Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services

Good morning. We will call Budget Subcommitee number three hearing to order, saying that there is no quorum. We will skip from item one and start with item two. As we are waiting for our presenters to come up for item two, I want to thank everyone who is here. The hearing today has a lot of information on the agenda, but we expect it to go no more than two hours. Okay, so we will start with issue number one under California Department of Public Health, our overview. Thank you.

Good morning, Madam Chair. My name is Brandon Nunes. I'm the Chief Deputy for operations at the Department of Public Health. Your agenda does a great job of providing an overview.

So I'll just kind of give a high level of what's going on in the Department, maybe provide a little roadmap for more of what you'll hear today regarding our budget. So proposed for 25-26 is a little over 5 billion for us, reflecting a 1.3% decrease from the 24-25 Budget Act.

For us, the breakdown is mostly federal funds at 2.3 billion. Special funds and reimbursements are 2 billion. And then roughly 730 million comes from the General Fund. And this funding, of course, supports public health infrastructure, disease intervention, emergency response and regulatory oversight across eight major program centers.

Discussing some of those centers and proposals that you'll hear about today in Center for Healthy Communities, which focuses on chronic disease prevention, tobacco control, oral health and injury prevention. We have usually some changes in our Prop . 99 and 56 funding due to lower than expected tobacco revenues.

We are seeing reductions in those funds for Center for Healthy Communities as well as our Center for Environmental Health. And you'll hear a little more about that later. We also have some proposals that implement legislation that passed in last session in Center for healthy communities.

SB 908, which helps track fentanyl related deaths in young children, and SB 1076, that will develop an online accreditation and certification application system for the childhood led program, are both up for your consideration in this year's budget.

Over in Center for Infectious Diseases, where the mission is to oversee disease surveillance, immunizations, outbreak response, HIV AIDS programs and STD prevention, some of the key budget proposals are in this area. We have updates to our AIDS drug assistance program.

We do an estimate for you every year and we do have some increases there to support rising medication and insurance costs. We do have a reduction that's related to the overdose prevention programs due to expiring opioid Settlement funds. And then we do have over 50 million that's been included for investment in our IT infrastructure.

In CID, we have about 27 million that's being included for our SAPHIRE system, which is our Surveillance and Public Health Information Reporting and Exchange. And that'll help support data modernization for disease tracking and public health reporting. There's 18 million included for CalConnect, which will maintain our contact tracing platform for infectious disease management.

And then finally 5 million for supporting our California Immunization Registry, which will upgrade for improved vaccine data tracking. I do want to acknowledge one thing, and you'll hear a little more about this in issue 4. But as it relates to the question there later in the agenda, that is part of our state's broader fiscal considerations.

We do not have funding that's been included for MyCalvax that was not included in the Governor's Budget. But of course, we'll have a conversation a little more about that. Initial, in Center for Family Health, which supports maternal, child and adolescent health, newborn screening, and the WIC program, we have updates to a couple more of our estimates there.

Our Women and Infants and Children estimate, which is seeing increases related to rising food costs. We have our genetic disease screening program, which also is seeing some increases related to maintaining laboratory services in Center for Healthcare Quality, which licenses and regulates hospitals, nursing homes, clinics and other healthcare facilities.

A couple of investments that you'll be hearing about today are related to expanding our public policy and legislative branch that will help us improve healthcare policy analysis there. And then we have an account that helps with quality improvement, literally called the internal departmental quality improvement account.

And we have some funding there that's being requested to modernize some of the online licensing systems for the center. And then finally in the Center for Lab Sciences, which conducts public health lab testing, food safety and disease research, the state develops an infant botulism treatment serum called Baby Big.

And usually we come to the Legislature for whenever we need to develop a new lot. And so that's what we have in front of you now is, is a funding request for manufacturing and regulatory costs related to developing the new Lotta baby pig. I'll leave it there. Of course, we're gonna get into a lot of this later. And your agenda, as I mentioned, does a great job of outlining that, but I'll stop there.

Thank you for that overview. Not sure if LAO or DOF is here and if they have any. No comments from either one. All right, great. And no other Committee Members are here. So we will move on to issue number two. State of the State Public Health thank you.

Welcome. Thank you. Good morning, chair. I'm Dr. Erica Pan and I have the great honor to serve as your new Director of the Department of Public Health and State Public Health Officer as of the beginning of February. I am 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 can 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 at least 97% of our health dollars in the United States caring for illness.

In the years leading up to the COVID 19 pandemic, public health funding in California remained flat or decreased and and 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, it decreased our life expectancy. For the first time in two decades, it went 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 no longer among the leading causes of death and and life expectancy has rebounded.

Thanks to this landmark 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 our future generations. Public health challenges are growing in complexity and frequency.

These include increasing health disparities, climate change driven extreme weather events, new and re emerging 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 approach which is working closely with many partners to address health across the animal, human and environmental health spectrum, preventing exposures from infected animals or food products and working with local health departments and healthcare 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 General public remains low, we must remain vigilant as we continue to learn more about this evolving virus and how it spreads.

Our CDBH 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 essential services like wic, and addressing mental health resources 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 key highlights of population health trends In California we have made important gains in lowering mortality since 2000, death rates for cardiovascular disease and cancers for men and women 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 among the leading causes of deaths.

In addition, Alzheimer's disease related deaths have increased in the last 20 years and are amongst the top causes of death in California, especially amongst older adults. What's also very striking to note is that 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 from for ages 25 to 54 years of age and they've risen to become the fifth leading cause of death overall amongst young adults.

The increasing and concerning rates of mental health conditions such as anxiety and depression are the leading cause for hospitalizations. Suicide is among the leading causes of death in younger adulthood and the highest rates are in male adults 75 and older.

Thus, our focus on addressing behavioral health is crucial to address these major preventable causes of young lives lost. Research shows that 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 Behavioral Health Services act prevention funding where we have a transformative opportunity to address and improve these heartbreaking years of life lost. Public health also recognizes that health and well being are linked to the conditions of the communities in which we live.

These are known as the 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, who we love, 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 that rates in our black infants and mothers are over five times higher than our lowest rates.

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

Vaccines are a shining example of public health success. If I were presenting to you before the existence of vaccines, I would be reporting infectious diseases as the leading causes of death and mortality and disability. We've essentially eliminated diseases like polio and diphtheria.

And while we now have five cases of measles this year in California exposed during international travel, the lack of additional linked cases or outbreaks is thanks to California's robust vaccination requirements.

We have maintained kindergarten MMR vaccination rates of 96% compared to 82% in an area in West Texas with an outbreak of over 200 cases and growing and tragically, the first death in a healthy, unvaccinated child since we eliminated measles in the US in 2000.

We must continue to promote and support vaccinations or we will lose ground on the success we've had. In conclusion, while Californians have seen major improvements in our health over the past 20 years, we are 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. We can leverage the data we collect to empower the communities we serve to be healthy and address equity.

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

Thank you so much for coming to present before us today. See, are there any questions?

Thank you, Madam Chair. First, I think it's so refreshing to hear at least one of our top dogs talk to us about vaccines and not have the secretary go and talk about the don't get vaccinated. So it's really nice that in California we have smart people leading us. A couple questions for you, Director. Can you first share with me just an update? If you were on silicosis, have we seen a downward trend or upward?

Sure, absolutely. This is a new sort of effort in public health. So as far as trends, I'm not as clear, but I can tell you we've identified 258 cases. Amongst those 15 deaths from silicosis. And what's the date range for this?

I'll have to get back to you on the date range, but we can definitely get back to you on that. I'm so sorry. Could you go? Can you start again? Sure. So it's 258 cases. We recently made this reportable. So it wasn't a reportable disease until within the last few years.

We'll have to get back to you on the timeline. And then 15 deaths and 30 lung transplants. And this is among primarily young Latino men in their 30s and 40s. So this is in young workers. So that is what do we do. With the data that we're tracking? We collect that and then what?

So we're doing a lot of work with that surveillance and working closely with our partners at Cal OSHA to do more education and outreach to the manufacturers and the workers on how to have preventive practices which are really challenging to implement because this is a very fine, you know, sort of dust almost that can get into our lungs.

Yes. And so you can imagine we all sort of know what silicone is. And if you once you have that in your lungs, you cannot get it out and it causes difficulty breathing. And you know, as noted, you know, we've had 30 lung transplants. Is there data sharing between the departments? Absolutely, yes. We collaborate very closely with Cal OSHA on many, many sort of occupationally related diseases, including silicosis.

And does the Department, Department during the tracking see if there is a geographic hotspot and then share that with Kaosha saying, hey, this is an area right now that is spiking focus in this area?

Yes, we have ongoing collaboration with them. And a lot of this is focused in certain urban areas where the manufacturing is happening. I'm just looking. zero, and sorry. This has been reportable since 2019.

So those numbers are since 2019 as far as, as far as the areas they're clustered around popuLation centers such as La, Orange County, San Diego and in the Bay Area.

So just to go back to my question, if there are hot spots in certain areas, do we share that information with Cal OSHA specific to an area or just statewide? Hey, this is what we're seeing.

My understanding is we have ongoing conversations again around this disease and others. So they know that the. The data around the clusters as well and where our priority areas to focus on.

Director, can we follow, Can I get a follow up from your office on just the. I know it's since 2019, but with the numbers, if we are seeing a downward trend. Sure, absolutely. Since the tracking. My second question is on measles. One case in LA County. Now what does that look like for your office? What process are we in for that?

