Assembly Budget Subcommittee No. 1 on Health

Mic on Correct? Is that right? All right. Okay, let's please call the roll.

[Roll Call]

I want to commend Assemblymember Solache for always hanging in here with me and welcome all of you. We will continue as a Subcommitee. Welcome to Subcommitee 1 on Health. Today's hearing is meant to deeply examine the alarming actions taken by the Federal Government that have targeted our public health and family planning systems.

In the span of just a few weeks, the Federal Administration has moved to cut more than $11.4 billion in critical public health funding and free $65.8 million in Title 10 family planning grants across the country. In California, this amounts to nearly $1.0 billion of programmatic impact to our health system.

This is definitely not an abstract policy dispute. As all of you know. These are real cuts with real consequences for real people. These actions are jeopardizing California's ability to conduct disease surveillance, infection control, vaccination efforts, and provide access to contraception and preventative reproductive care for hundreds of thousands of low income Californians.

The Subcommitee scheduled today's hearing back in February because we have long understood that the federal Administration was focused on creating deep and lasting damage to America's health and public health systems. We didn't know what they would target, how quickly or how recklessly.

But now we've seen a preview of how this is playing out with frontline public health workers and family planning providers who have received abrupt notice terminating federal grants with no transition period, no opportunity to plan, and no meaningful explanation.

On the public health side of things, these are state and local health departments who are being asked to plug a million, or excuse me, $1.0 billion gap in their budget and operations overnight.

And on the family planning side under Title 10, this is a shock to the system that has potential for grave outcomes, particularly for small clinics like many of mine on the Central Coast.

The Title 10 program in California is the largest in the country, serving more than half a million people annually and across 344 health centers, many of whom are low income individuals and families who rely on Title 10 as their first entry point of ongoing care.

And so I want to remind everyone that Congress has appropriated the Title 10 funds for birth counseling, infertility services, pregnancy testing and pregnancy prevention. And contrary to many of the false claims, Title 10 funds are not appropriated for abortion.

But as of April 1, providers under Title 10 are no longer receiving federal funds to support their services like contraception, STI testing, pregnancy care and birth counseling. Even more concerning is that the Federal Administration has shrouded their actions behind misdirection and misinformation.

In recent interviews, the Secretary of Health and Human Services claimed that he was unaware of the public health funding cuts and then proceeded to say that the cuts, if they did happen, that they were about dei.

The Federal Government has also falsely suggested that the freeze on public health and Title 10 funds are about enforcing civil rights compliance with the diversity, equity and inclusion policies.

And while it's not credible, I would say we had conversations just today around it also not being a mistake that this Administration has become more strategic and more focused in their efforts to cut dollars to health care under the guise of DEI so that agencies have particular difficulty getting those funding streams back.

The truth is for the public health funds, that Congress appropriated those funds not only to respond to Covid, but to build and sustain our public health infrastructure so it would be resilient in the face of future public health threats. Title 10 funds, again established and appropriated by Congress, enable states to deliver family planning services.

Today is really about trying to set the record straight, trying to get real information out into the world about what the effects of these cuts are are. Number one, that these cuts actually did happen. Number two, what the cuts are the effect on regular Americans who live here in California.

Number three, with the hope that the Secretary is listening, that the Secretary of Human Health and CMS are listening and understand the real impacts of what they're doing in the United States to American citizens and residents who live in California.

I do want to say a special thank you to Attorney General Bonta for his swift legal action and to his staff who we had a call with his staff today to really better understand the status of things and want to say thank you to the staff who is working swiftly to try to make sure that money that is owed to California stays in California and that public health continues. I want to say that litigation is just the stopgap.

We are thinking as a budget team about how to address and how to navigate the devastating decisions that are coming out of the Federal Government and how we will be able to move forward nonetheless to make sure that we are making decisions that have the best in mind for those Americans who reside in California.

I want to thank all of you today. I want to thank the panelists who are joining us. I think we have a couple changes for our agenda. Thank you for bearing with me for being late. I had a Bill that took much longer than I thought, but I appreciate all of you.

The hearing is going to cover two issues. Obviously, the federal funding cuts to public health and then the cuts to the Title IX program. I think we are going to issue two first so that we can accommodate folks who tried to make their flights at the right time and we threw them off.

Let's go to the Title 10 federal funding cuts first. You have background for this issue on page nine of your agenda and we'll welcome the panelists up as you come up. I'll just say that Title 10 family planning program is administered through the United States Health and Human Services Agency.

The grantee administering the funds in California is Essential Health access. And on March 31, 16 grantees across 22 states, including in California, one on the Central coast where I represent, received notice that Title 10 grants had been temporarily frozen.

So to provide information is Dr. Nomsa Khalfani, Co CEO of Essential Access Health Jodi Hicks, CEO and President of Planned Parenthood Affiliates of California Kayla Wilburn, clinical Director of Community Action Partnership of San Luis Obispo County, where I was just this morning, and Will Owens from the Legislative Analyst Office.

And we'll ask you to keep your testimony to five minutes and then we will move on to Member questions. And please go ahead and begin when you're ready.

Good afternoon chair and Members. My name is Dr. Nomsa Kalfani. I'm co CEO at Essential Access Health. Thank you for taking up this important issue of Title 10 funding cuts in today's hearing.

Essential Access Health has served as California's Title 10 grantee for 55 years, since the program was established in 1970 with bipartisan congressional support as the nation's family planning safety net.

Title 10 primarily serves people with low income, providing a pathway to essential and time sensitive health care like contraception, STI testing and treatment, cancer screenings for millions of patients across the country, including more than half a million Californians, served at nearly 350 health centers across the state.

On March 31, the day before the next grant cycle was to begin, we were notified by the U.S. Department of Health and Human Services that the disbursement for California's Title 10 grant, currently 13.2 million, is being temporarily withheld.

Essential Access was given 10 days to respond to an inquiry regarding compliance with federal policy and practices related to civil rights and Executive orders focused on DEI activities, and we submitted our response on April 10th.

Essential Access is one of 16 Title 10 grantees nationwide that received this notice from HHS and as a consequence, seven states, including California, are currently without any Title 10 funded services and another 15 states have reduced access.

We have not received a timeline or process for next steps or insight into HHS's decision making regarding the release of funds.

The grantees who were awarded funding on April 1 received received only six months awards and last week a leaked early draft of a fiscal year 2026 HHS budget began circulating which proposes the elimination of numerous programs and sub agencies including Title 10, the Title 10 Pregnancy Prevention Program and the Office of Population Affairs.

It is clear that additional attacks on Title 10 are forthcoming. California's Title 10 network is the largest and most diverse network in the county in the country. It includes city and county health departments, fairly qualified health centers, urban Indian health centers, University and hospital clinics, Planned parenthood affiliates, standalone women health and family planning providers.

Title 10 plays a critical role in their ability to provide high quality, equitable and patient centered family planning services.

In a poll we conducted among Title 10 Members 85% of respondents reported relying on Title 10 for Clinicians and staff including OBGYNs, nurse practitioners, nurse midwives and for many health center staff that cannot Bill insurance for their time.

Representing the bulk of staff impacted like RNs, nurse aides, community health workers and more, 88% of respondents reported depending on Title 10 for education and outreach to link patients to care, 82% to provide health education, 74% to serve patients without family planning coverage and 56% to provide youth programs.

While Medi Cal and Family Pact reimburse for clinical care provided by some Members of health care teams for income eligible patients, Title 10 funds in California are leveraged for non reimbursable health services provided care for vulnerable populations who are unable to use their insurance due to confidentiality concerns or other reasons.

Mobile care school based clinics, bilingual staff, provider training and wraparound services that link patients to care. For example, Title XI funds support 41 school based health sites across California. The current arbitrary immediate pause on funds is a direct threat to California's healthcare infrastructure and family planning safety net.

An extended delay or complete loss of these critical funds would have devastating effects on the health well being and economic stability of communities across California. Reducing critical care for people who already face significant barriers to time sensitive health services without Title 10 funding.

48% of California's Title 10 funded agencies report that they will certainly or likely immediate layoffs. 62% report that there will be immediate reductions in sexual and reproductive health services.

Health centers report that if Title 10 funding is cut or eliminated it will result in reduction of healthcare workforce, fewer available appointments and longer wait times for patients cuts to outreach and education program, reduced access to time sensitive and full range contraception, elimination of teen only clinic hours and more.

