Assembly Budget Subcommittee No. 1 on Health

Thank you. We'll start as a Subcommitee, and I'd like to welcome all of you to our first hearing of the Assembly Budget Subcommitee on Health. Today we'll begin a series of hearings to examine the 25-26 Governor's healthcare budget.

And over the next few months, this Subcommitee will review and help develop a fiscal plan that will Fund critical healthcare services to millions of Californians, including Medi Cal, Covered California, our state's mental health and substance abuse treatment systems, our public health and emergency preparedness infrastructure, our oversight and regulatory tools, and many other topics.

But before we begin today's hearing, I do want to acknowledge the significant challenges that we face this year and how we will navigate this moment on behalf of California's people, our values, and the pocketbooks of millions of Californians.

While California is a donor state paying more in federal taxes than we receive back, the federal Administration and our Congress are proposing to do us harm via historic cuts to federally funded health care programs.

Since assuming my role as chair, I've met with numerous advocates and stakeholders who have shared deep concerns about the uncertainty and the focus on harming California residents.

The federal threats have the potential to create sicker communities and to harm 15 million Californians who are getting care from Medi Cal, 2 million Californians who have signed up for Covered California and received subsidies from the Affordable Care Act.

And they also have the potential to harm California's doctors, hospitals, clinics and providers who rely on federal funding to keep their doors open and to continue to see patients again. These threats happen even as California taxpayers give more to the Federal Government than we receive back.

While the details of the federal cuts are unclear, I do want to say that I am committed to leading this Subcommitee in a way that advances California even in uncertain times, which means safeguarding health care coverage for undocumented people, upholding women's reproductive care, ensuring that Californians have access to comprehensive gender affirming care.

But it also means improving health care quality, lowering costs, expanding providers and investing in innovative solutions. And I will say that I believe this Subcommitee is fully prepared to respond to the shifts in the federal landscape and that we are committed to preserving the progress that we have made and building on hard won gains for our state.

To that end, we have scheduled a tentative hearing in April to review any federal policy changes and assess their impact on our state's health care system. And I want to say thank you to my colleague who is here and all of our colleagues who are on this budget Subcommitee for their partnership.

To the many advocates and stakeholders who have been standing up for Californians for years and to Members of the public for their continued input into this process. We have much work to do, but before we get into the hearing, I'd like to invite Assemblymember Bonta if she'd like to provide any additional opening remarks.

Thank you so much. Chair Addis, I am very thankful that you are taking on this incredibly important role for us in the state Legislature and the Assembly at this critical time when so many of our lives are literally at stake with the decisions that are coming down from the Federal Government right now.

And make no mistake, it's not only the impending decisions around Medicaid or waivers associated with the ACA, but and much more is the decisions around closure of the Nih, suspicion of the CDC and all the things that are happening right now in real time that are impacting.

We know what our healthcare system is going to look like today and tomorrow and in the future, unfortunately. So we will take this job with great the seriousness with which it deserves, and I'm very thankful that I get to serve with you in this capacity.

Well, thank you and a few housekeeping notes Today's hearing we will discuss the budgets for the California Department of Public Health as well as the Emergency Medical Services Authority.

We have eight issues as listed on the agenda, and the agenda is available online on our Committee website, and physical copies are available at the entrance of the Committee room. After we conclude a panel presentation on each issue, we will take questions from Members and then comments from the public.

All public comments will be taken in person at the end of each issue, and public comments should pertain to the specific panel presentation. If you're unable to attend this hearing in person, you may submit your comments via email to asmbudget.

And so we will move right into our first issue with the California Department of Public Health, the State of the Public Health Report. And our first is for our first issue, our Subcommitee will receive the State of Public Health report and you all have background information on page two of the agenda.

As a reminder, California law requires the State Public Health Officer to submit a biennial written report to the Legislature beginning in 2024. And in addition to this written report, the State Public Health Officer also presents an annual update to the Assembly and Senate budget Committees. And this year we are receiving the annual update.

So our Committee is very pleased to welcome Dr. Erica Pond, Director of CDPH and California's PO Public Health Officer. And we want to also take the opportunity to congratulate Dr. Pon, who was appointed to the role just earlier this month. Welcome.

Thank you very much. Good afternoon, Chair Addison Members, as noted, I am Dr.

Erica Pon and I have the great honor to serve as your new State Public Health Officer and Director of the California Department of Public Health as of this month, and I'm grateful for this opportunity today to present on the State of Public Health in California in 2025.

I'd like to start by emphasizing that public health aims to promote health and well being and to prevent illness and death before they occur, increasing protective factors and reducing exposure to things that may make us sick.

With this focus on prevention, we promote a healthy life course starting from the conditions we are born into and setting foundations for wellness throughout our lives. Public health activities are investments in keeping people well, in contrast to health care, where we spend most of our health dollars caring for illness.

In the years leading up to the pandemic, public health funding in California remained flat or decreased and it was largely funded by categorical, sporadic federal and state special funds restricted to very specific diseases or activities. COVID 19 was an unprecedented challenge that underscored the importance of a strong public health workforce and the need for 21st century infrastructure.

The introduction of COVID 19 disease not only changed all of our lives, the health impacts led to a drop in life expectancy for the first time in two decades, from 81 years in 2019 to 78.4 years in 2021.

Our statewide response included a large influx of one time state and federal dollars that allowed us to improve our data and disease response systems and expand our workforce dramatically.

Now, two years into recovery, COVID 19 is just now no longer among the leading causes of death and life expectancy has rebounded thanks to the future of public health investment. California has addressed some critical resource gaps and improved capacity and flexibility to maintain core public health operations.

This investment is crucial to sustaining some of the gains we've made, especially as we face upcoming expiration of significant amounts of one time federal COVID 19 funding in 2026. It will take continued commitment to address ongoing and future threats and improve population health for future generations. Our public health challenges are growing in complexity and frequency.

These include health disparities, climate change driven extreme weather events, new and reemerging infectious diseases, a rise in mental health issues, misinformation and an aging population in our H5N1 bird flu response. Enhanced data systems, surveillance and coordination capabilities that we gained during the pandemic have allowed CDPH and local health departments to respond swiftly.

CDPH is leading a one health response where we work closely with many partners to address health across the animal, human and environmental health spectrum.

We are preventing exposures from infected animals or food products and working with local health departments and health systems to detect, treat and contain human cases of bird flu, with a focus on protecting our farm workers at highest risk.

While the current risk to the public remains Low, we must remain vigilant as we continue to learn about this evolving virus and how it spreads. Our teams are also working closely with federal, state and local partners including LA County and Pasadena Public Health, to prevent and mitigate health impacts of the devastating urban wildfires in LA County.

Our response and recovery efforts range from supporting health facilities, providing translations, replacing vital records, providing environmental health guidance, ensuring minimal disruptions to key services like wic, and addressing mental health resources needed for survivors and responders.

The impacts of these fires will have long lasting impacts and CDPH will continue to work with partners to support recovery now for some highlights on some key population health trends In California we have made important gains in lowering mortality.

Since 2000, death rates for cardiovascular diseases and cancers for men and women have decreased and are at all time lows. Specifically, heart disease death rates have dropped by 39% and cancer death rates have decreased by 29%. These achievements are thanks to strong tobacco regulations, health education, stigma reduction and increased access to relevant health care.

While these rates have improved, heart disease including strokes continue to be leading causes of deaths. In addition, Alzheimer's disease related deaths have increased over the last 20 years and they are amongst the top causes of deaths, especially amongst older adults.

It's also striking to note the drivers of premature death are related to injury and mental health including road injury, homicide, drug and alcohol related deaths and suicide. Although the rate of increase has slowed, drug overdose death rates continued to increase in 2023 where they reached an all time high.

Sadly, overdoses are the leading cause of death for ages 25 to 54 years old and they have risen to become the fifth leading cause of all deaths. We are also seeing increasing and concerning rates of mental health conditions amongst young adults such as anxiety and depression including hospitalizations.

Suicide is amongst the leading causes of death in younger adulthood and the highest rates are in males, adult 75 and older. Thus, our focus on behavioral health is crucial to address these major preventable causes of young lives lost.

Research shows that a lack of social connection influences behavioral health outcomes and is an independent risk factor for deaths from all causes. CDPH and this Administration have prioritized investments like the Children and Youth Behavioral Health Initiative and the Behavioral Health Services Act Prevention funding.

We have a transformative opportunity to address these heartbreaking years of lives lost in public health. We recognize that health and well being are linked to the conditions of the communities we live in. These are known as social determinants of health. These upstream environmental factors have a profound impact on the length and the quality of our life.

By identifying and addressing these foundational influences of where we live, our education, our income, the color of our skin, and our access to opportunities, we work to advance equity across many areas of health. There are significant disparities with Californians of color, particularly Black and indigenous people disproportionately impacted. Homicide rates show some of the greatest racial disparities.

And while we can be proud that California has some of the lowest infant and pregnancy related mortality rates in the nation, it is unacceptable that our Black infants and families continue to experience worse outcomes.

Some examples of how public health addresses these disparities and promotes a healthy start include nutritional support, home visiting, behavioral health, disease screening, and other focused outreach in the communities where our data shows the highest needs. Finally, as a pediatric infectious disease specialist, I must highlight the impact of vaccinations. Vaccines are a shining example of public health success.

If I were presenting to you before the vaccine era, I would be reporting on infectious diseases leading as the leading causes of death and disability.

We've essentially eliminated diseases like polio and diphtheria, and thanks to our robust school vaccination requirements and federal programs like vaccines for children, we have maintained high vaccination rates and amidst multiple large outbreaks in many other states in recent years. We have not seen large measles outbreaks in California since our Disneyland outbreak in 2014.

In conclusion, while Californians have seen major improvements in health over the past 20 years, we're also facing a critical time with evolving challenges. We must do better to communicate and build confidence in the science that public health is built on and leverage the data we collect to empower our communities we serve to be healthy and address equity.

We know this work contributes to healthier Californians and we're committed to working with you and to sustain our investments and achieve our shared vision of saving lives and promoting healthy and thriving communities. Thank you for your partnership towards a Healthy California for all.

Thank you. Dr. Pon and I just have a couple quick questions before I turn it over to Members of the Committee. I'm sure have their own, but I wonder if you might talk to us about any challenges you're facing in public health given what you're hearing at the federal level.

We are tracking all of the changes very closely and coordinating and collaborating with our health and human services agencies partners and working also with our local health departments and other impacted partners. The federal health agencies are continuing to provide some guidance and funding of our core programs.

We have received support and coordination of response and recovery during our H5N1 outbreak for for one example, and we remain steadfast in our commitment to protecting our progress in improving health and well being. We're continuing to prioritize our historically marginalized populations that face health inequities and are more vulnerable to suffering health harms.

And we will continue to track this closely. But we're steadfast in our commitment to health equity.

Thank you. Given what we know and what you've just talked to us about in terms of leading causes of mortality, morbidity, where do you see us going from here?

Well, as I mentioned, I think having really this addressing the social determinants of health and working with all of you to really help show you how all of these policies, we call this approach a health in all policies approach, all of these social determinants are incredibly important to our healthy and thriving communities.

We really look forward to sustaining this investment in our public health Department and the data and the programs that we have to serve our most vulnerable.

Thank you. And are there any questions from the Committee?

Assemblymember hi, thank you so much for your report. I wanted to check on the, you know, or just I guess more express, I think how important that the abortion.ca.gov website is this moment.

It's something that I think needs updating and probably a kind of 2.0 version of itself, especially in light of evidence based information, facts about abortion treatment, safety, all of the medical information that has been lost at the federal level that it's really, I think, critical for us to fill that void as much as we can.

Has there been any discussions around that? Do you have a sense of what that might look like or what that might take from a budget perspective or any insights into that?