Sure. So we have sporadic cases of sort of what we would call imported measles like this, sporadically. And so we've actually had five cases this year. All of them have been people who were exposed in other countries where they're having large outbreaks. There are a lot of large outbreaks happening globally as well.

So what's really important is what public health does is when a case is reported, they do that investigation, they do contact tracing. They can find out if there's any high risk exposures, such as a pregnant woman, someone who's immunosuppressed, who can get post exposure treatment. So sometimes that can be like an antibody or a vaccine.

It sort of depends on the timing and what their risk factor is for potentially not being protected with immunity. And I think it's really important to know too, we haven't had outbreaks in California essentially since 2015 when we had a large Disneyland related measles outbreak. And then we firmed up a lot of our vaccine requirements.

And again I mentioned. But just to reiterate, we have over 96% overall in our state vaccination rates in our kindergartners. Whereas some of these outbreaks are happening in areas where they have lower vaccination rates. So it's really that whole community immunity that really works with vaccines if you maintain a certain level.

And we have seen vaccination coverage and rates and vaccine confidence decreasing over time.

Okay, so the local public health takes care right now until we see an increase and then we step in or we don't need to.

We work closely with local health departments. So again, the local health departments do that actual investigation, but they certainly report it to our team. This is handled in our immunization branch and they do a lot of technical consultation if needed.

If there's any questions about how to prioritize those contacts, who and if they need extra vaccine to do more outreach. But again, these have all been limited spread. Thankfully, we haven't seen any secondary cases that have been exposed here in California.

And my last question is, you shared some statistics. California, I guess safer is better, but we have one of the lowest maternal mortality rates in comparison to other states. Yes, that's right.

In the data that we collect, do we see or are we able to see a correlation with those cases in areas that have maternity wards that have closed?

That's a great question that we'll have to get back to you on as well. I actually don't know the answer to that.

Thank you. Madam Chair. Good afternoon. I just have a question, I guess, and I apologize for being late following up on what my former. My other veteran on the Committee said. We have a maternity Ward in Ridgecrest that has been closed. They just reopened it, but in rural communities. And Ridgecrest is different.

It's not just a rural community. It's an isolated community. So it's not a rural population. It's very well populated for the area that it serves. But the maternity Ward, because of the number of delivery, it is affected by this. And I guess, is there a solution? Is there something that's going to happen to address these issues?

Because no matter where you live in the State of California, you should be able to have somebody assist you in delivering a child.

Yeah. I do know that we're partnering with dhcs on sort of, you know, the perinatal pathway and improving maternal child care. I think specific to the wards, I think this is an area I need to. To be Frank, I need to get more up to speed on. But we can definitely. We agree this is a priority.

As I mentioned in my testimony, I think we want to maintain and share the important things we're doing for our overall rates and to decrease disparities and whether that's rural or based on race.

Okay. And then just to follow up on that, you know, they're high medi Cal populations. Right. These are high Medicaid populations. And so whether it's the Central Valley, we're okay right now there or East Los Angeles, whatever.

But in Ridgecrest, that specifically isolated area, because it is a large population, but Only isolated and the rates are significantly Low. And I know that's not really in your purview, but that's something that, if you're going to communicate with Department of Health Services, that that would be something that was addressed.

And another thing that if you could communicate just like offering some type of solution instead of or maybe just a thought for consideration. Not that you would take it or anybody else would, but there's also standby time or wall time, like for ambulance, ambulance providers or fire departments that drop off patients.

They can't just throw them in the emergency room and drive away. But there is a billing for standby or wall time that might be a solution. So if you have a labor and delivery person at the hospital and there's not a baby being delivered for a couple of days, maybe they get standby or wall time.

I don't know if that's a solution, but it's something that was offered to me at a meeting and if it's something could be considered, that would be great.

We can certainly share that with our other partners in the health and human services agencies. Thank you. Sure. I do have a quick follow up just from Senator Menjavar's question. The rates are increasing actually over time and we can send you a graphic of that and follow up of silcosis. Sorry. Yes.

Well, first off, I want to thank you for coming, but also congratulate you on this new position that you've been in for a little over a month. Really excited to have you in this role.

As was stated by my colleague Senator Menjavar, it is very refreshing for us to have our top public health official here in California who understands science, who believes in science, who informs and educates true evidence based science to try to keep all Californians healthy, to keep us immunized, to ensure that we're doing appropriate contact tracing.

And you know, at this time, it is extremely important more than ever to have someone who's really taking care of California residents. And the Public Health Department is extremely important. As you can see, one of the issues that we all talk about is labor and delivery wards, labor and delivery units.

But I do want to point out as an obgyn, the issue with the disparity in the maternal and morbidity rates does not have anything to do with the closure of labor and delivery units. This unfortunately has been an issue that the nation and the state has been dealing with for a very long time.

The disproportionate rate between black women and black infants. It is also, unfortunately, I wouldn't say fortunately or unfortunately. But it's also not linked to socioeconomic status. You can be on Medi Cal or you can be as wealthy as one of the Williams tennis sisters and unfortunately have a disproportionate outcome.

And we know that that deals with what you've mentioned before, social determinants of health that specifically racism and microaggressions that cause weathering on our bodies so that when we enter pregnancy, our bodies are older and weathered than our counterparts.

But it would be nice going forward since we now have more closure of labor and delivery units to see if we are seeing any adverse maternal morbidity mortality outcomes in the places that have closer labor and delivery units.

But with that, I really want to thank you so much for coming and presenting and we are actually going to move back in our agenda to now that. And first we're going to establish a quorum. Please call the roll.

[Roll Call]

Great. And so we will now go to the issue of the opioid. Opioid settlement Fund allocation. We will hear that presentation. Does anyone from the Department of Public Health have any comments on that? If not, then the recommendation from the Committee is to reject the recommendation. I will open it up for comments.

And I apologize, I had a question and since there's nobody asked it, maybe you guys, my colleagues can fill me in. Is there a reason why CDPH is requesting a reduction in expenditure for opioid use? I'm just. I don't have the background on that.

And I'm just curious if no one is here from the governor's office to answer that question. Do you guys have an answer for me? Just curious.

So we, last time we had the hearing, I believe the money was going to be. They wanted to reallocate it to different area for the naloxone distribution program and that item was rejected saying that this particular program, data wise, was more successful in terms of preventing opioid deaths, which I agree with.

So I'm curious about the reduction.

So that's their proposal and that's what we'll be voting on.

I apologize again. Thank you, Madam Chair for that explanation.

Thank you. Yes, last time with that Department, we rejected the proposal for them to get an increase. And so now we will be voting on this proposal to see if we would have a reduction in this area, seeing no other comments and no one from either office that want to comment. Okay. Someone is here.

Okay. Christine Cherdman Leong, Department of Finance. Just wanted to note for the Administration, since this is not reflected in the. Governor's Budget, that we're opposed to this proposal. Thank you.

All right. Seeing no other comments, we will now vote on rejecting this proposal. Do I have a motion?

Move. I'll make a motion. I mean. Okay,

We'll call the roll.

[Roll Call]

That has two aye votes that passes. Are we. Should we hold the roll? We will take a five minute recess.

Okay. Our hearing will now resume. We will close that roll and that agenda passes to zero. We will now move on to hear about our AIDS Drug Assistance Program estimate. And you may begin whenever you're ready.

Good morning, Chair Pearson. Members of the Committee, my name is Joseph Lagrama, Branch Chief of the ADAP Branch, and I'm glad to provide you 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 prepapp, 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. And PrEP app provides assistance with medication and medical out of pocket costs related to HIV prevention.

For 24-25, 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.

For 25-26, the Office of AIDS estimates the ADAP Budget Authority need will be $462.3 million, $352 million from the ADAP Rebate Fund and $110.3 million from the Federal Trust Fund. This is $51.8 million higher than reported in the 24-25 Budget Act.

In addition to the expenditures related to the Early Action Program enhancements, the ADAP estimate includes proposed expansions to ADAP's Employer Based Health Insurance Premium Payment Program, to ADAP's Medicare Premium Payment Program and to the Pre Exposure Prophylaxis Assistance Program. I understand that there were several questions from Subcommitee. Should I go ahead and proceed with responding to those?

The Committee requested an overview of the two loans to the General Fund from the ADAP Rebate Fund. The two loans from the ADAP Rebate Fund to the General Fund refers to the $400 million loan that was part of the 2023 Budget act and the $500 million loan that was part of the 2024 Budget Act.

The 2023 Budget act included control section language stipulating repayment in a future year when the Fund has a need for the monies or there is no longer a need for the Fund absent Invoking this control section language, this loan will be repaid in 2027-2028 for the $500 million loan.

The 2024 Budget act included provisions stipulating repayment if the Fund needed additional funds to maintain program operations to maintain uninterrupted access to drugs or services to expand eligibility criteria or add new medications to the formulary or if there's no longer a need for the loan funds.

Absent meeting these repayment triggers, the loan will be repaid in fiscal year 28-29. The $500 million loan is being taken in installments. To date, 350 million has been transferred from the ADAP Rebate Fund and the last installment of $150 million is scheduled to occur in April 2025.