Title 10 provides free or low cost access to essential health care, including contraception and STI and HIV prevention, testing and treatment, patient centered pregnancy options, counseling, cancer screenings and more. No matter your income, insurance or status or zip code.

In 2024, approximately 85% of Californians serve through Title 10 at a household income less than 100% of the federal poverty level, meaning less than 48,000 a year for a family of four. In the current landscape, we're seeing an increased demand for these confidential services. For many, Title 10 this is their only option for access to essential care.

Thank you again for hearing this important issue today and I'm happy to answer any questions you may have.

We'll take testimony from all the panelists first and then move to Member Question.

Good afternoon and thank you for this opportunity to share a little about what Title 10 means for my healthcare centers and our community on the Central Coast. I'm Kayla Wilburn, I'm the Clinic Director for the Center for Health and Prevention Clinics at Community Action Partnership in San Luis Obispo.

For over 53 years the Center for Health and Prevention or the center has provided quality, respectful, confidential family planning and reproductive healthcare for low income, uninsured and underinsured, marginalized and underserved Members of San Luis Obispo County.

We operate brick and mortar facilities, satellite sites and last year we launched a mobile clinic which delivers services directly to low income individuals at nine locations throughout San Luis Obispo county including one community school and the Grizzly Youth Academy and community of people experiencing homelessness on the border of Santa Barbara and San Luis Obispo Counties where we identified a large outbreak of serious STI in over 40 individuals.

We tested treated on site and also identified Hepatitis C, HIV and pregnancy among the unhoused living in that area because we had the means to do it and title 10 helped make that happen with a mighty team of 20 utilizing fee for service Medi Cal programs only so managed Medi Cal Family PACT, Cancer Detection Program, Every Woman Counts, the Breast and Cervical Cancer Treatment Program and Support from Title 10.

The center serves just under 6,000 low income individuals every year. We are known for asking questions and listening to the needs of the community and initiating prevention and support programs to respond to those needs.

We're known for initiatives such as Naloxone distribution to assist with overdose prevention, an in house food pantry and fresh food distribution on our mobile clinic in some of the most rural areas of San Luis Obispo County.

We have recently joined the ranks of benefits Cal Enrollment folks to be able to assist people to enroll in multiple benefits wherever our mobile clinic is going and we now co locate free mental health therapy on site at two of our brick and mortar clinics. Free to anyone who would like to access those services.

Last year we also initiated PREP and PEP services and our numbers continue to increase and that population is one of the most vulnerable of the folks that we serve who will be affected by the cuts to title 10 because they're accessing services that may not be covered by any of the programs that we have access to.

Title 10 fills critical operational funding gaps such as non reimbursement salaries, training, equipment and medical supplies and supports best practices and the methods we use to meet the needs of our community.

We began using Reserve funds on April 1st which is not adequate to maintain current staffing and service levels long term, especially since we've expanded services to meet the need as Title 10 expects us to do.

In the last year we've expanded service sites, locations and have loved being able to serve remotely as far as Shandon and to the border of Santa Barbara county.

Without the title 10 funds, long standing operations and recent program enhancements are in serious jeopardy and I'd like to end with a comment by a patient who responded to a confidential survey. I called at 10.30am and by 1pm I had been tested and received treatment for a painful uti.

The nurse gave me valuable information about my condition so that I can make better decisions about my own health care. I really appreciate everyone who works here. I don't like feeling like I'm just chattel being rushed through on the Assembly line, but I always feel valued as me here. You can expect a very personalized experience here. Thank you.

Thank you. Good afternoon Madam Chair and Members. My name is Jodi Hicks. I am the President and CEO of Planned Parenthood Affiliates California.

My organization represents the seven affiliates throughout the state operating 115 community health centers throughout California and collectively serve patients from all 58 counties, provide 1.2 million visits every year and almost 90% of our patient population is on Medi Cal or another public health benefit program or receives charity care.

We have been a trusted source of essential health care for generations of California and 1 in 4 Californians have received care at a Planned Parenthood health center in their lifetime and we are proud to be a part of the Title 10 network.

We rely on Title 10 funding to support family planning, also do community outreach and our education programs and that's especially true for our smaller affiliates that rely on this funding for the work that they do. At a very community based type of care. We have been here before in the previous Administration.

It was done a little bit differently that time. At that time they were attacking abortion providers. This time they're using DEI as their reason. But I think just to zoom out a little, and I just want to echo everything that has been said here already about the importance of the Title 10 program.

I do want to sort of zoom out and I know my colleague Nomsa mentioned the teen pregnancy prevention program. There's also another grant program called PREP that was in that leaked memo. I'm sure you'll talk about a lot of grants that are at risk based on that memo, but it's really indicative of what the intent is. And it's been three months. So in three months, this is what we know so far.

But I think it's important for this Committee, as you're planning sort of the investments that you need to make to fully understand that what this Administration, what this federal Administration really wants is for my organization, for Planned Parenthood to go away, to not exist anymore. That is also true. I will just say, for essential.

An organization like Essential Access Health, for organizations that are committed to providing sexual and reproductive health care, they are attacking those programs at their very core.

In this time period, we've had Executive orders that are threatening providers of gender affirming care, not just the service, but whether or not you can be in a program, a condition of participation in the Medicaid program altogether. They have called for investigations into medication abortion.

They have called for investigations into any funding to abortion through the Hyde Amendment. So it's very clear that they're trying to dismantle our public health care system, but especially for sexual and reproductive health care providers. I am extremely grateful. I think we all are.

That we are in the State of California, that we have the leadership of this Legislature, that we know that we have. You all have our backs and we're grateful for that.

And you know, when Roe was overturned and we knew what we were facing with half the country instituting abortion bans, we know what this Legislature did, which immediately invested in uncompensated care grants to make sure that we were filling those gaps.

And what I can commit for the Planned Parenthood affiliates and health centers is that we are committed to continue to serve patients. We're really built for times that are hard. We're not here just for times of abundance. And we do have a saying at Planned Parenthood. We are committed to continuing care for patients.

And we say care no matter what, and we're here for good. What that means is we care for California's most vulnerable patients. We're here for them during their most intimate decision making that they make, and we stay with them. And our affiliates and health centers have stayed open through this time.

And that's a commitment that, that we have to you. But we also know that we need partnership and continued partnership during this time. So title 10 is the first cut that, that we've felt and seen right now, but it certainly is not the last.

And you know, the uncompensated care grant, we're going to need that to be replenished. We're going to need investments from the State of California to ensure that our budget is reflective of our values and that we'll continue to embrace diversity and we'll fight for health equity.

And thank you for shining light on and trying to expose some of the misinformation and the different ways that they're going about the attacks.

But I think it's important for us to be eyes wide open as we go into what we need and preparing for this year and really appreciate the time and always appreciate, appreciate the partnership and commitment from this Legislature. So thank you.

Anything for Mr. Owens from the LAO's office.

So Will Owens, the Legislative Analyst Office. We are here to available to answer any questions the Committee may have. Thank you.

I just have a couple questions and then I'll turn it to my colleagues. I mean you talked a little bit about the difference between these attacks on Title 10 and past attacks. I wonder if you could flesh that out anymore of what you experienced last time under this Administration.

I felt like even maybe I'm dating myself, but I feel like even going back to the Bush Administration that there were attacks on Title 10. And so that each time there's a change at the presidential level, then we see a change in how we approach, approach family planning dollars and have to pivot.

And so I just wondering if any or all of you might flesh out a little bit how those attacks are different and how your responses are going to be need to be different at this time.

I would say the immediate difference is funding is being held. So I would say that's the immediate, most critical difference is that funding is being withheld. In the first experience we had program changes, right? So the program rules were changed which devastated the entire program system, right. So for California, our numbers decreased from over a million.

We went down to 200,000. So that was the change. So we had to adjust how we administer the program so money didn't necessarily decrease, but the program rules change, which then by principle, by making it difficult for folks to comply or even want to be in the program. That was the impact the first time.

Now it's about the money. So without releasing the funds, folks like Kayla and others right now don't have any money to actually continue to do their program. As the administrator, we are not. We don't have the money to release. We don't have the money actually to operate for ourselves as the grantee.

So that's the immediate hit right now. So they haven't changed the program rules, but what they have done was hold funds and not hold funds because we did something wrong as it relates to the program. So they haven't said we didn't comply to Title 10 program rules. We haven't heard that. We have. That hasn't been the issue.