I'll have to get back to you specifically on that website. But I do want to mention and highlight that one of my priorities in my new role is about our communication and our data and really being able to leverage and use our data to inform action.

And as the largest state in the nation with data on 40 million Californians, we are really committed to improving our updates overall and our communication to our populations and the public. So we'll have to get back to you specifically in that website. And we're also, of course, committed to reproductive health.

Thank you.

Sure.

Assembly Member Ponta thank you so much. Dr. Panel, I really appreciated the information provided around morbidity and mortality as it relates to the incidence of violence, homicide, suicide, drug, alcohol and death overdoses right now.

I've long fought for the notion of recognizing that our violence is a public health crisis, and we are certainly in it in my district in many parts of California.

Can you give a sense of kind of in your first 90 days on the job, what you think you might focus on for the Department of Public Health related to public violence and violence intervention interruption.

I think all of our interventions related to behavioral health are really going to improve resilience and really address a lot of these premature deaths that I was speaking to. It's really impressive to look at the charts of again, sort of premature deaths and young lives lost.

And all of them, I think, can really circle back to behavioral health and mental health and all of these other social determinants as well.

So I think being able to continue to invest in the California Behavioral Youth Initiative and as we are planning towards the Behavioral Health Service act prevention funds, I think all of those resources are really going to be looking at different aspects of mental health supports and resilience that I hope will really address both violence and other mental health conditions that are leading to these premature deaths.

Any other? No. Okay. Well, thank you so much, Dr. Pon. We really appreciate your insight and testimony. And we're going to open this issue for public comment. And so please do make sure your comments are directed toward the State of Public Health report. Is there anyone for public comment? Okay, seeing none.

I think we'll move to our next panel. No, please.

Good afternoon, Madam Chair and Members. My name is Carly Stelzer. I'm here on behalf of the California Behavioral Health Association, representing Members providing services to Californians in every stage of life across the state. Our Members are on the front line of delivering critical behavioral health services in the expansive fabric of our state system.

As the Department of Public Health presents its funding priorities, I urge this Committee and the Legislature at large to reaffirm and strengthen the commitment to mental health and substance use treatment across the state throughout the budget process. Despite the persistent challenges, we cannot afford to lose ground on the essential programs that support our community's well being.

Programs such as the California Reducing Disparities Project, the Office of Suicide Prevention, the Substance Use and Addiction Prevention Branch, these all play an irreplaceable role in addressing disparities, preventing crises, and ensuring that Californians can access life saving services.

Our Members are deeply engaged in these programs and we see firsthand the impact they have on individuals and Families across California. We urge the state to protect and sustain these investments in behavioral health and ensuring the programs made in prevention, early intervention and equitable access to care are not lost. Thank you for your time and consideration.

Is there any. No one else? Okay with that? We'll move on to our next issue. Thank you so much, Doctor. We're going to move on to our second issue under the California Department of Public Health, still the Budget overview and budget change proposals. You can find background information on page four of the agenda.

And for this panel, we will welcome representatives from the California Department of Public Health, the Department of Finance, and the Legislative Analyst Office. And we are asking the Administration to give short overviews of the department's eight centers, the CDPH proposed budget, and the 10 budget change proposals that are listed on the agenda.

And I'm going to ask each of you to introduce yourselves before your testimony. And I'll turn it over to whoever wants to start first.

I'll begin. Thank you. Madam Chair. Brandon Nunes. I'm the Chief Deputy for Operations at the Department of Public Health.

Riley Thompson, Budget analyst at the Department Of Finance.

Will Owems Analyst with the Legislative Analyst Office.

And please feel free to begin your testimony. Thank you. Thank you.

Director Pon gave a good overview of the programs and the centers within the Department. So in interest of time, I'll go through those proposals that you mentioned.

The budget proposals that we have in General for our Department, we have a budget for 2526 of 5.1 billion that's broken down by $730 million General Fund, about 2.3 billion from federal Fund sources, and then 2 billion from special funds or reimbursements from other departments.

The 10 BCPs that you mentioned that we have proposed, I'll just as you mentioned, give a very quick high level overview of all of them. The first one is an augmentation to our Baby Big program, our infant botulism treatment and prevention program.

This particular request is requesting 3 million for 2526 and 2.2 million ongoing from our special Fund that will support two positions in this program and it will be used to address increased manufacturing and regulatory costs for Baby Big, which is the sole license treatment for infant botulism in the U.S.

our next proposal is related to our biomonitoring program. This is a funding realignment. We partner with the Department of Toxic Substances Control and we usually do a contract with them for $425,000. This will just ship that funding to DTSC so that they'll have the funding that they need to support their environmental chemistry laboratory.

Moving on to our Center for Healthcare Quality we have an internal departmental quality quality improvement account in the Department. We are requesting $3.11,000,001 time from that Fund and it's going to Fund the Center's transition to an automated online licensing application system. Also in our Center for Healthcare Quality is our Public Policy and Legislative branch.

We're proposing an expansion to that branch of $1.1 million from our licensing and Certification Special Fund that'll go to support seven positions. It'll help us reduce a backlog of approximately 33 regulatory packages ensuring that healthcare facilities are operating under updated standards.

Over in our Center for Healthy Communities we have a proposal for the Governor's Advisory Council on Physical Fitness and Mental well Being. This request is to reappropriate funding from previous years.

We're requesting 2.5 million in General Fund on a one time basis that'll be use through June 30th of 2027 and this will help us continue the Council's work in promoting physical fitness and mental well being.

The next proposal going back to our Center for Health Care Quality is and the next few are related to legislative bills that passed over the last session. This first one is related to Assembly Bill 3030 related to artificial intelligence.

We're requesting 670,000 from our licensing and Certification Special Fund that'll go to support three positions and it'll ensure that healthcare providers that are using AI for patient communication provide disclaimers and clear instructions describing how a patient can communicate with a human healthcare provider. The next proposal is related to Senate Bill 1354, long term healthcare facilities.

We're requesting 300,000 from our licensing and certification program Fund to support 1.25 positions and that will help us implement SB 1354 which required skilled nursing facilities to disclose census and staffing Data. The last two BCPs are related to our mental health and impacts on social media.

That Bill From Assembly Bill 1282 is requesting 463,2526 and 230,000 in 2627. This is all one time funding.

In this case it's going to help us develop a legislative report on the impact of social media on youth mental health and then finally for BCPS workers Secondhand Cannabis Smoke guidance related to AB 1775 this is a request for 183,000 General Fund and one position that will support the development and implementation of CDPH guidance on secondhand cannabis smoke exposure for workers at cannabis consumption sites.

We have a couple of adjustments that we do every year related to our tobacco funding. Prop 56 and Prop 99, as was highlighted in your agenda, had updates to six different accounts that we use out of both of those funds. As you may be aware, those tobacco funds are a declining revenue source.

And in this case, for Governor's Budget, we're proposing a reduction across all Those accounts of 38.11.0 million million 1.0 as a result of the available revenue. Department of Finance will of course assess that again, the May revision and we might come back to you with adjustments at that time.

And then we do adjustments to a number of different estimates that we have in the Department. Our genetic disease screening program, our licensing and certification program, and of course our Women Infants and Children program. For GDSP, we're proposing 140 million, which reflects an $800,000 increase at this time.

And that's going to ensure the continued operation and expansion of the genetic disease screening program for licensing and certification. 486.1 million in total is being requested, which is an $11.5 million increase from last year. And then finally for the WIC program, it's a $1.25 billion program for 2526, primarily from federal WIC grant funds.

And this represents a $31.5 million increase from last year. I'll leave it there to see if there's any questions. And I have support in the audience for those who administer these programs.

We'll do all the testimony first and then move to questions. Thank you. I'll turn it over to nothing to add at this time from the Department of Guidance.

Yes, so specifically on the proposal to reappropriate the funding for the Governor's Advisory Council on Physical Fitness and Mental well being, we would just note that given the state's budget condition, the Legislature may wish to weigh this proposal for funding against other kind of discretionary legislative priorities, given the State of the budget and moving forward.

That being said, from the other proposals, we have not raised any concerns but are available for questions.

Great, thank you. I think I'll start with my main question, which is considering the conversation around Medicaid funding and how that might affect you. What are you thinking in terms of where to go next with the budget and how to navigate if there are Medicaid issues that affect Medi Cal and some of the things mentioned here.

Are you. Just to clarify, are you perhaps.

So I'm thinking about the federal funding that flows through.

Yeah. And as Director Pan mentioned earlier, that's of course something that we are definitely watching very closely. We're going to be working with our agency and Department of Finance to the extent we identify issues with federal funding to date. None at this point to report, but we'll definitely keep the Legislature in the loop as we learn more.

And then my other question is really around the tobacco tax funded programs that we're all very happy that people are smoking less but obviously it's causing funding issues and I do hear about them quite a bit in my community. And so what you're thinking is, you know, how we adjust.

Yeah, it's, it's. Thank you for the question. It's definitely a two sided corner. You know, to the extent, you know, we're able to do cessation, it also impacts the taxes or the tax revenue that we receive. You know, we're still working within the administrator.

We're not the only Department that obviously spends out of these, these accounts in 56 and 99. There's a number of other departments that do. So I think we need to identify an Administration wide solution for it.

But you know, there are things, you know, the immediate things that you would think of like General one backfills obviously like we just mentioned with one of the other ones, they're competing General Fund priorities as well. So I think we still need to work within the Administration as far as potential options there for the finance.

If there's anything you want to add.

Any other questions?

Assemblymember Bonta, can I ask you to be a little bit more specific about the Prop 99 and Prop 56 funds and has there been any kind of budget planning around the step down of those funds in terms of revenue, when that will be, the extent to which that will happen and just anything else to be able to provide some more information about that.

We'll bring my colleague up who's the lead on this issue.

Christine Trim, Department of Finance. So the question was planning, budget planning for budget planning.

So do you have any scenario planning around the decrease in the, in the Prop 99 and Prop 56 funds, relative percentages and timing associated with that?

You just want to know generally like the patterns and how much it's declining. So and we did get a few questions from Patrick about this. So this year is unique. So we do see a little bit larger of a drop this year compared to the last forecast. It's about a 10% drop.

Whereas in the last fiscal year we saw closer to a 1 or 2% drop. So it compared to the last forecast, we do see a steeper drop.

When we look at the year over year though now that we apply the updated forecast, the year over year, it's not drastically different from the year over year pattern from the previous year. It's year over year starting from budget year into the out years.

It's, it varies between negative 2 or negative 2.0 or declining 2.5% to 1.5%. Whereas in the last forecast, the year over year was about between negative 2.2 and 1.8.

And what is that in absolute dollars?

So our Prop 99 revenues in budget year are about $138 million. Prop 56 is about 819 million in budget year.

And so you just reflected the prior budget years. What's the predicted trajectory moving Forward?

So for 202425 Prop 99 revenues were make sure I'm looking at this right, 157, about 157 million. And Prop 56 was about 944 million.

That's the decline. That's the representative of the 2%.

So the decline from the last forecast is again around that 10% in whole dollars. For Prop 99 it's about 16 million. For Prop 56 it's about 97 million. And just a reminder that these funds are split out amongst multiple departments.

So this is not just cdph and what's your anticipated time when it will kind of level out.

So as Mr. Nunes said, this is a declining Fund source. I'm not sure about leveling out. This was designed, you know, to decline because as a consumption tax, as consumption declines, then the revenues will decline. So you know, in this, this year it was a little steeper because there was a market decrease in consumption.

And then there was also in a little bit of an accounting fix that was done. So something was over accounted for in the previous forecast that was, that was fixed. And then also there was higher than anticipated impact from the flavored tobacco ban that the updated flavored tobacco ban from 2023.

We had estimated a higher impact in the first year, but in fact the impact on consumption was increased in the second year. And so that was unexpected. So a combination of those things created, you know, kind of a larger impact this year.