Regarding the condition of the Fund balance, we receive a weekly cash balance of the ADAP Rebate Fund. As of Monday, March March 10th, the balance was approximately $269 million.

The Committee has also requested a status update on implementation of each of the components of the ADAP Early Action program enhancements beginning January 1, 2025 or as soon as is technically feasible thereafter, the Department of Public Health was to increase ADAP and PREP APP financial eligibility standards from a modified adjusted gross income that does not exceed 500% of the federal poverty level, household size and family size to 600%.

The Financial Eligibility Standards were successfully implemented on January 1, 2025. For 24-25, the estimated fiscal impact to ADAP is $1.5 million for 234 ADAP client enrollments for 25-26, the estimated net fiscal impact is $4.1 million for 701 client enrollments.

For 2425, the Estimated Fiscal Impact to PREPAPP is $82,000 for 46 PREPAPP enrollments and for 2526 the estimated fiscal impact to PREP APP is $586,000 for 137 PREPAPP client enrollments beginning January 1, 2025 or as soon as is technically feasible. CDPH was to increase the cap on Premium payments from 1,938 per month to 2,996 per month.

For ADAP's insurance assistance programs. The premium cap increase was successfully implemented on January 1, 2025. For fiscal year 24-25, the estimated fiscal impact is $1.8 million. For 25-26, the estimated fiscal impact is $3.5 million. The increased premium cap is not expected expected to contribute in increased enrollment beginning January 1, 2025 or as soon as it's technically feasible.

Thereafter, TDPH was to modify the ADAP formulary from a closed formulary to an open formulary and we continue to work internally and with contractors on planning and implementation of an of an open formulary for ADAP. A contract amendment is in development and the ADAP Branch anticipates implementation in fiscal year 25-26.

There is no estimated fiscal impact for fiscal year 24-25, however, for budget year the estimated net fiscal impact is $18.9 million. The open formulary is not projected to increase enrollments.

Regarding the allocation to the Transgender, Gender, Non Conforming and Intersex Wellness and Equity Fund, the annual allocation of $5 million for three years is part of a Cleanup Trailer Bill language being put forward forth by the Department and we anticipate implementing in fiscal year 25-26.

Regarding the allocation to Fund the Harm Reduction Supply Clearinghouse, the annual allocation of $10 million for three years has been implemented, the funds have been allocated, an agreement has been executed and activities began in February 2025.

Regarding the $200,000 in state operations available through June 30, 2027 to conduct a needs assessment and analysis for client NAVIG Services for clients enrolled in Orion White HIV AIDS Program through the Office of Aids.

We are currently working on executing the agreement and we're also working on agreement for the $200,000 that is available for the needs assessment and analysis for the Pre Exposure Prophylaxis Navigation Services program. Regarding the allocation to Fund a community based organization to make condoms available.

This is also part of the Trailer Bill language cleanup proposal and will be implemented in 25-26.

The Committee has also requested that we describe the Department's plan to engage stakeholders to develop an expenditure plan for the $900 million in ADAP rebate Fund resources and through ongoing stakeholder engagement, the Department of Public Health will continue to develop enhancements to ADAP and related programs. In consultation with stakeholders. We will ensure that proposed activities are ineligible.

Use of the ADAP Rebate Fund While ensuring the ongoing solvency of the ADAP Rebate Fund, we conduct strategic stakeholder engagement across multiple efforts and programs to inform policies and initiatives including monthly calls with the ADAP and PREP APP enrollment workers, bi monthly meetings with the ADAP and PREP APP enrollment Worker Advisory Committee meetings twice a year with a California Planning Group and monthly stakeholder engagement calls.

Additionally, the needs assessment and analysis for ADAP and PREP APP will inform the program enhancements that will be proposed. Program enhancements will be proposed on an ongoing basis through the ADAP estimate.

Additionally, it's important to highlight that some of the $900 million is subject to Federal Health Resources and Services Administration spending requirements and cannot be spent on non Ryan White Part B related activities. I'm happy to answer any additional questions.

Thank you. Are there any comments from LAO or DOF? No comment. Thank you.

Will Owens with the Legislative Analyst Office. No comments, but available for questions.

Thank you. Any questions from my fellow Senator Menjivar?

I wanted to first say thank you. I know we were going back and forth whether it was my office, our consultant here, or our budget team on the 5 million for condoms. So I do want to thank y'all for putting that back in and working on a way to get that out to our communities.

Thank you. Thank you, Madam Chair. Thank you guys for being here. I appreciate that. I may be wrong. Again, correct me if I am, but I was my understanding that the ADAP program was never intended for condom distribution or syringe distribution and also like therapeutic programs, it was.

The goal was based on my memory, to reduce the cost of expensive HIV drugs so that there was people had access to those drugs at a more reasonable rate. Am I correct or not?

Good morning. Adrian Barraza, Assistant Deputy Director with CID Center for Infectious Diseases. So we are able to use a subcomponent of our ADAP Rebate Fund for HIV prevention services, which could encompass condom distribution. It's a component that's not under federal purview. It's subject to what is in state statute.

So separate dollars for the rebate program versus the money we get from the Federal government

It's a very specific pot of rebates. A portion of our rebate is subject to federal spending requirements, and a very specific portion of it has more flexibility.

Okay, thank you. Thank you for that. Thank you, Madam Chair.

Yeah, thank you for clarifying that. So those funds are not using the federal funds, they're using the rebate funds? That is correct. Okay, thank you. All right. Not seeing any other questions. I want to thank you all so much for your presentation.

We will now move to the next item, which is maintenance and operations support public health information technology systems.

Thank you very much, Madam Chair. I'm going to just jump into a very quick overview of our proposal to maintain our three of our infectious disease data systems. So the California Department of Public Health is requesting state General Fund Support for the Safire, CalConnect and Care3 systems.

For CalConnect, we are requesting 18 million in fiscal year 25-26 to support maintenance and operations. The remaining M&O costs for 25-26 of 15 million will be funded through federal funds that are available in the budget year. For Safire, we are requesting 15. Excuse me.

We are requesting 15 positions and $27 million in General Fund in 25-26, $20.4 million in 26-27 and 16.3 million in 27-28 and ongoing for M and O support. And then lastly for the California immunization registry or Care3 project, we are requesting 5.1 million in General Fund in fiscal year 25-26.

The remaining costs associated with the Care3 project of 8.6 million are being requested from federal funds via Federal Match and then there was another question in the agenda. I'm happy to jump to that. Perfect. So I believe our Chief Deputy Director of Operations covered the first part of that question earlier.

So I'll jump right into the cost to continue the system which is 44 million for for the budget year 25-26 and without funding to support VMS in the budget year, CDPH would essentially have to decommission the VMS system. That would include all core systems that are encompassed within the VMS suite, including our core systems reporting data pipelines and integrations.

That includes platforms like MyCavax, MyTurn and Clinic, the DVR, the Digital Vaccine Record and Iris, our immunization registry information system, and would result in the loss of critical functions that include the loss of technical solutions to support ordering of vaccines for children vaccines for adults supported through the federal 317 immunization program and State General Fund vaccine programs.

This would mean that our most vulnerable populations, including children on Medi Cal, underinsured and uninsured minors and adult populations will not have access to critical vaccines that are currently provided through vms. This would result in millions of vaccines and vaccine products that cannot be ordered for the provision of California residents.

So for example, we would lose functionality for vaccine ordering and management for the VFC system that provides approximately half of all children vaccines in California. Specifically, VFC pays for all childhood vaccines for children on medi Cal and this is something that cannot be done without VMs.

In addition, health and Safety Code requires CDPH to provide access to immunization records and correction of immunization records. Currently, CAVMS supports the completion of over 700 record correction request tickets submitted by the public on a weekly basis and IT processes approximately 30,000 digital vaccine records on a weekly basis.

The decommissioning of VMS will also result in direct impacts and consequences for local health districts, the state and providers. For example, access to vaccine inventory management tools would be severed and would need to revert to manual process.

This would eliminate access to tools that are critical to vaccine management success, including supporting the reduction of vaccine waste and overall improvement in vaccine inventory management and accountability, cdph, local health districts and consequently the state would be limited in their ability to monitor vaccination rates, vaccination opportunities and support decision making.

In addition, providers, clinics and local health districts and jurisdictions throughout California now depend on VMS to administer their vaccine clinic management processes. And then local health districts and providers would also have to revert to manual processes for public scheduling and clinic management that do not currently exist.

And then lastly, without cma, vms CDPH would not have an effective tool to deploy vaccines for disease prevention and control in the event of an emergency or a large scale outbreak. With that, I'm happy to answer any questions the Committee has.

Thank you. What was the cost again to continue the system?

It's 44 million in budget year 25-26.

Okay, thank you. Any comments from LAO or DOF?

Nothing further than that, but available for questions.

Thank you. DOF, can you please comment on the recommendation not to continue funding my calvax?

Yes. Christine Cherdboonmuang, Department of Finance so this is still being evaluated. It's not in the Governor's Budget now, but there continues to be conversations and we're not able to share details of those conversations outside of the Governor's Budget.

I won't say you get used to it.

I never liked those answers last year and I don't particularly like them this year. Senator Menjewar, do you have any questions?

Yes, can you share? The automation of this was to make it less tedious for individuals. The spreadsheets, the phone calls. Is there going to be additional funding maybe not at this level to help with the increase of workload or how are we going to address the increase of workload?