What they did say is call out a document that was created in 2020, an equity document that really talked about that Black Lives Matter basically, and that we were going to center vulnerable communities. That was a document that got called out that's not about Title 10.

Because Title 10 right now, the current design focuses on equity quality and access. So if you're going to go, if you're going to talk about us doing something different than what the program says we're doing, we actually are in compliance.

I mean, I think last time they were able to target abortion providers, which is bad. This time I would. It's worse because they're targeting the entirety of the network and withholding the funding. So, I mean, you know, they're getting a little bit. I don't know, I don't want to say better, but they're. They understand how they can do harm. They're being more harmful this time around.

My other question, I'll turn it over to my colleague, is where will folks go? We know that when people can't access care, eventually they still need health care and they will go somewhere. So what happens if you don't have funding? What happens to people? How do they get care?

Care will still happen. It will just take longer. People will have to wait longer for care. And because if they have to wait longer, they may delay or they may not go. So that's what ends up happening. If you have to wait longer for care, we end up having what you look at unintended pregnancies will go up.

We will look at STI prevention, rates will get higher. So those we think of public health rates, those are the things, those are the negative unintended consequences when our public health, our safety net breaks.

I mean, I think you can look, honestly, you can look at other states and you can look at other states where they have successfully defunded Planned Parenthood, and the outcomes are really, really, really, really bad. Like in different areas that we wouldn't think of as this country, rich in resources would be.

So the outcomes of maternal mortality, the outcomes of horrible outcomes on birth rates, all of the poverty that's attached to that, all of the outcomes in places, a state like Texas, where they successfully defunded Planned Parenthood many, many years ago, you can see those outcomes, and they're horrific.

And the footprint, it's why I started with, for Planned Parenthood, the footprint we have in serving those patients. There is not a network of other clinics that can just absorb all of that, all of that work. And that's true for any, if any, one health center was to shut down. There's not.

There's not an exorbitant amount of other health centers that can absorb those patients. So the delayed care, especially for sexual and reproductive health care, for family planning, for STIs, those are. Those are horrible outcomes that are longstanding. You're talking about, you know, we'll be looking at.

At differences and things like they'll be able to mark how many people went to college 2 and 3 years later and see those Differences, I mean, it's horrendous. Again, I will say reiterate how grateful we are to be in the State of California and understand that we can attempt to make those investments with commitments.

But you can only look to, to other states, Alabama, where it's the most dangerous place to be pregnant in the country. And that's because of. They have chosen to devalue sexual and reproductive health and family planning.

I would say on the Central coast, specifically, all of the work that has been done through managed Medicaid programs to reduce utilization of emergency departments, improving access to care, will be dialed back.

People who are getting care at Planned Parenthood or at the center are going to end up in the emergency Department because the CHCs will not be able to absorb those patients. And wait times will be so, so far out. We may not survive the center may not survive this. I hope planned parent.

You know, none of us are guaranteed to survive this. None of the providers but the community health centers can't possibly absorb these patients. They're not serving them now because they don't have the capacity. And so the overall health of our community communities are statewide, are going to suffer.

Anything. Yeah. Assembly Member Schiavo

Thank you. You know, I just want to say, first of all, thank you for all that you do. And. And it's really scary times. It's really scary times. Can you talk a little bit about what, you know, I heard you say that there will be delays in care and kind of, you know, basically people are going to take themselves out of getting care because they can't get it in the time that they need it. Right. And, you know, which is funny, but funny. Not funny.

Not funny ha ha. But funny that a lot of times Republicans will talk about delays in care in other countries that guarantee health care.

And here they're instituting things that will do exactly that, that will delay care, that will deny care, that will put people in those same situations that they point at other countries as being problematic for being. But nobody dies in those other countries for lack of access to health care. No one goes bankrupt in those other countries either.

But can you. I assume you're saying that because there will be layoffs, there will be less staff that you can afford to pay to do the work to provide care.

And so if this funding is not restored, can you talk about what those implications are in terms of our reproductive health infrastructure and what that looks like if we're not able to get this funding restored?

So you might have missed some of this before you've Come in. We talked about. I'd shared 48% of Title 10 agencies will certainly or likely have immediate layoffs without having this funding. Because a lot going back to being in California, most of the Title 10 subrecipients use their Title 10 dollars for infrastructure.

That's what they actually use a lot of their money for. Right. But they use it for infrastructure to pay for staff, for training, for outreach. That's what they use a lot of their money for. And so without that, they will be letting staff go. And so if you let staff go, you're going to cut down on hours.

If you have what we sometimes refer to as specialty clinics, so special hours for adolescents, or you're in communities where folks, it's hard time to take off of work to go to your appointments. So you have extended hours or hours on weekends that are longer. Well, those hours will either be cut or, or eliminated.

So those extended hours will go away or you have less opportunities during, during the week. So then you're going to have less staff. So then if you have. Now you have less walk in hours. So then you have less appointment slots. So as well as less appointments for sexual and reproductive health care. Right.

Chronic disease appointments will probably take up more of those slots than sexual and reproductive health appointments. So then you have less access, less opportunities. And so folks are either not going to go or it's just going to be harder for them to make those appointments and can.

So I mean, so basically these cuts are going to mean rationed care. Yes. They're going to mean people who are struggling the most are not going to be able to get to appointments because they have to work.

It means that people who need timely care are not able to get it and are put in jeopardy because of that. Yes. Can you talk a little bit about. Because I think obviously this all clearly is coming from an attempt to attack organizations that provide abortion care.

But can you talk a little bit more about all the other care that you provide? Because this is also care for people who are trying to have children, who are doing family planning, who are trying to have healthy bodies to be able to safely carry a child full term. And that's gonna be interrupted as well. Can you talk about that a little bit?

So I wanna just make one quick correction. Title 10 is not about abortion. So I wanna make that clear. But I just, I just want to make sure we separate the two. Okay? So, yes, just to make that it.

Doesn't provide abortion care. However, who it hurts does provide abortion care.

That's One provider. That's only one set of providers. But there's a host of other providers. Right. So it is city and county health departments, it is FQHCs, it is standalone health, you know, family planning providers. So it hurts a network of providers, a wide range of providers. So even even though they may this go around.

Right. Or the focus may have been on abortion providers, the net now is everybody. So nobody is safe. When you look at the types of Providers.

What percentage would you say are? I don't know if you have a sense of this, but who provide abortion care or don't in Title 10 that.

Are in Title 10?

Grantees.

Grantees, yeah. Well, technically none of your providers should. Technically. Okay.

But it's right. Receive that funding. I mean, I think that you want. Okay, we'll let someone else. And to be clear. Yeah. Abortion provider that wasn't clear before and use Title 10 funding for education and community outreach and other important work that we do.

But I think, I mean simply put, I think for anyone that provides, whether it's abortion care, whether it's family planning services, any kind of sexual and reproductive health care, and I think this go around, they really are targeting anyone that is treating those vulnerable patients.

So whether that's folks that need sexual and reproductive health care, including abortion, folks that need gender affirming care, folks that you know, center DEI and health equity and treat undocumented individuals, I think they're targeting anyone that is bold enough to serve those population of patients that simply put, you're talking about the most vulnerable population of patients at their most vulnerable times.

That's what these cuts do and it's what makes them extremely cruel. Because this type of care is not something, not that any healthcare should ever be delayed. We want to value that equity and people get the health care they need. But certainly for sexual and reproductive healthcare, timely access is critical.

Otherwise you have a series of bad outcomes that affect generations. Right. That's what they're targeting with this. It's what, as I stated in my previous testimony, I think it's the camel's noes under a really bad tent that they'll continue to do throughout this Administration.

Thank you.

Well, I want to say thank you to the panelists. Thank you for everybody in this room, actually, for waiting for us to get started. I think it's an incredibly, incredibly important issue.

I see it as not just attack on abortion, but just an attack on women, an attack on children, an attack on anybody who just doesn't have the money to go have health insurance and go to the Doctor. And really, that's an attack on the American people. And these are very, very scary times.

I think it's an opportunity for us to come together in new and different ways, but it's not a fun opportunity. Oftentimes we try to make the best of really bad situations, and I think we're doing that right now.

But I want to commend, number one, the three of you and say thank you for traveling great distance to come up here to talk about what we often say are the most vulnerable people in the community. But the reality is some of those people are our friends. They're our families. They're our siblings, our cousins, our loved ones.

