Assembly Standing Committee on Health

Good afternoon. We will convene the Committee hearing on Health in the Assembly. I'm Chair Mia Bonta Presiding over Tuesday, March 25, 2025 session. Good afternoon, and welcome to the Assembly Health Committee hearing.

Before we begin, I want to make sure everyone understands our Committee rules to ensure we maintain order and run a fair and efficient hearing with the goal of hearing as much from the public within the limits of our time.

We seek to protect the rights of all who participate in the legislative process so that we can have a very effective deliberation on the critical issues facing California. The rules of conduct by Members of the public include no engaging in conduct that disrupts, disturbs or otherwise impedes the orderly conduct of this hearing.

Engaging in personal attacks of Members of this Committee, its authors, staff or other other witnesses talking or loud noises from the audience. Please be aware that violations of these rules may subject you to removal of the or other enforcement processes if you are providing witness testimony at this hearing. All witnesses will be testifying in person.

Main support and opposition will be allowed two main witnesses for a maximum of two minutes each. Additional testimony will also be in person and limited to name, position and organization. If you represent one, all testimony comments are limited to the Bill at hand when he arrives.

We would like to welcome Assembly Member Philip Chen, who has been appointed by the speaker to the Health Committee as Vice Chair and we will welcome him openly and with that we do not have yet quorum, so we will move forward as a Subcommitee and hear our first Bill which will be item number four. AB73, Jackson Mental Health Black Mental Health Navigator certification. Thank you, Dr. Jackson. Proceed when you're ready.

Thank you so much, Madam Chair, Committee Members. We are bringing back this Bill from last year, AB 73, which would require the Department of Healthcare Access and Information to create a Black Mental Health Navigator Certification within the Community Health Worker Certificate Program.

This Bill would require the Department to develop specific training and mental health resources, including crisis intervention training for non-emergency case—cases, entry level assessments, navigation support, and culturally-specific practices, relative to helping to connect individuals with licensed mental health professionals and wellness services.

This Bill would also require the Department to annually gather and publish data on individuals that earn a certificate, as well as the number of people who are actively employed as community health workers, as well. With me today is Traci Stafford, on behalf of the California Black Health Policy Advisory Council, to speak on the impact of this Bill.

Thank you. Chair Bonta and distinguished Committee Members, I appear before you today, as the Chair of the California Black Health Policy Advisory Council, to express our strong support for AB 73. Our council was formed to bridge the gap between community voices and policy development.

We conducted extensive state stakeholder engagement with healthcare professionals, community members, nonprofits, unions, and mental health experts, throughout California, to identify evidence-based solutions for persistent health disparities. Despite their different priorities, all shared a common concern: the mental health crisis devastating the black community.

They spoke of loved ones suffering in silence, of stigma preventing others from seeking help, from high rates of misdiagnosis, and of a system, after all that was exposed during the COVID years, that still fails to recognize the impact of Black experience in America.

Far from contradicting equal treatment principles, AB 73 actually promotes them, by addressing documented disparities in mental health care access and quality. This Bill supports equal treatment of all, by ensuring Black Californians have the same opportunities to receive effective, culturally competent care that is available to others—specialized certifications of standard practice throughout health care from maternal care to geriatrics.

Creating a specialty focus on the specific mental health needs of the Black community follows the same evidence-based approach. Black health navigators—mental health navigators—will serve as trusted bridges trained in assessment, crisis prevention, and culturally specific practices to connect people with appropriate and effective resources.

They'll help reduce stigma, navigate complex systems, and ensure care, rather than waiting until there's a crisis. The program also addresses critical workforce development needs. In—by—2030, there'll be a 21% increase in the need for health workers—for community health workers.

And AB 73 prepares California for the increased demand, while delivering equal access to effective mental health outcomes for the Black community. We respectfully urge you to join the California Black Health Network, the Greater Sacramento Urban League, First 5 California, the Disability League, and countless others and vote "Aye" on AB 73. Thank you for your consideration.

Thank you. Now we will hear any additional support. Please come forward and offer your name, organization, and position only.

Good afternoon. Lizzie Cootsona, here on behalf of the California State Association of Psychiatrists, in support. Thank you.

Chair, Members of the Committee. I'm Barbara Schmitz. I'm here on behalf of First 5 California. We're in support.

Members, Mel Assagai, for the Greater Sacramento Urban League, in support.

Good afternoon. Linda Way, with Western Center on Law and Poverty, in support.

Good afternoon, Madam Chair, Members. Malik Bynum, with the County Behavioral Health Directors Association, in proud support.

Elle Chen, on behalf of Drug Policy Alliance, in support. Thank you.

Liz Oseguera, with the California Alliance, in support. Thanks.

Symphony Barbee, with Planned Parenthood Affiliates of California, in support.

Thank you. Now, we'll move to any witnesses. Any primary witnesses in opposition? Seeing none. We'll move to any witnesses in oppos—any other "Me Toos" in opposition? Seeing none. I'll bring it back to the Committee for any questions or comments.

Well, thank you. Assemblymember, you may close.

I respectfully asked for an "Aye" vote.

Thank you so much for bringing forward this Bill, Dr. Jackson. As noted in the analysis, American Psychiatric Association and other entities note that Black communities encounter barriers to mental health care, including stigma, distrust of the healthcare system, and a lack of providers who are culturally competent or from similar racial and ethnic backgrounds.

I really appreciate the author bringing forward this Bill. You are a champion for mental health and culturally concordant care, at that, Dr. Jackson.

And this Bill is certainly a step in the right direction, to make sure that we are creating optional specialization, to train navigators that we know are incredibly helpful, like community health workers, more specifically, on mental health and wellness in our Black communities, which would help in navigators to address some of these long-standing barriers.

So, with that, we do not have the opportunity to bring a motion quite yet, because we will get to quorum, but I will definitely be supportive of the Bill at the time. Thank you.

We will take bills in file order, but whoever is here gets to present. So, thank you so much.

Assemblymember Ortega, we are going to now move on to your bill. Item number 10, AB499, the Robert F. Kennedy Farm Workers Medical Plan. Thank you so much Assemblymember. Feel free to begin whenever you can.

