Senate Standing Committee on Budget and Fiscal Review
- Scott Wiener
Legislator
We okay, the Senate Committee on Budget and Fiscal Review will come to order. We are here at 1021 O Street, room 1200. We do not have a quorum yet, so we will begin as a Subcommitee and we'll establish quorum as soon as we have enough Members here.
- Scott Wiener
Legislator
So I would ask Members to come down as soon as they can. Public comment will be heard after all discussion items have been presented. There's actually only one, so we'll do the one item and then we will have public comment.
- Scott Wiener
Legislator
Today we're hearing Assembly Bill 100, which is a budget Bill junior that amends the budget acts of 2023-24 and 2024-25. Most significantly, this Bill authorizes General Fund expenditure authority of $2.8 billion to support the MEDI Cal program in the 2024-25 fiscal year.
- Scott Wiener
Legislator
It also allows for the use of funding that we previously authorized an extraordinary session for the Eaton and Palisades fires in Los Angeles County to be used to offset property tax revenue losses for specified local governments in 2024-25, 2025-26 fiscal years, which is similar to previous property tax backfills after major natural disasters.
- Scott Wiener
Legislator
It also appropriates approximately $181 million from the from Prop 4 for purposes of wildfire prevention and resilience in areas across the state and regarding Medi Cal.
- Scott Wiener
Legislator
This early action budget Bill is intended to ensure that this critical health care program has sufficient cash flow to continue to pay managed care plans and healthcare providers up and down the state.
- Scott Wiener
Legislator
Hospitals, clinics, providers the Legislature, in partnership with the Governor, has made a commitment to ensure access to healthcare coverage for all Californians regardless of immigration status for everyone living here, people who are working, paying taxes, raising their families here.
- Scott Wiener
Legislator
This expansion plays a critical role in supporting our struggling hospitals by moving previously uninsured individuals from seeking the most expensive kind of care in emergency rooms to a more stable source of primary care at a Doctor's office that saves our healthcare system money.
- Scott Wiener
Legislator
Hospitals also now receive reimbursement instead of providing charity care for these individuals with no reimbursement. The Governor's Budget identified increased costs for our expansion of Medi Cal due to higher than expected caseload expenditures. This is not due to some sort of waste or fraud.
- Scott Wiener
Legislator
In large part, this is because the program is working as intended, providing coverage and care to our neighbors, our co workers, our family Members, their California residents.
- Scott Wiener
Legislator
The Legislature in partnership with the Governor is working to identify whether there are ways to deliver care for this population more efficiently through bringing down the cost of prescription drugs or connecting individuals with regular sources of lower cost care in addition to other options.
- Scott Wiener
Legislator
I also want to note the fiscal challenges that we are facing today and what we're excuse me, what we are the challenges that we're facing in this budget Bill Junior Pale in comparison to the disaster that is appears to be coming our way from the President of the United States and the United States Congress who are moving forward with potential budget legislation.
- Scott Wiener
Legislator
They're sort of chaotic, so you never quite know what they're doing, but they seem to be marching in lockstep to try to gather funds for perhaps the largest tax cut in United States history for rich people.
- Scott Wiener
Legislator
And those cuts appear to be targeting Medicaid as well as snap, Food assistance, Head Start, Medicare, Social Security, but significant cuts to particularly to Medicaid, snap, Head Start, et cetera, that could have profound implications for California's budget. So we're bracing for that.
- Scott Wiener
Legislator
I hope that our counterparts in Congress do the right thing and don't backstab their own constituents by taking health care and childcare and food away from them. But we are preparing for a potentially very, very bad budget situation.
- Scott Wiener
Legislator
But today we're focused on a simple cash flow issue first and foremost, as well as a few other issues to make sure we can continue to provide health care to all Californians. So with that said, I want to offer our Vice Chair, Senator Niello, the opportunity to make comments. Mr. Vice Chair
- Roger Niello
Legislator
Thank you very much, Mr. Chair, I won't, excuse me, question the points, detailed points you made about the issues before us. I would just point out that we are preempting the May revision process or more specifically, we are considering these issues without considering other budget priorities and seeking to approve this request again without any particular discussion of other things that are a call on state resources.
- Roger Niello
Legislator
And I would suggest that what we're dealing now pales in the light of the deficits that we're looking at in the out years, the three or four years beyond the 25-26 budget year, which is in the tens of billions of dollars.
- Roger Niello
Legislator
And I don't see any evidence of looking to control costs so as to reach solutions for that budget. And I would like to, if you could, hand this letter to the Department of Finance.
- Roger Niello
Legislator
This is a letter that Senator Jones and I wrote quite some time ago asking about the loan, which I realize we're not considering that here, but it's most definitely part of the same issue with regard to Medi Cal.
- Roger Niello
Legislator
I don't know if you've seen that letter, but it's dated March a few weeks ago and we have not received a response which is mildly irritating to Senator Jones and myself and we would like to see the data which actually is required by law in order to request that loan.
- Roger Niello
Legislator
So we certainly have challenges before us and let's keep a focus on the bigger problems of the out years and the alternative call that we have on funds as we head to the May revise, not just Medi Cal by itself.
- Scott Wiener
Legislator
Thank you, thank you so much, Mr. Vice Chair. I will now turn it over to Erika Li from the Department of Finance. I want to also note that our Legislative Analyst is here and will answer questions if they come up.
- Erika Li
Person
Thank you. Good morning Chair Wiener, Vice Chair Niello and Members of the Committee. Erica Lee with the Department of Finance to present on AB100 as was stated, is a budget Bill junior that amends the 2023 and the 2024 budget acts.
- Erika Li
Person
This Bill includes an increase in expenditure authority of 2.8 billion General Fund and 8.3 billion matching federal funds for the Medi Cal program. It also amends control sections from this year's enacted special session bills which provided 2.5 billion for use by state departments and entities for costs resulting from impacts of Southern California wildfires.
- Erika Li
Person
Specifically, this Bill authorizes augmentations to provide funding to be dispersed to Los Angeles County and cities within the county for unmet response and recovery needs resulting from damage caused by both the Eaton and Palisades fires.
- Erika Li
Person
It also requires the Executive Branch and any local entity receiving funding pursuant to these sections to seek the maximum amount of reimbursements from the Federal Government and requires that any federal reimbursement received be deposited back into the General Fund.
- Erika Li
Person
It also authorizes augmentations to backfill property tax revenue lost in 24-25 and 25-26 by cities, counties and independent special districts as a result of damages caused by these fires.
- Erika Li
Person
The Bill also augments the California Office of Emergency Services, or Cal OES reimbursement authority by 7.65 million to continue through June 30th of 2026 with a contract for an operational observer to monitor covered utilities implementation of measures to mitigate the risk of wildfire ignitions from util infrastructure, as well as to reduce the use, scope and duration of public safety power shutoffs.
- Erika Li
Person
The Bill also restores 2023-24 funding for the California Nonprofit Security Grants Program that was not encumbered before the appropriations availability expired, providing 20 million General Fund augmentation.
- Erika Li
Person
It also adds a provision to allow the state Controller to use existing funding from the property tax postponement Fund to pay for approved applications related to manufactured mobile homes in the 24-25 fiscal. It provides an Administrative Procedures act exemption for 2 million General Fund for the farmer program.
- Erika Li
Person
The existing farmer funding has an exemption already, so the California Air Resources Board would not be able to allocate this particular funding without that exemption. It also provides an additional 17 million from the enhanced Fleet modernization sub account to provide additional funding to local air districts for the clean cars for all programs.