We would expect to continue to see a decline as long as consumption continues to decline, unless there are other revenue strategies, of course.

So between the two revenue sources, I'm just trying to get a hard number to the extent possible. We're looking at between 100 and $120 million in declining revenue over time, year over year, year over year.

Prop 99, so we see about a 3.6 million decline in budget year from current year to 2627. It's a 2.4 million projected decline and that it stays in the 2 millions in the out years for Prop 99.

For Prop 56, we see a 30 million decline from current year projected and 262720.8 million decline and again across multiple departments.

So more in the neighborhood of 30 to 30 to 40 million year over year. For props. I just added the two together.

So you added the 30 and 30. 33.6 million and you're adding Prop 99 and Prop 56 together. So if you're adding those together, then about 33.633.7 decline combined. Yeah. From current year to budget year.

Okay.

I had a couple questions about the. Mr. Patterson, did you want to interject? I have a couple of other questions, but I don't want to. Okay. A couple questions about the Governor's Advisory Council. So what I'm understanding you to say is that you're essentially reallocating the or reappropriating the 2.5 million to General funds.

Did you indicate where it's being reappropriated to?

As far as where it's. Gino? Yes.

Hi. Maria Ochoa from Center for Healthy Communities. So the 2.5 million is actually a reappropriation of the original $7 million that was allocated in fiscal year 2223. Was that the question? I'm sorry.

No, that wasn't the question. The 2.5 million. Do you know where you're reappropriating a too?

It will continue to support efforts for the Fitness Council.

Okay, and then my last question is around the. The opioid settlement Fund, or is that for the next panel? Okay, can you just describe for us the source of the settlement Fund and why the funds are decreasing?

I think I'll defer to finance on that.

Sure. So you may have heard about a bankruptcy of the various pharmaceutical companies involved in the settlement. And so that's largely what's driving the decrease in revenues in bankruptcies.

Typically there are.

There's restructuring of the bankruptcies that were filed by these companies.

Well, under either of those circumstances, there's still debt to be owed. So wouldn't we be a. A debtor in that instance and still be afforded funds?

There is still revenue coming in, but from what I understand, the restructuring of those bankruptcies has decreased or the revenues and I will also.

I'll let you. I'm sorry. So there was an opioid settlement where we were holding accountable pharmaceutical companies, they restructured themselves, and now we no longer have access to those settlement dollars.

They. They filed bankruptcy, and then the bankruptcies have been restructured, and that's caused a decline in revenues. We still have revenues coming in, but it's. It's not as much.

Why is it the case that we. That there's a decline in revenue restructure doesn't necessarily mean that there's fewer assets to be able to.

Yeah, I'll have to take that back to the Department of Healthcare Services, which is the Fund administrator, and they can dive more into those details and share more with you.

Okay, that would be helpful.

Thank you, Assemblymember Patterson.

Maybe I should have went because that was the line of questioning I was gonna get to. I, too, would appreciate the information on exactly who's filed for bankruptcies and then what we would expect to get compared to what we had budgeted. I know. You know, just last year there was another settlement that was 272 million nationwide.

You know, I don't know if we expect more settlements, but my initial inclination when I was reading this document was, zero, we're getting more money, not less, with more settlements. But if it's because of a bankruptcy, you know, just would really appreciate more information on what we can expect from that.

And then also just, I mean, this is more of a policy issue for I think, just generally is if there are more of these types of things, you know, the risk of settlements if the company can go bankrupt and not fulfill its obligations is kind of concerning. But look forward to that information when it's available. Thank you.

Thank you.

One other question.

Sorry. For the bcp of 1.1 million for the Center for Healthcare Quality to be able to support licensing and certification. This is essentially to support the rulemaking process, Correct? Correct. When did the rulemaking process begin?

When does the rulemaking.

When. When did you all start the rulemaking process to redo the regulations?

zero, for CHCQ on that one.

Hi. Chelsea Driscoll with chcq. So the Department has a large number regulations that have not been updated in a number of years. Our current list, we have about 30 packages that are in process.

When we look at the average time that it takes to process and complete the regulatory development process, we identified that it would take, with our current resources, that it would take approximately 20 years to update everything that needs to be updated currently.

And so we're asking for the Additional resources to expand the capacity of the team to tackle more packages so we can get updates done quickly.

My question was, when did you start the process?

I'm not sure I am understanding the question.

So at some point, the Legislature provided a significant amount of funding to DCPH to do this regulation and rulemaking process. My understanding is that that happened decades ago with different tranches of funding provided over time to DCPH to continue this effort.

When we're down to counting every little penny, I'm wondering why that work wasn't completed and why we are looking at having to make another appropriation.

Okay, so I. I think I can address your question. So the Department has received resources to complete packages. However, as the law continues to change, there's an ongoing need to update regulations on an ongoing basis.

Have you completed the title 22 health regs? Have those been updated?

Those are the regulations that I'm speaking of.

Okay. All right. Thank you. Thank you. I think we'll. Unless there's anything else, we'll move to public comment. Is there any public comment? If you could please direct your comments towards the budget overview and change change proposals and keep your comments to close, as close to one minute as possible.

And if you're speaking to a previously stated position, if you could provide name, organization and state your position. Welcome.

Hi. Hello. My name is Sarah Whipple and I'm a co Director at the Yuba Harm Reduction Collective where co Director, free funded syringe program serving Nevada County, California. The CO FREE funding has saved thousands of lives and I know that firsthand because it saved my life.

When I was 23, I overdosed after taking a drug that contained fentanyl. But I didn't die. And I'm standing here today because a CO funded harm reduction program had given my friend free naloxone and taught him how to use it. And he used it to save my life. My story is far from unique.

Since 2018, over 190,000 lives have been saved by Californians who received naloxone from a harm reduction program and used it to reverse an overdose. The overdose crisis impacts everyone, but it disproportionately impacts communities of color. Please don't defund the front lines fighting this crisis. Continue the CO FREE funding and allow us to continue saving lives. Thank you.

Hi everyone. My name is Selena and I work at a trans and non-binary-led and serving harm reduction program in Sacramento largely funded by COFRI and I'm here to oppose the proposed $8.4 million cut to the COFRI budget.

We know that harm reduction programs are crucial to the health and survival of both of Trans communities and communities of color. With this funding, we staff and maintain programs by us and for us. In the past month alone, our program has safely disposed of over 4000 new syringes which would otherwise be on our streets.

And in the past year and a half, we know of at least 200 documented overdose reversals from naloxone distributed through our program alone with CO Free funds. Programs like ours center and care for communities that are often forgotten about.

This funding allows us to care for one another despite all the forces that do not want us to exist. Please continue the CO Free funding and allow us to continue saving our own lives. Thank you.

Good afternoon Committee. My name is Laura Thomas and I'm with the San Francisco AIDS Foundation. We are also a grantee of CO Free Dollars and we use that to distribute thousands of doses of naloxone in San Francisco and have been able to report hundreds of overdose reversals. I know that this money is.

This is funded with opioid settlement dollars. I understand that because of a couple of bankruptcies, some of this money is going down. However, there's still around $4 billion coming to the State of California through the opioid settlement funds.

We think that moving this $9 million away from COFRI will really undermine our state's efforts to turn the tide of the overdose crisis. As you heard from Dr. Pon that deaths are still going up. This is an investment in the most effective overdose outreach and reversal programs that we have in the state.

The Legislature invested $60 million in this programs a couple of years ago and we would ask that you continue that very cost effective investment and keep the money in the California Overdose Prevention and Harm Reduction Initiative. Thank you.

Hi, my name is Jordan Pugh. I work at Yupa Harm Reduction Collective up in Nevada county servicing the Grass Valley, Nevada City area. We are a state authorized syringe service provider along with a registered 501C3. Half of our funding for our programs are state funded. This is a very scary thing, especially when federal funding is at risk.

The State of California needs to continue leading the way for harm reduction services to keep overdoses down. Last year we saw a decrease in overdoses and we need to continue doing this. Back in 2020, Nevada county was in the top 10 of reported overdoses that are fatal.

And now it is no longer doing that due to the services our program is providing. Last November we provided a point in time survey and were able to collect data to help tell the story of our participants reversing a fatal overdose every other day for the State of for the year of 2024.

Please don't reallocate this funding so we can keep our jobs and keep doing the life saving work in our small town since we are one of the only ones doing it. Thank you.

Good afternoon Assembly Members. My name is Greg Gardner. I'm here on behalf of the Drug Policy Alliance. Also in opposition to the 8.4 million cut to CO3.

This is not the time to be reducing support for the community based organizations that have been most effective in reducing overdose and that do so much to establish connections to care for people that need them the most.

The community based programs funded by this initiative accounted for 56% of the overdose reversals reported to the state naloxone distribution program last year. To be most effective, Naloxone needs to be in the hands of those most likely to be present at the scene at the time and place of an overdose.

The harm reduction programs, their staff and volunteers are the ones that put naloxone in the right hands and train people how to use them. As you've heard today, we should build on those programs and invest more of them rather than cut them.

These funds were allocated to CDPH in 2023 in the 2023 budget to be spent over four and a half years. We urge you to let it move forward as planned. It does not negatively impact the General Fund and it is doing so much to save lives. Thank you.

Hello. Dr. Esther Chung. I'm an epidemiologist at RTI International, a nonprofit research Institute and I'm based in Oakland, California. We evaluated the initiative's predecessor program and found the CDPH supported programs distribute or sorry served more participants, distributed more naloxone and offered more buprenorphine treatment to participants than non supported programs.

Decades of research have demonstrated the effectiveness of syringe services programs in delivering evidence based interventions such as naloxone to vulnerable communities who are at the highest risk of morbidity and mortality. Across the US and in California, syringe service programs are not adequately funded and do not meet minimum funding amounts as recommended by CDC. CDC.

Please reinstate these opioid settlement funds so these programs can continue providing evidence based critically life saving services in our communities. Thank you.

Hi. Kat DeBurgh with the Health Officers Association of California representing the physician health officers in California cities and counties joining with my colleague to joining with my colleagues to support the Fund Staying in COFRI.

These vital harm reduction services not only distribute naloxone but also serve as a bridge to treatment and prevent the spread of disease, which is why we support these funds. Thank you.

Hi, my name is Matthew May. I just want to say a little bit about harm reduction. I remember the days when syringes were hard to come by and sharing a syringe was a common occurrence. Of course we knew to clean them with bleach, but a lot of people I knew got hepatitis C through sharing needles.

Seemed like nothing short of a minor miracle when the needle exchange program opened up through which I and many like me could get syringes, new syringes and just as importantly, safely dispose of used needles. Harm reduction programs helped me to get free non judgmental medical care when I needed it.

I also get free Narcan and education on how and when to use it. Keeping Narcan on hand when it allowed me to save the lives of people who had overdosed on at least six different occasions when I was ready for it.

A harm reduction program helped me to see a Doctor who prescribed me buprenorphine, which helped me to get off heroin and methadone. Once I stabilized on buprenorphine, my life changed for the better in so many ways and I remain free of the substances today. I know that harm reduction saves lives and it saved my life.

And please continue funding it. Thank you.

Chair Members. Kathy Mossberg, on behalf of APLA Health and a Member of the and the Epidemics Coalition. We just want to support the comments made here by all our colleagues. This funding is vitally important and we urge you to maintain it. It's incredibly cost effective. Thank.

Is there any other public comment? We're good. Well, thank you so much to our panelists. We appreciate your time. We're going to move on to issue three, which is information and technology proposals from the California Department of Public Health, which there's background on page 12 of your agenda.

And on this issue, we're asking the Administration to give a short overview of the department's key information technology platforms followed by an overview of your four IT related proposals that are included in the Governor's Budget. And we have representatives from cdph, the Department of Finance and the Legislative Analyst Office.

I will ask you to introduce yourselves and then please feel, feel free to start your testimony as soon as you're ready.