Thank you Madam Chair and Members for allowing me to present AB499 today. The Robert F. Kennedy Farmworker Medical Plan provides medical benefits to about 6,000 farm workers and their families. About 4% of the plan's budget is administrative and operational overhead.

96% of the RFK plan's budget goes directly to providing medical care and benefits to its beneficiaries and their dependents. The California Endowment estimates that the plan saves the state's general fund about $1.0 million annually in Medi-Cal expenditures.

Last year the plan needed to deplete millions in its reserves to pay for saving the life of a farm worker's son who needed a rare stem cell transplant. Currently, the RFK plan is reimbursed by the state for claims that exceed exceed $70,000. AB 499 simply lowers that amount to 50,000 to help keep the plant operational.

This bill, however, does not raise the existing annual $3 million limit on reimbursements by the state today. In support of this bill is Teresa Romero, President of the United Farm Workers.

Move the bill when we have a quorum, we will be able to do that. Ms. Romero, thank you so much. Please go ahead.

Good afternoon Madam Chair and Committee Members. Teresa Romero, President of the United Farm workers in support AB499 allows farm workers and their employers to continue contributing financially to their own health care and reduce California's medical costs.

This is particularly important when our medical plan experiences the occasional acute episode of care like we experienced most recently as Assembly Woman just mentioned and it was a young person who needed life saving stem cell transplant.

We're pleased to have worked with Stanford University Children's Hospital and share that we were able to save this young person's life with a medical plan as basic as ours. AB499 helps keep the RFK Farm Worker medical plan functioning with a modest adjustment to the state reimbursement trigger while still maintaining the existing $3 million annual cap.

The RFK Medical Plan is a joint labor management Taft Hartley health plan for farmworkers, the UFW and contributing agricultural employers deliver basic medical care for farm workers and their families at an affordable cost.

The plan is self insurer, subject to collective bargaining agreement between the UFW and agricultural employers and as Assemblywoman Ortega mentioned, It supports over 6,000 Californians, including approximately 2,000 children. With recent changes in California law, there is a reasonable expectation that the number of farm workers covered by UFW collective bargaining agreements will grow.

That growth will increase the RFK's generated state medical savings from the current $11 million annually. Thank you for your consideration.

Thank you Senora Romero. We will move on now to any other witnesses in support. We'll move on to any witnesses in opposition. Seeing none Assembly Member or I'll bring it back to the Committee for any questions or comments. Thank you. Seeing no comments. I will just ask Assembly Member to close.

I respectfully ask for your Aye vote. Thank you.

In a quorum. Thank you so much Assembly Member and want to just appreciate Mr. Romero for coming all this way to be able to represent the work of the United Farm Workers and this self sustaining, self insured plan that ensures that 6,000 Californians, largely farm workers and their children, have the ability to have affordable health care coverage.

It is a very important program for us to be able to consider to support. And with that I will call the roll. The motion is. Oh, sorry, we have to establish quorum first. Apologies.

[Roll Call]

Quorum is established and now we will go on to vote on the item number 10. AB499. Measure.

AB499 is do pass to Appropriations.

Moved by Cecilia Aguirre Curry. Seconded by Arambula.

[Roll Call]

That that measure is on call. Thank you so much.

Thank you.

We're going to take care of our business. Well, yes, let's go ahead and do that. We'll go back to item number four. AB73. Jackson, we need a motion motioned by Flora, seconded by Arambula. Secretary, please call the roll.

[Roll Call]

We'll now move back. That item is. That measure is on call. We will move back now to item number one, which is a vote on Committee rules for the Health Committee adoption of the Health Committee rules for 202526. Can I have a motion? Moved by Aguiar Curry, seconded by Flora. Secretary, please call the roll.

[Roll Call]

That measure for adoption of the Committee rules is on call. We are going to move now to vote on consent calendar. The following bills are proposed for consent for today's hearing. Any Member of the Committee may remove a Bill from consent for review. We have item number five. A.B. 225. Bonta. Motion is do Pass to appropriations.

Item number seven. A.B. 304. Chen. Motion is do Pass to Appropriations. Item number nine. A.B. 403. Ortega do pass to appropriations. Item number 11. A.B. 688. Mark Gonzalez. The motion is do Pass to Appropriations. Item number 13. AB951. Ta. Motion is do Pass to Appropriations. Moved by Aguiar Curry. Seconded by Flora. Secretary, please call the roll.

[Roll Call]

That measure is on call. We'll move now to Committee items because we don't have any other authors here. Oh, I was so sorry. There we are. Assemblymember Garcia. We'll move on to item number 12. AB843. Garcia, healthcare coverage and language access. Thank you, Mr. Garcia. Whenever you're ready.

Good afternoon, Madam Chair and Members of the Committee. Thank you for having me today to present my bill, AB 843, Safeguarding Language Access Programs. California's diversity is one of our state's greatest strengths, adding rich culture and economic prosperity to our communities.

Currently, a quarter of our state, over six and a half million individuals, have lived in the US for less than five years and have limited English proficiency. People with limited English proficiency disproportionately experience gaps in health insurance coverage and poor health outcomes as they struggle to understand our complex insurance system.

Those with language barriers are three times more likely to be uninsured than those who speak English proficiently. Poor communication also results in longer hospital stays, surgical delays, and greater risk of hospital readmission. Further, when language translation services are not accessible, it leaves patients dependent on family, friends, or even their young children to translate health care coverage and critical medical decisions.

In 2016, the Obama Administration adopted stronger federal language access requirements through the Affordable Care Act, only for them to be weakened by the Trump Administration in 2019. The Biden Administration implemented new language access requirements in 2024, building upon and strengthening the previous version.

Given the threats made against the ACA by the current Administration, in addition to their recent efforts to defund federal DEI initiatives, these federal language access protections could be in very real danger. So we need to support Californians by aligning our state laws with the Affordable Care Act's language access protections, ensuring no one is at risk of losing these vital resources and that everyone is able to fully understand their health care plans. I respectfully ask for an aye vote.

Moved by Cecilia Aguiar-Curry. Seconded by Carrillo. We will hear from our witnesses. You'll each have two minutes.