So they're not just faceless, vulnerable people in the community. They're actual people that we are connected to to and have a deep responsibility to serve. And so I want to say thank you to you. I'll let our panelists either stay up here to hear public comment or you're welcome to.

I know you all have things to do, but I do want to open the issue for public comment now. And if you could keep your comments to under a minute, it would be very helpful, particularly to the public health folks that are now three hours after they thought that they would be testifying.

I'm sure that they would appreciate it. And if you need to, if the panel need to go, you are welcome to go as folks are coming up to give their public comment. But a deep thank you to all of you.

Thank you.

And if there is no. Oh, okay. Thank you.

Hello. Good evening. Thank you for this opportunity to share today. I am Danielle Brewster and I'm the Director of External Affairs at Women's Health Specialists, and I traveled here from Redding today. I just want to share a little about Women's Health Specialists.

We are an independent California nonprofit health organization and we provide a wide range of services that include comprehensive reproductive health services for families and individuals in Northern California.

We have been operating for 50 years and we have been a significant family planning provider for 12 counties in northeastern California that covers over 30,000 square miles with a service area that's larger than Vermont and New Hampshire combined. We provide essential health services to individuals and families and at clinical sites in Chico, Redding and Grass Valley.

We also provide telehealth services to people throughout our large rural and our region. Support for reproductive services is essential and it's so we can continue to empower people throughout the small cities and towns that make up our beautiful section of this state.

We need continued support to provide clinical services and health education to our friends, our neighbors so that they can make the best health care decisions for themselves. We urge the California Legislator to continue this essential support. Thank you.

Omar Al Tamimi with the California Pan Ethnic Health Network. CPAN strongly supports the $15 million budget. Request introduced by Assemblymember Sharpe Collins to backfill the loss of the Title 10 federal family planning funds. Title 10 funding has been critical to ensure Californians with low incomes, particularly communities of color and LGBTQ Californians, receive the care that they deserve.

Catalyx providers are often the only access point for essential services like STI testing. Cancer screenings and birth control for individuals. Who already face systematic barriers to care. And so thank you. And we urge you to support the. $50 million budget request. Thank you.

Seeing no other public comment, we will end issue two that we move to issue one and move on to issue one that's coming second, which is public health Federal funding cuts as Folks are transitioning. Just a little background for this item is on page two of your agenda.

And on March 24, the CDC announced without advance notice that it was pulling back $11.4 billion in funding nationwide allocated to state and local public health agencies. On April 3, California and 22 other states were granted an emergency block on the funding rescission. Should the termination proceed forward. The impact to California is an estimated 840 million.

So today's panel will provide context on on the impact of those potential cuts for the state and local health departments. And at the risk of sounding flashy, I do hope for folks that are watching Anybody that does have a connection to folks in Congress, basically, and, or to the secretary who said that he does not know of these cuts and was not aware of these cuts.

I really do just urge folks to listen in to what's about to be said so that we can, number one, tell the truth, get the facts out into the world, and number two, really reconsider the way that we're moving forward with public health or the lack of forward movement in public health at the national level that is affecting real Californians every day.

Then I do want to say I said it at the top, but I'll say again, another thank you to the Attorney General staff who was willing to meet with us today before this hearing to just flesh out out some details on what they were doing.

And what I asked in that call was, what's the basic message that the California DOJ wanted to be shared with the public, knowing that we were going to have an opportunity to speak publicly on this?

Their message was really that they are paying close attention, that they are working hard, that they are aware of the devastation, and that they're putting everything they have into protecting California tax dollars.

And so I wanted to appreciate that because at the very beginning of this legislative year and even before, we had gone into special session and got a bit of pushback around allocating up to $25 million to the California DOJ for them to be able to bring lawsuits.

And I think day after day we're hearing that that was the right decision to make, that this is the way to protect California taxpayer dollars. And so with that, I'll turn it over to our panelists.

We have Dr. Erica Pan of the State Public Health Director and State Public Health Officer at the California Department of Public Health and her team, as well as Michelle Gibbons, Executive Director of the County Health Executives Association of California, Dr. Olivia Kasirye, Public Health Officer for Sacramento county, and then representatives from Department of Finance and LAO's office.

And my deep apologies. I'm sure I pronounced some of those names wrong, but thank you for being here. We appreciate all of you. If you can take about five minutes and we'd love for you to start when you're ready.

Great. I'll go ahead and get started. Good evening, Chair Addis, thank you for having us here today. As you noted, the California Department of Public Health received termination notices for three groupings of federal grants on March 28. These grants affect public health expenditures across multiple health conditions.

As the COVID 19 pandemic magnified the gaps in public health infrastructure nationally, these grants were issued to focus on improving surveillance, testing, treatment and vaccine expertise and delivery and data system modernization. They also included integrating disease prevention and addressing disparities. The comprehensive scope of these grants is clearly identified in CDC grant requirements and guidance materials.

Initially, over $3 billion was awarded for these grants in the early days of the pandemic. The first grouping is the epidemiologic lab capacity and this had included 14 individual supplemental and expansion grants. To date we've received termination notices for five of these supplements, including the two largest grants which are called Enhancing Detection and Expansion supplements.

These have been again to prevent and mitigate impact of clinical diseases comprehensively and and lay the foundation for the future of public health surveillance. These have been helpful for multiple diseases including COVID 19 as well as Tuberculosis, Mpox, HIV, Avian flu, Ebola and Marburg.

This supports our situational awareness, our testing, our lab capacity, our overall public health response and data modernization, including looking at hospital bed capacity, capacity in rural jurisdictions and infection control in high risk facilities. Our immunizations and vaccines for children is another of the big groupings.

These supplemental funds were provided to sustain and strengthen vaccine access for all ages and types of diseases and increase support for programs and systems to address vaccine preventable disease surveillance and response to outbreaks, including data modernization for our vaccine management system as well.

Thirdly, there was a health Disparities grant that was intended to strengthen public health infrastructure with an equity lens for for preparedness and response capabilities to advance health equity for the current pandemic and set the foundation to address future response.

This allowed us to provide resources for local health departments to focus on addressing disparities and for the State Health Department to distribute and provide technical assistance for this grant.

All of these grants again were expressly authorized to not only respond during COVID and improve preparedness for future pandemics, these have been key investments to address infrastructure that had not been enhanced, modernized or equipped to to handle previous health emergencies and large outbreaks of disease.

Of note as well, the grant Administration Heluna Health served as our fiscal intermediary and was the designated bona fide agent to submit and manage the ELC or EPI lab capacity grants. Thus, CDPH is a subrecipient of these ELC supplements. The grants for immunization and health disparities were issued directly to and administered by cdph.

You've already heard about the dates of notification and mentioned that it was over $840 million when we got that notific that had been unexpended and we are advised to finish work reconcile expenditures, submit invoices and prepare final reports within 30 days for hundreds of millions of dollars.

The total amount for the gap will be adjusted as invoicing and reconciliation proceeds. As you also noted, there was a temporary restraining order that has been extended again until at least April 29, but we have uncertainty about how long we have for full drawdown for closeout extension when a final determination is is made.

These grants were scheduled to end anywhere between May 31 of 2026 and July 31, 2027 depending on the grant. And then as far as staffing impacts, the funding terminations impacted support for over 70 state FTEs and approximately 200 contract staff from either UC or Haluna Health.

And just to briefly try to also highlight some of the program and system impacts, the loss of this federal funding would impact these investments and startup or maintenance of our key Data systems, including CalConnect for Public Health investigation and response, and also impedes our ability to update our surveillance system created in 2010.

In addition, important investments have been planned and are underway in our public health lab systems, our equipment, including the ability to do whole genome sequencing, which is how we track what kinds of variants and strains are circulating in California and how fast they're changing.

Any abrupt loss of funding could cause delays and disruption to timely prioritize public health response. So again, these are used for situational awareness and mandated disease reporting. We will have minimal ability to detect and track diseases, investigate their source, contain outbreaks or do any forecasting or projections.

And we would have reduced testing and sequencing capability for early detection and tracking. I'd like to just remind us too that the legacy vaccine systems we had in the beginning of the pandemic were inadequate. When we started vaccinated, we couldn't see how many people were being vaccinated in a timely way.

Now we have a linked system that can allocate, order and distribute all of our public health provided vaccines and automatically update our immunization registry. When those vaccines are administered. The public can look online for where to get vaccinated near them and book an appointment at many locations and quickly look up a complete vaccination record.