- Erika Li
Person
It authorizes the Department of Finance to approve expenditures up to 2 million from the Foster family home and Small family home Insurance Fund to address claims paid on behalf of foster family homes, small family homes, resource families and tribally Approved families.
- Erika Li
Person
It reappropriates 1 million 1 time Proposition 98 General Fund to the Fiscal Crisis Management and Assistance Team, also known as ficmat to provide technical assistance to local educational agencies that have been impacted by the LA wildfires. And as mentioned, it adds Control Section 15 to the Budget Act of 2024 to appropriate certain Proposition for climate bond funding.
- Erika Li
Person
Specifically the full amounts allocated are to six state conservancies for grants and projects related to wildfire and forest resilience as well as 10 million to the Department of Forestry and Fire Protection Fund training center infrastructure for a fire resiliency Center for the Kerak tribe. And finally this Bill makes other technical amendments. I am here and joined by my colleagues to answer any questions of the Committee at the appropriate time. Thank you.
- Scott Wiener
Legislator
Thank you very much. Okay, Are there any questions from colleagues? Senator Menjivar. Excuse me, Senator Blakespear had asked you had a question and then Senator Menjivar.
- Catherine Blakespear
Legislator
Is this time for questions? The comments are not long, but do you want that... Thank you for the information. I appreciate hearing that. I know that this needs to be done. We need to have the authority to cover our General Fund deficiency, particularly in the Medi Cal program. But I just.
- Catherine Blakespear
Legislator
I want to say that it's critically important that we also prioritize the policy changes that are needed in order to bring this escalating cost back under control. So I think we did not expect that this would be as high as it is and every day it continues to be high and higher.
- Catherine Blakespear
Legislator
And so my hope would be that at this exact moment when we're doing this, we would also be making policy changes that would accomplish cost containment. But we're not doing that. We're doing only budget.
- Catherine Blakespear
Legislator
But I just think it's really important that we realize that with our medi Cal program when we expanded it to people, regardless of documentation status and regardless of assets. So we have almost 40% of the state is on Medi Cal. And it's an enormous cost to the State of California and our budget, our General Fund budget.
- Catherine Blakespear
Legislator
And we have enormous uncertainty from the Federal Government. And we need to be fiscally responsible. We need to live within our means. We need to figure out how to cost contain this program and still provide critical medical care. But I think there are ways to provide the core of medical care without providing.
- Catherine Blakespear
Legislator
Without it being triple the cost of what we expected, basically. So I think it's very important to say this out loud because otherwise it's not clear that we are headed toward making sure that that's a priority. So I wanted to just really emphasize that. And with that, I'll yield back to the chair. Thank you.
- Scott Wiener
Legislator
Okay. Before we go to Senator Manjaro, we do have a quorum, so lightning has struck. And so let's call the roll, please.
- Caroline Menjivar
Legislator
Thank you. Mr. Chair, I'd like to talk on item six, where we're appropriating $2 million dealing with claims paid to foster family home.
- Caroline Menjivar
Legislator
I recognize that we need to pay these claims, but I think we're missing a big opportunity to address a bigger issue that should have been included in the early action package regarding these same entities, our FFAs that are closing at an alarming rate.
- Caroline Menjivar
Legislator
Nine have closed so far and they're going to have no assistance until the new rate reform goes into effect. In two years, we're going to see potentially a doubling of those FFAs closed. And when the rates are established and move forward, we're not going to have any FFAs in California working.
- Caroline Menjivar
Legislator
I'm disappointed that our body did not utilize this opportunity to do a stopgap investment on FFAs, seeing that they're closing. So I'm wondering how much you're able to share on the engagement from the Administration on addressing this crisis.
- Committee Finance
Person
Department of Finance. So I think I just want to start out by saying the foster family home and small family home insurance Fund indemnifies parents, not ffa. So basically protecting foster parents against expensive protracted litigation. If a foster child suffers an injury while under foster parents care, the FFA insurance protects the agencies that place foster.
- Caroline Menjivar
Legislator
I recognize the importance of number six. I know we had to do that. Respectfully, I don't need a description of what it does.
- Committee Finance
Person
Yeah, I think just trying to separate that. Just trying to indicate that these are two separate issues. And as far as like what the administration's doing, we're continuing to meet with FFA stakeholders regarding the challenges that FFAs are facing in getting insurance.
- Committee Finance
Person
In addition, we know the Department of Social Services has issued all county letter number 2427 and that was in October, which details the expedited portability process for foster parents and foster children when an FFA closes due to loss of insurance.
- Committee Finance
Person
So we are committed to ensuring that children that are impacted by the closure of FFAs are placed in stabilized placements and taken care of. And the Administration is continuing to work with stakeholders as required by AB 2496. And I think as part of AB 2496, we will be sharing some of the outcomes of some of those conversations and engagements in mid May.
- Caroline Menjivar
Legislator
Do anticipate this? Maybe this is a question, Mr. Chair. Do we anticipate this being the only early action package?
- Scott Wiener
Legislator
We don't have any further early action planned. So the goal, as I anticipate this will be the only early action. Of course, that can always change as circumstances change, particularly if Congress, if the Republican leadership in Congress gets it together faster, more quickly than we anticipate and takes a wrecking ball, then, you know, we don't. We would have to respond to that. But as of now, this is what we anticipate. Thanks.
- Brian Jones
Legislator
Thank you. Let me start with just saying I concur with the Vice Chair's comments earlier in the meeting, especially, you know, regarding the process and of course the letter that we submitted. Three things I'd like to kind of dig a little bit deeper into if we can.
- Brian Jones
Legislator
One is the Prop for Proposition for funding the $10 billion bond that was passed in November. I'm noticing that there's $181 million appropriation for conservancies. The conservancies are of course listed in the Proposition for language.
- Brian Jones
Legislator
But My question, the $181 million, once it leaves the state, once the state writes the checks to those conservancies, what accountability do we have or information do we receive from the conservancies to know that they're actually spending that money on fire resiliency and the other things that we've determined as a body to be the priorities of that $181 million?
- Stephen Benson
Person
Good morning. Stephen Benson with the Department of Finance. So when the funding gets appropriated to the conservancies, it hasn't actually left the state yet. Just as a point of clarification, they're state Department, so it's still in the state until they award grants, and those grant dollars are sent out to the awardees.
- Stephen Benson
Person
And there's a process for each of these conservancies where they have boards and those boards have to consider proposals that come in and the boards make approvals as to what those awards will go to.
- Stephen Benson
Person
So there is a public process and some accountability in terms of they'll put out a solicitation, proposals will come in, they'll be reviewed, scored. Their board will hear all of those proposals and take actions to approve them.
- Stephen Benson
Person
So there is a sort of a process that highlights what projects are proposed, what the board is considering approving, what does get approved in terms of those types of projects.
- Brian Jones
Legislator
Well, I appreciate that I used to serve on one of the conservancies, so I'm familiar with that process. But, you know, with my experience on serving on a very good conservancy, and I'm not saying that there's bad ones, I'm just saying I know the one that I served on was very good for the short period of time I had the opportunity to serve, there was very, you know, conscious of these funds and making sure that they got spent well.
- Brian Jones
Legislator
But how do we know that once these grants are awarded that whoever is eventually receiving the grant, unless we ask the conservancy. I guess what I'm picking up from what you're saying, unless we ask the conservancy, they're not going to report back to us on that.
- Brian Jones
Legislator
So is it up to each one of us as legislators, if we have a conservancy in our district to be paying attention to that or who else is paying attention to that?
- Stephen Benson
Person
So the Natural Resources Agency collects information on what projects are being done. There are actually databases and things that are being used now that the Wildfire Forest Resilience Task Force actually coordinates where all these projects are sort of being input into. They go into single, eventually into a single database that maps where the projects are.