Second part is why would we want to move backwards? If this system makes things smoother, why would we then go to a place where it's going to make it more difficult?

So we don't have any mitigation plans currently. If the event we have to decommission VMs, we would have to work very closely with our partners to try to insulate any potential fallout or impact to workload, but the reality is that it will have an impact on their workload and there will be a reversion to manual processes.

I wouldn't necessarily say that we want to revert back to archaic processes of working with the very manual, tedious and inefficient tools. There are a lot of benefits certainly that were reaped through the establishment of the vaccine management system that would be a ideal to maintain at this point. As my colleague with Department of Finance mentioned.

There are ongoing conversations and it's not in the Governor's Budget, but we're maintaining an open dialogue with Department of Finance.

And how many healthcare providers utilize this system.

I will have to get back to you on an exact number.

Do we know how many vaccines are distributed through this platform? Or, like, what's the impact?

Yeah, so, for example, in 2324, VMS supported more than 9,000 clinics and administering more than 1 million vaccine doses with more than 1 million Members of the public using the system.

I think, Madam Chair, I think it's frustrating, right, if we, if the Administration proposes a cut without proposing a solution to supplement that, it's really hard for legislators to look at things like this and say, well, I think we're just making the situation worse if we don't have something to replace it with.

Thank you. I also want to, first of all, thank all of you for presenting and agree with my colleague here. You know, last year in the administration's January budget, you excluded funding for the c. For the Department of Public Health CalConnect System for Communicable diseases, contact tracing and disease investigation.

And I know I had a very robust conversation, didn't get a lot of information as to why that was the case. I'm happy that it is being funded this year. But, you know, we all, including, you know, our Governor, live through this pandemic.

I have no knowledge of why the thought would be that we need to revert back to a system that did not work properly before. I just honestly, when you look at the things that are being cut and some of these things that are being funded, I have questions about why you would Fund certain things.

I cannot fathom why we would want to go back and impact the ability for people to get information and to get vaccines and for providers to be able to see that information. I honestly cannot understand it.

And so I hope when you all have your secret conversations behind the closed doors, you reconsider, strongly reconsider, putting this back in.

I would not like for us to be in a position where we have to go and figure out what we are not going to Fund so that we can ensure that we can keep Californians, especially our most vulnerable, safe. And with that, I, yes, I just.

Want to acknowledge that, you know, like I said, it's not in the Governor's Budget. And we do. We are listening closely to the priorities of the Department, the Legislature, stakeholders. So we are hearing that.

And, you know, at a high level, you know, we are, we are charged with ensuring that we're maximizing the use of the state resources. So that's something we're looking into. And we, you know, have appreciated the cost reduction strategies on a lot of these other IT systems.

And so we're looking into, you know, how we can continue to go down that path so that we can continue to meet the state's priorities with the best use of our resources.

And I appreciate that. And I think one of the things that is often not taken into those equations is within the health realm is the cost of not doing things.

So if you do not allow for the ability to educate and provide these immunizations, what is the overall cost to individuals and also to the health care system when we ultimately end up with a measles outbreak or another or a new virus outbreak?

And so although, you know, from the finance side, it's oftentimes looking at numbers, plugging and chugging when you're looking, when you're dealing with health, when you're dealing with public health, you have to also weigh in the risk and the cost and the impact on lives when you do not do something.

But I do appreciate all of you coming and at this point seeing no further comments, we're going to move to the next issue. Biomonitoring California Funding Realignment.

Good morning, Madam Chair, Subcommitee Members. My name is Ashley Mills. I'm an assistant Deputy Director and I'm with the Center for healthy communities at CDPH. The Governor's Budget reflects a reduction of 425,000 in General Fund.

This reduction is a Fund shift in lieu of continuing an interagency agreement that supports laboratory services provided by the Department of Toxic Substances Control. Per legislative mandate. Approval of this BCP would result in administrative efficiencies correcting a Fund split where funds have gone directly to the Department of Toxic Substances Control.

Improvement in budgetary planning and control for the Department of Toxic Substances and Control as funding would go directly to this Department versus coming to CDPH first. And just to note this BCP does not result in additional resources. This is those resources were already allocated for biomonitoring California partner agencies and departments.

The purpose of this BCP is to correct is to correct how those funds are split between the collaborating agencies and departments that make up biomonitor in California.

Thank you for the presentation. Any comments from LAO or DOF?

We have not raised concerns with this proposal. Thank you.

Thank you. Any questions? We will hold this one open and allow for continued communication and revisit it with the May revision. So thank you so much. With that, we'll Move on to the next issue. Extension of Governor's Advisory Council on Physical Fitness and Mental Well-Being.

Good morning Madam Chair and Committee. My name is Rita Nguyen. I am assistant health officer with CDPH.

The Governor's Budget reflects a reappropriation of 2.5 million in General Fund from unspent funds that were originally allocated in the 2022 Budget act with Language for Expenditure Authority through June 30, 2027 to support the Governor's Advisory Council on Physical Fitness and Mental well Being.

These funds would allow for continuation of the Council's work in the next two years to capitalize on efforts and impact that we've already gained around emphasizing the importance of physical activity as well as mindfulness to support youth and mental health well being.

The funds would allow for continued support of the quarterly meetings as well as the regular Subcommitee meetings to accomplish the aims set for forth by this Committee to promote physical activity as well as youth mental health.

Thank you. Any comments from LAO or DOF?

Yes, Will Owens with Legislative Analyst Office. So our office has identified this proposal as a discretionary proposal put forward by the Administration and given the state's budget condition, our office would say that maybe the Legislature may consider balancing this proposal against other legislative discretionary priorities.

Thank you. Any questions?

As we're quoting maximizing the state resources for this ain't it 100%, ain't it? I thought about we've already we invested in. I know it's not enough Cybhi, that is for mental well being of youth. I don't think we need an advisory council to continue telling us all the investments that we've already made.

I think we need to make sure those investments work from wellness coaches to everything else we've invested. And I will. I think this is one item I agree with you Will that shouldn't be prioritized at all.

Thank you, Senator Menjivar. We are in a budget crunch and as was stated, we are prioritizing things. Can you give me a sense on exactly what this council does and how it has improved the physical and mental well being of Californians or our youths?

Yeah, happy to expound. So the council when it formed in 2022, set forth this mission to emphasize the importance of physical activity and sports participation in fitness in particular as a means to promote mental wellness, as a mechanism to promote belonging and a sense of community.

And so the Committee has set forth four different domains of focus that include roadmaps around how we can get schools to Be more engaged around physical fitness.

There's a media campaign that really elevates the importance of physical fitness, sports participation to sort of change norms around the importance of physical engagement and how that might also support mental health and well being.

Throughout the course of the year, there's four council meetings of the council Members, but there's also regular monthly meetings to help advance the work of the subcommittees which have worked towards having roadmaps and strategic plans to roll out throughout the state, specifically in the school space of how can we elevate norms around fitness and sport participation to support mental health.

There's also occasional community activation events throughout the year to really raise awareness around how fitness and sports participation can promote belonging and well being.

Okay. And have there been any actually legislative proposals that have come forth from these advisory meetings? Not to my knowledge. No legislative. And these roadmaps, have they actually been implemented in schools and have we seen any outcomes from that?

So the roadmaps are actually being finalized this year in partnership with schools and other partners. And then the intent is that thereafter with continued funding, we could support implementation in the school space. Okay.

Senator Mendjilar, I'm happy to hear that we're prioritizing youth in sports, but just not Trans youth in sports. Right. That's not a distinction that the council has. The Governor said that he doesn't believe Trans youth should be playing in sports. So if that's his belief, we're not prioritizing them here. Right.

There's no distinction made in the council's work about gender.

Seems a bit contrary. If the leader of the council. This is the governor's council. I know it's led by the first partner. If he says no Trans youth in sports, then you wouldn't be considering them here.

That's again not a distinction that this council has made in terms of its focus or direction.

Again, contrary to what our leader is saying. But I would again, if you're looking to the wealth being, the well being of a youth, I hope we're including all youth.

Trans youth as well. Yes. And the mission of the Penn Council is to elevate physical fitness wellness for all Californians.

Thank you. I think as we have. You've heard from a couple different individuals. Appreciate the presentation. In this fiscal. In these fiscal times, we have to be very prudent about where we, what we Fund and what we don't Fund. And we want to make sure that, you know, people are able to continue to be healthy.

This is a part of it. But in the grandson scheme, we may have to think about whether or not we continue it, but thank you so very much. We will now move on to our next issue. Baby Big Infant Botulism Treatment and Prevention Program.

Good morning Madam Chair and respected Committee Members. Thank you for the opportunity to present on the infant Botulism Treatment and prevention program, Federal Orphan Drug Baby Big.

I'm Katya Ledin with Infectious Diseases Laboratories division in the Center for Laboratory Sciences and here in front of you to give a summary of the proposal for an increase in expenditure authority and also a small number of positions to meet the challenge of the increasing manufacturing and regulatory costs and work for this very special only one in the world orphan drug for the treatment of infant botulism.

So the Infant Botulism Treatment and Prevention program was established in 1995 with a mandate to produce and distribute the FDA licensed orphan drug which is made out of human donor plasma.

It's a very special process, as you can imagine, to produce a drug that is injected into newborns, it must meet absolutely the highest standards of FDA safety and regulations. And this program is done an amazing job of stewarding its resources. It's very conservative and it's 100% special Fund supported program.

