to upgrade those systems to do so. I also want to make sure that any of the standards created are reflective of our call centers that also process our CalFresh applications.

Under current law, Medi-Cal eligibility workers are cross-trained on CalFresh so that we offer them a CalFresh application as well. And so, for some of the delay in the call centers, it's because we're actually doing two jobs at once. We're both processing the Medi-Cal portion, but then additionally doing the CalFresh portion.

And so, we want to make sure that the standards are reflective of that as well. And so, I want to note for you all that we are concerned, especially because the Medi-Cal COLA has been potentially been eliminated.

And so, for that, the funding issues and making sure we have the ability to go forward with these standards is crucial for us. Thank you.

Any other witnesses in opposition? Seeing none. I'll bring it back to the Committee for comments or questions, motion by Arambula, seconded by Sanchez. Chair, thank you so much for bringing forward this Bill. I think the witness testimony just pointing out that highlighting the glaring challenges that we have and lack of service provided is incredibly critical.

I certainly hear a lot of the comments presented by the County Welfare Association. I'm sure in your closing you can address those.

I will say, though that what you are asking for is for us to set a basic standard and to be able to collect data, which are two things that we absolutely need to do as just a foundational aspect of the work, to ensure that everyone has Medi-Cal coverage in the way that they should, so that we don't have Medi-Cal members waiting without even us having a sense of whether or not they need to.

So with that, in your closing, please address.

Thank you, Madam Chair. I want to assure the Committee, you, Madam Chair, your Members and my colleagues sitting to the left and right of me how much we value the work that our counties perform in this space up and down the state.

I'm particularly and acutely aware of the work that the County of Riverside and the workers there perform every day to try to service those who are our most vulnerable. Those who we spend so much time working for and worrying about up here.

I am aware of the funding challenges in our counties, and I'm certainly aware of the workforce challenges in terms of recruiting and retaining workers to perform these extraordinarily valuable services.

So, I can assure you that there will be a stakeholder process associated with this Bill to the extent it passes and happens to be signed by the Governor, both prior to signature, prior to passage, and certainly afterward. As you also know, we're currently working through budget issues here in both houses.

I don't know quite know how those will all be resolved. I am aware that there are budget issues here with respect to potentially the funding for this Bill.

As we complete the budget process, we will continue to visit and revisit this issue to make sure that, to the extent possible, that our counties are fully funded for this and for the other important services that they perform. With that, unless there are other questions, respectfully ask for an aye vote.

Thank you, Chair Roth, we have a motion and a second. The motion is do pass as amended to Appropriations. Secretary, please call the roll.

[Roll call] 13 to zero.

That measures out 13 to zero. Thank you so much.

Thank you, Madam Chair and Members.

Members, that concludes the presentation of our bills to be heard today. So we will go on to voting first on our consent calendar, which are items 2, 6, 8, and 9, as previously stated, moved by Aguiar-Curry. Seconded by Arambula. Please call the roll.

[Roll Call]

Consent's out with a vote of 13 to zero. We'll move on to item number one now for vote SB 294 Wiener. The motion is do pass to Appropriations moved by Aguiar-Curry, seconded by Arambula. Secretary, please call the roll.

[Roll Call]

That measures out 10 to three. We'll move on to item number three, SB 1131 by Gonzalez. The motion is do pass to Public Safety. Secretary, please call the roll. Move by. Sorry, it's do pass to Appropriations, moved by Arambula, seconded by Rodriguez. Please call the roll.

[Roll Call]

That measures out 11 to two. Moving on to SB 1132, Durazo. The motion is do pass to Public Safety moved by Arambula, seconded by Aguiar-Curry. Please call the roll.

[Roll Call]

That measures out 15 to zero. We've now voted on all of the measures for this hearing. We will hold the hearing open for another 10. Oh, everyone's here. We'll go back and do add ons.

Item one, SB 294, Waldron. [Roll Call] Consent calendar. [Roll Call]l

Consent is now out 15-0.

Item four, SB 1131 [Roll Call]

Measure's out 12-2.

Item five, SB 1213 [Roll Call]

That measure's out 15 to zero.

Item seven, SB 1289, [Roll Call]

That measure's out 15 to zero. That concludes our hearing for the day. Thank you.