- Stephen Benson
Person
And so there are ways for folks to see specifically which projects are awarded and their progress and status and what's being done and you know, finance checks in with agency and the Conservancy's on a regular basis to find out what projects are and status.
- Brian Jones
Legislator
Okay, thank you. The second thing I wanted to ask about was Prop 36. Prop 36 passed by about 70% across the state and every single county approved it, including San Francisco, Marin and every other Bay Area County, LA County. Every county.
- Brian Jones
Legislator
So I'm not seeing a specific coverage of Prop 36 funding for either drug treatment, rehabilitation or anything else that Prop 30 the voters have asked for through that Proposition.
- Erika Li
Person
That is correct. There is nothing in this early action in regards to Prop 36. As I testified back in January, February for the Governor's Budget, the CDCR had increased costs based on projections of increased numbers. And that was to for program as well. And anything beyond that would be in our May revision or beyond. But it's not included in this.
- Brian Jones
Legislator
So I guess at least. The Governor's been noticeably silent on this issue. Are we expecting an update on the. On the May revise from him and what his priorities are going to be regarding Prop 36?
- Erika Li
Person
I would say that we're still continuing to develop the May revision, so I can't really speak to that at this time.
- Brian Jones
Legislator
Okay, thank you. I appreciate that. And the last thing, Mr. Chair, I'm sorry. In the opening presentation from Department of Finance, she said something that piqued my ears because I had it underlined in my notes as well. The Clean Cars for All program. Can you. I'm sorry, I missed. Can you restate what you said about that, please?
- Erika Li
Person
Sure. Just looking for it in my notes. Do you have this section? I can.
- Brian Jones
Legislator
It's just increases spending for the programs, such as Clean Cars for All. Thank you. I don't have the section. I'm sorry.
- Andrew March
Person
It was in your opening comments. Andrew March with the Department of Finance. So the early action package includes $17 million from the enhanced Fleet Modernization sub account, which is funded by a $1 fee on vehicle registration fees. And we're using this money to backfill some local air districts that have run out of funding for Clean Cars for All.
- Brian Jones
Legislator
Can you. I looked up the website yesterday for that program. I mean, it's pretty well written, but I just couldn't. I mean, it's pretty well graphically displayed, but I just couldn't make sense of the graphs, the matrices that were presented. Are you able to give us kind of like a brief explanation of what that program is?
- Andrew March
Person
Yeah. So Broadly, the program provides funding for low income individuals to replace their older polluting cars with zero emission vehicles or plug in hybrids.
- Brian Jones
Legislator
So if I can summarize what I think you said and tell me if I'm correct or not. The state is giving money to people who qualify at a certain income level to buy or lease a new ev, is that correct?
- Brian Jones
Legislator
It could be an ev. It could be a hydrogen vehicle as well. Okay.
- Brian Jones
Legislator
Do we know how many vehicles a year are being purchased on that program or leased on that program?
- Brian Jones
Legislator
I would love to have that information. As a former car guy, I'm very. My interest is very much piqued that the state is buying people cars in California that might actually be a better solution to the high speed rail, might be cheaper. But that's a discussion for another day. So thank you all very much. Thank you, Mr. Chair. I appreciate your patience.
- Rachel Ehlers
Person
Rachel Ehlers, Legislative Analyst Office. I'll just add a clarification. The program does not provide the full cost of a car. It's just a portion. I think it's around $7,000. Don't quote me on that. But it's something in that neighborhood.
- Rachel Ehlers
Person
And then the program also does include a requirement at the local air district level to scrap a polluting car. It's not just a voucher for a new car, but has that piece of it on the air district portion of the program.
- Brian Jones
Legislator
I would be interested to know the number of cars, the cost of this program. I looked at the website. It looks like the website is designed for a PC. I was trying to look at it on my phone. I am being serious. It looks like it's well done. I just couldn't follow it on my phone. So thank you.
- Scott Wiener
Legislator
Okay. Other questions, Comments, Senator Grove. And then Mr. Vice Chair,
- Shannon Grove
Legislator
Thank you. Just to follow up on my colleague's question, the Minority leader, what's the income level on that program?
- Andrew March
Person
Hi, Andrew March again. I don't have the exact income level requirements, but we can get back to you.
- Shannon Grove
Legislator
Is there somebody that does so that we can get this on the record?
- Rachel Ehlers
Person
I know that it's linked to the federal poverty level, but I don't. That piece of data is not in my brain, but I can run back and look at it and come back up Mr. Chair, in a moment if that would be helpful.
- Shannon Grove
Legislator
I was just curious if it was just that gives me a little bit closer number than I was thinking. I just wondered how the number was calculated. Who would qualify? I understand that.
- Shannon Grove
Legislator
Do you know if the program, for instance, those batteries only last seven to eight years, and if they keep that car, it's about $7,000 to replace those batteries. Does that program allow them to have a battery replacement or they just have to go buy a new car? Just curious.
- Shannon Grove
Legislator
I only bring that up because my neighbor's yelling at me that he bought a hybrid Lexus. Okay. And I get it. But it. And it was Lexus and it cost him $8,500 for a brand new battery and the car is like seven years old. So.
- Andrew March
Person
Yeah. So first point to follow up on the income requirement. So the income level is at 300% of the poverty, the federal poverty level,
- Shannon Grove
Legislator
Which is what now? 300% of the federal poverty. What's the federal poverty level? Because it's. Okay, is it $100,000 a year income?
- Shannon Grove
Legislator
And I'm not asking for my neighbor, I'm just asking, is this going to be a perpetual thing where with people in low income, if we give them the money to buy a car and the State of California is purchasing or not purchasing, but has an allocation for this and, you know, a few years down the road, I mean, I'm not.
- Shannon Grove
Legislator
Again, you know, most cars will last a long time, but it's very expensive to replace these batteries.
- Andrew March
Person
The federal poverty level, it depends on the income or the family size, but for a single person, it's around $15,000 a year.
- Andrew March
Person
Okay, that's 300% would be around $45,000 a year. And the program is designed for vehicle replacement, so not necessarily a new vehicle or replacing the battery on a vehicle. And I think, just to clarify, this funding can only be used for two purposes.
- Andrew March
Person
It can be used for this program, the Clean Cars for All program, or it can be used for the Bureau of Automotive Repairs Fleet Modernization program, which is funding to certain individuals if their vehicle fails smog, to retire that vehicle.
- Scott Wiener
Legislator
Okay, we'll go to the Vice Chair and then Senator Richardson and then Senator Durazo.
- Roger Niello
Legislator
Thank you, Mr. Chair. Back to the Medi Cal adjustments and sort of following up on Senator Blakespear's point comments that are important, as are Senator Jones in my letter indicates, with regard to the loan, which is what we knew about at that time, there are many details that, if I understand, are required by law to obtain the loan.
- Roger Niello
Legislator
But then shortly after that, the 2.8 billion General fundamentals Fund request was made, essentially through the media. And I don't think we have any detail on why those cost overruns that necessitate those additional funds. And I don't think you addressed that in your opening statement.
- Roger Niello
Legislator
And by the way, I'm looking forward to comments that the LAO will have on all this, which might help to answer the questions or create more questions. But did I miss that? Did you include those details?
- Erika Li
Person
I did not include details on the loan. This is this early action is specifically for the 2.8 billion that would, in combination with that 3.4 billion loan, help provide the funds needed to get through this fiscal year.
- Erika Li
Person
And so nothing specific to that, but in terms of the projected shortfall for the Medi Cal program, I think we've cited higher overall enrollment due to the continuation of eligibility flexibilities, which will go through this fiscal year and particularly for the senior population, as well as higher than projected enrollment and pharmacy costs for individuals with unsatisfactory immigration status.