Every time I register my daughter, we're our new school, a camp or another program. It's so much easier now to look up a quick record of all her vaccines, no matter where she received them. These funds have also enhanced her ability to do outreach to health care providers and the public.

And now it is more important than ever to work to provide reliable and accurate evidence based information about the safety and effectiveness of vaccines to large networks. We will also have to decommission a call Center for thousands of health care providers when they have questions about immunizations, ordering, storage, Administration, et cetera.

I mentioned already significant staffing and resources. We did have several BCPs that were dependent on leveraging funding from impacted federal grants, and we're still assessing those funding impacts to these data systems.

So finally, I just want to emphasize that about 45% of our CDPH funding comes from federal sources, making the Department particularly vulnerable to federal budget cuts and shifts in federal policy.

Although the specific focus and extent are unknown, the current reductions enforced to federal programs that Fund and provide national subject matter expertise and technical assistance are concerning for future cuts to federal support for many significant public health programs.

While we now have been able to incorporate COVID 19 disease into our overall respiratory disease response, so many of these tools and capacities we gain to be better prepared to other evolving outbreaks will disappear and will risk the inability to contain the spread or other disease and deliver countermeasures to treat or prevent disease.

We have needed and use these public health investments and tools to better respond to mpox, the threat of Ebola or Marburg virus, introduction to California, and the recent bird flu response, which continues to pose a threat as a novel flu that could mutate to lead to significant spread and more serious disease in humans.

This illustrates another stark example of the unfortunate pattern we experience in public health of panic and neglect. Further action is necessary to prevent elimination of crucial public health activities to protect the public. Thank you for your partnership.

Good afternoon, Madam Chair, Assembly Member Schiavo. My name is Michelle Gibbons. I'm with the County Health Executives Association of California. I represent local health departments throughout our state.

I have a whole script, but I think I want to pause for a moment and just say, on March 24th, I began getting furious calls from folks like, what is happening? What is going on all of a sudden in my grants portal? It's telling us that as of today, we may no longer use these funds for services.

These are not like, I mean, health departments are health departments. You don't get to just lay people off right away. You don't get to stop services right away. Like, these are important services that are happening. It's valuable to our communities. It protects us from disease.

And so I think the piece that I just want to convey to you all is that this means jobs, but this also means community protection in a number of ways. Just to give you a sense.

It was nearly 300 million for enhanced laboratory capacity, approximately 68 million for immunizations and vaccines for kids and approximately 18 million for health disparities funding. These funds have not just been helpful. These aren't just good to have, these are foundational funds.

At the beginning of the pandemic across the nation, we saw that public health departments, both state and local, had been vastly underfunded. And because of that, we lacked the infrastructure to really react in the way that we needed to and to protect our communities as we needed to.

So we had to hire and these dollars were used to hire people to be able to do that. I remember a Member of mine saying I tripled the size of my health Department. That's not because the work goes away.

It wasn't just about the pandemic, it was about the foundational things that you do to prevent pandemics or to prevent the disease spread.

Just so you all know, these dollars are used to hire and retain critical public health workforce such as laboratory personnel, epidemiologists, data analysts, disease investigators, infection prevention nurses, all frontline people that are super important for identifying and tracking and stopping disease.

It also helped partnerships, partnerships with schools, shelters, long term care facilities to really help them understand how to stop the spread. Learning how to separate your populations, learning how to use masks, different things like that. Without these dollars, we really do run the risk of just being exposed and unprepared.

I would just say, like ELC funding, it allowed California to also modernize our outdated IT infrastructure. As Dr. Pon just mentioned, at the start of the pandemic, local health departments were relying on antiquated systems, fax machines. Thanks to federal investments, CDPH stood up platforms like MycCA Vax, Sapphire and CalConnect.

Those systems are now vital to how we track diseases, how we distribute vaccines and how we communicate with the public. But maintaining those systems require ongoing investment and losing the support would first California to go backwards, back to manual processes, spreadsheets, cold calls. That is what local health departments were doing and they just don't meet today's needs.

The same is true for our immunization programs. Immunization funding enabled us to reach communities through mobile clinics, school site vaccinations and partnerships with trusted local organizations. The funding supported vaccines to underinsured and uninsured individuals. And without those fundings, those clinics will shut down. Already scheduled appointments have been canceled.

We anticipate more scheduled appointments for vaccinations to be canceled. Our ability to monitor vaccine coverage, as Dr. Pan just mentioned, it will slow. We won't have timely data that we need to keep our communities protected. And we can't ignore the vital role of the health disparities funding.

That funding allowed local health departments to do what we had long known as necessary, but just didn't always have the funding to do, which is to integrate equity into the foundation of our work. Local health departments hired equity officers. They partnered with CBOs.

They translated materials into multiple languages and engaged with residents who had been historically left behind. The work made our public health response more just more effective, more trusted. Losing the funding means that we'll lose that progress. And this is not the only threat to public health funding.

You heard about the title 10 cuts, which also impact local health departments. And then there was also a recently leaked health and Human services draft President's budget. That budget includes sweeping reductions to multiple areas such as chronic disease, HIV and STD funding and emergency preparedness dollars.

It's also not clear how the new restructuring of the CDC is going to impact state and local health departments. It's really difficult right now to figure out who do we talk to and for what and who is available still. Public health infrastructure is just that. It's infrastructure. It's not one time emergency response.

It has to be stable, it must be sustained. It needs to be scalable. We can't build it up in times of crisis and then tear it down when the headlines fade. Because the next the. Because the next public health emergency is not a matter of if, it's just a matter of when.

California does have an opportunity to lead the nation by sustaining and expanding future public health investment. This Legislature showed tremendous leadership in securing those funds. Initially it was 300 million ongoing for state and local health departments, which was scaled down to 276 million because of budget constraints last year. As a reminder, 70% of those funds must be used on staff.

So when we look at the federal landscape and we see that funding is likely to decrease in a myriad of areas, each jurisdiction will be able to use future of public health if you invest additional dollars and be able to figure out how they sustain their core.

So sometimes when you give disease specific funding, it's disease A and you can only use it for disease A. But if they need to maintain somebody that could work across disease A, chronic disease prevention and something else in the skill set could align across all three, you're not able to do that.

And that's why we're asking for the flexible funding into future of public health. It's not just about preparedness. It's also about prevention. It's about equity, it's about access. It's about ensuring that every Californian no matter where they live, can count on a strong public health infrastructure that's there for them when it matters most.

I would hate to see us be like other states where there's measles outbreaks and other things that we just don't have the capacity to address. But I do say that that's how the nation was when Covid first came and we shouldn't go back to that. And removing these funds puts us back to where we were pre Covid and we should have learned a lesson at that point.

Chiac, our Members and local health departments are asking that this Legislature continue championing and increasing the future of public health investment to fill both the gaps that we know and the ones that we don't even know that will be left because of the federal Administration. So we just ask that you protect public health because it protects you. Thank you.

Thank you. Good evening and thank you for having me here. I'm Dr. Olivia Kasirye and I'm the public health officer for Sacramento County. So the total amount that was impacted by these cuts that affected Sacramento county was 26.8 million.

These grants have been instrumental both during the pandemic and in the recovery phase to provide services to the community and to rebuild the hallowed out public health infrastructure and workforce for the three funding streams that were impacted. The COVID 19 reducing health disparities grant was a direct funding from the CDC.

There was about 3 million that was left on that Fund. We used this Fund to partner with community based agencies that have been instrumental in helping the county to address disparities in access to care and in building community resilience to disasters. The major projects funded through this were community Wellness hubs and the community Health Improvement project.

So basically through these hubs, we were reaching out to individuals that had barriers to care and helping them with being able to control and manage their chronic diseases, things like hypertension, diabetes, and also helping them to get access to care.

Through these programs we were able to help just this one year, 200 individuals be able to get access to care and then about 300 of them that were able to get additional help with controlling their chronic diseases.

We're also working with the community to develop a food action plan to help individuals with housing and also to ensure that they are able to access mental health care. With the epidemiology and lab capacity expansion grant there was about 18 million that was left. And this was funding that came through the state cdph.

Through this funding we used it to build the public health infrastructure. We used it to upgrade Lab equipment. And I want to point out one important difference between the public health lab and the commercial labs is that there are a lot of tests that public health does that are not provided through the commercial labs.

Some of the tests that we do, for example, for measles, when Covid first came, when MPOX first came, it was a public health lab that was able to do the testing on a day to day basis. The public health lab is very crucial in helping us to control outbreaks, be it foodborne or waterborne diseases, vector borne diseases.