Good afternoon. Adrian Barraza, I am the Assistant Deputy Director with the Center for Infectious Disease.

Hello. Christine Tribbenlong, Finance Budget Analyst, Department of Finance.

Will Owens, analyst with Legislative Analyst Office Reed.

And please feel free to start your testimony.

Thank you. Very much so. I'll start off with a brief overview of our IT platforms and then jump right into an overview of the budget change proposals. So CBPH operates several information technology systems to support vaccine distribution, immunization, record keeping, disease surveillance, and public health response coordination.

These systems are an important part of our infectious disease IT portfolio and are part of an integrated disease monitoring response and an immunization data ecosystem that function in a complementary way. This includes the California Vaccine Management System, which is a centralized vaccine management solution that is utilized statewide. This solution includes three interconnected platforms.

The first is MY cavax, which facilitates vaccine ordering and distribution distribution functionality this platform supports the ordering and distribution of more than 10 million vaccine doses annually to more than 7,000 healthcare providers and is essential for ordering and distribution for all vaccines provided to children on Medi Cal. The second platform in VMS is My Turn.

This platform facilitates vaccine clinic Administration which is directly tied to vaccine ordering and distribution. In addition, data about vaccines is delivered through vms. Supported clinics are provided directly to the California immunization registry or CARE.

In fiscal year 2324, VMS supported more than 9,000 thank you very much clinics administering more than 1 million vaccine doses with more than 1 million Members of the public using the system. And then the last platform is the Digital Vaccine Record or MY dvr.

This platform makes vaccine records from the immunization registry available to Members of the public and IT also has a function to correct errors in vaccine records. VMS links directly to CARE and IT makes immunization records accessible to the public. Members of the public can correct their care records automatically through the system.

Both public data access and data correction are required in Health and Safety code, and approximately 1.7 million people use this functionality each year and more than 6.5 million digital vaccine records are accessed annually.

The next system I'm going to briefly cover is a SAPPHIRE system which enables the Department to receive electronic data submissions from laboratories and health care providers. Data flowing through SAFIRE flow into downstream CDPH disease monitoring systems like Cal Ready to facilitate disease surveillance and CalConnect for case investigation and contact tracing.

SAFIRE is essential for monitoring more than 100 infectious and non infectious conditions at CDPH and processes more than 16 million disease reports each year. And then the last system I'm going to cover is CalConnect, which is a suite of tools that make case investigation and contact tracing activities more efficient and effective.

These tools enable CDPH and local health departments to understand and control several infectious diseases including COVID 19, monkeypox, tuberculosis, Avian Influenza Ebola and it's currently being configured to facilitate CAST investigation and contact tracing for sexually transmitted infections and HIV. CalConnect connects to the California Immunization Registry and it imports vaccination information automatically.

This supports decision making by disease investigators about how to best follow up and to advise persons exposed to infectious diseases such as COVID 19 and monkeypox. And then with that I'm happy to run through the budget change proposals. So CDPH is requesting state General Fund to support for three of our infectious disease data systems.

For CalConnect, we're requesting 18 million in fiscal year 2526 to support CalConnect maintenance and operations. The remaining M and O cost for budget year of 15 million will be funded through federal funds.

For Sapphire, we are requesting 15 positions and $27 million General Fund in budget year 20.4 million and 2627 and 16.3 million in 202728 and ongoing for M and O support. And lastly for the California Immunization Registry project we're requesting 5.1 million in General Fund in fiscal year 2526.

The remaining project cost for budget year of 8.6 million are being requested from federal funds via federal Match. And then there is one more budget change proposal. Related information technology.

There's a request to shift 381,000 in ongoing General Fund from CDPH to California Health and Human Services to replace the current interagency agreement for two positions that are working on IT Capital Planning Prioritization and IT Enterprise Portfolio Risk Management. And with that I'm happy to answer any questions that something may have.

Is there any other testimony? Nothing to add but I'm here to answer questions.

Thank you.

Well, thank you. I really appreciate that overview I'll start with the first question I have is really goes back to something that Dr. Pond said around vaccinations and in her opening testimony she pointed that out as well.

One of the huge steps forward that we've made in public health and that life would be very different if we were in a pre vaccination world. And so my understanding that the money for my CAVAX runs out in June of this year and that there's zero plan for that platform.

So the funding for YCAVAX and the broader VMS system does expire at the end of this current year. We do have around 5 million in federal funding that we were able to identify for fiscal year 2627 but absent finding additional funding there is a substantial gap that needs to be met to continue the system.

And did we know this funding was going to run out?

We did.

Okay. And so, knowing how important vaccinations are and the sharing of information around vaccinations, the decision nonetheless was made to just sort of let it go.

So I will actually defer to my Department of Finance colleague on that one.

Yes. So you don't see mycalvacs in the Governor's Budget, but this is something we're continuing to assess within the Administration in terms of ongoing funding requests and looking at various federal funds that could support this as well. I know my colleague mentioned some federal funds that they've identified. In addition, there's.

We're also looking at some Medicaid dollars, some Medicaid matching dollars.

Is the. Is the 5 million that you've identified enough to keep this program going and for how long?

No. So there's about a, I believe, a $39 million gap that needs to be bridged.

Okay. And. And so I think I'm hearing you say you're going to look to Medicaid, but we are hearing so much rhetoric about potential cuts there. And so is that the only place that you're looking for funding?

No, that's one source. And as I mentioned, that's a matching grant or matching matching Fund. So it would require a state match. Yeah. So we are. That we are continuing to assess the situation.

I think it would be important, and I'm sure other colleagues up here on the dais have questions about this, but I guess I find it incredibly concerning to hear the Director talk about how important vaccinations are and then to feel like what we're hearing in testimony is that there's really not a plan outside of federal funding matching grants.

And so I just would urge you to come back with something more substantial in that area. But I'll turn it over to my colleagues. I'm sure there's others on the dais who have comments. Assemblymember Banta and thence. Yeah, I just.

I'm sure Patterson want to be really clear, because I think for people who are listening, sometimes our government speak is really confusing. So we have this. My California Vax program. The purpose of that is to vaccinate people. All different kinds of vaccinations, Correct? Correct.

We've gotten a report from our Director that that vaccination program has been wildly successful in terms of reducing the incidence of public health crises. Yes. And we are choosing not to Fund $39 million towards that MyCalvax program at this time. That's a proposal on the table at this time.

And you know we, we are leaning on the deliberative budget process and it's, it is a two phase process and we at the time of Governor's Budget we weren't ready to make make that decision. We're still evaluating a number of factors in including how we can bring the costs down.

We do appreciate how CDPH has been able to bring costs down in other systems like Sapphire and CalConnect and continuing to look at how we can continue to do that on the system as well.

And then finally the proposed solution is to watch whether the Federal Government that currently has an anti vaxxer running the Department that would allocate these funds from the Federal Government, that we would somehow get that funding. That's the plan. Right now we're relying on the Federal Government.

That's not the plan. That's one of many resources that we're looking into and we recognize that those Medicaid dollars that I had referred to and the other funding that my colleague here referred to do not make up the whole budget.

The Medicaid funding would require us to, to actually Fund the program because it's match. Correct? Correct. And we're not planning to Fund it right now at this time. Yes. That seems a little circular in terms of planning for such a vital need. So I along with the chair would encourage the Department to reassess that particular strategy.

Any further questions from the Committee? No. Assembly Member Patterson.

Thank you. How much has been invested into the MyCalvax program?

I'll have to circle back to you with the exact numbers. We have worked to bring the cost down. And so as I mentioned, for fiscal year 25-26, we're anticipating we would need $44 million collectively for maintenance and operation.

So if we kind of extrapolate that over the three or four years VMS has been functional, I would venture to say it's over $200 million. But I would have to get back to you with specific dollar amount.

No, I'm not entirely sure all the process systems of all of these IT programs, including MyCalvax. But I think, you know, the Administration on the, especially the clinic level is pretty important. Just a small comment on the SAFIRE program. I, I'm really interested to learn more about these programs.

That one's called, you know, surveillance and you know, so on and so forth. I think, you know, we got to focus on the state has invested a lot of money obviously in these programs.

I think there's a General understanding that we ought to help especially if there's going to be another pandemic, something like that, you know, distribute state supplies, especially if it's procuring and have some system to get that going.

I do think there maybe might be a knowledge gap, including with a Legislator sitting right in my chair right now on exactly the types of, exactly what we mean by surveillance.

I think in understanding in the community about how much information is shared with the state and whether or not there's a necessity behind that and whether there could be savings there. But I think in terms of the Administration, it's a God awful amount of money. I mean, I can't believe it costs that much money.

But I do have concerns about people going back clinics going back to spreadsheets and stuff like that to track how their patients are being served with, with vaccines.

So one thing I love about being on the Budget Committee is that I do think that this is an area where the Legislature does a really nice job at setting its priorities. And to me it sounds like this is something that just letting it go away. I definitely wouldn't bank on federal funding for this.

I have no idea if it's coming through or what. But this, this is probably something that if California desires to do it, it's going to have to be funded by California wait and see approach until June is probably not really feasible on this. So.

Could I just ask for the LAO? Do you have any Thoughts on this?

Yes. So the Legislative Analyst Office, I think so. Kind of given the state of the budget condition. Earlier today our office released a brief kind of detailing some opportunities and options for the Legislature to do fiscal oversight of the state budget as a whole and different aspects of it as far as it relates to the.

The types of programs that would kind of work well for this kind of oversight. You know, as there are not too many new proposals right now in the budget and the kind of State of the budget condition moving forward.

You know, our office kind of has identified fiscal oversight as a major way for the Legislature to prepare for that. And you know, the CDPH IT programs kind of based on certain criteria could definitely merit kind of further review by the Legislature kind of moving forward.

So you know, to the degree that we'd be able to assist, you know, we'd be happy to kind of kind of work with staff to evaluate.

Thank you. If there's nothing else from Committee Members, I'll open it up to public comment and I'll just remind you if you can keep your comments directed toward the information technology proposals and if you can try to keep about a minute ish.

And if you are a me too, and you are with the previously stated position, if you could just provide your name, organization and position. Welcome. Great.

Good afternoon, Madam Chair and Members. Jack Anderson with the County Health Executives Association of California representing our local health departments. CHIAC does express our support for the Governor's proposed investments in public health information technology systems including CalConnect, Sapphire and Care3.

As noted, the Governor's January budget does not include funds for the California Vaccine management system or MyCAVACS beyond this June.

This system allows our local health departments to more efficiently order, distribute and manage vaccine supplies for all of CDPH's vaccine manage, excuse me, all of vaccine programs in coordination with CDPH and local local health care providers and systems.

We urge the Legislature and Administration to not return to pre pandemic practices where our local health departments must manually track, provide, call providers and otherwise use burdensome processes. Just as one example, one small jurisdiction each day had to open a spreadsheet that took 17 minutes to open.

So just to track the vaccines and get them to the correct place within the jurisdiction. So we do respectfully request that the Legislature do provide funding for the California vaccine management system. Thank you.

Thank you. Kat DeBurgh with the Health Officers Association of California echoing the comments of my colleague. He gave a small jurisdiction example. I'll give a large jurisdiction example. Who using time tracking showed that they save hundreds of hours every year with MyCavacs for flu vaccine distribution.

And without MyCavacs, they'd be going back to phone calls, emails and spreadsheets, which is why it's important to maintain the investment in this program. Thank you.

Katherine Flores, Executive Director for the California Immunization coalition. And since 1998, we've been advocating for the registry, helped with implementation and continue with development and support for the registry. And as Dr. Pond said during her presentation, California received substantial resources during COVID vaccinate during the COVID pandemic.

And through those resources, we were able to develop amazing additional projects that helped support what we're doing in vaccine Administration now. As my colleagues have said in the inventory management, the ordering, the distribution, and then of course, things like your digital vaccine record, where at that time we were able to see our Covid vaccines on there.