So it is requesting an increase in its expenditure authority that is completely within what it earns from the fees associated with the distributions of this drug. The program has been very successful in treating infant botulism. The treatment reduces the time and cost of hospital stay significantly by weeks and by.

It's avoided overall more than 130 years of hospital stay since the beginning of the FDA license just 21 years ago. And over 175 million in avoided hospital costs. It just reached a milestone of treating 3,000 patients last fall. And so it's just beginning the production of Lot 8 of the Special treatment.

And with the new manufacturing lot, the costs and the need to do a technology transfer to the one manufacturing plant that can produce the drug, there are significantly increased costs. And we're just requesting an increase in authority.

So for 3 million for the first year and then that's coming this new, this next fiscal year and 2.2 million ongoing. And so that we're resetting the baseline basically to cope with increased hospital and manufacturing costs. Our manufacturing costs have gone up almost 20% in the last five years.

So I'm here to answer any other questions you may have. Thank you so much. Any comments from LAO or DOF?

Nothing further to add, but available for questions.

Thank you. Any questions? All right, well, I want to thank you so much for your presentation. We will hold this over and continue discussing it. We will now move to the next issue. Laboratory field science phase. You may begin.

Good morning, Madam Chair and Committee Members. I am Charlet Archuleta, Assistant Deputy Director and Acting Branch Chief for Laboratory Field Services.

The trailer Bill proposal for Laboratory Field Services addresses inconsistencies in licensure fees in clinical laboratories and laboratory personnel, tissue banks and biologics facilities, including allowing CDPH to increase the fees, establish a fee methodology to administer the program, update the phlebotomist certification fee from a biannual to an annual fee, and make other technical corrections.

The proposal consolidates all the license fees under the same code section to streamline the fee adjustments and ensure consistency across different licensing categories. This will simplify the methodology used for fee modifications, including, excuse me, reducing administrative burden and improving transparency in the adjustment process.

Consolidation will allow for more predictable and equitable fee structures, ensuring adjustments aligned with inflation, cost recovery and industry standards. It will correct inconsistencies in the codes and provide a simplified method for fee adjustment. The licensing fees have not been raised since 2014, and in that year the methodology used to raise the fees was flawed.

Due to the complexity, the fees were not adequately adjusted to reflect the actual needs of the program, leading to a situation where the current fees are insufficient. The expected percentage change in licensure and renewal fees for applicants in each of these programs would be 60% to avoid program insolvency.

Without the proposed 60% increase in licensure and renewal fees, the program risk insolvency due to the expenditures outpacing the revenues. For 2024-25, Laboratory Field Services revenue will be 13.7 million with projected expenditures of 17.5 million. The Clinical Laboratory Improvement Fund will be insolvent by 2027-28 and the tissue Bank Licensure Fund will be insolvent by 2028-29. Happy to answer any questions.

Thank you so much for your presentation. Any comments from LAO or DOF?

Nothing to add but available for questions.

Thank you. Any questions from fellow Senators? Senator Menjivar,

What would you say to potential concerns or where we're hearing concerns that this might remove the ability for stakeholders to have an input?

I think at this time we would try to. We looked at several options of even rolling out maybe a stepped process of increases for the fee increase, but at that time when we looked at it, it would even be a higher fee increase at that time because we're so close to program insolvency.

For the stakeholders to. Have the input on the fee increase.

Yes, I'm sorry. The current stage allows more public comment and so forth. Where would that. What would that look like if we move to this different approach.

We have a CLETAC Committee that we can meet with as well to get their input as well.

We can or we will. We would. You would. Okay, so that'd be an opportunity for people to come. And can you just clarity. Would this put a cap? Would you have a cap and how much you'd be able to raise?

No, ma'am. What we would do is we would continue to readjust as needed as inflation occurred with the costs every year.

Without coming back to us for that approval.

Okay. Any other questions?

Thank you, Madam Chair. Thank you. I had the similar questions in line. I don't think it's ever a really good idea to just give blanket authority for fee increases without a cap.

I realize that there has to be some kind of funding mechanism here for any increase because of inflationary cost and other stuff that's going on for the services that you provide, but to not allow public input or you said you would allow some public input and the stakeholder, at least when we have a discussion in the Legislature to increase fees instead of giving blanket authority to an agency, there's a process where the public gets to participate and stakeholders can have an input on it.

And obviously us being elected, it's not really. Maybe not for all of us, but in my position we. We are elected and we are accountable to our constituents and to represent them. And to just give blanket authority for increases to a Department is not something that I think should be supported. But thank you for your testimony.

I understand.

Well, thank you so much for your testimony. We will leave this issue open for further discussion and move to the next item on the agenda, which is Women, Infant and children program. You may begin whenever you're ready.

Good morning. Fariha Chowdhury, WIC Division Director. I'm here to provide an overview on the WIC program estimate. WIC is funded entirely by discretionary federal grants that are approved by Congress along with infant formula rebates.

Our federal funding not only supports our participants operations and service delivery, but it also contributes to the state economy through purchases at grocers, including military commissaries and farmers and farmers markets. As a result of our federal funding, CDPH does not request any state funds from for administering the program.

The primary factors contributing to the continued increase in program costs are caused by food inflation and program participation. In terms of food inflation, the consumer price index rate for food at home is projected to be 1.92% for federal fiscal year 2526. And as an update on caseload changes.

WIC estimates average monthly participation will increase to 1.03 million participants, which is an increase of 2.1%. This would be a difference of 110,000 more monthly participants since state fiscal year 21-22. Lastly, according to the most recent data from the USDA, California has one of the highest coverage rates in the country, serving 69.7% of eligible WIC participants.

This is compared to the national average of 53.5%. This places the state's coverage rate as third highest nationally behind Puerto Rico and Vermont. I know we received questions ahead of the hearing on caseload and participant changes and coverage. I was able to cover that in my testimony. I can go into expenditure changes right now if needed.

Well, we'll see if there are any comments from LAO or DOF. Nothing to add? . Thank you. Any questions?

I can ask questions later.

Okay. Okay. Well, go ahead then.

Sure. So, as an overview of WIC expenditure changes, there are three main categories for expenditures. It's food expenditures, local Administration, and state participation. In state fiscal year 2025-26 WIC's food expenditures estimate is $1.072 billion. This is a slight increase of $11.8 million, or 1.12%, compared to the 2024 Budget Act.

The anticipated expenditures for local Administration are estimated to be around $342 million, which is an estimate of around $20 million, or 6.12%. This specific increase is driven by the growing caseload across the state for local agencies. State operations expenditures are estimated around $71 million, which represents an increase of 1.6 million, or 2.33%, from the 2024 Budget Act.

And this is due to baseline adjustments and annual position and expenditure authority approved last year for WIC modernization efforts.

Thank you. Any questions? Senator Menjivar?

Yes. Do you have any information you can provide me on an update on the WIC modernization program?

Sure. So last year in a BCP, we received 27 positions and we were hiring them in two phases. One in this fiscal year and then starting in the second phase will start next fiscal year. We've already started progress and work on our modernization efforts. So this includes expanding our food package options. That work is currently in place.

We're evaluating what options from the federal final rule for the food package we will implement in the states.

Did they give us the regulations already? Did we?. They did.

Yes, they did, So we're in the process of reviewing what options that we will implement in the State of California and this will be implemented no later than April 2026.

Are there any stakeholder discussions during this process or is this all internal?

This needs to be done by WIC Bulletin Regulations so there will be a stakeholder feedback.

Great. Any other further information you can share with me on Just the conversations we had last year around some of the concerns of the delivery and online where those are top of mind.

Absolutely. So top of mind is equity, both for ensuring that the participant experience has equity involved, but also ensuring that food deserts don't exacerbate. So we will be monitoring with our state partners as well as looking at pilots that are happening federally to ensure that there are no exacerbation of food deserts. The first thing that we need to do is ensure. Well, we have to see that the federal final rule takes place.

Once those federal regulations happen, we have to go through a process of state regulations with our WBR with bulletin regulations, and in that process, stakeholder feedback will be received to ensure that brick and mortar stores are not adversely impacted.

We'll also be able to monitor impacts to online shopping based on tracking, reauthorization, authorization of new vendors in addition to participating, and redemption of foods, especially in those regions.

Last question. Is there a timeline where all of this will then be presented to the Legislature?

We can present an update annually, but again, it depends on when the final rule happens federally for online shopping. And then the progress will take some time between regulations being implemented at the state level and then of course, the implementation from a technological standpoint.

Thank you. Any questions? All right. Well, I want to thank you so much for your presentation and we will now move to the next issue. Genetic Disease Screening Program.

Good morning. I'm Leslie Gaffney, the assistant Deputy Director at the Center for Family Health. It's been a quiet year for the Genetic Disease Screening Program. We won't be going live with any new screenings for either newborn or prenatal screening. And for the most part, our adjustments are caseload driven.

GDSP's budget estimates an overall decrease of 1.6 million in the current year and an increase of 809,000 in fiscal year 25-26 compared to the 2024 Budget Act. The budget is driven by two main programs, Newborn and prenatal screening. You've asked for an overview of the caseload and expenditures for both those programs.