Thank you, Madam Chair. Good afternoon, Chair and Committee Members. My name is Miguel Bastidas, and I am the Chief Deputy Legislative Director with the California Department of Insurance under the leadership of Insurance Commissioner Ricardo Lara.

As a proud sponsor of AB 843, Insurance Commissioner Ricardo Lara would like to thank Assembly Member Garcia for his leadership in authoring this important measure. As a proud son of immigrants who personally understands the barriers to health care access, Commissioner Ricardo Lara is honored to sponsor AB 843.

Children bear the enormous and unfair burden of translating doctor's appointments and complex insurance paperwork. At its best, this practice leads to imperfect translations and potentially embarrassing situations related to sensitive health information. At its worst, this practice leads to miscommunication and potential adverse health outcomes.

Additionally, as a result of lack of language assistance, individuals may struggle to understand insurance options, compare plans, or enroll in coverage. By providing language assistance services, insurers can alleviate this problem by helping individuals of LEP understand, obtain, and appropriately use the health insurance that they are paying for.

The federal regulations that were adopted in 2024 were based upon research and extensive stakeholder feedback. AB 843 seeks to modernize California's language access laws to align with federal regulations. Because the current Administration's history of substantially weakening similar regulations issued by past Administrations, we anticipate that it will again act to undermine the current rules.

This is why it is imperative that California adopt these updated federal requirements into state law. California's health care system is stronger when everyone has equitable access to health care coverage. AB 843 will diminish barriers and improve health outcomes by expanding access to healthcare for Californians with limited English proficiency.

On behalf of Insurance Commissioner Ricardo Lara, I respectfully ask for your aye vote thank you. Also with me today is Gabrielle Lessard, an attorney for with the Health Equity Access Office for the Department of Insurance, here to answer any questions that you may have.

Oh, thank you. Are there any other witnesses in support offering me toos? Please come forward. State your name, organization, and position only.

Hi. Lizzie Cootsona here on behalf of the California Academy of Child and Adolescent Psychiatry in support. Thank you.

Good afternoon. Linda Nguy with Western Center on Law and Poverty in support.

Jennifer Robles with Health Access California in support.

Omar Altamimi with the California Pan-Ethnic Health Network in support.

Thank you. Are there any witnesses in opposition? Seeing none. Are there any me toos in opposition? Seeing none. We can bring it back to the Committee for any questions or comment. This has been, motion made and seconded. Well, I want to thank Assembly Member Garcia. Is this your first bill?

Very first bill.

Very first bill. You all don't want to ask him one question? All right, go for it.

I won't ask a question, but I'll make a comment. Having worked with students who are English learners and some of them who face medical issues and their families face medical issues. And had an experience one time where I went to a family's home and the hospice nurse was there and she only spoke English and the family spoke a different language and I ended up translating.

And so I know that's very different from what this bill is, but I just want to really recognize and commend your work on this issue. It's incredibly important and a lot of people are not able to speak up for themselves. And so I just want to commend you for taking us, taking us forward in this area.

Thank you, Assembly Member Addis. Really appreciate it. No, it's a very real issue that you described and in situations that do happen, where children are put in that spot of having to translate and kind of sensitive, sensitive issues. So thank you.

Thank you, Assembly Member Garcia, for bringing this forward and for introducing this very necessary bill. I know we have seen coordinated attacks on inclusive policies such as this one. And I'm so proud that this Committee gets to be able to be clear that in California we are bringing more people in, not excluding. In the face of national threats, securing meaningful and equitable access to care and supporting our underserved communities is a much needed policy step. And I'm very proud to be able to support this bill. With that, Assembly Member, would you like to close?

I respectfully asked for an aye vote. Thank you, Madam Chair.

Thank you. This measure has been, has received a motion and a second. Secretary, please call the roll.

The motion is do pass to Appropriations. [Roll Call]

That measure is on call, but it's looking very good. Congratulations.

Thank you, Madam Chair. Thank you, Members of the Committee. Thank you so much.

Thank you. We'll move on now to item number six, AB257 Flora, Specialty Care Network, Telehealth and other virtual services.

Thank you, Madam Chair and members. First, I'd like to accept the committee amendments and appreciate your work on this bill. AB257 improves specialty health care access for Medi-Cal beneficiaries and underserved communities through a hybrid virtual care model addressing clinician shortages. AB257 aligns the state efforts with CAL HHS, HCAI and DHCS to expand healthcare access.

And with me is Jennifer Stoll, and I'll turn it over to you.

Good afternoon, Chair, Vice Chair Chen and members of the committee. For the record, I'm Jennifer Stoll, chief external affairs officer for OCHIN. We're a national, not for profit health technology and research organization. We support around 50% of the FQHCs and public health departments in the State of California and around 3 million patients in the state as well.

What we see, and we're here today in strong support of AB257. We have been studying this issue for many, many years at OCHIN. And what we see very, very clearly is that when patients, the most vulnerable patients in the OCHIN network get referred to a specialist, only three times out of 10 do those referrals actually get completed.

This issue around specialty care is one that is ripe for innovation for this committee. As you're thinking about redesigning health care in the State of California, whether it's looking at cost containment caps, whether it's looking at other ways to drive innovation, specialty care has been delivered in the same way for decades.

And it's really an opportunity to think about redesigning how to get access to the specialty care, particularly for the most vulnerable patients. And also specifically, as we're moving more of your dual eligibles into the as the D-SNP program is moving into managed Medicaid and what that looks like over time.

So, you know, our data very much shows that the most vulnerable in this state are not getting needed access to specialty care. Again, it's ripe for change and demonstration. And that's what this bill will do, is demonstrate a pilot. We've also seen this very, very successfully deployed in other states.

And California is really ripe to be able to take advantage of innovation in driving access to specialty care in an integrated way in partnership with the health centers. And for this purpose, we ask for your support. And then aye vote on AB257. And thank you, and I'm happy to answer any questions.

Moved by Arambula, seconded by Carrillo. We are going to do now additional witnesses in support. Are there any MeToos? Any witnesses in opposition? Seeing none. I will bring it back to the committee for questions. Dr. Patel.