- Erika Li
Person
So those are some of the main contributing factors that we're seeing. And to, to go back to Senator Blake Spier's comment, we are absolutely looking at ways to curb cost in this program, understanding that the decision to go forward at this time was based on a certain number, that number has increased.
- Erika Li
Person
We understand the unsustainability of the current program and, you know, the shared priorities that the Administration and the Legislature had to enact. The increase of access of healthcare for all continues. And I think we need to have a shared, shared solutions that the Legislature as well as the Administration work toward to curb those costs.
- Erika Li
Person
I think that that is I understand that is the concern Senator Blakespear had, the concern that you note as well in regards to the current Medi Cal program.
- Roger Niello
Legislator
So we're perhaps being a little bit too aggressive in the expansion of eligibility. I realize that's not exactly what you said, but it's kind of my interpretation of what you said with regard to out years. And I realize that's not part of this either.
- Roger Niello
Legislator
But I am curious to know, because if we wait until departments start developing the 26-27 budget to look for adjustments in the budget on the order of 20 to 60, $30 billion, I realize that's the LAO's number, your number is a little bit less than that, but nonetheless, still tens of billions.
- Roger Niello
Legislator
If we wait till the fall of the development of January next January's proposal, I think we'll be seriously behind the eight ball in finding that magnitude of adjustments. So is the Administration beginning to work now on looking at those out years again? I realize that's not quite of this proposal, but it's pretty important.
- Erika Li
Person
Yes, absolutely. We've been looking since the Governor's Budget has been put out and things have gotten worse in terms of the economy as well as a lot of uncertainty at the federal level, things that we did not know about as we were building the Governor's Budget in the fall.
- Erika Li
Person
So absolutely, we are aware of the the headwinds, the risks, as well as the expenditures that we are currently seeing balloon not just in Medi Cal but in other programs as well.
- Erika Li
Person
And so, yes, we are absolutely looking at ways to curb those costs across various programs currently for the May revision and leading into the 25 Budget Act.
- Gabriel Petek
Person
Gabe Petek Lao so Senator Niello, you raised some important longer term policy issues, I think, with regard to Medi Cal, just for the context, for the Committee to know that in the past year when the budget was being developed, there was greater uncertainty than there have been at other times, keeping in mind that the forecast, the projections were being developed in the midst of the unwinding of the federal policies still that were in place during the pandemic.
- Gabriel Petek
Person
And then there was the expansion of eligibility, the asset test elimination and the expansion to the undocumented population.
- Gabriel Petek
Person
And then also one of the there we have some of these newer pharmaceuticals that are quite costly, and those are now the volatility in the pricing and the cost variation from these newer pharmaceuticals or in all pharmaceuticals really is now being borne more directly by the state because we shifted in 2022 to a fee for service model in Medi Cal away from the managed care model under which the volatility of those price fluctuations would have been absorbed by the managed care organizations.
- Gabriel Petek
Person
And so those are just some of the reasons for why there does appear to be somewhat of a higher upward adjustment that was harder to forecast when the budget was developed.
- Gabriel Petek
Person
Not getting ahead of I know you have other, like I said, important policy issues, but for the context, and I don't know if my subject matter expert colleague would want to supplement anything I've said, but
- Jason Constantouros
Person
Jason Concenturos Leo yeah, I think you've heard correctly a lot of the sort of key issues in Medi Cal. We'll just emphasize that under the Governor's Budget, Medi Cal spending is about 2.6 billion higher. And so the early action you have before you today roughly aligns with what sort of had been anticipated, a Governor's Budget. The kind of key question is what is May revision going to look like?
- Jason Constantouros
Person
And that's something that, you know, has to come from the Administration. We don't have any additional information, but as you noted, there is an additional loan in addition to the sort of early action. And so there is sort of something to keep an eye on in terms of upcoming cost increases. Yeah. Thank you.
- Laura Richardson
Legislator
Thank you, Mr. Chair. I just wanted to provide a couple comments to the gentleman from, from Santee, San Diego. I recently visited a dealership in my district and asked the question of where we were in meeting the zero emissions as it relates to gas vehicles. And I was told.
- Laura Richardson
Legislator
So I don't know if this is written in stone yet, but I was told that 22% of the vehicles purchased were either hybrid or electric. And. And the majority of those were in fact, hybrid, not electric.
- Laura Richardson
Legislator
The second thing I just wanted to chime in as Subcommitee chair of number five, we do intend to do a Prop 36 overview after the May revise and before our summer recess because it's of great interest to many Members of how that's going to be implemented and the cost associated with it.
- Laura Richardson
Legislator
And the Administration has committed to getting us those numbers by that time frame. So I just wanted to share those two points.
- María Elena Durazo
Legislator
Thank you. Mr. Chair, just a few questions about the costs increases in medi Cal. On the pharmacy costs, do you have a specific amount or a number that says pharmacy cost increase by this much or this much in dollars? So we know what we're dealing with, right? Are we dealing with $10 increase?
- María Elena Durazo
Legislator
Are we dealing with millions of dollars increase? You know, it seems like as we look for ways to figure out what to do in our budget, that's one question. What, what information do we have about the actual cost and what kind of medications would account for the majority or less, whatever.
- María Elena Durazo
Legislator
So that's one question is more information about that. The second is that if we decrease the number of. Just nobody suggested, but if we were to decrease the number or make it less, make preventative care, Medi Cal less available to people, to poor people, what does that do as far as increase the emergency room usage?
- María Elena Durazo
Legislator
We know, I mean, that was a big part of decreasing our uninsured. We wanted to make sure that there was preventative care. Don't go to the emergency room. It's far more expensive for everybody to use emergency room.
- María Elena Durazo
Legislator
So it seems to me it fits in here that you may be talking about increasing the number of insured, but if we drop the number of insured, certainly they're going to look elsewhere. They May wait until, you know, they're seriously ill, but they will end up in emergency room one way or the other.
- María Elena Durazo
Legislator
So just in terms of cost, put aside the moral issue. Let's just deal with funding. How do those two fit in as far as. And can we get more information on. On those 2 items as we move forward? Thank you.
- Erika Li
Person
Yes, Senator Duazo, the pharmacy costs increased about 1.3 billion from the 2024 Budget act to the Governor's Budget. And in terms of more discreet details, we can provide your office that information. And then to your second question about reducing access to health care, I think we would see an increase in emergency costs.
- Erika Li
Person
I don't have what that ratio would be, but I think, you know, anecdotally we have heard that. And so there would be that cost decrease on one hand, cost increase on the other hand.
- María Elena Durazo
Legislator
Yeah. Can we figure out how to get it? Seems to me a big issue is, especially as we're looking for potential solutions, we should have that information in front of us.
- Jason Constantouros
Person
Jason Constanturos, Legislative Analyst Office just wanted to add a couple points. You first asked about pharmacy, and the Department of Finance noted that it's about 1.3 billion General Fund increase. That's about a 9% increase over what was kind of assumed sort of last year's budget.
- Jason Constantouros
Person
We also did look at what some of the underlying drugs are that might be causing some of the increase. When the Department does the modeling, they don't look specifically at each drug. They look at underlying trends and have a model to project that forward.
- Jason Constantouros
Person
But if you look at kind of over the last few years based on some limited data that's sort of available, what we found is a handful of drugs really were driving a lot of the increase, particularly more specialty diabetes and weight loss drugs, as well as some other kind of specialty drugs. Pharmacy spending is somewhat asymmetric.