We are very dependent on our public health lab to help us to do that. In addition, we are also able, very fortunate in Sacramento county to have a lab that is able to do testing for bioterrorism agents. So anthrax.

Whenever there are white powder scares, those are, we work with law enforcement to be able to do the testing on those specimens. In addition to the lab equipment, we've also been using the ALC grant for upgrading our electronic health system. In Sacramento county, we have four health systems.

And so it's very important for us to be able to have communication and with those systems. And the electronic health system we had before was not able to help us with that.

It's very important for being able to, in a timely manner, be able to report diseases and also for us to be able to get additional information to ensure that our communities are safe. We also upgraded our epidemiology surveillance system.

Prior to Covid, the way that we would contact individuals that may have been exposed to infectious disease was we had nurses that were making these calls. And as you can imagine, when it got to Covid, where we had a lot of people that we were trying to follow up on, it became impossible.

We just didn't have enough bodies. So having an electronic system that helped us to be able to do this was very helpful.

It was very helpful when we were monitoring people for MPOX because many times people were put in quarantine and the way that we were able to monitor them on a day to day basis was through this electronic system. Then lastly, with the COVID 19 immunization grant, that was about $4.9 million that were left on that.

And we use this to Fund for community providers to run vaccination clinics for school children and families, as well as support outreach to unhoused individuals. During COVID we know that a lot of families went without care, A lot of children fell behind with their vaccination.

And so we needed this extra help to be able to provide these families with a way of getting their Vaccinations and get up to date. Even though some of the schools do have vaccination clinics, they're not adequate to meet the need. Even Sacramento county, we do have a team of nurses, but it's a small team.

We don't have enough nurses that would be able to meet the need. Being able to have these additional community providers to have these clinics not only for the school children, but they were actually providing the vaccine vaccines for the entire family as well.

Oftentimes we'd hear about families of maybe five children that were having challenges with getting appointments because their healthcare provider would tell them that they could only schedule one child at a time. So you can imagine how difficult that is. Co pays were also a challenge and sometimes the providers did not carry these vaccines.

So being able to have partner with these community providers and be able to make sure that they had all the vaccines that were needed was really helpful. In addition, we had a vaccine strike team of about 14 nurses that were, in addition to these providers, also able to provide additional community clinics.

Some of these clinics, for example, during the flu season, they were able to vaccinate and give over 4,000 vaccines. During COVID they gave over 200,000 vaccines.

This team was very helpful, especially because when you look at communities that have challenges with getting to appointments, we found that we had to have these clinics within those neighborhoods in order for them to be able to access. They didn't have transportation, they didn't have childcare.

So being able to have nurses that could have these small clinics within the neighborhoods really helped to increase our vaccine reach. So following the CDC decision to abruptly end the grant funding, the county had to expedite the phase out of the programs and the services and we had to release some of the limited term positions.

As mentioned, there were 14 limited term positions and 4.5 permanent positions being charged to these grants. The limited term positions are being terminated.

The county chose to spend county Fund to extend the employment until the end of April to allow the nurses to be able to wrap up what they were doing and be able to look for alternative employment. And the county has been able to reallocate the 4.5 permanent positions elsewhere in the Department.

All the subcontractors were instructed to stop work and the contracts with the immunization providers have been terminated. The sudden disruption in services created a dilemma for the providers that had scheduled vaccination clinics and appointments a month out and they had to decide whether to cancel these appointments or where they could even refer these individuals.

So the temporary restraining order does give us A glimmer of hope that maybe the funding will be restored, but we have not been able to restart the programs because there's still that level of uncertainty of whether this will actually be restored or whether we would end up having the money clawed back.

And plus, for those contracts that are terminated, it becomes really difficult to go back and restart. And one thing that is hard to measure because it's not measured in dollars and cents, is the trust. Because when we have these programs in the community, we're actually building relationships, we're building trust with the communities.

And we found during COVID that this was very important. And so when you have these starts and stops to programs where somebody thinks, okay, finally I have an appointment, I can get all my children vaccinated, then you call them and say, sorry, you'll have to look elsewhere. It becomes really difficult because then that trust is broken.

Thank you. Anything from LAO? DOF?

Christine Cherdboonmuang Department of Finance. Nothing to add, but we're here to answer questions. Thank you.

I really want to thank you for your testimony. I know Assemblymember Schiavo and myself both have issues in our district where public health has been really impacted. But the main question I have is around what the Secretary of Health and Human Services has said, said that, one, he wasn't aware of the cuts, and if there had been any cuts, it was really around DEI.

And I was wondering if, number one, if there's any connection to dei, and two, if there is, and I imagine there is, mostly because DEI is very important, and we've done a lot of initiatives in California to make sure that our services are equitable, what those connections are, what that actually looks like in real time in terms of your services to the communities.

I'm happy to start. It's beyond me to not know that this much funding had been cut to vital services. What I will say is that the work of public health is equitable, but it benefits every single person in the community.

Going into a vulnerable population and ensuring that they have the protections that they need through immunization or additional supports means that we're stopping the spread of a disease that could go. It doesn't know boundaries. It doesn't know race. It doesn't know ethnicity. It doesn't know, you know, your income status. You know, disease is. It goes anywhere.

And so, you know, during COVID I could see where we had focused on certain populations where they were having a higher disease spread. It was to protect those vulnerable communities and to protect the rest of Californians as well. I think that's really important to point out.

These are not canceled because of DEI, the ELC, EPI and laboratory capacity or immunizations of vaccines for children. These are important investments that are for disease investigations, for vaccinating any child. These are for underinsured, uninsured. These are important investments. It's not directly tied to DEI.

I would also say that even health disparities funding, where that was the funding where you could probably have the biggest tie to dei, it wasn't around only addressing certain populations, but it did make an awareness and as part of the actual grant language, said that it was to address the disparities that we saw.

So that in the next, you know, as we prepared for the next thing, we didn't see populations or certain communities left behind or with a higher burden of disease in the way that we saw it during COVID 19. So the work that we do is equitable. It should continue to be equitable. It should continue to benefit, lift up vulnerable populations and benefit the entire state.

And only if you want to. Don't feel forced.

I mean, I think one thing I would just add is the written notifications actually said it was based on the end of the COVID 19, but again, in all of the grant supplements there was a lot of language that I've already described around this being an investment into, you know, needed to include COVID 19, which we do, but also again, building this infrastructure.

And some of the highlights even for the disparities grant was about rural communities as well. So I think that's really important to bring up as well that in many of these supplemental grants there was a focus again on access to care, and that might be based on many different factors, including rural communities.

Any questions? Assemblymember?

Yeah, I appreciate the chair's comment about needing a robust, really we need robust public health in our communities. We have a burning landfill where I hope more was being done actually, not less.

And, and one of the big frustrations I think around this too, that feels so short sighted, is that it's investments in infrastructure that's so critical to communicating, making sure both with patients, with healthcare providers that making that huge investment in those systems and then just letting it sit on a shelf or unraveling it after you've already made such an investment in an infrastructure that really makes a big difference and makes health care more efficient seems incredibly short sighted. Feel free to expand upon that or I know you all kind of touched on that in your testimony as well.

I'm happy to expand upon it. I could talk for days so you tell me when to stop. But because I believe in the value of public health, I think it's a system that we have neglected and underinvested in. And frankly, I think local health departments were ecstatic to get the investment of dollars.

They put it to good use. They didn't sit on it. They worked with communities, they hired people from the community. Actually, it was great to see these dollars did have an expiration date. We believe that we had at least a year and a half left.

And the hope was that Congress and the federal Administration would recognize that these dollars were benefiting people and were being put to good use. I can just continue to name and unravel.

But like in addition to COVID 19 Mpoke happened and we use these funds and the infrastructure that it provided to protect communities around Mpox, around Den, around H5N1, which is still a very real threat. Right. Also, and I can go on. There have been several outbreaks, measles, what, a year ago? A year and a half.

My timing is off post Covid, but there was a lot of, there were a lot of measles cases popping up in different jurisdictions. Just because we didn't see outbreaks didn't mean that those dollars weren't put to use. That is actually why we didn't see it.

Disease investigators were able to quickly contact trace to investigate the disease, find the source and stop the spread. That is a great public health infrastructure. That is what we should be protecting.

I will not opine on the reasons why these things are happening, but what I would say is that it's very short sighted and it's, it's harmful to communities, it's harmful to.