So GSP's budget estimates the newborn screening caseload for current year will decrease by 1/10 of 1%, 306 cases as compared to the actual 23-24 numbers. And in current Year we estimate to an increase of $4 million over the 2024 Budget act numbers. That's attributed to contract rate increases.

For 25-26 we estimate a caseload decrease of 1%, a little bit over 4000 births. And in the budget year we're expecting a $6 million increase compared to 2024 budget act and that is attributed to increased costs for laboratory supplies and services and caseload follow up.

And the caseload estimates are Based on the DOF's DRU estimates, the most recent ones and then for the prenatal screening program, the budget estimates a caseload of just 2/10 of of 1% increase for both the CFDNA screening and the neural tube defect screening over the 2324 actual numbers.

In current year there is a decrease of $5.6 million in prenatal screening attributed to a slight decline in CFDNA screening from 52 to 50% of pregnancies.

And then for budget year we are expecting an increase of CFDNA of 1.5% and neural tube defects about half of that 0.8% because we're already doing 62% of bursts for no tube defects in budget year we expect PNS expenditures to be approximately $4 million less than budget Act.

And then lastly, in addition to the local assistance Expenditure Authority for operational support which remains the same in current year and we'll have a decrease of $1.3 million in budget year because of the ending of the computer migration to Microsoft Dynamics for prenatal screening.

In line with the decrease in births and CFDNA participation, we'll see a $2.1 million reduction in the current year revenues and a $3.7 million reduction in budget year. But the testing Fund is healthy and we anticipate no fee increases this year.

Thank you. Any comments from LOA?

Nothing further to add but available for questions.

Riley Thompson, Department of Finance Nothing to add.

Okay great. I seeing no questions. Want to thank you so much for your presentation. We will move on to the next item. Genetic Counselor license fees.

Okay, so you've asked for an overview. The Genetic Counselor Licensure program was created in 2011 and at the the time the licensure fee in statute was written that it should not exceed $200.

New and temporary license fee for the temporary license fee is for counselors who have yet to take their certification exam and that has always been $200. And GDSP chose to set the renewal fee at $100. Could have set it at 2, but set it at $100 in the ensuing 14 years and the explosion of telehealth.

Because now any genetic counselor who serves a person in California needs to be licensed here. So even if they live in New Jersey, they have to be licensed here. We've had an explosion of work and we have never raised the fee. The fees are deposited into the Genetic Disease Testing Fund.

It's the same Fund that's used by both newborn screening and prenatal screening. And at this point in time, the current fee structure does not support support the operational costs of the program, nor will it allow us to modernize and do online registration for our genetic counselors and things that need to be updated.

And essentially the newborn and prenatal screening programs are subsidizing genetic counselor licensure. We anticipate raising the fee to $300 for both new temporary and renewal license. And that would be for for a three year license.

Thank you so much. Any comments from LAO or DOF?

Nothing further to add, but available for questions.

Nothing further to add. Thank you.

All right, thank you. I'm not seeing any questions. Senator Menjivar.

I'm just going to copy and paste my previous comments from the other request of moving away our ability to comment on these items and just have ongoing authority.

Yes, we are at least here are in a unique position because we come to you each year to approve our budget. So there is the opportunity for us to add it as part of the budget estimate that you as we do with our newborn screening and prenatal screening fees. When we raise those, they're always included as part of our budget.

And it's the same question I asked him before. Is this also a no cap on the income?

Yes, I believe because the way the trailer Bill is written, it's just giving the Director the authority to set the fee. Thank you. As she does with newborn screening and prenatal screening.

Thank you. Well, thank you so much for your presentation. We will now move to the next issue. Center for Healthcare Quality estimate. You may begin when you're ready.

Hi there. Michelle Bell, Operations Division Chief at the Center for Healthcare Quality. And I'm here with my colleague.

Chelsea Driscoll, Acting Deputy Director of the Center for Healthcare Quality.

Okay, so we'll start by giving an overview of our center. CHCQ is responsible for regulatory oversight of licensed healthcare facilities, healthcare professionals to assess the safety, effectiveness and healthcare quality for all Californians. We fulfill this role by conducting periodic inspections and complaint investigations of healthcare facilities to determine compliance with federal and state laws and regulations.

CHCQ licenses and certifies over 15,000 healthcare facilities and agencies in California in over 30 different licensure and certification categories. The U.S. Department of Health and Human Services, Centers for Medicare and Medicaid or CMS awards federal grant monies to CHCQ to certify that facilities accepting Medicare and Medicaid payments meet federal requirements.

CHCQ evaluates healthcare facilities for compliance and we contract with LA County's Department of Public Health to certify healthcare facilities located in LA County. In addition, CHCQ oversees the certification of nurse assistants, home health aides and hemodialysis technicians and the licensing of nursing home administrators.

CHCQ's activities are funded by the Licensing and Certification Fund, 3,098 federal funds, which is Title 18 and 19 grants reimbursements from the Department of Healthcare Services and the General Fund to support survey activities in state owned facilities. In terms of our organization, CHCQ is comprised of five divisions.

We have our Internal Operations Division, Field Operations north and Field Operations South Divisions which comprise our 15 district offices, our Statewide Surveyor Team, and oversight of our LA County contract.

The Licensing and Certification Division includes the Centralized Applications Branch, Healthcare Workforce Branch, Investigations Branch, Medical Breach Enforcement Branch and Emergency Preparedness and Disaster Response Section and finally our Public Policy and Prevention Division includes Healthcare Associated Infections Program, the Standards Interpretation Branch, and the Public Policy and Legislative Branch. Any questions otherwise I can proceed to Funding okay.

CHCQ is special funded with roughly one third of our activity funded through our Federal Grants, again Title 18 and Title 19, with the remaining core activities funded through healthcare facility licensing fees.

We also have four special deposit the Skilled Nursing Facility Minimum Staffing Penalties Account, which partially funds the Staffing Audit Program the Federal Health Facility Citation Penalties Account, which funds CMS overseeing civil monetary penalty projects in skilled nursing facilities the Internal Departmental Quality Improvement Account or IDQIA funded by hospital and Medical Breach Penalties which Fund quality improvement activity within our center and the State Health Facilities Citations Penalty Account which is funded by all other state penalty revenue and provides resources for temporary managers in long term care facilities.

In terms of our performance as of Q1 of fiscal year 20 year 2425, which is the most recent data available, CHCQ completed 96% of long term healthcare facility complaints within 60 days of receipt.

This represents a 30% improvement in the timeliness of long term care complaints since Q4 of 21-22 and furthermore, CHCQ has completed 100% of backlogged long term care complaints that existed as of April 1, 2021.

As of Q1 2425, we have completed 67% of non long term care well, non long term care healthcare facility complaints within 60 days of receipt and this is a 29% improvement since Q2 of 21-22. In terms of our applications, we receive roughly 12,000 facility change applications per year and one third of those are completed within 100 days.

Applications completed have exceeded applications received since Q2 of 23-24 and the amount of open applications has decreased by 50% since its peak in Q1 of fiscal year 23-24. We also receive roughly 14,000 license renewal applications per year and had about 2,400 open as of Q2 24-25.

But this number includes 1,200 HHA or Home Health Agency and 386 hospice applications which are on a moratorium. We also received roughly 158,000 healthcare provider license applications in 2024, including certified nurse assistants, home health aides and certified hemodialysis technicians. And we processed over 173,000 applications with only 343 open apps as of December 31st. I'll pause for questions.

Thank you. Any questions? Keep going.

Okay, so the second question. Please provide an update on our program's vacancy rate, particularly for the Health Facility Evaluator nurse classification and the results of recent recruitment efforts to improve vacancy rates. So as of December of 2024, our HEFN vacancy rate is 3.9%, which is a considerable decrease from prior years.

Because of an effective hiring and recruitment effort, CHCQ has established an internal recruitment team that utilizes social media platforms to attract and engage with potential candidates, but we also walk them through the complex state hiring process and ensure that they understand the unique nature of the role up front. Additionally, we have added an additional Surveyor classification.

These Health Facility Compliance Surveyors, or hfcss, are Staff Service Analyst and AGP Associate Governmental Program Analyst positions who assist with survey duties that don't require an RN license. And there are 15 of these positions, one per district office that we are in the early stages of hiring. Any questions on this item? Okay, third question.

Please provide an update on the most current timeliness metrics for investigation of complaints and facility entity reported incidents. I actually spoke to this earlier in our performance section. Thank you. Okay, so moving on to this would actually be issue 13.

Any further questions? Thank you so much. Any comments from LAO or DOF?

Nothing to add. Available for questions.

Okay, not seeing any questions. Go ahead. Senator Menjivar.

This might bleed into the next couple of, but I'll just put them here. I'd like to talk about the for profit psychiatric hospitals and the lack of regulations, the catastrophic treatment of the people in our care at these for profit facilities.

You can imagine, you probably know the three piece installment that has come out that has brought light, I think public light, because I think the Department has known about the treatment of these people.

I'm wondering what your office Department is doing where the article has captured that the Department does not get all the reports of deaths of abuse, of sexual abuse treatment, maltreatment of these individuals.

How can we become more aware of these reports and the ones that we do get the fine so small compared to the ability of the fines we can bring down for profits and how we continue to send people there. So I'd like to hear one.

Why licensures aren't getting revoked, why we're not pausing intake of patients, why we're not finding these for profit facilities at a nature that actually makes an impact on these facilities to create some change and what you will be doing hopefully to rectify that.