- Jason Constantouros
Person
There are drugs that are used more often but are not relatively costly, and then there are some relatively more expensive drugs. Those tend to drive a lot of this or spending increases over time. And then on your other question, I just also wanted to note. Yeah.
- Jason Constantouros
Person
In terms of the changes in eligibility and how that might translate to higher costs down the road, those can be very difficult to model. But another thing to consider is that in our healthcare system, not all the costs are necessarily borne by the state. Some of those costs could translate.
- Jason Constantouros
Person
It might result in, for example, more costs paid out of pocket by the consumer or to other sort of payers. So that's also kind of another thing to consider when you're weighing the policy merits of transactions. Changing eligibility is who sort of bears the cost, and does that sort of make sense? And is that a where does that fall into your priorities?
- María Elena Durazo
Legislator
But if you're losing your health insurance and you're poor, you're not going to pay out of pocket.
- Jason Constantouros
Person
And there also could be cases where people just defer treatment entirely, and that's also part of the policy consideration.
- Scott Wiener
Legislator
Okay. Senator Grove had a question, then Senator Blakespear, then Senator Choi.
- Shannon Grove
Legislator
Thank you. I'm going to just follow up on my colleague from Los Angeles. They're just going to defer treatment. Is that California State solution? They're just going to defer treatment.
- Shannon Grove
Legislator
You have cancer, you're coughing, you can't go to the hospital, you don't have Medi Cal insurance or you don't have Medi Cal and there's no medical rates, they're going to go to the emergency room. And your response and what was your title again? In the State of California, people will just defer treatment and not go get treated. That's our solution.
- Jason Constantouros
Person
Yeah. So Jason Constantouros Legislative Analyst Office so I wasn't suggesting that there's a solution that you're voting on today that would entail cutting back eligibility. When you do consider changes in eligibility, they do raise complicated policy trade offs.
- Jason Constantouros
Person
And those policy trade offs can include people deferring treatment or paying more for the cost of treatment out of pocket. There also could be savings to the state budget. These are trade offs that the Legislature has to weigh when it's considering different sort of actions.
- Jason Constantouros
Person
Again, there's nothing in the, in the early action budget today that's proposed and there's also not in the Governor's Budget. The thing to keep an eye on is when you're heading into May revision and if there are solutions, that would be the time to start weighing the trade offs of those pretty carefully.
- Shannon Grove
Legislator
Okay. I just wanted to make sure that you weren't suggesting that poor people that got cut off of insurance had to pay more out of pocket or defer treatment. Because that's what it sounded like you said to me. So I'm not trying to argue with you. I just caught that.
- Jason Constantouros
Person
Yeah. It wasn't a recommendation we were making. These are the potential consequences that you want to weigh.
- Shannon Grove
Legislator
Thank you. And I'm sorry, and my question had nothing to do with that until you responded to my colleague from Los Angeles. But I will need that gentleman to back up because I want to ask about the SCAR program again. Sorry. So basically you said it's 300% of the poverty level. The federal poverty level is $15,000.
- Shannon Grove
Legislator
So we did a rough estimate that it's a $45,000 a year income that an would be able to trade in an old car, get a subsidy of approximately $7,000. We don't know that number yet. Could be higher, could be lower from the State of California if you make $45,000 a year and let's just say you make 45.
- Shannon Grove
Legislator
There's no taxes, there's no FICA, federal, FUTA, SUTI. There's. Let's just say that's their net income. For easy calculations, the balance or the cheapest EV you can get is 39,900 in California. I just checked with, like six car dealerships. So I was walking out to get my coffee.
- Shannon Grove
Legislator
I checked with insurance companies, four of them, the leading insurance companies. The payment on that every month is going to be $144 a month. The payment, even if you take 7,000 from the 39,000, add interest to it, would be roughly $610 a month with financing fees.
- Shannon Grove
Legislator
How is somebody who makes $45,000 going to get an EV that costs $45,000, an EV that costs $40,000 or 39,900, plus interest, even with the credit? So I'm really curious about how much this program costs taxpayers, how effective it is. I want measurable goals, like how many people have taken advantage of this program?
- Shannon Grove
Legislator
Because I know, I mean, in my district, I have some of the most wealthiest people per capita and some of the poorest people per. And I don't see my farm workers are the people that make a poverty level.
- Shannon Grove
Legislator
I mean, I know they make like $20 an hour in a lot of them in my district, which is still not a great number for California and to live here. But I don't see how you make that work in your monthly income.
- Shannon Grove
Legislator
And how successful that program, and if I want to know the numbers, because if it's not successful, and this is something that is, I don't know, being managed by 150 people that you know, and who's it managed by? Those are questions I have. How successful is the program? Who's it managed? And how do people that make 45 grand a year pay for this?
- Andrew March
Person
So we can get you the information on sort of the uptake of the program, but the program, at least what the funding is in early action, is for the local air districts to implement the program. So it's implemented by the local air district.
- Andrew March
Person
So the South Coast Air Quality Management District, the Bay Area Air Quality Management District, these air districts manage it. And so they have different levels of uptake in the different. Different regions. To the point the price of the vehicle, it doesn't have to be a new vehicle.
- Andrew March
Person
So it can be a vehicle that is 8 years old or newer, and it provides potentially up to $11,000 for an individual, plus $2,000 for charging. So it does not have to be a new vehicle. It could be an older vehicle or a used vehicle, which in that case, the cost, I would assume would be lower than the previously cited cost.
- Shannon Grove
Legislator
Okay. I just base that calculation on what you had provided me earlier. The $2,000 for charging, is that a year? You know, charging infrastructure. Okay. Yes, ma'am.
- Rachel Ehlers
Person
Thank you. Rachel Ehlers with the LAO. I'll just note that there's also an option. Rather than getting a new or used car, a participant could get a voucher for up to $7,500 for alternative mobility. So that's a bike or an E bike or a bus pass or a train pass or public transportation.
- Rachel Ehlers
Person
So that's another option rather than the vehicle. The program also does include a capped interest rate loan at 8%, maybe to help with some of that. The monthly payments also cites that the federal poverty level in 2024 was 93,600 for a family of four, in case that's helpful as well.
- Shannon Grove
Legislator
Oh, yeah. I just based it on the information that was. I did. That's much better, I'm thinking.
- Andrew March
Person
Yeah. So the federal property level depends on family size. So I think what my. From the Legislative Analyst Office cited a family of four. What I cited was for a single person.
- Shannon Grove
Legislator
So it'll scale to all scale. I get it. It just piqued my curiosity when we did this. And is it a grant program that these people apply for at this air district boards. Right.
- Shannon Grove
Legislator
And if I wanted to know how many people got on this program, I have to go to each air district or just the information is collected by the California Air Resources Board.
- Andrew March
Person
So we can provide that information to you. We don't have it right now, but again, this is a supplemental funding because certain air districts are running out of Fund in their programs.
- Rachel Ehlers
Person
Yeah. And they do have a fact sheet from CARB that we've shared with your budget staff so they can share with you as well. Thank you.
- Scott Wiener
Legislator
Thank you. Before I go to Senator Blakespear, I do just want to say I appreciate that Senator Grove expressed concern about the possibility of scaling back health care coverage for poor people. I think I share that deep concern. We obviously have to balance our budget. I do just want to say.
- Scott Wiener
Legislator
And I said this at the beginning, and I'll be more specific. The House of Representatives Republican leadership has directed the House Committee on Energy and Commerce to cut 880 billion, almost $1.0 trillion out of its budget, which would. I'm going to read a headline from Kaiser News, a political fact check. Can house Republicans cut $880 billion without slashing Medicaid. It's likely impossible.