You know, we talk about never wanting to go back to the times of COVID but it really does set the stage for allowing that to happen again because you're not maintaining the infrastructure to protect against it.

And, you know, and I just don't think it can be stated enough that these cuts are actually making us, you know, sicker, less safe, more in danger of disease, more in danger of disease spreading.

You know, we're at the same time that we're doing this in the United States, we're cutting also the prevention of Ebola and protections against it coming to our country. And I don't think anyone wants to see that kind of an epidemic on our soil, which is terrifying.

And, you know, we're already seeing, you know, measles and, you know, other things pop up in California as well, and especially in other states where there's lower vaccine rates and so we see that connection around those increases that are going to be impacting communities and, and deaths have happened. Right.

We're talking about people's lives and life and death. So, you know, is there a contingency plan? Is there any kind of. I don't know if CDPH or the Department of Finance has kind of a short term plan to try to address this, which I know is difficult.

I'll start and then let others fill in. We for the short, short term, we've prioritized some of the most critical activities at the state level as well. And that includes looking for other state or federal funding that might be still available due to staff turnover or other hiring delays to maintain some continuity during this litigation.

And as far as state staff, you know, we would follow the normal procedures around that. But I think the longer term is still the bigger question. And just to reiterate and expand on something that you had asked about, I think, yes, interrupting these things midstream is also what's really harmful.

Again, there are upfront investments, as you're also noting whether it's the lab and being able to build up a public health lab capacity. We all remember in 2020 when we could not test enough to know how much disease was circulating in our communities. And we need our public health labs to do that. We need testing capacity.

We need these data systems to get out of faxing and spreadsheets. And I remember very early on I was still at the local level and we had stacks and stacks of paper of different cases and we couldn't prioritize them and see, zero, there are these that are all in this one setting. Or.

And then similarly, even with measles in 2015, when I was at the local level, we couldn't prioritize those contacts to see who's the pregnant woman who needs that intervention within 72 hours, who's the infant that needs help with an immune globulin because they've had measles exposures. And these tools are all helping us that. And to interrupt them is really, really harmful.

Yeah. I mean, there's clearly nothing efficient about what these decisions are going to make. And furthermore, if you are talking about when you're attacking inclusion in a healthcare system or you're attacking equity in a health care system, what you're saying then is that we should be excluding people.

You're saying that it should not be equitable that everybody shouldn't have access to health care. I mean, that is what that is saying. If you're attacking those things in a Health care system. You are saying let's exclude people. Let's only make it available for certain people.

Let's only have wealthy people who can afford to go to their private Doctor be able to get the health care that they need. I mean, that is what is being prioritized by this federal Administration.

I know you all don't need to know that, but I just have to say it out loud because there's all this talk about going after equity and inclusion. And that is the point of a good, robust, healthy public health system. It should be equitable. It should be available to everyone.

It should include people who have traditionally not been able to access the care that they need. Covid, as you mentioned, is a perfect example of how having healthy communities protects everyone. If you have someone with COVID working next to you, coughing on you, not to use you as an example, but that puts everyone at risk.

If my kid is next to, in school, in class, kids who cannot get access to the COVID vaccine or other vaccines, my kid is more at risk. And so we, you know, we cannot allow, I think that to be unsaid because this is in effect, and possibly intentionally trying to restrict, take away and access to healthcare for millions of people, millions of people just in California alone.

And I know that we're doing all kinds of things to fight against that and are hopeful about progress on the legal side, but it's unconscionable, really. And I know we'll fight against it as much as we can.

Might I add one more thing? I also just want to take us back to during COVID we lost a lot of our public health workforce during that time. There was an excessive amount of harassment and burnout and strain on the workforce.

What our local health departments are having to grapple with today is letting go some of the very people that stuck through the pandemic or stepped up during the pandemic. And because these dollars are ended abruptly, they are having those tough conversations on the grounds the public health workforce is not built overnight.

There is no guarantee that those individuals will return when we, if, you know, if we have more money down the line because you want job security.

And so I think it's really important to know that it's not only devastating to all the things that we are sharing with you all and what will not be protected, but it's also devastating when you think down the road what type of public health workforce you want.

We may not have the experience and the expertise and those folks staying, it may be that we lose them to other professions which is already a challenge in public health.

Yeah. And we spend so much time trying to create a pipeline to public health, trying to create a pipeline for healthcare workers to get into the work. Another example of why it's inefficient. I wanted to add something.

So in Sacramento county last year, we got three cases of measles and all three exposures were in emergency rooms. And for each of those exposures, we had 200 to 300 people that we had to follow up on that were in the emergency room at the same time as those individuals with measles.

And we ended up with not a single additional case. The three were not related. They were related to international travel.

But because of the work of the public health team and working alongside with the hospitals to identify all of the individuals that were in the emergency room to find out where they were, find out their vaccination status, make sure that they got vaccinated if they were not, and following up on them to monitor them for that 21 day period is very labor intensive.

But because we have a team that's dedicated and a team that's well trained, we're able to do that. The other thing also that's important is the vaccination rates in California. We're fortunate that we have, for example, for the children. Over 90% of our children are vaccinated for measles.

We may get one of those cases that will come through due to international travel, but because there's that community protection, we are able to prevent having additional cases.

It's very important for us to be able to continue the vaccination, not only for those who are able to go to their Doctor and easily get an appointment, but to be able to work with those that have barriers and make sure that they are protected as well.

Because when we protect them, we're actually able to protect the entire community.

Thank you. And I want to we're going to move to public Comment. I really appreciate the testimony and all of your time and you're welcome to stay and listen to Public Comment or I'm sure you also have places to be.

Really do want to appreciate everything that you've said here today and I'll just say my own experience with public health. I just want to let you know how grateful I am my children were when we moved and didn't have a pediatrician. It was public health that gave my children vaccinations. My mom was a public health nurse.

And then with the most recent Moss Landing fires, the Public Health Department has been boots on the ground with environmental health specialists and so just appreciate the work that all of you do and how important it is and it's very, very real work for people.

Since there's a number of public comments, we are going to set our timer for you and really ask that you keep your comments under a minute. We know that you've all waited a very long time, so I don't want to cut you off, but I also want to make sure that staff gets to go home tonight. So thank you so much to our panelists and we'll start public comment now.

Kelly Brooks, I'm here on behalf of Los Angeles County. In addition to the impacts on local jurisdictions already mentioned, Los Angeles County is a directly funded entity for certain public health grants from CDC rather than as a pass through from the state.

On March 24, Los Angeles County was notified that more than 45 million in previously awarded grant funds were terminated without notice. These the two direct CDC grants support infectious disease mitigation and laboratory services.

These cuts would lead to the elimination of disease outbreak management services at settings like jails, shelters, nursing facilities, schools and workplaces reduced capacity for genetic sequencing and sample testing at their public health laboratory disruption in health surveillance, data analytics and disease mitigation capacities.

Just As a reminder, Los Angeles County is a national epicenter for travel, trade and demographic diversity. Public health efforts protects not just our health, but our economy as well. We would urge you to help us in protecting public health funding. Thank you.

Good evening. Nora Angeles with Children Now. Children Now is in support of funding a strong public health and immunization infrastructure to keep our kids safe and healthy. With waning immunization rates of California's children and dangerous new measles outbreaks happening in communities across the nation, it is short sighted to undermine the state's vaccine management system.

We look forward to continuing this important conversation after the May revise.

Thank you Catherine Flores, Executive Director for the California Immunization Coalition. And as you observed at the beginning, these cuts are just beginning. Also, I think the budget cut, the HHS cuts proposed are even worse. And I really appreciate, we really appreciate you doing this work and having our wonderful speakers to share this with everyone.

I've worked in or with public health for over 25 years and every year it's like you either get what you got or a little bit less. And we just always make do and it's what we've seen what can happen when we have a little bit more.

And I really appreciate all of you doing the work to make sure we can continue, hopefully continue this amazing work to prevent what's preventable. Thank you.

Good evening. Chair Sebastian Pérez, the State Affairs Specialist with APLA Health and also a Member of the in the Epidemics Coalition, or ete. ETE is a statewide coalition that advocates budget and Bill priorities that address this endemic of HIV, viral hepatitis, STIs and overdose.

And we are asked, asking humbly, for support for our budget requests that are largely funded by special funds. So the California's AIDS Drug Assistance Program helps low income, uninsured and underinsured people access treatment and prevention services.