Thank you for bringing this bill forward. We do know that there's shortages and telehealth is a very tempting option for families and patients looking to seek immediate relief. My question is, are all the providers that are that will be participating in this program, are they licensed in California and California practitioners. Thank you.

Madam Chair, assemblyman. Yes. The intent is to create a network of willing health centers to create capacity within the State of California and not bring in external providers. It's to create capacity. What we're really seeing is that specialty access, unless we create it in the most vulnerable communities, it's just not available to us.

And so we need to think differently about specialty care. And this could go a long way in showing evidence to be able to support that.

Thank you.

Thank you for the question. I had an opportunity to visit with OCHIM at- OCHIN at one of my FQHCs, La Clinica, which is in center of a very urban community and also a very high need community in terms of healthcare.

I think one of the issues and questions that I raised during our conversation, which was actually about a different technology that OCHIN supports, is the question that Dr. Patel was getting to, which is at the end of the day, the ideal model is that a person would be able to see a specialty care provider in person.

And in the real. I know that assemblymember Flora represents a very, very rural parts of California where that's just not the case.

Can you share with us a little bit the what the opportunity costs are to not having that model for sure of having a specialty care provider in person and what OCHIN is essentially what this bill is proposing to be able to do and, and what we're giving up, if anything.

Yeah. Madam Chair, members of the committee. Well, I can demonstrate from the, the pilot that we ran in the State of Oregon, what we did was we integrated on demand access to a very, very rural, arguably frontier health center using Econsults and virtual visits.

Not with the idea of taking away in person care, but taking away the acuity and the need.

So being able to have access to these various services integrated into the primary care setting, into their workflows, into a on demand network that would be made up of California providers so that you know, there is space at a specialty level when an in person visit is needed.

But what we were able to see in Oregon for the specialty of dermatology is a significant reduction. And actually we were able to have what would be six month wait time, if at all, for access to dermatology down to within two weeks.

Every patient was able to be seen by a provider and there was capacity within the on demand, the in person visits because a lot of the acuity was taken out of the pipeline.

The other thing that we saw is that we had a payer partner that worked with us and there was a $100 savings per patient that resulted in significant cost savings because again it's taking out acuity of the system. Everything gets referred up into in person visits.

If we can take out that acuity, we can drive better care and lower costs at the same time.

Assemblymember Addis.

Thank you. I also represent an area where there's acute lack of providers is what I would say and some specialties, they either don't exist in the county or there might be one in the county. And so I'm just wondering if you roll out the pilot, is it every FQHC, is it geographically? Like who would be part of the pilot?

I think that would be up to the department to make those determinations.

Thank you.

Did you have a question?

I'm trying to, I'm walking my brain through this. So the business is in Oregon?

We are a national organization headquartered out of Portland. But I also serve as the President of the California Telehealth Network. And we also have the Telehealth Resource Center, which is a HRSA Grant that we operate in the State of California.

Okay. That's it.

Are you trying to get at that California providers piece?

Yeah, I am because I see sometimes we spend money in California and then we have our providers or whoever. Not necessarily, not necessarily in this state, but go out of state. And we have invested in the State of California and now they're working out of Oregon. That's where I'm stumped.

Madam Chair, assemblywoman the intent of the legislation would be to use the to partner with the health centers in California to deliver care to Californians. We are just the technology partner that would support the healthcare providers in the network that would be here in California. So the, and you know. Yes.

So the Clinicians are all California based.

So the technology company is headquartered in Oregon. The provider network that you are going to be tapping into are all California based.

That's correct. Thank you.

Okay. Any additional questions from the committee? Seeing none. Assemblymember Flora please go ahead and close.

Thank you, Madam Chair. And I appreciate the questions and I want to acknowledge your concern as well, because I think for Californians we need to keep Californians, you know, serving Californians and you know, the, the servers are in Oregon. Like I'm good with that. As long as it's California clinicians, which this bill is very particular on.

And I appreciate the makeup of this committee, quite frankly, because there's quite a few of us that represent rural communities and we have different needs and you're going to see a few bills on that this year. And it's not just specialty care, it's all types of care.

We don't always argue in our area about what kind of insurance card you have in your wallet because we don't have clinicians to actually go see. And so this to me is just a very important and small part of increasing access to our rural communities. And I respectfully ask your aye vote.

Thank you assemblymember Flora and I want to thank you for your presentation. This bill would really create a demonstration project to improve specialty care for patients of safety net facilities.

And we have to acknowledge that the pipeline of healthcare workers, particularly around specialty care needs, is one that is not robust enough to be able to manage successfully quality of care for everyone. I want to thank you for accepting the committee's amendments. Correct.

Which will clarify aspects of this bill, broadening the pool of potential applicants and require an independent evaluation, among other things. With that, thank you for closing. And we had a motion and a second, so we will go ahead and call the roll.

The motion is do pass as amended to appropriations. [ROLL CALL]

Thank you, Mr. Flora. That measure is up. We will move on. Now back to item number three, AB64 Pacheco, vital records, diacritical marks.

Thank you, Assemblymember Pacheco. Begin whenever you like.

Thank you. Good afternoon, Madam Chair and Members of the Committee. I am pleased to present Assembly Bill 64. I want to thank the Committee Staff for working with me on this Bill for the third year in a row, and I've often heard that third time's a charm.

So, I'm hoping that this will be our year. Actually, this will be our year. AB 64 will allow the inclusion of accents, umlauts, tildes, cedillas, and other diacritical marks on vital documents, such as birth certificates, death certificates, and marriage licenses. For many Californians, this Bill represents more than just a mark on a page.

Dignity, identity, and cultural cohesion are at stake. People have a fundamental right to have their names, and the names of their family members, recorded accurately. Many states, including Texas, Illinois, Kansas, Hawaii, North Carolina, Oregon, Alaska, Utah, Arkansas, Delaware, and Maryland, show respect for cultural identity by including diacritical marks on vital records.

As the most populous and diverse state in the nation, California should be a leader among the states on that list. In fact, just 39 years ago, California included diacritical marks on vital records.