And now it's been implemented so we can see all vaccine records and parents have access to those records very simply. And so we need to make sure, as Mr. Patterson said, we don't want to go back to spreadsheets.

We don't want to go back to faxes and paper pencil or having to keep track of a yellow card as much as possible. We want to make sure that we have those resources to continue what we were able to start with a bad event. We've been able to build to some new future improvements. Thank you.

Madam Chair Members. Bruce Palmer, California Association of Public Health lab directors Like Chiac and HOAC, we support the funding for CalConnect, which has been a critically important program in identifying, monitoring and mitigating the presence of infectious disease related to our work in the labs.

In addition, we support Safire MyCalvax Care3 planning for public health reporting and data exchange. Thank you.

Kelly Brooks here on behalf of the California Association of Public Hospitals and Health Systems, the urban counties of California and the County of Ventura, to express concerns about the lack of funding and the lack of a plan for funding.

MYCA vaxed Public health care systems and counties utilize the centralized system daily to manage vaccine supplies, reduce challenges with inventory management and reporting, and increase product provider capacity. My colleagues have talked about all of the administrative burdens that would sort of reemerge if we got rid of the existing system.

We're concerned that this increased administrative burden will disrupt vaccine procurement and distribution and could actually lead to reduced vaccine access. We urge the Legislature to support the continuation of funding from ICA backs in the state budget to avoid these types of service disruptions as well as public health impacts.

Thank you. Good afternoon Madam Chair and Members Jolie Onadera with the California State Association of Counties representing all 58 counties of the state here to echo the comments made earlier by both CHIAC and HOAC and requesting your support of full funding for ongoing operation of the MYCA VAC system. Thank you.

Hi. Good afternoon Members of the Committee. Mark Farouk on behalf of the California Hospital Association, also expressing concerns about the lack of proposed funding for the CalVax system. Just wanted to point out CalVax is a critical tool used by hospitals as well as other healthcare providers. A lot of the reasons that were previously stated.

It allows providers to screen patients vaccine histories to ensure that they're not vaccine duplications. It allows case management teams to help with the throughput of patients to post acute care.

And finally, it also allows for data driven decision making where that local officials and providers can collect this information and look at trends to support data driven outreach and prevention strategies. Thank you.

Good afternoon. Shannon Olivieri Hovis I'm the Vice President of Public affairs at Essential Access Health. As a Member of the California Future of Abortion Council Steering Committee, I just want to thank you for the critical investments in reproductive health care to date.

Today I'd like to lift up the importance of additional investments to update and maintain the state website established by cdphabortion.ca.gov to build on the initial site and ensure California can meet this national moment. I want to appreciate Assemblymember Xiaohu for her comments at the outset of the meeting.

Abortion.ca.gov is a critical resource to share timely and accurate information about abortion access in California, provide linkages to time sensitive care and combat disinformation. New and anticipated federal threats to abortion care and an evolving national landscape necessitate new investments to ensure the site is responsive, expanded and regularly updated.

During the first month of the new Federal Administration, clinical practice guidelines and public health data have been removed from federal websites, Reproductiverights.gov was taken down and searches for abortion on the CDC website prompt the suggestion to search for adoption. While a federal judge ordered the hhs, the CDC and FDA restore several of the web pages.

It is clear that the new Administration cannot be trusted to provide scientific evidence based, medically accurate and unbiased research data, guidelines and other sexual and reproductive health information.

Additional investments are needed to ensure that California's online hub for information about sexual and reproductive rights and linkages to care is maintained and regularly updated in partnership with content experts in the field. We also have to ensure the Members of the public know that this critical resource for time sensitive, trusted information is available to them.

We look forward to partnering with Assemblymember Chavo, Members of the Committee and other Members of the Legislature as well as CDPH to make this possible. Thank you.

With that, we're going to move to our next issue and say thank you so much to our panelists. We're going to move on to the CDPH AIDS Drug Assistance program. It's our fourth issue and you have background info on page 15 of your agenda.

We're asking the Department to provide an overview of the ADAP program and key adjustments anticipated for the upcoming fiscal year. So we've got cdph, the Department of Finance, the Legislative Analyst Office, and if you'd like to introduce yourself and begin your testimony when you're ready. Thank you.

Good afternoon. Chair Addis, Members of the Committee. My name is Joseph Lagrama, Branch Chief of the ADAP Branch and I'm glad to provide an overview of the ADAP estimate. The ADAP branch within the Office of AIDS Administers Adap, which stands for the AIDS Drug Assistance Program and PREP app, which stands for the Pre Exposure Prophylaxis Assistance Program.

ADAP provides access to life saving medications, health insurance premium payment assistance and assistance with medical out of pocket costs for eligible California residents living with HIV. PrEPapp provides assistance with medication and medical out of pocket costs related to HIV prevention for clients at risk of acquiring HIV.

For 2425, the Office of AIDS estimates the ADAP Budget Authority need will be $392.5 million, 277.3 million from the ADAP Rebate Fund and 115.2 million from the Federal Trust Fund, which is $1.8 million lower than reported in the 2425 Budget Act.

For 2526, the Office of AIDS estimates the ADAP Budget Authority need will be $462.3 million, $352.0 million from the ADAP Rebate Fund and 110 million 10.3 million from the Federal Trust Fund, which is 51.8 million higher than reported in the 2425 Budget Act. I'm happy to answer any questions.

Is there any other testimony? Governor's Office Raleigh Just here to answer questions. Thank you. Great. I'll start with a couple questions and then turn it over to Committee Members. First and foremost, is the state at risk of losing any federal funding related to Adap?

That's something that we are actually, I'll defer to Adrian Barraza.

Thank you. So I think more broadly, as you heard earlier today, we're really trying to assess broadly what impact some of the emergency orders or change in the federal Administration is going to have on our respective programs. So we're continuously assessing and at this time we don't have any other information to provide.

And then I understand that we loaned about 900 million in ADAP funds to the General Fund. Do we know when these loans will be repaid, what the timeline is, and if there will be delays in repayment?

Yes. So the $400 million loan from 2324 is planned for repayment in 2728 and the $500 million loan from current year is planned to be repaid in 2029. There are no planned delays at this time. And as, as you know, there is language in the Budget act that allows for repayment sooner if needed.

If, if there is a program.

And then lastly is around expenditures versus revenues and if expenditures are outpacing revenues, is this anticipated to continue and what's the impact that would have long term on adap and what's the thinking around either bringing revenues in line with expenditures or vice versa?

Yeah. At this time, projections for fiscal year 2526 do indeed show expenditures outpacing revenue with a gap between the two of approximately $54 million. It's important to note that these are point in time estimates and we will refine projections as more current data becomes available.

We're closely monitoring the ADAP rebate Fund balance and working diligently to ensure the solvency of the ADAP rebate Fund. It is however, important to note that as program enhancements are implemented or the ADAP rebate Fund is exposed, expanded to cover other non ADAP medication related services, the gap between expenditures and revenues will grow.

Great. Thank you. And are there any other questions? Simply Member Shiago.

Can you talk a little bit more about why, like where are the increased costs coming from? Is it because there's more demand of people wanting the services? Is it because pharmaceuticals are going up? Can you just explain a little bit more?

Sure. The 2425 Governor's Budget included several stakeholder proposals and legislative requirements that expanded the AIDS Direct Assistance program, including enhancements to our eligibility requirement, the financial eligibility requirements that went from 500% of the federal poverty level to 600% of the federal poverty level.

There's also a move from a closed formulary to an open formulary, as well as enhancements to the insurance premium cap. And so that is contributing and driving increases to expenditures.

Any other questions from Committee Members?

Assemblymember Bonta. Just trying to understand the relationship between the revenue that we receive. This is based on negotiations with drug manufacturers any in any given year, the expenses and the interplay of that around the loans that we receive.

So would this would adapt be sustainable if we decided not to loan funds to the General Fund from from adap?

You mean if we didn't take any further loans.

Yeah. Or yes. You yes. Receive about $1.0 billion in revenue with this particular vehicle, Correct.

I believe they're so annually. So you may be thinking of the 1 billion. At 1.0 there was a 1 billion Fund balance. But in terms of revenues, annual revenues come in at about, let's see3333 roughly 330, 320330 million annually.

But previous to this year, which is unique because we had so many enhancements that were approved by the Legislature previous to that expenditures were always lower than revenues. And so that's where you see that increasing Fund balance over time and why there was such a large Fund balance from which to pull those loans.

So because of the enhancements, the expenses now outstripped the $330 million for budget year.

We may see that go down because part of those legislative, legislatively approved programs, some of them were limited term for example, Harm Reduction Supply Clearinghouse Fund HIV prevention supplies for syringe access, that was $10 million annually for three years and that drops off in 2627.

And the Fund transfer to the Transgender, Gender Nonconforming Intersex Wellness and Equity Fund, that is over three years, 5 million annually over three years and that drops off in 2728. Whereas those three enhancements that my colleague mentioned, the increase in the federal poverty level, the open drug formulary and increasing the reimbursement threshold, those will be ongoing.

So that's a, I guess you can call that a permanent increase in the cost of the program.

Any other questions from the Committee? We'll open up to public comment then. And I'll remind you if you could please keep your comments directed towards the AIDS Drug Assistance Program and try to keep as close to one minute as possible and add on as a me too, with your name, organization and position only.

Thank you. And thank you for taking up the issue of the AIDS Drug Assistance rebate program. Again, I'm Laura Thomas. I'm with the San Francisco AIDS foundation and also with the End the Epidemics Coalition here in California.

And we believe strongly that the AIDS Drug Assistance rebate program is one of the huge Successes that we've had in negotiating with pharmaceutical companies to produce revenue that we have been able to use to fully cover the cost of HIV medication and affiliated programs here in California.

It's one of the most cost effective things that we have going. And we also firmly believe that the $900 million that has been loaned to the state General Fund, that that money needs to be returned and invested in HIV services, both services for people with HIV and those at greatest risk of HIV.

And to that end, the community organizations have put together a Prop for how we feel those funds should be invested. This is what the initial federal dollars in the federal Ryan White program are intended for.

I also think, just as somebody who follows this very closely at the federal level, if we are not making plans for what we will do if these federal Ryan White Dollars disappear, we are kidding ourselves about the, the direction that the Federal Government is planning to go.

We know that already they're trying to put in place Executive orders that would affect the ability of these funds to provide services to everyone in need of them. So thank you for taking this up.

We continue to be available for conversations both with the Department and with this Committee in the Legislature around how to ensure that this money is invested in the appropriate way to ensure that we're doing everything we can to provide services for people with HIV and preventing additional HIV infections in California.

Thank you, Chair Members. Kathy Mossberg of the APLA Health, as well as the end of the Epidemics Coalition. I just want to add a couple more comments to what my colleague has said, and we're in alignment with all the comments from our colleague Laura Thomas.

But I just want to add what happened last year in the reinvestments here. What I'm hearing is stated as if we're using too much money of the ADAP money. And so I just want to be clear. These were limited investments.

They were part of the negotiation that the advocates did with the Legislature as it related to the most recent loan. And these were, I think, I mean, and again, I didn't bring my numbers from last year.

We're talking about 20 million, maybe 30 when we're listening to, you know, a budget increase or amount of revenue coming in to the point of about 300.

And I think what we were trying to do as advocates is listen to the community, work with the dollars that were there and hopefully not see that level of surplus in the pot. Again, it just didn't make sense when we were still trying to get to end the epidemics and we knew we could.

And yet there was almost $1.0 billion sitting in a pot at adap. So we really did do this within the spirit of negotiation and that's where we came to those limited enhancements to the program. Thank.