- Scott Wiener
Legislator
And so when you look at how the Republicans in Congress have structured the budget process, they have set it up to take a wrecking ball to Medicaid, which will throw many, many poor people off, working class people that are off of health care here and around the country. 15 million Californians are on Medicaid.
- Scott Wiener
Legislator
I believe it's 70 million, if I'm not mistaken, nationwide. And in order to Fund tax cuts for rich people, they are basically trying to scrape together money wherever they can get it, and they're doing it on the backs of poor people and health care, Head Start, snap, et cetera.
- Scott Wiener
Legislator
It's reprehensible, it's despicable, but that's what we are facing. And so I would encourage anyone on this Committee who, who shares the desire to protect health care access for low income working class people to be doing everything in our power to persuade Members of Congress, including Republicans, not to do this and to stop them from doing this.
- Scott Wiener
Legislator
Because this will have a devastating impact on health care access for low income people in Kern, county, in San Francisco county, in LA County, in Alameda County, up in Orange County. It's going to throw people off health care and for those remaining will degrade their care.
- Scott Wiener
Legislator
And that is what is coming our way from the Republican majority in the United States Congress. I just want to be real clear about that in terms of what's happening here. With that said, I'll turn it over to Senator Blakespear.
- Catherine Blakespear
Legislator
Yes, thank you. So my colleague from Los Angeles was bringing up the specter of dropping people from health insurance. And so I just wanted to directly dive into that suggestion and state that I am 100% opposed to that, but I think there are ways to cost control without dropping people from health insurance and recognizing that it is really the pride of California that we have been able to insure so many people.
- Catherine Blakespear
Legislator
So calmatters reports that almost 95% of Californians have health insurance. And since 2011, approximately 5 million more residents in California gained health insurance. So if we look at our population in California and say 95% are covered with health insurance, I don't think that we should be thinking about dropping people from plans.
- Catherine Blakespear
Legislator
But the reality is that we have exceedingly high quality health care and it is available to people who have insurance, which is 95%. And I, you know, just speak personally from having a family that has young kids that are now teenagers, that has adult parents who are older. I helped a parent who was on Medi Cal for a while, a long time.
- Catherine Blakespear
Legislator
And just recognizing that, I think there is a big difference between core health and a lot of the additional services and things that we offer, which for any individual family who wants to have their, you know, wart removed from somebody's foot, it's like, really great that it happens. But is that core health?
- Catherine Blakespear
Legislator
I mean, I think there are enormous numbers of things that fall into the category of is it a generic or a premium drug? Is it something that's necessary for core health or not?
- Catherine Blakespear
Legislator
And we, I don't think we have been willing to or able to so far to do that really hard analysis to say we want to prevent diabetes and we want to treat cancer, and there are a large number of things that are part of that core health.
- Catherine Blakespear
Legislator
But having, you know, exploratory or analytic MRIs for various ailments, you know, that isn't part of core health. I don't think so. And there, you know, there is an MD actually sitting to my right who could speak much more deeply about this. But the reality is that given our very high quality healthcare, I think that we could.
- Catherine Blakespear
Legislator
We could limit our expenses without dropping people and still have 95% of the state covered if we were willing to say that there are things that are covered and there are other things that aren't covered that are more discretionary and that we would love to provide, but we are not able to because we don't have the budget to do that.
- Catherine Blakespear
Legislator
So I wanted to encourage us to do. To look at it that way and to not necessarily go to the idea that we can't enroll more people on Medi Cal or that we should be dropping people who are on it, we should still strive for that coverage.
- Catherine Blakespear
Legislator
But to say, you know, let's really look at all the services, all the drugs that are offered and have a core health focus. So. Thank you, Chair.
- Scott Wiener
Legislator
Yes. So actually we have Senator Choi, and then we can go back to Senator Grove.
- Steven Choi
Legislator
Thank you, Chair. Among the questions raised previously, I noticed that $3.4 million will have to be loaned to sustain the Medicare, and that is to Fund $2.8 billion General Fund to increase. So that is contingent upon $4.4 billion borrowed to sustain to increase $2.8 billion. Right.
- Erika Li
Person
So actually, the 3.4 billion was the loan that was already provided so that we could continue making provider payments timely. And this act today is an additional 2.8 billion for increased cost, Medi Cal cost. So combined, it's the 3.4 billion in addition to 3.3 billion.
- Steven Choi
Legislator
Yes. Which is a loan borrowed. That's right. 8 billion has to be increased to sustain.
- Erika Li
Person
Right. And I would just note that Medi Cal is a program that's budgeted on a cash basis. And so there are a lot of ins and outs of this. Dollars that come in from large things like MCO, the managed care organization tax that comes into it, and then dollars that flow out to pay providers.
- Erika Li
Person
And so unlike many of our other programs where there is a set allocation, this program works on a cash basis. And so the 3.4 billion is to allow for us to make timely payments to our healthcare providers. The 2.8 billion is an identified shortfall for which we're asking the Legislature for the authority for that today.
- Steven Choi
Legislator
So in adding that will be 5.0 over $5 million in shortage in 3.4 plus 2.8. That's the category.
- Erika Li
Person
Yeah. And again, I wouldn't necessarily add those two together to say that's the shortfall. Part of that 3.4 billion is to address cash flow issues, not necessarily just all deficit. It's a timing issue.
- Erika Li
Person
But yes, the Medi Cal costs are higher now than we had anticipated back at the Governor's Budget because these shortages came from support that resulted in $9.5 billion of supporting Medicare through for the undocumented 1.6 million people.
- Erika Li
Person
I would say it's the overall cost of the Medi Cal program for all Californians, of which expansion to undocumented immigrants is a large part of that. But it is the overall program which included it. Also the pharmacy, as I mentioned, includes higher enrollment, higher caseload than was anticipated.
- Steven Choi
Legislator
Yeah. Switching the program a while ago, also Clean cars for all. And there was what the income threshold would be and there was no clear answer. So that means the program Clean cars for all will include undocumented people.
- Steven Choi
Legislator
And as was discussed, so all means, you know, Medicare for all and clean cars for all. So that means to me, I can interpret that as everybody documented or undocumented. Right.
- Erika Li
Person
I don't know what all the eligibility requirements are outside of. We discussed some income requirements. I can get back to you on the overall eligibility requirements for those involved in that program.
- Jason Constantouros
Person
Jason Constantouros. LAO, we'd be happy to circle back with your office on your...
- Steven Choi
Legislator
Yeah, it's amazing. We face one time a couple years ago when I was Assembly, over $100 billion of surplus and we keep on spending, spending free and anybody just needed. We keep on supporting and then we go into deficit like this and still continue to support everybody.
- Steven Choi
Legislator
I mean, I understand as myself, you know, Member of immigrant family, and I understand that their hardships, but we have to all work, you know, to make our ends meet. But the government tries to provide everything, including their car. So when I didn't have a car, government didn't give me a car. You know, so whether that's.
- Steven Choi
Legislator
It's a policy matter, how we're going to sustain our budget, trying to take care of all meaning documented undocumented. So simply creating new programs like clean cuts for oil. So that doesn't make any sense. That's the reason I'm raising this question.
- Rachel Ehlers
Person
Senator, just a point of clarification. The Clean Cars for All program is not an entitlement program. We'll have to get back to whether undocumented individuals are eligible to apply. But it is a fixed amount of funding and once that funding is gone, it's gone. It's not. The title is somewhat misleading.
- Rachel Ehlers
Person
I think from that perspective, it's not an entitlement program where anybody who is eligible will automatically get to participate. In fact, that's part of the. I think the rationale behind the early action proposal before you is to provide some additional funding because it has been so oversubscribed. So that is a very clear distinction between the Medi Cal program.