But after the passage of Proposition 63 in 1986, which declared English as California's official language, the practice was discontinued, diminishing the rich multicultural heritage of many California residents. In some cases, the exclusion of a diacritical mark even changes the meaning of a name. The last name, Peña, becomes Pena without the tilde, which translates to shame in English.

For 39 years, we've been asking Californians with diacritical marks in their names to accept the misspelling of their names on official records. For seven years, one of our witnesses has been coming to Sacramento asking for this simple adherence to accuracy. The time for waiting is over, and I respectfully ask for your "Aye" vote on AB 64.

And with me today, I have two witnesses who can attest to the real impact this issue has on Californians I have Martin Devlin and I have Jose Escobedo. I will now hand it over to them.

Thank you. You'll each have two minutes.

My name is Martin Devlin, raised in Ireland—sorry—I was born and raised in Ireland, but I immigrated to California in 2001 to pursue my career as a software engineer. I am proud to have made California my permanent home, as I see California as forward-looking, innovative, and a place that respects its diverse population.

In April 2021, myself and my wife, Katie, were overjoyed at the birth of our first child. We did not decide on his name until after he was born. But we were already sure we wanted him to have an Irish Gaelic name. Giving him an Irish name was an important way to honor his heritage.

So, we decided on the name Dáithí. Dáithí is an old Irish name. It is spelled with a diacritic mark called a fada on the last letter. In the Irish language, this diacritic mark is just as important as any letter.

I cannot describe my absolute shock when we were informed in the hospital that our chosen name was not allowed to be spelled correctly on his birth certificate. I was stunned. As I sat in the hospital, I immediately felt an implicit pressure to change his name to something else, one without a diacritic mark.

But why should we be made to feel this way? I felt angry at the very notion that this very important decision, the name for my child, wasn't solely the decision of the parents to make, without interference. Today, my child's name is spelled incorrectly on his birth certificate. Last week, we enrolled him in transitional kindergarten.

We were again compelled to spell his name incorrectly in the school enrollment system, as it must match the birth certificate exactly. Presumably, we will repeatedly have to remind teachers of the correct spelling. This annoyance causes confusion for the child also.

The government shouldn't be in the business of telling parents what cultural affiliation their children's name must conform to, or how those names must be spelled. It is an artificial constraint and completely unnecessary. Also, it comes across as deeply disrespectful. Please pass Assembly Bill 64, out of respect for California's diverse population. Thank you.

Thank you. Please go ahead. You'll have two minutes.

Good afternoon, Chair and Committee Members. My name is Jose Escobedo. Eight years ago, when I was just 12 years old, I sat in front of this very Committee in support of the passage of Assemblymember Jose Medina's bill, AB 82, that would have allowed the inclusion of diacritical marks on state documents.

When I first testified, I thought all it would take would be for a little kid to have to ask for his name to be spelled correctly. It seemed like a no brainer. But almost a decade later, here we are again, still fighting to make this happen.

I'm 20 years old now, and I'm currently a student at the University of Oregon. By the way, and I was very surprised when I found this out, it turns out that in Oregon you are actually able to add an accent mark to your name on state documents if you choose to do so.

I've always been proud to be from California. It's a place that celebrates its diversity. That's why I think it's backwards that such a progressive, inclusive state would keep people like me from having our names spelled properly. These accent marks represent my family, my culture, and my traditions. Ultimately, they represent me.

Still, you might ask, what's the big deal if an accent mark is not on the birth certificate or a marriage license? The accent mark itself is not a big deal. If your name has an accent, you should just be able to add it. No big deal.

What's a big deal is how hard the California State Government has fought to keep these diacritical marks off, and it is particularly hurtful and insensitive that, at a time when diversity and inclusion initiatives are being banned across the country.

It's more important than ever that the State of California continues to advocate for the many cultures of its residents. That includes allowing people to record their names correctly.

While my name on my birth certificate doesn't have an accent, I'm hoping that with your help, on my marriage license, it will. Again, my name is José, with an accent. I've been asking you to take action on this matter for eight years, and all I've gotten from you is a resounding no way José.

I thank you for your time and consideration. Thank you.

Moved Bill. Moved by Aguiar-Curry. Seconded by—I heard Addis first over here. Thank you so much. Any other questions or comments from the Committee? Oh, sorry, yes. Any other witnesses in support?

I'm Jodi Hernandez. I'm Jose's mom, and I'm in support of AB 64.

I am Victor Escobedo. I am Jose's dad. I'm also a Spanish teacher. I taught Spanish for a while, and I think it's part of the language. And the language is part of our culture, so I support it.

Hello, my name is Emily Mudo. My mom's a Spanish teacher, and I'm Jose's girlfriend, and I'm in support of AB 64.

Omar Altamimi, California Pan-Ethnic Health Network, in support.

Thank you. Are there any witnesses in opposition? Seeing none. I brought it back to the Committee, has a motion and a second. I will say, Assemblymember Pacheco, 39 years, we've been trying to make sure that we are able to correct this, or acknowledging that we have not done this in the State of California.

And eight years, Jose and others have been fighting to make sure that we have an opportunity to do this. And you, Assemblymember, have been working on this for three years. Two of those times, actually all three, I believe, or two of those times, I've been able to make sure that it gets out of the Health Policy Committee.

And you've gotten it all the way to the Governor's desk. So, not yet. Okay, we're going to fight, but I know that we took some amendments that might make it more feasible to be able to get out, of out of appropriations, and we're very much looking forward to that.

I have a tilde on my maiden name, Villafañe, on the "n," and I couldn't agree more with the testimony that we need to be able to make sure that we have an opportunity to fully represent our cultures and our language. And so, I want to thank you for bringing forward this Bill.

Any other Member questions or comments? With that, we will ask you to close.

Respectfully ask for your "Aye" vote.

Thank you. And now, Secretary, please call the roll.

[Roll Call]

That measure is out. Assembly Member Pacheco. Yes. Yes, way Jose we're going to allow Members to add on at this time and we'll start from the top. Item number one. Committee rules. Health Committee, please call roll.

Lifting the call is [Roll Call] That measures out.

Item number three is out. Item number four, AB73 Jackson.