The states borrowed 900 million from the ADOP rebate Fund on the condition that they be repaid when there is a need to maintain and expand programs. So to echo earlier comments today, L.A.

county's Division of HIV STD Programs informed us as a provider that due to the CDC's elimination of its Division of HIV Prevention, its subcontracts with CBO would only be fully funded until May 31st. So everything's in jeopardy after that.

These cuts are gutting the county's HIV and STI services, which will undoubtedly lead to higher infection rates and more people living with living undiagnosed and out of care. And in light of this, we're asking for ADAP rebate funds to be used for HIV prevention, disease intervention specialists and hep C point of care test machines.

We're also thanking the State Senate and hopefully the Assembly can follow suit in rejecting the 8.4 million in funds proposal to be transferred to the from Coffee to the Naloxone Distribution Project. So please follow suit. Thank you very much. And also finally asking for support for the LBTQ Health Equity Initiative led by the Los Angeles LGBT Center. Thank you so much and happy to answer questions offline.

Good evening. My name is Paul Curtis. I'm the Director of Community Engagement for Sunburst Projects, which is a, which is a local HIV AIDS service provider here in Sacramento County. We've been around for 40 years. I've also been HIV positive for almost 40 years and working during that whole time on policy and advocacy for the community.

I represent also a Member of the Ending the Epidemic statewide coalition here to share some facts about HIV and especially around prevention and education which is critical in our state. In 2010 we had 5,288 new cases of HIV. In 2022, the last year we have data for those 4,856.

Between the work with the public health departments across the state along with CBOs like ours and others across the whole state, we've worked hard to end the epidemic and reduce new infections. Taken away the entire portion of federal funding for prevention and education has been cut.

It's critical that we continue to do prevention and education to prevent new cases. One final fact, avoiding one new case of HIV can result in an average of 850,557 doll and lifetime costs for one new infection. That's the critical number in terms of us doing the best we can in California State to reduce new infections. Thank you.

Good afternoon. Ryan Souza on behalf of the San Francisco AIDS Foundation, a Member of the End Epidemics Coalition, we just wanted to align our comments with a colleague from APLA Health that just spoke related to the California Overdose Prevention and Harm Reduction, urging the Assembly to also reject those cuts and seconding our support for the LGBT centers ask for the LBT Health Equity Initiative.

Finally, we support the comments on the proposed use of the ADAP drug program rebate funds. The HIV epidemic is worsening among a number of populations that face barriers to health care, including black Latin, a transgender and non binary individuals.

At the same time, California has seen decreased funding from federal services and programs and that was before the all out attack from this federal Administration on HIV funding that we've now seen substantively come today.

We urge this Legislature to take action on the rebate Fund in both supporting the repayment of funds and having it go towards these critical programs and services that are in need. Thank you so much.

Hi, good evening. Chair Beth Malinowski with SEIU California. Thank you so much for you and the staff working to put together this panel and this hearing this afternoon.

I wanted to thank so many of the remarks that are made today that very much align with the concerns that SDIU has in terms of where we are right now, public health, infrastructure and workforce and what's at stake right now.

Just offer a bit of a reflection given we're talking public health just a Few weeks ago that time, I think I may have shared that we had one county who had reached out to one local to express initial concerns with the direction things were going in D.C. since then, that number has grown just over the past week.

In particular, we started hearing feedback from additional locals and additional counties, including our largest jurisdiction, Los Angeles County. In their case, they sent an all staff email at the end of last week that reflected on a lot of the varied numbers you were all sharing today.

And the one that hand want to appreciate decision to do it because they are in crisis, they're feeling uncertainty, but also want to appreciate just what that means to the workforce, as was reflected on earlier.

So, well, we are saying to those workers that have been there for decades, now might be the time to consider whether or not it's your time to retire.

And for those just starting their careers, this might be sending a message to them that maybe public health and public service isn't right fit for you as you start your careers.

I know that's not what any of us want, so I just look forward to continue to work together to figure out how do we move forward not only in continuing the future of public health funding, but other things we could be doing to really stabilize and create some sense of security at both the local and state public health for all of us and everything that we need for our communities to stay healthy. Thank you.

Good evening, Madam Chair. I know it's a bit late, so I'd like to introduce myself. My name is Oussama Mokeddem. I'm the Director of State Policy at Public Health Advocates. We're one of the state's largest public health advocacy organizations. I had this whole message and public comment prepared.

But I will defer to our wonderful expert panelists as well as my colleagues here in Echo, everything that they advocated for. But I did want to mention a bit of an anecdote with my time.

I was actually in Monterey County this past weekend on a mini vacation with my partner and I came across a woman actually who we just struck a conversation and upon telling her what I do that I work in public health policy, the first question she asked was, what do you think of all the craziness that's going around, obviously referring to the funding cuts.

And I told her we're really working hard to ensure that our local health departments as well as the state public health infrastructure is invested in. And she said one thing that really struck me.

She said that of all the issues being tackled in California, public health is the issue that California is always the leader on and that the country follows on.

So with that, I would really like to continue to encourage and thank the Legislature for opening up these conversations and investing in figuring out how we can support our public health infrastructure as it faces these cuts. So with that, I really thank you all and wish you all a good evening. Thank you.

Thank you. Thank you. Good evening. Name is Omar Altamimi with the California Pan Ethnic Health Network. Obviously we're deeply concerned about the $11 billion funding cut for the CDC and the risks it poses to our most vulnerable communities.

Many of the now cut CDC grants help state and local health departments reduce health disparities and invested in trusted community partnerships.

For example, working with community health workers promotoras and other local leaders to provide key preventative programs that will save the state money in the long run, including staffing, immunization programs, disease surveillance systems and other public health programs. We urge the state to take bold values driven action.

First, protect and sustain state funding for local health departments to Reserve equity infrastructure and community based public health. Second, for CDPH and legislative leaders to guide and model equity centered approaches for local jurisdictions who are facing difficult budget choices.

We as legislators to ensure that our budget reflects a lasting commitment to health equity, racial justice and the resilience of our communities.

Thank you Chair Members Bruce Palmer with the California Association of Public Health Lab Directors. This has been an excellent hearing and I appreciate the preparation that you did for it. And every one of you gets what public health is about and how important it is.

And I align myself with the comments of this incredible panel here, my colleague Kat DeBurgh and HOAC. But we have been on an incredible slogan taking putting back together the public health system that most recently was devastated by the 2008-2009 recession. And thanks to the California Can't Wait Coalition, Chiac, HOAC.

Thanks to federal funding, the group I represent, the public health labs, 28 of them in this state, have not only survived because there was one point not less than 20 years ago that there were 42 labs in this state. And incredibly, with a state growing in population to nearly 40 million people, there were less labs.

But thanks to the federal money and thanks to what we've been able to do with futures at this level, that system is being reborn. Our Members, the directors of those public health labs, are striving for the best science, the best technology and the best professionals.

Thank you. Thank you, thank you, thank you. Kat DeBurgh with the Health Officers Association of California. I want to thank you for this hearing. Thank you for having our Member, Dr. Kasirya on the panel. We're so glad she was here to tell you about outbreaks that didn't happen. When public health works, it's invisible.

And it's so hard to tell our story because when we're doing our jobs, you don't know because you don't get sick. So thank you for listening to that and for supporting public health and helping us rebuild our infrastructure. Thank you.

Good evening. Good afternoon. Thank you so much for providing this opportunity. My name is Jake Bradley Rowe and I'm the Executive Director of Sunburst Projects and I represent the 1 to $3 million CBOs that really doing the work on the streets in California, specifically in the HIV and STD community.

These changes and cuts at the federal level won't slow our services. They will eliminate our services. We don't have rainy day funds or other opportunities.

So we rely on you, the Legislature in California to hopefully step in and make sure that we continue to do the life saving work and the change work that we get to do every day. As a leader of a small organization, it's passion work that I get to do.

It's hard to stand in front of my clients and my staff every day since the beginning of this new Administration and say, I'm not sure how long we'll be here, but we'll do it as long as we can. So I thank you for your support. I appreciate this opportunity.

Seeing no other public comment, we will close out and just say thank you so much to all of you for advocating for your communities. There is no other time like this to come together.

Certainly we as a budget team have a lot to think about and a lot to work on and just want to commend you for your continued advocacy, particularly in the face of what's happening at the federal level and the challenges we know we're facing here in California. So thanks to all of you and we'll adjourn the hearing.