- Scott Wiener
Legislator
Is that it, Senator Choi? Okay, so next, before we go to Senator Grove, I think Senator Jones wanted to have one quick response.
- Brian Jones
Legislator
Mr. Chair, for the benefit of the entire Committee on the Clean Cars for All program, obviously that's piqued a lot of interest. I've already directed my staff to look more into that. I totally trust the DOF and LAO folks to get back to us on that, and I'm happy whatever we learn from that program, I'm happy to disperse to everybody if you'd like.
- Scott Wiener
Legislator
Okay, thank you. I'm going to go to Senator Wahab next because she hasn't spoken yet. And then we'll go to Senator Grove.
- Aisha Wahab
Legislator
Thank you. I just wanted to understand this. I know we're talking about the Clean California's Clean Car for All program. I just wanted to understand. Last year, did we not defer about $600 million for this program just to address our deficits?
- Rachel Ehlers
Person
There was funding for a suite of zero emission vehicle programs that, yes, the funding was pushed to later years and switched to the Greenhouse gas reduction Fund. Not specifically just for this program. It was a range of different zero emission vehicle programs.
- Rachel Ehlers
Person
Do you have that? I don't have that in front of me. We can get back to you.
- Aisha Wahab
Legislator
Okay. So I just want to highlight this. Just hearing all of this and kind of reviewing some of the bullet points that we're trying to talk about. I'd like to kind of just address some of the concerns. We have over a $300 billion budget in the State of California.
- Aisha Wahab
Legislator
We like to tout that we are the fifth largest economy in the world. And we are, you know, have a lot of innovative and, you know, programming and things like that that I fully, fully support.
- Aisha Wahab
Legislator
But I want to be very clear when we're talking about the deficit and we don't know what the hit is going to be if there is a massive hole from the federal influx of cash as well as the delayed property tax, as well as, you know, whatever else can be. Right.
- Aisha Wahab
Legislator
And so my concern, and I want us to focus on people first. That is the number one goal. And what do people need is health, housing, education, public safety, and just the basics, food and shelter and so forth. Right. We keep talking about the undocumented work individuals.
- Aisha Wahab
Legislator
And I want to highlight that I think it's incredibly unfair to keep harping on them considering the fact that California also, including in every single industry, not just the service industry, have employed undocumented individuals to uplift their industry.
- Aisha Wahab
Legislator
And the fact that we are talking about whether or not health care should be provided to them, extended to them, which group should be given health care, which age factor should be included, I think that is a complete disservice to Californians across the board, including our undocumented individuals, that make us the fifth largest economy. Right.
- Aisha Wahab
Legislator
And there have been multiple different presentations from the Administration. I want to highlight this. I appreciate the governor's comments when he stated that he is not looking to roll back any of the services for our undocumented populations.
- Aisha Wahab
Legislator
But I also want to highlight that there is some frustration in how the Administration also speaks about our undocumented population, including the fact that when there is programming that they use the term satisfactory or unsatisfactory for citizenship status. Right.
- Aisha Wahab
Legislator
We also, you know, I do just want to highlight the main goals for the State of California in this year is affordability. Right. We see that LA has been hit with one of the most devastating fires in the nation.
- Aisha Wahab
Legislator
They have a lot of need that we need to prioritize in this particular budget as well as our previous actions. We have ensured that we are funding and taking care of our most vulnerable residents right now, which is The LA County folks, regardless of, you know, what city they live in. And I want to prioritize that.
- Aisha Wahab
Legislator
But I also want to say that, you know, I agree with some of the commentary here as well. You know, if we have these rebate programs, that's nice, but it should not be continued if we are having holes in health, education, social services, public safety, that is across the board, including housing. So that is my stance.
- Aisha Wahab
Legislator
I want us to get back to the basics. I want us to not necessarily keep prioritizing and propping up industry just because, hey, we did this or we did, you know, we started this program and we're in love with the program. No, no, no, no, no.
- Aisha Wahab
Legislator
Our main goal as a government is to ensure access and equal access to justice, public safety services that literally protect families, whether you're documented or undocumented. That's not the point. The point is to take care of our elders, take care of our children, and take care of the working people that Prop up this state.
- Aisha Wahab
Legislator
So I say that in, in support of what we have in front of us. I would like to make sure that again, we are not falling in love with a innovative idea just because it's something that we funded historically.
- Aisha Wahab
Legislator
If it's not, if it's taking money away from what I just stated, I just want to understand if that's. Do you guys have any feedbacks on that?
- Andrew March
Person
Yes. So just to point about the Clean Cars for All program. So it's not General Fund. The funding that's being discussed right now, the $17 million is from the Enhanced Fleet Modernization sub account which is funded by a $1 fee on vehicle registration fees. But that's my point.
- Aisha Wahab
Legislator
The fees, people are tired of a lot of these fees. I'm personally tired of a lot of these fees. Right. And again, half of these EV vehicles, first off, just to even, you know, I drive a hybrid, I'm just going to be very transparent about that. Right.
- Aisha Wahab
Legislator
If we are not taking care of the basic needs, these programs should not be the priority over regular back to basics issues for regular people. That is what Californians are stating across the state. Whether you're Republican or Democrat. How much of my dollar is going to remain in my pocket?
- Aisha Wahab
Legislator
The tariffs alone and what is happening at the international level and the federal level is concerning my district in particular, that deals with manufacturing. Right. We don't know what the impacts are one month from now, five months from now, six months from now, or throughout the year. So every single thing needs to be reevaluated.
- Aisha Wahab
Legislator
And again, just because it's a fee that we put on for the past several years and subsidized this great program. And I'm all for that, but right now is we're going to have to look inwards and say, what are we doing for regular people that are truly struggling? There are massive layoffs.
- Aisha Wahab
Legislator
Counties have talked to us in the Bay Area saying that they're going to lay off thousands of people. County governments. Right. We've had these conversations. These are people that, again, provide services to their residents. And we're talking about, you know, again, ensuring that this fee still remains on people. For what purpose? Right.
- Aisha Wahab
Legislator
So I just want us to get back to where we need to focus. And I truly feel like there is a disconnect in Sacramento versus like the rest of California. And the disconnect on the issue is largely on affordability. We cannot afford to stay in California if there's constant, I must say, gouging across the board.
- Aisha Wahab
Legislator
So I just want to highlight that I really, really want us to prioritize regular working people, the issues that matter to them, which is all surrounding affordability, whether it's housing, whether it's public safety, whether it's, you know, a cleaner and greener environment.
- Aisha Wahab
Legislator
We need to prioritize the affordability in all of those conversations, including health care and much more. So thank you. Those are my comments. If the Bill hasn't been pushed, moved, I'm happy to move it.
- Scott Wiener
Legislator
Okay. We have a motion by Senator Wahab, so we'll go to Senator Grove, then Senator Weber.
- Shannon Grove
Legislator
I just wanted to assure the budget chair that I did reach out to some colleagues and friends in D.C. the response from them, including the White House, is the Democrats are trying to create panic. The Trump Administration will not cut Social Security, Medi Cal or Medicaid benefits. President Trump himself has said that over and over again.
- Shannon Grove
Legislator
And nothing in the budget before the House has any language in it regarding Social Security, Medi Cal or Medicaid to cut.
- Scott Wiener
Legislator
That's called propaganda. With all respect, that's propaganda from a President who, who is a pathological liar.
- Shannon Grove
Legislator
Well, they did ask you to. They said, can you ask him where he sees it in the budget? Because it's not for us.
- Caroline Menjivar
Legislator
Where else are we going to take the cuts from? Yeah, that's just the $1.0 trillion savings for billionaires. Right.