[Roll Call]

That measure is out. Item number five, AB225 is on consent. Item number six, AB257 is out. Item number seven, AB304. Item. We'll go back to item number six. AB257. Lifting the call.

[Roll Call]

That measure is still out. Item number seven, AB 304 is on consent. Item number eight, AB sorry. Item number nine is on consent. Item number 10. AB 499.

[Roll Call]

That measures out item number 12. AB843. Garcia.

[Roll Call]

I We'll move on to consent. The consent calendar.

[Roll Call]

The consent calendar is out. I have two bills. I'll be handing the gavel over. To our Majority Leader.

Good afternoon, Assembly Member Bonta. You're more than welcome to start and present your bill.

Thank you. This is item, I don't know. AB 40. The... Sorry. AB 315, the Home and Community Based Alternatives Waiver. Members and Chair, I'm very pleased to present my bill, AB 315. This bill relates to a small but very important program within the larger Medi-Cal program called the Home and Community Based Alternatives, or HCBA Waiver.

Members, Medi-Cal is a state federal partnership. Medi-Cal waivers allow the state to waive federal rules to deliver care more effectively and often at a lower cost. The HCBA waiver enrolls individuals with disabilities who have complex medical needs who would otherwise qualify to receive care in a setting like a hospital or skilled nursing facility to instead receive a similar level of care in an alternative setting in the home or in the community.

For example, the HCBA waiver might enroll a child who has a feeding tube or uses a ventilator to breathe or an adult with severe physical and developmental disabilities who needs consistent nursing care. This bill addresses two key problems that are preventing the HCBA waiver from serving thousands more medically fragile individuals, disabled Californians at home and in community based settings. First, it addresses the capacity of the waiver.

This bill asks the Department of Healthcare Services to seek federal approval to accommodate a larger number of waiver slots in order to expand capacity to the number of slots needed to meet the projected demand. Second, AB 315 requires a study of rates for waiver services.

Because the rates for some waiver services have not kept up with inflation, it is becoming very difficult for waiver agencies to secure these services on behalf of individuals enrolled in the waiver. DHCS intends to eventually provide waiver services through managed care, and this will likely happen in the next few years.

But unless we have a good basis for understanding what a reasonable rate is for these services, we may not be trying to roll these services into managed care without the funding to support them. This bill will not actually change rates. That would need to be considered in the budget process. But the rate study will provide the Legislature a sound evidentiary base to make informed fiscal decisions about this program moving forward that can ensure access to these necessary services.

Finally, and this is important to emphasize, this program not only gives people back their lives and their dignity, allowing them to live in their communities with their families and get their medical needs met outside an institution, it also saves the state money.

Many times in healthcare, we talk about trade offs, but this program is truly an example of a win win. The federal government requires the waiver be cost neutral, which guarantees we will not spend more on services overall with the waiver than we would without the waiver.

Indeed, when DHCS expanded the capacity of the waiver by 1800 slots in the last fiscal year, we actually scored a cost savings of nearly $12.9 million. Even if we look at increasing rates or adding capacity, this program will still be cost neutral or cost saving to the state.

It has to be in order to meet the terms of the waiver. And we can do this because we're providing services in a more cost effective setting. To conclude, expanding the HCBA waiver is not only the right thing to do, but it is the smart thing to do from a budget perspective.

I'm pleased to be joined by Alexis Chettiar, CEO and Co-founder of Cardea Health, an innovative HCBA waiver agency with locations in my district and in the broader Bay Area, as well as Bronnie Hazelwood from Hayward, who is a recipient of HCBA waiver services and is willing to share his personal story with us today. I'm grateful to you both for traveling to Sacramento today to share with everyone here about the importance of this program and AB 315.

Welcome.

Hi. my name is Dr. Chettiar. I'm the CEO of Cardea Health. We're a nonprofit that provides HCBA waiver services to individuals in permanent supportive housing. So those are people coming out of unsheltered homelessness. As the Assembly Member mentioned, the waiver also supports adults with disabling conditions, elders who are aging in place, and children who have complex chronic medical needs. In California, we face a homelessness crisis, and one of the challenges within that crisis is that the fastest growing group of individuals entering homelessness are people who have major chronic medical needs.

So what that means is that we need to be able to respond with both health and housing resources. People can't live in the community without the care that they need to remain stably there. So we have an opportunity to do that in California when we provide HCBA waiver services to individuals in permanent supportive housing.

So again, these are people coming out of unsheltered homelessness. We see about an 80% reduction in use of emergency rooms, in hospital admissions, in nursing home visits. We see an improvement in quality of life. There's about an $88,000 per year saving savings among those individuals, and we have nearly 100% housing retention.

So I wanted to share the story of one particular individual. He is quadriplegic. He had spent more than a decade cycling through hospitals, nursing homes, and streets, being exited from nursing homes because he had behavioral health challenges, not eligible to reside in shelters because he couldn't care for himself physically.

So he's lived with us for more than two years. He's stable there. He hasn't had a hospitalization in the last couple of years. I brought a picture. You can't see, but he likes to be out in the sun, enjoying the weather, when that's good. He has a really amazing wheelchair contraption.

So we have an opportunity in California to provide this benefit across the state to individuals and communities that really desperately need it, but unfortunately are not able to extend services because of the caps on HCBA waiver enrollments. So we'd like to ask for your support of AB 315 in order to extend care to unsheltered individuals, aging elders, adults with disabilities, and children that have chronic medical needs. Thank you.

Thank you very much. Our next witness, please.

My name is Bronnie Hazelwood. I've been a recipient of the service for the last seven plus years. And in that time, it's basically not only changed my life, but helped me to reconstruct my life. I was pretty, pretty good at life before, but like a lot of us, I've had some difficulties and some challenges.

This program has helped me to regain my footing, to get back on track, to take life every day as a challenge and to enjoy it in the process. So I think it's an important bill. I think it's important not just for me, but for everybody in this backlog to get their humanity back.

This is a dignity level of program. When you feel like a person, you make a contribution. You're no longer after services that you want to find, but you also find your humanity. So it's important that we spend the money the right way. It's like that old commercial, you pay me now or you pay me later.