Okay, I can address that. First, I'd like to start with the regulations piece. Fully acknowledging that we do need to revise our regulations for acute psychiatric hospitals so that we can hold those facilities more accountable in terms of the news articles and the allegations that were identified as part of that effort.

We have gone back and looked at our internal records to find out whether or not we have actually investigated all of those events. Many of those cases we have investigated and issued deficiencies and penalties.

We also had identified some new issues that we weren't previously aware of and we do have intentions to investigate those fully and hold those facilities accountable in terms of the amount of the penalty we develop or issue the penalty based on the severity of the findings that we are able to prove based on our investigations.

And maybe correct me if I'm wrong, the article said that in the past, I think like six years or so, we've only fined $94,000. But approximately at just one hospital, like signature hospitals, I think it was like 20 people died. I don't think you could get more severe than that.

$95,000, you can't put a money value on a human, but that seems relatively really Low for the amount of deaths. So what is the fine that gets associated when you come to investigate that the end result was a death?

It depends on what has taken place and what evidence we were able to gather during the investigation. So we would take the totality of the evidence that we are able to gather and, and determine what we were able to prove and then we would adjust the amount of the penalty based on the criteria that's in our regulations.

Can you help me understand evidence? No evidence. If we have an individual under the care of prisons, psychiatric places or state hospitals, a death is an immediate failure of the individuals working that facility, regardless of there's actual evidence. If someone dies under our care that is 100% should tell us at least me. I'm not sure what other.

What more we need to prove that something wrong happened here if we're supposed to be taking care of them. Are you saying that the Department does not look at deaths as a just sweeping failure of that incident institution, that you need additional information?

So I think the death is obviously an outcome. What we have to be able to do is prove that the death was a result of a violation of a requirement that is in place. So if there is not a requirement that has been violated that we can directly point to, then it's harder for us to issue a fine.

Do we then need a change? Well, as you're doing the. Well, let me back up. As you're looking to create the regulations that were supposed to create. Be created. Was it like 25 years ago, 30 years ago in the 90s, we failed as State of California. We have failed that in 30 years.

We have not come up with regulations or started regulations. And as a result, in the past three years, people have died on our watch. We have to accept that failure. What is the timeline to get these regulations up and going?

Is it related or maybe to the next items where you're asking for positions to come up with those regulations?

Right. I think, you know, we try to prioritize the regulations where there's the greatest need, obviously the information that we would push back.

Okay, because people have died. Yes. You cannot say we prioritize for the greatest need, but people have died. I don't think you could get worse than that. I would ask, and I know this is not you, this is us. This is you weren't here. I don't know if you were here the past 30 years.

Okay, so it's not. I know it's not you. And please don't take this. It's not at you. But to say we're prioritizing regulations. I mean, we saw one death. That's enough. And how we haven't prioritized this in the past 30 years is inexcusable. But please continue.

Okay, so I was just going to say that we acknowledge that we need to shift this priority and bring this to the top of the list. So we are going to be reprioritizing our workload. We have a number of packages that are on the list and we know that we need to move this one up.

Last comments. I'll say to this. My ask is here. My ask here is that we need to be a heavier hand. And I think this applies to any institution that we regulate. Right. We've gone through nursing home sniffs that we've gone through years where there was, you know, abuse and so forth there.

Senator Grove can speak on what happens to our youth and other locations and so forth. I've talked about our prisons and so forth. We need to have a heavier hand. We continue to slap people on the wrist and we're giving them millions and billions of dollars for profit. Psychiatric hospitals are leading in beds.

Nonprofits and hospitals are closing their beds to give more beds to switch their patients to for profit. If that's the route we're going to take, we need to be more. We need to lean in more in the regulations. I want to see an avenue to. To revoke licensure.

I want to see an avenue that we're pausing intakes on future patients because a violation occurred. When we're dealing with human beings. I get very frustrated when we say we're going to just send a letter and I hope you do better and not kill the next person. I think we need to be stronger on this.

I think we owe it to the people and their families with how much we felt in the past 30 years.

Thank you, Senator. Any other comments? All right, you can move on to the next item.

Issue 13, which is our internal departmental quality improvement. The Governor's Budget reflects an increase of 3.1 million from the internal departmental quality improvement account Fund to support planning and implementation costs for the centralized applications branch or cabinet online licensing application project.

This project proposes to refresh, enhance and expand the technology of cabs original automated license application submission system. Excuse me. To enable all 35 healthcare facility provider types to submit applications electronically and to enable us to add facility additional facility types in the future.

This new system will integrate with other systems that we have, such as our electronic licensing management system. And it will reduce many of the cumbersome manual processes currently in place. It will provide a simplified workload that will increase provider satisfaction and allow a seamless route for application submission and processing.

And this will also allow providers to pay license licensing fees electronically rather than by paper check. Any questions on this item?

Thank you. Any comments from our two LAO and DOF?

Nothing further to add, but available for questions.

Thank you. Any questions? Okay. Thank you so much for your presentation. We will now move to the next issue item. Center for Health Care Quality Policy and Legislation Branch Expansion.

The Governor's Budget reflects an increase of seven positions and $1.1 million in 25-26 and ongoing from the State Department of Public Health Licensing and Certification Program Fund.

To support the public policy and legislative branch expansion, we are requesting to add seven new staff to the regulations team with five current staff and each regulation package taking up to three years to complete. CHCQ does not have enough staff to complete regulation development in a timely manner.

The additional staff requested will significantly improve our ability to update regulations timely and will allow us to accurately identify the potential costs for proposed regulatory changes. These changes will also increase staff retention, resulting in greater consistency and regulation development. Thank you.

Thank you. Any comments from LAO or DOF?

Nothing to add, but available for questions.

Nothing to add. Thank you. Thank you. Any questions from my colleagues? Nope. Thank you so much for that presentation. We will now move to the next issue item. Special Deposit Sub Fund Conversion to special funds.

This proposal abolishes the internal Health Information Integrity Quality Improvement Account, or Fund 3151 and directs future revenues to the internal Departmental Quality Improvement Account, or IDQIA the proposal replaces. Additionally, the proposal replaces four sub funds with special excuse me, with separate special special funds, which improves their efficiency, transparency and accountability.

So, under current law, administrative fines related to unlawful or unauthorized access to a patient's medical information are deposited into different funds depending on who is fined. Fines that are assessed against health facilities are deposited into the IDQIA Fund, while similar fines assessed against individuals are deposited into Fund 3151.

Both of these funds are used for quality improvement projects and consolidating the funds improves public reporting of Fund reserves, balances and expenditures. Additionally, we're requesting the conversion of the four special deposit sub funds into special funds.

Those four funds are the IDQIA Fund, the Skilled Nursing Facility Minimum Staffing Penalty Account, the State Health Facilities Citations Penalty Account, and the Federal Health Facilities Citations Penalty Account. Currently, these four sub funds are aggregated into one Fund despite the sub funds having different purposes.

By changing them into special funds and statutes, separate accounts would be created for each Fund to receive the balances, revenues and make authorized expenditures. There's no fiscal impact to this change and the funds named will be kept as is. It's simply a technical adjustment.

But these sub funds currently do not have an official Fund condition statement published in the Budget act detail and this will enable us to more efficiently monitor the funds of the health. The health of the funds. Any questions?

Thank you so much for that presentation. Any comments from LAO or dof?

We've not raised concerns, but available for questions.

Nothing to add. Thank you. Thank you. Any questions for my colleagues seeing? No questions. Thank you so much for your presentation. We will now move to the next item. Implementation of chartered legislation.

Good morning. Ashley Mills. I'm an Assistant Deputy Director with the Center for Healthy Communities. My first presentation is on AB 1775. The Governor's Budget reflects an increase of one position and 186,000 state operations and General Fund to implement secondhand and cannabis smoke guidance as required by Assembly Bill 1775.

AB 1775 requires CDPH to provide guidance on secondhand cannabis smoke exposure to address the health hazards affiliated with secondhand smoke exposure in the workplace. Specifically cdph.

Existing guidance related to secondhand smoke is tailored to the General public and not specific to workers and does not take into consideration the unique factors that are specific to occupational exposure exposure and I'll happy to take any questions or should we keep going? Okay. My next presentation is on AB 1282.

The Governor's Budget reflects an increase of 363,000 state operations and 100,000 local assistance and Behavioral Health Services Fund to implement mental health Impacts of Social Media Required by Assembly Bill 1282.

This Bill requires CDPH to develop a report due to the Legislature by December 31, 2026 that contains a statewide strategy to understand, communicate and mitigate mental health risks associated with the use of social media by children and youth. We're required to engage with children and youth and prioritize their perspectives and consult with California's mental health community. Those are my BCPs.

Okay. And we'll have the next person come down. You can stay here in case there's any questions at the end.

For AB 3030, the Governor's Budget reflects an increase of three positions and 672,000 in state operations from the Licensing and Certification Program Fund to provide resources to implement the provisions of AB 3030, which addresses healthcare services and artificial intelligence, and we are requesting three health facility evaluator nurses to implement this.

This Bill requires a health facility clinic, physician's office or office of a group practice that uses GENAI to generate written or verbal patient communication pertaining to their clinical information to ensure that those communications include a disclaimer and clear instructions describing how the patient can communicate with a human healthcare provider or other appropriate person.