- Scott Wiener
Legislator
We're like in George Orwell's 1984 Opposite Day. Anyway, but thank you.
- Scott Wiener
Legislator
No, no, I appreciate, I appreciate you checking. And they've been saying that publicly and it's a complete bald Face lie by the President and by Republican leadership in Congress. Just a bald faced lie. But I do appreciate you checking, Senator Grove. Thank you. Thank you, sir. Okay. Senator Weber.
- Akilah Weber Pierson
Legislator
Thank you Chair. Really appreciate you all coming and giving us this presentation and answering all of our questions. I will be supporting the Bill in front of us today and once it reaches the floor tomorrow. Wanted to piggyback off of what Senator Wahab was talking about in terms of affordability.
- Akilah Weber Pierson
Legislator
Unfortunately, California has become a state that is unaffordable for the majority of our residents. And even though we are the fourth fifth richest entity in the world, our residents don't feel it.
- Akilah Weber Pierson
Legislator
And so when we say it, it doesn't really mean much when people are having a very difficult time just getting by day to day and living from paycheck to paycheck. A part of the issue of affordability that we are going to have to deal with is our Medi Cal System.
- Akilah Weber Pierson
Legislator
As a physician, I do understand and always talk about the importance of preventative care, dealing with things before they become an issue. However, our current system is not sustainable as is.
- Akilah Weber Pierson
Legislator
I'm looking forward to all of us having conversations as to how we can reimagine a system that is affordable but still provides the ability for people, regardless of their immigration status, to get some form of health care. Many things have been thrown around, you know, generic versus non generic medications.
- Akilah Weber Pierson
Legislator
Does it include everything or just really the core things that people need? All of those things are and should be on the table. Because if we continue down this road, then very few of us, including myself, will be able to afford to live in this great state.
- Akilah Weber Pierson
Legislator
And so just wanted to bring that out there, especially since I was called out by my colleague. But look forward to these conversations so that we can present a budget that the people of California would be proud of.
- Akilah Weber Pierson
Legislator
And we can present a budget that will allow our future generations, like my children, to not live in deficit or worry about whether or not they will be able to pay for and afford to live in this great state. Thank you.
- Scott Wiener
Legislator
Thank you very much, Senator. Okay, any additional questions or comments? Seeing none, we will move to public comment so Members of the public could come forward. And if you could please keep your comment to no more than a minute, we would appreciate that.
- Linda Nguy
Person
Good morning. Linda Nguy with Western Center on Law and Poverty in support of AB100. As the chair noted, the increase in Medi Cal caseload showcases the program's success. So called expansions, these are actually elimination of exclusions.
- Linda Nguy
Person
Prior to 2024, low income Californians were treated differently due to their immigration status, seniors and people with disabilities were subject to a lower income eligibility threshold as well as an asset test. They were the only ones.
- Linda Nguy
Person
And so these are critical programs and without Medi Cal people would be forced low income Californ would be forced to decide whether to seek care, incur medical debt, pay rent and so do support AB100 thank you.
- Jean Hurst
Person
Thank you Mr. Chair. Members Jean Hurst here today on behalf of the Altadena Library District. The district is an independent library district serving the community of Altadena in Los Angeles County. The library receives the vast majority of its revenues from property tax as well as a local parcel tax.
- Jean Hurst
Person
Half the parcels in the district were destroyed by the Eaton fire and the library is the only public facility that is left standing in the community.
- Jean Hurst
Person
The property tax deferrals and losses have created significant uncertainty for the district and we view the provisions around backfill as a needed first step to ensure library operations can continue through this year and and next and want to extend our appreciation to the Administration and to the Legislature for including that in this early action package. Urge your aye vote
- Christine Smith
Person
Christine Smith from Health Access California just noting that rising healthcare costs are a challenge across the country. This is not a unique issue to California, which is why we are working to support the Office of Healthcare Affordability's cost containment goals.
- Christine Smith
Person
We do support maintaining the funding and Medi Cal programs and urge the Legislature to continue their commitments including to the health for all expansions. Our health system is stronger when everyone is included.
- Christine Smith
Person
As was noted, we oppose any threats to cut any eligibility or services to Medi Cal and we must ensure that families and communities who have come to rely on our safety net can continue to do so. Thank you.
- Scott Wiener
Legislator
Thank you. Before we get to the next Speaker, I do want to just say for any Members or staff who might be listening, now is a good time for Members of the Budget Committee. Please come down because we're going to be voting very shortly. Thank you. You can proceed.
- Omar Altamimi
Person
Good morning, Chair and Members Omar Altamimi with the California Pan Ethnic Health Network. We appreciate that the Legislature is acting swiftly to ensure Medi Cal is fully funded in the interim to meet all of its obligations.
- Omar Altamimi
Person
California is closer than ever to universality in healthcare coverage and its investments in Medi Cal that have helped make that a reality for families across California. In respect to some of the earlier comments, we believe that immigrants should not be used as a scapegoat for Medi Cal's fiscal problem.
- Omar Altamimi
Person
There are a number of reasons that Medi Cal costs have increased, including hospitals, pharmaceutical cost increases, the enrollment increases significantly in the pandemic and with federal flexibilities, the Prop 35 locked up funds that could have been diverted to shore up medi Cal cuts and then prescription drug costs that are too high. Thank you.
- Kimberly Lewis
Person
Kim Lewis, representing Aspirinet. We're a foster family agency and appreciate the inclusion of funding for the FISH Fund, which is also important for our resource family homes. And appreciate Senator Mengivera's comments around the crisis facing our foster family agencies and hope the revised will include some funding to help get us to the tiered rate structure. Thank you.
- Scott Wiener
Legislator
Thank you very much. Is there any additional public comment? Okay, seeing none. We'll bring it back to the Committee if there's no additional comments or questions. Senator Jones, just real quick.
- Brian Jones
Legislator
Mr. Chair, I just wanted to thank DOF staff and LAO staff very much for your presentations today. There's lots of criticism of the budget, and I just want the professionals that bring us this information to recognize from us that the criticisms of the expenditures and the programs, not the people making the presentations.
- Brian Jones
Legislator
We appreciate the hard work that you do, and thank you for doing that and keep up the good work. Thank you.
- Scott Wiener
Legislator
Okay, with that, we have a motion by Senator Wahab on AB100. And with that, seeing no further questions or comments, we will call the roll.
- Scott Wiener
Legislator
Okay, we will put that on call for absent Members. We're waiting for Senators Grove, McNerney, Ochobog and Perez, I believe. Okay, so thank you, everyone, and we. The Bill is on call and we'll ask CAPSA Members to come down as soon as they can.
- Scott Wiener
Legislator
Okay, we're gonna. We're going to open the roll. Please call absent Members.
- Scott Wiener
Legislator
Okay, we're going to take a brief recess as we wait for Members to come.
- Scott Wiener
Legislator
And can we please open the roll and call? Absent Members on AB100.
- Scott Wiener
Legislator
How are you? We're going to go back into a brief recess and open the roll and call. Absent Members, please.
- Scott Wiener
Legislator
Okay, we'll put it back on call. So we're going to go back on recess.
- Scott Wiener
Legislator
Okay, we are going to put it back on call and go back into recess. Okay. Okay, we're going to come back from recess and we're fine. No, it's all good. We're going to open the roll and call the absent Member.
- Scott Wiener
Legislator
Okay, what's the vote tally? Okay, we have 14 ayes, four no's, the measure. The motion passes. And with that, that concludes our business today. We are adjourned.
Committee Action:Passed
Next bill discussion: April 10, 2025
Previous bill discussion: March 20, 2025
Speakers
Advocate
State Agency Representative