If you do the right thing now. It helps us to avoid the challenges of hospitalization, mental health issues, the other ideas that go along with the investment. This is an investment. It's not just a program. It's an investment in our communities and investment in who we are as people. And I think it's important that we look at this very critically and find the support that's necessary.

I'm living proof of how the HCBA program works. I ask for your support in passing the bill. AB 315 is not something that we just asked for. It's something that we need. If we just simply do the right thing, we understand that we are our brother's keeper. And every scripture that I've read shares the fact that we need to take care of the person next to us. And I appreciate your help and thank you for your time.

We have a motion and a second. All right. Do we have other support witnesses that would like to come up to the podium. Name, organization, position only. Whoa. Welcome.

Good afternoon. Linda Nguy with Western Center on Law and Poverty. Proud to support.

Good afternoon, Mr. Chair and Members. Gregory Cramer on behalf of Disability Rights California. We're proud co-sponsors. Thank you.

Good afternoon, Madam Chair, Members of the Health Committee. Awet Kidane representing the Children's Hospital Association of California, strongly support the bill. Thank the author.

Good afternoon. Dylan Elliott on behalf of the City and County of San Francisco as well as the California State Association of Psychiatrists in support. Thank you.

Good afternoon. Omar Altamimi, California Pan-Ethnic Health Network, in support. Thank you.

Sumaya Nahar here on behalf of the Children's Specialty Care Coalition in support.

Janis Connallon on behalf of Family Voices of California in strong support. Thanks to the author.

Good afternoon. Emmalynn Chaubard with California Disability Services Association in strong support.

Tom Heinz, East Bay Innovations, waiver service provider, strongly in support of this critical bill.

Serom Sanftner, also with East Bay Innovations, in support.

Beatriz Saki with East Bay Innovations in strong support.

Jenna Tracy with East Bay Innovations, also in strong support.

Almira Bassam with East Bay Innovations in support.

Hi, my name is Andrea Doss with East Bay Innovations in strong support of this bill.

Hi. Giana Wright with East Bay Innovations in very strong support of this bill. Thank you.

Valentino Daltoso, work with waiver beneficiaries through Cardea Health, in support.

Mayuri Chandran, physician with Cardea Health, in strong support.

Karie Dewan, board member at Cardea Health, in strong support.

My name is Norma, CNA at Cardea Health, I support.

My name is Martina, caregiver, Cardea, support.

Yaneli at Cardea in support.

Melissa Cortez on behalf of Autism Speaks in support.

Bridget with Cardea Health in support.

Hello. My name is Justin Diamond, and I'm a registered nurse at TLC Home Healthcare in support.

I'm Nadja Wipp-Fürle with Cardea Health in strong support.

Evan Gutierra, California resident, in strong support.

California resident, in support.

My name is Catherine Hayes. I'm the Chief Clinical Officer at Cardea Health, and I'm here in support of AB 315.

Good afternoon. Lynn Keslar, I work for Cardea Health. I'm in strong support.

Evelyn Brake, caregiver, Cardea Health, in strong support.

Christina Stevenson, HCBA nurse. Here from Cardea Health, strong support.

Yolanda Taase, medical billing manager at Cardea Health, in support.

Monique Brown, Cardea Health, in support.

Good afternoon. Tylisha Johnson, Cardea Health, strongly supporting AB 315.

Celeste Bahner, enrollment specialist for Cardea Health, in strong support.

Mia Berry with Cardea Health in support.

Good afternoon. My name is Jorge. I is driving for Cardea Health. I am support. I'm sorry.

Andrew Mendoza on behalf of the Alzheimer's Association in support.

Amber King with LeadingAge California in support.

Thank you. Do we have anyone in opposition of the bill? Please come forward. Seeing none. Any questions from the Members? Any questions? All right, seeing none. We'll move on. Would you like to close?

Thank you, Members. And while there was certainly a wonderful representation of local program that receives HCBA waivers, I want to let us all know that these HCBA waivers and services are available statewide through local waiver agencies or through DHCS in counties where there are no waiver agencies like Alpine, Imperial, Inyo, Marin, Mendocino, Mono, and Napa.

I think Assembly Member Stefani has several agencies as well in her district. This is just a smart legislation that allows us to fully leverage the resources that we need through a waiver program and being able to address the cap limitation, given the fact that we have over 5,400 people currently waiting on a list to be able to have the same kind of experience that our witness, Bronnie Hazelwood, was able to talk about is something that is fixable in the State of California. Thank you.

Thank you very much, Assembly Member, and to your witnesses. Thank you for being here today. We will now... Secretary, would you please call the roll?

The motion is do pass to Appropriations. [Roll Call]

The Bill's out, thank you very much, Assemblymember. I'm going to pass the gavel over to Assemblymember Chen for the final.

First time in this Committee. So, what am I supposed to do?

Super non-controversial Bill that we're about to talk to Assembly Members about.

Madam Chair, pleasure.

Thank you. Good afternoon, Vice Chair. Welcome to our Committee and Members. AB 40 simply clarifies that state law defining emergency Services includes reproductive health services, including abortion.

According to the American College of Obstetrics and Gynecologists, or ACOG, severe complications where an abortion might be necessary to save a person's health, or life, include certain placenta-related conditions, Preeclampsia, or Eclampsia, and heart or Kidney conditions.

About 50,000 people in the US develop life threatening pregnancy complications each year, including major blood loss, sepsis, or the loss of reproductive organs, or in rare cases, doctors might need to terminate a pregnancy to protect the health of the pregnant person, especially in cases where there is no chance for a fetus to survive.

Unfortunately, there have been instances where parents in the middle of a miscarriage, or other pregnancy-related emergency, have been turned away from an emergency room and told to go to a different facility.

No one facing an emotional, vulnerable, and potentially life-threatening decision should be denied care, told to go home, or forced to drive to the next hospital. Abortion is health care, including emergency care, and this Bill makes it very clear California treats it as such.

Testifying in support today is Alena Chavez, Program Manager for TEACH, which stands for Training in Early Abortion for Comprehensive Health Care.