Is there any other public comment outside? Nothing. Okay, well, thank you so much. We're going to move on to our next panel. Our next issue, which is trailer bills. And do you have background info on page 17 of the agenda? We're asking the Department to provide an overview of four trailer Bill requests, requests by the Administration.

And we have cdph, the Department of Finance and the Legislative Analyst Office. And please feel free to introduce yourself and start when you're ready.

Thank you, Chair and Members. My name is Mara Alfarsi, Deputy Director of Legislative and Governmental Affairs. So I'll go through the four. I'll give the high level. You have questions. Let's dig in. So the first one is the Genetic Counselor Licensure Program.

What CDPEACH is proposing is changes to the the fee structure for this program which have not been changed since 2011. The proposal will remove the specificity and statute and instead allow CDPH to utilize the regulatory process with periodic adjustments going forward. Our next proposal relates to our laboratory field sciences fees. This one has a lot of components.

It will allow our CDP CDPH lfs we call it, to increase fees, establish a methodology to administer the program. We're going to update the phlebotomist certification fee from a biennial to an annual fee and make technical corrections to the statute. The reason behind this one is that we are expecting the program to become insolvent by 2027-2028.

The fees have not been updated in quite some time and our revenues do not meet the expenditures that we have for the for these programs. Our next one is the AIDS Drug Assistance Program Cleanup.

This is based on a on TBL last year that we had to support funding for the tgi, the Transgender Intersex Wellness and Equity Fund Trust. TGI Wellness Fund for short. In that process of negotiating with the Legislature, there were some technical errors that emerged.

This TBL will allow CDPH to administer the program as intended upon enactment of the budget. Additionally, and probably most importantly here we're going to make sure that the statute helps us be in line with federal ADAP rules.

Lastly, we have this one's a little more complicated for me, but it's the Internal Health Information Integrity Improvement and Fund Abolishment and sub Fund Conversion. So what we're doing with this one is abolishing the Internal Health Information Integrity Quality Improvement Account and directing future revenues to the Internal Department quality improvement account.

IDQIA and this proposal replaces for sub funds with special sub funds to improve efficiency, transparency and accountability. There are. I can go into what the four sub funds are, but I'm not sure you want me to. I'm happy to if you want. If that's a question you want me to answer. That's all for us.

Any other testimony? Riley Thompson, Department of Finance Nothing to add at this time, but happy to answer questions. Okay. I do have a couple questions. It looks, I think you said there's two bills that are related to licenses and renewal fees and removing those in statute and instead granting the authority to set those fee levels via regulation.

One of them, you said is becoming insolvent and that's the reason to do that. That's the laboratory field sciences fees, the genetic counselor license fees. Can you explain why that is that you would remove that from statute?

Yeah. So those fees, we have not been able to update them since, since 2011. The program has far outpaced the work that we do in that program has outpaced what a lot of states do in the genetic licensure program.

These the ideally we want to leave it to regulations because it is very challenging to go through the legislative process. Things can change over time.

The last thing I think I'll add to that is that these fees, what we're intending is really going to align the fees with what's happening in other states and bring them up to date from 2011.

So are you saying doing this via regulation would be quicker than doing this through the Legislature?

I think it allows us to equivalently take public comment and consideration into any future fees that we propose. But essentially that the regulatory process is just as transparent and would be probably quicker, subject to less negotiation and challenges, and we wouldn't have to do it every time we needed to increase fees.

So rather than coming back once every 23 years as needed, we would be able to propose regulations.

Got it. And it looks like you have a colleague that would like to come in. Leslie Gaffney, assistant Deputy Director at Center for Family Health. I will add to what, Maureen, in that currently the newborn screening and prenatal screening programs are actually supporting this.

The Fund, the genetic disease testing Fund, where the fees for genetic counselors are deposited, is also the place where newborn screening and prenatal screening funds go. So at this point in time, those funds are actually carrying this program. So the people who pay for newborn screening and prenatal screening are subsidizing this.

So we would like to write that and make sure that the licensees are actually supporting their program. In addition, GDSP has emergency regulation authority. So we're very able to quickly make the change in the regulations happen and as Mr. Rawal said, go through the regulatory process and get public feedback.

Got it. Okay. Thank you. Are there any questions from my colleagues, Assemblymember Scheidel and then Bonta also. So I just want to clarify. I heard you talk about the genetic counselor license fee, laboratory field science fee, ADAP cleanup, the very long named one. And I didn't. I had on the list here enhanced treatment program.

Is that also something that there's a fee update or any.

An enhanced. I'm not sure.

Or a trailer Bill on that. So that's Department of State Hospitals administered feeding program. So. Yeah, not something that CDPH can comment on. Okay. Okay. And are there other trailer bills that you expect at this time?

This is all we have.

Okay. Okay. Thank you, Assembly Member Bhatta.

Thank you. I'm having a problem reconciling the prior BCP request for 1.1 million to support rulemaking and the comments that were made. That essentially takes.

Says it takes a long time for a package of regulations to be passed through the regulatory process in CDPH and this request to essentially cut out the Legislature from the fee setting authority it currently has right now.

Sure. So I think in this instance, we are prepared to issue regulations quickly.

I'm not sure exactly where the 1.1 million estimate comes from, but the regulatory process, when starting from scratch and typically when we're talking about bills that are being introduced by the Legislature, if it's something new, it can be quite costly, two to three years for us to issue. In this instance, we.

These shortfalls for both of these programs have been building up over time and we're very prepared to move quickly on these as it's been something we've been working on internally. By no means are we trying to cut out the Legislature. The budget process includes you guys. And we of course want to have that conversation.

Yeah. Just to note to the chair that I am generally not in favor of relinquishing the Legislature's authority for fee setting under. I think it's. It's our function and we should be able to continue to do that.

Thank you. And just a quick comment for Assemblymember Shaiva. We will cover state hospitals in an upcoming hearing. Yeah. Make sure that any other comments or anyone from the panel. And I tend to agree with my colleague up here on the dais that I have huge concerns around giving away legislative responsibility to the Administration.

But any public comment.

Hi, good afternoon. Jason Sullivan-Halpern with the California Long Term Care Ombudsman Association.

And I just wanted to quickly bring to your attention that we have reached out to the Department of Finance, Department of Public Health and the Department of Aging about our concerns with the trailer Bill with the really fun name Internal Health Information Integrity Quality Improvement Fund Abolishment and sub Fund Conversion.

Unfortunately, this trailer Bill is directly at odds with federal regulations on how funding from the state and federal citations accounts can be utilized. That funding is earmarked for certain activities around quality improvement and skilled nursing facilities, including the Long Term Care Ombudsman Program.

We're asking the Department of Finance to strike subsections E and F under the amendments to Health and safety code 14.17.2. And we've already sent some information about this to the Subcommitee. Happy to keep the Subcommitee updated and answer any questions your offices have. Thank you.

Any other public comment? Okay, well, thank you so much to our panelists. We're going to move on to issue seven emergency responses under the California Department of Public Health. You can find that info on page 19 of the agenda.

And we are asking the Department to provide an overview of the department's response to the bird flu outbreak, to the Marburg virus, and to the various fires that have impacted California since the beginning of the year. We have cdph, the Department of Finance and the Legislative Analyst Office with us.

And please go ahead and introduce yourself and feel free to begin your testimony when you're ready. Hello, Madam Chair and Members.

My name is Melissa Rellis. I'm the Assistant Deputy Director at our Center for preparedness and response. So CDPH is requesting $13.5 million in the current year to help lessen the spread of H5N1 in humans and and prevent severe disease.

The funds are also needed to increase monitoring and prepare for a potential case of Marburg, which is a viral hemorrhagic fever disease.

With several outbreaks overseas, Marburg is a rare but highly fatal disease, similar to the Ebola virus, that spreads through contact with blood or other bodily fluids from infected persons, fomites contaminated with the virus or infected animals.

Since the original request and the recent outbreak of Marburg in Rwanda, CDPH is currently monitoring two new outbreaks, a Marburg outbreak in Tanzania with 10 fatal cases, and an Ebola outbreak in Uganda with nine cases.

CDPH monitors travelers returning to California for symptoms surveillance of the disease, provides technical assistance and outreach to local health departments and healthcare facilities. About infection prevention, proper PPE usage and symptom monitoring and testing, and coordinates healthcare facility preparedness. Many of the return travelers are healthcare workers and face an increased risk. CDPH anticipates high risk returning travelers.

Given our large state, our large academic community and collaborations in many of the affected countries. Funding will be used to support communications and outreach, ensure lab capacity, and to establish a Level 3 assessment center in Northern California.

Extensive facility preparedness and healthcare workforce protection functions are needed to respond to special pathogen cases and there is no Northern California hospital with a minimal assessment capability, leaving Cedars Sinai a level 1 regional treatment center to be the only hospital that serves this function for the entire state outside of LA County.

The emergence of H5N1 in California dairy cattle is a sudden, unexpected and an evolving situation with new human cases of H5N1 which could evolve to a novel strain with pandemic potential. CDPH activated our Medical Health Coordination Center for H5N1 in late August of 2024 when California had its first positive case in a cattle herd.

California had their first human case in a farm worker detected on October 3rd and as of today there are 38 confirmed positive human cases in California.

CDPH is taking a one health approach and working collaboratively with our partners at California Department of Food and Ag, California Fish and Wildlife, Department of Industrial Relations, the Governor's Office of Emergency Services and others to ensure a coordinated approach to reduce exposures and infections across the animal health spectrum.

CDPH is actively responding by conducting enhanced surveillance for any changes in the virus, genetics or unusual patterns of H5N1 in humans working with local health jurisdictions on farm worker monitoring, testing, dispensing of medications and vaccination developing and disseminating communication and outreach ensuring adequate laboratory capacity, including genomic sequencing and raw milk testing and distribution of PPE to farm workers.

Happy to take any questions.

Anything else from the panel? Nothing to add at this time, but happy to answer any questions. Okay, I do have a few questions. Some of this on budget, budget augmentations, some of this specific to bird flu, and then a couple questions related to the fire and Moss Landing and CDPH's roles there.

But the first is that just a question on how much you've spent so far on bird flu response and containment.

We're actually going to need to get back to you with that information.

Okay. I think the question's been asked previously, so I would urge us to to urge you to get us that information as soon as possible so we Understand how this $13.5 million budget allocation works in Comparison to what's already been spent and what's already done been done. The other couple questions around bird flu.

The first is how you're being affected by what's happening at the federal level, either with budget or the firing of employees that specifically were working on this issue.

So we're still monitoring everything at the federal level. I'm going to actually defer to Susan.

Hi, Susan Finley, Chief Deputy with Health Quality and Emergency Response. So we are continuing to work with CDC and usda. We're meeting with them regularly. They've been providing us a lot of detailed information at the national level. We've had CDC employees on site in California. So we, so far they've been great to work with.

We don't know what the future holds, but we'll keep monitoring that.

Great. And thank you for that. I'm glad to hear that CDC and USDA is still active and supportive on this issue. The other is how you're ensuring, I know you mentioned farmworkers, but how you're ensuring that farmworkers in high risk populations receive timely access to ppe.

And I'll just put some context to this that I met with our three county health departments and, you know, discuss this issue in depth. And I was a little bit concerned with the reality of how this works and if people actually are getting the PPE that they need.

We have distributed 4.6 million pieces of PPE. We have been taking requests for that. We're continuing that effort. So I think if there is a shortage or somebody not getting it, we need to connect with them because we do have PPE to send out. We have been sending it out regularly.

Do you know how that compares though? 4.6 million compared to the number of farmworkers. Like what percentage of farmers, farm workers you've been able to get to?

I do not have that information. We can get back to you. I think it's been at requests of different counties to get that out as well as CBOs and others. So we've been sending it out pretty widely.

And so if there is an area of the state where we need to send more, we just need to know that and get a request for that.