There are currently 15,000 open healthcare facilities and clinics with active licenses under CDPH's purview and based on increasing accessibility of Genai, we're estimating that 40% of facilities will use AI tools in patient communications and that CDPH will need to review roughly 6,000 facilities for compliance with the disclaimer requirements of AB30, and this would in turn generate an additional 12,000 hours of work per license renewal cycle.

Should. I move on to the next one. Okay, moving to SB 1354 long term healthcare Facilities, Payment Source and Resident Census the Governor's Budget reflects an increase of 1.0 positions and 307,000 from the Licensing and Certification Program Fund.

SB 1354 requires each long term care healthcare facility certified for Medi Cal to provide the same care, services and benefits to Medi Cal beneficiaries as to the public, regardless of payment source.

All SNFs are required to make their current daily resident census and nurse staffing data available to the public by either posting it on the facility's intranet or providing the information in response to a phone call or the manner preferred by the requester.

With this bill's additional transparency requirements, CDPH assumes there will be a 10% increase in complaints relating to SNF discharges and transfers and that this Bill will require an additional 1.3 to 5 surveyors to accomplish the additional workload.

And since SB 1354 takes effect on January 1st of 2025, we will absorb the increased workload in fiscal year 24-25 with existing resources thank you.

Thank you. Any comments from LIO or DOF on any of these proposals?

Nothing to add this time. Available for questions.

Any questions from any of my colleagues? Seeing None. I want to thank you so much for your presentations. We are now going to move on to the public comment portion of our hearing saying that we have heard all of the items. If you are interested in making a public comment, please line up now and you will have one minute.

You may begin. Good morning Chair Members. My name is Michelle Gibbons. I'm with the County Health Executives Association of California. We represent the local health departments across the state. I want to appreciate Dr. Pond's mention of the future of public health in our State of the state.

Locals are using these funds to do things that they couldn't do because they didn't have the capacity to the measles question. A jurisdiction had mentioned that they were able to do measles investigations while also continuing their core day to day public health activities, which surprisingly was not something that we could do before and that's why the funds were necessary.

With the federal uncertainty that's on the horizon if there are cuts to public health, CHIAC would encourage this Legislature to think about backfilling any funding cuts through the future of public health because it'll be flexible and allow them to protect core programs and services. On issue four, I appreciate the dialogue related to the MYCAVAX program.

I was there when the mycavax was being stood up during the pandemic. It was because we absolutely didn't have transparency or the efficiency that we needed in the vaccine distribution. Just to your question, around how many providers? It's over 700 providers that use the system and there's been over 10 million doses administered through the MYCAVAC system.

So CHIAC supports funding all public health IT systems, including the MYCA vaccine system, and hope that we don't have to continue bringing one system at a time for funding to you all in the future. Thank you. T

Good afternoon, Madam Chair and Members. Jolie Onodera with the California State Association of Counties here. Also to comment on item 4 regarding the MYCAVAX system. I would just echo my colleague's comments just before on should this not continue to be funded, there will be significant workload impacts to all our local health departments. Thank you. Thank you.

Kelly Brooks. I'm here on behalf of the California Association of Public Hospitals, the Urban Counties of California and the County of Ventura. We're here to comment on item 4 as well. Public health care systems and counties use MYCAVAX system daily to manage vaccine supplies, reduce challenges with inventory management and reporting, and increase provider capacity.

We're concerned about service disruptions and potential public health impacts. If we go back to the days of Excel spreadsheet and doing this by hand and paper, we encourage you to find funding for this computer system. Thank you. Thank you.

Laura Thomas with the San Francisco AIDS Foundation. I wanted to say, first of all, thank you very much for your vote earlier today to reject the cut to the California Overdose Prevention and Harm Reduction Initiative. As the Chair wisely noted, it is an extremely effective program.

Thank you to the Chair and the staff for your support of that program. And on a personal note, I wanted to thank Senator Menjivar for her advocacy on behalf of Trans athletes. It's appreciated. Thank you. Thank you.

Chair Weber Pearson, Senators Menjivar and Grove. My name is Jonathan Fr, also representing San Francisco AIDS Foundation. I'm testifying to bring to your attention the need to begin repayment of the loans from the ADAP rebate Fund as soon as possible. Federal law does require most ADAP dollars to be used for services benefiting people living with HIV.

The federal agency that oversees ADAPS conducted a site visit in California last year and found that the loan suggests, quote, a potential misuse of pharmaceutical rebate funds. This is a compliance issue that puts our entire ADAP at legal risk. In addition, according to DoF, the ADAP's expenditures will exceed its revenues in 202526.

This will cause the ADAP rebate Fund's reserves to fall to a record Low. The budget acts of 2023 and 2024 require that the loans from the Fund be repaid when the Fund has a need for the monies.

As today's presentations indicate there is a need for the monies to preserve ADAP's sustainability, we encourage you to consider initiating repayment of the loans and making the investments proposed by the End the Epidemics Coalition which are described under issue 17 of today's agenda. Thank you, thank you.

Good morning. Ryan Souza on behalf of APLA Health. First, we'd like to align our comments with the San Francisco AIDS foundation related to the California Overdose Prevention and Harm Reduction Initiative. Want to thank this Committee for their vote today on rejecting those cuts as it relates excuse me, as it relates to the AIDS Drug Assistance Program.

Unfortunately, the HIV epidemic is worsening among a number of populations that face barriers, including black, Latin, transgender and non binary individuals. At the same time, federal funding has been cut and decreasing and especially with the Federal Administration's all out war on HIV funders like the CDC.

We want to thank this Legislature for collaborating with APLA Health and the End the Epidemics Coalition and look forward to our ongoing work to leverage ADAP funding and continue working to get to zero. Thank you. Thank you so much.

Thank you Madam Chair Members of the Committee Megan Subers on behalf of the Los Angeles LGBT Center, I want to echo the comments of my colleagues from the End the Epidemics Coalition. Just highlight a couple of things. We urge that the loans from the ADAP program be repaid as soon as possible.

We reinforce and hope that you can consider the items listed in under the stakeholder proposals in item 17. This federal Administration has already attempted to discontinue CDC funded equity informed HIV prevention activities in California. They were unsuccessful due to a court order, but we fully expect this Administration to discontinue those activities after the current funding period ends.

Focusing limited HIV prevention resources on the populations at highest risk of HIV is not only the right thing to do, but the best use of taxpayer dollars. So thank you for your time. Thank you.

Chair Members Kathy Mossberg on behalf of Essential Access Health, want to comment on one of the items for reinvestment. As a Member of the California Future of Abortion Council Steering Committee, I want to thank this Committee and this legislation, the Legislature, and this Administration for all the investments into critical reproductive health to date.

Want to lift up the importance of abortion.ca.gov, our website to build on the initial site and to ensure California can meet the national moment. We do know that the feds have taken down a lot of this information, making our website more critical and more crucial to maintain.

Additional investments are needed to ensure that California's online hub for information on reproductive health, where to get care and how to access that care and also make sure it's updated by content experts is important to maintain. We must ensure that Members of the public know about this resource as well.

We want to work with Senator Caballero as well as those on the Assembly side, this Subcommitee and Legislature, along with CDPH and this Administration, to maintain this critical investment. Thank you for your time.

Madam Chair. Members Nora Angeles is with ChildrenNow Children Now supports restoring funding for the MyCavax program. We are very concerned about the waning immunization rates of California's children and dangerous new measles outbreaks happening here and across the nation. It is shortsighted to defund the state's vaccine management system and undermine the federal Vaccines for Children program. We urge you to Fund mycavax. Thank you.

Hi Madam Chair and Members. Kat Deburgh of the Health Officers Association of California here in support of the MyCavax program along with our colleagues and at her request. I am correcting my colleague Michelle who said that this 700 providers participated across the state is actually over 7,000 providers participate across the state. And as you all have pointed out, it would be a step backwards to defund that program now. Thank you so much.

Good afternoon. Beth Malinowski with SEI of California. I want to appreciate the hearing today. You know, earlier in the agenda in the State of the state there is a reference to the importance of our future of public health funding.

I want to appreciate this Committee, this Legislature and this Administration continue to support the workforce infrastructure investments of public health, especially in this federal environment. It's so important that we keep those things whole. Thank you so much.

Madam Chair and Members. Bruce Pomer California Association of Public Health Laboratory Directors CAFL supports future of public health funding because it's so important in maintaining our strong network of 28 local public health labs, which is an early warning system and is the first line of defense against disease outbreaks.

These funds enable local labs to quickly identify disease outbreaks using the best technology, highly skilled staff, advanced science to protect the public's health. We also support funding for CalConnect, which has been a critically important tool in identifying, monitoring and mitigating the presence of infectious disease.

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

Thank you. Good day. My name is Catherine Flores, Executive Director for the California Immunization Coalition, and we're a statewide nonprofit focused on ensuring that all Californians have access to vaccines. The MyCavaxs and other associated systems within the California Immunization Registry are how we are doing the important work of keeping Californians safe.

And we have a lot going on in public health, as you all know. And having these systems in place, tracking vital resources and managing records, helps us to be able to focus on these bigger issues that we have going on. So thank you, and we ask for your support.

Thank you so much. Seeing no further public comments, I want to thank all of those who presented today, all of those who spoke during the public comment hour. And I now will adjourn this Committee.