Good afternoon, members of the Committee. Thank you for having me today. My name is Alena Chavez, and I'm the Program Manager for TEACH, which stands for Training and Early Abortion for Comprehensive Healthcare. We're proud to be in support of AB 40.

With the closure of maternity wards and birthing centers, and OB-GYN and family doctor shortages in rural areas, hospitals with emergency departments serve as the most accessible source of reproductive health care, for medically underserved populations throughout California.

When someone is experiencing a reproductive health emergency, they should feel safe knowing that the ED, from which they are receiving their care, will do whatever they can to stabilize their life, as is protected under California's EMTALA, the Emergency Medical Treatment and Active Labor Act.

Clinical experts created ED-specific protocols on miscarriage, contraception, ectopic pregnancy, and medication abortion that empowers doctors to make life-saving decisions, in partnership with patients. Sometimes this looks like providing abortion care during a miscarriage or ectopic pregnancy, in order to stabilize or save the patient's life, making abortion care an emergency service that is protected under EMTALA.

AB 40 seeks to ensure that abortion care is recognized and clarified in state statute as an emergency service in California, preventing anyone from being denied care when they need it most, and bridging the gap in access to care for all Californians.

That is why I'm here today respectfully asking for your "Aye" votes. Thank you for your time.

Do we have any other people in support witnesses? It's been moved and seconded.

Ryan Spencer, on behalf of the American College of OBGYN's District 9, in support.

Good afternoon. Angela Hill with the California Medical Association. We didn't get our letter in, in time, but we are in support. Thank you.

Tim Madden, representing the California Chapter at the American College of Emergency Physicians, in support.

Jennifer Robles, with Health Access California, in support.

Kathleen Mossberg, with Essential Access Health, in support.

Symphony Barbee, on behalf of Planned Parenthood Affiliates of California, in support, and we also weren't able to submit our letter in time. Thank you.

Omar Altamimi, California Pan-Ethnic Health Network, in support. Thank you.

Thank you very much.

Now, do we have any witnesses in opposition?

You have two minutes, ma'am.

Thank you. Good afternoon and thank you for your time to hear an opposing argument to AB 40. My name is Dolores Meehan. I'm a board-certified nurse practitioner trained at UCSF. I've worked as an inpatient RN for 11 years, including the emergency department.

In my 15 medical missions to rural Africa, I've encountered every trauma and emergency situation known to man, with considerably fewer resources. When a pregnant woman presents to the ER, standard of care dictates that two patients are considered: the pregnant patient and the fetal patient.

The AB 40 language does not include consideration for the fetal patient, which is in direct opposition to EMTALA. When a pregnant patient is in a medical crisis, almost always, she is carrying a wanted child and is not seeking an abortion. She is seeking life-saving medical care for both her and her unborn child.

Standard of care, irrespective of policies on abortion, is to save the life of the mother and the child. If, in the course of saving the life of the mother, the unborn child dies, fetal demise is not considered the termination of the pregnancy.

Direct abortion, by contrast, which has its primary aim, the demise of the fetal patient, is not emergency health care. The tragic circumstances that prompted this Bill should never be the standard of care, regardless of policies on abortion.

Emergency services is an integral part of a hospital's ministry to the community, providing critical, timely care in life-threatening situations, and all women deserve compassionate and excellent emergency health care. The problem with naming abortion as the only required medical invention—intervention—gives abortion disproportionate weight for clinicians examining and evaluating pregnant patients.

Prompting specific procedures is contrary to the goals of the Emergency Services Law, which encourages emergency departments and physicians to use their best medical judgment for treatment and stabilization. Finally, our ERs are overcrowded as it is. This Bill sets a precedent for specific non-emergency services, that mandates emergency departments provide...

Thank you very much. If we could close. Thank you.

Okay. Uh, thereby adding a whole new layer of patients to our overburdened ERs and hobbles the ability of our ERs to carry out their unique mission of treatment and stabilization of emergency medical conditions. It is not the role of the ER to provide elective procedures such as pharmaceutical abortion.

Thank you. Thank you very much.

For these reasons, I urge a "No" on AB 40. Thank you very much for your time and consideration.

Thank you for your testimony. Do we have any other witnesses in opposition? Name, organization, and position only, please.

Greg Burt, California Family Council, in opposition.

Seeing no other witness in opposition. Members of the Committee, any questions, statements? Seeing none. Madam Chair, would you like to close?

Thank you. I would just like to clarify that emergency services and care includes abortion and other reproductive health services, as necessary, to relieve and eliminate an emergency medical condition. And if you look at the analysis on page one, you can see the further definition related to emergency services and care.

This, Members, is a very simple Bill, clarifying that we need to make sure, in the State of California, our state version of EMTALA is very clear, and that you will not be turned away in an emergency department, should you need care.

A person on the worst day of their life, losing potentially the baby they wanted so very much, should not have to also fear being able to receive life-saving care and denied that care. It's a very simple Bill. With that, I respectfully request your "Aye" vote.

Thank you, Madam Chair. Secretary, please call the roll.

[Roll Call]

Thank you, Madam Chair. The Bill is out.

All right, members, that concludes the agenda for bills to be heard for today in our Health Committee. All the bills are out right now, so we are just opening the lifting the call to be able to offer add ons for anyone who didn't have an opportunity to vote before. We will run down the list.

Item number one, committee rules for the Health Committee.

[Roll Call]

Thank you. We'll move on to the consent calendar.

On consent. [Roll Call]

Item number three, AB 64 Pacheco.

[Roll Call]

Thank you. That bill is still out. Item number four, AB 73.

[Roll Call]

Item number five is on consent. Item number six, AB 257.

[Roll Call]

That bill's still out. Item number seven is on consent. Item number eight, AB 315.

[Roll Call]

We'll move on to item number nine, which is on consent. Item number 10, AB 499 Ortega.

[Roll Call]

Item number 11 is on consent. Item number 12, AB 843 Garcia.

[Roll Call]

The measure is still out. Item number 13, AB 951 is on consent. We've all voted over here. Okay. We will keep the roll open for two more minutes for Assemblymember Sanchez to register a final vote if she so chooses. We are adjourned for the Assembly Health Committee of Tuesday, March 25, 2025.