Okay. And then I just wanted to ask briefly about the Moss Landing fires. As you know, we've had a major battery energy storage facility, 100,000 lithium ion batteries that were just on fire for six days and then reignited after a couple weeks, reignited overnight, causing a lot of concern.

And so just in General, what is CDPH's role in responding to chemical and hazardous materials incidents.

For us, it really is technical assistance on the ground to our local health jurisdictions and environmental health. You know, we review their approaches, their methodologies and their findings at the request of the local health departments. And so we've been doing that with a bunch different health officers of Monterey, Santa Cruz and San Benito counties.

Are there any lessons learned either from this disaster or similar industrial disasters that we should be aware of?

I think the lessons learned for me are having been in these for a long time is just the more we can be in sync with our local jurisdictions and all having the same message and providing the guidance that we need is probably what helps us to get through it.

Great. Well, thank you. And I'll. I know Assemblymember Schiavel, you have some questions and possibly Assemblymember Bhatta. I. I assume it's probably a similar answer, but I have the joy of representing the district that has the burning landfill, the Chiquita Canyon landfill. And I know CDPH has been engaged. What is, what would you.

How would you describe your role in.

Very similar technical assistance on the ground with the local jurisdiction, providing any assistance we can in terms of guidance on any testing we want to do, any air quality sampling, those kinds of things.

But the local jurisdictions don't really have to take your advice. Correct.

They do not really have to take our advice. But we do work hand in hand with them and I think we have a good collaborative relationship with them. So I don't think it's a question of them not wanting. We don't always agree exactly on the methodologies, but we usually come pretty close.

Okay. Any other questions? Okay, well, we'll turn it over to public comment. Is there anyone here for public comment?

Good evening. My name is John Poland. I'm the regional Executive Director of the Sierra Sacramento Valley EMS agency. We're a regional 10 county EMS agency in Northern California. I'm also the Legislative Chair for MSAC, Emergency Medical Service Administrators of California, representing all 58 counties and all 34 local EMS agencies.

And then last but not least, I'm one of the six appointed Regional Disaster Medical Health Corps coordinators in the State of California. So we're here to lend support to cdph, specifically to the Center for Preparedness and Response and just supportive of the work that they do from a local basis.

To answer your question, before we do work really closely with them, started 2017 with the Oroville Dam spillway incident, the campfire in 2018. These are all incidents that I have personally been involved with. Ebola, Covid, everything that was mentioned today.

And again, we have a good statewide collaborative effort on the local level with CDPH and just support the work that they do. Thank you.

Good afternoon. Jack Anderson with the County Health Executives Association of. California. CHIAC does appreciate the governor's proposed investments to support state level responses to some of the recent emergency events, including H5N1 and the recent wildfires.

We do want to highlight the important role of our local health departments in being the frontline defense against public health threats in communities throughout our state.

Our local health departments, as these types of emergency events arise, you know, are learning as the situation evolves and you know, the community's looking to our local health departments for that information and for that guidance.

And so just want to reiterate that CHIAC in our local health Department stand ready to continue to partner with the Administration and the Legislature on ensuring that our local health departments have adequate resources and the supports necessary to coordinate these emergency response events. Thank you.

Well, thank you. If there's nothing else from the dais, we'll move on to issue seven, which is the future of public health funding. That's on page 23 of your agenda. And we're still talking about the California Department of Public Health.

We're asking the Department to provide an overview of the future of public health funding, which is $188 million investment in local public health infrastructure.

And we've got CDPH as well as the Department of Finance and the Legislative Analyst Office, and then are also inviting the County Health Executives Association of California to join the panel to provide on the ground implementation perspective of this important funding.

So we'll start with testimony from the Department when you're ready, and then after that we'll hear from chiac's test will hear chiac's testimony. Go ahead and introduce yourself first.

Thank you. Hi. Thank you. Chair Members of the Committee. I'm Julie Nagasako. I'm the Deputy Director of the Office of Policy and Planning for CDPH and I'll be joined by my colleague Carolyn Kurtz from our Regional Public Health Office. We're here to provide a brief update on behalf of CDPH about the impact of future public health funding.

Future Public Health has been a critical investment of over $300 million in state General Fund to meet the ongoing and urgent need of building and sustaining public health infrastructure. These resources are essential to provide support for vital public health activities at the state and local level.

The Future of Public Health investment was originally structured with 99.6 million in state operations and 200 million in local assistance to support all 61 local health jurisdictions. For the 2024 budget agreement, CDPH applied a 7.95% reduction across all FOPH state and local funding.

The reduced budget for 2420 includes 92.7 million for state operations and 188.2 million for local assistance. Management and Administration of this funding is facilitated by the CDPH Office of Policy and Planning and Regional Public Health Office.

FOPH funding has been fully leveraged statewide for critical staffing and significant work that was previously unaddressed due to limited resources, including addressing critical vulnerabilities identified during the pandemic.

The spending plan for FOPH includes dedicated staffing to address six priorities within the foundational public health services that are key to strengthening California's public health infrastructure, including workforce preparedness and response, data communications, partnership and community health improvement.

These priorities were identified in collaboration with state and local partners and support the capabilities every public health system needs to be effective. By investing in these key areas, FOPH has allowed CDPH to more fully develop organizational capacity and enabled improvements across the Department. At the state level, 89% of the 406 FOPH positions have been filled.

Staff in these roles are carrying out the core work of public health in a range of areas including emergency preparedness and response enhancing our laboratory data and communications capabilities operations, strengthening our legal and fiscal oversight and expediting recruitment as well as a host of programmatic areas too numerous to mention.

Just a few examples include behavioral health, Influenza, overdose and alcohol harms prevention, cardiovascular disease and stroke prevention, occupational health, Alzheimer's, school health and equity. For 2425. The state operations spend rate is currently at 40% and on track to be fully spent by the end of the fiscal year.

The funding reduction was applied uniformly across all FOPH funded CDPH state operations programs. CDPH has prioritized retaining staff to ensure that key functions could be maintained to address the reductions program have worked to make adjustments by limiting expenditures in other areas including training contracts and overhead.

I'm going to switch off now so that we can cover the local assistance component.

Good afternoon. So switching gears to the local assistance the funding is to supplement and strengthen local public health workforce, particularly to fill staffing gaps that were identified during the COVID 19 pandemic and to increase LHDA capacity to deliver core governmental public health services. The funding is flexible and with different community needs and challenges and infrastructure.

For each of the LHJs, the FOP funding is being used flexibly in ways that are appropriate for each local context. As shared earlier, at least 70% of the funding is to support recruitment of permanent public health staff and we're proud to say that there's been strong progress made in that hiring.

93% or 1061 of the 1139 proposed positions have been filled statewide and are fully integrated into standard operations locally. With regards to local expenditure data, the fiscal year 2425 quarter one spend rate was 22% with over $41 million invoiced and distributed to LHJs, which we consider to be on track quarterly for this point in the fiscal year.

We've also reached out to all of our LHA partners in the Department. They have reported to the Department that they do not anticipate any unspent funds for fiscal year 2425 and are on track to fully expend the allocation for the current fiscal year.

As you know, the budget was reduced to 188.2 million this year for local health jurisdictions.

To implement that reduction in local assistance, the California Department of Public Health worked in partnership with the County Health Executives Association of California as well as the California Conference of Local Health Officers and used the following weighted methodology to determine the reductions for each LHJ.

20% of the $12.2 million reduction was applied in an even percentage across all LHJs, so every LHJ's allocation was reduced by 1.22%.

80% of the $12.2m reduction was applied to LHJs proportionally based on their proportion unspent funds for fiscal year 2324 and that was a result of their expenditure reports that they provided to the State from Quarters 1 to Quarter 4 with regards to the impact of the reduction that was incurred this year the reduction led to a reduction in total number of proposed filled positions, so funding is further reduced.

We can expect that LHJs may have a harder time keeping already filled positions. And since LHJs favored keeping already filled positions, those jurisdictions that have historically had harder times recruiting and retention challenges incurred greater cuts, including jurisdictions with rural that have rural and lower resource communities and also have some of the greatest infrastructure needs.

So some of the critical positions are the hardest also to fill and continue to be the last to be filled. And these include epidemiologists, nurses, laboratorians, physicians, accounting finance positions that are vital to building baseline capacity.

So so in conjunction with my colleague who just reported earlier on state operations, the state and local public health did prioritize maintaining staff. However, with the increasing cost of salaries and benefits, the same positions do cost more each year, so the reduction may further compound the hiring challenges that were explained earlier.

In conclusion, the availability of sustaining non capital funding and public health infrastructure at both the state and local level has been a game changer in maintaining the governmental public health system enables public health to address priorities that are relevant and meaningful to community needs and also contributing to the shared impact.

We're happy to address any questions after the complete testimony. Thank you very much.

Good afternoon Chair Members. My name is Michelle Gibbins. I serve as the Executive Director of the County Health Executives Association of California which represents local health departments across our state.

I want to begin by expressing our appreciation to this Legislature for your leadership in support for workforce and infrastructure for public health by investing in the ongoing future of public health dollars. This was something that the Legislature championed and we are really appreciative of.

These investments have been essential as local health departments were recovering from the pandemic and then already met with other public health threats like mpox, dengue, measles and Avian flu among others.

Thanks to these funds, local health departments have been able to add over 1100 positions and it's important to note that when we asked for these dollars, we did not ask for it to do new shiny programs which we would love to do.

We just asked because we had gaps in our existing core infrastructure and that is what we promised to dedicate those funds for. And it has happened. CHIAC published impact stories on our website. I'm happy to share them with you via email following the hearing if you don't have them already.

Just to illustrate the positive outcomes and I am really excited to share some of those with you. Today, Monterey County used FOPH funds to add 24 full time positions. They strengthened their emergency preparedness through training and exercises.

They supported home visits to reduce environmental health risks like mold and lead and created a new online communicable disease dashboard available in both English and Spanish. Santa Cruz directed future public health funds to enhance EPI efforts and disease control activities and their response to emergencies such as a shigella and a syphilis outbreak in homeless populations.

The funding also improved informatics to help better address health disparities and supported workforce training on trauma, informed care, diversity, equity and inclusion and resiliency. Alameda County used future public health funds to bolster their acute disease unit's response. In 2024 alone.

The team responded to cases of dengue malaria, H5N1, Avian flu, rabies, measles, mumps, West Nile, Zika, typhoid fever, and viral hepatitis. The funding also supported nearly 70 community outreach events and the development of educational materials for their Department and partners in El Dorado County.

They expanded their capacity for sexual health programs, vaccinations, communicable disease prevention, outbreak management, and emergency preparedness. They also improved their response time for outbreaks and supported rural communities with what they call the well Dorado Mobile Health Services.

Placer county expanded their communicable disease and EPI capacity as well, and the funding allowed normal public health operations to continue while conducting disease investigations, which is something that many local health departments had struggled with previously.

Los Angeles County used their Future of Public Health funded staff to respond to the H5N1 avian flu by conducting outreach, targeted testing and PPE distribution. Their staff also conducted outreach efforts including door to door education and testing in neighborhoods in response to locally acquired dengue cases.

Future of Public health also supported LA's response to the Hepatitis A outbreak in the homeless encampment and is supporting their translation of public health information into 12 threshold languages.

The Future of Public Health funding has also played a huge role in helping local health departments develop community health assessments Chas, which are comprehensive community based assessments that identify priority needs and the health needs and resident concerns. They also support Community Improvement Plans or Community Health Improvement Plans chips, which are actionable plans to address those identified needs.

Both processes do include robust community engagement. Thanks to future public health funding, several local health departments have been able to create their very first Cha orchard, including Berkeley, Calaveras, Calusa, Glenn, Inyo, Modoc and Tehama. Berkeley conducted its Cha with a focus on engaging underrepresented and hard to reach populations.

The funding supported a creation of a steering Committee to oversee the implementation of and they're currently working on a public facing dashboard to share the data. Results Their top community health concerns identified through this effort was mental health, housing, environmental health and climate change, and community safety.

Glenn also completed its first trial which was included which included an engagement excuse me which included the development of an engaging website, an informative video and an interactive geographic information systems dashboard. Their work provides insights into the health needs and priorities of the community that were identified as access to resources, provider shortages, behavioral health and transportation.

San Luis Obispo used future public health funds to coordinate their Slow Health Counts collaborative which includes residents, nonprofits, government agencies, schools and local leaders.

This collaborative focuses on the development and implementation of their TRON CHIP and supports their CHIP action teams to focus on the priority issues that their jurisdiction identified and that was community excuse me included healthy neighborhoods, access to health care and behavioral health.

These funds have a significant impact on supporting our local health departments and the communities they serve. We're encouraged to see the inclusion of these funds in the Governor's Budget, but we recognize the uncertainty surrounding federal funding and the unforeseen budget pressures.

And this time last year we were pleased to see it in the Governor's Budget and unfortunately the may revise there was a proposal to eliminate all of the funding.

So it's important to note that public health is also heavily reliant on federal funding, which is often categorical and designated for specific uses like Covid or tuberculosis, but very specific uses.

In the event that the federal funds do decrease in a variety of these programs, any or all, it's going to be really important to support the work of future of public health because it's flexible and it will allow each jurisdiction to make those decisions on how to bolster and continue their public health services.

Neglecting to sustain and strengthen our public health infrastructure will have serious consequences for the health of all Californians. Just consider the long term cost to our state if 40 million people and their health declines due to the loss of basic disease prevention.

It will leave us vulnerable to diseases like tuberculosis, measles and other diseases that we previously thought we had contained. Just want to thank you for allowing me to share how valuable this funding is. As you can see, I'm very excited about it.

CHIAC remains dedicated to working alongside the Legislature and the Administration to ensure that local health departments are equipped with the resources to safeguard their communities. Thank you.

Thank you. Any. Any other testimony?

Nothing to add.

Okay. No. Okay. All. Well, I want to say number one, it's so exciting to hear good news and I'm glad the Legislature has notched a win with the funding last year and I'm glad to see it in the budget this year.

I know though, often when we talk about flexible funding pots, folks get very nervous around accountability and that these funds are meant to supplement and not supplant and so just want to better understand compliance around supplementing, not supplanting and making sure that money is supposed is going where it's supposed to to go and not just, you know, leave it there.

Sure, I can start so we review all work plans at the state so those are submitted and the budgets as well. And also every local health jurisdiction annually must sign a certification of non supplantation to CDPH as a condition of receiving the allocation. And as I mentioned, this is done annually.

We've also on top of that developed guidance that is shared with all LHJs regularly to reinforce or to clarify or to answer questions with regards to this. And recently we did actually again update that because it does continue to come up to be a question. And we monitor their spend plans quarterly and we also hold office hours.

And so if there's a question of modifying and adding or changing things, we always have that conversation with our partners to ensure the non supplantation pieces is there as well.

Great. Thank you. Any other questions, Committee Members? Then we'll open it up to public comment. And I'll just remind you to keep your comments directed toward the future of public health funding. And if you can keep to a minute, we would be grateful. And if you're a me too, if you can provide your name, organization and position.

Sure. Good afternoon, Chair and Members. Beth Malinowski, the SCI California we proudly represent our public health workforce at state and local jurisdictions. Also a proud partner of the California Can't Wait Coalition to work with chiac, HOAC and other partners to stand up this program.

As noted by my colleagues, we are so grateful that these funds are here today.

Not only are they doing everything we'd hoped they would in terms of moving us forward from the pandemic, but additionally, you can't help but think about them in the context of the federal environment we're in right now and recognizing that us making this investment today is really providing an opportunity for us to be able to move forward, be well positioned as best we can if we are to see federal cuts that impact our public health infrastructure.

So I just want to thank you again for your leadership in this space and look forward to work with all of you on this.

Bruce Palmer, California Association of Public Health Laboratories CAFOLD supports future of Public Health funding because it's so important in maintaining our strong network of 28 local labs, which is an early warning system and is the first line of defense against disease outbreaks.

These funds enable labs to quickly identify disease outbreaks using the best technology, highly skilled staff and advanced science to protect the public's health. Thank you.

Kat DeBurgh with the Health Officers Association of California and strong support of the future of public health funding. At the beginning of the COVID pandemic. The New York Times ran an editorial. That said the cycle of public health funding is neglect, panic, repeat.

And California is proving that wrong by sustaining funding instead of neglecting it and then panicking when we need it again. So thank you very much.

Good evening. John Poland representing the Emergency Medical Service Administrators of California, all 34 Lemsas representing all 58 counties. We're here in support of future public health funding for our partners and local public health that we work with on a daily basis to respond to incidents and deal with medical health issues. Thank you.

Nothing else from the dais. I think we're going to move to our last issue and thank you to the panelists. And we're actually moving to away from the California Department of Public Health and onto emergency Services Emergency Management Services Authority to listen to your budget overview, budget change proposal and emergency response activity.

And for those who are interested, you can find this information on page 25 of the agenda. And we're asking the authority to provide a quick overview of your budget, your budget change proposal and your recent emergency response activities. And with us are representatives from emsa, the Department of Finance and the Legislative Analyst Office.

And I'll let you introduce yourselves and we'll start start with testimony from the authority. Whenever you're ready.

Thank you, Madam Chair. Gabby Santora, Chief Deputy Director of EMSA as as requested, providing an overview of our budget and our our GP proposal. The Governor's Budget reflects 54.7 million in proposed expenditures, of which 28 million is General Fund, as well as 121 positions within the Governor's Budget.

We include one proposal for 676 General Fund in 2526766,000 in 2627 and 676,000 in 2627 and ongoing to support EMSA's Health Headquarters Building lease, increased building security and tenant improvement costs.

I'm going to turn it over to my colleague Tim Reed, who's our chief of the Disaster Medical Services to provide an overview of our role in the response response to wildfires.

Good afternoon, Chair and other Committee Members. My name is Tim Reed, like she said. I'm the chief of the Disaster Medical Services Division at emsa. The Emergency Medical Services Authority plays a crucial role in the California's disaster response.

During the California or the Greater Los Angeles wildfires, which is the Palisades, Eaton Hughes, the Watershed Mission and some evacuation shelters, EMSA deployed the California Medical Assistance Teams to fire base camps and other evacuation shelters.

Our teams deployed to Southern California, including or our team that deployed included nine doctors, 16 registered nurses, seven EMTs and then six logistics or administrative personnel. During that time we treated 530 patients, transported 31 to a higher medical facility being a hospital and dispensed over 12,500 over the counter medications and 10,000 pharmaceuticals.

In addition, EMSA deployed four ambulance strike teams and one ambulance bus to the Los Angeles area. These teams included 17 paramedics, 19 EMTs and seven supervisors. These resources were used to transport skilled nursing facility patients from evacuation shelters to other facilities as beds became available.

The ambulance strike teams were also pre positioned for potential evacuations of other skilled nursing facilities, evacuation shelters and Encino Medical Center. Fortunately, they were not used for any of those further but they were ready and willing to respond.

On average, our California Medical assistance teams from a request to being on scene and able to provide medical treatment right now is on average of 15 hours from the time that we get it to the time wherever it is in the state that we're ready to provide our medical care.

Other than that, we had several other fires the latter part of last year for a total of 16 wildfires that we responded to.

We treated over almost 1800 patients, transported 95 of them, then administered over 77,000 over the counter medications and over 23,000 pharmaceuticals and all the staff that we deployed over fire season, 39 doctors, 63 RNs, 40 EMTs, 5 PAs, 2 nurse practitioners, 7 LVNs and 17 logistics and administrative personnel.

These numbers highlight EMSA's ability to rapidly mobilize medical personnel, coordinate emergency transportation and deliver deliver critical care to those in need. California wildfire season are growing more intense and unpredictable and AMSA remains committed to strengthening the disaster medical response capabilities to protect both our first responders and our communities.

Thank you for your time and I'm open to any questions.

Well, thank you. I you know, representing a district that has experienced numerous emergencies just in the couple years that I've been in the state Legislature, from the 23 atmospheric storms to huge storms again in 2025 where there was actually loss of life from large waves and things that were happening at the beach.

Very tragically, the emergency Services and disaster preparedness is something that is incredibly, incredibly important. I get a lot of questions around how adequately state are we well enough resourced? What's the status?

And so I just sort of turn it over to you in terms of long term projections around staffing and how you feel that we're situated knowing the increasing disasters that we face.

Thank you Madam Chair, really appreciate the question. Can you just speak overall that we're constantly evaluating how successfully we're meeting our mission of minimizing suffering, saving patients lives to see what resources we need to do that, do for that at this point in time, at Governor's Budget that encapsulates the resources we need.

But again, we're always evaluating and happy to engage with the Legislature in that endeavor.

Thank you. Please. Member Banta and then Shiva.

Just one question. The deployment of the Doctors, nurses, the EMTs, where are they coming from?

So they come, they have regular jobs of doing whatever licensing level they're doing. What we do is our Calmat program. Basically emergency hires them and they become staff of EMSA for a short period of time and then we deploy them out.

We have a large database of all of those positions in which we work monthly to create an availability poll of whoever can go out at whatever time and then we will coordinate their deployments through EMSA to wherever they're going.

Thank you for that. I believe that our colleague from Kern, County, Dr. Jasmeet Bains, is one of these doctors who's been deployed. And I can't tell you how helpful it is to have someone who is a Legislator and who has been deployed just share the day to day goings on of what their life is like.

So I just want to appreciate the work that you all have been doing so tirelessly for us during this critical time.

Thank you.

Yeah, I echo. Great. Thanks. I have the Hughes and Hearst fire were in my district. Fortunately no structures and no people, you know, were injured. But. But I know they were. They gave us a big scare and we were very grateful at the quick response. Can you talk a little bit about what.

So how does it work with. For example, we had a, you know, a shelter, an emergency shelter at College of the Canyons in my district for people who are evacuating from the Hughes fire. How do you work with Red Cross or are they completely separate operations or are they integrated?

How does that work on the ground or with local departments of public health? Like how does it work on the ground? Yeah.

So when the determination is made to open an evacuation shelter that is usually done by the county in which whatever incident is in. And then when they. They run and manage the shelter and then they can work through the Department of Social Services, the California Department of Social Services, who oversees the shelter sheltering operations for the state.

And they will work with whatever county it is in to provide services from the Red Cross if that's needed at the county. Some of the counties don't need it and they can handle it 100% on their own. But then there are some counties that cannot.

And Department of Social Services will then provide the Red Cross assistance to those shelters.

And so where or when do you come in when those two can't, don't have capacity and they need extra help.

So if there is patients that are unable to ambulate, like the scale skilled nursing facility patients, and they can't really like an evacuation shelter is not really for them. Right.

It's a temporary location in which if we have to evacuate skilled nursing facilities, they will take them there until they can find another bed available at a facility that is made for whatever their issue is. And then we will work with the county like Los Angeles and Pasadena.

We worked with taking those patients out of there and transporting them to whatever bed was available at another skilled nursing facility that was not in the affected area.

So your work is 100% focused on skilled nursing facilities and those patients or broader than that?

It's a little broader than that. If we are called because we can activate ambulance strike teams from all over the state and move them into an affected area, we have used those ambulance strike teams to bolster 911 systems.

If it becomes overwhelmed, we can pull ambulances from across the state and help those local EMS systems to run their 911 calls. We can help them with evacuations of skilled nursing facilities or whatever it takes to move those patients wherever they need to go.

Okay, thank you. Thank you. Nothing else from the dais. Thank you. Really appreciate it. We're going to, we are going to move to public comment. Is there any public comment?